Clinical Profile and Lab Findings of Dengue Fever in Children Admitted in a Tertiary Care Hospital.

Dengue is an arboviral infection dengue virus (DENV 1-4) transmitted by Aedes mosquito. It shows a wide range of clinical presentation from asymptomatic cases to undifferentiated fever, dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) or non-severe and severe dengue. Most cases of dengue are self-limiting; however, severe dengue has high mortality if not diagnosed and managed early during the disease. Dengue virus (DENV) infection is a serious global public health challenge resulting approximately 200 million cases of morbidity and 50,000 cases of mortality annually. Management is based on clinical and lab parameters with certain lab tests aiding in the early forecast of severe dengue. While serological tests (detection of nonstructural protein 1 [NS1] antigen, immunoglobulin IgM and IgG antibodies aid in diagnosis of dengue, simple, cost-effective, easy tests such as hematocrit and platelet counts have great utility in resource-poor healthcare systems for predicting onset of severe dengue. To determine the clinical profile and lab findings of different varieties of Dengue fever in children admitted in a tertiary care hospital. This retrospective observational study was designed to collect data from the medical records of children of both sexes, aged up to 12 years old. The study was conducted from April 2019 to September 2019 in pediatrics department of BSMMU, Dhaka. A total of 50 children who were admitted with the complaints of fever and were found positive for either NS1 antigen or dengue IgM or IgG antibodies were included in the study. Patients with chronic diseases or any concurrent infections were excluded. Samples were collected from hospital record and kept in a separate management system only for dengue patients. The demographics, clinical and laboratory findings were recorded via structured data collection sheet. Among 50 cases, 22 were dengue fever, 17 were dengue hemorrhagic fever and 11 were dengue shock syndrome. The mean age of study participant was 6.95. Out of 50 patients, Male 62.0% were predominant over the female 38.0% and majority 74.0% came from urban area. Fever (95.5%) was mostly the presenting feature in dengue fever. Bleeding (29.4%) and tourniquet test positive (47.0%) were most in DHF. Hypotension (90.0%), tachycardia (90.9%), edema (18.2%), shock (90.9%) and hepatomegaly (72.7%) were mostly present in DSS. Neutropenia (72.7%) was significant in DSS. Platelet count (32,588.24±22,335.67) was significantly low in DHF. Albumin count (27.82±5.25) and TCO2 (18.27±1.8) were significantly low in DSS. Statistical analysis was done by Kuskalwallis test for categorical data analysis and one way ANOVA test for comparison of continuous data. P value <0.05 is considered as significant. This time it was seen that bleeding, tourniquet test positivity with low platelet count is seen in DHF. But DSS was marked by hepatomegaly and hypoalbuminaemia.

Difference in Clinical Patterns between COVID-19 Affected Children and Adults.

Coronavirus has created a major global health problem since December 2019. People of all age groups were affected by this virus though children showed milder clinical characteristics and initially less number of children was affected by this virus. It is very important to know the difference in clinical patterns between COVID-19 affected children and adults. This cross-sectional prospective study was carried out in Kurmitola General Hospital, Dhaka from April to September 2020 to compare the clinical pattern and laboratory findings between COVID-19 positive children and adults. Total 150 COVID-19 positive patients were enrolled in this study, among them 100 patients were adults (>18 year) mean±SD age (49.9±14.33) and 50 patients were children (Day 1-18 year) mean±SD age (8.7±4.79). The adult group had 66 males and 34 females and the pediatric group had 27 males and 23 females. No significant sex difference was seen between the two groups (0.153). Most of the children were affected by family contact and they showed a mild type of illness but adult patients had contact from different sources. Fever and cough were the main symptoms of both groups but fever was more common in adults (81%) than children (36%), p-value (0.001). In children no severe or critical cases were found. But asymptomatic cases were 8%, mild cases (68%) and moderate cases (24%) in children. In adults no asymptomatic patients were found. Moderate cases were 72%, severe 14% and critical 5% (p value 0.001). Leucopenia, Lymphopenia and raised CRP and increased ferritin were found more in adults than children. Chest X-ray showed 42% of children had pneumonia and 83% adults had pneumonia. There was significant difference between the two groups (p value 0.0001). This study concludes that corona virus affects children like adults but their presentation is not so severe and children show mild clinical symptoms in comparison with adults.

Ganglioneuroma Mimicking Nephroblastoma: A Case Report.

Ganglioneuroma is an uncommon benign, slow-growing tumor arising from the neural crest. It rarely turns malignant even after decades of benign existence. Imaging modalities give a definite clue to the existence of a neurogenic mass but it is finally diagnosed on histopathology examination. Here, a 3-year-old girl presented with ganglioneuroma that mimicked renal mass on imaging in a tertiary care hospital, Dhaka, Bangladesh on January, 2016. Later on, it was confirmed as neuroganglioma by histopathological examination. As treatment differs widely between ganglioneuroma and nephroblastoma, a minor mistake in the accurate diagnosis may endanger the life of a patient through potential adverse effects of therapy. So, we should keep in mind about ganglioneuroma regarding evaluation of any kidney or abdominal masses.

Association between Child Undernutrition and Maternal Undernutrition: A Study in a Tertiary Care Hospital.

Undernutrition in children under five years remains a significant health problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although Bangladesh has made rapid progress over the last decade in the field of health and nutrition, there has been very slow progress in improving the state of child nutrition. Studies aiming at determination of interrelationship between child undernutrition and maternal undernutrition are to be scientifically established if appropriate intervention policy is to be introduced. This study was undertaken to see whether this assumption has a statistically proven basis that maternal undernutrition influences child undernutrition. The objective of this cross sectional analytical study was to evaluate the association between child undernutrition and their maternal undernutrition in child-mother pair in a tertiary care hospital and was conducted from July 2017 to April 2018 in the department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study subjects were 196 children between the ages of six months to five years who were admitted in BSMMU and their accompanying mothers. Children who had any known chronic diseases or clinically obvious syndrome were excluded. Before enrollment, parents of all the patients were informed about the study & its objectives. Anthropometric measurements of children and mothers were done by standard procedure. Demographic profile and relevant maternal information were collected by interviewing the mothers. Among the undernourished children, 17.3% were found underweight, 7.1% stunted, 16.3% wasted. Combined underweight & wasted were 34.7%, underweight & stunted 9.2%, stunted & wasted 5.1%, underweight, stunted and wasted 10.2%. Maternal undernutrition was more common (95.7%) in undernourished children group. Undernutrition was significantly higher in mothers of children with undernutrition (OR=40.75, p<0.001). Children having a better nutrition were born from mothers who were well nourished, educated, had good childcare knowledge and higher family income. This emphasized the need to provide the guideline for appropriate measure to be taken to reduce child undernutrition.

Serum Na+ Level in Children Suffering from Acute Bronchiolitis: A Review.

Bronchiolitis is the leading cause of lower respiratory tract infection (LRTI) in infants. Respiratory syncitial virus (RSV) is the most common cause of bronchiolitis in infants and young children. Hyponatremia is a commonly overlooked important extrapulmonary manifestation of bronchiolitis. It is now known that the syndrome of inappropriate anti diuretic hormone secretion (SIADH) occurs frequently in several pulmonary conditions including bronchiolitis which may lead to hyponatremia. In many studies,a good number of patients admitted with bronchiolitis were found to have hyponatremia e.g. Wilson et al. A high index of suspicion with prompt diagnosis and treatment can save life and prevent handicaps. Serum electrolyte level should be measured in all children hospitalized for bronchiolitis. Neurological complications may occur in hyponatremia and fluid therapy in vulnerable infants should be appropriately planned to reduce this risk.

Intraspinal Intramedullary Primitive Neuroectodermal Tumor in a Young Girl: A Case Report from BSMMU, Bangladesh.

Primitive neuroectodermal tumors are malignant tumor of pluripotent cells of neural crest. It has diverse clinical presentation and aggressive clinical behaviour. Clinical features may provide some clue but imaging studies such as MRI of brain; tissue histopathology, immune histochemistry and cytogenetic are essential to confirm the diagnosis. Here we describe a girl of 4½ years age admitted with the complaints of, low back pain for 2 months, gradually worsening weakness in both lower limbs for the same duration along with urinary incontinence and constipation for 1 month. On examination she was afebrile, mildly pale, no lymphadenopathy, having normal vital signs and anthropometrically well thriving. Back and spine examination showed angulation of spine involving T11 - L4, without paravertebral swelling. Neurological examination of lower limbs revealed decreased muscle tone, diminished muscle power (3/5), both knee and ankle jerks were also diminished and bilaterally equivocal planter response, sensory function of all modalities were impaired. MRI findings were suggestive of ependymoma. Consultation was done with department of neurosurgery and they did the relevant surgery. Tissue histopoathology and immune histochemistry confirmed the diagnosis of primitive neuroectodermal tumor. Finally the child was referred to Paediatric Haemato-oncolgy department for further management.

Goldenhar syndrome - a case report.

Goldenhar syndrome is a developmental abnormality of 1st & 2nd branchial arch involving the craniofacial microsomia with ocular & vertebral abnormality. Though most of the cases are sporadic, some familial association is also found in autosomal dominant or recessive manner. Teratogenic effect of some toxic substances may lead to the condition. Ocular abnormalities are epibulbar dermoid, lipodermoid & coloboma. Otic defects are preauricular tags, microtia, anotia & conductive hearing loss. Cardio-pulmonary & genitourinary abnormalities are common associations. Here we have described the case of a 10 years old girl had ocular, auricular & vertebral changes consistent with Goldenhar syndrome, she was managed with multidisciplinary approach and she was symptomatically improved but corrective surgery was planned as schedule of respective department.

Multifocal skeletal tuberculosis in children.

Multifocal bone involvement is though rare but is reported from some countries where tuberculosis is endemic. Here we report a case of three years old boy was admitted in Bangabandhu Sheikh Mujib Medical University, Dhaka with the complaints of difficulty in walking ,low grade fever for six months, swelling over the back, elbow joint, knee joint and upper part of forearm and legs for two months. Family history of tuberculosis was positive. Mantoux test was 18 mm, ESR 85 mm in first hour, chest X-ray reveals right hilar lymphadenopathy, X-ray dorsolumber spine shows wedge shaped deformity in T11, L4 and with paravertebral collection from L2-L4. X-ray of legs, knee joint and forearms show multiple lytic lesions in shaft with periosteal reaction and cortical thickening. Ultrasonograph of whole abdomen shows psoas abscess. Culture of bone marrow aspirate reveals Mycobacterium tuberculosis. Patient was given an anti tubercular regimen with Rifampicin, Isoniazid, Pyrazinamide and Streptomycin for initial two months which to be followed by Rifampicin and Isoniazid for another 10 months.

Comparison between CRP and IL-6 as early markers of neonatal sepsis.

Infection in neonates is difficult to identify solely on the basis of physical findings, because signs are not specific. C reactive protein (CRP) is an acute phase reactant which has been used in diagnosis of bacterial infection in neonates. IL-6 is a proinflammatory cytokine produced by monocytes and macrophages activated by bacterial infection. IL-6 can be detected in blood earlier than CRP during the course of bacterial infection. The objective of this study was to compare the usefulness of the level of interleukin-6 with CRP as early markers of neonatal sepsis. This was a queasy experimental study carried out in neonatal unit, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of September 2005 to February 2006. Forty five cases of suspected septicemia were enrolled in the study and thirty healthy newborns were taken for comparison. On the 1st day of symptoms and 1st day of admission, complete blood count, blood for culture and sensitivity and interleukin-6 (IL-6) estimation were done. After 48-72 hours CRP was estimated. In suspected septic babies with high leukocyte count, IL-6 level was found to be raised with high sensitivity (85.71%), negative predictive value (95%). IL-6 was found to have high sensitivity (76.9%), specificity (73.68%), positive predictive value (80%) and negative predictive value (70%) in CRP positive suspected sepsis cases. So, the conclusion was that IL-6 is a very early marker of neonatal infection. IL-6 was mostly positive within 24 hours of onset of sepsis in comparison with other tests. So IL-6 is more useful than other markers for early detection of neonatal sepsis.