Health science is transformative. The modifications in evidence-based protocols are synchronous to the inventions in therapies. When the world was in the grip of Covid 19, the messenger RNA vaccines, a novel formula, halted the spread and brought us out of the pandemic. Along with the vaccines, newer protocols were authorized for emergency use on moderate to high-risk patients needing critical care. CytoSorb use was one of them. Developed by CytoSorbents Corporation in the US, CytoSorb therapy received FDA Emergency Use Authorization in April 2020. It is an extracorporeal blood purification therapy given to critical care patients which modifies the host inflammatory response by removing the inflammatory chemical mediators responsible for the cytokine storm. The unprecedented Dengue outbreak in Bangladesh in 2023 caused the highest number of cases as well as casualties till date. Medical practitioners were forced to break the conventional therapies and seek newer options. CytoSorb therapy was applied successfully, and a specific case is discussed in this issue where a patient was revived by this therapy from dengue shock syndrome with multiple organ failure in a hospital in Bangladesh. It is a wonder how physicians across borders utilize their expertise to apply the same treatment for a different disease simulating similar symptoms.
Taj Mahal liver parenchymal resection is a lesser-known liver resection procedure usually indicated for hilar bile duct carcinoma or gall bladder carcinoma where extended liver resection is not possible.1 A complex case was presented with high-level bile duct stricture after having been through several life-threatening complications arising from a simple gall bladder removal by an inexperienced surgeon. Within a span of six months the patient suffered post-surgical peritonitis, which was treated by stenting in CBD, followed by exploratory laparotomy, then surviving ARDS in critical care, and again developing jaundice after stent removal. After proper evaluation, high-level bile duct stricture was diagnosed and the expert surgeons in the country performed the Taj Mahal liver resection procedure on the patient. The prerogative was to save a life, and to do that, the clinicians decided on a management that is usually preserved for a different indication.
Explosive inventions in molecular therapies are outpacing innovations in generic drugs. In the last nine years, more than 30 percent of all the drugs approved annually by the Food and Drug Administration in the US were personalized/precision medicines and gene therapies. Precision medicine is often termed- “the right patient with the right therapy at the right dose at the right time”. The development of these therapeutics is an outcome of extensive application of next generation sequencing (NGS) for genome study. All the developed countries, especially USA, UK, China, Singapore are generating genome database of millions of participants. The exome or genome study of any particular patient can be cross referenced with the databases in those catalogues to ascertain the specific personalized medicine applicable to the patient. It is a complex industry of cross disciplinary integration since genome cataloguing generates big data which requires meaningful analysis.
Acid-base balance is an integral component within the human body to maintain homeostasis. The equilibrium of pH is largely dependent on the buffering actions of the respiratory and renal system and is critical for preserving proper cellular processes. Interestingly, the dietary shift from the time of hunter gatherers to the modern-day energy intense foods have shifted the body’s pH to a more acidic level which induces diseases like myocardial infarction, dyslipidemia, essential hypertension, chronic obstructive pulmonary disease, type 2 diabetes mellitus, obesity, and colon cancer. Alkaline water in recent years has demonstrated beneficial outcomes like increasing lifespan by reducing oxidative elements, improving sleep patterns, and stabilizing intestinal activities. It is very popular among sports people as it improves exercise induced metabolic acidosis.
Aortic aneurysms are common in patients with hypertension and underlying conditions like atherosclerosis or even infections. Thoracic aneurysms are less common than abdominal aortic aneurysms and management of such cases are dependent on the size of the dilatation, rate of growth in a year, symptoms, and additional complications. There are advantages and disadvantages of both conservative and surgical intervention. A case management and review of the conservative treatment undertaken is discussed for further evaluation by our clinician readers.
Stroke is a leading global burden as a consequence of high prevalence of hypertension and diabetes mellitus. Anticoagulant therapies for preventing further strokes depend upon the type of stroke the patient had suffered. There is debate on the timing of initiating the anticoagulant therapy; studies reveal it can be commenced sooner than the practiced protocol in patients who had suffered ischemic strokes. The type of anticoagulant must also factor in the valvular involvement.
Mass vaccination brought us out of the pandemic. Surokkha online platform was the tool that triggered the entire vaccine roll out program in Bangladesh. Since EPI coverage has been one of the most successful public health stories in the country, a similar tool like Surokkha can be replicated for the validation of this success. Online vaccination records will be a smart health initiative that will always keep the individual vaccine records accessible to the beneficiaries or atleast till a certain age, depending upon the need of the records. There is a rising need of biologics and new molecular therapies for Bangladesh’s 170 million people. The unprecedented rise in cancer, kidney disease, heart failure, strokes and other inflammatory conditions arising from pathogens are pushing more and more people to critical care. The enriched pharmaceutical industry cannot overlook this need and must step up to provide these novel therapeutics to its people at an affordable cost. The doctor to patient ratio is far from the standard recommendation in the country and burn out of doctors are very common, yet there are those special healthcare providers who still go that extra mile and think out of the box to save their patients. The multi sectoral expertise available within the country needs to be leveraged in a collaborative effort to transform the existing health system to ensure service delivery and accountability on the supply side, and empower the beneficiaries to take responsibilities of their own health on the demand side.