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Solitary rectal ulcer syndrome (SRUS) is a relatively uncommon but troublesome chronic benign disorder more in young adults and less in children. It is usually presented as rectal bleeding, constipation, copious mucous discharge, prolonged excessive straining, tenesmus, lower abdominal pain, localized pain in the perineal area, feeling of incomplete defecation and rarely rectal prolapse.The underlying etiology is not well known. It is diagnosed based on symptoms and endoscopic and histological findings. J Enam Med Col 2021; 11(1): 47-51

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) is shaking the world heavily. SARS-COV-2 (COVID-19) infection has a wide variety of presentations as it affects almost every system of body. Gastrointestinal and hepatobiliary symptoms are frequently overlooked especially in children. Objectives: The purpose of this review was to discuss the gastrointestinal and hepatobiliary presentations of COVID-19 in children and compare with non-gastrointestinal presentations. Methods: This study was a narrative review. Recent available literature was searched by keywords. The most recent information from relevant articles were collected and reviewed. This write up was compiled after the review of articles from the last one and half year. Results: About 50.0% symptomatic children with COVID-19 had gastrointestinal manifestations. COVID-19 with gastrointestinal symptoms had delayed diagnosis, delayed hospitalization and worse outcome in compare with Covid-19 with non-gastrointestinal symptoms. Conclusion: Vomiting, diarrhoea, abdominal pain, anorexia, nausea are common gastrointestinal manifestations in children with COVID-19. Elevated transaminasemia is not uncommon. Bangladesh Med Res Counc Bull 2021; 47(1): 3-8

Osteopetrosis (Marble bone disease) is a very rare congenital genetic disease of skeleton, resulting from defective bone resorption, due to functionally defective osteoclast, leading to accumulation of excessive bone mass. Malignant infantile osteopetrosis (MIO) is one of the varieties of osteopetrosis, which is fatal and is diagnosed in early infancy. Malignant infantile osteopetrosis is present with abnormal bone remodeling, hematological abnormities, features of extramedullary hematopoiesis. Radiology is the key of diagnosis. In this case, we present a 5-month-old male infant diagnosed as malignant infantile osteopetrosis, who presented with bronchopneumonia, anemia, thrombocytopenia, hepatosplenomegaly, failure to thrive (FTT).

Purpose Colonoscopy is considered the most reliable method for the diagnosis of juvenile polyps. However, colonoscopic screening is an invasive and expensive procedure. Fecal calprotectin (FCP), a marker of intestinal inflammation, has been shown to be elevated in patients with polyps. Therefore, this study aimed to evaluate FCP as a screening biomarker for the diagnosis of juvenile polyps. Methods This cross-sectional, observational study was conducted at the Pediatric Gastroenterology and Nutrition Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. For children with polyps, colonoscopic polypectomy and histopathology were performed. FCP levels were analyzed before and 4 weeks after polypectomy in all patients. Information was recorded in a datasheet and analyzed using the computer-based program SPSS. Results The age of the children was between 2.5 and 12 years. Approximately 93% of the polyps were found in the rectosigmoid region. Children with juvenile polyps had elevated levels of FCP before polypectomy that subsequently normalized after polypectomy. The mean FCP levels before and after polypectomy were 277±247 µg/g (range, 80–1,000 µg/g) and 48.57±38.23 µg/g (range, 29–140 µg/g) (p

not available DS (Child) H J 2018; 34(1) : 55-58

Introduction: Acute liver failure is one of the common causes of death in pediatric gastroenterology and hepatology department. Outcome is different according to aetiology. Objective: To observe the aetiology, outcome and prognostic factors of pediatric acute liver failure. Methods: Consecutive 62 children aged 2 to 16 years of age who were diagnosed as acute liver failure from November 2015 to April 2018 were included in this study. All the clinical profiles, laboratory data and outcome were recorded in a preformed data sheet. Data were analysed by SPSS for Windows version 20. Results: Mean age was 8.5 years. Thirty-nine (62.9%) patients were between 5-10 years of age. Male were 53%. We made a diagnosis of 39 (63%) patients as Wilson disease alone, Another 3 Wilson disease acute liver failure patients had concomitent with either HAV, HEV or HSV in each one. HAV only was responsible for 17 patients and HEV for 1. One patient was Haemophagocyic lymphohistiocytosis and aetiology could not be identified in 1 patient. The overall death in study population was 48% (30). Twenty-four (57%) of 42 acute liver failure patients due to Wilson disease had died. Five (29%) of 17 patients due to HAV infection and 1 patient with HLH died. Ascites, high total bilirubin, high INR and etiology like Wilson disease were the worse pronostic factors for outcome of acute liver failure in children. Conclusion: Wilson disease was the most common aetiology of acute liver failure in children in this study. Early diagnosis is essential as outcome was worse. Majority of viral etiology improved with supportive care. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 56-61

BACKGROUND : Wilson disease (WD) is an autosomal recessive disorder caused by mutation in the Adenosine Triphosphate 7B (ATP7B) gene. The spectrum of ATP7B mutation varies in different populations. The objective of this study was to identify the mutation in exon 8 and exon 14 of ATP7B gene in Bangladeshi children clinically diagnosed as WD. We also aimed to explore the phenotypic presentation.It was a cross sectional observational study. The study was conducted at the Department of Paediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2018. A total of 37 patients diagnosed with WD were enrolled for the study. Venous blood (about 3 mL) was drawn aseptically from each patient into tube containing ethyline diamine tetraacetic acid (EDTA) and preserved at -30°C for long-term preservation. The peripheral blood leukocytes of the patients and genomic DNAs were extracted. Exons 14 and 8 of ATP7B and their associated splice-site junctions were amplified by the polymerase chain reaction (PCR). The size and quantity of PCR products were verified by electrophoresis in 1.5% (w/v) agarose gel. 74 (37 × 2) PCR products were sent for Sanger Sequencing. The sequences were analyzed by Chromas version 2.6.6 software and the nucleotide blast was done by National Center for Biotechnology Information (NCBI) nucleoblast. Finally, the sequences were analyzed using AB Applied Bio systems and were matched with the reference sequences using MEGA software.In this study, a single novel homozygous mutation pLeu.1071Val in the exon 14 was found in every (100%) studied child clinically diagnosed with WD. Heterozygous mutation p.Gly1061Glu in exon14 was also found in 6 patients (11%) with WD, which is one of the common mutations in this disease. In exon 8, p.Arg778Leu mutation was detected in one patient (2.7%), which is common in the Chinese and the South Asian populations and was heterozygous. Two novel heterozygous missense mutations p.K785R (2.7%) and p.S744F (2.7%) were also found in two other children in the exon 8.We found three novel mutations in Bangladeshi children with WD, one of which may be tagged as founder mutation for Bangladeshi population. This finding indicates the necessity to study the mutation profiles of the whole ATP7B gene in our population for risk prediction. A further large-scale study will help in the development of a Mutational Data Base of Bangladeshi population with WD.

Constipation is a common problem in children and a frequent cause of hospital visit in both primaryspecialized care, which needs proper evaluationmanagement. Presentation of constipation is variable among children. In Bangladesh there has been no published data regarding constipation in community among school aged children.To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.This descriptive cross sectional study was conducted in different schools of Dhaka division, Bangladesh. All school aged children between 5-16 years of age who attended school were included in this study. Samples were collected randomly. Proper clinical historyphysical examinations (without digital rectal examination)available investigations (if done previously) were recorded. Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation. Children with any red flag sign, known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded. Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20. For all statistical tests,Total study populations were 707 and male was 443 and female 264. Among them, 134 (19%) children had constipation. In constipated children, 78 children fulfilled the Rome IV criteria for functional constipation and it was 11% of total population. Mean age of children having functional constipation was 11.24 ± 3.54 years and Male female ratio was 1:1.78. Anorexia, nausea, abdominal pain, hard stool, blood with hard stool, alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group. Children of school, where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number (OR = 2.493, 95%CI: 1.214-5.120). Children who feel embarrassed to use toilet at school, had 3.6 times higher risk of constipation (OR = 3.552, 95%CI: 1.435-8.794). Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs (OR = 3.977, 95%CI: 1.884-8.397) and parents/grandparents (OR = 2.569, 95%CI: 1.172-5.629). Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake (OR = 1.972, 95%CI: 1.135-3.426). Children who passed electronic screen time of2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time2 h (OR = 2.138, 95%CI: 1.063-4.301).Constipation is not uncommon in Bangladeshi school aged children. Inadequate toilet number, family history of constipation, inadequate fluid intake, feeling embarrassed to use toilet at school, and electronic screen time for2 h/d were found as risk factors in the present study for functional constipation.

The most devastating pandemic of this era coronavirus disease-2019 (COVID-19) is caused by a novel virus named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Although it is primarily a respiratory pathogen, it can also result in several extra-pulmonary manifestations includes gastrointestinal symptoms, hepatocellular injury. Angiotensin-converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2), the entry receptor for the causative coronavirus SARS-CoV-2 is co-express in the gastrointestinal tract, hepatocyte, and cholangiocytes similar to the respiratory mucosa. The presence of these receptors facilitates the entry into the tissue and causes direct viral tissue damage, which is a proposed mechanism of injury. Diarrhoea, nausea, vomiting, abdominal discomfort are common gastrointestinal manifestations, whereas derangement of liver function tests is the most hepatic manifestation in COVID-19. In this article, we reviewed on SARS-CoV-2 disease COVID-19 regarding gastrointestinal, hepatic, and pancreatic manifestation, the mechanisms by which the virus may inflict damage, and their management perspective.

This article has no abstract. The first 100 words appear below: A 4-year-old boy presenting with constipation for 1 month of his age. He used to defecate 3-4 days interval with rectal stimulation. The stool was semisolid, ribbon-like, and not associated with abdominal or perianal pain. He had a history of delayed passage of meconium. There was no history of the delayed developmental milestones. He received several medications including lactulose, magnesium hydroxide but there was a poor response. On examination, he was mildly pale, with no facial dysmorphism, anthropometrically well thrived. The back and spine were normal. There was no thyroid swelling. The skin was normal. The tone and jerk of lower limbs were normal.

Background: Constipation is a common problem throughout childhood. It is important to be fully aware of the factors involved in developing constipation in children. There are few published articles on childhood constipation in Bangladesh. In this study, our aim was to evaluate demography and probable/potential risk factors for functional constipation in Bangladeshi children.Methods: The study was carried out among 179 children from May 2018 to June 2019 in the department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU) both indoor and outdoor basis. Children with constipation who fulfilled the ROME III criteria were evaluated for demography and probable/potential risk factors of constipation.Results: A total of 179 subjects were included in the final analysis. Among them, 54.75% were boys and 45.25% were girls. Constipation was found more in the age group above 5 years (56.42%), then in 2 to 5 years age group (33.52%) and lower in below 2 years of age (10.6%). Constipation was more among children living in urban area (55.3%) than in rural area (44.69%). Constipation was the presenting complaint in 76.54% subjects, other complaints were abdominal pain (47.49%), anorexia (24.02%), vomiting (19.56%). Diet low in fiber (72.63%) was found as the most common potential risk factor, other factors were ingestion of cow’s milk (32.96%), not having regular meals with parents (19.55%), consumption of junk foods (28.49%). Staying with grandparents (16.76%), living in hostel or madrasa / residential religious institute (5.03%), long period of academic activity, [homework (10.61%) / tutor and coaching (7.26%)], unhygienic toilet in school (6.14%) were also found to be probable associated factors in this study.Conclusions: Functional constipation was found more in boy’s and above five year age group. Low dietary fiber, consumption of cow’s milk and junk food, unwillingness to use toilets in school, long time in academic activity, were found to be potential underlying risk factors of constipation.