Dengue is a self-limiting acute mosquito born disease caused by Dengue virus. Dengue infections may be asymptomatic or can result in a wide spectrum of disease severity ranging from an influenza-like illness (Dengue fever) to the life-threatening Dengue hemorrhagic fever (DHF)/Dengue shock syndrome (DSS). We aimed to analyze the variation in clinical spectrum, outcome and possible risk factors for fatality among Dengue infected children. This was an observational study carried out over a period of one year involving 89 children up to 15 years of age. Upon clinical suspicion Dengue was confirmed by NS 1 antigen and/or Dengue antibody IgM, IgG. Positive Dengue cases were enrolled & interviewed and the information obtained related to the risk factors, clinical presentation, pattern of Dengue infection and outcome were documented in the pre-structured questionnaire. Among the 89 studied children the highest percentage (51.68%) was between 0-5 year and male female ratio was 1.2: 1. Mosquito net was not used by (74.15%) children and there was source of stagnant water in/near the house of (13.48%) children. Fever was present in (100%), rash in (48.31%), nausea/vomiting in (37.07%), headache in (12.35%), myalgia/arthralgia/backache (13.48%), retro orbital pain (1.12%) and abdominal pain in (23.59%) patient. Epistaxis was the commonest (70%) form of bleeding. CNS involvement was in the form of restlessness/irritability (19.10%), altered sensorium (2.24%) and convulsion. Pleural effusion was commoner than ascites; (25.84%) and (12.35%) respectively. Among the enrolled children Dengue fever was (74.15%), Dengue hemorrhagic fever (6.74%) and Dengue shock syndrome (19.10%). Two patients died out of 17 from Dengue shock syndrome which was (11.76%). World Health Organization (WHO) guideline based management should be applied in assessing and managing Dengue cases to reduce mortality rate. Public awareness should be widened to prevent Dengue.

The primary objective of this study was to determine the clinical improvement after oral magnesium (Mg 2+) supplementation in severely malnourished children. The specific objectives were to observe the changes in clinical signsymptoms between Mg 2+ supplemented and un-supplemented group and to see serum Mg 2+ level before and after oral Mg 2+ supplementation. This observational study was conducted in three tertiary level hospitals in Dhaka city involving 60 severely malnourished children of 6-59 months of age by non-probability purposive sampling from July'2016 to June'2018. Children were divided into two groups; Group I was given standard management for severe acute malnutrition according to the national guideline, Group II received similar treatment plus oral Mg 2+ supplementation. Improvement of the clinical profile and the serum Mg 2+ level was observed in children treated with Mg 2+ supplementation. The mean age of Group I children was 21.13±13.02 months and Group II was 22.52±12.13 months. Male female ratio was 1.2:1. Statistically significant improvement was observed in case of nausea/vomiting, appetite, generalized weakness and weight gain (p<0.01). Appearance, diarrhea, skin changes and edema also improved in Mg 2+ supplemented group but the results were not significant. Post-treatment serum Mg 2+ levels were significantly different in Group I and Group II i.e., 1.52±0.27mg/dL Vs 2.03±0.31mg/dL respectively (p<0.001). It was observed that oral Mg 2+ supplementation improved clinical outcome in severely malnourished children. Further large scale randomized control trial is needed to more precisely delineate the beneficial role of oral Mg 2+ supplementation in severely malnourished children.

Fever, skin rash, thrombocytopenia and bleeding are common manifestation of dengue fever (DF). Thrombocytopenia usually gets better and platelet count normalizes by day 10 of fever. Chronic thrombocytopenia is not a feature of dengue fever. Proposed mechanisms behind thrombocytopenia are many. Direct platelet destruction by dengue virus, immune-mediated platelet destruction and evenmegakaryocytic immune injury are proposed as underlying mechanisms. We are reporting a case of a 43 year old female who presented in dengue season in 2019 with fever and bleeding and wasdiagnosed as a case of dengue haemorrhagic fever. She had persistent thrombocytopenia which neededto be treated on the lines of immune thrombocytopenia and responded to steroids. Other causes of thrombocytopenia were ruled out. Bangladesh J Medicine January 2021; 32(1) : 62-64

Introduction: Tuberculosis (TB) in children is increasingly becoming an important cause of global child morbidity and mortality. Objective: The objective of this study was to evaluate the clinical spectrum of TB in children under the age of 15 years and document any changes that occur over time. Materials & Methods: This observational study was conducted in the pediatric outpatient department (OPD) of 250 Bedded TB Hospital, Shyamoli, Dhaka, from October'2016 to January'2017. A total 71 children of both sex up to 15 years of age, who were diagnosed as having TB and attended the pediatric OPD of TB hospital during the four months study period were enrolled. The data was analyzed on the basis of patient's age, gender, socioeconomic status, mode of presentation, BCG vaccination status, history of contact with smear positive TB patient, clinical findings, investigations and associated co-morbidities. Results: This study revealed that among the 71 cases of TB, (72%) had extra-pulmonary TB (EPTB) and (28%) had pulmonary TB (PTB), the commonest age group was 6 to 15 years with male preponderance (51%). Pulmonary TB was diagnosed mostly clinically (60%) followed by positive sputum smear result (20%), gastric aspirate for acid-fast bacilli AFB (5%) and sputum for Gene Xpert (5%). Distribution of extra-pulmonary TB (EPTB) according to the organ involvement was TB lymphadenitis (49%), osteoarticular TB (19.6%) and abdominal TB (5.9%). Cervical lymphadenopathy was the commonest presentation (76%) among the EPTB cases. Tuberculin skin test (TST) was positive in (69%) cases. Among the total cases (90%) children had TB alone whereas (10%) had other co-morbid disease along with TB. Conclusion: Extra-pulmonary TB (EPTB) was more prevalent among the childhood TB cases in a tertiary level set up Md. Mozammel Haque et al.: Pattern of Childhood Tuberculosis in the Outpatient Department of a Tertiary Level Hospital in Dhaka City where cervical TB lymphadenitis was the commonest.