Background: Central nervous system (CNS) involvement is one of the most important extrapulmonary manifestations of tuberculosis (TB) causing considerable mortality and morbidity. Presentations of CNS TB are extremely variable. Treatments are generally more effective if the disease can be detected early. This study is to find out the various clinical patterns and investigation findings that might help in early detection of CNS TB. Objective: This study was conducted to detect various clinical manifestations of adult CNS TB at an earlier stage of evaluation. Methods: This was a hospital based observational study (cross sectional type) conducted on 30 patients of CNS TB who were admitted in Sir Salimullah Medical College Mitford Hospital, Dhaka during a period of 6 months from October 2013 to April 2014 Results: Among the participants 53% were male and 47% were female, with a male female ratio of 1.13: 1. Mean age of the participants was 35.17±6.14 years. Tuberculosis involving brain (i.e. cranial TB) was most common (30.4%) in 15-24 years age group whereas spinal form of TB was most common (42.8%) in 25-34 years age group. Mean age of the participants having Brain TB was 36.46±6.90 years. Mean age of the participants having spinal TB was 32.36±12.52 years. Highest number of the cranial forms of TB was tuberculoma (52.2%) in this study and was found mostly in the young adults. Spinal TB was found in 25-34 years age group in highest number, all but one were Potts disease. Tuberculoma and tuberculous meningitis had an equal distribution in female sex while males had a higher (53.8%) occurrence of tuberculoma. On the other hand, spinal involvement was commoner in male sex (43.5%).Fever was the most common symptom noted in all forms of CNS TB patients (78.26% for brain and 71.43% for spinal cord TB patients) followed by headache and loss of consciousness representing 2nd and 3rd common symptom in brain TB patients. Most common clinical signs in brain TB were signs of meningeal irritation (65.22%), cranial nerve palsies and papillodema while spastic paraparesis with sensory level being the commonest in spinal cases. Tuberculoma was the most frequent neuro-radiologic findinds in case of brain TB patients and paraspinal soft tissue shadow with vertebral collapse was commoner in spinal TB patients. Conclusion: This study has highlighted the relative frequency of various types of brain and spinal TB lesions along with the symptoms, signs and laboratory findings in Bangladeshi adult patients. In Bangladesh, tuberculosis should be always an important differential diagnosis in patients of fever with headache as well as spastic paraplegia or quadriplegia for any duration in any sex group. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 76-84

Background: Diabetic polyneuropathy (DPN) has a significant positive correlation with poor glycemic control (HbA1c ≥7%). The clinical, biochemical and electrophysiological parameters of DPN in Bangladeshi citizens have not yet been explored elaborately Objective: The purpose of the study was to detect and categorize status of glycemic control of Bangladeshi people and to analyze its impact on clinical severity of DPN using Toronto Clinical Scoring System (TCSS) and electrophysiological severity by modified Michigan diabetic neuropathy score (MDNS). Methodology: This observational study was carried out on diabetic patients having probable DPN by purposive sampling, attending Neurology OPD of Dhaka Medical College Hospital, Dhaka, Bangladesh and Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorder (BIRDEM) Hospital, Dhaka, Bangladesh from July 2014 to June 2016. Clinical parameters were recorded and DPN was graded as “no neuropathy”, “mild”, “moderate” and “severe” neuropathy by the Toronto Clinical Scoring System (TCSS). A standard nerve conduction study was performed on each patient and electrophysiological grading according to modified Michigan diabetic neuropathy score (MDNS) was done. Diabetic status of patients was classified into “controlled” (HbA1c <7.0%) and “uncontrolled” (HbA1c ≥7.0%) groups and HbA1c level and the clinical & electrophysiological severity scores were compared and were analyzed. Results: Mean age of the patients was 57.2±9.37 years. 51.0% cases were males and 49% cases were females. The mean HbA1c in the study population was 7.6±0.94% and 56.0% patients had HbA1c≥ 7% .Motor nerve conduction studies revealed that both CMAP amplitudes and MNCV in the ulnar, peroneal and tibial nerves were reduced significantly in patients of uncontrolled (HbA1c≥7%) DM (p<0.001). Sensory nerve conduction studies revealed significant reduction in SNAP amplitudes of median and ulnar sensory and sural nerves in the uncontrolled group (p<0.001). Electrophysiologically, 65.43% patients had mixed sensory-motor neuropathy (p<0.00001). Clinically severe DPN patients were higher (45.2%) within the uncontrolled (HbA1C ≥7%) group (p<0.00001). Similarly, severity in electrophysiological grading was more in patients with uncontrolled DM (48.8%) (p<0.00001). Conclusions: Neuropathic severity, either clinically or electrophysiologically, was associated with higher values of HbA1c. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 177-184

Background Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors. Methods This cross-sectional survey was conducted in Dhaka Medical College from March 01–May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies. Findings The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period. Conclusions Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks.

Background: System B0 is a sodium dependent transporter that transports wide variety of neutral amino acids in the intestinal and renal proximal tubular epithelial cells. Methylmercury (MeHg) readily and non-enzymatically reacts with cysteine to form conjugate structurally similar to the amino acid methionine. Objective: In this study, we investigated the molecular mechanism of absorptive transport of MeHg in intestine using Xenopus oocytes expressing hB0AT1 and the uptake of metylmercry-Cys (MeHg-Cys) by heterodimeric amino acids transporter. Methodology: We confirmed the uptake of [14C] L-Leucine a potent substrate for the hB0AT1 amino acids transporter. The uptake of [14C] L-leucine by hB0AT1 was inhibited by MeHg-Cys conjugate, leucine, cysteine, methinine and phenylalanine in concentration–dependent manner. The IC50 of MeHg-Cys conjugate was significantly lower than that of leucine, cysteine, methinine and phenylalanine, indicating that hB0AT1 is a high affinity MeHg transporter. To assess MeHg-Cys conjugate transport, we measured [14C] MeHg uptake in Xenopus oocytes expressing hB0AT1 in presence or absence of sodium. The [14C] MeHg was transport only in the presence of cysteine and the transport was significantly sodium dependent and inhibited by a system B0 inhibitor 2-aminobicyclo-[2,21]- haptane-2-carboxylic acid (BCH). Result: The current findings indicate that hB0AT1 and heterodimeric amino acids absorb MeHg in the form of cysteine conjugate from the intestinal lumen across the brush-border membrane in to the cells and is supposed to be plays a critical role in the pathogenesis of Minamata disease and present results descried a major molecular mechanism by which MeHg is transported across cell membranes and indicate that metal complexes may form a novel class of substrates for amino acid carriers. Conclusion: In this experiment the results also suggest that uptake of Methionine and MeHg-Cys by heterodimeric amino acid transporter is significantly correlated where the uptake of Methionine and MeHg-Cys between heterodimeric amino acid transporter and hB0AT1 is not correlated. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 127-136

Juvenile myasthenia gravis (JMG) is a rare autoimmune disorder of childhood. Pediatric presentation of MG is more common in Oriental than in Caucasian populations. JMG need to be differentiated from congenital myasthenia gravis which do not have haan autoimmune basis. An 11 years old girl presented with drooping of eye lids which was more marked at the later part of day and was gradually progressive . She had complained of double vision. She had no family history of myasthenia gravis. Ice pack test, repetitive nerve stimulation test, and anti acetylcholine receptor antibody test support the diagnosis. She was treated with pyridostigmine and was started as 30mg four times daily and increased to 60 mg/qds. Subsequently her symptoms improved gradually and she became stable. Bangladesh Journal of Neuroscience 2013; Vol. 29 (1) : 64-69