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Background/Aims: Acute stroke is one of the leading causes of mortality and morbidity worldwide. The adverse outcome following acute stroke depends not only on severity of the neurological defects but also on other co-morbidities. Associated renal impairment has been found to be a major predictor of different outcome following acute stroke in several studies. The aim of this study was to evaluate the impact of the serum creatinine on the outcome of hospitalized patients after acute stroke. Methods: This was a Prospective cohort study conducted on 100 consecutive adult patients who were admitted in the Neurology department of Dhaka Medical College Hospital following acute stroke during January 2018 to December 2019.The patients were followed up for two weeks after the incident stroke. Results: Among the 100 patients with acute stroke 57(57%) were ischaemic and 43(43%) were haemorrhagic stroke. Mean age(SD) was 60.4(10.6) years. Patients with ischaemic stroke were older compared to haemorrhagic stroke (61.1(9.6); 53.8(9.4) years respectively; p

Cardiac cephalgia is a migraine like headache that occurs during episodes of myocardial ischaemia. Although most of the patients presenting with ischaemic heart disease have chest pain, there are other rare presenting symptoms like cardiac cephalgia. Headache can be the only presentation of coronary artery disease. We report a case of a 57 years-old man, Presenting with only headache during brisk walking, Exercise Tolerance Test (ETT) was positive for Electrocardiograph (ECG) evidence of provocable myocardial ischemia, who latter was diagnosed as double vessel coronary artery diseaseon Coronary Angiogram (CAG). As the patient preferred remaining without revascularization, he was put onto optimum medical management for ischaemic heart disease. A follow up visit after one month revealed, marked improvement of the headache with anti anginal medications. Early evaluation and diagnosis of the headache symptom should be done because treatment with anti-migraine drugs may deteriorate headache and undermine the diagnosis of coronary artery disease. Bangladesh Med J. 2019 Sep; 48 (3): 46-49

Introduction: Carpal tunnel syndrome (CTS) is a clinical syndrome that results from compression of median nerve within the carpal tunnel at the wrist. The aim of this study was to review the clinical and demographic characteristics and electrophysiological patterns of CTS patients who presented to a tertiary care hospital in Bangladesh. Methodology; A descriptive cross-sectional study was conducted on 150 CTS patients at the neurology department, Dhaka Medical College Hospital between January, 2019 to March , 2020 . All the subjects had clinical evaluation and standardized nerve conduction studies of upper limbs (300 limbs) using the same protocol. Results: 228 hands were found to have clinical and electrophysiological features consistent with CTS. There was female predominance (90%) and the highest occurrence of CTS was in the 45-55 years age group. Bilateral CTS was found in the majority of cases ie 78 (52%) and the rest had unilateral CTS. Among those with unilateral CTS, right hand was affected more (41, 57%) than left hand (31, 43%). Most of the cases were idiopathic. Neurophysiological studies showed most patients had mild CTS (121 hands, 53%). Most of the cases were idiopathic (102, 68%). Where a risk factor was found diabetes was commonest one (32) followed by hypothyroidism (12) and pregnancy (4). Conclusion: There was marked female predominance and the 45-55 years age group was predominantly affected. Majority of cases had mild CTS. Bilateral involvement was more common. Right hand was more affected than the left hand. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 96-99

Background: Studies assessing the impact of loss of consciousness (LOC) on prognosis of subarachnoid hemorrhage (SAH) has been limited. Objective: This scientific assessment was done to determine the effect of LOC on outcome of SAH. Methodology: This hospital based observational study was done in Department of Neurology of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2018 to December 2018. Patients with the diagnosis of SAH admitted in the in-patient wards of Neurology, Neurosurgery and Internal Medicine were taken as study population. The patients were divided in two groups with either presence (B) or absence of loss of consciousness (A). Group B was further subdivided into 3 subgroup depending admission WFNS scale grades (BI= WFNS II &III, BII=WFNS IV and BIII=WFNS V). Follow up was done in the stroke clinic, outpatient department of Neurology or by telephone interviews of patients, caregivers or family members. Outcome was measured by modified Rankin Scale (mRS). Result: A total of 75 patients were divided into group A and Group B. Six (8.0%) patients died during hospital stay, 6 died after 3 months. All those died during hospital stay were from group B. At 3 months, 16(21.3%) patients were lost during follow up. In group A at discharge 28.6% patients had poor outcome whereas 36% of patients in group B had poor outcome. Within group B most of the patients having poor outcome were in subgroup BIII (75.0%) compared to 33.0% cases in BI (p=0.023). About 16.7% cases in group A had poor outcome at 3 months and 75.0% cases in Group BIII. Furthermore, 8.3% patients died in Group A, however, 25.0% died in Group BIII. WFNS grade (IV or V) had statistically significant influence on poor outcome among patients having LOC (adjusted Odds ratio is 2.20, p=0.04 and 95% CI 1.03–4.71). Conclusion: Loss of consciousness at onset of SAH is an important marker for p oor outcome. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 20-24

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

Background: The National Institutes of Health Stroke Scale or NIH Stroke Scale (NIHSS) is a widely used tool for assessing stroke severity. We conducted this study to determine the severity of stroke patients admitted in a tertiary care hospital.Methods: This is a cross sectional study conducted in Department of Neurology, Dhaka Medical College Hospital from April 2016 to October 2016 involving 91 acute stroke patients.Result: About half (44%) of the patients were older than 60 years of age and mean age of the patients was 60.34(±16.1) years at onset and there is a slight female predominance (51.6%). Majority had hypertension (75.8%) followed by physical inactivity (67%), diabetes (37.4%), smoking (33%), obesity (23.1%), family H/O stroke (20.9%) and dyslipideamia (15.4%). Many patients were found to have hyperglycemia (14.3%) followed by hyperthermia (13.2%), hypotension (4.4%) and low oxygen saturation (3.3%) at the time of admission. Most of them had ischemic stroke (60%), followed by intracerebral hemorrhage (35%) and subarachnoid hemorrhage (5%). After leveling with NIHSS score more than half of the patients (51%) were found to be moderate grade on admission. Although, there was no association between risk factors of stroke and admission NIHSS score level, significant association was found between hypoxia and admission NIHSS score severity.Conclusion: Acute stroke patients, mostly have moderate grade of NIHSS score on admission. Hypertension, physical inactivity, diabetes, smoking, obesity, family H/O stroke and dyslipideamia are common risk factors observed among the patients which have no significant association with admission stroke severity determined by NIHSS score. There is significant association between hypoxia and admission NIHSS score severity.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 90-93

Objective: To determine the pattern of neurologic disorder in the specialized neurology out patient at tertiary care level.Methods: This observational study was carried out in specialized neurology outpatient clinic of Dhaka Medical College Hospital from July 2015 to July 2016, which included 8892 patients. Data were collected through a predesigned questionnaire from the hospital database kept at the clinic.Result: A total of 8892 patients were seen in neurology OPD in one year. About one third of the patients presented at 21-30 years of age. There was a male dominance (53%) with a male to female ratio of 1.12:1. Most of the patients had hypertension (3201, 36%) followed by diabetes and ischemic heart disease (1956, 22%; 1423, 16%) as co-morbid condition. Majority had Headache (4090, 46%) followed by vertigo (1067, 12%); vomiting (711, 8%) and neck and/ back pain (702, 8%) as presenting symptom at onset. Majority of the patients (46%) were diagnosed as headache disorder (Tension type headache in 33.5%, Migraine 7.5% and mixed headache in 5%) followed by ischemic stroke (896, 10%); polyneuropathy (446, 5%); vestibular disorder (441, 5%); movement disorder (267, 3%) and anxiety/depression (254, 3%). About 15% (1346) patient were undiagnosed at initial visit.Conclusion: Neurological diseases are not uncommon even at middle aged patients. Headache, vertigo, neck/back pain are common presenting symptom. Headache disorders and stroke are the commonest neurologic diagnosis at OPD.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 53-57

Background: Ischemic stroke is the end result of occlusion of a blood vessel supplying the brain by a thrombus originating somewhere outside the brain or as a result of a thrombotic stenosis of a cerebral blood vessel itself. Older people have higher prevalence of ischemic stroke. Objective: To evaluate the association between higher age and new onset ischemic stroke in patient with diabetes mellitus. Method: This cross sectional study was conducted in the Department of Neurology, BSMMU, Dhaka from February 2013 to September 2014 on 50 DM patients with first attack of ischemic stroke. mRS was measured on 14th day of the stroke. Result: Majority of the patients (40.0%) were in age group 51-60 years. The mean age was 58.9 ± 9.6 years with a range from 30 to 75 years. Males were 52.0% and females were 48.0%. Male to female ratio was 1.08:1. It was observed that more than one third (36.0%) patients were current smoker, 9(18.0%) were ex-smoker and 23(46.0%) were non smoker. Majority of the patients, 29(58.0%), had hypertension. Mean systolic BP was found 129 ±16 mmHg with a range from 90 to 160 mmHg. The mean diastolic BP was found 81±11 mmHg with a range from 60 to 100 mmHg. Age has significant positive correlation with modified ranking scale on 14th day of stroke [r= 0.322 (p=0.023)]. Conclusion: As per study result, it can be concluded that increasing age is associated with higher level of mRS. Bangladesh Journal of Neuroscience 2017; Vol. 33 (1): 1-5

Background: Heavy metals may produce various symptoms among the exposed, of which polyneuropathy is a matter of real concern. Our aim was to determine the pattern and association between polyneuropathy and blood lead level. Methods: This case control study was done in the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka in collaboration with Bangladesh Atomic Energy Centre from July 2001 to June 2002. The lead concentration in the blood was detected by Xray fluorescence (XRF) technique. Nerve conduction study and CSF examination were done among the cases. Result: Data were collected from 92 respondents, of whom cases and controls were equal in number with a male to female ratio of 8.17:1. Mean age of the cases and controls were 30.87 +14.53 years and 30.91+ 12.03 years respectively. Among the cases, 55% had sub acute type of polyneuropathy, followed by acute and chronic type of polyneuropathy among 30% and 15% respondants respectively. The mean CSF protein level was 112.00 + 65.04 gm/L. The mean CSF protein was higher in acute polyneuropathy than in subacute and chronic cases (p

Objective: To measure the changes in electro encephalogram (EEG) along with its sensitivity and specificity with clinical seizure among epilepsy patients referred to an electrophysiology lab in a tertiary care hospital of Bangladesh. Methods: This retrospective chart review was carried out in the electrophysiology laboratory of Dhaka Medical College Hospital from January 2011 to December 2013, which included 1154 patients. EEG was obtained through scalp electrodes following international 10/20 system. Information regarding patients was collected from the laboratory register with the help of a checklist. The EEG findings and clinical seizure events were then compared. Result: Among the 1154 patients, age varied from birth to 75 years. The mean age at presentation was 17±11.4 years and most of the patients were less than 10 years old (44.4%). The male predominated in our study (59.2%). Clinically diagnosed seizure was present in 970 patients (84.1%), among which Generalized tonic clonic seizure (GTCS) was the most common clinical type of seizure, followed by secondary generalized seizure in 19.4% (n=224) and focal seizure in 2% (n=30) patients and 6.8% (n=79) patients had pseudoseizure. Among the abnormal EEG (59%), generalized epileptiform discharge was found in 29%, whereas focal and secondary generalized discharge was found in 30%. The most common site of origin of epileptiform discharge was temporal lobe (28.3%). The overall sensitivity of EEG was 66% (ranged from 62% to 68% with a confidence interval (CI) at 95%) and specificity was 79% (72- 84% at 95% CI). The positive predictive value was 58% (55-61% at 95% CI) and negative predictive value was 41% (38-44% at 95% CI). Conclusion: Our study brings out the fact that EEG has a reasonable sensitivity and specificity as a diagnostic test and the superiority being the higher specificity of EEG. J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 215-222

To detect the changes in electro encephalogram (EEG) and correlate the findings with clinical seizure events among epilepsy patients. This retrospective chart review was carried out in the electrophysiology laboratory of Dhaka Medical College Hospital from January 2011 to December 2013, which included 1154 patients. EEG was obtained through scalp electrodes following international 10/20 system. Information regarding patients was collected from the laboratory register with the help of a checklist. The EEG findings and clinical seizure events were then compared. Among the 1154 patients, age varied from birth to 75 years. The mean age at presentation was 17±11.4 years and most of the patients were less than 10 years old (44.4%). The male (59.2%) female ratio was 3:2 in our study. Clinically diagnosed seizure was present in 970 patients (84.1%), among which Generalized tonic clonic seizure (GTCS) was the most common clinical type of seizure, followed by secondary generalized seizure in 19.4% (n=224) and focal seizure in 2% (n=30) patients and 6.8% (n=79) patients had pseudoseizure. Among the abnormal EEG (59%), generalized epileptiform discharge was found in 29%, whereas focal and secondary generalized discharge was found in 30%. The most common site of origin of epileptiform discharge was temporal lobe (28.3%). There was a negative correlation between EEG and history of seizure events (pearson correlation significance 0.33). Our study brings out the fact that EEG has a negative correlation with clinical seizure events. CBMJ 2014 July: Vol. 03 No. 02 P: 03-08