Common Pitfall in Post Operative Fluid and Electrolyte Management: A Retrospective Study in Two Tertiary Centers in Bangladesh.

Evaluation of our practice and recommend an appropriate fluid regime to maintain the fluid and electrolyte balance in the post operative period. The drug chart and clinical notes were retrospectively analysed manually of 758 patients who underwent surgery from January 2020 to January 2022 in Enam Medical College Hospital and Ibnsina Medical College Hospital, Dhaka, Bangladesh were reviewed by 3 individual clinicians and the obtained data were analysed. Total 407 patients met the inclusion criteria for the study. Fifty seven (57) patients underwent emergency operation and 350 patients had elective surgery. The average fluid replacement was 2.5 L/day, average Sodium- 154 mmol/day, average potassium 2.0 mmol/day and average glucose 125 mmol/day. Post operatively 97 patients developed hypokalemia. Among them 25 patients developed severe hypokalemia. A simple pathway for prescribing post operative fluid and electrolyte was proposed so that patients during 1st post operative day requiring maintenance fluid will have 25-30 ml/kg/day of water, approximately 1-2 mmol/kg/day Sodium and chloride, 1 mmol/kg/day of potassium and approximately 50-100 gm/day of glucose.

Elevated IgA antiphospholipid antibodies in healthy pregnant women in Sudan but not Sweden, without corresponding increase in IgA anti-ß2 glycoprotein I domain 1 antibodies.

OBJECTIVE: The role of antiphospholipid antibodies (aPL) during apparently normal pregnancy is still unclear. IgA aPL are prevalent in populations of African origin. Our aim was to measure all isotypes of anticardiolipin (anti-CL) and anti-ß2 glycoprotein I (anti-ß2GPI) in healthy pregnant and non-pregnant women of different ethnicities. METHODS: Healthy Sudanese pregnant women (n = 165; 53 sampled shortly after delivery), 96 age-matched Sudanese female controls and 42 healthy pregnant and 249 non-pregnant Swedish women were included. IgA/G/M anti-CL and anti-ß2GPI were tested at one time point only with two independent assays in Sudanese and serially in pregnant Swedes. IgA anti-ß2GPI domain 1 and as controls IgA/G/M rheumatoid factor (RF), IgG anti-cyclic citrullinated peptide 2 (anti-CCP2) and anti-thyroid peroxidase (anti-TPO) were investigated in Sudanese females. RESULTS: Pregnant Sudanese women had significantly higher median levels of IgA anti-CL, IgA anti-ß2GPI (p < 0.0001 for both antibodies using two assays) and IgM anti-ß2GPI (both assays; p < 0.0001 and 0.008) compared with non-pregnant Sudanese. IgA anti-CL and anti-ß2GPI occurrence was increased among Sudanese pregnant women compared with national controls. No corresponding increase during pregnancy was found for IgA anti-ß2GPI domain 1 antibodies. Both IgG anti-CL and IgG control autoantibodies decreased during and directly after pregnancy among Sudanese. Serially followed Swedish women showed no changes in IgA aPL, whereas IgG/M anti-CL decreased. CONCLUSIONS: IgA aPL are increased in Sudanese but not in Swedish women, without corresponding increase in IgA domain 1. Whether due to ethnicity and/or environmental influences the occurrence of IgA aPL during Sudanese pregnancies, and its clinical significance, is yet to be determined.

Anti-citrullinated peptide antibodies in Sudanese patients with Leishmania donovani infection exhibit reactivity not dependent on citrullination.

African patients with Leishmania donovani infections have signs of strong systemic inflammation and high levels of circulating immune complexes (IC) and rheumatoid factor (RF), all serologic markers of rheumatic disease. As inflammation in general is associated with citrullination, we sought to investigate ACPA responses in Sudanese Leishmania patients. Serum samples were collected from Sudanese patients with visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL) as well as from ACPA-positive Sudanese rheumatoid arthritis patients and compared to healthy Sudanese controls. Levels of circulating C1q-binding IC and anticyclic citrullinated peptide 2(CCP2) were investigated using ELISA, and RF was measured with nephelometry. C1q adsorption was carried out to investigate anti-CCP2 content in IC. Citrulline specificity was evaluated with control plates with cyclic arginine-containing control peptides. Leishmania-infected patients had elevated levels of RF and circulating IC but also a significant increase in anti-CCP2 (12%) as compared to healthy controls. Anti-CCP2-positive Leishmania patients displayed lower anti-CCP2 levels than Sudanese patients with rheumatoid arthritis (RA), and anti-CCP2 levels in Leishmania patients showed a continuum not resembling the dichotomous pattern seen in patients with RA. Whereas the anti-CCP reactivity of Sudanese RA sera was strictly citrulline dependent, anti-CCP2-positive Leishmania sera reacted equally well with ELISA plates containing arginine control peptides. There was a strong correlation between anti-CCP2 and circulating IC among the Leishmania patients, but IC depletion only marginally diminished anti-CCP2 levels. Our findings stress the importance to interpret a positive CCP test carefully when evaluated in non-rheumatic conditions associated with macrophage activation.

Survival after stroke in saudis : a hospital based study.

BACKGROUND: Prognosis of stroke has been studied in various population. Factors adversely affecting short term survival include impaired consciousness, leg weakness and increasing age. AIM OF THE STUDY: In this study, the prognostic effects of age, sex, hypertension, diabetes mellitus and presentation in coma on the survival pattern of stroke patients presenting to a referral hospital, are reviewed. METHODOLOGY: The medical records of all patients hospitalized with definite stroke at King Fahd Specialist Hospital, Buraidah, for the period between June 1986 and June 1991, were reviewed. The Cranial CT Scans were also reviewed. RESULTS: One hundred and seventy four patients, 106 males and 68 females, with a mean age of 64 years who had definite stroke were studied to estimate overall survival and the various risk factors influencing it. The case records and cranial CT scans were reviewed. CONCLUSION: The factors adversely affecting survival in this study, were age above 60 (P<0.04), presentation in coma (P<0.003) and pre-existing heart disease (P<0.0009). There was no significant effect on survival due to sex, hypertension and/or diabetes mellitus.

Evaluation of serum C-reactive protein in the diagnosis of arthritic and non-arthritic brucellosis.

The level of the acute-phase reactant C-reactive protein was determined in the sera of patients with brucellosis who had arthritic involvement (17 patients) as well as in those who had no arthritis (28 patients). The level was also determined in a group of age-matched controls (31 subjects). Patients with brucellosis had significantly higher levels than controls. Patients without arthritis showed a greater elevation than those with joint involvement. C-reactive protein assay is a helpful adjunct in the diagnosis, and in monitoring the treatment, of patients with brucellosis.

Increased circulating HLA-DR+ CD4+ T cells in systemic lupus erythematosus: alterations associated with prednisolone therapy.

Patients with active systemic lupus erythematosus (SLE) in the circulation have a selective increase of a subset of the CD4+ helper/inducer T cells bearing HLA-DR+, major histocompatibility complex class II antigens. We studied prednisolone-induced alterations of HLA-DR+, CD4+, and CD8+ T-cell subsets in three patients with active SLE. Prednisolone therapy was accompanied by a drastic reduction in circulating HLA-DR+, CD4+ T-cell subsets, serum anti-DNA titre, normalization of the serum immunoglobulin profile, and CD4+ T-cell responses to phytohaemagglutinin and concanavalin A. These changes in immune functions were associated with eventual improvement in the clinical condition of active SLE. A low percentage of HLA-DR+, CD8+ T-cell subsets was present in the circulation, which was not changed by prednisolone therapy. These results suggest that HLA-DR+, CD4+ T-cell subsets play a major role in the pathogenesis of active SLE, and that prednisolone-induced immunosuppression in this disease is mediated by changes in the HLA-DR+, CD4+ T-cell subsets in circulating blood.

Selective loss of the CD4+ inducers of suppressor T cell subsets (2H4+) in active systemic lupus erythematosus.

We investigated 2H4+ and 4B4+ T cell subsets from the purified CD4+ helper/inducer and CD8+ suppressor/cytotoxic T cells in circulating blood of 15 patients with severe active systemic lupus erythematosus (SLE), 6 patients with inactive SLE, 5 patients with rheumatoid arthritis and seven healthy controls. The percentage of the total CD4+ T cells increased and CD8+ T cells decreased in all patients with active SLE. Of interest, however, all the patients with active SLE and central nervous system (CNS) disease had a selective decrease in the percentage of CD4+ 2H4+ T cell subsets in circulating blood that is responsible for induction of the CD8+ suppressor T cells. This loss of the CD4+ 2H4+ T cells was accompanied by an increase in the CD4+ 4B4+ T cell subsets, that are the true helper/inducers providing help for B cell immunoglobulin production. A marked decrease in the CD4+ 2H4+ cell subsets in the circulating blood of all patients with severe active SLE and CNS disease is related with meaningful functional properties of the T cells in an abnormal immune system.