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Background: It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.

Patient: Male, 45-year-old Final Diagnosis: Cerebral venous sinus thrombosis Symptoms: Seizure Medication: — Clinical Procedure: Angiography • CT scan • magnetic resonance image Specialty: Critical Care Medicine • Infectious Diseases • Neurology Objective: Unusual clinical course Background: Multiple vaccines have been developed against COVID-19 as a collaborative worldwide effort. On March 18, 2021 the European Medicines Agency reported a serious and rare adverse effect of thrombosis with thrombocytopenia syndrome (TTS) after receiving the ChAdOx1 nCoV-19 vaccine; most of these cases were associated with cerebral venous sinus thrombosis (CVST). To date, there are no cases of TTS-related CVST reported after receipt of either of the 2 mRNA COVID-19 vaccines authorized for use in the United States. We report a case of CVST with the Moderna mRNA vaccine. Case Report: A healthy 45-year-old male patient without any risk factors presented with new-onset seizures 8 days after the receipt of the 2 nd dose of Moderna (mRNA-1273), with concomitant SAH as a complication. One day prior to admission, he noted headaches and neck pain unrelieved by over-the-counter analgesics. Computed tomography (CT) scan brain without contrast revealed a left frontal lobe intracerebral hemorrhage (ICH) along with subarachnoid hemorrhage (SAH). A subsequent contrast-enhanced magnetic resonance imaging (MRI) brain confirmed the CT findings as well as anterior superior sagittal sinus thrombosis. He had normal platelet count with a negative thrombophilia work-up and cancer screening. He was successfully anticoagulated with heparin and discharged on warfarin without neurological sequelae or further seizures. The case was reported to the US Vaccine Surveillance System. Conclusions: mRNA vaccine-related CVST is an extremely rare phenomenon. More data are needed to establish causality and understand the role of vaccine-related immune response resulting in thrombotic events with or without TTS.

Introduction: The proliferation of literature regarding the COVID-19 pandemic has served to highlight a wide spectrum of disease manifestations and complications, such as thrombotic microangiopathies. Our review with a brief case presentation highlights the increasing recognition of TTP in COVID-19 and describes its salient characteristics. Methods: We screened the available literature in PubMed, EMBASE, and Cochrane databases from inception until April 2022 of articles mentioning COVID-19-associated TTP in English language. Results: From 404 records, we included 8 articles mentioning data of 11 patients in our review. TTP was predominantly reported in females (72%) with a mean age of 48.2 years (SD 15.1). Dyspnea was the most common symptom in one third of patients (36.6%). Neurological symptoms were reported in 27.3% of cases. The time to diagnosis of TTP was 10 days (SD 5.8) from onset of COVID-19. All 11 cases underwent plasma exchange (PLEX), with a mean of 12 sessions per patient, whereas 6 cases received Rituximab (54.5%), and 3 received Caplacizumab (27.3%). One patient died from the illness. Conclusion: This review of available literature highlights the atypical and refractory nature of COVID-19-associated TTP. It required longer sessions of PLEX, with half of the patients receiving at least one immunosuppressant.

Objective Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic inflammatory diseases associated with a higher risk of cardiometabolic comorbidities compared to the general population. Individual studies examining mortality in these patients have produced conflicting results. The present study was undertaken to perform a systematic review and meta‐analysis to analyze the all‐cause and cause‐specific mortality in PsA and AS from the available literature. Methods A comprehensive database search was performed for studies reporting all‐cause or cause‐specific mortality in patients with PsA and AS compared with the general population. Pooled relative risks (RRs) were calculated using a random‐effects model. Results We included 19 studies (11 of PsA, 7 of AS, 1 of both). In PsA studies, there was no increased mortality compared to the general population (RR 1.12 [95% confidence interval (95% CI) 0.96–1.30]; n = 10 studies). We found a higher all‐cause mortality in female (RR 1.19 [95% CI 1.04–1.36]) but not in male (RR 1.02 [95% CI 0.66–1.59]) PsA patients. Cardiovascular‐, respiratory‐, and infection‐specific mortality risks were significantly higher for PsA patients (RR 1.21 [95% CI 1.06–1.38], RR 3.37 [95% CI 1.30–8.72], and RR 2.43 [95% CI 1.01–5.84], respectively), but not cancer‐related mortality (RR 1.01 [95% CI 0.91–1.11]). In AS, we found a higher risk of death from all causes (RR 1.64 [95% CI 1.49–1.80]; n = 6 studies) and cardiovascular causes (RR 1.35 [95% CI 1.01–1.81]; n = 3 studies) compared to the general population. All‐cause mortality was high in both male (RR 1.56 [95% CI 1.43–1.71]) and female (RR 1.85 [95% CI 1.56–2.18]) AS patients. The included AS studies did not report mortality data for non‐cardiovascular causes. Conclusion This systematic review and meta‐analysis showed a significantly increased risk of overall mortality in AS but not PsA. Cardiovascular‐specific mortality was higher for both PsA and AS, which emphasizes the importance of early screening and management of cardiovascular risk factors.