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Background: Well controlled blood pressure (BP) is associated with decreased risk of kidney disease progression, cardiovascular events and death. Patients with chronic kidney disease (CKD) are frequently seen to have low rates of BP control. This study aimed to find out the proportion of adult type 2 diabetic CKD patients with hypertension achieving the goal of target blood pressure. Methods: This cross-sectional study included 105 hypertensive subjects having type 2 diabetes and CKD at the outpatient department of Nephrology, BIRDEM General Hospital in Dhaka, Bangladesh from May to August, 2012. Results: The mean age was 55.6 years and maximum numbers of patients were in the age group of 39-66 years. Among 105 subjects, 52.3% were male and rest 47.7% were female. The mean duration of diabetes, CKD and hypertension were 6.73 (±3.22), 3.12 (±2.47) and 3.1 (±1.77) years respectively. The study revealed that ischemic heart disease (30.5%), dyslipidemia (56.1%) and stroke (13.3%) were associated comorbidity along with diabetes and CKD. Mean estimated glomerular filtration rate was 52.19 ml/min. Mean serum creatinine level was 3.4 mg/ dl. It was observed that majority (49.5%) of the study subjects were prescribed at least two drugs to control hypertension. Three anti-hypertensive medications were given in 35.2% subjects. Among 105 study subjects, 25.7% were found to have high systolic blood pressure and 8.8% high diastolic blood pressure. It was observed that only 40% subjects achieved target systolic blood pressure and 68.6% reached the target diastolic pressure for CKD with diabetes. In correlation analysis, it was observed that both systolic and diastolic blood pressure was significantly correlated with age of the subject, duration diabetes and duration of HTN. Conclusion: From the present study it was seen that both the target systolic and diastolic blood pressure were correlated with numbers of medications used for controlling hypertension but only diastolic blood pressure control was significantly correlated with number of medication used in this present study. BIRDEM Med J 2021; 11(3): 212-217

Background: Patients of stroke or transient ischaemic attacks (TIA) are at risk of further stroke. Our objective was to study patients admitted with stroke/TIA regarding their knowledge about risk factors for having anew event of stroke/TIA, possible associations between patient characteristics and patients’ knowledge about risk factors, and patients’ knowledge about their preventive treatment for stroke/TIA. Methods: A questionnaire was used for 200 patients with stroke/TIA diagnoses. We asked 13 questions about diseases/conditions and lifestyle factors known to be risk factors and four questions regarding other diseases/ conditions (“distractors”). Additional questions concerned with the patients’ social and functional status and their drug use were asked. Categorical variables were analyzed using chi square test, while one-way analysis of variance and univariate analysis of variance were used for continuous variables. Logistic regression was employed to describe risk. A p value of, p < 0.05 was considered statistically significant. Results: The risk factors that were most often identified by the patients were Diabetes(75.9%), hypertension(83.3%), previous stroke or TIA(81.5%), smoking (85.2%), regular exercise(75.9%), older age(83.3%), overweight (75.9%) and patients with ischemic heart disease (70.4%). Atrial fibrillation and carotid stenosis were identified by less than 50% of the patients. 44.5% of the patients could identify 10 or more stroke/TIA risk factors. We observed that higher age, having a diagnosis of cerebral infarction/TIA, patients residing in urban area, high income group, businessman/retired service holder, family history of cardiovascular disease, past history of stroke / TIA were related to better knowledge of stroke/TIA risk factors. Anticoagulants and antiplatelets are important drugs for stroke/TIA prevention but only 20(9.3%) of the patients who reported anticoagulants and 76(35.2%) of the patients taking these drugs marked them as intended for prevention. Conclusion: Knowledge about diabetes, hypertension and smoking as risk factors was good, and patients who suffered from atrial fibrillation or carotid stenosis seemed to be less informed about these conditions as risk factors. The knowledge level was low regarding the use of anticoagulants and antiplatelets for stroke/TIA prevention. Better patient educational strategies for stroke/TIA patients should be developed. Furthermore, individuals with less knowledge should be given special consideration when developing strategies and programmes thus improving awareness of stroke risk factors. Birdem Med J 2021; 11(1): 22-29

Background: Stroke is an important cause of disability among adults and is one of the leading causes of death worldwide. Strokes in young adults can have a significant impact on the affected individuals, their families and societies in general as the affected patients are in the economically productive period of their lives.This study was aimed to find out the demographic profile and explore the associated risk factors of the first-ever ischemic stroke of young adults.Methods: This retrospective study reviewed the records of 64 patients, age 18-49 years, ischemic stroke patients consecutively admitted in the Neurology department, BIRDEM General Hospital during the period January 2016 to June 2017. Study variables included hematological and biochemistry investigations and radiological and imaging findings. Stroke sub-typing was done following to TOAST criteria. Data of follow-up data at 3 month were also included. Data were expressed as number (percent) and managed by SPSS for Windows Version 15.Results: Of the 634 patients diagnosed as acute ischemic stroke 64 (9.90%) were in the 18-49 (yr) age range and the majority (55.4%) were male. Stroke was more common (47 out of 54) among the 31-49 years category as compare with the

Introduction. Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. Methods. This study was a hospital based descriptive cross sectional study done in BIRDEM general hospital between July, 2015 and June, 2016, for a period of twelve months. The initial clinical diagnosis of DPN was made and was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Results. A total of 354 cases were finally analyzed with 153 (43.2%) patients being symptomatic and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. Majority (38.4%) of patients belonged to the age group of 51-60 years. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). Study subjects with CTS had significantly higher BMI, higher fasting blood sugar and higher HbA1c in comparison to patients without CTS. The mean compound motor action potential was not significantly different between patients with and without CTS. Conclusion. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions should be made carefully after nerve conduction study and proper diagnosis.

In young adults 20%-47% cases of stroke is due to cardiac embolism. Cardiac Myxoma is an infrequent cause of embolic stroke in young. We are reporting a case of a ischemic stroke in a young adult of 34 years with a history of recreational drug use who was eventually diagnosed with Left Ventricular Apical Myxoma, Systemic Lupus Erythematous (SLE), Lupus Nephritis, Secondary Anti phospholipid Syndrome, Hyper homocysteinemia, and Dyslipidemia.Bangladesh Heart Journal 2017; 32(1) : 55-61

Background: Complications of diabetes mellitus (DM) represent the major cause of morbidity and mortality in the modern era, diabetic polyneuropathy (DPN) being one of the most frequents. Nerve conduction study is employed to detect neuropathy. This study is done to see the electrophysiological pattern of diabetic polyneuropathy in a tertiary care setting.Methods: Study was carried out in 100 diagnosed DM patients attending department of neurology, BIRDEM General Hospital from July, 2015 to June, 2016. Diabetic patients with good glycaemic control were grouped in group A and that with poor glycaemic control in group B. Clinical questionnaire and neurological examination were administered, and nerve conduction study (NCS) were performed using standard techniques.Results: Among the 100 patients studied, 54 (54%) patients were Male and 46 (46%) patients were Female. 39% patients who had normal HbA1C was designated as group A and 61% patients having high HbA1c was designated as group B. Mean age of patients in group A was 55.02±10.45 years and group B was 54.94±11.13 years. Mean duration of diabetes in group A was 10.49±4.43 years and group B was 12.44±5.14years. Alterations in NCS included lowered amplitudes and slowed conduction velocities. Most common axonal pattern was found in peroneal nerves and most common demyelinating pattern was found in sural nerves. Sensory conduction velocity in significantly reduced in all sensory nerves in group B in comparison to group A. Compound motor action potential (CMAP) is significantly reduced on peroneal nerve in group B.Conclusion: Risk of neuronal involvement is increased as Diabetes mellitus progresses further which can be accelerated by poor glycaemic control. NCS is used to as an important tool to diagnose the peripheral neuropathy. Early diagnosis of neuropathy can be done by routine NCS and complications of neuropathy can be prevented by controlling Diabetes mellitus more meticulously.Birdem Med J 2017; 7(2): 114-120

Background and Objectives: Diabetes in the young patients, less than 30 years of age, usually has sudden onset and severe hyperglycemia who are resistant to ketosis. Taking the advantage of this uniqueness of this group of patients the present study was aimed to evaluate their peripheral nerve functional status, explore its relationship with glycemic status and find out utility of nerve conduction study for detection of neuropathy at diagnosis to introduce timely intervention in the necessary cases.Materials and Methods: A total number of 32 newly diagnosed untreated diabetic patients, age 30 years or less, consecutively attending the BIRDEM Out-patient department were recruited. Age-matched healthy subjects (n=30) with no family history of diabetes served as controls. Motor and sensory conduction velocities (NCV), distal latencies (DL), compound muscle and sensory nerve action potentials (CAMP, SNAP) of ulnar, peroneal and sural nerves were studied following standard protocol. Glucose was determined by glucose-oxidase, Fructosamine by enzymatic colorimetric method.Results: Ulnar motor NCV (m/sec, mean±SD) was significantly slower in diabetic group compared to the controls [58.29±6.88 vs 66.56±6.13; p

Aims: The study was aimed to evaluate vascular territories of infarcts involved in patients with stroke for the first time with diabetes on CT and/ or MRI of brain. Methodology: This cross sectional descriptive study was carried on a total of 100 adult patients with first ever stroke consecutively reported in the Department of Neurology, BIRDEM General Hospital, Dhaka, over a period of six months. Results: The mean age was 61.45 years and majority (35%) belongs to age group of 50-59. Ten (10%) subjects had age above 80 years. Male were 68% and 32% were female. Majority (89%) of the subjects had hemiplegia following acute stroke. Aphasia (71%), headache (39%), convulsion (23%), vomiting (18%) and cranial nerve palsy (17%) were also found. Additional preexisting risk factors were hypertension (72%), dyslipidaemia (59%), smoking (56%) and alcohol abuse (2%). Among the study subjects the diabetic complications were peripheral vascular disease (4% ), neuropathy (8%), nephropathy( 9%)and retinopathy(25%). CT scan and/ or MRI brain showed parietal lobe lesion in 57% cases. Majority (76%) had infarcts in middle cerebral artery territory. Involvement of anterior and posterior cerebral artery territory was found in 7% and 5% subjects respectively. Vertebro-basilar arterial system involvement was observed in 6% cases. 4% subjects had involvement of both middle and posterior cerebral arteries. Both anterior and posterior arterial territory infarcts were found in 2% cases. Conclusions: In conclusion most of the diabetic subjects with first ever ischemic stroke had involvement of middle cerebral artery. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19951 Bangladesh Crit Care J March 2014; 2 (1): 16-20

Background.Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh.Methods.Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded.Results.Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected in 32.5% of the cases. Only 16 (2.4%) died during treatment, and 436 (64.2%) patients had their mRS score of 3 to 5. Age greater than 70 years was associated with poor outcome on discharge [OR 1.79 (95% CI: 1.05 to 3.06)] adjusting for gender, duration of hospital stay, HDL, and pneumonia. Age, mRS, systolic blood pressure, urinary tract infection, pneumonia, and stroke severity explained the Barthel score.Conclusion.Mortality was low but most of patient had moderate to severe disability at discharge. Age, mRS, systolic blood pressure, urinary tract infection, pneumonia, and stroke severity influenced the Barthel score.