Utility of Median-to-Ulnar Sensory Comparative Nerve Conduction Study to Increase Diagnostic Accuracy in Mild Carpal Tunnel Syndrome

Electro-physiological diagnosis of mild Carpal Tunnel Syndrome (CTS) based on traditional median motor and sensory studies are often inconclusive. Therefore, we wanted to investigate the utility of Median-to-Ulnar Sensory Conduction studies in diagnosis of mild CTS. Data from Nerve conduction study (NCS) of 82 cases with symptoms suggestive of CTS from September 2017 to October 2020 attending electrophysiology department of Mount Adora Hospital, Sylhet, Bangladesh was selected for study. About 54(66.0%) out of 82 symptomatic patients were diagnosed as CTS by the conventional method, and 28(34.0%) patients required further investigation as their test report were found to be inconclusive. combining methods showed 70(85.37%) were found to be positive and 12(14.63%) were negative in comparison study. Thus, it can be concluded that those patients found to be negative in conventional methods; comparison method is an option for diagnostic confirmation.

Efficient Excitation of Micro/Nano Resonators and Their Higher Order Modes

We demonstrate a simple and flexible technique to efficiently activate micro/nano-electromechanical systems (MEMS/NEMS) resonators at their fundamental and higher order vibration modes. The method is based on the utilization of the amplified voltage across an inductor, L, of an LC tank resonant circuit to actuate the MEMS/NEMS resonator. By matching the electrical and mechanical resonances, significant amplitude amplification is reported across the resonators terminals. We show experimentally amplitude amplification up to twelve times, which is demonstrated to efficiently excite several vibration modes of a microplate MEMS resonator and the fundamental mode of a NEMS resonator.

Stroke in Bangladeshi patients and risk factor

To evaluate comprehensively the distribution of established risk factors of stroke among Bangladeshi patients. This is an observational study. It involved 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years. Common established risk factors of stroke e.g. age, sex, family history, hypertension, diabetes, ischemic heart disease, smoking, obesity, dyslipidaemia, alcoholism, use of oral contraceptive pill, lack of fresh fruit consumption etc. were evaluated in these patients through a preformed questionnaire and data were analyzed. Majority of the stroke events occurred after the age of forty (82.3%) and the ischemic stroke (72%) is the most common. Apart from non modifiable risk factors (advancing age, sex, Family history of stroke) hypertension was the most common modifiable risk factor found in stroke patients (57.6%) followed by smoking (44.6%), tobacco use (24.3%), OCP use in female (40% of female stroke), diabetes (23%), ischemic heart disease (17.1%), obesity (10.6%) and dyslipidaemia (5.3%). Lack of fresh fruit consumption and alcoholism were found in some of the patients. Stroke is common after the age of forty. Ischemic events are commonest type of stroke. Hypertension, smoking, tobacco use, diabetes and ischemic heart disease were five most common risk factors of stroke. Outlining the common stroke risk factors in our settings, may help the physicians and care givers in managing this disabling disease properly.

Precipitating factor of seizure in epilepsy: experience in a tertiary care hospital

Patients with epilepsy experience recurrent, unprovoked seizures. In most of the cases seizure occurs spontaneously, but there may be association with various triggers. These triggers may act as seizure precipitating factors (SPFs). This study was done to find out the most common SPFs and their relationship to different types epileptic patients attending a tertiary care hospital in Bangladesh. This cross sectional study was carried out in specialized epilepsy weekly outdoor clinic and Medicine outpatient department (OPD) of Dhaka Medical College Hospital from January 2008 to July 2011, which included 1168 epilepsy patients. All patients attending the clinic were included in the study. Epilepsy syndromes were broadly classified into four categories using the classification system of international league against epilepsy (ILAE) namely, generalized epilepsy (GE), localization related epilepsy (LRE), symptomatic and unclassified. Each patient was evaluated and classified by consultant neurologist. All participants were interviewed through a predesigned close ended questionnaire that included a long list of 30 precipitating factors. Among all the patients 71.5% were male, with most common age group 11-20 years (36.8%). About 62% could indentify at least one precipitator. Excitation (25.2%) was the most common SPF reported by patients followed by emotional stress in 17.7%. Fever precipitated seizure in 16.4% of the subjects. A good number of them (15.5%) noticed that whenever there was sleep deprivation, they had an attack of epilepsy. However, drug withdrawal, playing outside and head trauma were also common among the patients, about 11.7%, 11.3% and 8.4% respectively. Most of the patients can identify their seizure precipitant and clustering of many SPFs suggests a common patho-physiologic mechanism for these triggers. Excitation, sleep deprivation, fever, watching television and head trauma showed a strong association with generalized epilepsy. Patients with seizure disorder should be evaluated for presence of SPFs, because identification of these might help in proper management of epilepsy.

Endovascular management of a young patient of stroke with absent right upper limb pulse

A 39 years old, right handed, hypertensive non-diabetic smoker presented with ischemic stroke with left sided hemiplegia and absent right upper limb peripheral pulses. Possible causes of young stroke were searched. Cerebral digital subtraction angiography (DSA) revealed 95% stenosis at origin of brachiocephalic trunk with absent flow in right sub-clavian artery and 75% stenosis at osteum of left vertebral artery with flow reversal through right vertebral artery. Subsequently, stents were placed within the stenosed portion Right brachiocephalic trunk and left vertebral artery. The intervention resulted in immediate restoration of right upper limb pulses and cessation of flow reversal in vertebral artery.