Background: The use of epidural catheters provides the best quality intra- and post-operative pain relief for various major thoraco-abdominal and lower limb surgeries. The process of placing an epidural catheter into the epidural space between the vertebrae can be challenging due to variations in spinal anatomy of different level, narrow intervertebral spaces and can cause catastrophic neurological complications. Though various studies have been shown to overcome the placement of epidural catheter using standard ultrasound method, using the pre-existing computer tomography depth correlate with loss of resistance in placing the epidural catheter would be a well adjunct tool for the procedure. Objectives: To correlate measurements taken from pre-existing computed tomography (CT) imaging to the loss of resistance depth as recorded during epidural placement. Methods: This Single procedural observational study was performed in Combined Military Hospital (CMH), Dhaka from 1st December 2018 to 30th November 2019. Fifty adult patients scheduled for lower abdominal and lower limb surgery under epidural anaesthesia (EA). The patient’s advised/routine abdominal CT film was inspected by a radiologist, who was blinded to the results of the actual needle length, to determine the distance from the skin to the ligamentum flava the corresponding level of L2 to L5 interspinous spaces. The distance on the CT film in the midline was measured using a ruler against the measurement scale, conventionally represented as a 5 cm-10 cm scale with 1-cm divisions. The CT-derived depth was calculated using the principle of Pythagorean triangle trigonometry. Result: In this study, Sixty eight percentages of patients (68%) Epidural- skin distance (ESD) had 4.7-6.8cm. Mean Epidural-skin distance 5.8±1.7cm. On evaluation of Loss of Resistance Depth, 46% of patients had 5.2-7.3cm depth of LOR, followed by 30% patients had 3.0-5.1cm and 12% patients had 7.4-9.5cm. Mean loss of resistance depth was 6.3±1.4 cm. It was evident from this study that positive significant correlation (r=0.941; p=0.001) between the CT-derived distance and Loss of Resistance Depth. Conclusion: It is conclude that using pre-existing CT-scan derived distance is helpful in prediction of the epidural space depth and it is correlates with actual loss of resistance epidural needle insertion depth placing the catheter in lumber region.

Introduction: Acute meningitis is a major cause of death and disability worldwide. Differentiating bacterial from nonbacterial meningitis is very important in deciding on treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic meningitis which carries relatively better outcomes. Aim of the study: The aim of the study was to identify the importance of the CSF-CRP test in diagnosing acute bacterial meningitis. Methods: This cross-sectional observational study was conducted at the Department of Pediatric Medicine, Dhaka Shishu Hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2017 to June 2017. A total of 100 children visiting the inpatient department of the hospital were selected for the present study following inclusion and exclusion criteria. Result: 57% were diagnosed as bacterial meningitis cases, while 43% were diagnosed with aseptic meningitis. Among the 57 cases of bacterial meningitis, 61.40% belonged to the youngest age group of 0-2 years, while among the aseptic meningitis cases, 37.21% belonged to the age group of 3-6 years. Total WBC and PBN were significantly higher among the bacterial meningitis cases. The sensitivity of CSF-CRP was 89.47%, specificity 90.69%, accuracy 90%, a positive predictive value of 92.72%, and a negative predictive value of 86.66% in diagnosing bacterial meningitis. Conclusion: The study findings conclude CSF-CRP to be an important prognostic factor and initial testing method in diagnosing acute bacterial meningitis. CSF CRP has high diagnostic accuracy in determining the incidence of acute bacterial meningitis.

Background: Moderate to severe pain develop after knee surgery results prolong hospital stay and delay return to normal daily activities. Various analgesic modalities have been used for postoperative analgesia in patients undergoing knee surgery. Both femoral nerve block (FNB) block and fascia iliaca compartment block (FIB) are used routinely for postoperative pain relief in patients undergoing knee surgery. Objectives: To compare the efficacy of postoperative analgesia of FNB & FIB in postoperative period among patients undergoing knee surgery under sub- arachnoid block. Methods: This Randomized Clinical Trial was performed in Combined Military Hospital (CMH), Dhaka from July 2020 to December 2020. Forty patients scheduled for routine knee surgery under sub-arachnoid block belonging to ASA class I, II and III were included in the study and randomly divided into two groups with 20 patients in each group. At the end of surgery, In Group A (n= 20) femoral nerve block was employed & in Group B (n=20) fascia iliaca compartment block was employed. Results: Significant relief of pain occurred in recovery room in group B than group A (3.67±0.802 vs 4.3±0.877; p<0.05). This improvement was noticed in group B at 6 and 24 hours follow up (p<0.05 in all follow up). Post-operative analgesic consumptions was also lower in group B at 1, 12 & 24 hours follow up (p<0.05 in all follow up). Demographic characteristics were similar across the two groups in terms of age, sex, BMI and ASA grading (p>0.05 in all cases). No significant difference was noted in both pre-operative, post-operative and recovery room heart rate (p>0.05) and mean arterial pressure (p>0.05). Complication was similar in both groups. Conclusion: Fascia iliaca compartment block (FIB) for management of post-operative analgesia in knee surgery is more effective than femoral nerve block (FNB).

Introduction: Bacteria that enter the bloodstream and mobile to the brain cord cause bacterial meningitis. The disease is less frequent in developed countries compared to developing countries. In Bangladesh, bacterial meningitis constitutes 25% and the case fatality rate was 14%. The mortality from meningitis is near 100% in untreated individuals and can still be up to 40% in children who received appropriate antibiotic therapy in developing countries. Aim of the Study: The study aims to investigate the specificity, sensitivity, and diagnostic accuracy of CSF-CRP in the diagnosis of Acute Bacterial Meningitis (ABM). Methods: An observational cross-sectional study was carried out in the Department of Pediatric Medicine, Dhaka Shishu Hospital (DSH), from 01 Jan-2017 to 30 Jun-2017. A total of 100 patients were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. Result: Among the study population majority of patients (43, 43.0%) were 0-2 years old. One-third of bacterial meningitis (35,35.0%) occurs commonly at an early age (0-2 years). Out of fifty- seven cases (n=57) of bacterial meningitis, twenty-two cases were culture negative and thirty-five cases were culture positive. In the case of bacterial meningitis, in fifty-one cases (51,89.4%) out of fifty-seven, the CSF CRP test was truly positive, with mean±SD 21.7±10.9, false negative were only six cases (6, 10.5%). In aseptic meningitis thirty-nine cases (39,90.6%) out of forty-three cases, the CSF-CRP test was truly negative, and false positive were four cases (4,9.3%). The sensitivity of CSF CRP in differentiating bacterial meningitis from aseptic meningitis was 89.47%, specificity 90.69%, & diagnostic accuracy was 90%. Conclusion: Bacterial meningitis is fatal and more communal in children under one year of age to sixteen years of age. Increased consciousness and initial gratitude and apposite antibiotic treatment can decrease morbidity and mortality. Diagnostic accuracy can be applied as the initial test for the diagnosis of bacterial meningitis.