Journal of National Institute of Neurosciences Bangladesh

Association of Ischaemic Heart Disease with Hospitalized Ischaemic Stroke Patients in a Tertiary Care Hospital

Sun, 07 Apr 2024 00:00:00 +0000

Background: Stroke and IHD is a major health problem all over the world. But few studies have been done in our country to see the association of IHD among ischaemic stroke patients. Objective: The purpose of the present study was to evaluate the prevalence of IHD among hospitalized ischaemic stroke patients and to identify their common risk factors. Methodology: This was a cross-sectional study carried out in 50 ischaemic stroke patients admitted in Medicine Wards of Khulna Medical College Hospital, from July 2012 to December 2012. The patients were taken in both sexes having more than 18 years age and CT-scan evidence of ischaemic stroke by purposive sampling technique. After recruitment of patients IHD was established by ECG findings. Subsequently other risk factors were identified and were recorded. Results: The incidence of stroke for individuals older than 80 years was approximately 30.0% compared with 8.0% for individuals between 31 to 40 years of age. Among them IHD was more common in 51 to 60 years old stroke patients (33.33%) but less common in older than 80 years of age (8.33%). All of those having both ischaemic stroke and IHD were hypertensive. Among them 58.33% cases had severe hypertension but those having only stroke but no IHD 73.68% cases were hypertensive. Among them 34.21% had severe hypertension. Regarding lipid profile those having both ischaemic stroke and IHD 83.33% were dyslipidaemic but of those having only stroke but no IHD 52.63% were dyslipidaemic. This study revealed 41.67% diabetic patients developed both Ischaemic stroke and IHD compared to 31.58% diabetic patients developed only ischaemic stroke. Conclusion: In conclusion IHD and ischaemic stroke patients share similar pathophysiological mechanisms and, consequently, many risk factors.

Journal of National Institute of Neurosciences Bangladesh, July 2023; 9(2):98-102

Comparative Efficacy of Intranasal Midazolam with per Rectal Diazepam to Control Acute Seizure in 6 months to 12 years’ Children

Sun, 07 Apr 2024 00:00:00 +0000

Background: Convulsions are the most frequent neurological disorders affecting children. Acute seizure is a medical emergency, requires prompt and urgent control of ongoing seizure activity. Among the procedure to control seizure, treatment options like intranasal midazolam and per rectal diazepam are available for immediate management.

Objective: The study was done to compare the safety and efficacy of intranasal midazolam and per rectal diazepam to control acute seizure.

Method: This randomized controlled trial was conducted in paediatric department of Dhaka Medical College Hospital from 1^st June 2008 to 15^th April 2009.Children aged from 6 month to 12 years who came with acute seizure of any aetiology were included.

Result: Among 110 patients mean time to control acute seizure in diazepam group was 4.1 minute and in midazolam group it was 3.2 minute and the difference was statistically significant. No significant side effects were noted in either of the group except for a transient fall in oxygen saturation.

Conclusion:In this study midazolam effectively controlled acute seizure compared to diazepam. Time taken to control seizure was significantly less in midazolam group. No serious complications were noted after administration of drugs. Intranasal midazolam could be a better alternative as it is effective in controlling seizure and has no significant side effects compared to the standard.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):103-107

Clinical Characteristics, Laboratory Findings and Functional Outcomes of Guillain-Barre Syndrome: Experience of 50 Cases in Bangladesh

Sun, 07 Apr 2024 00:00:00 +0000

Background: Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy which is one of the most frequent causes of acute flaccid paralysis. GBS has diverse clinical phenotype and functional outcome.

Objective: The purpose of the present study was to evaluate clinical profiles and outcomes of GBS patients admitted in a tertiary care centre of Bangladesh.

Methodology: This prospective cohort study was conducted in the Department of Neurology from January 2016 to June, 2020 in BIRDEM General Hospital, Dhaka, Bangladesh. Adult patients more than or equal to 18 years of age who had fulfilled the diagnostic criteria of GBS were included in the study.

Results: Majority of the patients were male (64.0%). The most common presenting symptom at entry was ascending paralysis that occurred in 24 patients (48.0%). Mean age of the study population is 31.5 years ranging from 19 to 60 years. Twenty four (48.0%) patients had GBS disability score of 4 at entry. On the contrary, 39(78.0%) cases had GBS disability score of 4 at nadir. Diarrhea was reported in 14(28.0%) cases and respiratory tract infection was reported in 9(18.0%) cases. Fifty six percents of patients had GBS disability score of 0 to 2, 38.0% had 3 to 4 and only 6.0% had 5 to 6. Majority of the patients had Brighton criteria level 1 certainty of diagnosis (62.0%) in this study. GBS variants according to nerve conduction studies were AIDP (54.0%), AMAN (34.0% and AMSAN (12.0%). CSF protein was raised in 72.0% cases. Patients diagnosed with AMAN and AMSAN had worse outcome after 3 months in comparison to AIDP group of patients if we consider GBS disability score.

Conclusion: GBS has been found more in younger and male population group in this present study where Antecedent events were not found in majority of the patients. AIDP was the commonest variant in our study with comparatively good outcome followed by AMAN.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):108-115

Evaluation of Expression and Association of ER, PR and Ki67 Tumour Markers in Carcinoma Breast

Sun, 07 Apr 2024 00:00:00 +0000

Background: Several factors contribute to determine tumor prognosis and treatment strategies of breast cancer patients. Use of hormone receptor are relatively new and have proven its efficacy.

Objective: The purpose of the present study was to evaluate the expression and association of ER, PR and Ki67 tumor markers in carcinoma breast patients.

Methodology: In this analytical cross-sectional study, fifty-two adult cases of carcinoma breast with tru-cut biopsy underwent breast conservative surgery (BCS) or mastectomy in the Department of Surgery at Sir Salimullah Medical College and Mitford Hospital. This study excluded patients who had received neoadjuvant therapy, had recurrent breast carcinoma, had extensive metastasis, or had advanced breast carcinoma. Each participant signed an informed written consent form. Demographic information, a detailed history, and a clinical examination were all obtained. All samples were examined histopathologically and immunohistochemically. The immunohistochemistry report was used to collect biomarker data. The relationship between ER, PR, and Ki67 and histopathological findings was then investigated. SPSS 12.0 was used to analyse the collected data.

Results: Half of the patients belonged to age group 51 to 60 years (50%). Majority respondents were from rural area (65%) and maximum were poor (57.7%). Majority respondents were T2 (48.1%) stage of tumor size followed by Tl (36%) and T3 (15.4%). According to histological grading, 44.2% had Grade II tumour, 38.5% had Grade I tumour and 17.3% had Grade III tumour. Among the respondents 80.8% had ductal carcinoma followed by decreasing order 15.4% had lobular carcinoma and 3.8% had others types of carcinoma. Regarding lymph node status, 30.8% had N1 stage lymph node involvement followed 28.8% had N2 stage lymph node involvement 26.9% had N0 stage lymph node involvement and 13.5% had N3 stage lymph node involvement. Among the respondents 65.4% had L0 and 34.6% had LI stage of lymphatic invasion. Moreover, 78.8% had V0 stage vascular invasion and 21.2% had V1 stage vascular invasion. Of the patients, 44.2% had both ER and PR negative and 17.3% had both ER and PR positive. ER positive was found significantly higher among grade I carcinoma, PR positive was found significantly higher among grade I carcinoma and Ki67 was found significantly lower in grade I carcinoma. Among the patient's results had been found significant, ER positivity and PR positivity decline with higher lymph node staging whereas direct relation was present with Ki67. There's a significant decline in ER positivity and PR positivity with lymphatic invasion, but not with Ki67. ER and PR positivity declined with vascular invasion, whereas there was a direct correlation between Ki67 and vascular invasion.

Conclusion: Higher grading, higher lymph node staging, and lymphovascular invasion result in a decline in ER and PR positivity, whereas Ki67 showed a direct correlation.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):116-121

Trend of Patients Attended at Emergency Department of Referral Neurosciences Hospital in Bangladesh

Sun, 07 Apr 2024 00:00:00 +0000

Background: Emergency Department is very important place for the patient.

Objective: The purpose of the present study was to assess the trend of patients attended at emergency department of referral neurosciences hospital in Bangladesh.

Methodology: This was a retrospective study carried out from January 2018 to 2021. This study was carried out in the Department of Microbiology at National Institute of Neurosciences & Hospital, Dhaka, Bangladesh. National Institute of Neurosciences & Hospital, Dhaka has been started its journey from September, 2012. It is situated in the health hub of Sher-E-Bangla Nagar, Dhaka, Bangladesh. This is the only Govt. run tertiary care neuroscience center in Bangladesh. We are having specialized out patient service and 24×7 emergency service. Our 100 bedded comprehensive stroke unit is running. Detailed medical record for each of the study sample was obtained from the record office.

Results: A total number of 180145 cases were found with the duration of three years. This data showed that the number of neurology patients were attended at emergency department of Neurology at National Institute of Neurosciences and Hospital. The trend of patients who were attended at emergency department was stedily increase from January to December of 2020. It was found that a total number of 4786 cases were attended at emergency Department of study place. Later, this trend was increased.

Conclusion: In conclusion the trend is increase from 2019 to 2021.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):122-126

Surgical Reconstruction of Sole by Sural Flap among Patients with Loss of Soft Tissue at Distal Portion of Lower Limb

Md Nazrul Islam, Md Rabiul Islam, Tahmina Begum, Md Moshabbirul Islam — Sun, 07 Apr 2024 00:00:00 +0000

Background: Soft tissue loss on distal one third of leg, around ankle and foot is a big problem. There are many options, but each of them has advantages and disadvantages. Sural fasciocutaneous flap is an option for this problem which has excellent results with minimum morbidity.

Objective: The purpose of the present study was to role of surgical reconstruction of sole by sural flap among patients with loss of soft tissue at distal portion of lower limb.

Methodology: This interventional study was carried out in the Department of Orthopedic Surgery, Ad-Din Sokhina Women’s Medical College, Jashore, Bangladesh from January 2022 to December 2022 for a period of one year. All patients with open fracture on the distal third of the tibia, exposed Achillies tendon, ankle, lateral and medial malleoli or heel reconstruction were performed by sural flap. The flap viability rate and durability of the flap at these sites were evaluated.

Results: 14 patients from 14 to70years old were included in this study. We obtained excellent results with this type of flap in all the patients and success rate was considered as 100% approximately.

Conclusion: With a few limitations, high success rate and collaboratively easy operative procedure; sural flap may be a good option for soft tissue loss at distal leg, ankle and foot.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):127-131

Anthropometric Analysis between Naso-aural Inclination and Their Correlation in Bangladeshi Buddhist Rakhain Ethnic Females

Sun, 07 Apr 2024 00:00:00 +0000

Background: Naso-aural Inclination most prominent structure of the face, influencing facial appearance and profile.

Objective: The aim of the study was to describe anthropometric analysis between naso-aural inclination and their correlation in Bangladeshi Buddhist Rakhain Ethnic females.

Methodology: This cross-sectional observational study was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2011 to December 2011 for a period of one (01) year. Adult healthy Bangladeshi Buddhist Rakhain females in the age group of 18 to 30 years were included as study population. Standard of normative facial anthropometric values related to nose inclination and ear inclination were measured.

Result: A total number of 100 adult healthy Bangladeshi Buddhist Rakhain females were recruited for this study. The mean nose inclination was 29.85±5.59 degree and ear inclination left was 11.93±3.44 degree.

Conclusion: In conclusion the standard of normative facial anthropometric values related to nose inclination is significantly greater than ear inclination among the Bangladeshi Buddhist Rakhain females.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):132-135

Behavior of Non-Hybrid and Hybrid Forms of Fibro-Osseous Lesions in the Cranio-Maxillofacial Region of Patients Attending at the Tertiary Care Hospital in Dhaka City of Bangladesh

Sun, 07 Apr 2024 00:00:00 +0000

Background: Fibro-osseous lesions of the craniofacial complex are represented by a variety of disease processes that are characterized by the nature of ossifications and calcifications.

Objective: The purpose of the present study was to see the behavior of non-hybrid and hybrid forms of fibro-osseous lesions.

Methodology: This was a cross-sectional study at the Department of Oral & Maxillofacial Surgery of Dhaka Dental College & Hospital, Dhaka (DDCH), Shaheed Suhrawardy Hospital, Dhaka (SSH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2004 to December 2005. Participants were selected for the study who attended into outpatient and inpatient departments with fibro-osseous lesions during study period, irrespective of age & sex. patients were included who gave informed consent, patients attended with jaw swellings, and radiologically suspecting as fibro-osseous lesions, Biopsy proven fibro-osseous lesions. All patients were advised initially for radiological examination which includes orthopantomogram (OPG), postero-anterior (P/A) view of skull with mandible, lateral view of skull with mandible. After taking informed consent, biopsy was done. The diagnosis was established initially in all cases preoperatively on the basis of an incision biopsy. Postoperatively every surgical specimen was examined carefully and sectioned to examine the nature of tissue within the tumour and examination of the expansion and perforation of the bone was performed. Then histologic examination was done for re-evaluation.

Result: A total number of 40 patients were included, in Hybrid form, the growth pattern of majority of swellings were slow at first but later rapid (66.7%) while in Non-hybrid form, it was slow always (61.8%). Maximum site of involvement was in mandible (66.7%) in Hybrid form whereas both mandible and maxilla were equally involved in Non-hybrid form. Hybrid form has significantly higher probability of tenderness in comparison with Non-hybrid form (p <0.001). Tenderness was found in all cases of hybrid form (100%) whereas in Non-hybrid form it was 17.6%. Most of size of Non-hybrid swellings were less than 35 sq. cm but for Hybrid form the size were comparatively bigger. In Non-hybrid form, only 2.9%% of swellings were hard and egg shell crackling but it was 33.3% for Hybrid form and the difference was significant. Recurrent bleeding from the swellings was noted in few cases of hybrid form (33.3%) but it was noted in minority of non-hybrid form (5.9%).

Conclusion: In conclusion the behavior of non-hybrid and hybrid forms of fibro-osseous lesions is varied from each other.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):136-140

Effects of Carbetocin and Oxytocin on Haemodynamic among Women with Post-Partum Hemorrhage after Caesarean Section: A Single Blind Parallel Arm Randomized Controlled Trial

Sun, 07 Apr 2024 00:00:00 +0000

Background: Management of haemodynamic among women with post-partum hemorrhage after caesarean section.

Objective: The purpose of the present study was to compare the effect of carbetocin and oxytocin on haemodynamic among women with post-partum hemorrhage after caesarean section.

Methodology: This randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2015 to December 2015 for a period of six months. Pregnant women diagnosed on the standard criteria admitted in BSMMU, Dhaka, Bangladesh were selected as study population by consecutive type of sampling. Randomization was performed according to computer generated simple random sampling method. An Uterotonic was an agent used to induce contraction or greater tonicity of the uterus. Then the patients were monitored per operatively and post operatively. All the information was recorded in data collection sheet. Main outcome variables were estimated blood loss.

Results: A total number of 96 pregnant women were recruited for this s tudy of which 48 cases were enrolled in group I and the rest of 48 case were enrolled in group II. The mean age with SD of the group I and group II were 24.4±4.7 years and 24.7±3.7 years (p=0.729). Before administration of drug, mean systolic blood pressure was found 115.6±5.8 mmHg in group I and 114.8±7.8 mmHg in group II. At 24 hours after caesarean section, mean systolic blood pressure was found 116.9±5.8 mmHg in group I and 113.9±8.8 mmHg in group II (p>0.05). Before administration of drug, mean diastolic blood pressure was found 75.8±7.9 mmHg in group I and 76.9±9.9 mmHg in group II. At 24 hours after caesarean section, mean diastolic blood pressure was found 76.7±6.6 mmHg in group I and 76.1±7.2 mmHg in group II (p>0.05). Before administration of drug, mean maternal blood loss was found 376.4±110.4 ml in group I and 439.4±199.9 ml in group II. At 24 hours after caesarean section, mean maternal blood loss was found 468.2±121.9 ml in group I and 532.6±243.0 ml in group II (p>0.05).

Conclusion: In conclusion the systolic blood pressure, diastolic blood pressure and blood loss are not significantly varied in group I and II.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):141-146

Pattern of Histopathological Grades of Astrocytoma Patients attended at a Tertiary Care Hospital in Dhaka City

Rehana Khanam, Shafeya Khanam, Tasnia Kabir, Ehsanul Kabir — Sun, 07 Apr 2024 00:00:00 +0000

Background: Different grades of astrocytomas are presented as the variant of brain tumour.

Objective: The purpose of the present study was to evaluate the frequency and distribution of different grades of astrocytoma patients.

Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging with the collaboration of Department of Neurosurgery and Department of Pathology at Sir Salimullah Medical College (SSMC & MH), Dhaka from January 2013 to December 2013 for a period of one (1) year. Patients presented with clinically diagnosed cases of intracranial astrocytoma who were attended in the OPD and IPD were selected as study population. The postoperative resected tissues were histopathological examined in the respective department.

Result: The sample size of the present study was 48 astrocytoma patients. The mean age (±SD) was 39.96 years (±12.440). During MRI pilocytic astrocytoma, low grade astrocytoma, anaplastic astrocytoma and glioblastoma multiformis are found in 8.3% cases, 31.2% cases, 52.1% cases and 52.1% cases respectively.

Conclusion: MRI is an effective tool for the diagnosis of astrocytoma.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):147-150

Genetic Basis of Alzheimer's Disease: Bangladesh Perspective

Maliha Hakim — Sun, 07 Apr 2024 00:00:00 +0000

Abstract Not Available

Journal of National Institute of Neurosciences Bangladesh, July 2023; 9(2):96-97

Rare Association between Congenital Dorsal Dermal Sinus with Tethered Cord Syndrome: A Case Report

Sun, 07 Apr 2024 00:00:00 +0000

Congenital dermal sinus tract is an innocent‑appearing spinal dysraphism that may lead to devastating morbidities if not timely addressed. Congenital dermal sinus may be associated tethered cord syndrome. Here we report one patient who is presented at the age of eighteen months with lower limb weakness at Dr. M R Khan Shishu Hospital and ICH and was diagnosed as dorsal dermal sinus with teathered cord syndrome. Our aim is to illustrate the advantages of the early diagnosis of this rare treatable disorder and to prevent neurological sequelae.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):151-156

A Rare Case Report of Acrania

DM Arman, Sudipta Kumer Mukherjee, Joynul Islam — Sun, 07 Apr 2024 00:00:00 +0000

Acrania is a rare congenital anomaly and characterized by partial or complete absence of the calvarium. Although acrania associated with anencephaly is a well-recognized entity but isolated acrania is a rare anomaly. Ultrasound allows early diagnosis of this anomaly. The fetus was found to have a completely formed brain, base of the skull and facial structures but lacking a cranium. Authors present a rare case of acrania.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):157-160

Subclavian Steal Syndrome Presented with Recurrent Syncope: A Case Report

Sun, 07 Apr 2024 00:00:00 +0000

The Subclavian Steal Syndrome is a rare vascular disorder that results from the stenosis of the subclavian artery proximal to the origin of the vertebral artery. This obstruction causes the retrograde blood flow in the ipsilateral vertebral artery called “steal” because it steals blood from the cerebral circulation. We report a case of subclavian steal syndrome in a 57 yrs old male with HTN and CKD. The patient presented to the emergency department of a tertiary-level hospital with a one-week history of recurrent syncopal attack with an injury mark during his last episode. He had no known cardiac structural abnormality. Further clinical examination revealed absent radial and brachial pulse and non-recordable blood pressure in the left arm. Duplex study of the left upper limb arterial system showed left subclavian artery stenosis with the retrograde flow in the left vertebral artery (subclavian-vertebral steal). A coronary angiogram confirmed proximal stenosis of the subclavian artery. The condition was successfully treated with left subclavian stenting.

Journal of National Institute of Neurosciences Bangladesh, July 2023;9(2):161-167