Background: Azithromycin sensitivity cannot precisely identify the strains of typhoid and paratyphoid fever for successful treatment. Most of the studies show that azithromycin is highly effective in uncomplicated typhoid fever. Very few studies have been carried out in Bangladesh to see the effectiveness and sensitivity of azithromycin in children with uncomplicated typhoid fever. Objective: To assess the clinical response of azithromycin in uncomplicated typhoid fever. Materials and Methods: This randomized clinical trial was conducted in Dhaka Shishu (children) Hospital from January to December 2009. Children between 2–12 years of age with characteristic clinical presentation of uncomplicated typhoid fever with positive blood culture for S. typhi or S. paratyphi were included in this study. Patients were treated with oral azithromycin 20 mg/kg/day for 7 days in one group and intravenous ceftriaxone 100 mg/kg/day in another group. Effectiveness and sensitivity pattern were documented and compared. Results: Fifty patients were allocated randomly with azithromycin and 48 with ceftriaxone. Twenty two percent of the subjects were below 5 years and 78% above 5 years. Average time of defervescence was 4.44 ± 1.25 days in azithromycin group and 4.38 ± 1.21 days in ceftriaxone group. Response to treatment in both groups was excellent: 94% in azithromycin and 97.9% in ceftriaxone groups. The occurrence of complication was very low in both groups. Eighteen percent showed resistance to azithromycin and 2.1% to ceftriaxone. In azithromycin sensitive group 97.6% showed improvement and in resistant group 77.8% showed improvement. A good percentage of patients who were resistant to azithromycin showed clinical improvement following treatment with this drug. Conclusion: Current study recommends that azithromycin is effective in the treatment of enteric fever in children. The study also shows that some patients resistant to azithromycin showed clinical improvement following treatment with azithromycin. DOI: http://dx.doi.org/10.3329/jemc.v5i1.21495 J Enam Med Col 2015; 5(1): 34-38

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Background Wilson disease (WD) is an inherited disorder of copper metabolism commonly involving the liver, cornea, and brain. Its incidence is increasing day by day worldwide. Early diagnosis and prompt treatment are the key for best outcome. Material and methods A cross-sectional descriptive study was done from January 2014 to December 2019. Sixty children of both genders between 3 and 18 years were diagnosed by clinical and laboratory profile meeting selected criteria. Results Mean age was 8.42 ± 2.6 years and male female ratio was 1.5:1. Consanguinity of marriage was found in 38.3% cases. Seventy percent of cases were hepatic, 16.7% were neuropsychiatric, 5.0% were hepatic with neuropsychiatric, and 8.3% cases were manifested asymptomatically. Asymptomatic and hepatic WD were reported between 3 and 10 years and most of the neuropsychiatric and hepatic with neuropsychiatric manifested after 10 years of age. More than 50% cases improved, a little more than 20% children died, 18.4% were unchanged and 6.6% were hepatic added neuropsychiatric manifestations. Most of the asymptomatic (100%) and hepatic (61.9%) cases improved. High mortality was found with 76.9% cases of acute liver failure (ALF), 7.7% case of chronic liver disease (CLD) and 25% cases of CLD with portal hypertension (CLD and PH). Most of the neuropsychiatric cases (90.0%), and approximately two-third (66.6%) of hepatic with neuropsychiatric cases remained unchanged. Neuropsychiatric manifestations were added in 15.4% cases of CLD and 25% cases of CLD with PH patient. The treatment was well tolerated in 66% children without any side effects. Low WBC (6.3%) and platelet count (4.3%), vomiting (6.3%), anorexia (4.3%), loss of taste (4.3%), rash (4.3%), and proteinuria (2.1%) were found in few cases. Conclusion Majority of the children were presented with hepatic manifestations. More than half of patients with WD treated by D-penicillamine (DP) were improved. Significant mortality was found in acute liver failure whereas neuropsychiatric presentations had persistent abnormalities. No major side effects of DP was observed in most of the cases. Early diagnosis and prompt treatment were crucial for better outcome.

not available DS (Child) H J 2021; 38(1): 56-60

Background: Non-Hodgkin Lymphoma (NHL) is the third most common childhood malignancy. With histopathology based intensive chemotherapy and CNS-directed therapy, survival can reach more than 80%. Objective: The study was conducted to observe the clinico-pathological findings of NHL in Bangladeshi children. Methods: A prospective observational study was conducted in the Paediatric Haematology and Oncology Department of BSMMU from June 2012 to December 2012. Newly diagnosed NHL patients were included in the study. Patient’s initial clinical presentations, time interval from onset of symptoms to diagnosis were recorded. Diagnostic and staging workups were done by CBC, biochemistry, radio-imaging, histopathology (FNAC/excision biopsy), serous fluids/CSF cytology (cytospin), and bone marrow aspiration. Result: Among the 34 patients, BL had preponderance (n=23, 68%) then LL. Median age was 7.6 years. Male: female ratio was 2.1:1. Delayed diagnosis was found in 59% patient. Primary sites were abdomen (65%), thorax (32%), and head-neck (3%). At initial presentation, 83% patients of Burkitt NHL and 100% Lymphoblastic NHL patients came with advanced disease. Bone marrow involvement was found in 23.6% patients and 12% had CNS involvement at their presentation. Irrespective to histology, most common stage was stage-III, which was 53% and then stage-IV was 35%. Median LDH was 1719 U/L. Patient with abdominal variety of NHL came with abdominal complaint like pain (66%), distension (65%), ascites (48%), mass like hepatomegaly (39%), splenomegaly (26%), intussusceptions (8%), testicular involvement (4%). B symptoms were commonly found in 74% patient. Pallor (82%), anorexia, nausea & vomiting (48%), oedema (25%), peripheral lymphadenopathy (49%) were also noticed. In case of thoracic variety of NHL, most common presentation was respiratory distress (90%), superior mediastinal syndrome (SMS) (45%), with high incidence of B symptoms (90%), peripheral lymphadenopathy (72%) with other respiratory finding like chest bulging, mediastinal mass, pleural effusion was also found. Conclusions: About 59% childhood NHL patients tend to present with delayed diagnosis and 88% with advanced disease. Burkitt NHL is the commonest childhood lymphoma, mostly presented with abdominal complaint. Thoracic variety is mostly Lymphoblastic lymphoma. Histopathological findings following excisional biopsy is the most significant and confirmatory for diagnosis. Serum LDH were found significantly high level in both varieties. DS (Child) H J 2021; 37(1): 21-27

Background: Worldwide cancer is the second leading cause of death in children under 15 years and acute leukemia is the most prevalent cancer among children. Objective: The objective of the study was to analyze the incidence and overall outcome of childhood leukemia patients aged 0-12 years in Combined Military Hospital (CMH), Dhaka. Methods: It was a retrospective cross-sectional study. Children below 12 years of age with confirmed diagnosis of leukemia and received treatment from the paediatric oncology unit of department of paediatrics of CMH, Dhaka were taken for this study. Data has been collected from Hospital based cancer registry records from 2011 to 2021. There present status has been collected from regular OPD or by phone calls. Results: The commonest cancer was found Acute Leukemia (52%), among them Acute Lymphoblastic Leukemia (ALL) 83.15% and Acute Myeloid Leukemia (AML) 16.85%. Morphological (FAB classification) sub-divisions revealed ALL-L2 (31%) was the commonest group for ALL. In case of AML, AML-M3 (APML) was the commonest (27%). Immunophenotyping of cells revealed Pre-B ALL was the commonest. Cytogenetic analysis revealed ETV6-RUNX1 (21%), t(1;19) ((q23,p13) E2A/PBX1 (11%) were two most common genetic abnormalities found in ALL and t(15;17) (q22;q12) M3,M3v PML-RARA was the commonest cytogenetic abnormalities and (8;21) (q22;q22) RUNX1/RUNX1T1 for AML. In case of ALL overall survival was 54% and in case of AML 40%. About 10% of patients reported relapses. Conclusion: Incidence of acute leukemia was the highest among all childhood cancer. At the end of the study, overall survival was 52% of cases, and relapses were seen in 10% of cases. DS (Child) H J 2021; 38(1): 17-26

Background: Pediatric colonoscopy is a safe, sensitive and crucial tool for diagnosing as well as treating children with lower gastrointestinal diseases. In resource-limited countries like Bangladesh, the practice of pediatric colonoscopy remains rudimentary, lacking in trained professionals and appropriate instrumentation. Objectives: The aim of the study was to find out the indications, common colonoscopic findings along with histopathologic evaluation and immediate post procedure complications of colonoscopy in children. Methods: This was a retrospective study; the records of all the patients whose age was less than 18 years and who underwent colonoscopy from January 2017 to December 2021 were studied. Results: Among the total of 196 children (8.23±4.12), the most common indications were lower gastrointestinal bleeding (LGIB) in 107 (54.6%) patients followed by chronic diarrhea in 33 (16.8%), recurrent abdominal pain (RAP) in 16 (8.2%), follow up Inflammatory bowel diseases (IBD) in 14 (7.1%), chronic constipation, weight loss, recurrent oral ulcer, intestinal tuberculosis (TB) and melena. The most common pathologic findings were polyps in 81 (61.4%) children followed by non-specific colitis in 19 (14.4%), IBD in 17 (12.9%) and infectious colitis in 09 (6.8%) cases. Minor adverse events occurred in only 2.0% of children. Conclusion: The commonest indication for pediatric colonoscopy was LGIB and the most common findings were colonic polyps. Pediatric colonoscopy is safe and effective diagnostic as well as therapeutic option for lower GI diseases. DS (Child) H J 2021; 38(1): 8-16

Background: Nearly half of all deaths in children under-five are attributable to malnutrition, translating into the loss of about 3 million young lives a year. The interaction between malnutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. They have altered defense mechanisms during an early infections process, with an increased synthesis of some acute phase proteins including CRP. Objectives: Objective of the study was to identify whether CRP response is helpful in early detection of infection in severe SAM. It may also help to reduce childhood mortality associated with SAM. Methods: This cross-sectional study was conducted with total 50 SAM patients who were admitted in the Gastroenterology Hepatology and Nutrition unit of Dhaka Shishu (Children) Hospital from October 2010 to March 2011. Immediately after admission, clinical evaluation and management was started after sending several investigations along with serum CRP. Re-evaluation of serum CRP was done approximately after 7 days. Data were analyzed by using SPSS version 24. Results: Among the 50 SAM patients, 29 patients were presented with oedema(group-A) and 21 patients were without oedema (group-B). Majority (40) were below 2 years of age with male predominance. Thirty-five patients were partially immunized [69% in group-A and 71.4% in group-B]. During initial assessment, 46% children were hypothermic and76% were hypoglycemic. Nutritional status (z score) weight-for-age, height/length-for-age, weight for height/length in group-A were -4.56±1.00, -4.27±1.97, -2.71±0.97 and in group- B were -4.65±0.78, -5.06±2.34, -2.58±1.00 respectively. Pneumonia (42%) and diarrhoea (36%) were more common. Increased WBC count was found in 80% patients; and only 10% had low hemoglobin level (<5 gm/dl). Majority (44%) of them had pulmonary infection which was found in their chest X-rays. Immediately after admission serum CRP were high [mean CRP 39.44(±16.04)] in all most all patients, irrespective of their types of malnutrition. After 7 days of management, their CRP became normal [07.24 (± 2.75)], p=<0.001. Mean CRP was less [34.90 (±16.60)] in group-A than in group-B [45.72 (±13.16)] on admission and the finding was statistically significant, p=<0.001. Conclusion: Plasma level of CRP constitute a good screening test for the presence of infection in malnourished children and act as a sensitive indicator of recovery from infection and malnutrition. DS (Child) H J 2020; 36(2): 125-133