Background: Disorders of sodium (Na+) and water homeostasis are common in hospitalized patients particularly in Intensive Care Unit (ICU). Irrespective of the etiology it is associated with worse outcome and increase length of ICU stay. Objectives: Objective of the current study is to determine the frequency of hyponatremia and its association with the outcome of critically ill Patients admitted in the Department of Critical Care Medicine, BIRDEM General Hospital. Methods: This prospective observational cross-sectional study was taken place in department of Critical Care Medicine for a period of one year from 1st July, 2017 to 30th June, 2018. Consecutive 296 critically ill patients during this time period were included in this study according to selection criteria. Data were collected in preformed data collection sheet and analyzed by the statistical packages for social science (SPSS) software (version 20.0) Results: In this study total 296 patients after fulfilling the inclusion criteria were selected as study participants. The mean age of the patients was 62.21±12.974 years and there were61.5% male and 38.5% female. Among male patients 39.6% had hyponatremia and among female patients 44.9% (p=0.09). Overall frequency of hyponatremia was 41.2%. Majority of the patients presented with respiratory distress (61.5%), altered level of consciousness (33.4%), hypotension (30%) and fever (18.9%). DM (90.5%), HTN (75.5%) and CKD (50.5%) were the most frequent comorbidities present among the participants. Most of the hyponatremic patients were euvolemic (50.00%). Mean APACHE ll score among hyponatremic patients was significantly high (p= 0.001) moreover, hyponatremic patients required more mechanical support (p= 0.001).Duration of ICU stay was not related to severity of baseline hyponatremia during admission (p= 0.08)). In addition, outcome of the patients also depends on the overall incidence of hyponatremia and degree of hyponatremia (p<0.05 in both cases). Conclusion: More than one-third of critically ill patients had hyponatremia and it was related to poor outcome of the critically ill patients. Bangladesh Crit Care J September 2021; 9 (2): 68-73

Background: Stroke is a global health problem, leading cause of death all over the world. It accounts for chronic illness and disability in a large segment of population. It imposes a great loss on economy of the nation due to loss of service of the workforce during illness and extended hospitalization they require during recovery. Stroke continues to have a great impact on public health. It is associated with multiple risk factors and co-morbid conditions. Objective: To find out the hospital outcome of acute stroke patients associated with various risk factors and co-morbidities. Materials and methods: This is a cross sectional observational study, carried out in the department of Medicine and Neurology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh for a period of 6 months. One hundred patients presented with acute stroke diagnosed on clinical & investigational background fulfilling the inclusion and exclusion criteria were enrolled in the study. Stroke severity was assessed using National Institute of Health Stroke Scale (NIHSS) score. Patients’ symptoms, degree of disability or dependence in the daily activities and clinical outcome were evaluated and measured by the modified Rankin Scale (mRS). Result: This study showed that a majority of patients (49%) were in the 51-60 years age group, mean age was 56.81 years. Male and female ratio was 1.38:1. Among all all-risk factors, hypertension is the most common, present in 72% cases; the next most common risk factors were DM (59%), smoking (47%), heart disease (35%), and migraine (14%). About 72% of patients had a mild stroke, 17% of patients had a moderate stroke and 11% of patients had a severe stroke according to NIHSS score at admission. Seventy-four (74%) of them had infarction and the rest had hemorrhage. The study showed that 62% of the patients recovered (mRS score 0 to 2) and among them the maximum were ischemic stroke. 29% had poor outcomes, disabled and they were discharged on request or risk bond (mRS score 3 to 5). 9% expired during hospital stay (mRS score 6). Logistic analysis revealed that age >50 years, hypertension, diabetes mellitus, heart disease, hyperlipidemia, family history of CVD, CAD, past history of stroke / TIA, migraine and peripheral vascular disease were associated with poor stroke outcome. Conclusion: This study shows that the main risk factors & the comorbid conditions for a stroke were hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia and smoking. People suffering from a stroke with these risk factors have poorer outcomes than those with no risk factors & comorbidities. Identifying characteristics of people at high risk of recurrence has important implications for planning secondary prevention strategies to reduce the disease burden. Early detection and prevention of the risk factors can reduce health care burden and disability. Bangladesh Crit Care J March 2022; 10 (1): 15-18

Background: Cirrhosis is the end stage of chronic liver disease, resulting in formation of fibrous tissue, derangement of liver architecture and ultimately results in portal hypertension and its complication. Objective: To find out the correlation between splenic size and endoscopic grading of esophageal varices in diagnosed cases of cirrhosis of liver. Methods: This prospective observational cross-sectional study was carried out in the Department of Radiology and Imaging in collaboration with GHPD, BIRDEM, Dhaka. 110 liver cirrhosis patients with or without esophageal varices diagnosed by endoscopy of UGIT referred to the department of Radiology and Imaging were included in this study on the basis of selection criteria. Result: The following observations and results were obtained in this study the mean age was 44.81 (±14.42) years, minimum age was 18 years and maximum age was 65 years. Majority 69% were male and 31% were female. Esophageal variceal grading of the study population majority 47(42.73%) were grade I, 24(21.82%) were grade II, 16(14.55%) were grade III, 12(10.91%) were grade IV and 11(10%) were no varices. Splenic size by ultrasonography, majority 66(60%) were 12-14.9 cm, 37(33.64%) were ≥15 cm and 07(6.36%) were < 12 cm. In splenic size ≤ 15 cm, grading of esophageal varices, 15.07% had no varices, 60.27% had grade I, 20.55% had grade II, 2.74% had grade III and 1.37% had grade IV. In splenic size ≥ 15 cm grading of esophageal varices, 8.11% had grade I, 24.32% had grade II, 37.84% had grade III and 29.73% had grade IV. That means there is a positive correlation between ultrasonographically measured splenic size and endoscopic grading of esophageal varices in liver cirrhosis patients. Conclusion: Positive correlation was found between ultrasonographically measured splenic size with endoscopic grading of esophageal varices. Bangladesh Crit Care J March 2022; 10 (1): 57-61

Background: Hepatocellular carcinoma (HCC) is a common cancer in humans. Its mortality ranks third among human malignancies. Cirrhosis of liver is a major contributor to hepatocellular carcinoma, about in 80% of the affected individuals. Fine needle aspiration cytology (FNAC) of the liver which is a minimal invasive procedure is essential to sort out primary and secondary neoplasm of the liver. Objective: The aim of this cross-sectional study was to determine the accuracy of ultrasound for diagnosis of HCC in comparison with FNAC findings. Materials and Methods: This study was done in the Radiology & Imaging Department in Enam Medical College & Hospital, Savar, Dhaka in collaboration with the Department of Pathology of the same institution for FNAC correlation during October 2017 to November 2019. A total number of 50 patients with CLD with known hepatic mass, referred to the department were included in the study. Ultrasound was done with TOSHIBA using low frequency curvilinear probe of 3.5 MHz. USGguided aspirations was performed using 18G needle under full aseptic measure. USG findings were validated by histopathology reports. Analysis was done by SPSS 19.0. Results: Mean age of the study population was 58.6 ± 10.9 years, of whom 37(74%) were male and 13 (26%) were female. Mean size of the hepatic lesions was 4.7 ± 1.08 cm. The lesions were characterized as iso-, hypo- and hyperechoic as compared with hepatic parenchyma. Doppler study shows both central and peripheral vascularity. Compared with FNAC findings, accuracy of USG findings was determined. Sensitivity of USG in detection of HCC was 97.7%, specificity was 66.7%, and positive prediction value 95.6% and negative prediction value 80%. Conclusion: Conventional USG can be used as a screening method in patients with CLD having hepatic masses. However, further workup is required for definite diagnosis. J Enam Med Col 2020; 10(3): 153-158