Introduction:Klebsiella pneumoniae are common causative agents of various infections and are of great concern for developing resistance against commonly prescribed antibiotics. This study gives an account of isolation of K. pneumoniae from various clinical specimens and their antimicrobial susceptibility, in a tertiary care hospital of Bangladesh. Materials and Methods: Various clinical specimens like urine, wound swab, sputum, blood and endotracheal aspirates were collected and processed for isolation of K. pneumoniae followed by their antimicrobial susceptibility testing. Results: Among the 316 samples that yielded culture positivity, K. pneumoniae were identified as second most common organism. The highest yield of K. pneumoniae (37.33%) were observed from wound swab followed by sputum (26.67%). Most of the isolates were resistant to sulphamethoxazole-trimethoprim (90.67%) and ceftriaxone (90.67%) followed by cefotaxime (89.33%), ceftazidime (89.33%) and cefuroxime (89.33%). The most sensitive antibiotic for the isolates was tigecycline. Conclusion: Isolated K. pneumoniae showed resistance to commonly prescribed antibiotics, which is very alarming and showing the importance on continuous monitoring and strict antimicrobial policy. Medicine Today 2020 Vol.32(2): 95-99

Background: Extended-spectrum β lactamases (ESBLs) continue to be a major challenge in clinical setups world over, conferring resistance to the expanded-spectrum cephalosporins. Objectives: The aim of this study was to determine the prevalence of extended spectrum β-lactamase (ESBL) in strains of Klebsiella pneumoniae isolated from different clinical specimens in Dhaka Medical College Hospital, Dhaka, Bangladesh. Methodology: This cross sectional study was carried out at the Department of Microbiology of Dhaka Medical College, Dhaka, Bangladesh from July 2016 to June 2017. Klebsiella pneumoniae were isolated from different clinical specimens from adult hospitalized patients. These isolates were screened for ESBL production according to Clinical and Laboratory Standards Institute (CLSI) guidelines. ESBL production was confirmed by the phenotypic confirmatory double disc synergy test (DDST). Results: Among the 500 collected samples 75 Klebsiella pneumoniae were isolated. Among them, 68 isolates were selected for confirmatory tests of ESBL according to CLSI guidelines. Finally, 19 isolates were confirmed as ESBL producers by DDST (25.33%). Conclusion: In the present study, a large number of isolates are found to be ESBL producers. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 101-104

Background: Seller and suprasellar space occupying lesions are frequently encountered intracranial lesions now-a-days. Surgery through transsphenoidal route is the most preferable approach which is frequently performed for excision of these space occupying lesions. The lesions are located in a very critical area because they are surrounded by the hypothalamus, pituitary gland and cavernous sinus which are responsible to maintain various hormonal functions as well as regulation of plasma osmolality and plasma electrolytes. So, during and after operation various types of osmolality and electrolytes related complications are often encountered. Among them serum sodium imbalance is the most frequent one. Objective: Tumour size is one of the very important predisposing factors which influence the serum sodium level after surgery. For investigating the correlation between the size of sellar and suprasellar space occupying lesions with the incidence of postoperative sodium imbalance after transsphenoidal surgery of the patient having these lesions. Material and method: Thirty patients with sellar and suprasellar space occupying lesions meeting the inclusion criteria were enrolled. The largest diameter of the tumour was measured in the coronal or sagittal planes from pre-operative MRI’s. They underwent transsphenoidal surgery and were observed for first 7 postoperative days and serum electrolytes was measured every day. Patients in this study were considered to have serum sodium imbalance if the narrow range of 135-145 mmol/L was not maintained. Then according to the tumour size they were divided in to two groups. Then the two groups were compared and the frequency of development of post-operative sodium imbalance, their time of onset and types of imbalances were observed. Result: 60% of the patients in our study developed post operative serum sodium imbalance after transsphenoidal surgery. Among them 40% of the patients developed hypernatraemia, 13.3% of the patient developed hyponatraemia and only 6.7% patient developed combined imbalance. Hypernatraemia is more common than hyponatraemia after transsphenoidal surgery. Peak incidence of hyponatraemia occurred on 3rd post-operative day and hypernatraemia occurred at 1st postoperative day. In the large size tumour group (>30mm) 46.66% had serum sodium imbalance and imbalance was observed in 13.33% of the small size group (d”30mm) and there is significant difference of sodium imbalance between large and small size group and p-value was 0.001. r- value 0.776 indicates that the size of the tumour strongly correlates with postoperative sodium imbalance and there is significant association between size of the tumour with sodium imbalance. The study found no significant association between age, sex or types of the lesions with postoperative sodium imbalance (p=0.43). Conclusion: Post operative serum sodium imbalance after transsphenoidal surgery is a burning issue for the neurosurgeon now a day. Early prediction of these types of notorious complication is helpful for preoperative and post operative management of the patient. The size of the lesion is one of the most significant markers. As well as a strong association between size of the tumour with post operative sodium imbalance was found. This will help us in perioperative management of the patients, and reduces complication related mortality and morbidity after the transsphenoidal surgery. Bang. J Neurosurgery 2020; 10(1): 82-91

Background: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression. Methods: Seventy patients presented with VS who had undergone operative procedures performed in our unit from 2017 to 2019. The facial nerve function and hearing assessment was done according to House-Brackmann [HB] grading and pure tone audiometry (PTA) respectively. All patients were operated by retro-mastoid suboccipital approach. Results: Most patients had large tumors and had no useful hearing (85%), had disabling cerebellar ataxia (92.86%) and presented with features of raised intracranial pressure (48.57%). Large sized tumors were in 32.86% and giant sized tumors were in 57.14% cases. Complete tumor excision was carried out 92.86% and anatomical preservation of facial nerve was achieved in 73.85% cases. Hearing preservation was achieved in 4 patients. Cerebrospinal fluid leak with or without meningitis and transient lower cranial nerve paresis were common complications. The mortality rate was 7.14%. Conclusions: Complete tumor excision with good facial nerve preservation can be achieved in large vestibular schwannomas. Hearing preservation is difficult in larger tumors. Primary microsurgical resection is an appropriate management option for large VS. In our experience, this goal can be achieved safely and successfully by using the retrosigmoid approach. Bang. J Neurosurgery 2021; 10(2): 175-181

Background: Decompressive craniectomy gives space for brain to allow outward herniation, prevents compression of brainstem structures and reconstruct brain perfusion Duroplasty further decreases ICPObjectives: The objectives of this study was to asses overall outcome of decompressive craniectomy in intracerebral hematoma (ICH), traumatic brain injury (TBI), malignant cerebral infarction and acute subdural hematoma.Methodology: This was a cross-sectional observational study conducted over patients who were undergone decompressive craniectomy subsequently from 2007 to 2014 for a period of seven (07) years. Parameter of outcome was categorized into death, favorable (Glasgow outcome scale GOS 4 or 5) and unfavorable (GOS 2 or 3). Outcome was also assessed according to preoperative GCS. The mean time of measuring outcome was 3 month.Results: The pathology for which DC done was ICH in 19 cases malignant MCA infarction in 3 cases ASH 3 cases TBI 7 cases. Decompressive craniectomy was performed in 32 cases of which 19 cases were intracerebral haematoma, 7 cases were traumatic brain injury, 3 cases were malignant cerebral infarction and 3 cases were acute subdural hematoma. Mean age was 52 years. Male female ratio was 5:3. ICH was more common in elderly age group and age range of TBI was lower than ICH. Preoperative GCS was categorized into two group 3 to 6 and 6 to 9. 14(43.25%) patients were between 3 to 6 and 18 patients 3 to 9 55(25.0%). 11(37.5%) patients died postoperatively, outcome was favorable in 12(37.5%) cases and unfavorable in 9(28.0%) cases. Outcome in relation GCS was in 3 to 6 group 3(21.0%) cases was favorable unfavorable 4(29.0%) and 7(50.0%) cases died in 6 to 9 GCS group. Outcome was favorable in 9(50.0%) cases unfavorable in 5(27.0%) cases and 4(23.0%) patients died post operatively.Conclusion: Decompressive craniectomy bears better outcome in term of survival but the problem is quality of life issue after survival especially in poor GCS (3-6) group.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 80-83