Clinical and Biochemical Profile of Hepatitis A Virus infection in Children

Background: Acute hepatitis A virus infection in children in developing countries is a matter of concern though the incidence has come down in developed countries.To observe the clinical presentation and biochemical profile of hepatitis A virus infection in children hospitalized in a tertiary care center in Bangladesh.Material & Methods:In this cross-sectional observational study, data were collected from the records of pediatric patients who were admitted due to acute hepatitis. Demographic data were collected, and complete physical examination findings and laboratory data were also taken. Serum samples were tested for LFT, Anti-HAV IgM and other viral markers among them Anti-HAV IgM positive children were included in the study.Results:Among the total of 40 patients suffering from Acute Viral Hepatitis (AVH), male predominated over female with 57.5% vs. 42.5%. The majority of the study population (65%) came from the urban area. In this study, 65% of the patients used tap water and 35% used tube well water for drinking purposes while the majority 70% used boiled water. Most of the patients (80%) consumed both homemade and outside foods and drinks while 20% consumed only homemade food. Positive family history of viral hepatitis was found in 12.5% of cases. Common presentations were fever (100%), jaundice (100%), anorexia, nausea (95%), vomiting (85%), abdominal pain (50%) etc. On examination Jaundice (100%) and hepatomegaly (95%), splenomegaly (5%), and ascites (7.5%). Only 7.5% of patients developed complications like cholestasis,7.5% showed ascites,5% had relapsed and 2.5% develop liver failure.Conclusions:This study showed that poor sanitation and poor hygiene are the main risk factors for hepatitis A. The common presenting features which should alert the clinicians include fever, jaundice, anorexia, nausea, vomiting, diarrhea, abdominal distension, hepatosplenomegaly and ascites. In Bangladesh, safe water supplies and proper sanitation will constitute the best solution to eliminate endemic hepatitis A.

A Comparative Study Between Cytomegalovirus Immunoglobulin M-Positive and CMV Immunoglobulin M-Negative Biliary Atresia in Infants Attending a Tertiary Care Hospital in Bangladesh / 대한소아소화기영양학회지

Purpose@#Perinatal cytomegalovirus (CMV) infection can lead to biliary atresia (BA) in different entities. This study aimed to compare the clinical, hematological, biochemical, and histological features of infants with BA based on their CMV immunoglobulin M (IgM) status at presentation. @*Methods@#This cross-sectional descriptive study was carried out between January 2019 and June 2020 at the Department of Pediatric Gastroenterology and Nutrition at the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka. Forty-three patients with BA were selected purposively and categorized into either the CMV IgM-positive or CMV IgM-negative BA group. Categorical variables were compared using Fisher’s exact test and chi-square tests, while the Student’s t-test and Mann–Whitney U-test were used to compare continuous variables. For all statistical tests, a p-value <0.05 was considered statistically significant. @*Results@#Thirty-three (76.7%) of the cases were between 2 and 3 months of age on admission.The clinical, hematological, and biochemical parameters did not differ significantly between the CMV IgM-positive and CMV IgM-negative BA groups. Most (50.0%) of the CMV IgMpositive cases had fibrosis stage F2, while 43.5% of the CMV IgM-negative cases had fibrosis stage F3, with no significant difference between the groups (p=0.391). @*Conclusion@#Our data shows no significant distinction between CMV IgM-positive and CMV IgM-negative BA, suggesting that CMV does not contribute to BA pathogenesis.

Wilson's Disease in Bangladeshi Children: Analysis of 100 Cases / 대한소아소화기영양학회지

PURPOSE: To evaluate clinical and laboratory profile of Wilson's disease (WD) in children. METHODS: This cross sectional study was conducted at Bangabandhu Sheikh Mujib Medical University Hospital. Bangladesh, over a period of 3 years. One hundred consecutive children of WD between 3 to 18 years of age were evaluated. RESULTS: Mean age was 8.5+/-1.5 years. Male female ratio was 2:1. Ninety-one percent of patients were Muslim and 9% Hindu. A total of 53% cases of hepatic WD presented between 5 to 10 years of age and most of the neurologic WD manifested in 10-15 years age group. Sixty-nine children presented only with hepatic manifestations, 6 only with neurological manifestations, 14 with both hepatic and neurological manifestation, 10 children was asymptomatic and 1 patient presented with psychiatric features. WD presented as chronic liver disease (CLD) in 42%, CLD with portal hypertension in 34%, acute hepatitis in 20% and fulminant hepatic failure in 4% cases. Stigmata of CLD were found in 18% patients. Keiser-Fleischser ring was found in 76% total patients. Elevated serum transaminase was found in 85% cases, prolonged prothrombin time in 59% cases and hypoalbuminaemia in 53% cases. A total of 73% patients had low serum ceruloplasmin, basal urinary copper of >100 microg/day was found in 81% cases and urinary copper following penicillamine challenge of >1,200 microg/day was found in 92% cases. CONCLUSION: Majority of studied WD children presented with hepatic manifestation of which 76% presented with CLD. Any child presented with jaundice after the age of 3 years should be investigated for WD.

Ulcerative colitis in infancy

Ulcerative colitis [UC] is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter started with immunosuppressive drugs. After initial induction therapy with parenteral steroid and infliximab, the patient is now on remission with azathioprine and mesalamine. UC is rare in Bangladesh, especially in children, and it is rarer during infancy. Several conditions like infective colitis, allergic colitis, Meckel's diverticulitis, Crohn's disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as differential diagnosis

Epidemiological study of risk factors related to childhood visceral leishmaniasis.

This case control study was carried out to determine certain clinical and epidemiological risk factors related to childhood visceral leishmaniasis (VL). Study was conducted in paediatric wards of Mymensingh Medical College Hospital. Dependable variables are sex, age, housing, use of mosquito net, malnutrition, sleeping habit and seasonality. A total of 60 cases and 60 suitably matched controls were studied between January 2000 to December 2000. The exposure rate of VL is more in boys (70%) than in girls (30%). The frequency rate of VL was higher in children >10 years of age group (66.6%) than in other age groups. Mud house dwelling is significantly associated with the development of VL (81.6%) and carries 28.9 times greater risk of developing VL, than those dwelling in bamboo house (13.3%). The difference of this proportion is statistically significant (p<0.001, OR=28.9). The exposure rate of VL was slightly higher (51.6%) in mosquito net non-users than the mosquito net users. Grade III malnutrition was found significantly associated with (83.3%) VL (p<0.005). The frequency rate of VL was higher in children sleeping on floor than in children sleeping on Chowki or Khat (OR=2.07). Rainy season is significantly associated with VL (60%) and carries 2.4 times greater risk of developing VL than other seasons (p<0.05, OR=2.4). It can be concluded that mud house dwelling, grade III malnutrition, sleeping on floor and seasonality (rainy season) are the important risk factors of VL in children.

Carcinoma-rectum in an 11 years old boy.

Carcinoma rectum is a very uncommon malignancy in childhood. The incidence of colon cancer is found to be 1.3 cases per million children. An eleven years old boy with carcinoma rectum was admitted in the Department of Paediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU). The boy presented with irregular fever, altered bowel habit, poor appetite, gradual weight loss and abdominal pain. His abdomen was tender with no organomegaly. The rectal wall was tender and hard mass could be felt in the surrounding area on direct rectal examination. Diagnosis was confirmed by biopsy of the tissue from the growth. Surgical resection and anastomosis was done. After one month of surgery chemotherapy was started. Since carcinoma rectum in children has not been reported in Bangladesh we share the information with professionals.

Effects of prolonged use of injectable hormonal contraceptive on serum lipid profile.

The current study was carried out to determine serum levels of total cholesterol, triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) in human female volunteers taking injectable hormonal contraceptives. For this purpose, 200 (two hundred) subjects with age range of 20-35 years were selected. Out of them, 140 (one hundred and forty) were experimental subjects and 60 (sixty) were control. Women without hormonal contraceptive were selected as the subjects of control group. The experimental subjects were taking injectable hormonal contraceptive, DMPA (depo-medroxyprogesterone acetate) for 3-5 years uninterruptedly. The mean serum total cholesterol and mean serum triacylglycerol levels of the DMPA users were significantly (P<O.05 and P<0.01 respectively) elevated in comparison to that of the non-users. The mean serum HDL-cholesterol was decreased in subjects using DMPA in comparison to that of the control group. But the decrease was not significant (P>0.05). The mean serum LDL-cholesterol level of the subjects of DMPA users was significantly (P<0.05) elevated in comparison to that of the control.

Effect of prolonged use of injectable hormonal contraceptives on blood pressure and body weight.

The study was undertaken to determine the effect of prolonged use of injectable hormonal contraceptive on blood pressure and body weight in young women. Two hundred volunteers were selected for the purpose. Of them, one hundred and forty were taking injectable hormonal contraceptive, DMPA for 3 to 5 years uninterruptedly. Rest forty subjects served as control using no contraceptive steroid. Blood pressure, systolic as well as diastolic, was measured by sphygmomanometer. Body weight was measured by weighing machine. It was observed that there were insignificant (P>0.05) elevations of systolic and diastolic blood pressure from DMPA use. But body weight of the experimental subjects was significantly (P <0.05) increased in comparison to that of the control.

Protective effect of dietary fibers against colorectal carcinoma.

Dietary fibers are remnant of plant cells resistant to hydrolysis by human alimentary tract enzymes. These are cellulose, hemicellulose, lignin, pectins and gums. Intake of dietary fibers or foods rich in dietary fibers decreases the incidence of colorectal carcinoma. Reduced risk of colorectal carcinoma is reported when populations with diet high in red meat and total fats switched to a diet high in total fibers and certain whole grain, goods. Fibre intake is also inversely related to mortality from colorectal carcinoma. Beneficial influence of most vegetables and fruits against colorectal carcinoma is confirmed and this is due to their fibre contents.