Milestones of Development in Infancy: A Prospective Study in a Tertiary Level Hospital of Bangladesh.

The timing of milestone is influenced by many factors. Sex and socioeconomic status has significant effect to some psycomotor milestones. The study was conducted to determine the pattern of milestones of development of infants in our country and to compare it in different sex and socioeconomic condition. It was a hospital based prospective study done in Sir Sallimullah Medical College and Mitford Hospital, Dhaka, Bangladesh from October 2014 to November 2015. Healthy term newborn infants with average birth weight were included in this study and milestones of this birth cohort were assessed monthly from birth to 12 months of age by using a set of 60 milestones. Total number of 217 babies was enrolled but during follow up 0.9% developed meningitis, 43.7% was lost to follow up and 55.2% of the cohort was followed up to 12 months of age. Among 120 babies 51.7% were male, 48.3% were female babies and 51.7% belong to lower, 32.5% middle and 15.8% upper socioeconomic group. There was no significant difference between male and female infants achieving most of the milestones of development except in language development in which female infants were little bit higher than male infants.

Red Cell Alloantibodies in Thalassaemia Patients Who Received Ten or More Units of Transfusion.

Thalassaemia patients are the highest consumers of blood. Recurrent exposure to allogenic red cell antigen puts this population at increased risk of alloimmunization. This causes delayed hemolytic transfusion reactions. So transfusion requirement increases. But no data regarding alloimmunization was available in Bangladesh. Aim of this study was to estimate the prevalence of alloimmunization and to find out the potential factors associated with its development. This analytical cross sectional study was done by enrolling 97 patients, received at least 10 units transfusions, through convenient sampling. Indirect and direct antiglobulin tests were done to detect immunization by spin tube technique keeping an autocontrol and carried out in the Department of Haematology & Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2016 to March 2017. Polyclonal anti-AHG reagent was used. A total 21 patients developed alloimmunization (21.6%) and 4 patients (4.1%) developed autoimmunization. Age, gender, splenectomy and number of transfusion are shown significant risk factors for alloimmunization. Data from this study demonstrate that the RBC alloimmunization is significantly high in our country. So, pretransfusion antibody screening needs to be initiated in order to ensure safe transfusion and RBC phenotyping should be started before starting first transfusion to prevent alloimmunization.

A Young Boy with L-asparaginase-Induced Seizure.

L-Asparaginase is a critical component in the treatment of acute lymphoblastic leukemia in children. It is known to cause coagulation abnormalities, thrombosis and hemorrhage in the central nervous system in addition to vasculitis and hypersensitivity reactions. This syndrome generally occurs after a few weeks of therapy and may occur after L-asparaginase therapy is completed. Seizures are uncommon symptoms. We report a case of seizure associated with L-asparaginase therapy but no evidence of hemorrhagic or thrombotic cerebrovascular events, completed in the department of Hematology of Bangabandhu Sheikh Mujib Medical University during March & April 2016.

Pulmonary Arterio-Venous Malformation (PAVM): A Rare Case Report.

A 6-year-old boy from Comilla, was admitted in Dhaka Medical College Hospital with exertional dyspnea, central cyanosis, clubbing and was finally diagnosed as pulmonary Arterio-Venous Malformation (PAVM) by bubble contrast echocardiography, and pulmonary CT angiography. As PAVM is rare in children, it is often not thought of in differential diagnoses and the diagnosis remains in disguise. In this report, we described the clinical presentation of 6-year-old child with PAVM and also how to investigate the case to get the diagnosis.

Disseminated intravascular coagulation in acute promyelocytic leukaemia and its impact on the induction failure: a single centre study.

Life-threatening coagulopathy associated with acute promyelocytic leukemia (APL) has been the defining clinical characteristic and is an important risk factor for fatal haemorrhage and early death. Pathogenesis of coagulopathy in APL is complex and mainly includes disseminated intravascular coagulation (DIC). The study was done to see the status of DIC and its impact on the outcome of APL in our setting. Among the total 60 patients, induction mortality rate was 30% and remission rate was 70%. The main cause of induction mortality was bleeding that accounts for 66.7% of mortality. DIC was present among 32 out of 60 patients (53.33%). Induction mortality has significant relationship to DIC as the induction mortality rate is 47% in patients with DIC and 11% in patient without DIC (P value 0.0009). Induction motality rate in low, intermediate and high risk group is 6.70%, 24% and 58% respectively (p value < 0.0001). Finally, risk group subclassification revealed presence of DIC in high risk group has the highest early mortality rate.

Response of vincristine, melphalan, cyclophosphamide and prednisolone in refractory multiple myeloma.

In refractory and relapsing multiple, myeloma good complete response rates may be achieved by Vincristine, Melphalan, Cyclophosphamide and Prednisolone (VMCP) like regimen which is effective alternative and less expensive in developing country like Bangladesh. The study was conducted to see the response of VMCP as an alternative in relapsing or refractory multiple myeloma. The study has been carried out in the department of Haematology, Bangabandhu Sheikh Mujib Medical University from July 2004 to June, 2005. This study was conducted on refractory case of multiple myeloma, having aged between 45 to 70 years. A total of ten patients had been taken for this study group. Newly diagnosed multiple myeloma is not included in this study. All of the 10 patients were treated according to the following VMCP protocol, Vincristine 1mg IV, d1, Melphalan 6mg/m2/d p.o. d1-d7, Cyclophosphamide 120mg/m2/d p.o. d1-d7 Prednisolone 60mg/m2/d p.o. d1-d7. Cycles were repeated every 28 days for 6 cycle. Six out of ten patients with refractory multiple myeloma displayed minimal response (60%) after treatment with 6 cycle of VMCP protocol, three patients entered partial remission (30%), and one (10%) showed complete response.