Clinico-epidemiological Features Research Articles

#1731 Clinico-epidemiological characteristics of early versus late onset cytomegalovirus disease among renal transplant recipients: two decade experience

Abstract Background and Aims The epidemiology of the Cytomegalo virus (CMV) disease among renal transplant recipients has changed with the advent of effective antiviral prophylaxis usually occurs in the later part of the post transplant period. To study the difference between CMV infections occurring in early versus late post renal transplant period with respect to nature of immunosuppressive medications (induction agents, maintenance agents and heightening of immunosuppression), type of CMV infection and occurrence of biopsy proven rejection post CMV infection. Method A single centre retrospective observational study was conducted among renal transplant recipients who underwent kidney transplant between 1st January, 2002 and 31st December, 2021. CMV disease was classified as early or late depending on detection before or after 90 days post transplant. The differences in clinical presentation between early and late onset CMV disease, use of immunosuppression, and the impact on graft outcomes were studied. Results Total number of recipients with CMV disease was 156 (7.2%) out of total 2164 renal transplant recipients. Twenty-five (16%) patients had early CMV while one hundred and thirty one (84%) had late CMV. The two groups did not differ with respect to induction or use of maintenance immunosuppressive agents. Proportion of CMV syndrome was more among early CMV group (56.0% vs 26.7%, p = 0.01) while tissue invasive disease was more frequent among late CMV group (44.0% vs. 73.3%, p = 0.01). Diarrhoea was more frequent in late (63.4%) versus early CMV (36%) (p = 0.01). Graft loss occurred in 4.0% of early and 25.2% of late CMV cases (p = 0.03). However, both groups did not differ with respect to occurrence of biopsy proven rejection post infection. Conclusion Early CMV presents more frequently as CMV syndrome while late CMV usually manifests as tissue invasive disease. Graft loss is more common in patients with late onset disease.

Host-related low-prevalence gastritides: Epidemiological and clinical characterization

IntroductionA recent consensus meeting (RE.GA.IN) addressed “host-related, low-prevalence gastritis”: eosinophilic (EoG), lymphocytic (Hp-pos_LyG and Hp-neg_LyG), collagenous (CollG), and granulomatous gastritis (GrG). Our study evaluates their clinico-epidemiological characteristics. Materials and MethodsWe extracted all patients with a diagnosis of EoG, LyG, CollG, and GrG from a clinicopathological database and compared their demographics, clinical and endoscopic characteristics, associated conditions, and clinical awareness to those of all other subjects in the database (controls). ResultsThere were 1,781,005 unique patients (median age 57 years; 55.7 % female). Hispanics were overrepresented amongst those with Hp-pos_LyG. Subjects with GrG had a high prevalence of erosions and ulcers. Clinical awareness of these conditions was dismal (<1:10,000 patients). Some clinical manifestations were more common in patients with certain gastritides (e.g., vomiting and diarrhea in CollG; anemia in LyG), but none were sufficiently distinctive to suggest a clinical diagnosis. EoG was associated with EoE; LyG had a strong association with celiac disease; CollG with microscopic colitis; and GrG with Crohn disease. ConclusionsThe diagnosis of these gastritides (between <1: in 1,000 and 1 in 5000 subjects) rests on histopathology. They remain poorly characterized and clinically neglected. Yet, their associations may herald other conditions: eosinophilic gastrointestinal diseases (EGID), celiac, and Crohn disease. Patients might benefit from increased detection and characterization.

Clinicoepidemiologic Characteristics and Prevalence of Venous Insufficiency in Patients with Pigmented Purpuric Dermatosis

Clinicoepidemiologic Characteristics and Prevalence of Venous Insufficiency in Patients with Pigmented Purpuric Dermatosis

Clinico-epidemiological characteristics, management, and outcomes of atrioventricular blocks in hyperthyroidism, A systematic review

Clinico-epidemiological characteristics, management, and outcomes of atrioventricular blocks in hyperthyroidism, A systematic review

Clinico-epidemiological characteristics of early- versus late-onset cytomegalovirus disease among renal transplant recipients: A two-decade experience

BackgroundReactivation of cytomegalovirus (CMV) infection in transplant patients is high because of immunosuppression. We have evaluated the clinical and epidemiological characteristics of early versus late onset of CMV infection among renal transplant recipients. MethodsA single center retrospective observational study was conducted among renal transplant recipients who underwent kidney transplant between January 2002 and December 2021. CMV disease was classified as early or late depending on its detection prior to or after 90 days post-transplantation. Herein, we reported the differences between early and late onset of CMV disease with respect to clinical symptoms, the use of immunosuppression and the impact on graft outcomes. ResultsOut of total 2164 renal transplant recipients, 156 patients (7.2%) were diagnosed with CMV disease. Among these 156 patients, 25 patients (16%) had early CMV while 131 patients (84%) had late CMV. Overall, the two groups did not differ with respect to the induction or maintenance of immunosuppressive agents. However, the proportion of CMV syndrome was greater among early (56.0%) than late (26.7%) CMV groups (p = 0.01). In contrast, tissue invasive disease was more frequent among late (73.3%) in comparison to early (44.0%) CMV groups (p = 0.01). Among clinical symptoms, diarrhea was more frequent in late (63.4%) vs. early (36%) CMV-affected patients (p = 0.01). Graft loss occurred in 4.0% of early CMV group vs. 25.2% of late CMV group (p = 0.03). Neither of the clinical groups differed with respect to occurrence of biopsy-proven allograft rejection post-infection. ConclusionsEarly CMV disease presents more frequently as CMV syndrome while late CMV disease usually manifests itself as tissue invasive disease. Graft loss is more common in patients with late onset of CMV disease.

Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India

Background: Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. Methods: This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000–2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. Results: A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. Conclusion: In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.

High prevalence of MAFLD in general population: A large cross-sectional study calls for concerted public health action.

Metabolic associated fatty liver disease (MAFLD) is a relatively new term with limited studies done in South Asian population. To determine prevalence and clinico-epidemiological characteristics of MAFLD in general population. A cross-sectional study was conducted in randomly selected regions across Delhi, India. Data were collected on socio-demographic particulars, health status and lifestyle factors. Anthropometric measurements, transient elastography, and laboratory investigations were carried out. Altogether 6146 participants (mean age: 43.1 ± 13.9 years, 48.1% males) were included. The prevalence of MAFLD was 56.4% (n = 3468), of which lean MAFLD constituted 11.3%. Higher age (OR: 2.47; 95% CI: 2.21-2.76), low education level (OR: 1.23; 95% CI: 1.09-1.39), upper socio-economic class (OR: 1.32; 95% CI: 1.17-1.49), and low physical activity (OR: 1.15; 95% CI: 1.03-1.28) were more common in MAFLD. The association of female sex with MAFLD differed in age groups <40 years (OR: 0.64 and 95% CI: 0.55-0.75) and >40 years (OR: 1.40 and 95% CI: 1.22-1.62) in both magnitude and direction (p < 0.001). Liver fibrosis was present in 23% of the study population (32.2% among MAFLD group). Advanced liver fibrosis was three times more common in MAFLD group (6.2% vs 1.8%, p < 0.001). Obesity and fibrosis had a statistically significant relationship and 75.8% of the individuals with advanced stages of fibrosis had obesity. Nearly half of study population was found to have MAFLD. Advanced hepatic fibrosis was three times more common in these subjects. Aggressive public health measures are urgently required to raise awareness and introduce interventional strategies.

Lichen planus and its clinical variants: a retrospective study in a tertiary care centre

Background: Lichen planus is a chronic pruritic immune-mediated disorder involving skin, oral and genital mucosa, nail and hair with several morphological variants. Although not lethal, the chronic nature of the disease have significant impact on patient’s quality of life and their psychological wellbeing. Aim was to find out clinico-epidemiological profile of LP and its variants including Dermoscopic features and its association with systemic diseases like Diabetes, Hypertension and Hypothyroidism. Methods: This is a hospital based retrospective observational study. Medical records of all patients with LP during the period from January to December 2022 were noted. Various clinico-epidemiological and dermoscopic features along with systemic disease association were analysed. Results: A total of 257 cases were reported. Most common age group affected was 41-60 yrs. Male:female ratio was 0.72:1 with female preponderance. LP in children (&lt;18 yrs) was seen in 9.7% of cases. Classical LP was the most common type (29.5%) followed by Mucosal LP (12.45%). More than one variant was seen in 20.6% of cases. LP in association with systemic diseases was seen in 36.1% of cases with DM being the most frequent. Most common dermoscopic features were pigmentation (100%) followed by Wickham’s striae (83.6%) and vascular findings (49.4%). Conclusions: LP is a common papulosquamous disorder affecting middle aged adults with slight female preponderance. Childhood LP contributed to significant number of cases. Classical LP was the commonest clinical variant observed. LP is associated with DM, HTN and hypothyroidism. Dermoscopy is an useful tool in diagnosis and differentiating from other similar conditions.

Clinico-epidemiological Characteristics and Risk Factors Associated with Multidrug- resistant Bacterial Ear Infections at a Tertiary Care Centre in Northern India: A Retrospective Analytical Study

Introduction: A total of 360 million people worldwide have been reported to suffer from hearing loss. The most common cause of ear infection is otitis media, which can be attributed to bacterial pathogens such as Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae. Aim: To identify the incidence and risk factors associated with multidrug-resistant bacteria causing ear infections at a tertiary care centre in India. Materials and Methods: A retrospective analytical study was conducted in the Bacteriology section of the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from January 2021 to January 2023, and analysed in February 2023. A total of 83 ear discharge samples sent to the laboratory were included in the duration of the study and all clinical and laboratory data were extracted from the hospital information system and the laboratory register, respectively. All pathogens were identified using routine biochemicals and Matrix-assisted Laser Desorption/ Ionisation- Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay, and their antibiotic susceptibility testing was performed using the Kirby Bauer Disc Diffusion method. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 20.0 (SPSS Inc.). The Chi-square test was used for all categorical variables, and the comparison of two means was performed using GraphPad Prism version 9.5.1 (GraphPad Software Inc.), with p-value&lt;0.05 considered statistically significant. Results: The mean age of the participants in the present study was 35.39±20.93 years and majority, 56 (67.47%) participants were males. Among total 83 samples, 69 (83.13%) patients with suppurative bacterial ear infections. Postoperative conditions in 40 (48.19%) samples and respiratory allergies in 36 (43.37%) samples were the most common risk factors associated with ear infections. Postoperative conditions (p-value=0.005) and Diabetes Mellitus (DM) (p-value=0.026) were statistically significant risk factors for developing ear infections. Pseudomonas aeruginosa was recognised as the most common pathogen in 22 acute cases and 10 chronic cases of otitis media. For all the antimicrobial agents tested, the highest resistance was observed towards fluoroquinolones in 51/67 (76.11%) samples, followed by extended-spectrum beta- lactams in 43/67 (64.18%) samples. Conclusion: The current study describes the incidence and risk factors associated with multidrug-resistant ear infections, the spectrum of pathogenic microbial isolates and their drug susceptibility, aiming to prevent morbidity and complications leading to the loss of auditory function.

Household Transmission of SARS-CoV-2 in the Third Wave of the Pandemic with Special Reference to Clinico-epidemiological Characteristics.

Coronavirus disease 2019 (COVID-19) pandemic began in India in 2020. Despite successful vaccination, cases again started increasing from mid-December 2021. Therefore, this study was undertaken to find out the clinico-epidemiological characteristics and effectiveness of vaccination in the household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in and around Pune. All samples received from December 15, 2021, till February 15, 2022, were included in the study. Samples received in viral transport medium (VTM) were extracted by the MagMAX RNA Extraction Kit, and reverse transcriptase-polymerase chain reaction (RT-PCR) was performed by the CoviPath Kit as per kit guidelines. Values of nucleocapsid (N) gene and open reading frame (ORF) less than 37 were considered positive. Clinico-epidemiological data were analyzed from the sample referral form (SRF). A total of 712 of 1032 household contacts of 271 families were positive. When geographical areas were compared, it was found that rural areas were affected more (63.76%) as compared to urban areas (36.24%). Males were more affected than females. The most commonly affected age group was 41-50 years (26.54%). Small families were found to have more household transmission. Mild symptoms were present in 97.89%. Among 271 infected individuals, seven were admitted to hospital, of which one patient died due to pneumonia. Two doses of vaccination were completed in 93.95%, and 3.79% had taken booster dose. Data from this study showed that a high rate of transmission was observed in household contact despite two doses of vaccination. However, these vaccinated individuals had mild symptoms, maybe due to the effect of vaccination and infecting variant omicron.

The spectrum of parasitic infections with emphasis on the clinico-epidemiological characteristics and risk factors among immunocompromised and immunocompetent patients at a university hospital in Northern India.

Intestinal parasitic infections pose a substantial threat to public health and are a huge burden to the economic development of a developing country. We aimed to identify the spectrum of intestinal parasitic infections with an emphasis on demographic and clinical characteristics observed among immunocompromised and immunocompetent patients. This observational study was performed in the Parasitology section of the Department of Microbiology from January 2022 to July 2022. A total of 2628 stool samples were obtained from patients presenting with chief complaints of abdominal pain, distension, vomiting, and foul-smelling feces. All the clinical and diagnostic data of the patients enrolled in the above-mentioned period were extracted from the ward files, hospital electronic records, and laboratory registers. A total of 2628 stool samples were sent to the Parasitology section of the Department of Microbiology. Out of the above-mentioned samples, 70 (70/2628, 2.66%) samples yielded gastrointestinal parasites on microscopic examination. The mean age of the patients included in our cohort study was 32.53 ± 16.21 years with a male predominance of 72.86% (51/70, 72.86%). The most common gastrointestinal parasite identified from stool samples was Giardia lamblia (61/70, 87.14%). All cases of opportunistic gastrointestinal infection caused by Cryptosporidium spp. (4/70, 5.71%) in our study cohort were found to infest the immunocompromised patients. This study determines the spectrum of intestinal parasitic infections among the immunocompromised and immunocompetent individuals and guides physicians in starting appropriate anti-parasitic treatment along with the instillation of strict hand hygiene techniques.

Clinico-epidemiological characteristics of patients with Leprosy in a reference center

Introducción: La lepra o enfermedad de Hansen es una enfermedad infectocontagiosa, crónica, causada por el bacilo Mycobacterium leprae. Es causante de neuropatía periférica, y afecta a la piel, nervios periféricos, vías aéreas superiores y ojos. El objetivo fue evaluar las características clínicas y sociodemográficas a los pacientes con Lepra que acudieron Hospital Menonita Km 81 de Itacurubi de la Cordillera en los años 2018-2022. Material y Método: Estudio observacional descriptivo. retrospectivo, de corte transversal en pacientes con Lepra del Hospital Menonita Km 81 en la ciudad de Itacurubi de la Cordillera del Departamento de Cordillera del año 2018 al 2022. Los datos se obtuvieron de la revisión de las fichas epidemiológicas de pacientes con diagnóstico de lepra en el período abarcado en un periodo de 5 años, 2018 al 2022. Resultados: Fueron reportados 286 casos de lepra en pacientes provenientes de los 18 departamentos del Paraguay. El año con más casos detectados fue el 2019 con 79 casos, siendo el departamento de Alto Paraná con mayor incidencia con 17 casos diagnosticados, seguido del año 2018 con 76 casos. La ocupación más frecuente de los pacientes fue la agricultura. El sexo más frecuente fue el masculino 203 (71%) casos con lepra. El rango de edad de mayor frecuencia fue entre 49- 63 años de edad (29,56%). El motivo de consulta más frecuente fue el de Mácula en 139 (49%). Conclusión: Se requiere aumentar la calidad de la atención primaria y el compromiso del personal de salud para el control y el diagnóstico oportuno de la Lepra en nuestro país.

Viral-induced asthma exacerbations

The COVID-19 pandemic has once again brought to the attention of researchers and medical practitioners the issue of viral infections in the management of chronic respiratory diseases, especially bronchial asthma. Viral infections, especially rhinovirus, are an important risk factor for asthma exacerbations. Asthma exacerbations are a major cause of asthma morbidity and mortality, leading to a progressive decline in lung function in some patients. The increased risk of exacerbation is a consequence of either a deficient antiviral response of the asthmatic patient, or the ability of some viruses to increase the Th2 inflammatory response, specific to the asthma phenotype. Understanding the pathophysiological mechanisms and clinico-epidemiological features of each viral infection may be crucial in developing a targeted therapy for the most common viral pathogens to effectively prevent asthmatic exacerbations.

Mpox and Chickenpox Coinfection: Case Series From Southern Nigeria.

We describe clinicoepidemiologic characteristics of mpox-chickenpox coinfection in Nigeria. A retrospective cohort analysis was performed of confirmed mpox cases in Nigeria from January 2022 to March 2023. Mpox and chickenpox were confirmed by real-time polymerase chain reaction (RT-PCR). Of 94 (60.0%) suspected cases, 56 had confirmed mpox, of whom 16 (28.6%) had chickenpox coinfection. The median age of confirmed mpox cases was 29 years (interquartile range, 20-37 years), 24 were men (60.7%), 6 (10.7%) were bisexual, and 5 (8.9%) died. Mpox-chickenpox-coinfected patients had more complications than mpox-monoinfected cases (56.3% vs 22.5%, P = .015). The high frequency of mpox-chickenpox coinfection argues for accelerated access to mpox and chickenpox vaccines in Africa.

Epidemiology and Etiology of Community-Acquired CNS Infections in Iran: A Narrative Review

CNS infections are associated with significant morbidity and mortality. The epidemiology of CNS infections shows striking differences in geographic regions. We reviewed the literature on clinico-epidemiological features of community-acquired CNS infections in Iran. Our review highlighted that the causes of CNS infections in Iran are diverse but information regarding the epidemiology and precise estimates of the burden of disease are lacking for most neuroinfections. Enteroviruses, S. pneumoniae, and Klebsiella species are the most commonly reported causes of viral, bacterial, and neonatal meningitis, respectively, whereas neurotuberculosis and neurobrucellosis place a huge burden. Improving the national surveillance system and implementing a nationwide data registry system for CNS infections are necessary to provide practically useful information regarding the microbial spectrum and the burden of CNS infections to suggest optimal preventive, diagnostic, and therapeutic strategies.

Malignant Transformation of Long-Standing Ileal Crohn's Disease Likely Favors Signet Ring Cell Adenocarcinoma Histology.

Signet ring cell adenocarcinomas (SRCCs) are a rare and aggressive histological subtype of adenocarcinomas typically with poor prognosis usually secondary to late stage at detection. In the small bowel, they constitute only 1% of all malignancies. In the last decade, there have been multiple case reports and small case series that have identified SRCCs, typically in the ileum, in patients with Crohn's disease. Crohn's disease is a transmural inflammatory condition that normally manifests in the distal ileum and colon, and is known to temporally increase the risk of malignancy. Given the profound rarity of SRCCs, establishing an association between Crohn's disease and SRCC is challenging. In this study, we performed a systematic review of case reports and small case series describing small bowel SRCCs in Crohn's disease patients. Most cases were found in the distal/terminal ileum, at a mean age of 59 years old. Virtually all tumors were locally advanced (pathological T stage 3 and 4), typically with at least N1 nodal disease. Two case studies (one is a case-control study and the other a cohort design) demonstrated that small bowel SRCC, as opposed to conventional adenocarcinoma, was significantly correlated to a history of Crohn's disease (35% vs. 0%, 73.5% vs. 28.5%), with a propensity to arise in the ileum (95% vs. 30%, 66.7% vs. 42.1%), and at earlier mean age (43 vs. 68 years, 53.7 vs. 61.7 years). We additionally used the Surveillance, Epidemiology, and End Results (SEER) database for insights into the clinicoepidemiological characteristics of ileum SRCCs. SRCCs composed 28.1% of all ileal SRCCs, compared to 11.0% for the adenocarcinomas, with a younger age at diagnosis (60.7 vs. 64.6 years), more distant disease at presentation (41.3% vs. 26.4%), and shorter overall median survival time (20 vs. 39 months). In summary, while there is limited direct evidence to support an association between small bowel SRCC and Crohn's disease, the phenomenon has been increasingly documented in the literature in the last decade. Clinicians treating Crohn's disease patients should consider this in their differential diagnosis, particularly when managing disease complications, as early detection and surgical intervention offer the best prognosis.

Clinico-epidemiological characteristics of the biliary samples and their antibiotic susceptibility pattern at a teaching hospital in Northern India.

Bile is deemed a sterile fluid, with the presence of clinical conditions like cholelithiasis, cholecystitis, previous biliary interventions, biliary strictures, and so on, leading to bile stasis, and increases the chances of bacteriobilia. In this study, we recognize the bacterial spectrum of microorganisms isolated from bile samples, diagnostic parameters, and antibiotic sensitivity patterns. A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2021 to 2022 to evaluate biliary infections in patients who underwent surgical procedures related to the biliary tract and associated organs. A total of 234 patients' bile samples were included in our study. The mean age of patients was 48.04 ± 14.74 years, with more patients below the age of 65 years among those with infected bile samples. One hundred and sixty-three (163/234, 69.66%) patients infected by 209 pathogenic microorganisms were recognized. The most common microorganism isolated was Escherichia coli (83/209, 39.71%), followed by Pseudomonas aeruginosa (37/209, 17.7%). Acinetobacter baumannii and Klebsiella pneumoniae isolate owed to more than 90% penicillin, extended-spectrum beta-lactamase, carbapenem, and fluoroquinolone resistance among all isolates. Length of hospital stay, malignant obstruction, and chronic kidney disease were identified as statistically significant risk factors that lead to the isolation of multi-drug-resistant isolates from bile culture. We recognized the spectrum of pathogens causing biliary tract infections at our center along with the antibiotic resistance pattern to guide and facilitate prompt and appropriate treatment by primary health care professionals and family medicine practitioners.

Severe neurocysticercosis in a quaternary hospital from Mozambique: Case series analysis

BackgroundNeurocysticercosis (NCC) is severe and leading global cause of morbidity and mortality. The disease presents with a variety of clinical presentations from focal to diffuse neurological symptoms. Despite being an endemic country, there are no studies describing the clinico-epidemiological characteristics of NCC in Mozambique. Herein, we describe a consecutive cases series of NCC from the national reference Hospital in Maputo, capital of Mozambique. MethodsConsecutive cases of NCC diagnosed during a 3-year period (January/2020–December/2022) were retrieved from the institutional clinical files and imaging database. ResultsSix cases of NCC were identified, with mean age of 43.1 years (range 26–66). Four were males (66.6 %). The median time from the beginning of clinical manifestations to the diagnosis was 6 months (range 3–18 months). All patients presented with severe parenchymal NCC, with seizures (n = 5, 83 %) being the most common manifestation. Other clinical manifestations were dementia (n = 1) and hydrocephalus (n = 1). The imaging showed multiple lesions at different stages, with half (n = 3) of them showing the coexistence of nodular calcified lesions at earlier stages (vesicular, colloidal and granular stages). Patients were treated with anthelminthic drugs, corticosteroids and anticonvulsants and no deaths to report. The 3rd month modified Rankin scale was ≤ 2 in 83 % of patients. ConclusionIn our case series, patients with NCC presented very late, with severe advanced stage disease, with multiple coexistent short and long-term brain lesions. These findings can be explained eventually because of the Maputo Central Hospital being national referral center receiving commonly more severe cases. Studies aiming to clarify the diagnosis pathways/barriers and NCC awareness among medical doctors working at primary and secondary health care level is mandatory to assess the real burden of NCC and implement timely diagnosis and care of patients affected by this neglected disease.

A paradigm shift in non-viral liver cirrhosis: a multicenter study on clinicoepidemiological characteristics and outcome of non-B non-C cirrhosis

BackgroundChronic hepatitis C (HCV) and B viruses (HBV) represent the commonest global causes of liver cirrhosis. Other etiologies of non-viral cirrhosis such as autoimmune, metabolic, vascular, or biliary diseases are underestimated. The study aimed to identify causes, clinicoepidemiological characteristics, and outcome of non-B non-C liver cirrhosis. This Egyptian multicenter study recruited patients with liver cirrhosis excluding HCV and HBV. Clinical evaluation and the mortality were recorded. Laboratory, radiological, and histopathological assessment to diagnose the etiology was performed.ResultsOne hundred eighty-eight patients were included: 54.3% were males. Autoimmune hepatitis (AIH) was the most common cause of cirrhosis (28.2%), followed by Budd-Chiari syndrome (BCS) in 25%, and cryptogenic in 23.9%. Metabolic causes such as Wilson’s disease, non-alcoholic steatohepatitis (NASH), and hemochromatosis were reported in 7.4%, 3.2%, and 1.1%, respectively. Biliary and cardiac cirrhosis were less frequent. Older age was prevalent in hemochromatosis (67.5 ± 17.7 years) and NASH (60.7 ± 11), while young age in Wilson’s disease (29.5 ± 14.8) and secondary biliary cirrhosis (14.8 ± 4.8). Rural residence was common (60.6%). Mortality was reported in BCS (40.4%), cryptogenic (28.9%), cardiac (25%), Wilson’s disease (21.4%), AIH (17%), and NASH (16.7%). Hepatocellular carcinoma complicated 10.6% of cases. A significantly high percentage of patients had decompensated cirrhosis. Child–Pugh class and rural residence were significant predictors of mortality.ConclusionThis first report on non-B non-C cirrhosis in Egypt revealed a high prevalence of AIH, BCS, and cryptogenic cirrhosis. Advanced Child class and rural residence were the predictors of mortality.

Clinico-epidemiological characteristics of patients with vitiligo in Bangladesh

Clinico-epidemiological characteristics of patients with vitiligo in Bangladesh