Clinical and laboratory characteristics and outcome predictors of cerebral venous sinus thrombosis in a referral neurology hospital in Bangladesh.

OBJECTIVE: We aimed to describe clinical and laboratory characteristics and determine the predictors of outcome in patients with cerebral venous sinus thrombosis. METHODS: This prospective study was conducted over 2 years among hospitalized patients with cerebral venous sinus thrombosis. Patient outcome was assessed using the Modified Rankin Scale (mRS) score at 3 months. Outcome predictors were identified using logistic regression analysis. RESULTS: Eighty-one patients were included in this study. The median mRS outcome at 3 months was 1 (interquartile range 1-3). Poor outcomes were observed in 27.2% of patients, and the mortality rate was 9.8%. Factors associated with poor outcomes were age >60 years (relative risk [RR] 5.1), hemiparesis (RR 5.4), altered level of consciousness (RR 7.1), and transverse sinus involvement (RR 1.1). In general, mRS scores were not associated with D-dimer levels (RR 2.4). However, older patients with elevated D-dimer levels showed a significant association with poor outcomes (1.6) according to mRS scores. CONCLUSION: Older age, hemiparesis, and altered consciousness levels were independent predictors of poor outcomes in patients with cerebral venous sinus thrombosis. High D-dimer level showed no association with functional disability, except in older patients.

Pattern and Predictors of Infection Among Patients With Rheumatological Disease on Immunosuppressive Medications: A Retrospective Study in a Tertiary Care Hospital in Bangladesh.

Background Immunomodulatory therapy for chronic rheumatic disease carries a risk for infectious complications. In Bangladesh, there is limited information regarding patterns and factors associated with infections among patients receiving immunosuppressive medications. Objective The present study aimed to find out patterns and predictors associated with infection among patients who were on different immunosuppressive medications due to chronic rheumatological disease. Methodology This was a retrospective study; all confirmed cases of (new and old) different rheumatological diseases on disease-modifying agents attended at the rheumatology clinic of Dhaka Medical College Hospital from January 2019 to December 2021 were enrolled. Result Among 489 cases, 90 (18.4%) patients had documented infections. The most common rheumatological diseases were systemic lupus erythematosus (28, 31.1%), ankylosing spondylitis (26, 28.8%), and rheumatoid arthritis (20, 22.2%). COVID-19 (28, 31.1%) was the most commonly occurring infection followed by urinary tract infection (14, 15.6%), fungal infection (12, 13.3%), herpes zoster (10, 11.1%), pulmonary tuberculosis (TB) (eight, 8.8%), latent TB (seven, 7.7%), community-acquired pneumonia (six, 6.6%), and sepsis (three, 3.3%). Infection was most prevalent among patients who received steroids of more than 10 mg per day (17, 18.8%) than those less than 10 mg steroid per day (six, 6.7%), Factors associated with infections were (odds ratio, 95% CI, p-value) underweight (2.3, [1.3-2.7], 0.001), anemia (1.8, [1.1-5.7], 0.01), neutropenia (1.6, [1.1-2.9], <0.002), hypoalbuminemia (3.1, [1.6-4.9], 0.001), hypovitaminosis D (1.9, [1.3-4.5], 0.001), high blood sugar (1.5, [1.1-5.3], 0.02), inadequate counseling of steroid side effect (1.7, [1.1-3.9], 0.03), prednisolone >10mg/day (2.2, [1.19-4.10], 0.001). Conclusion COVID-19 pneumonia, urinary tract infections, fungal infection, tuberculosis, herpes zoster, and community-acquired pneumonia were commonly occurring infections among patients receiving different immunosuppressive medications. Factors like poor nutritional status, presence of anemia, leucopenia, hypoalbuminemia, hyperglycemia, and hypovitaminosis D had a significant association with infection. Moreover, inadequate counseling of steroid side effects and history of daily intake of prednisolone (>10mg/day) were also significant factors associated with infection.

Clinicopathological Patterns of Malignant Solid Tumors in Adult Patients: A Hospital-Based Study From Bangladesh.

BACKGROUND: Solid malignant tumors are abnormal masses of tissue that usually do not contain any cysts or liquid areas. The causation of these tumors is multifactorial, and the disease process differs at different sites. AIM: This study aims to determine the clinicopathological patterns of malignant solid tumors in adult patients admitted into the department of internal medicine of a tertiary care hospital in Bangladesh. METHOD: This cross-sectional study was conducted between January 2018 and June 2018 at the Department of Medicine, Dhaka Medical College Hospital, Bangladesh. We recorded the complete socio-demographic characteristics, clinical patterns, and pathological characteristics of malignant solid tumors in adult patients. RESULTS: A total of 100 patients with confirmed malignant solid tumors were included in our study. The mean age of the patients was 47.5 years (SD: ±4.20); most of them (27%) were between 58 and 67 years of age. Male patients constitute 59% of the total study sample. Most of the patients were of the middle socio-economic class (59%) and most of them (61%) were nonsmokers. Among the patient diagnoses, 19% had lung cancer, 29.27% had breast cancer, and in 14%, lymphoma (tumor arising from the lymphatic system) was the common solid tumor. Lung cancer was found to be the most common form of cancer in males. Additionally, the majority of those diagnosed with lung cancer smoked. Breast cancer was found to be the most common type of cancer in females. CONCLUSION: This study reflects that solid malignant tumors can affect any socio-economic class of people. Based on findings in our study as well as others, prevention efforts should focus on the reduction in tobacco use and the incorporation of other lifestyle changes, such as diet modification and exercise. Additionally, the incorporation of economic factors and how they affect cancer presentation in different contexts is crucial.

Para Kala-Azar Dermal Leishmaniasis: A Case Report.

Rarely, post-kala-azar dermal leishmaniasis (PKDL) may coexist with visceral leishmaniasis (VL). The concomitant PKDL and VL are referred to as Para-kala-azar dermal Leishmaniasis. We report a case of Para kala-azar dermal leishmaniasis in a chronic Hepatitis-B virus-infected patient who presented with an abdominal lump and multiple maculopapular skin lesions and is resistant to sodium stibogluconate but successfully treated with liposomal Amphotericin-B.

Acute Hemorrhagic Leucoencephalitis (AHLE): A Rare CNS Presentation of Mycoplasma pneumoniae.

Acute hemorrhagic leucoencephalitis (AHLE) is a rare inflammatory disease of the brain. Literature on the presentation and management of this rare disease is limited. A Mycoplasma pneumoniae infection is considered a possible trigger for acute hemorrhagic leucoencephalitis (Weston-Hurst syndrome). We report a case of a 58-year-old man presenting with an altered level of consciousness following a history of acute respiratory tract infection. He had also clinical and laboratory features of disseminated intravascular coagulation (DIC). Brain imaging was suggestive of hemorrhagic encephalitis involving both the fronto-temporo-parieto-occipital lobes involving the cortical, subcortical, and splenium of the corpus callosum and the posterior limb of the right internal capsule. Antibodies against Mycoplasma were strongly positive in serum. The patient was treated with fresh frozen plasma, broad-spectrum antibiotics, and methylprednisolone. However, the patient died after 17 days of hospitalization probably due to multiorgan failure and brain herniation.

Acute Ischemic Stroke With Central Retinal Artery Occlusion as a Rare Presentation of COVID-19 Disease.

In this report, we present a case where the patient developed a border-zone ischemic stroke with central retinal artery occlusion (RAO) following coronavirus disease 2019 (COVID-19) disease. The COVID-19 disease has been described to induce inflammatory changes that predispose to thrombotic disease in both venous and arterial circulation. Angiotensin-converting enzyme 2 (ACE2) receptor expression in the blood vessel with which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds is the cornerstone of inflammation although the pathogenesis of central RAO is multifactorial. The effects of COVID-19 inflammatory and pro-coagulant state on cerebral and retinal vascular systems are still inadequately understood. Combined presentation of central RAO with ischemic stroke has not been documented in the literature yet. As of now, no guidelines exist regarding treatment modalities to be employed in such instances. Hence, further research is warranted regarding the treatment of this condition with respect to the association with COVID-19.