There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

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In neonates, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 -COVID-19) is lower. There is the potential for vertical transmission of SARS-CoV-2. To date, only a few reports suggest this possibility. Neonates usually have mild symptoms, but some develop multisystem involvement, which is a concern. COVID-19 infections have been reported both in pregnant women and their neonates. However, the evidence of vertical or horizontal transmission modes has not been fully established. We recorded a case study where a 33-year-old mother was tested positive for COVID-19 infection by RT-PCR during her 27 th week of gestation and needed ventilator support for her respiratory distress at that time for 11 days.Subsequently, she gave birth to a female baby at the 35 th week via a lower uterine segment cesarean section. The neonate manifested a severe multisystem inflammatory syndrome associated with her possible COVID-19 infection. Sharing her uncommon clinical presentation, immunological syndrome, and disease outcome are noteworthy for similar unforeseen pediatric case management to help guide future investigations and care.

Introduction: ST segment elevation myocardial infarction (STEMI) due to coronary artery occlusion caused by intracoronary thrombosis in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. We present a case of intracoronary large and mobile thrombus formation after CO poisoning. Case presentation: A previously healthy 50-year-old woman was referred for CO poisoning. She had chest pain after exposure to CO. Her initial mental status was preoccupied with chest pain. Her initial CO fraction was 28.1%, and initial laboratory data showed creatine kinase–myocardial isoenzyme of 134 U/L (upper limit 25 U/L) and troponin I of >50 ng/mL (upper limit 0.06 ng/mL). Electrocardiography was carried out on admission, revealing an ST segment elevation in the inferolateral leads. After initial evaluation, coronary angiography was performed and an intracoronary large mobile thrombus was seen in the proximal left anterior descending (LAD) artery with no significant stenosis. We administered tenecteplase with heparin. After the thrombolytic therapy, ST elevation in the inferolateral leads resolved. Repeat angiography was performed after 24 h; the thrombus in LAD had resolved. The patient was discharged after 5 days, with persistent Q wave in the inferior leads and mild hypokinesia of the inferoposterior wall suggesting myocardial injury. Conclusion: We describe intracoronary thrombus formation induced by CO poisoning. Because intracoronary thrombus can result in myocardial infarction, its consideration following CO poisoning is important. Patients with CO poisoning who have symptoms of STEMI should be carefully evaluated with serial electrocardiograms, cardiac biomarkers, and an echocardiogram. When there is evidence of acute myocardial injury, a primer in coronary angiography can determine which patients could benefit from intervention.

Introduction: Coronary artery diseases are currently the major cause of death in developing countries. Acute coronary syndrome (ACS) is defined as any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non-ST elevation myocardial infarction (NSTEMI) to STelevation myocardial infarction (STEMI). Accurate diagnosis and management of ACS has life-saving implications of its outcome. Objective: To compare the outcomes of STEMI and NSTEMI in a percutaneous coronary intervention (PCI) capable centre. Materials and Methods: The patients who undergone percutaneous coronary intervention (PCI) in Combined Military Hospital, Dhaka were considered from January 2013 to January 2017. Diagnosis of acute MI was based on the clinical presentation, electrocardiogram (ECG) and raised highly sensitive troponin I. Acute MI patients were classified into 2 groups, STEMI and NSTEMI. Their coronary risk factors, co-morbidity, ECG, echocardiogram, coronary angiographic (CAG) findings and short-term outcomes were collected. All statistical data were analysed by SPSS 22.0 software. Results: There were 464 patients enrolled for analysis. Among them, 208(44.8%) patients had STEMI and 256(55.2%) had NSTEMI. The ratio of male/female was greater in STEMI as compared to NSTEMI (4.0 vs 1.9; p=0.041). Among NSTEMI patients, 88(34.4%) had ST depression, 168(65.6%) patients had other ECG changes like T wave abnormalities in 66(25.7%) and poor R-wave progression in 16(6.3%). NSTEMI patients had less regional wall motion abnormality on echo cardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2 vs 0.78 %), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3 % vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. NSTEMI patients had less regional wall motion abnormality on echocardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2% vs 0.78%), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3% vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. Coronary angiogram shows that left anterior descending artery was the most commonly involved artery in STEMI; however, the left circumflex artery or right coronary artery was involved more commonly in NSTEMI (p<0.001). Conclusion: The first step in successful treatment of acute MI depends on early diagnosis. Inspite of immediate management, STEMI had relatively worse outcome compared to NSTEMI. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 22-27