Background: Chronic subdural hematoma (CSDH) is an increasingly common neurological disease in daily neurosurgical practice. Despite the wide prevalence of CSDH, there remains a lack of consensus regarding numerous aspects of its surgical management. The diagnosis and treatment are well established but there are different surgical procedures and outcome related to these procedures are not completely understood.Methods: The study conducted was conducted in department of neurosurgery at Ibrahim cardiac hospital and research institute, Dhaka, Bangladesh between January 2019 to July 2020, 105 patients were treated for chronic subdural haematoma This study evaluated the clinical features, radiological findings and surgical outcome by mini craniotomy assessed by modified Rankin scale (mRS) score and Glasgow outcome scale (GOS) score in a large series of patients treated at single institution.Results: At 6 months follow up, only one patient died (0.95%) because of co-morbidities and not directly related to the chronic subdural haematoma, 15 patients (14.3%) improved to mRS 0, 33.33% showed only mild symptoms without any significant disability-mRS 1, slight disability was observed in 28.5% patients, moderate disability was observed in 17.14% patients-mRS 3, moderately severe disability was observed in 5.7%-mRS 4.Conclusions: GOS score at 6 months follow up which shows majority of the patient improved to GOS score 4 (45.71%) and 5 (38.09%). Based on these results, among various method of surgical management, mini craniotomy provides better outcome.

Background & Objective: The purpose of the study was to evaluate the clinical presentation and severity of community acquired pneumonia in adults. Methods: The present cross-sectional study was conducted in Sir Salimullah Medical College & Mitford Hospital, Dhaka over a period of 1 year. Patients admitted with the symptoms and signs suspected of pneumonia and confirmed by clinical examination and necessary investigations were the study population. The baseline characteristics, patients’ behavioural factors, presenting complaints, co-morbidities, examination findings and investigations were recorded. Data were processed and analyzed using software SPSS (Statistical Package for Social Sciences), version 11.5. The test statistics used to analyze the data were descriptive statistics. Result: In the present study, a large proportion of patients were 50 years or more than 50 years with mean age of the patients being 46.4 ± 13.3 years. A male predominance (58%) was observed in the series. Over half (56%) of the patients was smoker and 8% were alcoholic. Fever (90%) and purulent sputum (70%) were the common complaints. The second most common complaints were chest pain and haemoptysis (each of 44%). Thirty eight percent of the patients had dyspnoea and a very few had other symptoms. Eighteen percent of the patients had COPD, another 18% had diabetes and 4% had cardiac insufficiency. About one-quarter (24%) of the patients had agitation stupor, 88% bronchial breathing and 68% crackles. Right lower lobe (31%) and right middle lobe (26%) were commonly affected by pneumonia of the patients detected with a chest X-ray. Assessment of severity pneumonia by CURB-65 score shows that 83% of the patients had mild (score 0 – 1) CAP, 12% had moderate (score 2) and 5% had severe CAP (score 3 or more).Over two-thirds (68.5%) of the patients exhibited positive sputum for Gram’s stain. Conclusion: The study concluded that CAP is more likely to occur in older males with preexisting comorbidities like diabetes and COPD. Fever and purulent cough are the predominant presentation of CAP followed by chest pain and haemoptysis. Pneumonic consolidation on chest X-ray and +ve gram stain are diagnostic of CAP, while raised total count of WBC with neutrophilic leucocytosis are supportive to it. Assessing pneumonia severity by CURB-65 scoring system revealed that severe pneumonia (score 3 or more) is now a rarity. Patient evaluation should focus on severity of illness, patient age, comorbidities, clinical presentation, epidemiologic setting, and previous exposure. The majority of patients with CAP are treated empirically based on the most common pathogen(s) associated with the condition. Ibrahim Card Med J 2020; 10 (1&2): 51-56

from July 2010 to December 2010 with a sample size of 30 to observe the presenting feature, radiological findings and complications of burrhole aspiration of intracerebral haematoma by using urokinase. Purposive Sampling technique was used using a semi-structured data collection sheet designed for this study. Equipments used for the study were CT Scan, Soft catheter' and Standard burrhole instrument. It was observed that 73% of the cases were within 9-12 GCS. Basal ganglion was involved in about 77% cases while fronto parietal lobe was involved in only 3% cases. CT scan revealed that half [15 (50.00%)] of the patients' haematoma was in the left hemisphere. Without considering the volume of extension into the ventricles, the average intracerebral haematoma volume was 41.43 ml and the volume ranged from 20.0 to 80.0 ml. 18 (60.0%)] of the patients' had ventricular extension of the haematoma. Three-fifth of the haematomas were complicated with ventricular extension. More than one-fourth of the patients [8 (26.67%)] died before 3rd POD. In a single (3.33%) patient GCS decreased. Out of the remaining 21 cases, GCS increased 1 to 5 points. Pneumocephalous was the complication in about 17% cases, while accidental catheter withdrawal and aspiration pneumonia were the complications in about 7% each. It was revealed that 50% deaths were due to respiratory failure and all these deaths were before 3rd POD. Involvement of different areas of the cerebral hemisphere had strong association in outcome, when only death was considered; i.e. only 14.3% patients with cortical haematoma died on the contrary, 85.7% patients with ICH in the basal ganglia with ventricular extension (3 or more ventricles) died. Early treatment (within 24 hours of occurrence) by using minimally invasive technique and clot removal by urokinase mediated clot lysis can improve the consequences especially those with haematoma volume <40 ml, lobar haematoma and without ventricular extension.

Pancytopenia is a triad of simultaneous presence of anemia, leucopenia and thrombocytopenia. It is result from a number of disease processes. Both hematopoietic and nonhematopoietic conditions manifest with features of pancytopenia.Methods: This was a cross-sectional study carried out in the Department of Medicine, Dhaka Medical College Hospital between December 2016 to July 2017. We included adult patients of both sexes having age 16 years and above. Criteria for inclusion were persistent pancytopenia on peripheral blood film of more than one week duration. All patients underwent a detailed medical history and full physical examination followed by blood sampling for the investigations. After taking all the aseptic measures and with standard technique the diagnostic bone marrow aspiration and trephine biopsy were done.Results: There were 36 patients with pancytopenia which were included in this study. There were 20 (56%) males and 16 (44%) females with a 1.25:1 male to female ratio and a mean age 47.30 years ± 15.01 SD. The most common complaints were bleeding manifestation (29/36), followed by generalized weakness (27/36) and fever (25/36). Anaemia was the most common (100%) clinical feature followed by jaundice and splenomegaly (6/36). Aplastic anemia was the commonest cause that was observed in 27.78% (10/36) cases followed by Megaloblastic anemia 16.67% (6/36) and erythroid hyperplasia 13.88% (5/36).Conclusion: Aplastic anaemia is leading cause of pancytopenia in this study followed by megaloblastic anaemia and hypersplenism being second and third common causes respectively. Pancytopenia should be suspected on clinical grounds when a patient presents with unexplained anemia, prolonged fever and tendency to bleed.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 157-161

Background: Intraventricular hemorrhage (IVH) is an acute neurosurgical condition. The aim of this study was to identify the relationship between modified Graeb score (mGS) and intraventricular hematoma volume with Glasgow outcome scale (GOS) and modified Rankin scale (mRS).Methods: This is a Quasi-experimental study conducted in the department of neurosurgery, Chittagong Medical College Hospital, Chittagong, Bangladesh during the period from 24 July 2018 to 23 July 2019. After a detailed history and clinical examination, 150 patients were selected for this study. The study participants were divided into two major groups- external ventricular drainage (EVD) and conservative; both groups consisted of 44 patients. Written informed consent were taken from the participants. Data were analyzed using statistical package for the social sciences (SPSS) software.Results: Overall mean age was around 60 years with an age range from 15-85 years. More than three fourth of the patients in both groups were from the age group of >50 years (73.83%). There were no differences between EVD and conservative groups regarding medical comorbidities. Most prevalent comorbidity among the patients of both groups’ hypertension, followed by diabetes and previous ischemic stroke. Overall the most frequent symptoms in the studied patients were vomiting, followed by loss of consciousness, headache and convulsion. There were no significant differences between the two groups regarding presenting symptoms. The mean Glasgow coma scale (GCS) score level was significantly lower in the patients with EVD than their counterpart from 1st post-operative day to 8th post-operative day. However, within-group comparison shows that the GCS score was significantly increased from 1st day to 8th day in both groups of patients.Conclusions: These findings can be used to identify patients in whom an EVD may provide measurable outcomes benefit with respect to patient mortality and help guide neurosurgical decision-making in particular patient subgroups with acute IVH.