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Background: Stroke is a leading cause of death and disability globally and particularly in low and middle-income countries, and the burden is increasing. To prevent complications and permanent defects in stroke, early diagnosis is the key that can easily obtained by a CT scan of brain. However, quick access to CT scanning is not available in every country and hospital specially in Bangladesh, various clinical findings especially neurological signs and symptoms and risk factors differentiation are helpful in differentiating the types of stroke. Objective: This study aimed to see the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis in the detection of stroke subtype. Methods: This hospital based cross-sectional comparative study was conducted in Department of Medicine, Rangpur medical college hospital, Rangpur, Bangladesh from January 2010 to December 2011 on three hundred (300) suspected acute stroke patients selected by purposive sampling technique. The clinical diagnosis of type of stroke was made on the basis of mode of presentation, risk factors and signs and confirmed by CT scan of brain within 1 week of attack. Then the clinical diagnosis was compared with the results of CT scan. Statistical analyses related with this study were performed by using of SPSS-19 package program. Results: Among the 300 patients, 73(24.3%) patients were clinically diagnosed as hemorrhagic stroke and 227(75.6%) patients were as infarctive stroke. Out of 73 clinically diagnosed haemorrhagic stroke patients, CT scan revealed that 61 (83.6%) patients had intracerebral hemorrhage, 5 (6.8%) had infarct. And out of 133 diagnosed ischemic stroke patients, CT scan revealed that 203 (89.4%) patients had infarction, 6 (2.6%) had intracerebral hemorrhage. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of hemorrhagic stroke were 91.0%, 94.8%, 83.6%, 97.4% and 94.0% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of infarctive stroke were 97.6%, 73.9%, 89.4%, 92.2% and 90.3% respectively. Conclusion: CT scan of brain remains the gold standard for differential diagnosis, but the availability of CT scan is not always feasible, and it is virtually impossible to submit all stroke patients to CT scan. Adequate knowledge on risk factors, clinical features and initial investigations may contribute to such a differentiation of cerebral infarction from intracerebral hemorrhage with high accuracy where rapid access to Computed Tomography (CT) is lacking. J Rang Med Col. March 2023; Vol. 8, No. 2:33-39

We report an isoniazid-induced encephalopathy in a man with chronic renal failure. Drug-induced encephalopathy is a common side effect of many drugs. Isoniazid (INH), a first-line drug for tuberculosis, can cause encephalopathy in patients with chronic kidney disease (CKD). For Pott's disease of the thoracic spine, he received rifampicin, INH, pyrazinamide, and ethambutol with pyridoxine and prednisolone. But the patient is free of pyridoxine for two and a half months. Subsequently, after treatment, the patient experienced recurrent episodes of altered consciousness, irrelevant conversations, and disorientation. After ruling out other causes, isoniazid-induced encephalopathy was suspected and confirmed by improvement of symptoms after discontinuation of high-dose isoniazid and pyridoxine. J Rang Med Col. March 2023; Vol. 8, No. 1:72-75

Background: Hypertension is a growing issue of public health problem of the adult population in both developed as well as developing world, is a serious medical condition that significantly increases the risks of heart, brain, kidney, and other diseases. There is a strong association between Microalbuminuria (MA) and hypertension. Microalbuminuria (MA) is the independent risk factor for developing cardiovascular and cerebrovascular morbidity and mortality in hypertension, suggesting that microalbuminuria (MA) could be a useful marker to assess the risk management of cardiovascular disease and renal disease. Objective: To assess the frequency of microalbuminuria in hypertension and to evaluate its association with left ventricular hypertrophy (LVH), ischemic heart disease (IHD), retinopathy, and stroke. Methods: This cross-sectional descriptive study was conducted at the Hypertension & Research Centre, Rangpur from January 2010 to January 2012. A total of 75 hypertensives without diabetes mellitus and/or other conditions causing microalbuminuria were purposively selected. Urine albumin was assessed and microalbuminuria was defined as albumin excretion between 20-200 microg/min. The relationship of microalbuminuria with the duration, severity, body mass index (BMI), lipid profile, and target organ damage (TOD) like left ventricular hypertrophy (LVH), ischemic heart disease (IHD), hypertensive retinopathy, and stroke was assessed by univariate analysis. Results: The patients were in between the age of 20-79 years with mean age of 52.98±12.2. Out of 75 subjects, 47 (62.7%) patients were male and 28 (37.3%) were female. Of the study group, 53 patients had stage 1 and 22 patients had stage 2 hypertension. Among the stage-1 hypertensive (53), 5 patients had microalbuminuria and 6 patients had microalbuminuria in stage-2 hypertensive (22) (p=0.047). Microalbuminuria was significantly higher in those with longer duration and greater severity of hypertension (p =0.039). Older age (p =0.008), and adverse lipid profile (p =0.003) were the other identifiable risk factors for microalbuminuria. Stroke (OR=9.77), echocardiography-proven LVH (OR=6.25), ECG and/or echocardiographyproven IHD (OR=8.71) and hypertensive retinopathy (OR=4.14) were significantly higher in those with microalbuminuria. Conclusion: The prevalence of microalbuminuria in hypertensive subjects is high and patients with microalbuminuria have high odds of developing TOD like stroke, LVH, IHD, and hypertensive retinopathy. So the early detection of microalbuminuria in hypertensive as well as prompt treatment may reduce the burden of TOD. J Rang Med Col. March 2023; Vol. 8, No. 2:3-10

Introduction: Coronary and cardiovascular illnesses are among the leading causes of death globally. Cardiovascular illnesses have several causes and risk factors, one of which is hypertension, often known as high blood pressure. It is one of the illnesses for which there are no obvious symptoms or a cure. As a result, it is frequently identified in its advanced form, with severe symptoms. Socioeconomic variables, among many others, are one of the causes of hypertension. However, the specific relationship between socioeconomic level and hypertension has not been determined, as numerous researches provide contradictory results. Body weight has often been connected to hypertension and cardiac damage, and the present study was conducted to observe the. Aim of the study: The aim of the study was to observe and evaluate the effects of body weight in select hypertensive patients. Methods: This was a cross-sectional analytical study conducted at the Department of Medicine, Rangpur Medical college Hospital, Rangpur, Bangladesh during the period from January 2016 to December 2016. The study was conducted with 252 participants selected by random selection method among the participants admitted into the study hospital. The study only contained participants of Hypertension Stage 1 or above. Result: The age range of the participants was from 18-67 years, with 57.14% belonging to the age group of 21-39 years. The male: female ratio was 5.14:1. 67.86% of the participants had a sedentary work life, and 46.03% of the participants were overweight, with only 8.73% being obese. Excessive salt intake, family history of hypertension and smoking were some of the major additional risk factors. A good level of knowledge regarding HTN was present in only 50% of the participants, with excellent knowledge present in 13.10%. Conclusion: Increasing bodyweight has a positive relation with hypertension prevalence, and leading a sedentary lifestyle also increases the risk of hypertension. ..........

Congenital myasthenic syndromes (CMS) comprise a heterogeneous group of rare inherited diseases in which the neuromuscular transmission in the motor plate is compromised by one or more genetic pathophysiological specific mechanisms are characterized by fatigable weakness of skeletal muscle (e.g., ocular, bulbar, limb muscles) with onset at or shortly after birth or in early childhood; rarely, symptoms may not manifest until later in childhood. The diagnosis of CMS is based on clinical findings, a decremental EMG response of the compound muscle action potential (CMAP) on low-frequency (2- 3 Hz) stimulation, absence of anti-acetylcholine receptor (AChR) and anti-MuSK antibodies in the serum, a positive response to acetylcholinesterase (AchE) inhibitors and lack of improvement of clinical symptoms with immunosuppressive therapy. Pathogenic variants in one of multiple genes encoding proteins expressed at the neuromuscular junction are currently known to be associated with subtypes of CMS. The most commonly associated genes include: CHAT, CHRNE, COLQ, DOK7, GFPT1 and RAPSN. We studied on a sibling presented with progressive fatigability and fluctuating ptosis with frequent exacerbations of muscle weakness during infections since infancy. On both cases CT scan of chest were negative for thymoma, antibodies against the acetylcholine receptor (AChR) and the muscle specific kinase (MuSK) were negative and decremental response on electrophysiological study of Repetitive nerve stimulation (RNS) and EMG were consistent with disease of neuromuscular junction (post synaptic) and they were only on pyridostigmine for long time with marked improvement of symptoms and signs. Considering all scenario both of our cases mostly fits with the autosomal recessive, post synaptic CMS associated with Rapsyn deficiency. Objective : As in Bangladesh, there is inadequate data on the epidemiological profile of CMS, our aim is to describe these cases for their rarity and the difficulty encountered in diagnosis as they are easily confused with Juvenile Myasthenia Gravis (JMG) and familial myopathies. As both the cases are very rare, it should be an original article. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 95-103