The stroke patients comprise a large number of hospital admissions and stroke is one of leading cause of significant mortality and morbidity. This prospective observational study was carried out among 100 hospitalized stroke patients admitted into different medicine units of Chittagong Medical College Hospital (CMCH), with a view to study clinical presentation and epidemiology of stroke. Data, collected in prescribed protocol, were analyzed in simple statistical percentage and cases were selected irrespective of age and sex. Stroke was found most commonly in 51-60 age group (45%in hemorrhagic and 51.75% in ischemic stroke).Most of the patients were male with male, female ratio 3:1 in hemorrhagic stroke and 1.35:1 in ischemic stroke. Most of the patients were from rural area (60% in hemorrhagic stroke and 57.5 in ischemic stroke). Ischemic stroke was found in 80% cases and hemorrhagic stroke was found in 20% cases. The commonest presentation in both ischemic and hemorrhagic stroke was hemiplegia or hemiparesis. Rightsided hemiparesis was the predominant finding in both types. Headache (60%) and vomiting (75%) were found to be more common accompaniment of hemorrhagic stroke. In case of ischemic stroke the association with these clinical features was less marked where headache was present in 46.25% and vomiting in 40% cases. 50% of patients of hemorrhagic stroke presented with Glasgow Coma Scale (GCS) level 9-12(grade2) and 5% with GCS level 4 - 8(Grade 3). Whereas, 52.5% of patients of ischemic stroke presents with GCS 9-12 and also 46.25% with GCS13-14 (grade 1). Hypertension was the commonest risk factor associated with both types of stroke. In hemorrhagic stroke it was 80% and in ischemic stroke it was found in 56.25% eases. Smoking was associated with 50% of hemorrhagic and 55% of ischemic stroke. Diabetes mellitus was associated with 26.25% of ischemic stroke   doi: 10.3329/jom.v10i2.2820 J MEDICINE 2009; 10 : 86-89

Background: Feeding is a basic component of care and it is the most common and difficult management issue for stroke patients.

DOI: 10.3329/jom.v11i2.5465J MEDICINE 2010; 11 : 167-169

Snake bite is a serious global health problem. Incidence is high in Bangladesh and mortality is identified to be one of the highest in the world. Most bites are occurred by nonpoisonous snakes and as many as 40% bites inflicted by venomous snakes do not produce features of envenoming. They need supportive treatment only. Poisonous bites are treated with antivenin. But most people apply tight tourniquet and take useless and harmful treatment from traditional healers before getting admitted in hospital. Delay in diagnosis and treatment causes fatality in many cases. 46 patients admitted in department of Medicine, MMCH from April,07 to March,08 with snake bites were studied. Among them 35% were poisonous and 65% were nonpoisonous bites. Male and female ratio was 3.6:1. Mean age (years) was 34.9 ± 16.2 SD. Mean time of interval between bite and hospitalization (hours) was 7.8 ± 9.5 SD. 94% bites occurred in land and 7% in water. 100% patients applied multiple tourniquets in the affected limb. 24% patients received treatment from traditional healers with development of cellulitis in 64% of them. None received proper first aid management. Most incidences were in July - August. Snakes could not be identified in 50% poisonous and 77% non-poisonous cases. Among the identified poisonous snakes, kraits were 84%. Clinical features were also suggestive of krait bite in 88% poisonous cases. Among poisonous cases, 94% presented with neurological manifestation and ptosis was present in all of them. 75% poisonous snake-bite patients received antivenin and none of them developed anaphylaxis. Among 4 poisonous snake bite patients who did not receive antivenin, 2 survived. Mortality in poisonous cases was 44%. All of the non-poisonous cases improved with supportive treatment. DOI: 10.3329/jbcps.v27i2.4249 J Bangladesh Coll Phys Surg 2009; 27: 70-75

Objectives General: To assess the safety, efficacy and dose response of convalescent plasma (CP) transfusion in severe COVID-19 patients Specific: a. To identify the appropriate effective dose of CP therapy in severe patients b. To identify the efficacy of the therapy with their end point based on clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality c. To assess the clinical improvement after CP transfusion in severe COVID-19 patients d. To assess the laboratory improvement after CP transfusion in severe COVID-19 patients Trial Design This is a multicentre, multi-arm phase II Randomised Controlled Trial. Participants Age and sex matched COVID-19 positive (by RT-PCR) severe cases will be enrolled in this trial. Severe case is defined by the World Health Organization (W.H.O) clinical case definition. The inclusion criteria are 1. Respiratory rate > 30 breaths/min; PLUS 2. Severe respiratory distress; or SpO2 ≤ 88% on room air or PaO2/FiO2≤ 300 mm of Hg, PLUS 3. Radiological (X-ray or CT scan) evidence of bilateral lung infiltrate, AND OR 4. Systolic BP < 90 mm of Hg or diastolic BP <60 mm of Hg. AND/OR 5. Criteria 1 to 4 AND or patient in ventilator support Patients’ below18 years, pregnant and lactating women, previous history of allergic reaction to plasma, patients who have already received plasma from a different source will be excluded. Patients will be enrolled at Bangabandhu Sheikh Mujib Medical University (BSMMU) hospital, Dhaka medical college hospital (DMCH) and Mugda medical college hospital (MuMCH). Apheretic plasma will be collected at the transfusion medicine department of SHNIBPS hospital, ELISA antibody titre will be done at BSMMU and CMBT and neutralizing antibody titre will be checked in collaboration with the University of Oxford. Patients who have recovered from COVID-19 will be recruited as donors of CP. The recovery criteria are normality of body temperature for more than 3 days, resolution of respiratory symptoms, two consecutively negative results of sputum SARS-CoV-2 by RT-PCR assay (at least 24 hours apart) 22 to 35 days of post onset period, and neutralizing antibody titre ≥ 1:160. Intervention and comparator This RCT consists of three arms, a. standard care, b. standard care and 200 ml CP and c. standard care and 400 ml CP. Patients will receive plasma as a single transfusion. Intervention arms will be compared to the standard care arm. Main outcomes The primary outcome will be time to clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality. The secondary outcome would be improvement of laboratory parameters after therapy (neutrophil, lymphocyte ratio, CRP, serum ferritin, SGPT, SGOT, serum creatinine and radiology), length of hospital stay, length of ICU stay, reduction in proportion of deaths, requirement of ventilator and duration of oxygen and ventilator support. Randomisation Randomization will be done by someone not associated with the care or assessment of the patients by means of a computer generated random number table using an allocation ratio of 1:1:1. Blinding (masking) This is an open level study; neither the physician nor the patients will be blinded. However, the primary and secondary outcome (oxygen saturations, PaO2/FiO2, BP, day specific laboratory tests) will be recorded using an objective automated method; the study staff will not be able to influence the recording of these data. Number to be randomised (sample size) No similar study has been performed previously. Therefore no data are available that could be used to generate a sample size calculation. This phase II study is required to provide some initial data on efficacy and safety that will allow design of a larger study. The trial will recruit 60 participants (20 in each arm). Trial Status Protocol version 1.4 dated May 5, 2020 and amended version 1.5, dated June 16, 2020. First case was recruited on May 27, 2020. By August 10, 2020, the trial had recruited one-third (21 out of 60) of the participants. The recruitment is expected to finish by October 31, 2020. Trial registration Clinicaltrials.gov ID: NCT04403477. Registered 26 May, 2020 Full Protocol The full protocol is attached as an additional file, accessible from the Trial’s website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.