Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)

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.

The objectives of this study were to determine and compare the correlation of intravesical prostatic protrusion (IPP) and prostate volume (PV) with bladder outlet obstruction (BOO). This study was conducted in the department of urology, Bangabandhu Sheikh Mujib

Background: A large number of children with Urinary Tract Infection (UTI) are seen in the community by general practitioners , but there is frequently delay in treatment and not all are referred for further investigations. There is evidence that many cases are misdiagnosed. It is important to optimize diagnostic and management strategies. Result: UTI is an important cause of acute illness, it may be a marker of underlying urinary tract abnormality. Bacteria causes the large majority of UTI in children- Escherichia coli is the most common (90%) bacterial cause. Urine culture & sensitivity is the gold standard for the diagnosis and mandatory for confirmation of UTI. On culture, a colony count of more than 105/ml organisms of a single species is considered confirmatory of UTI. But there is a strong recommendation that , presence of both pyuria and at least 50,000 Colony Forming Unit (CFU) / ml of a single uropathogen in an appropriately collected specimen makes the diagnosis . There is a recommended imaging schedule in childhood UTI to detect anatomical abnormality. Management depends on type of infection. There is no role of prophylactic antibiotics to prevent febrile recurrent UTI without VUR. Conclusion: UTI is a very common disease and may be associated with renal abnormalities and long term squeale. There is debate about best investigation and management strategies. The greatest potential for prevention of renal damage lies in increased awareness, better diagnosis and management of young children with UTI in primary healthcare. DOI: http://dx.doi.org/10.3329/bjch.v36i2.13085 Bangladesh J Child Health 2012; Vol 36 (2): 90-97

Six infants, three of them neonates, were diagnosed as having acute lead poisoning; four of them had acute encephalopathy. All had been given an indigenous preparation, 'Bint Al Zahab' (Daughter of Gold), for abdominal colic and early passage of meconium after birth. Chemical analysis of this powder revealed a lead content of 82.5%. The index case had anaemia with punctate basophilia, dense metaphysial lines on X-ray and markedly raised blood lead levels, arousing a strong index of suspicion for the early diagnosis of subsequent cases. Computerized axial tomography (CAT) scan in three cases showed signs of early cerebral cortical atrophy. The picture of cerebral oedema was absent in the four cases of acute lead encephalopathy. The importance of prevention and the ideal management is discussed.

Indications of prostate biopsy are high serum prostate specific antigen (PSA) value and or abnormal digital rectal examination (DRE) findings. Although serum PSA value of 4 ng/ml is the most commonly used threshold for recommending prostate biopsy, significant proportion of men harbor prostate cancer even when their serum PSA values are less than 4.0 ng/ml. Therefore present study was designed to determine the performance status of serum PSA in lower cut-off values. This hospital based prospective study was conducted in the Department of Urology of Bangabandhu Sheikh Mujib Medical University (BSMMU) and Comfort Nursing Home Pvt. Ltd, Dhaka from July 2009 to October 2010. Two hundred six male patients aged over 50 years having lower urinary tract symptoms (LUTS) and serum PSA more than 2.5 ng/ml were prepared for prostate biopsy. Trans rectal ultrasound (TRUS) guided biopsy was done. The test statistics used to analyze the data were descriptive statistics, sensitivity, specificity, positive and negative predictive value, ROC curve. For all analytical tests, the level of significance was set at 0.05 and p<0.05 was considered significant. In 2.5-4 serum PSA range, 28.26% (13 out of 46) of all malignancy were found, which would be missed if we take cut off value 4. At 2.5 PSA cut-off, Sensitivity 91.3%, Specificity 14.37%, PPV 23.46%, NPV 85.18%, Efficacy 31.55%. At 4 PSA cut-off value, Sensitivity 71.73%, Specificity 46.25%, PPV 27.73%, NPV 85.05%, Efficacy 51.94%. So it can be concluded that, for early diagnosis of prostate cancer cut-off value of serum PSA of 2.5 ng/ml can be recommended as an indication for prostate biopsy. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14333 Bangladesh Med Res Counc Bull 2012; 38(3): 90-93 (December)

The aim of this study was to evaluate the safety and efficacy of the supracostal access for percutaneous nephrolithotomy (PCNL). Between

A prospective observational study of 43 children with idiopathic nephrotic syndrome (INS) were selected randomly out of 480 children admitted with the disease at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2003 to January 2005. Aim of this study was to correlate the difference in frequency of atopic attack, hypertension, complement c3 level and urinalysis in different types of Idiopathic nephrotic syndrome. Result: Among 43 children with idiopathic nephrotic syndrome (INS), 24 children were steroid sensitive nephrotic syndrome (SSNS) and 19 children having steroid resistant nephrotic syndrome (SRNS) cases, of SSNS group 13 were infrequent relapse nephrotic syndrome (IFRNS) and 11 were frequent relapse steroid dependant nephrotic syndrome (FRNS + SDNS). Bronchial asthma and allergic dermatitis were found in about 63% cases of both steroid resistant nephrotic syndrome (SRNS) and frequent relapse steroid dependant (FRNS+SDNS) group. Hypertension was found in higher number of patient in SRNS compared to SSNS (P> 0.05) It was absent in IFRNS. Steroid contributed more than the disease process in producing hypertension (P< 0.01). Complement C3 comparison among the group could not reach statistically significant level. Similarly, comparison of hematuria showed no difference among the groups but pyuria was higher in SRNS compared to IFRNS (P >0.05). UTI were found equally in all the groups. Conclusion: Higher incidence of asthma, atopic dermatitis were noted in all the groups of idiopathic nephrotic syndrome (INS). C3 was not found significantly low in INS. Persistent elevation of blood pressure is found in higher number of SRNS compared to SSNS and steroid contributed more than the disease process. DOI: http://dx.doi.org/10.3329/bjch.v35i1.10367 BJCH 2011; 35(1): 11-15