Clinical and Immunological Profile of Systemic Lupus Erythematosus: A 5-year Retrospective Analysis from Northeast India.

OBJECTIVE: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with a wide range of clinical manifestations having considerable variation in clinical features that are influenced by ethnic, sociocultural, and geographical factors. This disease primarily affects young women aged between 18 and 35 years. The aim of this present study was to delineate the clinical manifestations and immunological patterns of SLE patients from the Northeastern (NE) region of India. MATERIALS AND METHODS: The study was carried out in a tertiary care hospital from January 2016 to January 2021. Adult patients of age >18 years fulfilling systemic lupus international collaborating clinic criteria (SLICC) for classification of SLE were included in this study. Immunology such as antinuclear antibodies (ANA) and double-stranded deoxyribonucleic acid (dsDNA) were also performed followed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Over a period of 5 years, 142 patients were recruited for the study, with an overall female-to-male ratio was 9.9:1, a median age at onset of 25 years (interquartile range age 21-32 years) and a mean disease duration was 15.25 months (range 2-60 months). Our study revealed that ANA was positive in 97.18% of patients while anti-dsDNA was positive in 78.68%, indicating that women from this region have higher positivity rates. CONCLUSION: Our findings support the notion that SLE is a multisystem disorder that predominantly affects young females, especially during the second and third decades of life. Hematological, mucocutaneous, and renal manifestations are common in our patients. Moreover, pulmonary, cardiovascular, and gastrointestinal (GI) manifestations were understudied in other cohorts, which is one of our study's strengths.

Neurotuberculosis: A mystery seeking it's answers in pulmonary tuberculosis.

Neurotuberculosis remains a mystery and presents a formidable challenge in diagnosis and management. While pulmonary tuberculosis has a well understood pathophysiology and well researched management strategies, CNS tuberculosis still has plenty of unanswered questions. The purpose of this review is to highlight the debatable issues in the current understanding of the clinical, diagnostic, and therapeutic aspects of Neurotuberculosis.

Association between Physical Fitness and Perceived Well-Being in Functionally Independent Community Dwelling Elderly of North-Eastern India.

Background: Regular physical activity helps in independent living, prevention of chronic health problems and quality of life in the elderly. The aim of the study is to determinewhether physical fitness is associated with multiple dimensions of well-being in the community dwelling elderly. Materials and Methods: A community-based cross-sectional study was undertaken to assess the physical fitness and perceived wellness in 400 elderly (≥65 years) subjects. The Senior Fitness Test (SFT) for assessing functional/physical fitness and Perceived Wellness Survey (PWS) were used to assess their well-being. Bivariate correlation analysis was used for individual testsand multiple linear regressions were used to analyze relationship of wellness composite score with physical fitness test. Results: 284men and 116 women (mean ages 69.80±3.82 and67.25±2.57 years, respectively) were assessed for physical fitness tests and perceived wellness.'Arm-curl' and 'chair-sit' testsshowedlinear decrease in strength with increasing age. In 'back-scratch' and 'chair-sit and reach' tests lower limb flexibility was better than upper limb in all except the 65-69 year sub-group. Maximum time to perform the '8-feet up-and-go' test increased progressively with age, whereas '2-minute step' test showed a linear decrease in mean score with advancing age. Wellness composite score (14.54±2.31) inmaleswas maximum in the 75-79 year age-group, while in females it (15.26±2.29) was maximum in the 70-74 year age-group. Correlation analysis of physical fitness test with perception of wellness (composite score) showed significant association of 'arm-curl' test (p=0.012), 'back-scratch' test (p=0.0002), '8-feet up-and-go' test (p=0.005), '2-minute step' test (p=0.005) with the composite wellness score in the male participants, whereas in the females such significance was observed only in the '2 minute step' test (p=0.007) with the wellness score. Conclusion: Screening of physical fitness and wellness are important measures in assessing wellness of community dwelling elderly, and in predicting theiroverall state of well-being, including age-specific comparison of fitness performance and wellness score.

Validity and Test-retest Reliability of perceived Wellness Survey among Geriatric Population: A Community-based Study from North Eastern India.

OBJECTIVES: Chronic illness and functional decline threaten elderly well-being. "Perceived Wellness Survey (PWS)," which measures psychosocial, physical, and intellectual well-being, may be appropriate for assessing the wellness of the geriatric population. This work has been planned to find out the validity and test-retest reliability of a PWS as a wellness-measuring tool for community-based elderly peopleMaterials and methods: This observational study was undertaken in the community was undertaken to assess PWS in 60 elderly individuals (≥65 years). The validity of PWS was tested using Pearson product-moment correlation test. For test-retest reliability, the internal consistency of PWS was tested by Cronbach's alpha testResult: Around 60 individuals ≥65 years (mean 69.45 ± 4.27 years), 48 males were selected by convenient sampling. Pearson's correlation showed psychological, emotional, and physical subscale scores had a very strong positive relationship (0.734, 0.703, and 0.722, respectively) with a composite score of PWS score. Spiritual, intellectual, and social subscales showed a strong positive relationship with the composite PWS score. Test-retest variability between observations for subscales was ≥0.8, which showed good reliability, except for the physical subscale, which showed unacceptable reliabilityConclusion: Perceived Wellness Survey (PWS) is an effective, feasible, highly reliable, and valid measure as a clinical assessment tool for assessing wellness in the elderly population.

Pharmacological effect of Heritiera fomes on Long Evans rats against Postprandial Hyperglycemia and adsorption in vitro.

Background: Natural restoratives from traditional medicinal plants are considered to be a convenient, potent, and risk-free substitute treatment for hyperglycaemia. Our objective was to explore the activity of the crude extract of Heritiera fomes on postprandial hyperglycaemia by assessing relative measurements in a laboratory animal model. Methods: The Streptozotocin induced diabetic rat (n = 88, twenty-two per group) was used for the glucose tolerance test as an initial support for the study. BaSO4 was administered orally as a marker to measure gut motility after one hour of methanolic extract (500 mg/kg body weight) administration where, only purified water (10 ml/kg) was used to treat the control group (n = 12) and a dose (500 mg/kg) of H. fomes extract was used for the test group (n = 12 in each group). After 60 min of incubation of the mixture of extract and glucose with 10% (v/v) yeast cell suspension, the absorbance was measured to determine the capacity of glucose absorption by yeast cells. Sixty Long Evans rats (n = 12 in each group) were used to assess disaccharidase enzyme activity as µmol/mg protein per hour by Lowry's protein estimation method. The carbohydrate absorption investigation was executed to evaluate the leftover sucrose content in the gastrointestinal system (n = 64). Results: After oral administration of MHFL (71.84%), MHFB (71.41%), and MHFR (72.55%), GI motility (%) increased significantly (p < 0.001) compared to the control group (59.06%). A significant increase in glucose uptake and adsorption capacity measured by different concentrations of glucose ensures the decrease of glucose bound rate and a significant drop in blood glucose concentration. The significant (p < 0.001) decrease in intestinal disaccharidase activity of MHFL (1.40), MHFB (1.36), and MHFR (1.20) in comparison to the control group (1.50) indicates that the presence of H. fomes may reduce glucose absorption in the small bowel. Significant (p < 0.001 & p < 0.05) accumulation of sucrose content in the six different parts of the GI tract suggests the absorption of sucrose was decreased. Conclusions: The findings of this study provide evidence on probable mechanisms for the anti-diabetic characteristics of H. fomes, and it is predicted that this plant will be studied further for the development of strong anti-hyperglycemic medicines.

Exposure and health risks of metals in imported and local brands' lipsticks and eye pencils from Bangladesh.

Elemental contamination in cosmetics is a serious health concern as it can pose a cumulative effect on the user's body over a long period. The prime motive of the study was to assess the concentration of 10 concerning chemical elements (Pb, Cd, Cr, As, Co, Ni, Cu, Zn, Fe, and Mn) in imported and local lipsticks and eye pencil samples collected from retail outlets in central Bangladesh (Dhaka city) and to assess their dynamic health risks for users. A total of 18 lipsticks and 24 eye pencils were studied and concentrations of chemical elements were examined with atomic absorption spectrophotometer. The health risk assessment was performed for dermal and ingestion routes of the contaminants. The results reveal that the concentrations of the examined elements vary with colors, brands, and origins. Pb and As concentrations were found below the permissible limit but Cr concentration in some samples exceeded the allowable limit in cosmetics. Cd was not detected in any samples; however, other examined elements such as Co, Ni, Cu, Mn, Zn, and Fe were detected in considerable concentrations. Elements like Mn, Zn, and Fe were found at high levels. In the case of lipstick samples, elemental concentrations followed the order of Fe > Zn > Mn > Ni > Cr > Cu > Pb > Co > As, while the order was Fe > Cu > Mn > Zn > Ni > Cr > Co > Pb > As for eye pencil samples. Results of the hazards quotient (HQ) indicate that there were no non-carcinogenic or carcinogenic risks of elements in samples for dermal exposure. But the cancer risk values of Cr (HQ > 1 for ingestion) in brown color lipsticks and Ni indicate that lipsticks have some carcinogenic effects if they enter the user's body. Dermal cancer risk for eye pencils has also been calculated and for Pb, Cr, Ni, and As; the values were found within the acceptable ranges of 10-6-10-4. It is suggested that the allowable limit of all toxic elements in cosmetics must be established. Furthermore, continuous monitoring is urgently needed for personal care products like lipsticks and eye pencils commonly available in the local markets in the country like Bangladesh.

Comparison of Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment, and Quick Sequential Organ Failure Assessment Scores to predict Mortality in Sepsis.

OBJECTIVES: Sepsis-3 criteria define sepsis as ≥2 points rise of Sequential Organ Failure Assessment (SOFA) score, either from zero or a known baseline. We compared the efficacies of quick Sequential Organ Failure Assessment (qSOFA), SOFA, and Systemic Inflammatory Response Syndrome (SIRS) scores to predict sepsis mortality. METHODS: Prospective, hospital-based study was undertaken to determine the efficacies of various sepsis-scoring systems to predict mortality in sepsis. The "Sepsis-2" criteria of "severe sepsis" and "septic shock" were used as selection criteria as they correspond to "sepsis" and "septic shock" of "Sepsis-3". Statistical analysis was done by SPSS Statistics version-16. Mortality predictions were made using receiver operator characteristic curve testing. RESULTS: We included 122 sepsis patients diagnosed by "Sepsis-2" definition; 78.68% (n = 98) of whom met "Sepsis-3" criteria for sepsis. All-cause mortality was 50%. On univariate analysis, we found age over 60 years [odds ratio (OR) = 4.244, 95% confidence interval (CI) = 1.309-13.764, p = 0.016], invasive mechanical ventilation (OR = 7.0076, 95% CI = 3.053-16.0809, p<0.0001), and presence of acute respiratory distress syndrome (ARDS) (OR = 2.757, 95% CI = 1.0091-7.535, p = 0.048) were significant predictors of mortality. The SOFA score yielded the best result with "area under the curve" (AUC) of "receiver operating characteristic" (ROC) curve of 0.868. On comparing AUCs between these scores difference between both SOFA and qSOFA was highly significant (p < 0.0001) compared to SIRS. However, such statistical difference was not found between AUCs of SOFA and qSOFA. CONCLUSIONS: Both SOFA and qSOFA are superior prognostication tools compared to SIRS to predict sepsis mortality; SOFA being better than qSOFA.

A comparative study of Proximal Femoral Nail (PFN) versus Dynamic Condylar Screw (DCS) in management of unstable trochanteric fractures.

Trochanteric hip fractures have become very common with 35-40% of these fractures being unstable. Trochanteric fractures, especially unstable ones are associated with high rates of mortality and morbidity and thus remain an inordinate challenge for surgeon to treat these fractures with proper choice of implant. Aim of the study was to compare the proximal femoral nail and dynamic condylar screw in the management of unstable trochanteric fractures. Our study was a prospective comparative study which included 26 patients with fresh (≤3 weeks old) unstable trochanteric fractures AO 31A2 and AO 31A3, with age ≥18 years of both sexes. Eleven patients in DCS and fifteen patients in PFN were included. Harris hip score was used to compare functional outcomes. Average age of patients in DCS group was 59.82±11.59 years and PFN was 54.2±16.22 years. AO 31A2 fracture pattern (63.64%) was more common than AO 31A3 in DCS group and AO 31A3 fracture pattern (60.00%) was more common than AO 31A2 in PFN group. Mean operative time for DCS was 96.36±15.51 minutes and for PFN it was 79.67±12.02 minutes with P-value of 0.003. Two patients in DCS group and 1 patient in PFN group were lost to follow up. Two patients in DCS group and 1 patient in PFN group died. Seven out of 11 (63.64%) patients in DCS group and 13 out of 15 (86.60%) patients in PFN group were available for final follow up. Union seen in 2 (28.57%) patients with DCS and 12 (92.31%) patients fixed with PFN with P-value of 0.007. Mean HHS of 62.29±24.26 in DCS and 86.92±11.65 in PFN with P-value of 0.037. Patients with combined excellent and good HHS in DCS group and PFN group were 2 (28.57%) and 11 (84.62%) respectively. Non-union was seen in 5 (71.43%) patients fixed with DCS and 1 (7.69%) patient fixed with PFN. Implant failure was seen in 3 (42.86%) patients in DCS group in which barrel plate was broken in 2 (28.57%) patients and lag screw cut out through femoral head in 1 (14.29%) patient and 1 (7.69%) patient in PFN group due to varus collapse and complete backout of screw. Varus collapse was seen in 3 (42.86%) patients in DCS group and 4 (30.76%) patients in PFN group. Proximal femoral nail is better implant as compared to dynamic condylar screw which was statistically significant in terms of lesser operative time, higher union rate and better functional outcome. So PFN is a better implant choice for unstable trochanteric fractures when compared with DCS.

COVID-19 infection among health care workers: A hospital based study from Indian state of Meghalaya.

Background: COVID-19 can infect any individual, but the group most susceptible is the Health Care Workers (HCWs) who are directly involved in COVID-19 patient care. Despite adhering to the recommended personal prospective equipment, a disproportionately large number of cases of COVID-19 were reported among the HCWs. Aims and Objectives: To study the burden of COVID-19 infection among the HCWs and to study the probable factors associated with increased risk of COVID-19 infection among HCWs. Materials and Methods: A hospital-based prospective cross-sectional study was conducted at a tertiary care teaching institute in the state of Meghalaya, India for the period between 1st May 2020 and 30th June 2021 and included only laboratory-confirmed COVID-19 cases. Data collected included: A) Demographic data - age, gender, category of HCW, B) History of exposure, place of posting, C) Clinical presentation and disease category. Results and Observations: A total of 144 cases were included in the study. The mean age of affected HCWs was 33.83 ± 1.408 years and male to female ratio was 0.47:1. The commonest age group affected was 18 to 30 years of age (45.14%). The majority of the HCWs were Nursing Officers (staff) (52.78%) followed by Resident Doctors (18.06%). Out of all cases, 135 (93.75%) were either asymptomatic or had mildly symptoms. In 96 (66.67%) HCWs, there was high-risk contact with a known case of COVID-19. High-risk contact outside the COVID-19 designated area of the hospital was noted in 53 (36.81%) cases; however, only 22 (15.27%) patients had a history of working in the COVID-19 designated area at the workplace. Conclusion: The most common group that got infected was the nursing staff followed by the resident doctors, with more than ninety percent of the cases having either mild symptoms or were asymptomatic. The risk of contracting COVID-19 infection was higher in non-COVID-19 as compared to COVID-19 designated areas of the hospital.

Epidemiology, clinical, and laboratory profile of patients with hepatitis C: A prospective, observational study from north-eastern India.

Low and middle-income countries (LMICs) contribute to 80% of the global hepatitis C virus (HCV) infection burden. Intravenous drug use (IVDU) is not uncommon in Northeastern India, thus contributing to HCV. Its epidemiology, clinical, and laboratory profile were studied in a tertiary care centre in northeastern India.HCV patients (age >18) of either sex were prospectively assessed for demographic, virological, and genotype distributions. Most were male (M: F, 5.8:1) with a mean age of 37.1 ± 11.8 years. The most common risk factor was IVDU(77.69%), followed by concomitant alcohol use in 69.2%. Besides genotype 3 (59.2%), genotype 1 (26.1%) and genotype 6 were also common (14.6%). The demographics, liver disease severity, and biochemical parameters were similar across genotypes.

COVID-19 Vaccination Status Among Healthcare Workers and Its Effect on Disease Manifestations: A Study From Northeast India.

Background and objective Since being declared a global pandemic, coronavirus disease 2019 (COVID-19) has led to millions of cases and deaths worldwide. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to wreak havoc on individuals, healthcare systems, and economies, the intensive vaccination strategies adopted by several countries have significantly slowed the progress and the severity of the disease. In this study, we aimed to determine the COVID-19 vaccination status among healthcare workers (HCWs) and examine the effects of vaccination on disease manifestations. Materials and methods This cross-sectional study was conducted at a teaching hospital in Northeast India from April 2021 to September 2021, during the second phase of the COVID-19 pandemic. HCWs employed in the hospital who were laboratory-confirmed cases of COVID-19 based on semiquantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) or cartridge-based nucleic acid amplification test (CBNAAT) on oropharyngeal samples were included in the study. Data analysis was performed using Microsoft Excel (Microsoft Office Professional Plus 2019, Microsoft Corp., Redmond, WA) Results A total of 178 HCWs reported positive for COVID-19 infection during the study period. Of these, 42 (23.59%) were males and 136 were females (76.40%). Among them, 86 (48.32%) HCWs were fully vaccinated, 58 (32.58%) were partially vaccinated, and 34 (19.10%) were not vaccinated. Most of the HCWs experienced mild disease (145, 81.46%), and only four (2.24%) reported moderate to severe disease. Compared with unvaccinated HCWs, individuals who have had either one or two doses of vaccines were less likely to have moderate to severe disease or seek treatment at the hospital. On symptoms analysis, shortness of breath was found to be more common in unvaccinated individuals than in vaccinated patients, and anosmia and loss of taste were more common in vaccinated than in unvaccinated individuals. No deaths were reported among the participants included in this study. Conclusions Following the first and second waves of the COVID-19 pandemic, a substantial proportion of HCWs were infected with SARS-CoV-2, likely as a result of the acquisition of the virus in the community during the early phase of local spread. Fully vaccinated individuals with COVID-19 were more likely to be completely asymptomatic or only mildly symptomatic compared to unvaccinated HCWs.

Clinical and Demographic Profile of COVID-19 Patients: A Tertiary Level Hospital-Based Study From Northeast India.

Background and objective The coronavirus disease 2019 (COVID-19) outbreak, which was first detected in Wuhan, China, has turned into a rapidly spreading global healthcare crisis. The clinical and laboratory features of COVID-19 are associated with significant regional variations. In this study, we aimed to describe the clinical and demographic profile of COVID-19 patients from a tertiary care hospital in Northeast India. Materials and methods This was a hospital-based cross-sectional study that included all laboratory-confirmed COVID-19 cases admitted to the institution from 1st July to 31st October 2020. The information was collected on a predesigned proforma, which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors. Results The study included 180 laboratory-confirmed COVID-19 cases. A history of contact with laboratory-confirmed COVID-19-affected individuals was found in 92 (51.1%) patients. The median age of the patients was 37.17 years (range: 18-80 years), and there were 104 (57.78%) males in the cohort. Of the total enrolled patients, 102 (56.67%) were asymptomatic from the time of exposure till their admission. The common presenting complaints were fever (n=55, 70.51%), cough (n=42, 53.85%), and shortness of breath (n=32, 42.02%). The case fatality rate among the admitted cases was 15%. Comorbidities were found in 84 (46.67%) patients with the most common one being diabetes mellitus (n=31, 36.9%) followed by hypertension (n=29, 34.52%). Patients with advanced age (more than 60 years) and coexisting comorbidities were at higher risk of progression of disease and death. Conclusion The COVID-19 pandemic is not only a huge burden on healthcare facilities but also a significant cause of disruption in societies globally. The majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Patients of advanced age with comorbidities were found to have more complications. An analysis of the trends related to COVID-19 in different hospital and institutional settings will help to achieve better preparedness and lead to improved patient care to combat the COVID-19 pandemic in a more efficient manner.

Hemophagocytic Lymphohistiocytosis Secondary to Adult-Onset Still's Disease.

Hemophagocytic lymphohistiocytosis (HLH) is a rare hematological condition resulting from dysregulation of the immune system. This unusual clinical syndrome is characterized by fever, cytopenia, liver dysfunction, increased ferritin level, and evidence of hemophagocytosis in the bone marrow. We report a case of a 21-year-old female who presented with recurrent high-grade fever, transient rash, and polyarthritis who was subsequently diagnosed with adult-onset Still's disease (AOSD) with secondary HLH. The patient improved with aggressive management. Our case highlights HLH as a life-threatening and underdiagnosed complication of AOSD.

Diffusion tensor imaging analysis in scrub typhus meningoencephalitis to determine the alteration of microstructural subcortical white-matter integrity.

BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI) of the brain in scrub typhus meningoencephalitis is non-specific, and in the majority of the cases, conventional MRI fails to detect any abnormality. However, autopsy reports depict central nervous system involvement in almost all patients. There is therefore a need for research on the quantitative assessment of brain parenchyma that can detect microstructural abnormalities. The study aimed to assess the microstructural integrity changes of scrub typhus meningoencephalitis by using different diffusion tensor imaging (DTI) parameters. METHODS: This was a retrospective analysis of scrub typhus meningoencephalitis. Seven patients and seven age- and sex-matched healthy controls were included. Different DTI parameters such as apparent diffusion coefficient (ADC), fractional anisotropy (FA), relative anisotropy (RA), trace, volume ratio (VR) and geodesic anisotropy (GA) were obtained from six different regions of subcortical white matter at the level of the centrum semiovale. Intergroup significant difference was determined by one-way analysis of variance followed by Tukey's post hoc test. Receiver operating characteristic curves were constructed to determine the accuracy of the DTI matrices. RESULTS: There was a significant decrease in FA, RA and GA as well as an increase in ADC and VR in the subcortical white matter in patients with scrub typhus meningoencephalitis compared to controls (p < 0.001). The maximum sensitivity of the DTI parameters was 85.7%, and the maximum specificity was 81%. CONCLUSION: There was an alteration of subcortical white-matter integrity in scrub typhus meningoencephalitis that represents the axonal degeneration, myelin breakdown and neuronal degeneration. DTI may be a useful tool to detect white-matter abnormalities in scrub typhus meningoencephalitis in clinical practice, particularly in patients with negative conventional MRI.

Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited Resources: Perspective of a Developing Country.

BACKGROUND: The situation of coronavirus disease 2019 (COVID-19) pandemic in the Indian subcontinent is worsening. In Bangladesh, rate of new infection has been on the rise despite limited testing facility. Constraint of resources in the health care sector makes the fight against COVID-19 more challenging for a developing country like Bangladesh. Vascular surgeons find themselves in a precarious situation while delivering professional services during this crisis. With the limited number of dedicated vascular surgeons in Bangladesh, it is important to safeguard these professionals without compromising emergency vascular care services in the long term. To this end, we at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, have developed a working guideline for our vascular surgeons to follow during the COVID-19 pandemic. The guideline takes into account high vascular work volume against limited resources in the country. METHODS: A total of 307 emergency vascular patients were dealt with in the first 4 COVID-19 months (March through June 2020) according to the working guideline, and the results were compared with the 4 pre-COVID-19 months. Vascular trauma, dialysis access complications, and chronic limb-threatening ischemia formed the main bulk of the patient population. Vascular health care workers were regularly screened for COVID-19 infection. RESULTS: There was a 38% decrease in the number of patients in the COVID-19 period. Treatment outcome in COVID-19 months were comparable with that in the pre-COVID-19 months except that limb loss in the chronic limb-threatening ischemia patients was higher. COVID-19 infection among the vascular health care professionals was low. CONCLUSIONS: Vascular surgery practice guidelines customized for the high work volume and limited resources of the National Institute of Cardiovascular Diseases and Hospital, Dhaka were effective in delivering emergency care during COVID-19 pandemic, ensuring safety of the caregivers. Despite the fact that similar guidelines exist in different parts of the world, we believe that the present one is still relevant on the premises of a deepening COVID-19 crisis in a developing country like Bangladesh.

Dermatological manifestation can be an early sign in Covid-19: Report of three cases with a novel manifestation masquerading Steven Johnson syndrome.

Various dermatological manifestations have been observed in patients with Coronavirus disease (COVID-19) infection ranging from maculopapular rashes, urticaria, chickenpox-type lesions, chilblain-like, distal-limb ischemia, and livedo racemosa. While most of these cutaneous findings are self-resolving, they may aid in the timely diagnosis of this infection. We are reporting three patients presenting with dermatological features resembling (i) varicella zoster, (ii) herpes labialis, and (iii) Steven Johnson Syndrome (SJS) who were subsequently diagnosed with Covid-19 infection. The skin lesions disappeared after successful treatment of Covid-19.

Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrium Tumor Thrombus.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer and cancer related deaths worldwide. Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor thrombus invasion through the major hepatic veins and of vena cava inferior with continuous extension into the right cardiac cavity. Right heart metastasis without invasion of inferior vena cava (IVC), which may be caused by haematogenous spread of cancer cells, is rarely reported. We report a case of HCC with IVC and right atrium (RA) thrombus in a patient who presented to us with decompensated cardiac failure. Strikingly, the patient was young and with negative serum HBsAg, and anti-HCV results. Our case highlights a rare presentation of metastatic intracardiac tumor thrombus involving the RA in advanced HCC without any symptoms of cardiac failure, and henceforth, the role of screening echocardiography for all patients with advanced HCC especially with vena caval involvement to rule out intracardiac thrombus.

Clinical Spectrum and Medical Comorbidities in Tuberculosis: A Hospital-Based Study in Northeast India.

Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associated with comorbidities. However, data regarding TB and comorbidities are lacking from northeast India. The aim of the study is to see the clinical spectrum of TB and the frequency of comorbidities. Methods This was a prospective observational study of all hospitalized TB patients between January 2016 and June 2017 who were selected by consecutive sampling. Data were analyzed using SPSS v. 17.0 (IBM Corp., Armonk, NY), and a p-value of <0.05 was considered significant. Results Of the 173 patients selected, the mean age was 41.05±17.04 years with a male:female ratio of 4.27:1. Pulmonary TB (PTB) was found in 43.94%, extra-pulmonary TB (EPTB) in 52.02%, and disseminated TB in 4.04%. Fever (61.27%) was the most common presentation, followed by cough (54.33%) and breathlessness (32.94%). Of the 76 patients with PTB and seven with disseminated TB, making a total of 83 patients, 56 (67.4%) were sputum positive. Out of 90 patients suffering from EPTB, pleural effusion (53.33%) was the commonest type of EPTB, followed by central nervous system (CNS) tuberculosis (26.66%) and abdominal tuberculosis (8.88%). Comorbidities were present in 53.17% of the patients, of which diabetes mellitus (DM) (26.58%) and hypertension (17.34%) were the most common. Comorbid conditions were significantly higher in PTB than EPTB (51 of 83 vs. 41 of 90, p<0.05). Mean glycated hemoglobin (HbA1c) was significantly higher in PTB as compared to EPTB (8.74±2.04 vs. 7.58±0.29, p<0.05). Conclusion Comorbidities, particularly DM, were present in half of the patients, mostly in PTB than EPTB, with glycemic control being significantly poorer in PTB patients.

Metabolic Syndrome and Atherogenic Indices in Rheumatoid Arthritis and their Relationship with Disease Activity: A Hospital-based Study from Northeast India.

BACKGROUND AND OBJECTIVE: Metabolic syndrome (MetS), a constellation of metabolic abnormalities including hypertension, obesity, glucose intolerance, and dyslipidemia, is highly prevalent in patients with rheumatoid arthritis (RA). Our aim was to assess the magnitude of MetS and its determinants in RA patients and to evaluate different atherogenic indices that are reflective of the risk for future cardiovascular disease. PATIENTS AND METHODS: The study was conducted on 104 RA patients and 103 age- and sex-matched healthy controls. The frequency of MetS was assessed using the guidelines recommended for Asian Indians. RESULTS: A total of 104 RA patients participated with majority being females (85.6%), with a mean age of 43.82 ± 13.32 years. The frequency of MetS in patients with RA (36.5%) was significantly higher than in controls (15.5%). The atherogenic indices were found to be significantly higher in RA patients than controls (P < 0.01). On logistic regression, disease activity score (DAS28) scale for 28 joints and disease duration remained significant independent predictors of the presence of MetS in RA patients (P < 0.01 and 0.05, respectively). CONCLUSIONS: RA is a kind of chronic disease of long course, and MetS and atherogenic indices are often concomitant in these patients. The study showed that the frequency of MetS was higher in patients with RA than in controls, and that DAS28 and disease duration remained significant independent predictors of the presence of MetS in RA patients.