Association of CSF Total Protein with Clinical Heterogeneity, Disease Severity and Electrophysiological Pattern in GBS Patients.

Guillain-Barre Syndrome (GBS) is considered as an immune mediated inflammatory disease of peripheral nerves and nerve roots. The significance of CSF total protein (CSF-TP) in subtypes of Guillain-Barre syndrome has not been well established. This observational, cross sectional study's aim was to identify association of CSF total protein with clinical heterogeneity, disease severity and electrophysiological subtypes in GBS patients. This study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from September 2017 to February 2019 on 50 (fifty) admitted GBS patients as per inclusion and exclusion criteria. About 3-5 ml of CSF was taken around 10±2 days from disease onset for detection CSF cell count and protein. Pattern of clinical presentation, disability status by Hughes scale and NCS findings of these patients was documented. Mean CSF-TP were substantially higher for Sensori-motor GBS (195.42 mg/dl) and GBS with cranial involvement (226.12 mg/dl) than that of GBS with motor (134.00 mg/dl) and autonomic involvement (155.21 mg/dl). Mean CSF total protein (CSF-MTP) in severely ill GBS patients (Grade-IV) was 217.04 mg/dl and very severely ill GBS patients (Grade-V) was 138.00mg/dl which was significantly higher than mean CSF total protein in mild GBS patients (CSF-MTP: 99.86mg/dl) and moderately ill GBS patients (CSF-MTP: 172.00 mg/dl). Mean CSF total protein is 245.00mg/dl in AIDP which is also higher than mean CSF total protein of AMAN (153.36 mg/dl) and AMSAN (165.17mg/dl). CSF-TP is thought to be a sensitive test for GBS in the second week after onset, but it may be a reliable predictor of clinical severity. There is a significant association of CSF-TP elevation with demyelinating electrophysiologic pattern.

Clinical Profile of Parkinson's Disease Patients in a Tertiary Hospital.

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. The pathogenesis of PD is yet unknown. Aim of this study was to analyze the clinical profile of patient with early Parkinson disease. A total of seventy-six early Parkinson's disease patients were enrolled in this cross-sectional observational study which was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2014 to March 2016. Analysis of the history and clinical findings were done among these patients. This study was performed with 76 early Parkinson disease patients. Among them, male and female were 69.7% and 30.3% respectively. The mean±SD age of patients was 53.25±11.53 years with an age range of 24 to 77 years. The patients were found in primary level accounted for 42.1% which was followed by secondary 19.7% and illiterate or non-formal education 17.1%. Only 5.3% study population was found in post-graduate. Occupant as 28.9% were service holder, 26.3% as a housewife, 1.3% as business and 43.5% other occupations. Regarding smoking, 28.9% was a current smoker, 59.2% non-smoker and 11.8% ex-smoker. Of them, 11.8% had a family history of Parkinson's disease. Of the total population, 30.3% had dyslipidemia, 21.1% had hypertension, and 7.9% had diabetes mellitus. Males are predominant in affecting this disease. Middle aged people are vulnerable to it. Parkinson's disease is common in nonsmoker and dyslipidaemia. Few patient had family history of Parkinson's disease.

Ice test in diagnosis of ocular myasthenia.

This observational, non-control, non equivalent pretest and post test descriptive study was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2009 to December 2009 to compare the efficacy of ice test and repetitive nerve stimulation (RNS) in diagnosis of ocular myasthenia gravis. Ten patients with fluctuating ptosis (4 male and 6 female) who were suspected of having ocular myasthenia were included in the study. Male and female ratio in the study was 2:3. The mean age of the patients was 28.1 years. Positive response to pyridostigmine was taken as confirmation of ocular myasthenia. A piece of ice (2cm × 1cm) was placed over the upper eyelid for 2 minutes and the vertical eye lid fissure height was noted before and after the application of ice. Repetitive nerve stimulation was performed in the same subjects subsequently. Results of two tests were compared. Eight patients shows good (>2mm) elevation of eyelid with ice and three patients had abnormal RNS. In conclusion, ice test appears as more sensitive clinical test to detect ocular myasthenia than RNS test.

Urinary microalbumin as a risk factor for ischaemic stroke.

Microalbuminuria (MA), a microvascular irregularity of the blood - urine interface within kidney glomeruli, may reflect the renal sign of global endothelial dysfunction, and has been associated with an elevated risk of serious cardiovascular events including stroke. This case-control study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2008 to December 2009. This relationship appears graded with higher levels of microalbuminuria being independently associated with a greater magnitude of vascular risk over time. We studied 60 patients of ischemic stroke with in 4 weeks of onset of symptoms and performed a case control study for MA by spot urinalysis. The incidence of microalbuminuria was 31.7% of the patients compared with 8.3% of the controls. Of all the traditional risk factors for stroke - age, male gender, hypertension, diabetes, dyslipidemia, smoking showed a positive correlation with the presence of MA (p<0.05). The effect of microalbuminuria and subtypes of ischemic stroke was observed that small vessels stroke (lacunar infract) were more (70%) than large vessels stroke (30%) and effect of microalbuminuria 21.67% higher in small vessels stroke than large vessels stroke. The presence of microalbuminuria appears to independently predict proper clinical outcome following acute stroke.