Browsing by Author "Islam, Tasbirul"

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    Coagulopathy of Dengue and COVID-19: Clinical Considerations
    (MDPI, 2022-08-25) Islam, Amin; Cockcroft, Christopher; Elshazly, Shereen; Ahmed, Javeed; Joyce, Kevin; Mahfuz, Huque; Islam, Tasbirul; Rashid, Harunor; Laher, Ismail; Medicine, School of Medicine
    Thrombocytopenia and platelet dysfunction commonly occur in both dengue and COVID-19 and are related to clinical outcomes. Coagulation and fibrinolytic pathways are activated during an acute dengue infection, and endothelial dysfunction is observed in severe dengue. On the other hand, COVID-19 is characterised by a high prevalence of thrombotic complications, where bleeding is rare and occurs only in advanced stages of critical illness; here thrombin is the central mediator that activates endothelial cells, and elicits a pro-inflammatory reaction followed by platelet aggregation. Serological cross-reactivity may occur between COVID-19 and dengue infection. An important management aspect of COVID-19-induced immunothrombosis associated with thrombocytopenia is anticoagulation with or without aspirin. In contrast, the use of aspirin, nonsteroidal anti-inflammatory drugs and anticoagulants is contraindicated in dengue. Mild to moderate dengue infections are treated with supportive therapy and paracetamol for fever. Severe infection such as dengue haemorrhagic fever and dengue shock syndrome often require escalation to higher levels of support in a critical care facility. The role of therapeutic platelet transfusion is equivocal and should not be routinely used in patients with dengue with thrombocytopaenia and mild bleeding. The use of prophylactic platelet transfusion in dengue fever has strained financial and healthcare systems in endemic areas, together with risks of transfusion-transmitted infections in low- and middle-income countries. There is a clear research gap in the management of dengue with significant bleeding.
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    Renal and Bleeding Complications in Critically Ill Covid-19 Patient-A Case Report
    (Bangladesh Journals Online (BanglaJOL), 2020-06-03) Pia, Masuma Islam; Islam, Tasbirul; Medicine, School of Medicine
    The ongoing outbreak of Covid-19 presented with a wide variety of clinical manifestations. Apart from the common respiratory complications, acute renal impairment and bleeding complications on full anticoagulation has been also observed in some patients. Here we report a 67 year old male with COPD and CKD presented with symptoms of covid-19 and found ground glass opacity on CT scan and bibasilar opacity on chest X-ray, admitted to the hospital and he was initially stable after supportive management, discharged home on antibiotics but readmitted after 4 days with worsening shortness of breath, hypoxia, tachycardia (A-fib with Rapid Ventricular Response) and high ESR. He was started on High flow nasal cannula (HFNC), diltiazem, adenosine and antibiotics ultimately needed intubation. While he was on antibiotics, hydroxychloroquine, DVT prophylaxis and statin he developed septic shock two days after intubation. Next day he had to receive Continuous Renal Replacement Therapy (CRRT). He was placed on heparin infusion. With clinical improvement the patient was extubated to HFNC, but after one day of extubation he developed bradycardia, hypotension and gradually became unresponsive. He was given vasopressors and intubated again. CT scan showed retroperitoneal hematoma 10 x7 x 12 cm. His heparin was discontinued and was managed conservatively. With supportive treatment his clinical condition improved gradually and was extubated again. CRRT was switched from CVVH (Continuous Veno -Venous Hemofiltration) to HD and eventually he was discharged home. Clinicians should remain watchful at all stages of critical care management of COVID 19 because timely intervention and drug adjustment is lifesaving.