BackgroundThe global burden from cancer is rising, especially as low-income countries like Bangladesh observe rapid aging. So far, there are no comprehensive descriptions reporting diagnosed cancer group that include hematological malignancies in Bangladesh.MethodsThis was a multi-center hospital-based retrospective descriptive study of over 5000 confirmed hematological cancer cases in between January 2008 to December 2012. Morphological typing was carried out using the “French American British” classification system.ResultsA total of 5013 patients aged between 2 to 90 years had been diagnosed with malignant hematological disorders. A 69.2% were males (n = 3468) and 30.8% females (n = 1545), with a male to female ratio of 2.2:1. The overall median age at diagnosis was 42 years. Acute myeloid leukemia was most frequent (28.3%) with a median age of 35 years, followed by chronic myeloid leukemia with 18.2% (median age 40 years), non-Hodgkin lymphoma (16.9%; median age 48 years), acute lymphoblastic leukemia (14.1%; median age 27 years), multiple myeloma (10.5%; median age 55 years), myelodysplastic syndromes (4.5%; median age 57 years) and Hodgkin’s lymphoma (3.9%; median age 36 years). The least common was chronic lymphocytic leukemia (3.7%; median age 60 years). Below the age of 20 years, acute lymphoblastic leukemia was predominant (37.3%), followed by acute myeloid leukemia (34%). Chronic lymphocytic leukemia and multiple myeloma had mostly occurred among older patients, aged 50-over.ConclusionsFor the first time, our study presents the pattern and distribution of diagnosed hematological cancers in Bangladesh. It shows differences in population distributions as compared to other settings with possibly a lower presence of non-Hodgkin lymphoma. There might be under-reporting of affected women. Further studies are necessary on the epidemiology, genetics and potential environmental risk factors within this rapidly aging country.

Background : Kawasaki disease (KD) is an acute, febrile, self-limiting vasculitis of the medium-and small-sized arteries of unknown etiology. Recently its incidence is increasing worldwide.

Background: Community-acquired pneumonia (CAP) is an infectious disease and common reason for hospitalization of children throughout the world. There are few published data about radiological findings and their relationship with community-acquired pneumonia (CAP) severity. Objective: This study was conducted to evaluate radiological findings in children with community acquired pneumonia (CAP) of different severity. Materials and method: A prospective study was conducted in the department of Paediatric Respiratory Medicine (Pulmonology) in Dhaka Shishu Hospital from November 2016 and April 2017. A total number of 35 children of 1 month to 10 years, who were admitted with cough or respiratory difficulty and radiological pneumonia were included in this study. Results: Majority of the study participants 18 (51.43%) were infants with a male preponderance. The most common symptom was cough (94.29%) followed by fever (82.86%) and respiratory distress (42.86%). Crepitation (54.29%), tachypnoea (42.86%) and chest indrawing (28.57%) were the most common signs. Out of total 35 children 17 (48.57%) cases had pneumonia and 18 (51.43%) cases had severe pneumonia. Among chest X-rays, severe pneumonia had greatest frequency of primary end point consolidation (PEP) on right side (n=10, 55.55%), right infiltrates (n=5, 27.78%), bilateral infiltrates (n=2, 11.11%) followed by right sided pleural effusion (n=3, 16.67%) and pneumothorax (n=2, 11.11%). There was no association found between CAP severity and presence of radiological findings of pneumonia. Conclusion: This study shows that severe CAP may not always be associated with positive radiological findings. This finding may be taken into consideration during the diagnosis and management of CAP. Delta Med Col J. Jan 2019 7(1): 21-25

Background & Objective: Patent ductus arteriosus (PDA) is a common condition in preterm infants and is associated with profound morbidity and mortality. Pharmacotherapy (indomethacin or ibuprofen) is the first choice to close the PDA, but if pharmacological closure is contraindicated or failed, surgical ligation is usually performed. But following surgical ligation of PDA, preterm infants may develop severe hypotension and respiratory failure. Prophylactic stress hydrocortisone (HC) has emerged as a therapy to prevent complications, although its efficacy in reducing postoperative hypotension and oxygenation difficulties has not been rigorously tested. The purpose of this study was to compare the outcomes in preterm infants who received stress HC before their PDA ligation to those who did not (standard treatment group or control). Materials & Methods: This comparative clinical trial was conducted in Dhaka Shishu Hospital (DSH), Dhaka over a period of 15 months between April 2014 to June 2015. A total of 40 infants with a significant PDA and a history of failed medical treatment were included in the study and were divided into two groups (each group having 20 infants) – one receiving stress HC before PDA ligation (Case) and the other did not (Control). Respiratory support, expressed as highest FiO2, highest mean airway pressure and mode of ventilation, was noted as was cardiovascular support including inotropic medication, its dose throughout the preoperative and the postoperative periods. Post-operative cardiovascular and respiratory supports were the main outcome measures which were measured within 72 hours following PDA ligation. Result: At baseline both the study groups were almost similar with respect to their sex, gestational age, birth weight, and age at surgery and prenatal steroid exposure. However, there was more incidence of preoperative steroid exposure in standard treatment group. Urine output was somewhat higher in the standard treatment group compared to the HC group but it was not statistically significant (1.33 vs. 1.21 ml/kg/min, p = 0.205). The mean arterial pressure was higher in the HC group than that in the standard treatment group (92.5 vs. 86.7 mmHg, p = 0.018), but it was clinically insignificant. The study observed that infants who received stress dose HC rarely needed vasopressor support post ligation and their average and highest doses of dopamine were also significantly lower compared to their standard treatment group. The postoperative high-frequency ventilation was more often needed in the standard treatment group, although none in either group needed this support preoperatively. The mean airway pressure was although similar in both groups the highest FiO2 was much less in the HC group. Conclusion: The study concluded that stress dose HC given to preterm infants before surgical ligation of PDA may improve the postoperative cardiorespiratory outcomes. But as the sample size was too small, this finding requires validation by large-scale study. Ibrahim Card Med J 2015; 5 (1&2): 9-14

Background & objective: Juvenile idiopathic arthritis (JIA) is the most disabling illness in children. There are number of disease modifying antirheumatic drugs (DMRDS). Methotrexate (MTX) is one of them and for the last two decades has become the cornerstone for the treatment of JIA, because of its efficacy and safety profile. However, debate is still continuing regarding its route of administration (orally or parenteraly) to have wider efficacy and safety. The present study was conducted to compare the outcome of oral and subcutaneous MTX in the treatment of JIA. Materials & Methods: This comparative clinical trial was conducted in Dhaka Shishu Hospital & Bangladesh Institute of Child Health, over a period of 3 years between January 2013 to December 2015. The study initially included 72 children; of them 22 dropped out or did not comply with treatment protocol and hence were excluded from final analysis. Of the remaining children 25 were in Oral and 25 in subcutaneous group. Primary outcome was defined as the percentage of patients reaching ACR Pedi 30 improvement criteria after 6 months of treatment. The ACR Pedi 30 was reached if there was an improvement of ≥30% in at least 3 of 6 core variables, with no worsening of >1 of the remaining variables by ≥30%. Results: The study demonstrated that children with JIA responded well to MTX treatment irrespective of their route of administration, as was evidenced by the achievement of ACR Pedi 30 criteria by majority of the children after 6 months of treatment. However, in terms of core set of variables, subcutaneous route worked better and faster than the oral route. The mean numbers of active joints in the Oral group dropped from 5 at baseline to nearly 2 and < 2 at 3 and 6 months respectively, which in the Subcutaneous groups dropped from 6 at baseline to 2 and < 1 at 3 and 6 months respectively. The average numbers of joints with limited range of motion at baseline in the Oral and Subcutaneous groups were 3 and > 3 which decreased to 1 and < 1 respectively at month 6. Likewise patient/parents’ global assessment of overall wellbeing improved earlier in Subcutaneous group than that in the Oral group (p < 0.001). Physician’s global assessment of disease activity also responded better in the subcutaneous group compared to that in the Oral group (p < 0.001). The C-HAQ disability index in the Oral group reduced insidiously from 1.3 at baseline to 0.4 at 6 months; in contrast the same parameter steeply decreased from 1.5 at baseline to 0.0 at 6 months indicating that Children Health Assessment Questionnaire responded rapidly to Subcutaneous MTX. The ESR in Oral group decreased from 79 at baseline to < 40 at month 3 and to close to 30 mm at month 6, which in the Subcutaneous group decreased from over 70 at baseline to < 30 and < 20 at month 3 and 6 respectively indicating that the decrease being much faster in the latter group. Conclusion: The study concluded that children with JIA responded well to MTX treatment irrespective of their route of administration, as was evidenced by the achievement of ACR Pedi 30 criteria by majority of the children after 6 months of treatment. However, considering the response in terms of core set of variables, it appears that subcutaneous route worked better and faster than the oral route did. Ibrahim Card Med J 2015; 5 (1&2): 27-34