Search

A 7-month-old girl had been suffering from progressively deteriorating pneumonia despite getting multiple courses of broad-spectrum antibiotics as well as anti-fungal drugs for adequate duration. To find out the cause behind this deterioration, the patient underwent thorough clinical and relevant laboratory evaluation including chest radiology & imaging, screening for primary immune deficiency disorders (PID), cystic fibrosis, tuberculosis, invasive fungal pneumonia, congenital heart disease, covid pneumonia, TORCH etc. but failed to solve the mystery. Upon further detailed re-evaluation, it was discovered that the child had a history of being forcefully fed lentil-based khichuri (a rice-lentil mixed dish) during her weaning process and diagnosis was finally confirmed as hypersensitive pneumonia due to lentil aspiration by a high level of IgG, specific to lentil antigen. Treatment was commenced with prednisolone resulting in significant improvement in her clinical and radiological condition within 72 hours.

Objectives. To evaluate the interaction between childhood asthma and S. 25(OH) cholecalciferol among Bangladeshi children. Methods. This case control study was conducted in child asthma clinic, Bangladesh Shishu Hospital Institute during March-August 2021. Comparison was made between clinically-diagnosed (following GINA guideline) asthmatic children (2-12 years-old) (cases = 87) and age and sex-matched children having no respiratory illness (controls = 90) using SPSS’ (Statistical Package for Social Science, V.23.0 Windows) software. Results. Serum 25(OH) cholecalciferol was found to be significantly lower among the cases than the controls ( P

Summary: Background: We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia. Methods: This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2–59 months with severe pneumonia with or without malnutrition received DCA or UC. The DCA treatment settings comprised of urban primary health care clinics run by NGO under Dhaka South City Corporation and in rural Union health and family welfare centres under the Ministry of Health and Family welfare Services. The UC treatment settings were hospitals in these respective areas. Primary outcome was treatment failure (persistence of pneumonia symptoms, referral or death). We performed both intention-to-treat and per-protocol analysis for treatment failure. Registered at www.ClinicalTrials.gov, NCT02669654. Findings: In total 3211 children were enrolled, 1739 in DCA and 1472 in UC; primary outcome data were available in 1682 and 1357 in DCA and UC, respectively. Treatment failure rate was 9.6% among children in DCA (167 of 1739) and 13.5% in the UC (198 of 1472) (group difference, −3.9 percentage point; 95% confidence interval (CI), −4.8 to −1.5, p = 0.165). Treatment success within the health care systems [DCA plus referral vs. UC plus referral, 1587/1739 (91.3%) vs. 1283/1472 (87.2%), group difference 4.1 percentage point, 95% CI, 3.7 to 4.1, p = 0.160)] was better in DCA. One child each in UC of both urban and rural sites died within day 6 after admission. Average cost of treatment per child was US$94.2 (95% CI, 92.2 to 96.3) and US$184.8 (95% CI, 178.6 to 190.9) for DCA and UC, respectively. Interpretation: In our population of children with severe pneumonia with or without malnutrition, >90% were successfully treated at Day care Clinics at 50% lower cost. A modest investment to upgrade Day care facilities may provide a cost-effective, accessible alternative to hospital management. Funding: UNICEF, Botnar Foundation, UBS Optimus Foundation, and EAGLE Foundation, Switzerland.

Introduction: Copy number variations (CNVs) play a critical role in the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh.Methods: We have conducted chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare CNVs. To identify candidate genes within the rare CNVs, gene constraint metrics [i.e., “Critical-Exon Genes (CEGs)”] were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using the R package.Results: Of all the samples assayed, 12.26% (26/212) and 57.08% (121/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. While 2.83% (6/212) patients’ pathogenic CNVs were found to be located in the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs compared to males (OR = 4.2; p = 0.0007). We have observed an increased number of Loss of heterozygosity (LOH) within cases with 23.85% (26/109) consanguineous parents. Our analyses on imprinting genes show, 36 LOH variants disrupting 69 unique imprinted genes and classified these variants as VOUS. ADOS-2 subset shows severe social communication deficit (p = 0.014) and overall ASD symptoms severity (p = 0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (

Due to lack of robust data on childhood cystic fibrosis (CF) in Bangladesh we sought to evaluate their clinico-epidemiology. A cross-sectional observation was conducted adopting CF-foundation consensus-panel-diagnostic criteria in 3 tertiary-care-hospitals in Bangladesh from 2000 to 2017. Clinically suspected 95 CF-cases were subjected to sweat-chloride testing using locally-developed a fast, cheap and effective indigenously body-wrapped sweating technique measured by US-Easy Lyte-automated microprocessor-controlled analyzer marking ≥60 mmol/L as positive. Mean-age of CF-cases at disease-onset was 16.9 ± 26.6 months that significantly differed with age-at-diagnosis ( P

Background: Hand, foot and mouth disease (HFMD) is a common contagious disease among children under 5 years, particularly in the Asia-Pacific-region. We report a localized outbreak of childhood HFMD for the first time from Bangladesh, diagnosed only based on clinical features due to lack in laboratory-diagnostic facilities. Methods: Following the World Health Organization’s case-definition, we conducted a rapid-appraisal of HFMD among all of the 143 children attending Pabna Medical College and General Hospital with fever, mouth ulcers and extremity rash. Data were collected between September and November 2017 using a preset syndromic approach and stringent differential diagnostic-protocols. Results: The mean age of children was 2.9±2.3 years. There was a significant difference among the age and sex of children (P=0.98), first sibling being more belonging to middle-income families (62%). Younger children (

Background: Seizure is a common neurological disorder in neonatal age group!. Primary metabolic derangement is one of the important reason behind this convulsion during this period. Among primary metabolic derangement hypoglycemia, is most common followed by bypocalcaemia, hypomagnesaemia, low zinc status etc. As causes of many cases of convul­sion remain unknown in neonate. Objectives: To see the zinc status in the sera of neonate with convulsion. So that if needed early intervention can be taken up and thereby prevent complications. Method: A total of 50 neonates (1-28 days) who had convulsion with no apparent reasons of convulsion were enrolled as cases and 50 healthy age and sex matched neonates were enrolled as controls. After a quick clinical evaluation serum zinc status was estimated from venous blood by atomic absorption method in Chemistry Division, Atomic Energy Centre. Low zinc was considered if serum value was

Abstract

Airway foreign body aspiration (FBA)is a frequent problem that affects young children, present with acute respiratory distress and cough followed by sudden chocking. Prompt identification and early treatment can save the child from a life-threatening emergency.Delayed diagnosis due to lack of history and clinical suspicion may lead to permanent lung damage, which may be a curse for a lifetime.We share an experience of a 4^-year-old boy who presented with suppurative lung disease was associated with neglected FBA. Early diagnosis and intervention canprevent,and ultimately reduce long-term morbidity and mortality, along with improving the better outcome regarding FBA. [ABSTRACT FROM AUTHOR]

Despite major improvements in the diagnosis of pathogenic organisms causing acute respiratory infections (ARIs), details of infections caused by atypical pathogens are not well understood, particularly in developing countries. This clinical and epidemiological research was conducted in Bangladesh to explore the prevalence of atypical pathogens in causing childhood pneumonia. Sixty-four children with ARI were studied at the Pediatric Outpatient Department of Dhaka Medical College Hospital, Bangladesh, during September through December 2000. In addition to clinical examination, hematological, radiological, and bacteriological examinations were performed. Antibody titers from paired sera against Mycoplasma pneumoniae and Legionella spp. in the acute and convalescent phases revealed that none of these children were infected with M. pneumoniae, while only one serum sample was positive for L. pneumophila serogroup 4. Antibody titers against Chlamydophila (Chlamydia) pneumoniae, determined by an indirect microimmunofluorescence method, and by an enzyme-linked immunosorbent assay (ELISA) kit (HITAZYME C. pneumoniae kit) indicated that 13 children (20.3%) were infected with C. pneumoniae. Our results indicate a high prevalence rate of C. pneumoniae, suggesting it is as an important causative pathogen of childhood pneumonia in Bangladesh. [ABSTRACT FROM AUTHOR]

Introduction: Both auditory brainstem response audiometry (ABR) and otoacoustic emission (OAE) are two widely used tests for a neonatal hearing screening. The OAE is easier to perform, faster, and cost-effective. However, ABR is precise with few false-positive results. We intended to know the sensitivity and specificity of OAE compared to ABR. Methods: This cross-sectional study was conducted on 282 neonates in a neonatal intensive care unit (NICU) at Dhaka. All the neonates had one or more risk factors for hearing impairment (as defined by The Joint Committee of Infant Hearing). All the study subjects were screened by an expert team with a proper environment and machine (GSI AUDIOscreener, Denmark). Initial DPOAE was done within 30 days of age and then ABR, at three months. The results were expressed as “Pass” (probably no hearing impairment) or “Refer” (further evaluation is needed). Results: Among the 282 neonates, 44(15.6%) neonates were referred at the initial screening. However, at ABR it was found that 27 (9.5%) had a hearing impairment. Among these 27, twenty-four were also referred at DPOAE (true positive). But 3 were not detected by DPOAE (false-negative). Other 20 neonates who were referred at DPOAE, were normal at ABR (false-positive). So it was estimated that the sensitivity of DPOAE for identifying hearing loss was 88.9% and the specificity was 92.2%. Conclusion: The DPOAE is a good screening test for neonatal hearing screening with high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Introduction: Inadequate knowledge on nutritious foods and feeding practices are determinant of malnutrition rather than lack of food. Health professionals particularly nurses pass long contact time with the mothers, so positive attitude among them can be used in motivating mothers for infant and young child feeding. There is little data available in this regard, therefore evaluation of nurses' knowledge, attitude and practice on complementary feeding is very important. This study was conducted among the female nurses in a tertiary level hospital of Bangladesh to find out the knowledge, attitude and practice of complementary feeding to their own under-2 children. Methods: The descriptive study was carried out at Dhaka Medical College Hospital between September 2014 and August 2015. Total 95 nurses having children from 6 months up to 2 years of age were enrolled as sample. Results: It showed that 63.1% of the nurses had good understanding on complementary feeding. But 46.3% of them did not know the duration correctly and 27.4% considered infant formula as the complementary food. Almost all had the positive attitude but 28.4% stated that distraction during feeding is needed. Among the respondents, 97% strongly agreed about the importance of complementary feeding but 67.4% of the nurses introduced complementary food before 6 months of age. Only 58.9% of them continued breast feeding up to 2 years. Conclusion: The study reflects that although most of the nurses have adequate knowledge and positive attitude towards complementary feeding but deviation was noted in timely introduction of complementary food and use of feeding bottle. This indicates clear disparity between knowledge and practice of the female nurses. [ABSTRACT FROM AUTHOR]

Rosai-Dorfman disease (RDD) is a type of sinus histiocytosis. It is a rare disease (1:200000), particularly in children and commonly presents with massive, painless and usually bilateral cervical lymphadenopathy along with fever and weight loss. Leukocytosis, elevated erythrocyte sedimentation rate and hypergammaglobulinemia are common. A definitive diagnosis can only be made by histological analysis of affected lymph nodes. Emperipolesis and a typical immunohistochemical pattern characterized by positivity for S-100 protein and CD68 antigen and negativity for CD1a antigen are diagnostic for RDD. Here we report a case of RDD occurring in a 10-month-old child with progressive cervical lymphadenopathy and persistent fever. Histopathological and immunohistochemistry studies of a lymph node biopsy established the diagnosis. A watchful follow-up resulted in the resolution of fever and lymphadenopathy. [ABSTRACT FROM AUTHOR]

Objective: This prospective study was carried out from July-December 1999 to see the status of zinc in CSF of children with febrile convulsion and to compare this to that of control.Methods: Forty-two cases of febrile convulsion and 30 controls (fever without convulsion) were enrolled into the study. CSF zinc was estimated by atomic absorption spectrophotometry (AAS) in Atomic Energy Center, Dhaka and compared between the two groups.Results: The mean zinc level in CSF in the study sample was 40.19mgm/L and that in control was 74.98mgm/L. This difference was statistically significant (p<0.001).Conclusion: The study concludes that a significantly lower of zinc exists in CSF of children with febrile. However no relationship was found between CSF zinc status with age, sex, degree & duration of fever and time of lumbar puncture after convulsion. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy and safety of F-100, diluted F-100 (F100D), and infant formula (IF) for dietary management in the rehabilitation phase of severe acute malnutrition (SAM) of infants aged under 6 months (u6m). Methods: Double-blind randomized clinical trial was conducted to assess the efficacy and safety of F-100, F-100D, and IF at the Nutrition Rehabilitation Unit, icddr,b. Infants (n = 153) u6m with SAM were enrolled and randomly assigned to any of the three diets after stabilization. Two ml blood was collected on study days 1, 3, and 7 for measuring serum electrolytes, creatinine and osmolality, urine samples for specific gravity and osmolality creatinine ratio. Renal Solute Load (RSL) and Potential Renal Solute Load (PRSL) were calculated. Infants were discharged when gained 15% of the admission bodyweight or had edema-free weight-for-length Z-score ≥ − 2. Results: Infants fed F-100 and F-100D had higher weight gain than infants who received IF. Mean difference between F-100 and IF was 4.6 g/kg/d (95% CI 1.5–7.6, P = 0.004) and between F-100D and IF was 3.1 g/kg/d (95% CI 0.6–5.5, P = 0.015). Total energy intake from study diet and breast milk was significantly higher in infants fed F-100 compared with other two diets (P = 0.001 in each case). RSL was highest in infants fed F-100 but serum sodium showed no sign of elevation. Urinary specific gravity and serum sodium values were within normal range. Conclusions: F-100 can be safely used in the rehabilitation phase for infants u6m with SAM and there is no need to prepare alternative formulations. [ABSTRACT FROM AUTHOR]

Background and objective: Neonatal sepsis is associated with increased mortality and morbidity of newborns. Moreover, inability to tolerate enteral feeding contributes to prolonged hospital stay and nosocomial sepsis. Probiotics confers health benefit to host by altering the gut environment. This study aimed at determining the efficacy of probiotics in reducing nosocomial sepsis and feeding intolerance in hospitalized low birth-weight infants. Methods: A quasi experimental clinical trial to compare between newborn infants getting probiotics along with breast milk (experimental group) with those getting breast milk only (non experimental group). Study was conducted from June to December 2013 with a total of 49 newborns, weighing 1000 to 2000gm. Results: In weight category 1000-1250 gm, 15.8% developed culture proven sepsis in probiotics/experimental group (n=9) and 10.5% in breast milk/non experimental group (n=10); p value was 0.655. Feeding intolerance was developed in 10.6% of the probiotics group and 31.5% of breast milk group, p value was not significant but the mortality was significantly lower among the probiotics group i.e., 5.3% in probiotics group Vs 42.1% in breast milk group (p 0.018). Between weight range of 1250-1500 gm, sepsis and feeding intolerance showed no significant differences (p value 0.305 & 0.305 respectively) but mortality differed significantly (0% probiotics group Vs 20% breast milk group; p 0.043). In weight range 1500-2000 gm, the result was not statistically significant for sepsis (p value 0.292), feeding intolerance (p value 0.292) and mortality (p value 0.292). Mortality was significantly lower in two weight categories (1000-1250 gm & 1250-1500 gm) and hence the overall result showed significant difference in the statistical analysis (p value 0.001).There were no differences either in nosocomial sepsis or feeding intolerance between the probiotics group and the breast milk group. Conclusion: Probiotics does not have any impact in reducing nosocomial infection and feeding intolerance but the use of probiotics seems to reduce mortality especially in the lower weight category. [ABSTRACT FROM AUTHOR]

Background: The use of disposable diaper is gradually increasing for the infants in our country. However, the major hazard of diaper is diaper dermatitis. The magnitude of diaper related hazards is unknown in Bangladesh. This study was conducted to assess the frequency of hazards of wearing diaper among infants. Objectives: The study was conducted (i) to observe diaper related hazards among infants and (ii) to assess the factors affecting diaper related hazards. Materials and Methods: This observational study was conducted at department of Pediatrics of Dhaka Medical College Hospital & Bangabandhu Sheikh Mujib Medical University during May to September 2012. Fifty children aged 7 days to 12 months wearing disposable diaper for at least 7 days were enrolled in this study. A face to face interview was taken and finding were recorded on a preset questionnaire. The infants were also examined for presence of diaper rash. Obtained data were analyzed thoroughly by SPSS 21. Results: Among 50 children, 24(48%) male and 26(52%) female infants. Of them 13(26%) infants developed diaper rash in their diaper wearing time. The age distribution of the cases was 3(23.1%) below 01 months; 2(15.3%) 1-6 months and 8(61.6%) 7-12 months. Six (24%) male infant and 7(27%) female infant developed rash in their diaper wearing time. Diapers are mostly used by solvent families as diapers are not cost effective. The frequency 84.6%, increases with increased duration of using a single diaper at a time for more than 4 hours without change whereas those who changed diaper more frequently every 3-4 hours and 1-2 hours have diaper rash 15.4% and 0% respectively. Conclusion: From the result of the present study it can be concluded that the frequency of diaper rash is increased with increasing age of infants and use of diaper for long duration. [ABSTRACT FROM AUTHOR]

Background: Acute bronchiolitis is an acute viral lower respiratory tract infection in early childhood and is the leading cause of hospitalization in infants below 2 years of age. Being a viral disease, there is no effective treatment of this problem other than supportive care. To provide this care, both 3% hypertonic saline and 7% hypertonic saline has been used and found effective. However, which option is more effective to reduce clinical severity and length of hospital stay, still remain unsettled. Objective: To determined the efficacy of 7% hypertonic saline in children with acute bronchiolitis. Methodology: The study was a randomized controlled trial and carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Dhaka between January 2015 to December 2016. A total of 135 children from 1 month to 2 years of age irrespective of sex with clinical presentation of acute bronchiolitis admitted in the paediatrics ward of DMCH were included in the study and were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 3% nebulized hypertonic saline (Group-II = 90) in ratio (1:2). The main outcome variables were clinical severity score and length of hospital stay. The outcome was evaluated at 12 hourly and 24 hourly intervals till discharge (up to 120 hours) Result: In this study both groups were almost similar with respect to their demographic characteristics like age and sex and baseline clinical characteristics. The study demonstrated that respiratory rate score, wheezing score, retraction score, general condition score and clinical severity score of both treatment modalities were reduced. Children of group-I (7% HS) 40(88.9%) recovered at the end of 72 hours where as 67(74.4%) of the children of group-II (3% HS) recovered from the disease during the same period. Length of hospital stay was shorter in 7% hypertonic saline group compared to 3% hypertonic saline group (56.36 ± 16.33 hours vs 63.07 ± 21.48 hours, p=.067). The patients of 7% hypertonic saline group required a shorter duration of oxygen therapy compared to 3% hypertonic saline group (16.53 ± 3.98) hours vs (20.25 ± 4.15) hours, (p=0.109) respectively. Conclusion: Nebulized 7% hypertonic saline as well as 3% hypertonic saline both were effective in acute bronchiolitis and found no significant difference in efficacy between these options in terms of reducing clinical severity, length of hospital stay and duration of oxygen therapy. No side effect were observed in either group. [ABSTRACT FROM AUTHOR]

Background & objective: Perinatal asphyxia affects all organs of the body and brain is the most affected organ. The study was undertaken to find out the status of serum magnesium and calcium level and their significant association among asphyxiated term newborns with moderate to severe HIE. Material & methods: The Cross sectional study was done in the Department of Neonatology, Dhaka Medical College Hospital during January 2012 to July 2012. A total of 102 asphyxiated term neonates were enrolled, who has H/O perinatal asphyxia and had Apgar score of 6 or <6 at 5 minutes. Clinical grading of HIE into moderate and severe was done according to modified Sarnat and Sarnat scoring system .Under aseptic precautions with standard protocol, estimation of serum magnesium and calcium level in venous blood was done at 48 hours and 7th day of birth . Among the study population, 17 patients had died during follow up and 4 patients were absconded. Finally 81 patients were evaluated by both blood samples though initial 102 cases were evaluated by their first sample. 50 normal healthy infants were also evaluated for serum magnesium and calcium at their 48 hours of birth. Chi-square test was used to assess statistical significance, Pearson correlation coefficient test was done to find out correlation between serum magnesium and calcium status and APGAR score & t test was done to assess the comparison between the values of serum magnesium and calcium found on two occasions. Results: Of 102 cases majority (58%) were male. Most of the cases (65.68%) were moderate HIE. Mean serum magnesium was 1.36(0.9-2.8) mg/dl and 1.16(.88-2.6) mg/dl among HIE II and HIE III respectively (p<0.05). Mean serum calcium of HIE II and HIE III were 7.14(5.1-9.6) mg/dl and 6.58(5.3-9.0) mg/dl respectively (p<0.05). There is positive correlation with individual APGAR score with serum magnesium (r=0.229, p=0.02) and serum calcium (r=0.231, p=0.019) level. Hypocalcaemia was found 35.82% and 57.14% among HIE II And HIE III cases respectively (p<0.01). Hypomagnesaemia was found 28.36% and 45.71% among HIE II and HIE III (p<0.05). Conclusion: Hypomagnesaemia and hypocalcaemia are significantly associated with the degree of severity of HIE. [ABSTRACT FROM AUTHOR]

Introduction: Kidney is the 2nd commonest affected organ as a consequence of asphyxia1. Most attention is given to prevent CNS damage and neurological sequel but hypoxic renal insult not only influences neonatal morbidity & mortality but may give rise to CKD. to assess the renal functional status of asphyxiated babies. Material & Methods: This cross sectional study was conducted in the Department of Neonatology & Department of Gynecology and Obstetrics, Dhaka Medical College Hospital during January 2012 to January 2013. A total of 150 inborn, term asphyxiated neonates with e" 2.5 kg who had history of delayed or no cry with Apgar score <7 at 5 minutes were enrolled. Then, the cases were grouped into mild (AS: 6-7), moderate (AS: 4-5) and severe asphyxia (AS: 0-3) based on Apgar score. Forty eight neonates were excluded according to exclusion criteria. Finally, the renal functions were assessed among 102 neonates by measuring urine output 8 hourly and estimated creatinine clearance (eCCL) on the 3rd day of life using Schwartz formula (eCCl=Height (cm) x.37/S.creatinine). Neonates with impaired renal function were further classified as stage-I (risk), II (injury), III (failure) using pRIFLE criteria. Data were analyzed by Chi-square & Pearson correlation coefficient test to find out correlation between Apgar scores and renal functional status. Results: Of the 102 cases studied, majority 48% were in moderate, 30.4% in mild and 21.6% in severely asphyxiated group. In the mild asphyxiated group 58.06% had normal renal function. However, the remaining cases 29.03% & 12.90% had stage I, stage II renal injury respectively and had no renal failure. In Moderately asphyxiated group, 26.53% had normal renal function & the remaining 32.65%, 34.69%, 6.1% had stage I, II, III renal injury respectively. None of the severely asphyxiated babies had normal renal function. However they had impaired renal function ranging from Stage I (27.27%), stage II (27.27%) & stage III (40.90%). Variable proportion of kidney injuries were noted among the asphyxiated neonates. The lower the Apgar score, the more severe the injuries and association between stages of kidney injuries and Apgar score was observed statistically significant (p<0.001). The renal functional status (eCCL) was also found positively correlated with low Apgar score (r=0.6, p<0.002). Conclusion: Variable functional impairment of kidneys was found among the asphyxiated neonates and the severity of impairment significantly correlated with low Apgar score. [ABSTRACT FROM AUTHOR]

Background: Acute Bronchiolitis and pneumonia pose significant morbidity and mortality of under five children. This outcome is further influenced by poor nutritional status of the affected child because of depressed immunity. Objective: We sought to evaluate nutritional status of children suffering from acute bronchiolitis and pneumonia in Bangladesh. Methods: This cross sectional study was conducted in the Department of Pediatrics of Dhaka Medical College Hospital and Dhaka Shishu Hospital from July, 2010 to June, 2011. A total of 50 patients of pneumonia aged 2-24 months and 50 patients of acute bronchiolitis of same age were enrolled in this study according to case definitions. After enrolment, the patients were thoroughly assessed with particular emphasis on the anthropometric measurements. Weight, length, MUAC and OFC were measured and recorded in a pretested semi structured questionnaire. For each group Z score of weight for age, weight for length, length for age, OFC and MUAC were calculated. Z score +2 to -1 was defined as normal, -1 to -2 z score as mild poor, -2 to -3 z score as moderate poor and <-3 z score was defined as severe poor status. Results were compared between pneumonia group and bronchiolitis group by using calculated Z value. A calculated Z value more than 1.96 was regarded significant (calculated z value > 1.96 is equivalent to p value< 0.05). Results: Children with pneumonia more often had severe underweight (weight for age <-3 SD) (50% vs. 30%, p= 0.04), microcephaly (OFC <-3SD) (30% vs. 12%, p= 0.03), and low MUAC (<115 mm) (40% vs. 10%, p= 0.03) compared to those with bronchiolitis. Although, there was an increased trend of severe wasting (weight for length <-3 SD) and severe stunting (length for age <-3 SD) in children with pneumonia compared to those with bronchiolitis, the difference was not significant. Conclusion: There thus, the overall nutritional status in children having pneumonia was poor compared to those with bronchiolitis. However, multicenter case control study with larger sample is imperative to consolidate our observation. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 12 1/2-year-old boy with seizures and was found apathetic and mentally ill. Topics include the red nodular angio-fibromas on the patient's nose and cheeks, performing Electroencephalography (EEG) and computed tomography (CT) scan of the patient's brain, and the diagnosis of Tuberous sclerosis complex (TSC) and vigabatrin.

Background : Intractable neonatal seizure are common acute medical emergency in neonatal period than at any other period of life. In our daily practice treatment of intractable neonatal seizures still relies primarily on phenytoin, despite an estimated efficacy of less than 50% and concern over neurodegenerative side effects. Several studies indicate value for lidocaine as an anticonvulsant in the treatment of intractable neonatal seizure. Aim : The objective of this study was to compare the efficacy of Phenytoin with Lidocaine in the management of intractable seizure in neonate. Methodology : A Randomized control trial was carried out in the Department of Neonatology, Dhaka Medical College Hospital (DMCH), Dhaka between July 2013 to June 2014. A total of 78 newborn with neonatal seizure. admitted in SCABU & not responding to total doses of Inj. Phenobarbital (40 mg/kg) were included in the study and were randomly assigned to either Inj. Lidocaine (Group A=39) or to Inj. Phenytoin (Group B=39). The main outcome variables were control of seizure, adverse effects, time of cessation of seizure. Results : The study demonstrated that intractable seizure of 24 neonates (75%) were controlled with Inj. Lidocaine and intractable seizure of 20 neonates (57.1%) were controlled with Inj. Phenytoin(P-Value 0.124). Adverse effects of drugs such as apnea, bradycardia, drowsiness and lethargy were observed in 4 patients (12.5%) of Lidocaine group (Group A) and 10 (28.6%) of Phenytoin group (Group=B) (P-Value 0.106). Time required for cessation of intractable seizures were nearly similar in both groups. In group A 75% of patients responded within 24 hours and in group B 71% patients responded in same duration(P-Value 0.931). Length of hospital stay was less in phenytoin group compare to lidocaine group(P-Value 0.352). None of the following results were statistically significant. Conclusion : The study concluded that Inj. Lidocaine is similar to Inj. Phenytoin in controlling intractable neonatal seizure. [ABSTRACT FROM AUTHOR]

Background: Streptococcus pneumoniae is a leading cause of meningitis in countries where pneumococcal conjugate vaccines (PCV) targeting commonly occurring serotypes are not routinely used. However, effectiveness of PCV would be jeopardized by emergence of invasive pneumococcal diseases (IPD) caused by serotypes which are not included in PCV. Systematic hospital based surveillance in Bangladesh was established and progressively improved to determine the pathogens causing childhood sepsis and meningitis. This also provided the foundation for determining the spectrum of serotypes causing IPD. This article reports an unprecedented upsurge of serotype 2, an uncommon pneumococcal serotype, without any known intervention. Methods and Findings: Cases with suspected IPD had blood or cerebrospinal fluid (CSF) collected from the beginning of 2001 till 2009. Pneumococcal serotypes were determined by capsular swelling of isolates or PCR of culture-negative CSF specimens. Multicenter national surveillance, expanded from 2004, identified 45,437 patients with suspected bacteremia who were blood cultured and 10,618 suspected meningitis cases who had a lumber puncture. Pneumococcus accounted for 230 culture positive cases of meningitis in children <5 years. Serotype-2 was the leading cause of pneumococcal meningitis, accounting for 20.4% (45/221; 95% CI 15%-26%) of cases. Ninety eight percent (45/46) of these serotype-2 strains were isolated from meningitis cases, yielding the highest serotype-specific odds ratio for meningitis (29.6; 95% CI 3.4-256.3). The serotype-2 strains had three closely related pulsed field gel electrophoresis types. Conclusions: S. pneumoniae serotype-2 was found to possess an unusually high potential for causing meningitis and was the leading serotype-specific cause of childhood meningitis in Bangladesh over the past decade. Persisting disease occurrence or progressive spread would represent a major potential infection threat since serotype-2 is not included in PCVs currently licensed or under development. [ABSTRACT FROM AUTHOR]

Background. Pneumonia contributes substantially to childhood mortality in Bangladesh. We conducted a study to characterize the disease severity and risk factors for mortality among children hospitalized for pneumonia in Bangladesh. Methods. We analyzed data on hospitalization, patient characteristics, and mortality collected by a multicenter hospital-based surveillance of pneumonia in Bangladesh. Results. From May 2004 through April 2007, 4155 children aged 2-59 months who met a pneumonia case definition adopted by GAVI's Pneumococcal Vaccines Accelerated Development and Introduction Plan-sponsored surveillance networks were enrolled after blood culture specimens were obtained. The mean duration (± SD) from illness onset to hospital admission was 6 ± 3 days; 1842 children (44%) received antimicrobial treatment before hospitalization, and an additional 924 (22%) received antimicrobial treatment after admission to the hospital. Bacteria were isolated from 161 (4%) of the 4155 specimens, including 10 (6%) Streptococcus pneumoniae isolates and 5 (3%) Haemophilus influenzae type b isolates. The case-fatality rate for pneumonia in the hospital was 4% (150 deaths), and the children who died did so after a median of 2 days of hospitalization (range, 0-24 days). Infancy was highly associated with death due to pneumonia (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3-3.2), as were very severe pneumonia (OR, 7.9; 95% CI, 5.6-11.2), a blood culture positive for bacteria (OR, 3.4; 95% CI, 2.0-5.8), severe malnutrition (OR, 4.6; 95% CI, 2.9-7.4), and delayed admission (mean [± SD] duration from illness onset to admission, 6 ± 6 days, compared with 5 ± 4 days for survivors; P< .04). Conclusions. The prevalence of pneumonia among children aged <5 years in hospitals in Bangladesh is high. However, the isolation rate of bacteria is low, possibly because of the high (68%) background use of antibiotics. Multiple risk factors associated with pneumonia case fatality suggest multiple strategies, including vaccines, to reduce pneumonia-related and overall child mortality in Bangladesh. [ABSTRACT FROM AUTHOR]

Background. Vaccines offer the prospect of primary disease prevention of pneumococcal disease in childhood. For introduction of such vaccines in developing countries, information about disease epidemiology is necessary. Methods. We evaluated antimicrobial susceptibility and serotype distribution of invasive Streptococcus pneumoniae disease in children aged <5 years in a network of 7 hospitals in Bangladesh from May 2004 through May 2007. Results. Of 17,969 blood cultures and 3765 cerebrospinal fluid cultures, 139 yielded S. pneumoniae isolates; 94 were from meningitis cases, 13 were from pneumonia cases, and 32 were from sepsis cases. Among the children with positive culture results, 73% were aged <12 months and 90% were aged <24 months. Complete resistance against penicillin, chloramphenicol, and cotrimoxazole was found in 0%, 6%, and 32% of isolates, respectively. Of the 37 serotypes observed, the predominant serotypes were 2 (17%), 1 (12%), 14 (7%), 5 (6%), 7F (6%), 45 (7%), and 12A (4%). Serotypes differed between meningitis cases and nonmeningitis cases, especially for serotype 2 (25% of meningitis cases vs. 0% of pneumonia cases; P< .001). The 7-, 10-, and 13-valent vaccines would cover 20% (95% confidence interval [I], 13%-27%), 43% (95% CI, 35%-51%), and 50% (95% CI, 42%-58%) of these cases of invasive pneumococcal disease overall, with higher coverage of nonmeningitis cases, compared with meningitis cases (7-valent coverage, 23% vs. 18%; 10-valent coverage, 55% vs. 38%; 13-valent coverage, 66% vs. 42%). Conclusions. High levels of nonsusceptibility to cotrimoxazole and susceptibility to penicillin suggest that penicillin may be a drug of choice for treatment of invasive pneumococcal disease. Although serotype distribution is diverse, with changes over time and differences between syndromes observed, implementation of use of the currently available 10- or 13-valent vaccines would have a substantial impact on pneumococcal disease in Bangladesh. [ABSTRACT FROM AUTHOR]

Objective: Since the underlying mechanisms of febrile seizure (FS) having multi-factorial aetiology yet remains unclear, we conducted this prospectively designed cross-sectional study to determine if there was any simultaneous change in zinc (Zn) concentration (conc.) in serum and cerebrospinal fluid (CSF) among the FS children in comparison to their matched non-seizure febrile (NSF) peers. Methods: Zn concentration (level) in both serum (intravenous blood) and CSF (lumber puncture: LP) of 50 children with FS and 30 NSF peers (serving as control) were measured employing graphite furnace atomic absorbance spectrophotometer. Data were analysed to compare Zn level between two groups using appropriate statistical tools employing SPSS/Windows 12.0. Results: Mean Zn conc. in both serum and CSF was less in FS children (464.60 ± 64.57 and 46.28 ± 7.46, respectively) than their matched NSF peers (749.33 ± 73.19 μg/L and 111.28 ± 19.11 μg/L, respectively) showing significant differences both in serum (p < 0.001) and CSF (p < 0.001). None of serum or CSF-Zn differed significantly with age, degree and duration of fever between FS and NSF peers. CSF-Zn among these children showed an upward trend in LP specimen taken beyond 12 h following FS episodes. Conclusion and recommendation: Serum and CSF-Zn simultaneously decreased in FS children in comparison to their matched NSF peers. Further prospectively designed multicentral studies are recommended to conduct in geographically diverse regions involving larger sample to confirm or refute our findings. It remains crucial in standardizing/strengthening national seizure prevention protocol with adequate Zn supplementation. [ABSTRACT FROM AUTHOR]

Objective Nipah virus (NiV) is an emerging zoonosis. Central nervous system disease frequently results in high case-fatality. Long-term neurological assessments of survivors are limited. We assessed long-term neurologic and functional outcomes of 22 patients surviving NiV illness in Bangladesh. Methods During August 2005 and May 2006, we administered a questionnaire on persistent symptoms and functional difficulties to 22 previously identified NiV infection survivors. We performed neurologic evaluations and brain magnetic resonance imaging (MRI). Results Twelve (55%) subjects were male; median age was 14.5 years (range 6-50). Seventeen (77%) survived encephalitis, and 5 survived febrile illness. All but 1 subject had disabling fatigue, with a median duration of 5 months (range, 8 days-8 months). Seven encephalitis patients (32% overall), but none with febrile illness had persistent neurologic dysfunction, including static encephalopathy (n = 4), ocular motor palsies (2), cervical dystonia (2), focal weakness (2), and facial paralysis (1). Four cases had delayed-onset neurologic abnormalities months after acute illness. Behavioral abnormalities were reported by caregivers of over 50% of subjects under age 16. MRI abnormalities were present in 15, and included multifocal hyperintensities, cerebral atrophy, and confluent cortical and subcortical signal changes. Interpretation Although delayed progression to neurologic illness following Nipah fever was not observed, persistent fatigue and functional impairment was frequent. Neurologic sequelae were frequent following Nipah encephalitis. Neurologic dysfunction may persist for years after acute infection, and new neurologic dysfunction may develop after acute illness. Survivors of NiV infection may experience substantial long-term neurologic and functional morbidity. Ann Neurol 2007 [ABSTRACT FROM AUTHOR]