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Objective Hand, foot, and mouth disease (HFMD), caused by various human enteroviruses (EVs), has emerged in the children of Bangladesh in recent years. However, the etiological agents of HFMD in Bangladeshi children are not yet elucidated. This study aimed to investigate the causative agents with molecular characterization. Methods Viral RNAs were detected from the blister fluid samples by reverse transcription polymerase chain reaction; genotyping was done by sequence-based analysis of the partial viral capsid protein 1 (VP1) region, and the evolutionary relationships among the genotypes were investigated by phylogenetic analysis. Results EV-RNAs were identified in 14 (61%) blister fluid samples out of 23 children who were suspected of HFMD during an outbreak in Rajshahi in 2020. Genome sequence analysis of the VP1 gene was performed on four strains: all the four were coxsackievirus A16 (CVA16) that clustered in B1c subgenotype. These strains showed 95 to 98% nucleotide identity with those reported in India in 2013/2018. Conclusion After our first report on clinical evidence of childhood HFMD in Bangladesh, this time, we provided laboratory confirmation of the emergence of CVA16 as a causative agent of HFMD in Bangladeshi children. There is an urgent need for nationwide, in-depth, clinicoepidemiological surveillance on HFMD including its virology and genetics before it becomes endemic in Bangladesh.

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. J Bangladesh Coll Phys Surg 2022; 40: 299-301

Background: Short stature can cause psychosocial problems both in parents and children. It can be a normal variant or secondary to an underlying pathological condition. It is necessary to evaluate cause of short stature and thus to decide whether further management needed. This study aimed to determine the causes of short stature in children and adolescents. Methods: This cross-sectional study was done at the paediatric endocrine out patient department, BIRDEM General Hospital 2, Dhaka from January to December 2019. A total 175 patient with short stature who fulfilled the inclusion criteria were recruited. Detailed history, physical examinations including anthropometric measurements and relevant investigations were recorded. Results: The mean age of the children was 9 ± 4 years, with female preponderance (female: male 1.27:1). Majority of the children had normal variation of growth (29%). Systemic illness and non-endocrine causes were found in 27.4%, endocrine cause in 26.85%, 13.7 % cases had dysmorphic features and idiopathic short stature was found in 2.85% cases. Familial short stature (FSS) was the most common cause (20.57%) followed by hypothyroidism (13.14%), familial short stature co-existing with nutritional problem (8.6%), growth hormone deficiency (7.4%), Turner syndrome (6.28%). Other causes that contributed for short stature in our study included constitutional delay of growth and puberty (CDGP) (2.85%), FSS coexisting with CDGP (5.7%) and systemic diseases and chromosomal abnormalities. Conclusions: The majority of short stature in children had normal variations of growth. Potentially treatable causes such as hypothyroidism, growth hormone deficiency, nutritional problem, Turner syndrome etc. accounted for a considerable percentage of short stature in our study. BIRDEM Med J 2022; 12(2): 117-123

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. J Bangladesh Coll Phys Surg 2022; 40: 87-92

Backgrounds: Children are mostly the victims of pneumonia and bronchiolitis for which they are often hospitalized. Acute respiratory infection(ARI)results in 1.9 million deaths per year in developing countries(Taneja et. al 2009). It is important to know the recovery time of individual acute lower respiratory tract infection (ALRTIs) like pneumonia and bronchiolitis for better understanding the clinical feature and outcome. Knowing the length of stay (LOS) in case of ALRTI has not yet been worked out and studied well. Objective: To determine the recovery of different clinical features Length of hospital Stay and outcome of two common LRTIs viz pneumonia and bronchiolitis. Methods: A cross-sectional analytical study was done in department of pediatrics of Dhaka Medical College Hospital during the from October 2013 to September 2014. Cases were selected according to selection criteria. Pneumonia was diagnosed on the basis of fever, cough, breathing difficulty, and found chest indrawing, fast breathing, and bronchial breath sound or crackles on examination and consolidation or patchy opacity in chest X-ray and bronchiolitis on the basis of presence of runny nose followed by cough, breathing difficulty and wheeze on auscultation in a child below 2 yrs. Cases of pneumonia were treated with standard protocol of WHO and cases of bronchiolitis were treated with national guideline. The cases were followed up 12 hourly for 8 days using case collection sheet by monitoring 17 clinical features. Results : There were 54 cases of pneumonia and 54 cases of bronchiolitis. Baseline selected clinical-sociodemographic parameters of both the cases were similar in terms of sociodemographic status and some clinical features. The following clinical features were similar in both groups viz. cough(100% vs 100%) breathing difficulty (100%vs 100%), feeding difficulty (92.6%vs96.3%), chest indrawing(92.6%vs 96.3%).The dissimilar clinical features were fever (100%vs77.8%, p

Background: Smoking means the activity or habit of smoking cigarettes; this is very much common all over the world. The consumption of cigarettes in developing countries is increasing, while in the industrialized country is declining or static. Objective: The aim of the study was to estimate the prevalence of smoking among school children in Dhaka city. Material & Methods: This cross-sectional study was conducted in high schools of Dhaka city from June 2006 to December 2006. Students of classes VIII, IX and X were selected by random table selection. A total of 2474 participants were included in the study. The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 10.0. Results: The age of the study of children was between 12 to 18 years. Among the study children, 8(0.32%), 354(14.3%), 900(36.3%), 850(34.3%), 324(13.1%), 30(1.21%), 8(0.32%) belonged to 12, 13, 14, 15, 16, 17, 18 years of age respectively. Male and female students were 1876 (75.8%), 598 (24.2%) respectively. The prevalence of smoking among male and female students was 36.0% and 17.0% respectively. The prevalence was 32.0% and only 4.0% of the students are regular smokers combining boys and girls together. Only 06 (0.76%) did not want to leave smoking and 786 (99.24%) wanted to leave smoking. Conclusion: The prevalence was 32.0% among all students of this study. In boys, 36.0% were found smokers and in girls, 17.0% were smokers. Almost all (99.24%) students were willing to quit smoking in future. Adolescents should not be allowed to buy cigarettes for parents or family members.

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 (PSMC3 gene as a strong candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability.Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis, therapy and management of NDD patients.

Background: Junior doctors form the majority of the workforce in patient care. Their job is perilous, highly critical, tedious and exhausting and it is imperative that they stay motivated while at work. Improving the morale of physicians has the potential to increase efficiency, ensure patient safety and improve patient outcomes. We aimed to identify the existing status and explore the factors affecting junior doctors’ morale, their sense of feeling supported and their levels of autonomy in 2 large teaching hospitals in Bangladesh. Methods: This cross-sectional observational study was done across 2 large tertiary hospitals- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders(BIRDEM) General Hospital and Dhaka Shishu Hospital, over 4 months period from September- December 2020. The study was carried out on 120 junior doctors by an online questionnaire, distributed through emails and Facebook messenger, asking junior doctors to rate their morale, sense of feeling supported and autonomy and rank the top factors that positively affected them. Results: Data were finally collected from 117 junior doctors after 3 incomplete data were discarded. Most of the junior doctors felt ‘neither good nor bad’ in the domains of existing ‘morale’ (44.4%), ‘feeling supported’ (46.5%) and ‘autonomy’ (48.7%). Additionally, ‘good’ morale was seen in 39.3%, while around 34% rated their support system as ‘good’ and around 24% reported a ‘good’ autonomy. The most important factor positively affecting morale was recognition and reward for good performance (70.1%), factor influencing support was an easy access to senior clinicians (70.4%) and that defining autonomy was constant senior supervision of the everyday work (61.1%). Conclusion: The study aims to identify the existing level of morale, support and autonomy of the junior doctors at their workplace and explore the factors positively affecting them. It is concluded from this study that the junior doctors rated their existing morale, support and autonomy as ‘average’. According to the opinions of the doctors, this study also concludes that, to improve their morale, there is a need to recognize and reward their good work and provide positive feedback. Doctors identified an easy access to senior clinicians with a problem was the primary factor influencing support. Finally, junior doctors wanted constant senior supervision of their everyday work in the wards to improve output. BIRDEM Med J 2022; 12(1): 30-35

Over the last few years, there is a rise in the use of button batteries(BB) in children’s toys and home appliances. Easy availability and small size of these batteries pose a significant risk of ingestion by small children which is exceedingly dangerous. After ingestion, the BB may lodge in the esophagus or enters easily into the stomach due to its variable sizes. If lodged in the esophagus, BB can cause injury due to their caustic and electric properties, as well as by direct pressure. In our case, the 16 months old boy had accidentally ingested a BB, removed approximately after 30 hours from the esophagus, had developed esophageal perforation followed by tracheaesophageal fistula, complications related to aspiration and finally expired due to bronchopneumonia with septicemia and respiratory failure. So, Prompt removal is mandatory to reduce devastating outcome if it is a button battery BANGLADESH J CHILD HEALTH 2021; VOL 45 (1) : 41-44

DiGeorge syndrome is caused by a micro-deletion of chromosome 22q11.2 that disrupts development of the third and fourth pharyngeal pouches during early embryogenesis. Other structures forming at the same period are also frequently affected. So, the phenotypic spectrum shows a wide variability. In this case report, we describe a 1-month and 24-day old male child who presented with history of recurrent afebrile seizure and noisy breathing since early neonatal period. He had history of repeated chest infections. On examination, patient had stridor, facial dysmorphism, pectus excavatum and clinical features of pneumonia. Investigations revealed hypocalcaemia, hypoparathyroidism, consolidation on X-ray chest and cellular immunodeficiency. Echocardiography findings were normal. Fluorescent in situ hybridization (FISH) was performed which confirmed the diagnosis 22q11.2 deletion. Birdem Med J 2021; 11(2): 128-132

Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a major cause of mortality, morbidity and long-term neurological deficits. Objective: The aim of the study was to determine the severity of encephalopathy and immediate neurodevelopmental outcomes in term neonates with HIE admitted in NICU at a tertiary care hospital. Materials and Methods: This was a Prospective Cohort study conducted between July 2016 and June 2017 at Dhaka Medical college Hospital, Dhaka. Asphyxiated term newborns who came within 12 hours of birth were enrolled in this study. Sarnat and Sarnat score was used to assess newborns immediately after birth to classify HIE. Neurodevelopmental assessment was performed using age specific rapid neurodevelopmental assessment tool (RNDA) at and 3 months after discharge to identify impairment in specific developmental domains. We determined the relation between severity of HIE and clinical outcome. Results: 60 patients were included in this study and their mean duration of hospital stay was 7.19 ± 5.26 days. The majority, 40% had moderate HIE, followed by 33.33%, 26.67% that had mild and severe HIE respectively. A total of 20% died, and most of them had severe HIE (83.33%). Normal development was found in only 11.67% cases. Moderate and severe neurodevelopmental impairment (NDI) was found in 33.33% and 25% cases respectively. At discharge, the most severely impaired domains were speech, seizure, primitive reflex and behaviour whereas at 3 months of age it was gross motor and seizure. When neurodevelopmental outcome was compared with different stages of encephalopathy, significant association was found between moderate to severe impairment/death with stage III of HIE. Conclusion: Apart from mortality, a significant proportion of term neonates with HIE developed NDIs and adverse neurodevelopmental outcomes was significantly associated with severity of encephalopathy. Bangladesh Crit Care J March 2021; 9(1): 22-27

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 4½-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. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.208-211

Background: Nebulized salbutamol is commonly used in treatment of asthma in children. The use of nebulized MgSO4 is one of the different treatment options available during acute exacerbation. Objective: To compare the efficacy of nebulized MgSO4 with nebulized salbutamol in the treatment of acute asthma in children. Materials and method: This randomized controlled study was conducted in Dhaka Medical College Hospital between January to December 2016. Children of 7-12 years with acute exacerbation of asthma were randomized into study group-A (MgSO4 group, n=30) and control group-B (Salbutamol group, n=30). Children of both groups were treated with serial nebulization thrice at 20 minute intervals by either 2.4 ml (4% MgSO4, 96 mg) or salbutamol (0.15 mg/kg minimum 2.5 mg) with 2.5 ml of isotonic normal saline. Results: The mean final PEFR were not different between the two groups (275.0±41.42 L/min in MgS04 group and 263±36.17 L/min in salbutamol group). The increase in PEF was statistically significant and comparable in both groups (by 35.1% in the MgS04 group and by 42.1% in the salbutamol group). Fischl score improvement was comparable and significant in both groups (4.31 to 0.43 in MgS04 group and 4.29 to 0.76 in salbutamol group). Statistically significant increase in oxygen saturation and reduction of heart rate was found in MgS04 group without any side effects. Nebulized MgSO4 was found having significant bronchodilator effect which is comparable to salbutamol. Conclusion: Nebulized MgS04 was found equally effective as nebulized salbutamol in the treatment of severe acute asthma in children. Bangladesh J Child Health 2020; VOL 44 (1) :24-29

Background: Dengue is a major health problem affecting Bangladesh. The number of cases have increased over the last few years with a large number of population being children. However data regarding dengue among children is limited. The objectives of this study were to see the clinical and laboratory profile of dengue fever (DF) in children and their outcome. Methods: This cross - sectional study was carried out in the department of Paediatrics, BIRDEM General Hospital 2 from June 2018 to August 2019. Three hundred and ten confirmed dengue cases were enrolled in the study. Their clinical profile and laboratory findings including haemoglobin (Hb%), haematocrit (Hct), total count of white blood cells (TC), differential count of white blood cells ( DC), platelet count (PC), serum alanine aminotransferase ( S. ALT), serum aspartate aminotransaminase (S. AST), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT) were documented. Comparison was made between the clinical and laboratory profile with severity of dengue. Results: One hundred and ninety eight (63.9%) had dengue fever, 58(18.7%) had dengue haemorrhagic fever (DHF I, II) and 54 ( 17.4 %) had dengue shock syndrome ( DHF III and IV). All the patients had fever, vomiting was present in 40%, ascites and skin rash in 21 %, pleural effusion 20%, abdominal pain 14% and 12.2% came with shock.Thrombocytopenia, raised hct, raised liver enzymes and abnormal coagulation profile were more common in dengue haemorrhagic fever when compared to patients with dengue fever. Conclusion: Gastrointestinal features like vomiting, ascites ,abdonminal pain were common presentations. Thrombocytopenia, raised hct, raised liver enzymes, abnormal coagulation profile were more common in dengue haemorrhagic fever. Birdem Med J 2020; 10(3): 200-203

Introduction: To determine the clinical types and etiological factors and to assess the biochemical abnormalities in neonates with seizure. Materials and Methods: This was a Cross-sectional, comparative hospital based study. Ninety neonates, age up to 28 days of both sexes were evaluated for clinical types, etiological factors and biochemical abnormalities with seizure and compared with those having no seizures. The variables were analyzed using student t- test. All the data was processed and analyzed by computer software SPSS version 15.0. Level of significance was considered as p value less than 0.05. Results: Most of the neonates having seizures (72%) within 3 days of life. The seizures were common in male babies (62%). 35% of the mother of baby with seizure gave history of prolonged labour. HIE was diagnosed 56.67% neonates with seizure whereas infection were found in 25% cases with seizure. Among the seizure subtypes, subtle seizures were 58% followed by clonic seizures 30%. Significant biochemical changes we found in 43.34% of neonates with seizures. Hypocalcemia (46%) was most common followed by hypoglycemia(38%). Conclusion: Hypoxic ischemic encephalopathy was the commonest cause of neonatal seizure followed by neonatal infections including meningitis and sepsis.. Biochemical abnormalities are more common in neonates with seizure than neonates free from seizure. Among the biochemical abnormalities hypocalcaemia and hypoglycemia occurs most commonly followed by hyponatraemia and hypomagnesaemia. Medicine Today 2020 Vol.32(1): 37-41

Background: Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality that is spasticity. Objective: The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. Methodology: This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Results: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in Tizanidine group and 35 patients were in baclofen group. Furthermore, 70 cerebral palsy children were taken as control who were treated with placebo. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using Modified Ashworth scale in different time periods from AS score-3 to score-2 (p physician rating scale from AS score-3 to score-2 (crouch p Adverse effect was more in baclofen group. Conclusion: For reducing generalized spasticity with regards to muscle tone, joint angle and improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.

Background: Copy number variations (CNVs) play a critical role into 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 genome-wide chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare chromosomal abnormalities (deletion /duplication/ rearrangements). To identify candidate genes within the rare CNVs, multiple 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 R package. Results: In our cohort, the head circumference of males are significantly greater than females (p=0.0002). Of all samples assayed, 12.26% (26/212) and 47.17% (100/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. 2.83% (6/212) pathogenic CNVs are located at the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs in comparison to males (OR=4.2; p=0.0007). ADOS-2 subset show 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 (PSMC3 gene as a potential candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability. Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis therapeutics and management of NDD patients.

Background: Acute bronchiolitis is an acute viral lower respiratory tract infection of infants and is the leading cause of hospitalization of 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 0.9% normal saline with salbutamol and 3% hypertonic saline has been found effective. This study was undertaken to assess the efficacy of 7% hypertonic saline on recovery from acute bronchiolitis. Methodology: This was a randomized controlled trial, carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Bangladesh between January 2015 to December 2015. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted as acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 0.9% nebulized normal saline with salbutamol (Group-II = 45). The efficacy was determined by assessing clinical severity score and length of hospital stay. Data were analyzed using computer software SPSS version 19. Result: In this study the two groups were almost similar with respect to their demographic and baseline clinical severity score. After intervention the clinical severity score of both treatment modalities were reduced (Group-I(HS) were 7.9, 6.8, 3.8, 1.4, 1.33 while in Group-II(NS+ Salbutamol) score were 8.6, 7.6, 4.9, 3.11, 2.12) but the reduction was significant more in children who received 7% nebulized hypertonic saline than those who received 0.9% nebulized normal saline with salbutamol. Majority 42(93.3%) of group-I(HS) children recovered at the end of 72 hours whereas 17(37.8%) of the children of group-II (NS+ Salbutamol) recovered from the disease during the same period. Length of hospital stay was shorter in hypertonic saline group compared to normal saline with salbutamol group (56.36±12.33 hours vs71.07±13.48 hours, p

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). 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. 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. F-100 can be safely used in the rehabilitation phase for infants u6m with SAM and there is no need to prepare alternative formulations.

Background: Bronchiolitis is an acute seditious lesion of the lower respiratory tract. Further, than 70 cases are caused by a respiratory syncytial virus (RSV); other less common pathogens include parainfluenza, influenza, rhinovirus, adenovirus, mortal metapneumovirus, mortal Boca contagion and mycoplasma pneumonae. The aim of the study was to evaluate the efficacy of nebulized hypertonic saline in children with acute bronchiolitis in the improvement of clinical features and decreasing length of hospital stay.Methods: The study was a randomized control trial carried out in the department of paediatrics, Dhaka medical college hospital (DMCH), Dhaka between January to December 2013. A total of 100 children from 1 month to 24 months of age irrespective of sex with clinical presentation of bronchiolitis admitted in the paediatric wards of DMCH were included in the study and were randomly assigned to either 4 ml 3% hypertonic saline nebulization (group I=50) or to 4 ml normal saline and 0.4 ml salbutamol respiratory solution nebulization (group II=50). The therapy was repeated 8 hours every day for 120 hours.Results: The clinical severity scores (CS) based on respiratory rate, wheezing, chest retraction and general conditions at baseline on the first day of treatment were 9.0±1.0 in group I and 9.3±1.8 in group II (not significant). The study demonstrated that clinical severity score improved by three days but the improvement was more significant in children who received nebulized hypertonic saline (1.7±1.2) compared to those who received nebulized normal saline and salbutamol (3.5±1.8). The cases of group I required a shorter duration of oxygen therapy compared to those of group II (15±6.0 hours versus 26.4±5.4 hours; p

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 vs63.07±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.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 153-156

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

Background: The present study was intended to make a comparison of acute kidney injury (AKI) diagnosed and classified by two diagnostic modalities such as paediatric Risk Injury Failure Loss of End Stage Renal Failure (pRIFLE ) criteria and acute kidney injury network (AKIN) staging .Methodology: A total 44 neonates (from 3 – 28 days) with AKI as case and other 26 neonates without AKI as control were also included in the study. Both were admitted in special care baby unit (SCABU) Dhaka Medical College Hospital.Results: The neonate of ≤7 days old comprised the main bulk. Majority of the neonates were of average birth weight. The diagnosis was based on estimated creatinine clearance (eCCL) criteria of pRIFLE showed that 40.9% neonates were at risk of AKI, 20.5% have had already injured. Higher proportions of neonates were classified as failure (38.6%).The diagnosis was based on Serum creatinine criteria of AKIN showed that about 64% of the neonates were at AKI-stage I, 22.7% at stage-II and 13.6% at stage-III. Higher proportions of neonates were classified as stageI.We found moderate agreement between pRIFLE criteria and AKIN staging, these two diagnostic modalities for diagnosis of AKI by kappa- statistics. Outcome of neonatal AKI predicted by pRIFLE criteria was significantly higher compared to AKIN staging (p < 0.001) in respect to SCABU stay, multiorgan failure, need for dialysis. Here 43% neonates with AKI were improved with normal renal function and 16% improved with impaired renal function. Increased frequency of death (34%) in this series was due to multiorgan involvement with acute kidney failure (AKF). Mortality was significantly higher (p=0.03) in failure group by pRIFLE criteria compared to AKIN stage III. So it is evident that pRIFLE criterions are highly sensitive to classify AKI, it is also superior to AKIN staging in predicting early diagnosis, need for intervention and immediate outcome.Conclusion: The study concluded that pRIFLE criteria and AKIN staging are useful in the diagnosis of AKI in neonates and pRIFLE criteria are fairly sensitive for better characterization of AKI.Bangladesh J Child Health 2017; VOL 41 (3) :147-154

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.J Bangladesh Coll Phys Surg 2018; 36(2): 48-52

not availableJ Bangladesh Coll Phys Surg 2018; 36(2): 44-46

Congenital pulmonary airway malformation (CPAM) is a very rare congenital cystic lung disease in children. Frequent respiratory tract infections (RTI) are major concerns in these patients. When a child having recurrent episodis of RTI, CPAM could be the underlying pathology. Surgical excision is recommended to make a definite diagnosis and exclude hidden malignancies and is also the treatment of choice. Here in, we report a 6 months old girl presenting with an acute respiratory infection for the first time. An routine USG of abdomen incidentally showed multiple cystic lessions in the left lower lung. CT scan of chest also revealed similar lessions in some area. After receiving treatment for pneumonia surgical excision was performed and she was doing well after surgeryBangladesh J Child Health 2017; VOL 41 (2) :129-134

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.J Bangladesh Coll Phys Surg 2017; 35(4): 170-173

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

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. J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 94-99

not availableBangladesh J Child Health 2017; VOL 41 (1) :60-63

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 1.96 is equivalent to p value< 0.05). Results: Children with pneumonia more often had severe underweight (weight for age

Melioidosis is a relatively uncommon but fatal infectious disease caused by the gram negative bacterium, Burkholderia pseudomallei which is usually found in the wet soil, mud and pooled surface water in tropic and subtropics. Documented reports of melioidosis from Bangladesh have been few and sporadic. All of the reported cases in Bangladesh were on adult. Melioidosis is commonly associated with underlying diseases like diabetes mellitus, renal diseases and immunodeficiency disorders. Early and correct diagnosis is important, as mortality in untreated melioidosis is high. Our patient, an eleven years old boy, a known case of diabetes mellitus, presented with fever for one month associated with right sided neck swelling, abdominal distension & pain for 10 days. He had an abscess on the right side of the neck and hepatosplenomegaly. Ultrasonography of abdomen showed multiple abscesses in the liver and spleen. Culture of pus drained from the neck abscess revealed growth of Burkholderia pseudomallei. After getting parenteral antibiotics and insulin, his abscesses gradually resolved and cured completely.Bangladesh J Child Health 2018; VOL 42 (1) :46-48

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 (

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).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.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.F-100 can be safely used in the rehabilitation phase for infants u6m with SAM and there is no need to prepare alternative formulations.

Introduction: Acute bronchiolitis is a condition where patients are presenting with breathing difficulties, cough, poor feeding, and irritability. Treatment of bronchiolitis have many controversies. Most trials of bronchiolitis treatment suffer from 2 constraints: possible inclusion of patients with asthma and inconsistent outcome measures. The aim of the study was to determine the efficacy of prednisolone in recovery from acute bronchiolitis who have a family history of atopy. Material & Methods: This randomized double blind placebo controlled trial (RCT) was conducted in the department of pediatrics Dhaka Medical College Hospital (DMCH) from July 2008 to June 2010. Sixty (60) bronchiolitis patients having family history of atopy were included in his study. Prednisolone and placebo were packaged in identical envelops with separate code number given by the guide and the code number were recorded in a preformed questionnaire. The trial was so planned that neither the parents nor the investigator were aware of group allocation. The collected data were analyzed thoroughly by SPSS program version of 16.0 software. Informed written consent from parents or legal guardians was taken and ethical clearance was obtained from the ethical review committee of Dhaka Medical College to conduct the research works. Results: In our study, mean age of the patients of this series were 3.68 months (±1.29SD) and 3.52 month’s (±1.1SD) in prednisolone and placebo group respectively. Use of accessory muscle score was assessed twice at 8 am and 8 pm each day for three days. On first assessment at day 1 the score was similar in both the treatment groups (P>.05). More people in Prednisolone arm recovered within 3 days then the placebo group. The difference is statistically significant (P

Background : The cause of acute kidney injury (AKI) in neonate is multifactorial. The short-term outcome of AKI in newborns is highly dependent on the underlying etiology, the condition of other organs, and the facilities for renal replacement therapy.Objective : The aims of the present study were to find out the etiology and immediate outcome of AKI in neonate.Methodology : This observational study was done over a period of six months, at special care baby unit (SCABU) in Dhaka Medical College Hospital (DMCH). Neonates (aged 3-28 days) admitted in SCABU, who had AKI were the study population. Among them 44 neonates with AKI were included purposivly. AKI was diagnosed and classified by pediatric RIFLE (pRIFLE) staging criteria. Etiology of AKI was find out by dividing pre renal, renal and post renal cause of AKI. All neonates were treated conservatively and with intermittent peritoneal dialysis (IPD) as needed. Immediate hospital outcome was determined by improved with normal renal functions; improved with impaired renal functions and death.Result : The diagnosis based on estimated creatinine clearance (eCCL) criteria of pRIFLE showed that 43.2% neonates were at risk (R) stage, 22.7% were at injury (I) stage and 34.1% of neonates were at Failure (F) stage of AKI. Among 44 neonates 21 were male and 23 were female. Pre renal cause of AKI is predominant in this series. More than two-thirds (68.2%) of the neonates experienced perinatal asphyxia stage-II and III and 52.3% were exposed to meconium stained liquor during delivery. Septicemia with shock, history of aminoglycoside use were reported to be 59.1%, 52.3% respectively. Post renal cause was found in 16% neonates, like obstructive uropathy due to posterior urethral valve, exstrophy bladder and cloacal exstrophy. Neonate at Failure stage of AKI (n=15) had a significantly longer stay at SCABU (p < 0.001). Multiorgan failure was found to be significantly higher in failure group (p = 0.026). Majority of the failure group needed dialysis (p < 0.001). Most of the neonate at risk and injury stage was improved with normal renal functions. The resolution from AKI was almost similar among the groups (p = 0.885). The mortality was progressively higher from Risk to Failure Groups (p = 0.106). Overall 27% of the neonates diagnosed as AKI died from this illness, 57% improved with normal renal function and 16% improved with impaired renal function.Conclusion : The study concluded that perinatal asphyxia, septicemia with shock and use of aminoglycosides were the commonest cause of AKI in neonate. The mortality was higher in Failure group.Northern International Medical College Journal Vol.7(2) Jan 2016: 127-130

not availableJ Bangladesh Coll Phys Surg 2016; 34(2): 53-55

not availableBangladesh J Child Health 2015; VOL 39 (2) :99-101

Not Available J Bangladesh Coll Phys Surg 2020; 38(3): 109

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

not available DOI: http://dx.doi.org/10.3329/bjch.v38i3.22828 Bangladesh J Child Health 2014; VOL 38 (3) :164-168