Biological therapy increases the risk of fungal infections in chronic inflammatory rheumatism patients. Objectives: To determine the incidence of fungal infections in spondyloarthritis patients on biotherapy in the Moroccan registry (RBSMR) during 3-year follow-up and to identify associated factors. Methods: Patients' socio-demographic, clinical and para-clinical data were collected. The type of biotherapy used and episodes of fungal infections were determinated. Also, the frequency of corticosteroids and NSAIDs use, disease activity, and various comorbidities before and at the time of fungal infection during the 3 years of follow-up were defined. Regarding fungal infection, the germ and location were specified. Results: Seven spondyloarthritis patients out of 194 had a fungal infection (with 8 episodes). Mean age was 44±17 years, with mean disease duration of 11 years. All these patients had comorbidities before and during the fungal infection. At the time of this, all patients were on TNF alpha inhibitors, specifically, one patient was on Adalimumab but later switched to Etanercept, five were on Etanercept, and one was on Infliximab. No case of systemic fungal infection was noted. In the 8 fungal infection episodes, there were 7 cases of appendages’ involvement and 1 case of vaginal candidiasis. Conclusion: The incidence of fungal infections in patients with spondyloarthritis remains low and seems to be related to disease activity and type of biologics.

Background: Despite different strategy to retard the progression of CKD, majority still progress to ESRD. Other than conventional risk factors inflammation is considered as one of the reversible factors responsible for CKD progression which can be intervened. Therefore, we have studied the level of inflammatory marker CRP and IL-6 at stages 3-5 of CKD patients and their association with CKD stage progression determined by eGFR. Methods: We have conducted a cross sectional study among 150 CKD patients and 32 healthy controls at OPD of Nephrology department of National Institute of Kidney Diseases and Urology, Dhaka from January`2016 to December`2016. Purposive sampling method was the tool for case selection and CKD was defined as eGFR <60ml/min/1.73m2. AKI, history of dialysis, kidney transplant, patients having acute infection, malignancy or liver disease, received chemotherapy or immunotherapy (<6 months) and patients with connective tissue disease were the exclusion criteria. Fasting blood glucose, Hb%, serum Ca++, serum PO4, serum total cholesterol and serum triglyceride level were measured for both case and controls. eGFR has been calculated using MDRD equation. For the cases CRP had been measured on two occasions at an interval of one and half month. Those cases who had raised CRP level in both occasions were selected for measurement of IL-6 from second sample. CRP had been measured by turbidimetry method using fully automated chemistry analyzer. IL-6 had been measured using enzyme linked immunosorbent assay (ELISA) based on the Biotin double antibody sandwich technology. Scatter diagram and multiple regression models were used to examine the association between CRP and IL-6 with stage 3-5 of CKD denoted by eGFR. Results: The mean of CRP were 9.5±2.7 mg/L in CKD patients vs. 2.9±0.5 mg/L in controls without CKD and the mean of IL-6 were 29.5±13.0 pg/ml in CKD patients vs. 3.3±0.3 pg/ml in controls without CKD. Both were elevated and significant statistically (p=.001). Scatter diagram showing correlation coefficient (r value) -0.592 and -0.615 for eGFR vs. CRP and eGFR vs. IL-6 respectively which indicate both are negatively correlated with eGFR. But IL-6 had a more strong negative correlation. Multiple regression analysis shows regression co efficient (B) for CRP and IL-6 is -1.251 and -2.826 respectively after taking into account other factors which can alter eGFR level (age, Hb%, serum Calcium, S. Total Cholesterol, S.PO4, S. Triglyceride) that indicates in the prediction of eGFR, IL-6 had significant negative association than CRP after adjusting the conventional factors responsible for CKD progression. Conclusion: Our data suggest that though CRP and IL-6 both are significantly raised in advanced CKD stage 3-5, IL-6 is more rapidly increasing and more strongly associated than CRP with the severity of CKD measured by eGFR.

Breast cancer has become the leading cause of cancer-related death among women, partly due to therapeutic resistance and treatment-related complications. Chemotherapy and hormone therapy play a crucial role in managing breast cancer patients, providing essential treatment for both disease control and overall survival. However, as new therapeutic approaches are introduced and life expectancy continues to increase, the use of these treatments has been associated with persistent adverse effects, including dyslipidemia. This article presents the case of a breast cancer patient treated with chemotherapy and tamoxifen-based hormone therapy who developed severe mixed dyslipidemia. It also reviews lipid metabolism alterations observed in breast cancer patients, emphasizing the importance of monitoring lipid levels in these patients, particularly those undergoing hormone therapy or chemotherapy, to prevent cardiovascular complications.

Background: Excessive and uncontrolled internet use can significantly impair daily functioning in various life domains. Despite the numerous benefits of the internet, its addictive use is a growing concern, particularly among youth, who are prone to anxiety, depression, and stress-related disorders. Understanding the current scenario is essential for devising effective interventions, yet no scientific data is available in Bangladesh. Objective: To assess between depression, anxiety, and stress among youth with problematic internet use (PIU) attending a tertiary care hospital. Methods: This cross-sectional and descriptive study was conducted at the Department of Psychiatry, Department of Bangabandhu Sheikh Mujib Medical University, from October 2020 to September 2022. Participants were interviewed using a structured socio-demographic questionnaire, the Bangla versions of the Internet Addiction Test (IAT), and the Depression Anxiety and Stress Scale-21 (DASS-21-BV). Data were analyzed using SPSS 26.0, with significance set at p<0.05. Results: Among the 90 participants (mean age: 21.33 years; 68% male, 32% female), 95% were students, and 87% were from nuclear families. Internet use exceeded one year for 83% of participants. PIU levels were minimal in 15%, moderate in 62%, and excessive in 22%. Severe depression was observed in 15% of participants, severe anxiety in 25%, and severe stress in 25%. Extremely severe levels of depression, anxiety, and stress were found in 14%, 5%, and 14% of participants, respectively. Significant risk factors for PIU included male gender (χ²=8.217; p=0.02) and over three hours of daily internet use (χ²=35.289; p=0.001). PIU was significantly associated with depression (χ²=20.380; p=0.001), anxiety (χ²=16.159; p=0.019), and stress (χ²=14.734; p=0.019). Conclusion: Depression, anxiety, and stress are significantly associated with PIU. Early risk assessment, proper internet use, and initial screening are essential for managing potential mental disorders linked to PIU.

Background: Prurigo Nodularis (PN) presents as a challenging chronic dermatological condition characterized by intensely pruritic nodules on the skin, leading to significant morbidity. Despite its prevalence and impact on patients' quality of life, treatment options remain limited, necessitating evidence-based approaches to address this complex condition effectively. Objective: This study aims to provide an updated overview of evidence-based management strategies for PN, highlighting recent advancements in treatment modalities. Method: A systematic review of clinical studies on PN treatment was conducted by searching the PubMed and Scopus databases from January 1, 2001, to December 1, 2023. A total of 706 unique studies published in English were identified and screened for inclusion criteria. Only primary clinical studies investigating treatment strategies in PN patients were included, while case reports and series with fewer than five patients were excluded. Relevant publications were further supplemented by searching bibliographies for additional studies meeting the inclusion criteria. Results: The review identified significant advancements in evidence-based management strategies for PN, driven by a growing body of clinical research and therapeutic innovation. Pharmacological interventions targeting pruritus, inflammation, and lesion resolution have shown efficacy, including topical agents such as corticosteroids, emollients, Vitamin D3 analogues, tacrolimus creams, and systemic therapies like antihistamines, gabapentinoids, immunosuppressant and anti-inflammatory agents, JAK inhibitors, retinoids, and sometimes selective serotonin reuptake inhibitors (SSRIs). Additionally, emerging biological agents and non-pharmacological approaches, such as multidisciplinary interventions, have demonstrated promise in improving patient outcomes. Conclusion: Evidence-based management of PN represents a dynamic field with evolving treatment modalities. While challenges persist, including limited efficacy and safety concerns of certain treatments, recent developments in targeted therapies, systemic immunomodulators, and novel pharmacological approaches offer hope for improved patient care. Further research into genetic underpinnings and personalized therapies is warranted to address the heterogeneous nature of PN and enhance treatment efficacy and safety.

Objective: To identify the significant level of Case fatality of Covid-19 Patients with Ischemic Heart Disease in selected hospitals in Dhaka city. Method: This cross sectional study was carried out at NICVD/ Lab aid cardiac hospital/ Universal cardiac hospital from January 2023 to February 2023. Where a total of 384 adults (>18 ages) with Ischemic Heart Disease who admitted in hospital and tested positive for Covid- 19 were included as a sample population. After collecting data from sample population, data was checked and re-checked for completeness and correctness. The Collected data was analyze via statistical Software’s like STATA, SPSS etc. Results: during the study, majority were belonging to 51-60 years age group, 32.81%. followed by 27.60% were belong to 41-50 years age group and 23.18% belong to >61 years age group and majority were male, 80%.42.71% had normal weight whereas 28.13% were overweight & 24.74% were obese. 80.47% had chest pain, followed by 13.28% had dyspnea, 12.50% had cough, 10.68% had palpitation, 4.17% had vomiting. where 46.61% had STEMI, followed by 17.19% had NSTEMI, 19.27% had unstable angina, 25.78% had systemic hypertension, 21.88% had diabetes mellites, 6.77% had Heart valve disease, 4.43% had Arrhythmia. Plus, majority didn’t get their vaccination, 89.60%.49.48% had abnormal level of anxiety status whereas 55.73% had abnormal level of depression. Multivariable logistic regression found residence, age, profession, and income to be statistically significantly associated with anxiety after controlling for the other factors found to be significant at the univariate level. Plus, Chronic disease, STEMI, NSTEMI to be statistically significantly associated with anxiety after controlling for the other factors found to be significant at the univariate level. Cardiovascular Drug Therapy at Hospitalization of Covid-19 shows Medical therapy included ACE inhibitors (22.1% of the patients), ARBs (20.57%). mean length of hospital stay was 10.7±2.7 days, with an overall in-hospital mortality of 5.8% (515 of 8910 patients) in this population of patients with completed outcomes. Conclusion: Our findings indicate that health care providers, particularly cardiologists and nurses, should take extra care to detect and evaluate all heart disease patients for level of anxiety and depression in a clinical setting. There is a need to develop a quick screening approach in hospitals dealing with cardiovascular inpatients to identify those needing extra evaluation and care.

Background: The nasal cavity is the upper part of the respiratory tract which communicates with the external environment through the anterior apertures. It also communicates with the nares, and the nasopharynx via the posterior apertures. The nasal cavity is divided into two by a septum, each cavity consisting of a roof, floor, medial wall, and lateral wall. The nasal cavity is formed laterally by the inferior, middle and superior nasal conchae (turbinates). Aim: The aim of the study was to investigate the dimensions of the inferior turbinate as seen in selected Nigeria subjects and develop novel anatomical parameters and indices with potential clinical implications. Methods: This retrospective study was done in the Radiology department of the Rivers State University Teaching Hospital following ethical approval, 339 CT films of adults (males and females) were analysed in this study. Sex and side differences were analysed using t-test, while relationship between anatomical structures were analysed using the Chi square test. The confidence interval was set at 95% and p < 0.05 was considered significant. The volume of the inferior turbinate and nasal cavity were measure and the inferior turbinate/nasal cavity ratio was calculated. Results: The mean volume of the inferior turbinate for males was 2.01±0.12, female was 2.22±0.14 and for the entire population it was 2.12±0.13. The mean volume of the nasal cavity for male and female were 15.98±0.40 cm3 and 14.73±0.34 cm3, respectively, whereas the average for the population was 15.35±0.37 cm3. Conclusion: To the best of our knowledge, this is the first research that used well defined anatomical landmarks in estimating the volume of the nasal cavity and inferior turbinate. This study also provided a clinically objective tool in assessing the degree of nasal cavity obstruction by providing a grading system for the inferior turbinate/nasal cavity. This tool will particularly be very useful in resource poor settings like ours where nasal endoscopy and rhinometry may not be readily available and affordable. Therefore radiologist can use this grading system to grade the degree of inferior turbinate hypertrophy and predict the degree of nasal obstruction and severity of symptoms.

Introduction: SARS Cov2 infection still represents a real threat whose clinical severity results from an inadequate immuno-inflammatory reaction. The objective of our study was to determine the prognostic interest of the value of CRP and the rate of lymphocytes in the management of patients contaminated by SARS-Cov2. Material And Methods: This is a prospective, descriptive and analytical study of interest to patients with severe COVID-19, admitted to medical intensive care at the Oued Eddahab military hospital, for a period of one year. The biological parameters were analyzed on admission and during the stay in intensive care. The ROC curve was used to determine the sensitivity and specificity of CRP and lymphocytes as well as their optimal predictive threshold values. Results: 32 patients were included in our study. The average age of admissions was 65 years ± 12.38 with a sex ratio of 5.4 in favor of men. The optimal predictive threshold for the severity found was 147mg/l for CRP with a sensitization of 95% and a specificity of 83.3%, and 807/mm3 for lymphocytes with a sensitivity of 91.7% and a specificity of 95%. The odds ratio (OR) found for CRP and lymphocytes was > 1. Conclusion: The CRP and the level of lymphocytes at the threshold defined above are risk factors for the severity of Sars-Cov2 infection.

Background: Hypothyroidism in patients with metabolic syndrome is associated with worse outcomes. However, this has not yet been adequately investigated in Bangladeshi people. Objective: To find out the proportion and covariates of hypothyroidism among patients with metabolic syndrome. Materials and methods: A hospital-based cross-sectional study was conducted with 323 patients from the Endocrinology and Allied Medicine Department at BIRDEM General Hospital. Patients with metabolic syndrome but no prior diagnosis of hypothyroidism were included. Detailed history, physical examinations, and thyroid function tests—Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), and Anti-Thyroid Peroxidase Antibody (Anti-TPO Ab)—were performed. Subclinical hypothyroidism was defined as TSH >4.12 mIU/L and <10 mIU/L, while overt hypothyroidism was defined as TSH >10 mIU/L. Statistical analyses, including Chi-square tests, ANOVA, Pearson's correlation, and multiple linear regression, were conducted to explore associations between components of metabolic syndrome and thyroid dysfunction. Results: Out of the 323 participants, 62.8% were euthyroid, 28.5% had subclinical hypothyroidism, and 8.7% had overt hypothyroidism. Autoimmune hypothyroidism was confirmed in 31.6% of hypothyroid patients through elevated Anti-TPO Ab levels, a statistically significant finding. Hypothyroidism was significantly more prevalent in females and obese individuals. Significant positive correlations were observed between TSH and waist circumference (r=0.153), systolic blood pressure (r=0.271), and triglycerides (r=0.128), while FT4 showed negative correlations. Multiple linear regression indicated significant associations between waist circumference, fasting plasma glucose, and thyroid dysfunction. Conclusion: It was concluded that a higher proportion of metabolic syndrome cases were suffering from hypothyroidism. This necessitates that all MetS patients be screened for thyroid profile and autoimmune status and managed accordingly.

In GH deficiency, rhGH is deemed appropriate when epiphyses are open, while Turner's syndrome poses unique considerations due to associated malformations like cardiac aortic bicuspidity and aortic coarctation. Renal malformations, including Horseshoe kidney and hydronephrosis, further highlight the complexity of Turner's syndrome, requiring a comprehensive, multidisciplinary approach to care. We report the case about of an elderly child 3 years and 5 months old patient with cardiac and renal malformations notably a tight postductal isthmic coarctation and a left pyeloureteral junction syndrome with dilatation of the pyelocalic cavities, admitted for further management of a staturo-ponderal delay. She presented with functional signs of constipation, no chills, no digestive disorders and no hypoglycemic malaise. On physical examination, dysmorphic features included low hairline and short neck, pterygium coli, low ear implant, hypertelorism, nipple spread, keloid lesion on face. Test results showed a 45x karyotype in favour of Turner syndrome, HBA1c: 5.6%, the rest of the tests were normal. GH was indicated in the patient after cardiac surgery for coarctation of the aorta and pyelo-caliceal junction. The patient was referred for heart and kidney surgery. It is crucial to closely monitor height velocity during catch-up growth, particularly in patients with concurrent conditions leading to short stature. Additionally, there is an emphasis on educating parents about the potential impact of Turner syndrome on aspects such as growth, growth hormone (GH) substitution, ovarian failure, malformations, and related health risks.

Exophthalmos is typically associated with Graves’ ophthalmopathy. Although originally described by Harvey Cushing, exophthalmos is an underappreciated sign of Cushing’s syndrome. We present a case of a patient aged 40 years with no pathological history presenting with generalized asthenia associated with weight loss of 15kg for 2 months, epigastralgia and incoercible vomiting. Clinical examination revealed a normotensive, normocardiac patient with pain on epigastric palpation, bilateral exophthalmos, and an unremarkable cervical examination No cushingoid syndrome especially no facial erythrosis, no purple stretch marks, no buffalo hump, no amyotrophy of the lower limbs. An abdominal CT scan performed before the abdominal pain revealed an adrenal incidentaloma, a right adrenal nodule, well limited, of low density, homogeneous, very discreetly and homogeneously enhanced after injection of contrast medium, whose hemodynamic behavior was in favor of a benign adenoma. The patient underwent surgery for right adrenalectomy, with morphological and immunohistochemical findings in favour of adrenocortical carcinoma, with clinical and biological improvement. We discuss the possible mechanisms causing exophthalmos in patients with either endogenous or exogenous hypercortisolemia.

We report a case of Clostridium limosum lung abscess in a 71-year-old male heart transplant recipient. The patient presented with a week-long history of productive cough and confusion. His medical history included nonischemic dilated cardiomyopathy, chronic renal disease, and past Klebsiella pneumoniae bacteremia, among others. Imaging revealed a thick-walled cavitary lesion in the right lung, initially suspected to be a pulmonary abscess. Lung biopsy culture confirmed the presence of Clostridium limosum, a rare pathogen in humans, typically associated with farm animals. Following six weeks of Piperacillin/Tazobactam treatment, the patient showed significant clinical improvement. This case emphasizes the importance of considering zoonotic pathogens in immunosuppressed patients, especially those with occupational exposure.