Comorbidities in Patients with Psoriasis

Psoriasis, a chronic inflammatory disease is associated with a long list of comorbidities. In our practice we like to draw attention in comorbidities of psoriatic arthritis and we are adapted with cardiovascular comorbidities. A great deal remains unknown about psoriasis associated comorbidities. An understanding of these comorbidity patterns can help us to ensure better care of patients with psoriasis. Objective of the study was to find out the comorbid conditions in the patients of psoriasis. This observational case control study was conducted 150 diagnosed cases of psoriasis and 150 age matched healthy control. Purposively 150 patients of psoriasis were selected from the Dermatology OPD of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to December 2018 as case. After a complete physical examination, a pre-designed structured questionnaire was fulfilled with patients and controls. To detect unknown comorbidities the following tests was done in both groups and compared: Blood sugar, urine routine and microscopic examination, serum creatinine, serum AST, ALT, GGT, and ALP levels measured by an enzymatic method, X-ray chest view, USG of whole abdomen/KUB. The diagnosed comorbidity was listed and referred for treatment accordingly. Charlson-age comorbidity index chart was used to estimate risk of mortality in two groups. The mean age of incident psoriasis was 38.64 years. Diabetes mellitus (4.67%), hypertension (4%), ischemic heart disease (IHD) (3.33%) were the top three comorbidities in patients with psoriasis. among them 11(7.33%) patients of psoriasis was with single comorbidity and 5(3.33%) of them was with multiple comorbidity. In control group 3(2%) participants was detected with comorbidity and that difference was significant statistically. In current study Charlson-Age Comorbidity index (CACI) was used as a tool to estimate the risk of mortality in two groups. The mean CACI score was 2.5 and 1 in two groups respectively and the difference was significant (p<0.05). The estimated risk of death (ERRD) score was calculated form CACI chart and the score was 2.78 and 1.47 in two groups respectively. There was no significant difference in two groups (p>0.05). The rate of occurrence of comorbidity was more in psoriasis group than in control. The listed comorbidity was in mild severity range but the risk of mortality was same in psoriasis group and control.

Binocular Visual Discomfort after First Eye Cataract Surgery: An Inattentive Burning Issue

Cataract surgery is the most frequent surgical procedure performed among the elderly. Aniseikonia and anisometropia increased after the first eye cataract surgery. The study was performed to evaluate unwanted visual status after first eye cataract surgery. It was an observational and cross-sectional study performed among the cataract surgery patients attending in out patient department (OPD) of Dr K Zaman BNSB Eye Hospital, Mymensingh from July 2018 to September 2018 for post-operative follow up. Five hundred patients were selected randomly. Patients with gross corneal diseases were excluded from the study. Three hundred forty one patients (68.2%) were with first eye cataract surgery, among them 319 patients (63.8%) had different degree of cataract in other eye. One hundred forty three patients (44.7%) had good presenting vision (≥6/18) in operated eye and much reduced vision in other eye due to cataract, experienced binocular visual discomfort when opened two eyes, which was not experienced by the patients who had reduced vision in both eyes or good vision in both eyes. Cataractous eye interfered with visual function of the pseudophakic eye. So, cataract Surgery for both eyes in separate events is the appropriate treatment for the patients with bilateral cataract to eliminate visual disability and to achieve comfortable visual outcome.

Management of Infective Corneal Ulcer: Epidemiology Needs To Be Evaluated As Priority Basis

Because of known and unknown etiology, management of ocular devastating situation like corneal ulcer is still a challenge for the Ophthalmologists. The cross sectional study was designed for detection of predisposing factor and identification of causal agent. To serve the above purpose, a cross sectional study was performed among 140 patients of the corneal ulcer at Dr K Zaman BNSB Eye Hospital, Mymensingh and Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh. Detail history of patient was taken and recorded in a pretest questionnaire sheet. Two pieces of sample were collected from each corneal ulcer patient. One sample was examined in KOH wet mount for fungus. Other sample was nourished into nutrient broth and for further culture and identification. Bacterial corneal ulcer was higher among the patient of age group ≥46 years (61.9%) followed by 31-45 years (21.5%). P value is 0.261. Males were found predominant (58.5%). P value is 0.13. Agricultural related work was identified as most risky occupation in 83.1% of the total bacteria positive samples. P value is 0.01. Trauma was noted as most predominant influencing factor (56.9%). P value is <0.05. Bacteria were identified in 65(46.4%) and fungus in 40(28.6%) samples. Pseudomonas species were predominant (52.3%) followed by Staphylococcus species (26, 2%) and Streptococcus species (21.5%). No mixed infection was identified. For easier and earlier diagnosis of corneal ulcer, information about epidemiology is very essential. History should be taken meticulously followed by the laboratory procedures.

Is malnutrition a risk factor of stroke?

Obesity is an established risk factor of stroke. Malnutrition in post-stroke period is common and can influence outcome. But malnutrition, though predicted, has not yet been established as a risk factor of stroke. This descriptive study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Department of Neurology, Dhaka Medical College (DMC), from January 2009 to December 2010 to explore whether malnutrition is an independent risk factor of stroke. Nutritional status of 100 stroke patients and 100 healthy controls were assessed in this study. Anthropometric measurements including Body Mass Index (BMI), Triceps skin fold (TSF), Mid-arm circumference (MAC) and Arm-muscle circumference (AMC) were measured within 7 days of stroke. Haemoglobin and haematocrit percentage, serum iron and serum albumin were measured at the same time. No significant difference was observed regarding TSF thickness, MAC, AMC, mean Hb and mean albumin level between the stroke patients and the control group, although iron level was significantly lower in stroke group. Multiple logistic regressions analysis showed that increase in age, smoking and decreased serum iron level has a positive association with stroke. Malnutrition is, according to this study, not a significant risk factor of stroke and triceps skin fold (TSF) thickness, mid-arm circumference (MAC), arm-muscle circumference (AMC), hemoglobin and serum albumin are not appropriate predictor of stroke.

Emotional and behavioral disorders in children with epilepsy

This cross sectional study was done to observe the prevalence of emotional and behavioral disorders in children with epilepsy, in the Department of Psychiatry, Pediatrics and Neurology, of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from July 2007 to June 2008. In this study, information about psychiatric disorders of 50 epileptic children, age ranging from 5-17 years with mean±SD (11.1±1.43) years, and 50 age, sex and socio-demographic status matched controls children (age ranging from 5-18 years with mean±SD (11.6±1.82) years were enrolled by parent, teacher and self version of Development And Well-Being Assessment (DAWBA) (Validated Bangla Version). Emotional disorders are more prevalent than behavioral disorders among epileptic children. Forty four percent (44%) of children with epilepsy had psychiatric disorder and this rate was significantly higher than that of healthy control (p>0.05). Disorders include major depressive disorder (20%), obsessive compulsive disorder (25%), other anxiety disorders (25%), specific phobia (15%), separation anxiety disorder (10%) and panic disorder with agoraphobia (5%).

Psychiatric and psychological comorbidities in patients with psoriasis- a review

Psoriasis is a common inflammatory skin disease. The impact of psoriasis on quality of life is significant even when it involves relatively limited body surface area (BSA). Life stresses have been found as both a cause of psoriasis and as an aggravating factor in the disease. In different large epidemiological studies up to 79% patients of psoriasis had a negative impact on their lives, and Psoriasis was reported to be associated stressful life event in 10-90%, depression in 24-51%, felt shame and embarrassment over their appearance in 89%, lack of confidence in 42%, family friction in 26%, wish to be dead to active suicidal ideation in 9.7-5.5%, addiction and alcoholism in 18% and also significant impact upon sexual function. Children with psoriasis had 25-47% higher risk of developing any psychiatric disorder, 23-62% higher risk of develop depression and 32-250% higher risk of anxiety.

Spectrum of skin lesions of post-kala-azar dermal leishmaniasis in kala-azar endemic areas of Bangladesh

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) and serves as a potential reservoir for Leishmania parasite. The study was aimed to evaluate the spectrum of skin lesions of PKDL in kala-azar endemic areas in Bangladesh. This cross sectional study was carried out to observe the characteristics of skin lesions among 250 PKDL cases. The suspected PKDL patients in highly endemic villages of Fulbaria Upazilla of Mymensingh district.were subjected to a dipstick test (rK39) for kala azar. The median time interval between diagnosing kala-azar and PKDL was 23 month (m-21, r- 0-60 months). The most common skin lesions were multiple symmetrical hypopigmented macules with irregular margins in 179(71.6%) cases followed by erythematous facial induration in 74(29.6%), papular in 33(13.2%), nodular in 28(11.2%) cases, combination of macules, papules, nodules and plaques in 88(35.2%) cases, annular in 7(2.8%) cases and Papillomatous mucosal growth in 2(0.8%) cases. Sites of involvement were mostly in face (92.4%), Trunk (84.8%), extremities (33.2%), oral mucosa and tongue (0.8%) and Genitalia (1.2%). Suspicion of PKDL on the basis of skin lesions will lead to early diagnosis and prompt treatment will impart an important role in prevention and eradication of Leishmaniasis in Bangladesh.

Epidemiology and outcome of non viral keratitis

This cross sectional study was done to evaluate the epidemiological pattern of fungal keratitis. It was done among 120 patients, selected randomly, at the cornea clinic, BNSB Eye Hospital, Mymensingh during the period of April 2008 to July 2008. In this study Chi-square test was done and males were predominant. Rural patients were mostly affected (93%). Study showed bacterial infection (41.66%) and fungal infection (39.16%). Among the fungus infected patient, 49% had history of trauma and 51% had no history of trauma (p>0.05), about 30% had vegetative injury and 19% had injury other than vegetative. Fungus was identified under microscope, 95% of which was confirmed by culture. Fifty five percent (55%) patients of bacterial infection and 31% patients of fungal infection attended with hypopyon (p<0.05). For fungal keratitis, trauma considered as the important predisposing factor. Immuno-compromised condition, ocular surface disease and climatic effects should also be kept in consideration. Microscopic investigation at the beginning of the treatment might help to achieve better outcome.

Cutaneous leishmaniasis

Leishmaniasis is an increasingly prevalent, major world health problem caused by infection with a protozoan which is transmitted by sand fly bites. It is endemic in 88 countries on 4 countries. More than 90% of visceral leishmaniasis cases occur in Bangladesh, Brazil, India and Sudan. Although Bangladesh is one of four countries those bearing the most burden of visceral leishmaniasis, cutaneous leishmaniasis is rare in Bangladesh. Cases of cutaneous leishmaniasis (CL) are usually imported to Bangladesh from other endemic countries. A patient from an endemic area of cutaneous leishmaniasis, a non-healing nodulo-ulcerative lesion with "volcanic crater" on exposed part of the body, constant dermal infiltration with lymphocytes, histiocytes and plasma cells and demonstration of intracellular parasites in lesional skin establish the diagnosis of cutaneous leishmaniasis. We here represent a case of cutaneous leishmaniasis in an overseas worker, returned from Saudi Arabia. He presented with multiple asymptomatic nodulo-ulcerative lesions on exposed part of the body. The patient's clinical history, morphology of lesions, laboratory analysis and histopathological examination of lesional skin were consistent with cutaneous leishmaniasis, a rare disease for Bangladesh. Cutaneous leishmaniasis may arise as a health problem among people returned from the Middle-East. Our findings of high titre (>1:64000) direct agglutination test (DAT) in cutaneous leishmaniasis may be an additional point of further study.

A study on radiographic repeat rate data of several hospitals in Jeddah

Radiographic repeat rate data in diagnostic radiology in King Fahad Hospital (KFH), King Abdulaziz Hospital (KAH), and Maternity and Children Hospital (MCH) in Jeddah, Saudi Arabia, have been studied. The study provided valuable information to suggest preventive measures to reduce repeats. The variables included in the study are exposure techniques, examination types, total number of films used, number of films repeated, the film sizes, gender, the age groups of the patients, and reason for repetition. The total number of examinations in all three hospitals is 6001 using 8887 films on 5412 patients. The average repeat rate was 7.93%, where the individual hospital repeat rates were 9.57% in the MCH, 7.84% in KAH, and 7.44% in KFH. The repeat rate for children and infants was found to be undesirable. The quality assurance (QA) programme can effectively reduce the unnecessary exposure and can identify the cause of the exposure. The overexposure, underexposure, and position fault were the foremost contributors for repeats and constitute 32.91%, 28.94%, and 22.98% of the total respectively. The QA study identified that human error and equipment malfunction are the major contributors to these causes of repeats. The highest repetition rate was for pelvis, 13.64%, followed by skull, 11.59%, and abdomen, 10.41%. It is estimated that the total area of wasted film in all three hospitals is 74.3 m2. As per the average repeat rate, the cost of repeat films in the entire kingdom per year has been projected to be about 1.82 million US dollars (SR 6.83 million) in the government hospitals only. Based on the findings of this study a set of recommendations have been prescribed for the radiology department to reduce the repeat rate and to improve the safety culture.