Background Cerebral venous thrombosis (CVT) is an uncommon cause of stroke in humans and the mainstay of treatment is anticoagulation unless contraindicated. Non-vitamin K oral anticoagulants have not been duly evaluated in randomized controlled trials in CVT. Objective To compare the efficacy and safety of oral rivaroxaban with vitamin K anticoagulant (warfarin) in preventing recurrent venous thromboembolism (VTE) in patients with CVT. Methods Adult patients with CVT, who were stable after 5–12 days of treatment with parenteral heparin 1 mg/kg, were screened for eligibility. The patients were randomly divided into two groups to receive oral rivaroxaban 20–30 mg daily or warfarin 1, 3 or 5 mg daily (with the dose adjusted to maintain an INR of 2–3), for 3–12 months. Recanalization rates, periprocedural complications, and clinical outcomes were assessed by Magnetic Resonance Venography (MRV) and National Institutes of Health Stroke Scale (NIHSS) at 3rd, 6th and 12th month follow-ups. Results In total, 45 patients with CVT were randomized to the two treatment groups (21 to rivaroxaban and 24 to warfarin). Overall recanalization was achieved by 18 (86%) and 20 (83%) cases from rivaroxaban and warfarin group, respectively at 6th month follow-up; and by all 45 (100%) cases from the both groups at 12th month follow-up. Excellent outcome (NIHSS score 0) was obtained by 20 (95%) cases from rivaroxaban group at 3rd to 12th month follow-ups; and by 23 (96%) cases at 6th to 12th month follow-ups. There were no major bleeding events during the trial. None of the patients developed recurrence of thrombosis. Statistically, no significant difference between the two treatment groups in terms of recanalization and clinical outcomes could be observed. Conclusion Rivaroxaban is a safe option in CVT however; larger randomized controlled studies will impact the results validity.

IV pulse CYC immunosuppression was followed by remarkable clinical and endoscopic improvement of SSc-associated GAVE.

Thrombotic thrombocytopenic purpura (TTP) is usually defined as microangiopathy characterized by low platelet count and low red blood cell count, i.e., hemolytic anemia. It can either be acquired or immune-mediated. TTP requires quick diagnostic identification and emergent management. According to the evidence-based guidelines, the recommended therapy is plasma exchange and immunosuppression. Caplacizumab is used alongside the standard recommended therapy. Caplacizumab is a monoclonal antibody (Mab) that binds to von Willebrand factor (VWF). This prevents A1 VWF to bind platelet glycoprotein 1b receptor. The recommended dosage for this drug is 10mg. At the start, 10mg intravenous (IV) dose is given before plasma exchange, followed by daily 10mg subcutaneous (SC) dose after plasma exchange. Moreover, the SC dose is continued even after the daily plasma exchange is stopped. This review aims to consolidate findings related to the efficacy of this recently approved drug.

Bickerstaff’s brainstem encephalitis (BBE) is a rare neurological disease characterized by ophthalmoplegia, ataxia and altered sensorium.1 Its etiology is thought to be autoimmune in nature and sometimes certain infections precede illness.2-4 It is a spectrum of illnesses with Guillain-Barre Syndrome (GBS) and Miller Fischer Syndrome (MFS).5-6 We describe an atypical case of BBE which was initially misdiagnosed as meningo-encephalitis. As such, we report this case for its rarity. Informed consent was received from the patient before undertaking and reporting this study.

Introduction: Coronavirus has spread rapidly in Pakistan. These patients were kept at quarantine facilities on suspicion, even before RT-PCR was done. We were able to collect clinical, laboratory, and management features from them.  Objective: To assess the features of Corona confirmed and unconfirmed patients, and compare them. It could help in deciding if confirmed and unconfirmed patients were correctly identified and managed appropriately. Material and Methods: Retrospective, Descriptive, Crossectional study between 8th April to 30th April 2020. Patient data was collected from different sites retrospectively, on a Performa. Clinical, Laboratory, and Management data as collected. It was analyzed on SPSS 23. All patients in quarantines and ICU were included, irrespective of their corona PCR status, if the treating physicians had a strong suspicion. Home quarantine and less than 15-year old patients were excluded. Results: Clinical features showed more preponderance for males and smokers. Chronic disease patients were also significantly involved. Fatigue, nasal congestion, runny nose, sickness, and vomiting were more common in confirmed patients. CURB 65 scores 3 and 4 were more in unconfirmed patients. CT involvement was more common in unconfirmed patients as was high white cells and neutrophils. More patients had mechanical ventilation in the unconfirmed group, and they also had more secondary infections and shock. Antibiotic use was more common in the confirmed group. Conclusion: Corona was more common in males and smokers. Though fever and cough were common, the presence of fatigue, runny nose, nasal congestion sickness, and vomiting discriminated confirmed patients. Antibiotics should be used irrespective of RT-PCR results, especially if CT showed an abnormality.