Background Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors. Methods This cross-sectional survey was conducted in Dhaka Medical College from March 01-May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies. Findings The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period. Conclusions Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks.

Background Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. Objective To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. Design, setting, and participants This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. Results The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. Conclusions The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion.

Background Post-coronavirus disease (COVID-19) syndrome includes persistence of symptoms beyond viral clearance and fresh development of symptoms or exaggeration of chronic diseases within a month after initial clinical and virological cure of the disease with a viral etiology. We aimed to determine the incidence, association, and risk factors associated with development of the post-COVID-19 syndrome. Methods We conducted a prospective cohort study at Dhaka Medical College Hospital between June 01, 2020 and August 10, 2020. All the enrolled patients were followed up for a month after clinical improvement, which was defined according the World Health Organization and Bangladesh guidelines as normal body temperature for successive 3 days, significant improvement in respiratory symptoms (respiratory rate <25/breath/minute with no dyspnea), and oxygen saturation >93% without assisted oxygen inhalation. Findings Among the 400 recruited patients, 355 patients were analyzed. In total, 46% patients developed post-COVID-19 symptoms, with post-viral fatigue being the most prevalent symptom in 70% cases. The post-COVID-19 syndrome was associated with female gender (relative risk [RR]: 1.2, 95% confidence interval [CI]: 1.02-1.48, p = 0.03), those who required a prolonged time for clinical improvement (p<0.001), and those showing COVID-19 positivity after 14 days (RR: 1.09, 95% CI: 1.00-1.19, p<0.001) of initial positivity. Patients with severe COVID-19 at presentation developed post-COVID-19 syndrome (p = 0.02). Patients with fever (RR: 1.5, 95% CI: 1.05-2.27, p = 0.03), cough (RR: 1.36, 95% CI: 1.02-1.81, p = 0.04), respiratory distress (RR: 1.3, 95% CI: 1.4-1.56, p = 0.001), and lethargy (RR: 1.2, 95% CI: 1.06-1.35, p = 0.003) as the presenting features were associated with the development of the more susceptible to develop post COVID-19 syndrome than the others. Logistic regression analysis revealed female sex, respiratory distress, lethargy, and long duration of the disease as risk factors. Conclusion Female sex, respiratory distress, lethargy, and long disease duration are critical risk factors for the development of post-COVID-19 syndrome.

HaNDL syndrome (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) is a rare headache disorder previously known as Migraine with cerebrospinal fluid pleocytosis. The disease is characterized by one or more episodes of headache and transient neurological deficits associated with cerebrospinal fluid lymphocytosis. It is a benign disorder and a stroke mimicker. We describe a case of 50 years old lady presented with acute onset headache, right hemi sensory tingling and bilateral papilloedema. Her blood test, MRI of brain and MRV was normal. CSF study revealed lymphocytic pleocytosis. The patient was discharged with full recovery. HaNDL syndrome is a diagnosis of exclusion. High degree of suspicion and characteristic clinical and laboratory findings are important to recognize. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 89-91

Background: Post COVID syndrome is defined in this articles as: 1. Persistence of the symptoms beyond the virologic clearance. 2. New development of symptoms or exaggeration of chronic diseases within 1 month after initial clinical and virologic cure, the etiology of which postulated to be viral. The study aims to find the incidence, association, and the risk factors for the development of the syndrome. Methods: This Prospective Cohort study was conducted in Dhaka Medical college Hospital, from 01, June 2020 to 10, August 2020.  Consecutive patients were enrolled and followed up for at least 1 month after recovery. Findings: Among 400 recruited patients 355 patients were analyzed. Mean (SD) age was 39•9(13•4) years, with male dominance (1•4:1). Total 162 (46%) patients developed post COVID symptoms. Among them post viral fatigue117 (70%) was most prevalent. Post COVID features are significantly higher among the female [RR, 95% CI, p 1•2, (1•02-1•48), 0•03], those who suffered for longer period (p= 0•00) and those who had prolonged positivity [RR, 95% CI, p; 1•09, (1•00-1•19), 0•00] for Covid 19. Severity of the COVID had also positive association (p value=0•02). Those who have Fever [RR, 95% CI,  p; 1•5, (1•05-2•27), 0•03], Cough [RR, 95% CI, p; 1•36, (1•02-1•81),, 0•04] respiratory distress [RR, 95% CI, p; 1•3, (1•4-1•56),0•001], and lethargy [RR, 95% CI, p ;1•2, (1•06-1•35),0•003] as the presenting features were more susceptible. Logistic regression established female gender, respiratory distress, lethargy and long duration of the disease as risk factors. Interpretations: Female gender, patient presenting with respiratory distress, lethargy and who suffered for long duration are the risk factors. Funding: Received no funds from any source. Declaration of Interests: The authors declare that there is no conflict of interests regarding the publication of this paper. Ethics Approval Statement: Ethical approval was obtained from institutional ethical committee.

Objective We evaluated whether ivermectin combined with doxycycline reduced the clinical recovery time in adults with COVID-19 infection. Methods This was a randomized, blinded, placebo-controlled trial in patients with mild-to-moderate COVID-19 symptoms randomly assigned to treatment (n = 200) and placebo (n = 200) groups. The primary outcome was duration from treatment to clinical recovery. Secondary outcomes were disease progression and persistent COVID-19 positivity by RT-PCR. Results Among 556 screened patients, 400 were enrolled and 363 completed follow-up. The mean patient age was 40 years, and 59% were men. The median recovery time was 7 (4–10, treatment group) and 9 (5–12, placebo group) days (hazard ratio, 0.73; 95% confidence interval, 0.60–0.90). The number of patients with a ≤7-day recovery was 61% (treatment group) and 44% (placebo groups) (hazard ratio, 0.06; 95% confidence interval, 0.04–0.09). The proportion of patients who remained RT-PCR positive on day 14 and whose disease did not progress was significantly lower in the treatment group than in the placebo group. Conclusions Patients with mild-to-moderate COVID-19 infection treated with ivermectin plus doxycycline recovered earlier, were less likely to progress to more serious disease, and were more likely to be COVID-19 negative by RT-PCR on day 14. Trial Registration ClinicalTrials.gov Identifier: NCT04523831. Data Repository ID Dryad. doi:10.5061/dryad.qjq2bvqf6

Subcortical Heterotopia is a rare developmental disorder of human brain due to mutation in the DCX or LIS1gene.It is predominantly a disease of female. It usually present with refractory seizure and varying degree of mental retardation. Here a case of 22 years lady who presented with refractory seizure is reported. Her MRI revealed Double cortex and her EEG revealed Frontal intermittent rhythmic delta activity (FIRDA). Bangladesh Journal of Neuroscience 2018; Vol. 34 (2): 106-109

Background: Migraine headache is one of the commonest cause of primary headache. This study aims to reveal the clinical profile of migraine headache in Bangladeshi people presented in Headache clinic, Dhaka Medical College Hospital. It will give an overview on presentation of migraine and its functional consequences among the people of Bangladesh. Methods: The study was a hospital based cross sectional observational study. It was conducted in the Headache clinic Dhaka Medical college Hospital from January 2018 to December 2018. About 854 patients with headache was attended in the headache clinic during the study period. Of that 234 patients were diagnosed as migraine according to ICHD-3 classification and 75 patents were enrolled in this study by systematic sampling. Details were collected using a preformed questioner. Results: In this study migraine burden among the headache patients found to be about 25%.The mean age of the onset of the migraine headache in this study was found to be 25.2±11.86 years, in most of the cases (4 68%) in 15-34 years age group. In this study 36% of the patient with migraine had positive family history which is significantly higher in patients with migraine with aura (52% vs. 30% p value <0.5). In this study about 81% of the patient has single or multiple trigger factors. Along with other known factor sun exposure and journey was found to be the important trigger factors for Bangladeshi population. In this study 22% of the female migraineurs and 33% of male migraineurs had aura. About 53% of the patient with aura had combinations of aura and 47% patient had exclusive visual aura. In the present study 100% of the patient had visual aura, 42% had brainstem aura and 10% had sensory aura. The study revealed that 25% patient had chronic daily headache due to migraine, 26% patient had >5 attack/ month and 15% patient had < 4 attack per month. In this study 44% had moderate headache and 56% had severe headache according to VAS score. Chronic migraine with anxiety, chronic migraine with medication overuse Migralepsy, Status migrainosus were found as a complications of migraine in this study. According to MIDAS score Patient largely had Mild (32%) to Moderate (34.67%) disability. Conclusions: Clinical profile of migraine in Bangladesh differs in some trigger points and migraine subtypes than the western world. Sun exposure and journey found to be most important triggers. Migraine with brainstem aura occurs in a significant number of the patient. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 1-9