Case: a girl of 4 months with osteogenesis imperfecta

The girl, 4 months of age admitted in our hospital for Pneumonia. But her history reveals # of the rt upper arm at the age of 7 days for which she was taken admission in the other hospital of the city. They made multiple x-rays and found # in other sites also.




She was labelled as a case of Osteogenesis imperfecta and advised the parents to take precaution to handle the baby and provide necessary counselling.



badrud doza

Link:

Osteogenesis Inperfecta Foundation

Case: Neuroblastoma with severe anaemia

Atunu Acharjee, 1 yr 4 months from Chittagong admitted in our hosspital for severe anemia. On examination , a huge mass on the left side of the abdomen, firm, non tender with no notch likely kidney and multiple small masses all over the abdomen were found . Liver was also enlarged 6 cm from the costal margin, firm and non tender.

On evaluation of history, it was found that the patient was consulted in Kolkata 2 months back and CT scan there suggest abdominal neuroblastoma, diffuse tumour infiltration of the left kidny and encasement of large vessels like aorta by the tumor mass.

Laparotomy was done in a hospital there and excised leftsided mass including part of the left kidney.The histopathology suggests Neuroblastoma. Patient was discharged on palliative treaatment from there.

In our ward, we have given the patient blood transfusion and refered the patient to oncologist.


Dr. Badrud Doza
Dr. Abu Sayeed

Link:

Neuroblastoma in Children in Cancerbackup/Uk
Neuroblastoma in NIH

Case: a boy of 11 months with scleroderma

Minhaj, aged 11 months, Male baby was lying stiff on the bed. On first look , I first mistook it as a case of cerebral palsy –spastic quadriplegia.

But his birth history is normal and the spasticity is of 7 months duration and gradually progressing. Both the extremities are markedly affected and the facial muscles are also affected and it could not cry with his full mouth open.

His skin is thick like sclerema but in almost all the body and he has no sign of infection.
.
Clinically we suspect the case as “Scleroderma’.

We arranged skin biopsy for him. The sample was taken the thigh. The report narrates increased fibrosis and moderate numbers of chronic inflammatory cells around the periappendigeal region in the dermis. The subcutaneous fat is partly replaced by collagen. The overlying epidermis shows no significant changes and concludes that the features are compatible with scleroderma.

Dr. Badrud Doza
Dr. Fahim

Link:
Screloderma Foudation

Case: Solid mass in the left Iliac fossa with acute abdomen

The patient was seen at my chamber in practice. The girl of 11 years presented with severe abdominal pain and intermittent fever of two days duration.
Menustartion yet not started.

On examination, moderate tenderness was present in the left iliac fossa but no mass could be palpated. The patient was admitted on emergency and given conservative treatment for Acute Abdomen. Later, on evaluation a solid mass of 5cmX 4 cm was found in the left Iliac fossa on ultrasonography.
The patient was improved on conservative treatment of antibiotic, fluid, antipyretic and analgesic.
The follow up X-ray also showed a solid mass pushed the uterus to upward and to the right.
Laparotomy was done. The mass was found to be of ovarian origin and brown in color.
The change of color and solidity of the mass is likely due to haemorrhage into the overy due to torsion of the ligament of the overy.

News: we organised workshops on management of severe malaria

We have organised training programs for the physicians of the malaria prone areas in our hospital from 1st June 2008 in three batches, each bach having 5 day course. About 60 doctors from mainly from government health centres and some of our hospital attended the program.

The program was sponsored by GFATM and cordinated by the Malaria Control Program of Bangladesh Health Directorate and supported by WHO.

In the program, case defination of malaria, clinical presentation, diagnosis and assessment, management, recovery and follow up of severe malaria were elaborately discussed.

In addition, picture quiz were interesting and also there was multiple case studies. In the hospital real cases were seen,examined and recoded and then presented by the participants.

There was special session for microbiology- microscopic identification of malarial parasite, Rapid diagnostic test and preparation of thickand thin film.

The whole program was in micro-teaching format and participatory in nature.

Professor Emran bin Yunus, who is working as monitor in different countries of Africa and Asia on Malaria Research Program was focal person of the programs in our hospital, a private one and Chittagong Medical College Hospital, the public hospital.

I worked as the resouce person and the co-ordinatorof the program that is organised in our hospital.

We are happy that the program ended successfully on 18th June, 2008.

Case: Near Drowning

A boy of 13 months admitted in our hospital after 4 days of drowning with unconsciousness and repeated convulsion.

He was drowned in salt water pond four days back and stayed drowned for half an hour. After recovery from the pond, he was admitted in the local health centre but with no improvement.

On admission in our hospital he was unconscious and hypotonic. his GCS score was 4/15,
Hr-136/m, BP-120/70 mmHg, He was dysnoec but there was no other chest finding.
Opthalmoscope finding was normal.

His CBC, electrolytes was found normal.X-ray chest -normal.

He was labeled as a case of Near Drowning.

His convulsion was difficult to control. After repeated trial with Inj Phenobarbitone, Phenytoin and mannitol , it was controlled after after 2 days. By the next, few days though he regained his consciousness, but he developed spasticity of the limbs, visual impairment and hearing defect.


Dr. Badrud Doza
Dr. Fahim

Link: Drowning

Case: Ectodermal dysplasia-anhydrotic type

The mother with worry in her face told me in the outdoor setting that the boy, 10 months old, has no sweating and shoots to high rise of temperature especially in hot environment.

He was normally delivered, breast fed, immunized with normal milestone development, first child of a non-consanguineous parents of a upper middle class family, had no other major illness in the past.
On examination, the child is otherwise healthy, alert, well nourished. But his hair is sparse, scant eyebrow, no eruption of tooth, dry skin, little deformed nail. IQ normal.
His systemic examination reveals normal.
Provisionally we diagnosed the patient as Ectodermal Dysplasia-anhydrotic type

His skin biopsy was done which indicates the absence of epidermis and absence of sweat glands that conforms to the diagnosis.


Badrud Doza

Selected links for ED : 1) National Foundation for Ectodermal Dysplasia