Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p<.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.

Background: This study was carried out to see the association of the low total cholesterol level with primary Intracerebral Hemorrhage (ICH) in Bangladeshi population.Materials and Methods: This was a case–control study carried out in the department of Neurology, Chittagong Medical College and Hospital from January 2013 to December 2013. Total of 132 patients were enrolled where 67 patients of hemorrhagic stroke were in the experimental group and 65 age and sex matched persons were in the control group. Low total cholesterol was designated as level less than 200mg/dl. Data were analyzed and compared by SPSS version 19.Results:The proportion of ICH patients with low total cholesterol was significantly higher than the controls (74.6% vs. 32.3%). Mean total cholesterol was also significantly low in ICH patients compared with controls (180 mg/dL vs. 217 mg/dl; P-value = 0.001). Low-density lipoprotein cholesterol (LDL-c) and triglycerides were also significantly low in ICH patients compared with controls. Mean LDL-c in the ICH patient group was 106 mg/dL, whereas it was 128.5 mg/dL in the control group (P-value = 0.001). There was no significant difference in the high-density lipoprotein (HDL) levels in both groups. Although lower mean cholesterol was seen in both young and older individuals in the ICH group than in controls, the difference was significant only in the older group (age >60 years). In multivariate analysis, odds ratio of low cholesterol in the hemorrhage cases was 6.03 (95% CI = 2.1–16.059) which was adjusted other risk factors of hemorrhagic stroke.Conclusions: The inference of this study is that, there is an increased risk of primary ICH associated with low total cholesterol, especially in older individuals.Bangladesh Crit Care J March 2018; 6(1): 26-30

Background: There is growing evidence that the incidence of Postdural Puncture Headache (PDPH) after Lumber Puncture (LP) with the smaller, non-cutting needle is less. Nevertheless, larger, cutting needles are still widely used for this procedure in Bangladesh. The aim of this study was to compare the incidence and severity of PDPH between 22 G standard needle and 25 G atraumatic needle for diagnostic LP in patients with neurological symptoms. Methods and materials: This single-blind, randomized, controlled trial was carried out in Department of Neurology, Chittagong Medical College Hospital, during February 2017 to January 2018. One hundred consecutive patients admitted in Neurology ward fulfilled the set inclusion and exclusion criteria were enrolled in the study and randomly divided into two equal groups: Group A (LP was done with 22 G standard needle) and Group B (LP was done with 25 G atraumatic needle). The incidence and severity of PDPH was interviewed on day 5 following LP. Results: Effective sample size was 99 (50 in Group A and 49 in Group B) as one patient was dropped out. Both groups were similar in terms of baseline sociodemographic and clinical characteristics. LP was successful in first attempt in 25 (50%) and 28 (57.8%) patients in Group A and Group B respectively. Incidence of PDPH was significantly higher in Group A than Group B. Severity of PDPH was also significantly higher in Group A than in Group B with regards to presence of moderate degree of PDPH. Analgesics use was significantly less in Group B in comparison to Group A. Absolute adjusted risk of mild to moderate PDPH with 25G atraumatic needles was reduced by 3.74 times (95% CI: 1.22-11.44) compared to 22 G standard needle. Conclusion: 25 G atraumatic needles significantly reduced the incidence and severity of PDPH as compared to 22G standard needle. So, using 25 G atraumatic needle would be beneficial for diagnostic LP procedure. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 67-71