Autism spectrum disorder is a developmental disorder that includes deficits in social communication and interaction, and restricted and repetitive behaviours, interests, or activities. This survey was done to assess autism spectrum disorder prevalence in 16- to 30-month-old children at an urban–rural distribution and determine the association of socioeconomic and demographic conditions. An observational cross-sectional study was conducted in 30 districts of Bangladesh. Three-stage cluster sampling was used with ‘Red Flag’, Modified Checklist for Toddlers and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, respectively. Data editing and analysis were done using CSPro 6 and SPSS 23. The survey included 37,982 households (71% rural, 29% urban) with 38,440 children. ‘Red Flag’ was positive in 209/10,000 children. Modified Checklist for Toddlers was positive in 149/10,000 children. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition–positive autism spectrum disorder prevalence was 17/10,000 young children (boys 24/10,000, girls 9.8/10,000). Prevalence was higher in urban than rural (25/10,000 and 14/10,000 respectively). It was 77/10,000 in mothers aged 35–39 years and 23/10,000 in children of fathers aged 40 years. For families within the lowest wealth quintile, the autism spectrum disorder prevalence was 15/10,000. Autism spectrum disorder at very young ages in Bangladesh is still low. It was higher in urban areas, with the advanced age of parents, especially mothers, and in families with higher wealth quintiles. Lay abstract A nationwide survey was done in Bangladesh to assess autism spectrum disorder prevalence in 16- to 30-month-old children at urban–rural distribution and to determine the association with socioeconomic and demographic conditions. A three-stage cluster sampling method was used where districts from all divisions were selected in the first stage, census enumeration areas as blocks of households were selected in the second stage and households (within the blocks) were selected in the third stage. Thereby, it included 38,440 children from 37,982 households (71% rural, 29% urban) aged 16–30 months from 30 districts of eight divisions of Bangladesh. Screening was done with a ‘Red Flag’ tool and Modified Checklist for Toddlers and a final diagnosis using Diagnostic and Statistical Manual of Mental Disorders, 5th Edition for autism spectrum disorder. Autism spectrum disorder prevalence was 17 per 10,000 young children – in other words, one in 589 young children. Boys were found at higher risk of autism (one in 423 boys; one in 1026 girls). Prevalence of autism spectrum disorder was higher in urban environments than in rural ones – 25/10,000 and 14/10,000, respectively. More autism spectrum disorder children were found in advanced age groups of parents, especially mothers, and in households with a higher wealth quintile. This survey is significant as it covers both urban and rural areas and specifically targets very young children. The involvement of the Bangladesh Bureau of Statistics, as well as support from the entire healthcare system infrastructure, makes this survey more representative on a national level. Its results will form a database to support the development of an effective early intervention programme in Bangladesh. We hope it will prove useful for researchers, clinicians and frontline healthcare workers, and inform the decisions of policymakers and funders in Bangladesh.

DOI: 10.3329/bjch.v33i3.5692Bangladesh Journal of Child Health 2009; Vol.33(3): 111-113

Key words: Tuberculoma; children; case reportDOI: 10.3329/jcmcta.v21i2.7737 Journal of Chittagong Medical College Teachers' Association 2010: 21(2):41-43

Wilson disease (WD) is a multisystem disease of defective copper metabolism. Excess copper is accumulated in different organ of body including liver, brain, kidney, eyes etc. Accumulated copper causes dysfunction of different parts of brain and produce signs and symptoms of neurological disease. Epidemiological data suggested psychiatric symptoms may be the presenting problem in 30% of WD patients. Psychiatric symptoms developed almost 100% cases of WD patients at any time of the disease course. Psychiatrc symptoms are affective mood disorder, psychotic behavioral, personality changes, anxiety & depression as well cognitive deterioration. Common neurologic symptoms are dystonia, hypertonia & rigidity, tremors and dysarthria. Rarely patients may present with polyneuropathy or dysautonomia. So both neurologic and psychiatric evaluation and specific treatment is essential for both the conditions. Diagnostic evaluations of Wilson disease include estimation of serum ceruloplasmin, 24 hours urinary copper, MRI of brain. Magnetic resonance (MR) imaging of the brain or computed tomography (CT) may detect structures involved like basal ganglia. Knowledge of behavioral problem of WD is helpful for early diagnosis of many cases and overall management. Mainstay of treatment of Wilson disease is dietary restriction of copper-rich diet, copper-chelating agents, symptomatic treatment for dystonia & rigidity as well as behavioral psychiatric therapy. For dystonia trihexy phenidyl, tetrabenazine, codopa & clonidine can be used. Neurologic as well as psychiatric symptoms would be reduced where chelation therapy is effective. More over sometimes pharmacologic treatment for psychiatric symptoms is required. J Bangladesh Coll Phys Surg 2022; 40: 121-127

Here we describe a case of 55-year-old lady who was admitted in hospital for evaluation of recurrent anaemia, polyuria and polydipsia with history of splenectomy 9 months back. Physical examination revealed anaemia, dehydration and scar mark of splenectomy. Initial laboratory tests were suggestive of chronic lymphocytic leukaemia (CLL) and further bone marrow examination & immunophenotyping confirmed the diagnosis. At the same time Polyuria & polydipsia was evaluated by water deprivation test and diabetes insipidus was diagnosed.