Grading of perinatal asphyxia by clinical parameters and agreement between this grading and Sarnat & Sarnat stages without measures.

A cross sectional study was done in Neonatal unit of Dhaka Shishu Hospital (DSH) to develop a grading system of perinatal asphyxia by clinical parameters, to show an agreement between this grading and Sarnat & Sarnat stages and to assess the outcome. Consecutive 60 cases of asphyxiated term newborn, aged between 0-48 hours were enrolled in this study who were classified according to new proposed scoring and Sarnat & Sarnat staging system simultaneously on same set up. All asphyxiated cases were managed as per protocol of neonatal unit of this hospital and followed up accordingly till 3 months of age. Out of 60 cases, sarnat stage-I cases were 16 of which all were mild according to proposed scoring system. Sarnat stage-II cases were 20 and among them 2 were mild, 16 were moderate and 2 were severe according to proposed scoring system. Sarnat stage-III cases were 24, among them 24 were severe according to proposed scoring system. The level of agreement between proposed scoring & Sarnat staging was 93.3% where kappa value was 0.899. Overall mortality of asphyxiated cases was 33.3%. About 42.9% of Sarnat stage-II and 80%(8) of Sarnat stage-III cases had neurological deficit whereas 50%(3) of moderate and 80%(4) of severely asphyxiated cases had neurological deficit on follow up at 3 months of age. Brief clinical grading system is more convenient & easier than that of Sarnat & Sarnat staging. But it is also equally as effective as Sarnat staging in classifying asphyxiated babies into different grades & to assess the outcome of perinatal asphyxia.

Chikungunya virus infection, a threat to public health.

Many countries in the world have reported human infections by chikungunya virus (CHIKV) a mosquito-borne togavirus belonging to the genus alpha virus. After half a century of focal out breaks of acute febrile poly arthralgia, the disease had spread unexpectedly in the past decade with large outbreaks in Africa around the Indian Ocean and in Bangladesh. In Asia, CHIKV is thought to be transmitted by the same mosquito as dengue, Aedes aegypti and Aedes albopictus. Due to similarities in clinical presentation with dengue, limited awareness and a lack of laboratory diagnostic facilities, CHIKV is probably often under diagnosed or misdiagnosed as dengue. Treatment is supportive. The prognosis is generally good although some patients experience chronic arthritis. There is no vaccine or antiviral therapy against CHIKV. Early identification of disease and control of vector will prevent the spread of disease.

Relationship between serum IgE and frequent relapse idiopathic nephrotic syndrome.

This prospective case control study was carried out in Renal and Dialysis Unit of Dhaka Shishu Hospital, Bangladesh from January 2004 to December 2004 to determine serum IgE level in frequent relapse Idiopathic nephrotic syndrome and to evaluate any role of IgE in the rate of relapse. Thirty cases of frequent relapse (FR) Idiopathic nephrotic syndrome (INS) were considered as cases and thirty cases of infrequent relapse nephrotic syndrome (IRNS) were considered as control. Serum IgE level was measured in all patients at the time of relapse and again four weeks after steroid treatment when patient was in remission. The test statistics used to analyses the data were descriptive statistics, Chi-square probability test, Student's "t"-Test, Mann Whitney test and Wilcoxon Signed Rank test. Majority of the patients' age in both the groups was between 2-6 years. The male female ratio in FR group was 2:1, while that in IR group was 3:2. Forty percent of the frequent relapsers and 30% of infrequent relapsers were found to possess the history of atopy. However, the difference between the two groups was not statistically significant (p>0.05). The mean serum albumin in FR was observed to be significantly lower (13.73±0.59 gm/L) than that in IR (15.73±0.67 gm/L) (p<0.05). Mean serum IgE at the time of relapse in FR (1791±95 IU/mL) was found to be more than 3 times higher than that in IR (560±50 IU/mL) (p<0.001). Serum IgE level at the time of remission has decreased to almost normal in IR group (204±21 IU/mL) but it was still found 5 times higher in FR group (1086±79 IU/mL) (p<0.001). Serum IgE level is high in both FR and IR groups of nephrotic syndrome at the time of relapse. It reverts back to normal in IRNS but persistently and significantly high in FR group in both relapse and remission. Level of the serum IgE can be used as a predictor of FRNS.