Hand, foot, and mouth disease (HFMD) also known as vesicular stomatitis with exanthema, first reported in New Zealand in 1957 is caused by Coxsackie virus A16 (CVA16), human enterovirus 71 (HEV71) and occasionally by other HEV-A serotypes, such as Coxsackie virus A6 and Coxsackie virus A10, are also associated with HFMD and herpangina. While all these viruses can cause mild disease in children, EV71 has been associated with neurological disease and mortality in large outbreaks in the Asia Pacific region over the last decade. It is highly contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. This is characterized by erythrematous papulo vesicular eruptions over hand, feet, perioral area, knee, buttocks and also intra-orally mostly in children, typically occurs in small epidemics usually during the summer and autumn months. HFMD symptoms are usually mild and resolve on their own in 7 to 10 days. Treatment is symptomatic but good hygiene during and after infection is very important in preventing the spread of the disease. Though only small scale outbreaks have been reported from United States, Europe, Australia Japan and Brazil for the first few decade, since 1997 the disease has conspicuously changed its behavior as noted in different Southeast Asian countries. There was sharp rise in incidence, severity, complications and even fatal outcomes that were almost unseen before that period. There are reports of disease activity in different corners of India since 2004, and the largest outbreak of HFMD occurred in eastern part of India in and around Kolkata in 2007and Bhubaneswar, Odisha in 2009. In recent years there are cases of HFMD have been seen in Bangladesh also. Although of milder degree, continuous progress to affect larger parts of the neighboring may indicate vulnerability of Bangladesh from possible future outbreaks.Bangladesh J Child Health 2016; VOL 40 (2) :115-119

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Tuberculosis is a devastating infectious disease causing many deaths worldwide. Recent investigations have implicated neutrophil extracellular traps (NETs) in the host response to tuberculosis. The aim of the current study was to obtain evidence for NETs release in the circulation during human tuberculosis. For this we measured the plasma concentrations of nucleosomes in conjunction with neutrophil elastase, in 64 patients with active pulmonary tuberculosis and 32 healthy controls. Patients with active tuberculosis had elevated plasma levels of nucleosomes and elastase when compared with local healthy blood donors. Furthermore nucleosome and elastase levels showed a positive correlation. These findings provide the first evidence for the release of NETs in the circulation of patients with active pulmonary tuberculosis.

Iron deficiency anemia (IDA) and beta-thalassemia trait (BTT) are the common causesof microcytic hypochromic anaemia. Several discrimination indices have beenintroduced to discriminate quickly these similar entities via parameters obtained fromautomated cell counter. The purpose of the study was to compare the value of twodiscrimination indices, red cell distribution width index (RDWI) and red cell distributionwidth (RDW) in differentiation of BTT and IDA. This study consists of 57 cases ofBTT and 72 cases of IDA. Severe anaemia (<7.0 gm/dl) had been excluded becausethese cases are not confused with BTT cases in practice. Sensitivity, specificity,positive and negative predictive values and Youden’s index of both indices indifferentiation of BTT and IDA had been calculated. RDWI appears to be reliable anduseful index for differentiation of iron deficiency anaemia and beta thalassaemia trait.Again RDWI is better than RDW in differentiating BTT from IDA.Key words: Microcytic hypochromic anemia; discrimination indices.DOI: 10.3329/bjch.v33i3.5690Bangladesh Journal of Child Health 2009; Vol.33(3): 100-103

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BackgroundTuberculosis (TB) is an important cause of morbidity and mortality worldwide. Toll-like-receptors (TLRs) are important for the recognition of the causative agent Mycobacterium tuberculosis. Negative regulation of TLRs is necessary to control deleterious inflammatory damage, but could provide a means of immune evasion by M. tuberculosis as well.MethodsTo obtain insight in the extent of expression of inhibitory regulators of immunity in patients with active TB, peripheral-blood-mononuclear-cells (PBMCs) and plasma were obtained from 54 TB patients and 29 healthy blood donors from Chittagong, Bangladesh. Bilateral alveolar macrophages were obtained from an infected versus a contralateral normal lung segment of 9 patients. Statistical analyses were performed using Mann–Whitney U and Wilcoxon matched pairs testing. Correlations were calculated using the Spearman rho test.ResultsPBMCs harvested from TB patients demonstrated increased mRNA expression of IL-1-receptor-associated-kinase-M, suppressor-of-cytokine-signalling-3 and Toll-interacting-protein. Flow cytometry revealed enhanced expression of IL-1-receptor-like-1 (ST2) on lymphocytes. Plasma soluble ST2 was elevated in patients with TB and correlated with established TB biomarkers, most strongly with soluble interleukin-2 receptor subunit α and interleukin-8. Alveolar macrophage mRNA expression of negative TLR regulators did not differ between the infected and contralateral lung side.ConclusionThese results show enhanced expression of distinct negative regulators of innate immunity in PBMCs of patients with TB and identify plasma soluble ST2 as a potential novel biomarker for TB disease activity.

Background: Liver biopsy is an established procedure to diagnose disease, to assessprognosis and to follow up of liver diseases. Although liver biopsy is a confirmatory diagnosticprocedure of majority of the hepatological disorders, it carries the risk of complications.Though major complications rarely occur, minor complications are common. To minimizecomplications, several biopsy techniques have been developed. The present study wasintended to correlate the clinical diagnoses with histological diagnoses and to observethe complications encountered by the children with percutaneous liver biopsy procedure.Patients and Methods: A total of 30 paediatric patients of suspected liver diseases,based on predefined eligibility criteria, were subjected to biopsy for confirmation ofdiagnosis. An ultrasound of liver was routinely performed before the procedure to markthe site for percutaneous biopsy. The field was prepared with alcohol-based solution(povidone-iodine) and sterile drapes were placed over the patient. Local anaestheticwas administered with 2% lidocain solution 20mg/ml (preferably levobupivacaine 2.5mg/ml) in both superficial and deep planes. A blind liver biopsy was done at the point ofmaximum dullness by percussion over the right trunk. We used cutting needle. Thediameter of the needle used in our study was 14-gauge (1.4 mm) which allowed adequatecollection of tissue for diagnosis. The biopsy material was taken in a very small amountof sterile normal saline and was immediately sent to the laboratory for evaluation.Results: Half (50%) of the patients was more than 5 years of age with median agebeing 5.0±3.9 years. Majority (80%) was male. Ninety percent of the patients belongedto poor socioeconomic class. Clinically the cases were diagnosed as having chronichepatitis (23.3%) followed by CLD (16.7%), isolated hepatomegaly (16.7%), livercirrhosis (13.3%) and storage disease (13.3%). Hepatosplenomegaly and congenitalhepatic fibrosis, each was 6.7%. Histological diagnoses of biopsy material obtainedfrom the liver confirmed that one-sixth (16.7%) of the cases had liver cirrhosis. Storagedisease and glycogen storage disease each comprised 13.3% of the cases andcongenital biliary atresia 10%. Very few cases had moderate fatty changes withcholestasis, congenital hepatic fibrosis, chronic inflammatory cells, chronic viralhepatitis and secondary biliary cirrhosis. Nearly half (46.7%) patients had mild painand discomfort at the site of biopsy, most of which spontaneously went away. However,some 3 (10%) patients developed major complications needing management.Conclusion: Liver biopsy is a well established procedure in the diagnosis and follow upof liver diseases. But it is not without risk of complications. So, before deciding for aliver biopsy, the indications and risks must be assessed cautiously for each patient.Key words: Percutaneous liver biopsy; clinical diagnoses; histological diagnoses; complications.DOI: 10.3329/bjch.v34i1.5694Bangladesh Journal of Child Health 2010; Vol.34(1): 1-6

Background: Acute watery diarrhoea (AWD) is a leading cause of illness and death amongst children in developing countries. Electrolyte and acid-base disturbances play an important role in the associated morbidity and mortality. Objectives: To observe the acid-base and electrolyte changes in moderate and severe dehydration in AWD in children. Methods: This cross sectional study was carried out in the Observation and Referral Unit of Dhaka Shishu (Children) Hospital from July 2018 to December 2018. Children below five years of age who came with acute diarrhoea with moderate to severe dehydration were included in the study. After admission 2ml of whole blood was collected with all aseptic measures at the time of insertion of intravenous cannula before giving intravenous fluids to measure serum levels of Na and K while arterial blood was also taken for analysis. The data was analyzed by using SPSS version 20. Results: Total 125 AWD cases were admitted among them 98(78.4%) had moderate dehydration whereas 27(21.6%) had severe dehydration. Hyponatremic dehydration was present in 41(32.8%) cases. Among them 30(30.6%) had moderate dedydration and 11(40.4%) had severe dehydration, hypernatremic dehydration was present in 11.11% cases, hypokalemia was present in 54(43.2%) cases. Among them 42(42.86%) had moderate dedydration and 12(44.44%) had severe dehydration. Metabolic acidosis was present in 38(30.4%) cases [28(28.57%) in moderate dedydration and 10(37.04%) in severe dehydration]. The comparison of mean serum sodium and potassium value of the children with moderate and severe degrees of dehydration did not attain statistical significance, but there was a significant difference in bicarbonate concentration among moderate and severe dehydration cases (p=0.02). Conclusion: Hyponatremia and hypokalamia was the commonest electrolyte abnormality among moderate to severe dehydration with AWD. Mean serum sodium and potassium of the children with moderate and severe degrees of dehydration did not attain statistical significance, but bicarbonate concentration was significantly low among severe dehydration cases. DS (Child) H J 2020; 36(2): 120-124