Tufayel Ahmed Chowdhury

Cervical spinal injury: experience with 82 cases

Abstract A retrospective study of 82 cases of cervical spinal injury was made. These patients were treated in Dhaka Medical College Hospital, Mitford Hospital, Dhaka, and in some private hospitals in Dhaka City during the last 10 years from January 1991 to December 2000. Sixty-eight patients (82.92%) were between 21 and 50 years of age. Male and female ratio was almost 6:1. The most common cause of cervical spinal injury was a fall (53.65%), which was followed by road traffic accident (24.39%). The most common presenting symptoms and signs were: pain in the neck in all cases, quadriplegia/quadriparesis in 56 (68.29%), temporary loss of consciousness in 20 (24.39%) and sphincter disturbances in 48 (58.53%) patients. Twenty-six (31.70%) cases were free from neurological deficit. Plain X-ray cervical spine was done in all cases. Radiological evidence was found of cervical spinal injury in all but six cases (7.31%). Cervical myelogram was done in 12 (14.63%) cases and MRI of the cervical spine was done in 24 (29.27%) patients. Commonly affected sites of cervical spinal injury were found at C4/C5 and C5/C6 levels (43.92%). Forty-three (52.45%) cases were treated conservatively by Tong Skull traction and immobilization, and 39 (47.55%) were operated upon. Anterior fusion was done in 25 cases (30.49%) and posterior fusion in 10 (12.19%). Results of treatment were: full recovery in 30 patients (36.57%), good recovery in 16 (19.52%), partial recovery in 26 (31.71%) and no change in neurological state in 6 (7.32%). Recurrence of dislocation and consequent neural compression was found in six (7.32%) cases of the conservative treatment group of patients. Mortality was three (3.66%), also in the nonoperative group of patients. It was seen that there were better treatment results in cases of surgical fusion in unstable cervical injury, and there was a chance of instability and delayed loss of neurological function in conservative treatment of unstable cervical spinal injury, which needed subsequent surgical fusion.

Rifampicin Induced Acute Interstitial Nephritis in a Patient with Tubercular Lymphadenitis: A Case Report

Rifampicin is one of the most effective anti-tubercular agents. Among its rare adverse effects, acute interstitial nephritis (AIN) is noteworthy. Here, we describe the case history of a 55-year-old female with tubercular lymphadenitis who developed rifampicin induced AIN upon re-exposure and recovered satisfactorily without requiring steroids. Rifampicin induced AIN should be kept in mind when patients present with acute kidney injury as prompt diagnosis and discontinuation of the drug has excellent prognosis.

Outcome of Acute Kidney Injury in Patients with Type 2 Diabetes Mellitus

Background: Diabetic patients are more vulnerable to develop acute kidney injury (AKI) when compared to non diabetic counterpart. However, it is not known whether outcome of AKI is variable according to etiology in diabetic subjects. This study was aimed to observe the causes of AKI in diabetic population and to evaluate the outcome. Methods: This cross-sectional study was done in Department of Nephrology, BIRDEM General Hospital, from May 2009 to April 2010. During the study period a total of 50 subjects were included. All cases of AKI and AKI on chronic kidney disease (CKD) were included except AKI due to trauma. Results: AKI due to acute gastroenteritis, non-steroidal anti-inflammatory drugs (NSAIDs),septicemia, gentamicin, obstructive uropathy, rapidly progressive glomerulonephritis (RPGN) comprised 46%, 42%, 4%, 2%,2%, and 4% cases respectively. All cases of AKI due to acute gastroenteritis improved. Among NSAID induced AKI, 26% improved, 6% improved with residual renal damage, 8% did not improve and 1% patient expired. All cases of septicemia induced AKI improved. Patient with gentamicin induced AKI improved with residual renal damage. Patient with obstructive uropathy improved. None of AKI cases due to RPGN improved. Conclusion: It may be suggested that outcome of AKI is variable according to etiology. Outcome is better in AKI due to pre-renal and post-renal causes than AKI due to intrinsic causes. Further study can be done to compare the outcome of AKI according to etiology between diabetic and non-diabetic populations. Birdem Med J 2016; 6(2): 95-99