We present a case of a 55 year old lady, hypertensive and diabetic who was infected with COVID-19 presenting with acute 6th cranial nerve palsy. The patient was diagnosed with COVID-19 on Sept 01 2020. Seven days later she developed double vision and headache. At that point on complete neurological examination including examination of cranial nerves she was found to have 6th cranial nerve (Abducens) palsy with convergent squint. As the patients cranial nerves were all intact initially it is suspected that her 6th nerve palsy was related to the viral illness. She was assessed by ophthalmologist and neurologist. She underwent MRI scan of the brain to look for other causes of 6th nerve palsy and it was unremarkable. After almost one week of continued inpatient management her diplopia improved but she still complained of intermittent diplopia with convergent squint. Bangladesh Crit Care J September 2020; 8(2): 129-130

Background : This study is a sub analysis of data submitted on behalf of Bangladesh to an international study (2013-2014) involving Asian ICUs and merits comparison with prior study done in Bangladesh in 2007 which had similar objective. Objective : To assess structure, organization and delivery of ICU care in ICUs of Bangladesh with attention to hospital organizational characteristics, ICU organizational characteristics, staffing etc. Method : Prospective cohort study involving ICUs of 51 hospitals of Bangladesh done in 2013-2014. The hospitals in our study were divided into three groups : clinics/hospitals less than 50 beds (n =18), clinics/hospitals more than 50 beds(n=24) and Govt. hospitals/academic hospitals/ medical colleges hospitals (n=9). Results : Most respondent hospitals were from Dhaka (77.4%). Only 17.6% hospitals were university affiliated. The average number of hospital beds were 225. The average number of ICU beds were 14. 19.6 % hospitals had infection control committees. Basic life support training was required for doctors and nurses in 31.4 % and 27.5 % hospitals respectively. Small clinics/ hospitals (less than 50 bed capacity [n=18]) had significantly less government funding (p < 0.0001), were less attached to university hospital (p < 0.0001), had fewer referral centers (p < 0.001), had less total hospital beds (p < 0.004) and were less in case of ICU beds : hospital beds percentage (p < 0.003). 28 ICUs had no single room. Govt. hospitals/academic hospitals/Medical colleges had relatively more ICU beds .(12.33% - p < 0.004). 60.8% ICUs were operated as open units. Open units were more likely present in hospitals/clinics more than 50 beds. Multivariable analysis showed that the presence of 1:1 nursing staff was much lower in private hospitals. Funding sources and types of hospitals were independently associated with lower percentage of ICU beds (p < 0.002) and (p < 0.0001) respectfully. University affiliations was more likely associated with closed ICU (p < 0.002). Presence of MD CCM qualified intensivists are more in government funded hospitals (p < 0.003) than those of private hospitals Conclusions : Our study demonstrates considerable variation in the organization and staffing among Bangladeshi ICUs. Compared to 2007 study it shows increased trend in number of closed units( 39% vs 15%) and percentage of ICU beds relative to number of hospital beds (6.5% vs 4.8%) . Bangladesh Crit Care J March 2019; 7(1): 3-11

:Objective : To assess the role of noninvasive positive pressure ventilation (NIPPV)

Background : This study is a sub analysis of data submitted on behalf of Bangladesh in an International study ( ACME 2012) involving physicians working in Asian ICUs. Objective : To describe attitude of physicians of ICUs of Bangladesh toward withholding and withdrawal of life sustaining treatments in end of life care, to assess factors associated with these observations and to compare the findings especially with those of physicians of low – middle income Asian ICUs. Method : Self-administered pre-set structured and scenario based survey conducted among 101 physicians working in 38 ICUs of Bangladesh. Results : For patients with no real chance of recovering a meaningful life, 20 of 101 respondents reported that they almost always or often withheld life-sustaining treatments and 18 of 101 respondents almost always or often withdrew life-sustaining treatments.44 respondents in our study reported that they almost always or often withheld life sustaining treatments whereas 10 respondents almost always or often withdrew life sustaining treatments. 72% of all our respondents would implement DNR orders. In Bangladesh, religion (Islam) does not influence decision of complying with DNR order requested by family. Our study showed 71% of physicians were more likely to “do everything” if a patient with hypoxic-ischaemic encephalopathy developed septic shock. In our study, physicians were more ready to withdraw vasopressors and hemo dialysis than enteral feeding and intravenous fluids. Physicians from Bangladesh generally perceived more legal risk with limitation of life sustaining treatments because of lack of legislation for such practices. When it comes to limit aggressive lifesaving treatments, Bangladeshi physicians were less likely accede to families request to withdraw them on financial ground. Conclusion : Like physicians of low-middle income countries of Asia, Bangladeshi ICU physicians’ self-reported practice of limiting life sustaining treatments, role of families and surrogates and perception of legal rights were significantly different than physicians of high income countries of Asia. However unlike physicians from other low income Asian countries, physicians from Bangladesh were less likely to accede to families request to withdraw life sustaining treatments on financial ground. Bangladesh Crit Care J September 2019; 7(2): 66-72

Narcolepsy is a sleep disorder presented with excessive sleepiness. Excessive sleepiness is key symptom of Narcolepsy. In obstructive sleep apnea excessive daytime sleepiness is also a remarkable symptom. Here we presented a 67-year-old female with uncontrollable sleep attacks and hypnagogic hallucination. She was previously diagnosed as obstructive sleep apnea and under BiPAP therapy for last few years. Her multiple sleep latency test become positive to meet diagnostic criteria for Narcolepsy. Clinicians should be cautious about possibilities of coexisting sleep disorders like Narcolepsy and obstructive sleep apnea in excessive day time sleepiness complaining patients. Bangladesh Crit Care J September 2022; 10(2): 161-162