Dhaka Central International Medical College & Hospital

The study was conducted to estimate the protective effectiveness (PE) of complete primary or booster dose regimens of COVID-19 vaccines deployed in Bangladesh. The study was conducted in four hospitals in Dhaka between December 30, 2021, and August 31, 2022 following a test-negative design. Patients aged ≥18 years attended with COVID-like symptoms were enrolled and tested for RT-PCR. Test-negative controls were matched to confirmed cases at a 1:1 ratio considering site, date, and age groups. Conditional logistic regression was used to estimate the PE considering the association between receipt of complete primary with or without a booster regimen and development of COVID-19 disease symptoms. Whole genome sequencing (WGS) was carried out to confirm the variants. RT-PCR positive 847 cases were matched to 847 controls. WGS of strains revealed 6% to be the Delta variant and 94% was Omicron variant. The PE conferred by receipt of complete primary regimen with or without booster dose of any vaccine revealed no significant protection (15%, 95% CI: -11 to 36, p = .23) against any COVID-19 disease or severe disease (14%, 95%CI: -23 to 39, p = .42). However, there was a protective association between receipt of complete primary regimen with or without booster dose of one mRNA vaccine (Pfizer-BioNTech) against any COVID-19 disease (88% (95% CI: 26 to 98, p = .023)) for the first 90 days. The analysis suggested little vaccine effectiveness during Omicron surge, with the possible exception of one mRNA-vaccine 90 days after dosing.

Neurosarcoidosis is a rare and often challenging condition that primarily affects the central nervous system, frequently leading to complex endocrine disorders. This case report presents an uncommon manifestation of neurosarcoidosis in a 30-year-old woman who developed panhypopituitarism, complicated by diabetes insipidus (DI) and subclinical multifocal pneumonitis. The patient had a 1-year history of low-grade intermittent fevers, cognitive decline, unintentional weight loss, and symptoms of DI, including excessive thirst and urination. MRI imaging revealed nodular leptomeningeal enhancement and thickening in the hypothalamic-pituitary region, which was consistent with neurosarcoidosis. A high-resolution chest CT scan revealed multifocal pneumonitis. The patient was diagnosed with panhypopituitarism secondary to neurosarcoidosis, along with DI and subclinical pneumonitis. This case emphasizes the importance of maintaining a high index of suspicion for neurosarcoidosis in patients with unexplained endocrine and neurological symptoms, especially when respiratory symptoms are subtle. Diagnosis was confirmed by clinical evaluation, imaging, and laboratory findings. Prompt diagnosis and multidisciplinary management, including hormone replacement and immunosuppressive therapy, were key in preventing further complications. Early recognition and treatment are crucial to managing neurosarcoidosis-induced panhypopituitarism and preventing permanent pituitary dysfunction. This case underscores the significance of a comprehensive diagnostic approach and increased clinical awareness in managing rare complications related to neurosarcoidosis.

When a deadly non-missile object like a teta gets impacted in the maxillofacial region, the management becomes challenging. This region has a complex anatomical structure with high vascularity and contains vital structures like the orbit and airway. To avoid ophthalmic or neurological abnormalities in addition to the risk of infection and bleeding, accurate clinical and radiological diagnosis and optimal surgical techniques with postoperative management are crucial. This paper emphasizes the significance of careful preoperative planning and a concerted effort of the multidisciplinary team in managing penetrating maxillofacial injuries. A 26-year-old man was admitted under the Department of Neurosurgery at Dhaka Medical College Hospital (DMCH) with a teta impacted in his face just below the right lower eyelid, which travelled through the area of the right maxillary sinus, passing the internal carotid artery (ICA) and rested in the middle part of clivus just before basilar artery. We successfully removed the teta without any vital structure injury or visual problem. Penetrating injury in the maxillofacial region with teta due to interpersonal violence is uncommon because of the presence of protecting reflexes, and there is a dearth of documentation in the literature. The presentation, diagnosis, risk evaluation, surgical management, and outcome made this case unique.