Background: The majority of children with Cerebral Palsy have feeding difficulties. It has a great impact on growth and development in children with cerebral palsy. Feeding difficulties may leads to chronic respiratory disease, malnutrition and reduce quality of life of both children and caregiver. Feeding difficulties cause stressful meal time for caregivers and fear of food for children. In well resource country many hi-tech equipments for the management of feeding difficulties are available but which is not available in low resource country like Bangladesh. Though some of low tech approaches have started a little but the effectiveness or outcomes of these technologies are not evaluated. This study is aimed to evaluate the effect of feeding training on feeding difficulties in children with cerebral palsy. Methods: This is a quasi experimental study. Twenty children with cerebral palsy aged 2 -9 years having feeding difficulties enrolled as study subjects. Initially degree of feeding difficulties were assessed by evaluating body posture and frequency of aspiration during feeding which is scored according to the response of the child. After giving feeding training to the mother feeding difficulties were reevaluated. Mean score of feeding difficulties before and after intervention were compared by paired 't' test. Results were analyzed by SPSS. Results: Among the study subject 14(70%) were male and 6(30%) were female. Most of them were found to have hemiplegic CP 7(35%). The mean score in terms of positioning and frequency of aspiration were significantly changed after intervention (14.15 vs. 15.85 p = <0.0005), (11.6 vs 15.5 p = < 0.0005). Conclusion: Low-tech strategies and therapies are helpful for the management of feeding difficulties in children with cerebral palsy. Foods and drinks modifications should need to get extra attention for the nutritional improvements of those children. Government and international and national health NGOs should studied more about these low tech strategies to improve the condition of the children with cerebral palsy and to reduce the stress and sufferings of the parents.

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Background: Thalassemia is the most common hemoglobin disorder in the worldincluding Bangladesh. Population migration and intermarriage between differentethnic groups have had a major impact on disease epidemiology. To observe theprevalence and specturm of thalassemia as well as demographic and social factorsof thalassemia patients. Materials and methods: This descriptive cross-sectional study was conducted in theThalassemia Care Center of Chattogram Maa Shishu-O-General Hospital,Chattogram from July, 2013 to June, 2014. Parents of 70 thalassemia patients aged2-18 years interviewed with a formulated questionnaire based on social anddemographic characteristics. Data were analyzed by both manually and by SPSS-18. Results: Mean age of patients was 6 years (± 3.66). Near about half of patients(40%) were diagnosed at the age less than 5 years. Mean age of diagnosis was 1.6years (± 1.53 SD). Majority of patients belonged to lower middle class (42.9%) withmale predominance (62.9%). A good number of patients (22.8%) were not engagedin any educational activity. Mean annual income of family was 262000 taka/year ±245477.35 (USD 3324.87 ± 3115.19). Mother contributed to annual income in only4.7% families. The percentage of Hb E/b thalassemia was the highest (54.4%)followed by b thalassemia major (37.1%) and Hb E disease (4.3%). Malepredominance was found in every type of thalassemia. Half of the thalassemiamajor patients were diagnosed during infancy and majority (60.53%) of Hb E/bthalassemia patients were diagnosed at the age less than 5 year. Conclusion: A nation-wide screening program should be carried out to address thecarrier status of population at risk. There may be further analysis regarding clinicaldiversity of thalassemia. Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 33-37

Background: Cerebral Palsy (CP) is a diagnostic term used to describe a group of permanent disorders of movement & posture causing activity limitation that are attributed to non progressive disturbances in the developing fetal or infant brain. The motor disorders are often accompanied by disturbances of sensation, perception, cognition, communication and behavior as well as by epilepsy, secondary musculoskeletal problem and feeding difficulties. Aims: To see the development of a child with cerebral palsy after comprehensive feeding & seating intervention. To recommend measure for reducing neurodevelopmental problems. To improve mother-child interaction. Methods: This hospital based prospective cross sectional observational study was done in Child Development Center (CDC) of the Department of Pediatrics, Chattagram Maa Shishu-O-Genaeral Hospital (CMSOGH), Chittagong from July 2013 to December 2013. Children with Cerebral palsy aged 1-15 years included in this study. Results: Most of the patients (60%) before intervention were having only liquid food. After intervention most of the patients were having either a combination of semi-solid and solid food (48%) or only semi-solid food (42%). After intervention 80% of patients were sitting during feeds which was only 12% before intervention. After intervention feeding time is reduced to 15 to 30 minutes which was 30 min to one hour. Most of the patients (90%) never ate by themselves before intervention, only 4% were selffed. After intervention 56% were self feeding for some part of the meal & 24% were self feeding at every meal. Conclusion: Feeding problems in children with cerebral palsy are common. Simple home based measure, like feeding and seating intervention, should be carried out under the guidance of Child Development Center run by developmental therapist with assistance from pediatricians & child psychologists in order to improve the development of the child with cerebral palsy as well as the quality of life.

Background: Autism Spectrum Disorders (ASD) is becoming global problem as it is being diagnosed very frequently amongst the non communicable diseases. Lack of socialization, communication skill and behavioural abnormality are the main problem belongs to the disease. Cornerstone of the management is based on early intervention program directed to improve the communication and socialization skill. In Bangladesh different early intervention strategies are implicated adopting from evidence based practices in the developed countries. To determine the effect of early intervention program on the improvement of socialization and communication skills of children with ASD who attended an early intervention programme at the

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Background: Thalassemias are the most common heritable blood disorders that represents a major public concern. Poor awareness and lack of knowledge lead to increase number of carrier that is a silent reservoir of the disease. To observe the knowledge and awareness level of parents of thalassemic children about the disease. Materials and methods: This descriptive cross-sectional study was conducted in the Thalassemia ward of Chattogram Maa Shishu-O-General Hospital, Chattogram from July 2013 to June, 2014. Parents of 70 thalassemia patients aged 2-18 years interviewed with a formulated questionnaire based on knowledge status and awareness level of parents towards thalassemia. Data were analyzed by both manually and by SPSS-18. Results: Majority of patients were from rural background (54.3%). Only 8.6% parents were consanguineous parents and majority of them completed only secondary education. 44.3% resolved it as inherited disorder. 52.9% resolved thalassemia cannot be cured. Only 24.3% regarded bone marrow transplantation as a measure of cure. More than half (55.7%) did not know how to prevent thalassemia. Only 37.1% knew about prenatal diagnosis. Carrier status of both father and mother were unknown in majority of patients (80%) and screening of sibs was not done at all in a significant number of patients (51.5%). Only 34.3% wanted to do prenatal diagnosis after conception and 65.7% parents were ready to accept therapeutic abortion if fetus would be diagnosed as thalassemia by prenatal diagnosis. Conclusion: Knowledge level and awareness of parents of thalassemic child regarding the disease is unsatisfactory. To reduce disease burden an awareness program regarding the disease and its prevention covering premarital screening, acceptance of prenatal diagnosis and therapeutic abortion is essential. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 12-15

Background : Valproic Acid (VPA) is an effective anticonvulsant widely used for the treatment of epilepsy in children, but there are pitfalls in VPA therapy, especially in case of various endocrine organs like thyroid. So the aim of this study was to evaluate the thyroid dysfunction in terms of subclinical hypothyroidism during Valproic Acid (VPA) therapy in children with epilepsy. Methods: The study was conducted in the Department of Paediatrics, and Shishu Bikas Kendra, Chittagong Medical College Hospital (CMCH) over one year duration on 50 newly diagnosed idiopathic epileptic children who were decided to start Valproate at the dose of 20mg/kg/day. At the same time similar number (n=50) of age and sex matched children visited the paediatric OPD for other health events(e.g. acute upper respiratory infection, Influenza like illness and Acute watery diarrhoea) other than epilepsy were included in the study as control group. Thyroid function status like serum levels of Thyroid-Stimulating Hormone (TSH) Free Triiodothyronine (FT3) and Free Thyroxin (FT4) were evaluated at baseline and after six months. Moreover, serum VPA level was also measured in children receiving valproate at follow up visit. Anti thyroid peroxidise antibody (Anti TPO ab) was checked at follow up visit in those having TSH level beyond normal reference range. After collecting all data it was analyzed by SPSS-19. Results: In the current study, cases consisted of 30(60%) male and 20(40%) female children. Male to female ratio was 1.5:1. Gender and age were matched in cases and control group (p>0.05). Most of the population in the cases were from rural areas 29(58%) and most of them 40(80%) belonged to middle class family. The mean±SD of TSH level significantly increased after six months in comparison with base line values (1.76±0.57μIU/ml vs. 2.70±1.50μIU/ml, p<0.05) and with control group at follow up visit (1.74±0.73μIU/ml vs 2.70±1.50μIU, p<0.05). On the other hand, in the control group there were no significant changes of TSH level in comparison with base line (1.82±0.55μIU vs 1.74±0.73μIU/ml, p=0.16). The mean±SD of FT4 value decreased significantly in the cases after six months though remained within normal reference range (1.24±0.27ng/dl vs1.11±0.13ng/dl, p<0.05) FT3 level remained unchanged. Five (10%) epileptic children in the cases were found to have subclinical hypothyroidism at follow up who had TSH level beyond the normal reference range. Anti thyroid peroxidase antibody was negative among them. In contrast, no one in control group was found to have TSH level beyond the normal limit. All cases were clinically euthyroid. No significant correlations were found between TSH level and serum VPA level (r2 = 0.035 p= 0.193). Conclusion: Subclinical hypothyroidism develops in children with epilepsy during VPA therapy. Proper attention should be given so that development of overt hypothyroidism can be avoided. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 14-20