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Background: Proper feeding practices are essential for attaining and maintaining optimum nutrition, health, and development of infants and children. Exclusive breastfeeding during the first six months of life and continued breastfeeding for two years, together with age-appropriate, nutritionally adequate complementary feeding initiated after six months of age, are optimum Infant and Young Child Feeding (IYCF) practices. However, often many aspects of infant and young child feeding practices are not optimum, with serious consequences for the child. Objective: To determine the impact of Infant and Young Child Feeding (IYCF) practices on the nutritional status of children. Materials and Method: This Cross-sectional descriptive type of study was conducted among 314 children from 6 months to 24 months of age at the Pediatric Outpatient Department and EPI center of Rajshahi Medical College Hospital during the period of January 2017 to December 2018. Collected data were analyzed by using 'SPSS version 16. Result: Among 314 children exclusive breastfeeding (EBF) rate was 68.2% for the first six months, and timely started complementary feeding was 58.5% of cases. In 214 exclusive breastfed infants, only 4.7% and 1.4% of children were moderate to severely wasted and stunted, respectively. On the other hand, among 97 infants who were not exclusively breastfed, the percentage of moderate to severe wasting and stunting was 11.4% and 13.4%, respectively. Among the 175 timely started complementary feeding children, only 12% and 6% were moderate to severely underweight and wasted, respectively, no one was stunted, but among the inappropriately started complementary children, 20.2%, 12.5%, and 12.8% were moderately to severely underweight, wasted and stunted respectively. Conclusion: Most of the children who were given exclusive breastfeeding in the first six months and started complementary food at an appropriate time after six months had normal nutritional status. Both moderate to severe stunting and wasting were common in those children who were non-exclusively breastfed and started complementary feeding either early or late. TAJ 2022; 35: No-2: 83-91

Bronchiolitis is a viral infection of lower respiratory tract that occurs most commonly in young children (< 2years). It is one of the most common cause of hospitalization of infants. It has a major public health hazard throughout the world exerting significant morbidity and mortality. Methods: This randomized controlled trial study was conducted in the Department of pediatrics, Rajshahi Medical College Hospital. Total 120 patients with acute bronchiolitis were selected who were less than two years of age. Two groups were randomly selected by lottery method. One group was given salbutamol along with prednisolone (Experimental group) another was only salbutamol (Placebo group) to compare the efficacy and evaluate the outcome of both treatment groups. Result: The mean age of the experimental group was7.09±4.71 months and mean age of placebo group was 5.70±4.26 months. The majority number of patients 96(80%) came from middle class family with 30(25%) houses with crowded conditions. About 16(13.3%) patients were born in preterm condition and 18(15%) were low birth weight. Among the family members 21(17.5%) had asthma and 43(35.18%) had smoking history. After treatment notable outcome clinically observed after 3 days of treatment in experimental than placebo group (p-value

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.

Progressive pseudorheumatoid dysplasia (PPRD), also known as spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA), is an autosomal recessive disorder, resulting from mutations in the WNT1-inducible signaling pathway protein 3 (WISP3) gene involving the axial skeleton as well as small peripheral joints. Because of rarity here we present a case of 14-year-old boy, 1st issue of consanguineous parents who was presented with pain & gradual development of contracture in 3rd distal interphalangeal joint of right hand when he was 4-year-old, then gradual involvement of other interphalangeal joints of hands, bilateral wrists, elbows, shoulder, knees &ankles occurred over years with the development of contractures and restricted movement. For last few years, he developed difficulty in walking. Clinically spinal scoliosis and coxa vara was present. Mobility of spines and multiple joints including proximal & distal interphalangeal joints of hands, wrists, elbows, shoulders, knees, ankles were restricted with flexion contractures. The gait of the patient was limping. Radiological evaluation showed osteopenia in X-ray of pelvis with both hip joints and both knee joints. Generalized osteopenia, fusiform swelling in distal interphalangeal joint, flexion deformity in distal interphalangeal joint of middle and ring fingers of both hand was shown in X-ray of both hands. MRI of lumbosacral spine showed dorso-lumbar vertebral bodies dysplastic with anterior wedging producing bullet nose. Superior epiphyseal deformity was also noted in lower dorsal bodies suggestive of spondyloepiphyseal dysplasia of dorso-lumbar spine. Genetic study showed homozygous nonsense variation in exon 5 of the WISP3 gene suggestive pathogenic variant. Finally, he was diagnosed as a case of PPRD and treated with physiotherapy, family counseling, and anti-inflammatory medications. AKMMC J 2022; 13(1) : 52-55

Multisystem inflammatory syndrome in children (MIS-C), also termed pediatric multisystem inflammatory syndrome (PMIS) temporally associated with coronavirus disease-2019 (COVID-19) is rare but an emerging alarming condition. Though the exact pathogenesis is unknown, COVID-19 can trigger the condition directly or indirectly via immune complex mediated or antibody-dependent enhancement. Patients with MIS-C can present with persistent fever and a constellation of symptoms including hypotension, multiorgan involvement and elevated inflammatory markers. Presentations of MIS-C have overlapping features of Kawasaki disease (KD), toxic shock syndrome (TSS) and Kawasaki disease shock syndrome. Age of presentation, features of shock and more predilections for myocardial dysfunction can distinguish MIS-C from Kawasaki disease. Early recognition is essential, followed by prompt admission to the hospital for specialist attention. Admission to a pediatric intensive unit is mandatory for children with hemodynamic instability (shock, arrhythmia), significant respiratory compromise, or other potentially life-threatening complications. It is also necessary to maintain an appropriate follow-up schedule to observe the long-term outcome. The prognosis of PMIS/ MIS-C is uncertain, given that it is a new clinical entity and understanding of the disease is still evolving. J Bangladesh Coll Phys Surg 2021; 39: 249-260

Micronutrient deficiencies, especially those related to iodine and iron, are linked to different cognitive impairments, as well as to potential long-term behavioral changes. Among the cognitive impairments caused by iron deficiency, those referring to attention span, intelligence, and sensory perception functions are mainly cited, as well as those associated with emotions and behavior, often directly related to the presence of iron deficiency anemia. In addition, iron deficiency without anemia may cause cognitive disturbances. At present, the prevalence of iron deficiency and iron deficiency anemia is 2%–6% among European children. Given the importance of iron deficiency relative to proper cognitive development and the alterations that can persist through adulthood as a result of this deficiency, the objective of this study was to review the current state of knowledge about this health problem. The relevance of iron deficiency and iron-deficiency anemia, the distinction between the cognitive consequences of iron deficiency and those affecting specifically cognitive development, and the debate about the utility of iron supplements are the most relevant and controversial topics. Despite there being methodological differences among studies, there is some evidence that iron supplementation improves cognitive functions. Nevertheless, this must be confirmed through adequate follow-up studies among different groups. TAJ 2021; 34: No-1: 115-122

Mucormycosis is an invasive fungal infection caused by different saprophytic environmental fungus occurring predominantly among immunosuppressed patients. Pulmonary mucormycosis is the second most common form after rhino-cerebral mucormycosis and may accompany with other infections. Coronavirus disease 2019 (COVID-19) itself and its treatment with immunosuppressive drugs and oxygen delivery systems etc. are setting the scenes for opportunistic and co-infections with fungus and other pathogens. A middle aged Bangladeshi man, with background diabetes mellitus, hypertension, bronchial asthma and COVID-19, presented with fever, respiratory symptoms and cavitary lung lesion. Diagnostic work-up confirmed pulmonary mucormycosis and he responded with liposomal amphotericin B. To the best of our knowledge, this is the first case of post-COVID mucormycosis reported from Bangladesh. Bangladesh J Medicine July 2021; 32(2) : 156-160

Although two live oral rotavirus (RV) vaccines, Rotarix and RotaTeq, play a critical role toward reducing disease severity, hospitalization, and death rate in RV infections, regular monitoring of vaccine effectiveness (VE) is yet necessary because the segmented genome structure and reassortment capability of RVs pose considerable threats toward waning VE. In this study, we examined the VE by a test-negative study design against G9P[8]I2 strain during a seasonal outbreak in February-May, 2018, in an outpatient clinic in Kyoto Prefecture, Japan. It remains important because G9P[8]I2 strain remains partially heterotypic to these vaccines and predominating in post-vaccination era. During year-long surveillance, RV infections were detected only from February to May. During this outbreak, 33 (42.3%) children out of 78 with acute gastroenteritis (AGE) remained RV-positive, of which 29 (87.8%) children were infected with G9P[8]I2. Two immunochromatographic (IC) assay kits exhibited 100% sensitivity and specificity to detect G9P[8]I2 strain. Only 23.2% children were found to be vaccinated. Yet, significant VE 69.7% (95% CI: 2.5%-90.6%) was recognized against all RV strains that increased with disease severity. Similar significant VE 71.8% (95% CI: 1%-92%) was determined against G9P[8]I2 strain. The severity score remained substantially low in vaccinated children. Our data reveal that vaccine-preventable G9P[8]I2 strain yet may cause outbreak where vaccination coverage remains low. Thus, this study emphasizes the necessity of global introduction of RV-vaccines in national immunization programs of every country.

Background: Emphysematous pyelonephritis (EPN) is a rare severe necrotizing infection of the renal parenchyma, collecting system and/or perirenal tissues. Patients with diabetes mellitus, renal stones and renal tract obstruction are at risk for development of EPN. Escherichia coli is the most common aetiological agent and treatment is aimed at infection control and interventions in appropriate cases. This study aimed to identify the aetiological agents responsible for EPN and the outcome of such cases. Methods: This observational study was done in BIRDEM General Hospital and Bangabandhu Sheikh Mujib Medical University over a period of three years (2011-2013). Twenty adult EPN cases were included in this study. Results: The mean age of the study participants was 59.2 years with female predominance (80%). Risk factors included diabetes mellitus (90%), renal stones (5%) and kidney transplant recipient (5%). Fever, loin pain and dysuria were common. Six patients had class 1 EPN, seven had class 2 disease, five had class 3 and two patients had class 4 EPN. Aetiological agents were cultured in 19 cases; E. coli in 12 (68%), Klebsiella in three (16%), Pseudomonus in two (11%) and Proteus and Enterococcus, one each (5% each). Carbapenems appeared as the most sensitive antibiotic. Along with antibiotic, half of the patients required interventions; percutaneous drainage in two, open drainage in two and six patients required nephrectomy. Regarding outcome, five patients died, 10 patients recovered completely and five patients recovered with residual renal dysfunction. Conclusion: E. coli was the most common causative agent in present EPN cohort. Outcome was poor. With improved management strategy, combining nephrologists, intervention radiologists and urologists – all together, a good outcome is expected. Birdem Med J 2021; 11(2): 108-111

Background: Cutaneous drug reaction (CDR) is a growing health hazard in the world. Adverse drug reactions are common complications in drug therapy. About 3-8% of all hospital admissions are the results of adverse drug reactions, among them 2-3% are children and these can cause significant disability to patients. Early identification and management of adverse cutaneous drug reaction has both short term and long term prognostic significance. Objective: To know the cutaneous reaction to drugs in children in a tertiary care hospital. Study design: Hospital based descriptive, observational study. Subjects: 50 children with cutaneous drug reactions were studied in the department of Dermatology and Pediatric respectively in Rajshahi Medical College Hospital, Rajshahi. Methods: Data were collected by detailed history taking, physical examination and laboratory investigations in a prefixed data collection sheet and with the help of GOLD guideline after taken informed consent of the patient. Results: This study showed a significant male predominance. Male: female ratio was 1.08:1 .In this study prevalence was highest among 1-5 years age group. Cotrimoxazole, NSAIDs, anticonvulsant and quinolone were most offending medications. Maculopapular eruption, Stevens Johnson Syndrome, fixed drug eruption and urticaria were most common morphological types. Majority of CDRs were noted with oral route of administration. It was observed that almost all the CDRs that were reported involved mainly the skin. Majority of adverse cutaneous drug reactions reported were moderate in severity. Conclusion: Frequency distribution of the offending drugs and the adverse reactions revealed that adverse cutaneous drug reactions occurred mostly by cotrimoxazole, NSAIDs and quinolones. Maculopapular rash and Stevens Johnson Syndrome were the most common morphological types. A better understanding of the mechanisms underlying CRDs is important in drug development and in patient care. TAJ 2020; 33(2): 56-62

Pediatric urinary tract infections (UTI) are associated with significant morbidity and potential long term complication like extensive renal scarring leading to end stage renal disease. Prompt diagnosis and early initiation of treatment is necessary to prevent long term complications. Knowledge about bacteriological profile of pediatric urinary tract infections and their antimicrobial sensitivity pattern is helpful for initiation of empirical antibiotic treatment. The aim of this study was to identify the causative bacteria and antimicrobial sensitivity pattern of community acquired UTI in children attending outpatient department of a tertiary level hospital of Bangladesh. This was a cross-sectional study conducted in pediatric outpatient department of Rajshahi Medical College Hospital, Bangladesh over 6 month period from 1st January 2017 to 30th June 2017. Children aged < 12 year who presented with clinical features suggestive of urinary tract infection were subjected for urinary routine and microscopic examination and culture. Colony counts of the culture positive cases were done and antibiotic sensitivity and resistance patterns were studied. Samples with colony count of ≥ 105 CFU/ml were considered significant. Among the 134 clinically suspected cases significant bacteriuria was found in 81 (60.45%) children. Escherichia coli was the most common isolate (74.1%) followed by Proteus (9.8%), Klebsiella spp. (8.6%), Pseudomonas (6.2%) and Staphylococcus saprophyticus (1.2%). E. coli was found to be highly sensitive to imipenem, amikacin, nitrofurantoin and ciprofloxacin. Klebsiella showed good sensitivity against ciprofloxacin and imipenem whereas proteus, Pseudomonas and Staphylococcus saprophyticus showed sensitivity against imipenem, amikacin and ciprofloxacin. Increased resistance was noted against the commonly used empirical antibiotics such as cephradin, cefuroxime, cefixime, ceftriaxone and co-trimoxazole. Therefore, selection of empirical therapy should be based on local bacteriological profile and their antimicrobial sensitivity pattern. TAJ 2020; 33(2): 27-31

Typhoid and paratyphoid fevers, collectively known as enteric fever, is caused by Salmonella enterica subspecies serovars Typhi and Paratyphi A, B and C. Despite this declining global trend, enteric fever is still considered to be a major public health hazard in Bangladesh and other developing countries due to poor sanitation, inadequate food safety measures and poor personal hygiene. In Bangladesh, the incidence of typhoid fever was reported to be 200 episodes per 100,000 person-years during 2003–2004. Multidrug-resistant (resistance to the first-line antimicrobials ampicillin, cotrimoxazole, and chloramphenicol) strains of S. Typhi and S. Paratyphi are on the rise globally and even cases of extensively drug-resistant (XDR) typhoid cases resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, third generation cephalosporins and fluoroquinolones are being reported from many corners of the world. This descriptive, observational study was carried out in Rajshahi Medical College Hospital Hospital, Rajshahi, Bangladesh from July 2017 to June 2019. Antibiotic sensitivity pattern of total 76 cases of enteric fever due to Salmonella Typhi were studied. Blood culture was carried out by BACT ALERT-3D, Automated blood culture analyzer from BioMeriuex SA, France Patented FAN Plus method. Based on the minimum inhibitory concentration (MIC), the organism was categorized as sensitive, intermediate, and resistant against the respective antibiotics as per Clinical and Laboratory Standards Institute (CLSI) criteria. We are reporting antibiotic sensitivity and resistant patterns of S. Typhi documented in Rajshahi Medical College Hospital, a large tertiary care hospital in Northern Bangladesh. TAJ 2020; 33(2): 10-14

Background: The highest prevalence rates of childhood obesity have been observed in developed countries, however, its prevalence is increasing in developing countries as well. Early detection of obesity and identification of risk factors are the key to successful prevention of obesity. Objectives: This study was conducted to determine the proportion of obesity and presence of risk factors in obese children in primary schools of Rajshahi city. Methodology: This cross sectional study included total 225 children chosen from different primary schools of Rajshahi city during the school year 2016-2017. Data collection tool used for the study was an interview schedule and this predesigned questionnaire. The main outcome measures were obesity and risk factors prevalent in the obese school children. Data were analyzed by SPSS version 20 and ‘Chi square’ test was applied for the test of significance. Result: Among the total 225 respondent, 121 (53.8%) were male, while 104 (46.2%) were females, with a mean age of 7.9 ±1.1 years. The mean and standard deviation of anthropometric measurement were weight 22.7±5.3 kg, height 120±8.1 cm and BMI 15.5±2.1 kg/m. Out of 225 participants, 2.7% (total 6) were overweight, 5.3% (total 12 students) were obese, 83.6% (total 188 students) were normal weight and 8.4% (total 19 students) were underweight. The rate of obesity was highest at the age of 8-9 years (10.7%) and overweight were highest at the age of 9-10 years (5.5%). Playing, biking regularly was strongly associated with fewer incidence of overweight and obesity (p value -.001). Faulty dietary habit, having more fast food, chocolate, sugary juice lead to a higher BMI and more fresh fruit and vegetables had lower BMI (p value .001). Conclusion: This study shows that childhood obesity is on rise in our country. Addressing the problem at its earliest could be achieved through identifying high risk groups and planning early intervention. Effective interventions and preventive strategies should be instituted at local and national level to reduce the incidence and comorbidities associated with obesity. TAJ 2020; 33(2): 39-45

Background In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. Methods The Centers for Disease Control and Prevention’s Emerging Infections Program sites in 10 states each recruited ≤25 general and women’s and children’s hospitals. Hospitals selected a survey date from May–September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Results Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6–50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). Conclusions Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

Background: Starting on 31 December 2019, from Wuhan City, China, Coronavirus disease 2019 (COVID-19) caused a global pandemic by 11 March 2020. Bangladesh detected its first case on 8 March 2020, only 66 days later the detection of the first case in China. We aimed to describe the epidemiology, clinical features, laboratory characteristics, and outcomes of Bangladeshi COVID-19 patients. Methods: This retrospective chart analysis compared Bangladeshi COVID-19 patients with hypoxemia compared to those without hypoxemia treated in a makeshift COVID-19 unit of icddr,b. Results: By March 2021, 207 remained in-patient. Nineteen patients (9.2%) died, whereas 10 (4.8%) were referred to different facilities for definitive care. Out of 207 in-patients, 88 patients required oxygen therapy. Multivariable logistic regression identified age (1.07 (1.02–1.13)), dyspnea (3.56 (1.06–11.96)), high CRP (1.13 (1.03–1.25)), and lymphopenia (6.18 (1.81–21.10)) as the independent predictors for hypoxemia in patients hospitalized for COVID 19 (for all, p < 0.05). Conclusion: Older age, dyspnea, high CRP, and lymphopenia are simple, but important, clinical and laboratory parameters. These may help clinicians to identify COVID-19 patients early who are at risk of fatal hypoxemia. Close monitoring, and prompt and aggressive treatment of these patients would curb their morbidity and mortality, especially in resource-limited settings.

BACKGROUND Persistent diarrhea (PD), diarrhea for ≥14 days, accounts for 36%-56% of all diarrhea-related death. Studies demonstrated that green banana helps in the resolution of diarrhea. OBJECTIVE We assessed whether a lactose-free diet rice suji (RS) or rice suji containing green banana (GB-RS), improves outcome compared with 3/4th strength rice suji (3/4th RS) in 6 to 35 months old children having PD in the icddr,b Dhaka hospital. METHODS In this open-labeled, randomized, controlled trial, children with PD not improving with milk suji (the initial diet) received any of the three study diets: GB-RS, RS, 3/4th RS. The primary outcome was the percentage of children who recovered from diarrhea by day 5 with an intention to treat analysis. RESULTS From 1st December 2017 to 31st August 2019, we randomly allocated 45 children to each group. By day 5, 66 children recovered from PD, of whom 26 (58%), 14 (31%), 26 (58%) received GB-RS, RS, and 3/4th RS respectively. Significantly more resolution of PD occurred in GB-RS and 3/4th RS groups compared to RS group [relative risk (RR) 1⸱71, 95% CI 1⸱19-2⸱60; p=0⸱019]. Two (10%) children died, one each in RS group and GB-RS group. TaqMan array card (TAC) identified EAEC, rotavirus, norovirus, EPEC, astrovirus, and Campylobacter as the major pathogens associated with PD. CONCLUSIONS GB-RS and 3/4th RS are efficacious in the management of PD in young children. We also demonstrated a wide range of entero-pathogen associated with PD by TAC which needs further study to find a causal link. CLINICALTRIAL ClinicalTrials.gov, ID: NCT03366740 Registered on 8th December 2017 INTERNATIONAL REGISTERED REPORT RR2-10.2196/15759

Although Coronavirus disease (COVID-19) can affect all age groups, severity of clinical presentation among children and newborns are milder than in adults. Along with classical symptoms, atypical presentation could be noted in the neonate. We report here a case of neonatal COVID-19 where a newborn infant presented with fever, lethargy, respiratory distress and recurrent seizure. Early detection and prompt management is the prerequisite for limiting transmission and reducing neonatal death rate. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 87-89

Miliary tuberculosis is a form of disseminated tuberculosis, which is more frequent in immunocompromised patient. Ocular involvement of mycobacterium tuberculosis is also an uncommon presentation of disseminated tuberculosis. Tubercular uveitis is most frequent form of ocular tuberculosis. If treatment is delayed, it may cause loss of vision. In many case of the systemic TB with ocular involvement, there may be no eye symptoms in early stage. On the other hand, many cases of ocular TB may not have any evidence of systemic TB. Here we have described a case of miliary tuberculosis with ocular uveitis who initially presented with fever without any significant physical findings and later developed eye symptoms including diminished vision. Bangladesh J Child Health 2019; VOL 43 (2) :126-130

Background: Thalassemia is a common hematological disorder in our country having wide spectrum of clinical presentation. The frequency and severity of the several types of thalassemia depend on the racial background of the population. Hb-E Beta thalassemia is prevalent in our country. Objective: To see the clinical features of different types of Thalassemia in northern area of Bangladesh. Methods: Hundred cases were selected from Thalassemia patient admitted in department of pediatrics, on May 2012 to October 2012. A prescribed questionnaire was used to record the information. The methods were explained to the patients and consent was taken. Necessary physical examination was performed and investigations were done. The data was analyzed by standard procedure. Results: Out of hundred (100) cases, most (61%) were Hb-E beta Thalassemia, less common (1%) was Hb-E disease, and 1 % case was Hb-E trait. Majority (64%) manifested clinically under one year of age. 54% were male and 46% were female. The major presenting symptom was progressive pallor in 70% cases. Others presenting complaints were low grade fever (40%). Hemoglobin concentration at the time of diagnosis was below 5 gm/dl in 53.33% patients. In hemoglobin electrophoresis it was Hb-E ranged from 54.64 ± 13.02%, Hb-F 34.84±13.73%, Hb-A 23.32± 18.15% and Hb-A2 3.5± 70%. Radiological findings revealed gross bony changes occur in long standing cases. Enlarged cardiac shadow was found in those cases having severe anemia with heart failure. Conclusion: In countries with a high incidence of thalassemia, it is vitally important to offer prospective genetic counseling and to warn carriers about the risks of intramarriage. Nutritional and folic acid supplementation with regular blood transfusion along with iron chelation therapy is essential to improve the prognosis. TAJ 2018; 31(2): 6-11

Background: Acute bronchiolitis is a clinical syndrome produced by inflammation of the terminal bronchioles. It usually occurs in association with viral respiratory tract infection. Children with bronchiolitis are at risk of developing hyponatraemia. The objective of this study is to find out any change of serum Na+ values in bronchiolitis. Methodology: A cross sectional observational study was done during January to June 2015 among the children between age of 2 months to 2 years admitted in the pediatric ward of Institute of Child Health & Shishu Sasthya Foundation Hospital, Dhaka, who were diagnosed as acute bronchiolitis. Data were collected by interviewing, physical examination and laboratory investigations and recorded through a proforma. Data were processed and analyzed using computer software SPSS. Results: A total of 50 cases suffering from bronchiolitis were studied. Among them only 5 (10.0%) cases had hyponatraemia considered as group I and rest 45 (90.0%) patients had normonatraemia considered as group II. The mean age was found to be 10.8±5.3 months and 8.91±5.8 months in group I and group II respectively. Male was found 4 (80.0%) in group I and 27(60.0%) in group II. Mean respiratory rate was found to be 50.0±1.4 per min in group I and 54.18±3.9 per min in group II, which was significantly higher in normonatraemia group. Seizure, requirement for mechanical ventilation and mortality were not found in any child suffering from acute bronchiolitis. Conclusion: These results indicate that normonatraemia was predominant and hyponatraemia was found only 10% cases and all were in mild degree. The clinical outcome of all the hyponatraemia cases was good and they were not associated with any complications. Bangladesh J Child Health 2018; VOL 42 (3) :4-8

Antibiotic exposure in the intensive care unit (ICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine predicting factors, outcomes, and the utility of simple screening tools to avoid antibiotic overuse in the ICU. We analyzed 510 young children who did not receive antibiotics during ICU stay to those treated with antibiotics. The logistic regression analysis revealed that cases were more often older and independently associated with hypernatremia. Cases less often had severe underweight, altered mentation, age-specific fast breathing, lower chest wall in-drawing, adventitious sound on lung auscultation, abdominal distension, developmental delay, hyponatremia, hypocalcemia, and microscopic evidence of invasive diarrhea (for all, p

Background: Persistent diarrhea (PD), diarrhea for ≥14 days, accounts for 36%-56% of all diarrhea-related death. Studies demonstrated that green banana helps in the resolution of diarrhea. We assessed whether a lactose-free diet rice suji (RS) or rice suji containing green banana (GB-RS), improves outcome compared with 3/4th strength rice suji (3/4th RS) in 6 to 35 months old children having PD in the icddr,b Dhaka hospital. Methods: In this open-labeled, randomized, controlled trial, children with PD not improving with milk suji (the initial diet) received any of the three study diets: GB-RS, RS, 3/4th RS. The primary outcome was the percentage of children who recovered from diarrhea by day 5 with an intention to treat analysis. Findings: From 1st December 2017 to 31st August 2019, we randomly allocated 45 children to each group. By day 5, 66 children recovered from PD, of whom 26 (58%), 14 (31%), 26 (58%) received GB-RS, RS, and 3/4th RS respectively. Significantly more resolution of PD occurred in GB-RS and 3/4th RS groups compared to RS group [relative risk (RR) 1⸱71, 95% CI 1⸱19-2⸱60; p=0⸱019]. Two (10%) children died, one each in RS group and GB-RS group. TaqMan array card (TAC) identified EAEC, rotavirus, norovirus, EPEC, astrovirus, and Campylobacter as the major pathogens associated with PD. Interpretation: GB-RS and 3/4th RS are efficacious in the management of PD in young children. We also demonstrated a wide range of entero-pathogen associated with PD by TAC which needs further study to find a causal link. Clinical Trial Registration Details: ClinicalTrials.gov, ID: NCT03366740, Registered on 8th December 2017. Funding Information: This protocol is supported by icddr,b’s core fund through capacity building for clinical research initiatives. We thank the governments of Bangladesh, Canada, Sweden, and the UK for providing unrestricted support to icddr,b. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: IRB of icddr,b approved the trial protocol (approval ID: PR 17075) which is available online. Written informed consent from parents or caregivers.

Anthrax is an acute, zoonotic infectious disease caused by gram positive, aerobic, spore forming bacterium Bacillus anthracis. Cutaneous anthrax is the commonest form of anthrax, comprising more than 95% of cases. Incidence of anthrax is declining in the developed countries; but because of inadequate livestock vaccination program, it remains a public health hazard in the developing countries. Several cutaneous anthrax outbreaks were observed in Bangladesh over the last few years and the latest one occurred in Lalitnagar village, Godagari Upazilla of Rajshahi district in September 2016. We are reporting clinico-demographic profile and treatment outcome of the affected patients with the aim of increasing awareness among the clinicians and public health experts.TAJ 2017; 30(1): 17-20

Bacterial contamination of stethoscope and its role in transmission of nosocomial infection is little known among the healthcare workers of Bangladesh. The objectives of our study is to evaluate stethoscope handling and cleaning practices, to find out the bacterial agents contaminating the stethoscopes, to determine the antibiotic sensitivity patterns of bacterial isolates from stethoscopes, and to evaluate the relationship between stethoscope cleaning practices with contamination of stethoscope in Rajshahi Medical College Hospital. This observational cross sectional study was carried out in Rajshahi Medical College Hospital during March, 2017. One hundred doctors working in different departments of RMCH were chosen randomly and were asked to fill up a self-explanatory simple questionnaire. Samples from100 stethoscopes were obtained after swabbing the diaphragm and the bell of the stethoscope with a sterile swab moistened with saline. These swabs were immediately streaked onto blood agar, Mcconkey agar and chocholate agar following the standard protocol. Out of 100 stethoscopes examined for bacterial contamination, 19 stethoscopes (19%) were found to be contaminated. The organisms isolated were MRSA, pseudomonas aeruginosa, and E. coli. Among the 19 participants with bacterial contamination of stethoscope, 6 doctors (31.6%) said they used to clean their stethoscope at least occasionally and 13 doctors (68.4%) had never cleaned their stethoscope. This difference was found to be statistically significant (p value

This study was a cross-sectional descriptive type of study, conducted at Pediatrics department of Rajshahi Medical College Hospital from July 2014 to June 2016. A total 382 children were enrolled by purposive sampling among which 219 (57.3%) male, 163 (42.7%) female. The aim of this study was identify demographic as well as social status of malnourished children in tertiary care hospital. In this study the prevalence of underweight 42% (moderate & severe), wasting 34% (moderate & severe), and stunting 24% (moderate & severe) were found. Considering various Socio-demographic characteristics - maternal factors, paternal factors, socioeconomic status, and residential status had significant association with nutritional status of the children. Beside these various risk factors- birth weight, exclusive breast feeding, colostrum feeding, timing of weaning practices, type of complementary feeding and associated morbidities also had significant association with nutritional status of the children. The degree of malnutrition was found to more prevalent in the early age of children. Among the studied children more than half (60.5%) lived in rural area and rest of them lived in urban area (36.6%), semi urban area (2.9%) respectively. Children more than half (53%) were from lower class family. Rest of them was middle class (40.6%) and upper class (6.3%) family. Education level of the majority (59.4%) mother were primary to SSC, (22.5%) were below primary and (18.1%) were HSC and above. Education level of the majority ie.40.6% father were below primary, 39.8% were primary to SSC and 19.6% were HSC and above.TAJ 2017; 30(1): 56-60

Haemolacria or bloody tears is a rare clinical condition caused by various ocular and systemic conditions; some cases may be drug-induced and some are idiopathic. We are reporting a case admitted with recurrent bilateral idiopathic haemolacria. A 9-year old girl was admitted in our hospital with complaints of recurrent spontaneous bloody tears from both eyes for 1 month. There were no other bleeding manifestations. Blood stained discharge from punctum was not observed during compression of either nasolacrimal duct. Psychiatric assessment and ENT examination were normal. Further evaluations for underlying causes were unremarkable. There was no abnormality on the ophthalmological and radiological investigations. The patient was diagnosed as a case of idiopathic haemolacria. Patients presenting with complaints of bloody tears should be evaluated with a detailed history focusing on etiologic factors, ocular examination, and nasal and paranasal examination. TAJ 2018; 31(1): 70-72

Importance Hospital antimicrobial consumption data are widely available; however, large-scale assessments of the quality of antimicrobial use in US hospitals are limited. Objective To evaluate the appropriateness of antimicrobial use for hospitalized patients treated for community-acquired pneumonia (CAP) or urinary tract infection (UTI) present at admission or for patients who had received fluoroquinolone or intravenous vancomycin treatment. Design, Setting, and Participants This cross-sectional study included data from a prevalence survey of hospitalized patients in 10 Emerging Infections Program sites. Random samples of inpatients on hospital survey dates from May 1 to September 30, 2015, were identified. Medical record data were collected for eligible patients with 1 or more of 4 treatment events (CAP, UTI, fluoroquinolone treatment, or vancomycin treatment), which were selected on the basis of common infection types reported and antimicrobials given to patients in the prevalence survey. Data were analyzed from August 1, 2017, to May 31, 2020. Exposure Antimicrobial treatment for CAP or UTI or with fluoroquinolones or vancomycin. Main Outcomes and Measures The percentage of antimicrobial use that was supported by medical record data (including infection signs and symptoms, microbiology test results, and antimicrobial treatment duration) or for which some aspect of use was unsupported. Unsupported antimicrobial use was defined as (1) use of antimicrobials to which the pathogen was not susceptible, use in the absence of documented infection signs or symptoms, or use without supporting microbiologic data; (2) use of antimicrobials that deviated from recommended guidelines; or (3) use that exceeded the recommended duration. Results Of 12 299 patients, 1566 patients (12.7%) in 192 hospitals were included; the median age was 67 years (interquartile range, 53-79 years), and 864 (55.2%) were female. A total of 219 patients (14.0%) were included in the CAP analysis, 452 (28.9%) in the UTI analysis, 550 (35.1%) in the fluoroquinolone analysis, and 403 (25.7%) in the vancomycin analysis; 58 patients (3.7%) were included in both fluoroquinolone and vancomycin analyses. Overall, treatment was unsupported for 876 of 1566 patients (55.9%; 95% CI, 53.5%-58.4%): 110 of 403 (27.3%) who received vancomycin, 256 of 550 (46.5%) who received fluoroquinolones, 347 of 452 (76.8%) with a diagnosis of UTI, and 174 of 219 (79.5%) with a diagnosis of CAP. Among patients with unsupported treatment, common reasons included excessive duration (103 of 174 patients with CAP [59.2%]) and lack of documented infection signs or symptoms (174 of 347 patients with UTI [50.1%]). Conclusions and Relevance The findings suggest that standardized assessments of hospital antimicrobial prescribing quality can be used to estimate the appropriateness of antimicrobial use in large groups of hospitals. These assessments, performed over time, may inform evaluations of the effects of antimicrobial stewardship initiatives nationally.

The incidence of head and neck cancers among young individuals is increasing in the United States. Various sexual behaviors, heavy tobacco and alcohol use, HPV infection, and lack of HPV vaccination may increase the risk of head and neck cancer in the younger male population. The study was conducted to identify the risk factors for head and neck squamous cell cancers (HNSCC) among college students. A convenience sample of 1,685 students from an undergraduate health course was selected for the study. The self-reported, anonymous electronic questionnaire included items on the following risk factors: tobacco and alcohol use, HPV infection and/or presence of genital warts, oral hygiene, open-mouth kissing, and practice of various sexual behaviors. Statistical results showed that among college-aged males, the use of tobacco products and alcohol is much higher than females (P=0.000). Significance was also found between gender and sexual behaviors in one’s lifetime and within the past 12 months (P=0.000). On average, males have higher numbers of vaginal and oral sex partners than females. In addition, males reported having twice the number of open-mouth kissing partners compared to their female counterparts (6 as opposed to 3). Importantly, the percentage of males who completed all three HPV vaccinations in the series is much lower (10.1%) than females (89.9%) which make them more vulnerable to HPV transmission, thus increasing the risk of HNSCC. College-aged males seem to be engaged in more high-risk activities related to HNSCC compared to their female counterparts. Integration of preventive public health strategies should be considered.

Osteopetrosis is a heterogeneous group of heritable conditions in which there is a defect in bone resorption by osteoclasts. The disease has variable mode of inheritance with variable expression of severity. We are reporting a 14 year old asymptomatic girl with autosomal dominant type II osteopetrosis and then the literature is reviewed.TAJ 2009; 22(1): 251-254

Noonan Syndrome is an autosomal dominant disorder characterized by short stature, typical facial features and congenital heart defects. Other associated features are webbed neck, chest deformity, mild intellectual deficit, cryptorchidism, bleeding tendency and lymphatic dysplasia. We are reporting a 13 year old boy of Noonan syndrome presenting with lymphoedema of lower limb and genitalia. DOI: http://dx.doi.org/10.3329/jom.v13i2.12771 J Medicine 2012; 13 : 243-245

Crigler-Najjar syndrome type 2 in an autosomal recessive congenital non-hemolytic hyperbilirubinemia caused by UDP-glucuronosyltransferase deficiency. Only a few hundred cases have been described in the literature so far. We are reporting Crigler-Najjar syndrome type 2 in an 18 year old female born out of consanguineous marriage. Keyword: Crigler-Najjar syndrome; UDP-glucuronosyltransferase; Bangladesh DOI: 10.3329/jom.v12i1.6359J Medicine 2011; 12 : 81-85

Objectives: To see the (a) type of congenital heart disease, (b) Clinical presentation of the cases, (c) association with extra-cardiac anomalies and disease, (d) complications of different CHD, (e) outcome of patients during hospital stay. Methodology: it was a prospective study conducted in the department of pediatrics of Rajshahi Medical College & Hospital over a period of one year.115 children from birth to 12 years of age who had congenital heart disease confirmed by echocardiography were included. All patients were treated conservatively and observed for immediate out come during the hospital stay. Result: major types of CHD were VSD (42.6%), TOF (18.3%), ASD (14.8%), PDA (7.8%). Male outnumbers female child. Common symptoms were breathlessness (60%), fatigue (54.8%), cough (43.5%), poor weight gain (41.7%), recurrent chest infection (34.8%), fever (28.7%), feeding problems (26.1%), palpitation (21.7%) and bluish discoloration of lips and fingertips (20%). Murmur with or without thrill and cardiomegaly was the most important cardiac finding. Frequently observed complications were heart failure, pulmonary hypertension and growth failure. doi: 10.3329/taj.v21i1.3221 TAJ 2008; 21(1): 58-62