Class 4 emphysematous pyelonephritis with emphysematous cystitis: report of a rare case from Bangladesh.

Emphysematous pyelonephritis is a rare, severe form of necrotising infection of the kidneys and peri-nephric tissues with gas accumulation, occurring predominantly among patients with diabetes mellitus. Computed tomography scan can identify the distribution of gas in the affected reno-ureteral units and so establish and classify the diagnosis. We report a case of class 4 emphysematous pyelonephritis with emphysematous cystitis, occurring in a young Bangladeshi male, who presented with features of upper urinary tract infection. He had a background history of fibro-calculous pancreatic diabetes and chronic kidney disease. Imaging also revealed renal stones. He responded to conservative treatment.

Quantifying the air quality and health benefits of greening freight movements.

Commercial vehicle movements have a large effect on traffic-related air pollution in metropolitan areas. In the Greater Toronto and Hamilton Area (GTHA), commercial vehicles include large and medium diesel trucks as well as light-duty gasoline-fuelled trucks. In this study, the emissions of various air pollutants associated with diesel commercial vehicles were estimated and their impacts on urban air quality, population exposure, and public health were quantified. Using data on diesel trucks in the GTHA and a chemical transport model at a spatial resolution of 1 km2, the contribution of commercial diesel movements to air quality was estimated. This contribution amounts to about 6-22% of the mean population exposure to nitrogen dioxide (NO2) and black carbon (BC), depending on the municipality, but is systematically lower than 3% for fine particulate matter (PM2.5) and ozone (O3). Using a comparative risk assessment approach, we estimated that the emissions of all diesel commercial vehicles within the GTHA are responsible for an annual total of at least 9810 Years of Life Lost (YLL), corresponding to $3.2 billion of annual social costs. We also assessed the impact of decreasing freeway-sourced diesel emissions along Highway 401, one of the busiest highways in North America. This is comparable with a removal of 250 to 1000 diesel trucks per day along that corridor, which could be replaced by alternative technologies. The mean NO2 and BC exposures of the population living within 500 m of the highway would decrease by 9% and 11%, respectively, with reductions as high as 22%. Such a measure would save 1310 YLL annually, equivalent to $428 million in social benefits.

Septicemic melioidosis complicating undiagnosed chronic kidney disease and beta-thalassemia minor in a Bangladeshi farmer.

Melioidosis is an emerging infectious disease in many countries including Bangladesh. Patients with diabetes mellitus are at increased risk for infection by Burkholderia pseudomallei, the causative agent for melioidosis. Here, we report an autochthonous case of septicemic melioidosis occurring in a middle-aged non-diabetic Bangladeshi farmer who presented with prolonged pyrexia and splenomegaly. Diagnostic workup revealed splenic micro-abscesses, previously undetected chronic kidney disease (CKD) and beta-thalassemia minor. This case stresses the importance of searching for less common risk factors for melioidosis such as CKD and hemolytic anemia.

Experience Managing Adult Patients on Continuous Ambulatory Peritoneal Dialysis in Bangladesh.

Continuous ambulatory peritoneal dialysis (CAPD) is becoming increasingly known to the patients of Bangladesh, and patient numbers are increasing. Here, we report our experience and clinical outcomes in this field.Our analysis included all CAPD patients managed in a tertiary care hospital in Bangladesh between 2003 and 2015. All patients received a Tenckhoff double-cuff catheter by mini-laparotomy, and twin bags were used in most patients. In acute cases, regular exchanges were started manually with small-volume dwells the same or the next day.During the study period, 500 patients (mean age: 62 ± 18 years; 62% men; 86% percent with diabetes) were managed. Selection of CAPD was made by choice (47%) or for hemodynamic instability (32%), remote residence (17%), or poor vascular access (4%). Total duration of follow-up was 9364 patient-months (range: 1 - 78 months). The peritonitis rate was 1 episode in 30 patient-months. Fewer than 5% of patients required catheter removal. Similarly, the percentages of catheter tip migration and fluid leak were at the lower end. Patient survival was 68%, 48%, 38%, 22%, and 8% at 1, 2, 3, 5, and 7 years. Deaths were mostly attributable to vascular events.In a population with predominantly diabetic patients, CAPD was shown to be a viable mode of renal replacement therapy. The rates of peritonitis and catheter-related complications were low. Survival in the initial years can be considered acceptable.