Dhaka Hospital Research Articles

Risk of Pre-Eclampsia in Women with Low Serum Ionized Magnesium

Background: There are many risk factors of development of preeclampsia among the pregnant women. Objective: The purpose of the present study has set out to assess the relationship between preeclampsia and blood ionized magnesium levels.
 Methodology: This case-control study was performed in the Department of Obstetrics and Gynaecology, Dhaka Medical College and Hospital from January 2020 to December 2021 for a period of 2(two) years. Pregnant patients who showed preeclampsia were all the amounts of ionized magnesium in venous blood collected from patients with preeclampsia. Additionally, the magnesium levels of age-matched, healthy pregnant women were determined.
 Results: A total number of 100 pregant women included in this study of which 50 pregnant women were designated as case and the rest 50 pregnant women were control. It has found that serum levels of ionized magnesium were significantly decreased among preeclamptic cases (0.58 ± 0.06) as compared to normal pregnancies (0.72 ± 0.05) (p < 0.001). Using a cut-off value of 0.7 mmol/l, the serum ionized magnesium level was divided into two groups and was compared between cases and controls. The risk of developing preeclampsia was more than 33 (95% CI = 10.9 – 102.1) times higher in pregnant women with serum magnesium level < 0.7 mmol/L than those pregnant women with serum magnesium level 0.7 or > 0.7 mmol/L.
 Conclusion: Low level of serum ionized magnesium is a risk factor of development of preeclampsia.

Breast Conserving Surgery (BCS) is Superior to Mastectomy in Early Stage Triple Negative Breast Cancer (TNBC) a Comparative Study

Background: Breast cancer is the most prevalent form of cancer in women worldwide and the second-leading cause of death from cancer in women. Because the estrogen receptor, progesterone receptor, and HER2 are not expressed, triple-negative breast cancer (TNBC) has an aggressive clinical history. The highest rates of recurrence and survival, higher average grades, and larger tumor sizes at diagnosis are all characteristics of TNBC. Objective: To compare between breast conserving surgery (BCS) and mastectomy patients with early stage Triple negative breast cancer (TNBC). Materials and Methods: We conducted a comparative retrospective monocentric study that evaluated TNBC patients treated with upfront surgery at CMH Dhaka, CMH Bogura and Kurmitola General Hospital, Dhaka. The observation period was from 1 January 2021 to 31 December 2022. All patients received biopsy to obtain the pathological tissue before treatment, and their immunohistochemical results met the diagnostic criteria for TNBC. Study patients divide din to two group 40 surgeries with primary site were categorized as receiving BCS and other hand 40 surgeries with categorized as receiving mastectomy. BCSS and OS were the primary outcomes of our study. Results: Tumor grade II, tumor size >20.0 mm and lymph node 2 were significantly associated with breast cancer-specific survival. Tumor size >20.0 mm and lymph node 2 were significantly associated with TNBC survival. Conclusion: TNBC is a breast cancer type that is aggressive and has a bad prognosis. With regard to breast cancer-specific survival, advanced age, being single, left side of laterality, tumor grades II and III, large tumor size, and lymph node 2 were all substantially related.

Old tools, new applications: Use of environmental bacteriophages for typhoid surveillance and evaluating vaccine impact.

Typhoid-conjugate vaccines (TCVs) provide an opportunity to reduce the burden of typhoid fever, caused by Salmonella Typhi, in endemic areas. As policymakers design vaccination strategies, accurate and high-resolution data on disease burden is crucial. However, traditional blood culture-based surveillance is resource-extensive, prohibiting its large-scale and sustainable implementation. Salmonella Typhi is a water-borne pathogen, and here, we tested the potential of Typhi-specific bacteriophage surveillance in surface water bodies as a low-cost tool to identify where Salmonella Typhi circulates in the environment. In 2021, water samples were collected and tested for the presence of Salmonella Typhi bacteriophages at two sites in Bangladesh: urban capital city, Dhaka, and a rural district, Mirzapur. Salmonella Typhi-specific bacteriophages were detected in 66 of 211 (31%) environmental samples in Dhaka, in comparison to 3 of 92 (3%) environmental samples from Mirzapur. In the same year, 4,620 blood cultures at the two largest pediatric hospitals of Dhaka yielded 215 (5%) culture-confirmed typhoid cases, and 3,788 blood cultures in the largest hospital of Mirzapur yielded 2 (0.05%) cases. 75% (52/69) of positive phage samples were collected from sewage. All isolated phages were tested against a panel of isolates from different Salmonella Typhi genotypes circulating in Bangladesh and were found to exhibit a diverse killing spectrum, indicating that diverse bacteriophages were isolated. These results suggest an association between the presence of Typhi-specific phages in the environment and the burden of typhoid fever, and the potential of utilizing environmental phage surveillance as a low-cost tool to assist policy decisions on typhoid control.

Comparison of Characteristics of Children with Severe Acute and Chronic Malnutrition Hospitalized with Diarrhea.

Children with malnutrition present with aberrant laboratory parameters. This study aimed to identify high-risk diarrheal children with varied nutritional status. The data were obtained from the electronic database of Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh from 2019 to 2021. Among 1,068 children under 5 years of age with diarrhea, 177 (14%) had severe acute malnutrition (SAM; weight-for-length/height Z score < -3), 239 children (17%) had severe stunting (SS; length/height-for-age Z score < -3), and 652 did not have malnutrition (weight-for-length/height and weight-for-age and length/height-for-age Z score > -2). We independently assessed the relationship of nutritional profiles with each clinical and laboratory parameter. After adjustment for age and sex in the multiple regression model, hyponatremia (adjusted odds ratio [aOR] = 2.37 [95% CI: 1.52-3.68]; P < 0.001) and dehydration (aOR = 2.42 [95% CI: 1.67-3.52]; P < 0.001) were independently associated with SAM compared with children without malnutrition. In comparison to non-malnutrition, SS was less likely to be associated with acute watery diarrhea (aOR = 0.66 [95% CI: 0.47-0.92]; P = 0.014) but was significantly associated with anemia (aOR = 2.18 [95% CI: 1.57-3.02]; P < 0.001) and thrombocytosis (aOR = 2.43 [95% CI: 1.78-3.32]; P < 0.001). The presence of hypernatremia was substantially lower in children with SAM (aOR = 0.38 [95% CI: 0.22-0.65]; P < 0.001) or SS (aOR = 0.56 [95% CI: 0.35-0.88]; P = 0.012) than in children without malnutrition. Severe stunting was less likely to be associated with dehydration (aOR = 0.44 [95% CI: 0.29-0.67]; P < 0.001) in contrast to SAM. Therefore, children hospitalized with diarrhea may have different clinical and laboratory manifestations depending on their nutritional status and may require differential treatment.

Bacteriological Study and Antibacterial Susceptibility in Ludwig’s Angina in a Tertiary Level Hospital in Dhaka, Bangladesh

Background: The knowledge of the local pattern of infection and antibacterial sensitivity in Ludwig’s angina is essential to enable efficacious treatment for it. Objective: To find out the pattern of bacteria responsible for developing Ludwig’s angina and their antibacterial susceptibility. Methods: It is a prospective, observational type of study carried out in the Department of Otolaryngology &amp; Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka, and the Department of Clinical Microbiology, ICDDR, B, Dhaka, Bangladesh, between April and September of 2016. A total of 100 patients were included in this study. Results: This study was done among 100 patients. In this study, 42 cases (42%) were in the 31-45 years age group. The male patients were 60 (60%) and females were 40 (40%). Majority of patients 70(70%) came from poor class family with educational level up to HSC (75%), maximum 35(35%) patients use meswak to clean teeth, 70 (70%) patients came from rural area, 70 (70%) patients had dental infection, 25 (25%) patients had diabetes mellitus, all the cases (100%) presented with swelling in the floor of the mouth and neck, pain and tenderness and fever. The major complication was necrotizing fasciitis 8 (8%), 36 (36%) patients were discharged within 1-2 weeks after treatment, Streptococcus 40 (40%) was the most common organism and the most effective antibiotic was Ceftriaxone (65%). Conclusion: The most frequently isolated organism in Ludwig’s angina is Streptococcus and sensitivity results showed a majority of isolates are susceptible to Ceftriaxone. Mugda Med Coll J. 2023; 6(2): 71-76

Implementation of bubble continuous positive airway pressure for children with severe pneumonia and hypoxemia in intensive care unit of Dhaka Hospital, Bangladesh-Effect on pneumonia mortality.

After the completion of a randomized trial at Dhaka Hospital in 2013, bubble continuous positive airway pressure (BCPAP) oxygen therapy was incorporated as the part of the standard treatment for children with severe pneumonia with hypoxemia in an intensive care unit at Dhaka Hospital in August 2013 instead of World Health Organization (WHO) standard low flow oxygen therapy. To understand the long-term effectiveness of the introduction of bCPAP oxygen therapy by comparing pneumonia mortality in the post-trial period (August 2013 to December 2017) with the pre-trial (February 2009 to July 2011) and trial periods (August 2011 to July 2013). It was a retrospective analysis of prospectively collected hospital data of all admissions. Mortality rates of all children with WHO-defined pneumonia, and the subset of children with severe pneumonia and hypoxemia (oxygen saturation <90%) were evaluated. The analysis covered 10,107 children with pneumonia: 2523 in the pre-trial (414 with severe pneumonia and hypoxemia; none of them received bCPAP), 2959 during the trial (376 with severe pneumonia and hypoxemia; 79 received bCPAP), and 4625 in the post-trial period (1208 with severe pneumonia and hypoxemia; 1125 had bCPAP). The risk of death from pneumonia in the post-trial period was lower than in pre-trial (adjusted risk ratio [RR] = 0.73, 95% confidence interval [CI] = 0.58-0.92; p = 0.007), among children with severe pneumonia and hypoxemia, the risk of death was lower in the post-trial period than in the pre-trial (adjusted RR = 0.46, 95% CI = 0.37-0.58, p < 0.001), and the trial period (adjusted RR = 0.70, 95% CI = 0.51-0.95; p = 0.023). After the introduction of bCPAP oxygen therapy as part of the routine management of severe pneumonia and hypoxemia in the ICU of the Dhaka hospital, we observed significantly lower mortality, even after accounting for measurable confounding.

First Ever Organ Transplantation from A Brain-Dead Person in Bangladesh: A Successful Outcome of The Human Organ Transplantation Act

On the 19th of January 2023, a historic event took place in the field of medical practice and country’s healthcare system. A 20-year-old girl named Sarah Islam was pronounced clinically dead on Wednesday (18 January, 2023) while being treated at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, with her terminal illness as she has been suffering from tuberous sclerosis since her childhood. Her final act was termed 'heroic' by her attending physicians as she became the first patient in the country to donate her organs while being brain-dead. The next day in the early morning (19 January, 2023) doctors conducted the country's first-ever cadaveric kidney transplantation as taken from her. The recipients were two females in their 30s who were reportedly recovering well after the surgery. Those two surgeries were performed separately at Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital and the National Kidney Foundation Hospital in Dhaka. The Human Organ Transplantation Act (HOTA) officially came into force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors; after long discussion, some amendments were ratified by the Parliament in 2018. The Act places some legal requirements around the collection and preservation of human organs as well as ensuring their transplantation into a human body. Few years back, religious leaders came forward to issue a fatwa (religious approval) that recognize both living and brain death criteria and permit both living and brain-dead donors to donate organs for transplantation. Based on that fatwa and a long medical discussion the country’s parliament passed this Act. Enacting the HOTA shows an immense influence in our society on cadaveric organ donation and transplantation especially from brain-dead individuals, and we hope that this historic donation will create more awareness and pave a new path for organ donation campaign in the country in near future. CBMJ 2024 January: vol. 13 no. 01 P: 102-106

Premalignant and Malignant Esophageal Lesions in Bangladeshi Patients-A Study in a Tertiary Care Hospital

Background: In Bangladesh esophageal carcinoma is the leading malignant condition. Mortality rate of esophageal cancer is very high. Like other malignancies, early detection offers the best prognosis for esophageal carcinoma. Regular endoscopic and histologic surveillance have become standard procedure for follow up of patients with premalignant lesions. Objectives: The aim of this study was to evaluate the frequency and pattern of esophageal lesions with respect to age and sex groups and to determine the trends of histology, site distribution and risk factors of it. Methods: This study was a cross sectional study, carried out at the department of Pathology in Dhaka Medical College and Hospital from March 2018 to February 2020. Total 54 cases of esophageal biopsy were included in this study. All obtained samples were selected for routine histopathological study. Results: Most of the patients were male and mean age was 55.04 (±15.48) years. Squamous cell carcinoma was the most common malignancy seen in (26 cases) 48.15 % of patients and Barrett’s esophagus was common (13 cases, 24.07%) premalignant lesion. Maximum malignant and premalignant lesions (40 cases, 74.07%) were located in lower thoracic region of esophagus including gastro esophageal junction. Dysphagia was the main presenting complain in 96.3% of patients and 55.6% of patients were smoker. Conclusion: Barrett’s esophagus was the common premalignant lesion and squamous cell carcinoma was the commonest esophageal carcinoma followed by adenocarcinoma. Central Medical College Journal Vol 7 No 1 January 2023 Page: 20-25

Evaluation of serum interleukin-12 and interleukin-4 as potential biomarkers for the diagnosis of major depressive disorder

Recently, scientists have focused on pro-inflammatory cytokines and immunological dysregulation in major depressive disorder (MDD). Some research suggests pro-inflammatory cytokines' role in MDD development, whereas anti-inflammatory studies are sparse. There is no systematic investigation of Bangladeshi MDD patients' pro- and anti-inflammatory cytokines. This study examines the blood levels of IL-12 and IL-4 in Bangladeshi patients and healthy controls (HCs) to determine the diagnostic accuracy of these cytokines to identify MDD patients from those without MDD. A total of 110 people with MDD from the department of psychiatry of a teaching hospital in Dhaka and 107 HCs from Dhaka participated in this case–control study. Depression and illness severity were gauged using DSM-5 criteria and Ham-D scores. Commercially marketed ELISA kits were used in accordance with manufacturer guidelines to measure the levels of IL-12 and IL-4 in peripheral blood, allowing a comparison of the patient and control groups. In comparison to HCs, MDD patients (5333.00 ± 307.40 pg/ml) showed noticeably higher levels of IL-12 than in HCs (2331.00 ± 207.40 pg/ml). The increased levels were positively correlated with Ham-D scores (male: r = 0.351, p < 0.050; female: r = 0.389, p < 0.050), suggesting a possible relationship to disease progression. Additionally, compared to HCs (272.81 ± 23.94 pg/ml), MDD patients had significantly higher peripheral blood levels of IL-4 (876.35 ± 66.73 pg/ml) (p < 0.001). Also, there was a positive correlation between IL-4 serum levels and Ham-D scores (male: r = 0.361, p < 0.050; female: r = 0.398, p < 0.050). Therefore, we observed increased levels of these serum cytokines and their association with the severity of depression. The results of this study demonstrate the possibility of IL-12 and IL-4 blood levels as distinct markers capable of differentiating between MDD patients and HCs, possibly acting as markers of MDD susceptibility. To ascertain the diagnostic effectiveness of these two cytokines, more research is necessary.

In-house environmental factors and childhood acute respiratory infections in under-five children: a hospital-based matched case-control study in Bangladesh

BackgroundAcute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under five globally, particularly in regions like South Asia and sub-Saharan Africa. Bangladesh has made substantial progress in reducing child mortality, yet pneumonia remains a significant contributor to under-five deaths. This study aimed to investigate the association between in-house environmental factors and childhood ARI, considering factors such as household crowding, smoking, and sanitation facilities.MethodsThis case-control study was conducted at a tertiary-level children’s hospital in Dhaka, Bangladesh, from March to September 2019. The study included children aged 6–59 months. Cases were children with ARI symptoms, while controls were children without such symptoms. Rigorous matching by age and gender was employed to ensure comparability. Data were collected through structured questionnaires, and bivariate and conditional logistic regression analyses were performed.ResultsSeveral household environmental factors were significantly associated with childhood ARIs. Children from overcrowded households (AOR = 2.66, 95% CI = 1.52–4.71; p < 0.001), those using unclean cooking fuels (OR = 2.41, 95% CI: 1.56, 3.73; p = < 0.001), those exposed to in-house smoking (AOR = 1.74, 95% CI = 1.01, 3.05; p = 0.04) and those with unimproved sanitation facilities faced higher odds (AOR = 4.35, 95% CI = 2.14–9.26) of ARIs. Additionally, preterm birth and higher birth order were associated with an increased risk of ARI. In contrast, exclusive breastfeeding was a protective factor.ConclusionIn-house environmental factors, including sanitation, crowding and in-house smoking, significantly influence childhood ARIs. Additionally, birth order and preterm birth play a crucial role. Promoting exclusive breastfeeding is associated with a lower ARI risk among under-five children in Bangladesh. These findings can guide interventions to reduce ARIs in low-income regions, particularly in South Asia.

Bacterial Isolation from Wound Swab and Pus with their Antibiotic Susceptibility Pattern in a Tertiary Care Hospital of Bangladesh

Background: Wound infection is a global health problem, plays an important role in development of chronicity, delaying wound healing associated with long hospital stay. Objective: This study was aimed to identify the bacterial pathogens present in infected wounds and characterize their resistance profile to the most common antibiotics used in the therapy. Methods: This observational study was conducted from January, 2023 to June, 2023 in a tertiary care hospital in Dhaka, Bangladesh. A total of 220 wound swabs and pus samples were collected from the outpatient and inpatient department of this hospital with skin and soft tissue infection. Samples were inoculated on appropriate media and cultured and the isolates were identified by standard procedure as needed. Antimicrobial susceptibility testing was done by disc diffusion method according to ‘The Clinical Laboratory Standard Institute Guidelines’. Results: Out of 220 cases 165(75%) were Male and 55(25%) were female. Majority of the patients 77(35%) were in the age group of 21-31 years. Of the total 220 isolates, 156(70.91%) were culture positive cases. Among the isolated organisms, predominant bacteria was Pseudomonas spp 76(48.22%) followed by Klebsiella 27(17.31%), Escherichia coli 19(12.18%), Proteus 13(8.33%), Staphylococcus aureus 12(7.69%) and Acinetobacter 9(5.77%). Among the gram negative isolates, Pseudomonas was highly sensitive to colistin(88.15%), followed by piperacillin-Tazobactam(77.63%)and Imipenem(50%) and low sensitivity found in ceftriaxone(14.47%), Amoxiclav(13.16) and Clotrimoxazole (13.16%). Klebsiella found sensitive to colistin (90.47%), Piperacillin-Tazobactam (85.71%), Imipenem (76.19%), Gentamycin (71.43%). Escherichia coli shows low sensitivity to almost all the drug except Imipenem (94.74%), Piperacillin-Tazobactam (84.21%) and colistin(84.21%). Stapylococcus aureus show sensitivity to linezolid (100%), vancomycin (91.67%) and Ciprofloxacin (61.67%). Conclusion: Antibiotic sensitivity pattern of various isolates will guide for appropriate selection of the antibiotic against wound infection and reduce the spread of resistance bacteria. Bangladesh Heart Journal 2024; 39(1): 38-43

A case of unusual hemorrhage as a complication of dengue fever in a tertiary hospital in Dhaka

Common bleeding complications of dengue hemorrhagic fever are epistaxis, gum bleeding, gastrointestinal bleeding, menorrhagia, hematuria.1 Major hemorrhage like intracranial hemorrhage have been documented but rare. We present here a case of a 24 year old man with complaints of high grade intermittent fever for 5 days, upper abdominal discomfort for 3 days and swelling of right upper limb for same duration. Laboratory investigations revealed a positive dengue serology, thrombocytopenia and elevated transaminases. USG of the hand revealed a hematoma involving the right upper arm. The patient was managed conservatively with elevation and immobilization of the upper limb and recovered gradually. J MEDICINE 2024; 25: 100-101

Exploring sex difference in the risk factors and prognosis of inoperable lung cancer

BackgroundLung cancer remains a leading cause of cancer-related deaths globally, with increasing incidence among females. Sex differences in lung cancer risk and outcomes are influenced by various factors, including biological characteristics. In Bangladesh, where lung cancer mortality rates are high, patients often present at advanced stages. However, real-time data on sex-specific survival outcomes for inoperable lung cancer in Bangladesh is lacking. MethodsThis retrospective study analyzed patients with inoperable lung cancer at the National Institute of Cancer Research and Hospital in Dhaka, Bangladesh, from 2018 to 2019. Patient demographics and clinical parameters were assessed, with survival tracked until June 2020. Statistical analyses included descriptive statistics, Chi-square tests, t-tests, Kaplan-Meier curves, and multivariable Cox regression models. ResultsFemales were diagnosed at a younger age (55.3 ± 12.7 vs 60.5 ± 10.2 years, p < 0.001) and had higher comorbidity rates (36.2 %, p = 0.004). Males had higher smoking rates, while females used more smokeless tobacco. Adenocarcinoma was more prevalent in females (47.2 %) and squamous cell carcinoma in males (42.7 %). After adjusting for various factors, females showed a significant survival advantage (median 16 vs 12 months), particularly in adenocarcinoma (HR: 0.64, 95 %CI:0.46–0.90, p = 0.01) and squamous cell carcinoma (HR: 0.52, 95 %CI:0.32–0.85, p = 0.009). Females also demonstrated better survival when receiving supportive care, chemotherapy, or radiotherapy alone but not in combined therapy. Older males (>70), illiterate, smokers, and those with comorbidities had a poor prognosis compared to females. ConclusionThis study reveals significant sex-based differences in inoperable lung cancer patients in Bangladesh. Despite earlier diagnosis and higher comorbidities, females demonstrated better survival rates, particularly in adenocarcinoma and squamous cell carcinoma. These findings highlight the need for sex-specific approaches in lung cancer management to improve patient outcomes.

Informal Caregiver’s Burden of Stroke Patients at Tertiary Care Hospitals in Dhaka

Informal Caregiver’s Burden of Stroke Patients at Tertiary Care Hospitals in Dhaka

Pattern of Presentation of Retinal Vein Occlusion in a Referral Eye Hospital in Dhaka, Bangladesh

Abstract Background: Retinal vein occlusion (RVO) is an important cause of loss of vision of vascular origin, second only to diabetes retinopathy. Aim: This study aims to determine the pattern of presentation of RVO in a tertiary ophthalmic hospital. Study Design: The study design involves a hospital-based retrospective observational study. Materials and Methods: This study was carried out at the Retina Eye Hospital in Dhaka, Bangladesh, from June 2017 to December 2017. Details of bio-data, ophthalmic and systemic history, and ophthalmic findings were collected from the case files of 89 patients and analyzed. Results: The results revealed that findings from 89 eyes of 89 patients were analyzed comprising 52 females and 37 males giving a female-to-male ratio of 1.4:1 with a mean age of 52.83 years (SD ± 10.444) and with a range of 31–77 years. Conclusion: The study revealed that all the patients presented with sudden visual deterioration, with a mean duration of presenting complaints of 6.134 weeks, and a range of 0.3–24 weeks. Branch RVO was the predominant type (69.7%). Hypermetropia was the most common refractive error (40.4%), and hypertension was the most prevalent risk factor for patients with RVO (60.7%).

Analysis of the current Bacteriological Profile and Antibiotic Susceptibility Patterns of Organisms Isolated from Aural Swabs in a Tertiary Care Hospital in Dhaka, Bangladesh

Analysis of the current Bacteriological Profile and Antibiotic Susceptibility Patterns of Organisms Isolated from Aural Swabs in a Tertiary Care Hospital in Dhaka, Bangladesh

Frequency of Viral Hepatitis among Symptomatic Patients Attending in a Tertiary Care Hospital in Dhaka

Frequency of Viral Hepatitis among Symptomatic Patients Attending in a Tertiary Care Hospital in Dhaka

Retrospective Study of Bacterial Profile in Wound Swab and Their Susceptibility Pattern in A Tertiary Care Hospital in Dhaka, Bangladesh

Retrospective Study of Bacterial Profile in Wound Swab and Their Susceptibility Pattern in A Tertiary Care Hospital in Dhaka, Bangladesh

Retrospective Bacterial Profile in Pus Sample and their Susceptibility Pattern in a Tertiary Care Hospital in Dhaka, Bangladesh.

Retrospective Bacterial Profile in Pus Sample and their Susceptibility Pattern in a Tertiary Care Hospital in Dhaka, Bangladesh.

Association of Interleukin-6 and Interleukin-10 Levels with Severity of Systemic Lupus Erythematosus Patients Attending in a Tertiary Care Hospital in Dhaka, Bangladesh

Association of Interleukin-6 and Interleukin-10 Levels with Severity of Systemic Lupus Erythematosus Patients Attending in a Tertiary Care Hospital in Dhaka, Bangladesh