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Background: Clostridium difficile Associated Diarrhea (CDAD) is considered to be one of the commonest causes of nosocomial diarrhoea worldwide. Gastrointestinal infections in the form of diarrhoea are common in pediatric oncology patients in Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. The study was conducted to find out the frequency of Clostridium difficile infection (CDI) among diarrheal children with haematological malignancy. Materials and Methods:This prospective observational study was conducted from April 2012 to March 2013 at the Pediatric Hematology and Oncology Unit, BSMMU, Bangladesh. Total 58 diarrheal episodes occurred in 51 children with various types of haematological malignancies were included consecutively. Faecal samples of the children were sent to International Centre for Diarrheal Disease Research, Bangladesh (ICDDR, B) laboratory for detection of Clostridium difficile antigen (GDH) and toxins (A and/ or B) by Enzyme Immunoassay (EIA).Results: Among 58 diarrheal episodes 22.4% faecal samples were positive for GDH, but none of the faecal samples was positive for toxin A and or B. There were a significant association with leucopenia, severe neutropenia; usage of meropenem plus vancomycin, cefepime plus amikacin, imipenem, cytarabine and omeprazole with GDH positive diarrheal episodes. Conclusion:Positive GDH antigen with a negative result for toxin indicates C. difficile colonization. Among GDH positive episodes, a significantly higher proportion of children had leucopenia, severe neutropenia and usage of some drugs known as risk factors for C. difficile infection. To confirm the CDI advanced tests are needed.

Background : The study aimed to demonstrate the pattern of clinical presentations and outcome of Immune Thrombocytopenic Purpura (ITP) in Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka. Materials and methods: A retrospective study was conducted by record reviewing and analyzing the data of 103 patients of acute ITP, ageing between 1-16 years, at the Department of Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka from June 2017 to December 2019. We reviewed the data regarding age, sex, clinical presentations, history of preceding viral infections, vaccination history, laboratory values, different treatment options used and response to the treatment concerning complete response, partial response and poor responders. Statistical analysis performed by using IBM SPSS statistics version 20. Results: We retrospectively reviewed a total of 103 patients. The median age, at the time of presentation, was 5±3.4 years while the mean age was 4.5±2.9 years. The male to female ratio was  1.28:1. Mean platelet count on presentation was 7 x 109/L (Range: 0-24). Twenty three (22.3%) patients had the history of preceding febrile illness. Bruises, petechiae, epistaxis and hematemesis remained the common presentations. Six (5.8%) patients showed spontaneous recovery while 97 (94%) patients received treatment for ITP. Overall, 71 (68.9%) showed a response after treatment. Sixty-two patients (59.22%) showed loss of response and received treatment again. Among these patients, thirty-four patients (33%) developed chronic disease. Conclusion: Majority of patients presenting to our tertiary care centre had severe acute ITP on presentation.After management and follow-up, almost one third of the patients develop chronic disease hence the incidence of developing chronic disease remained high as compared to the other centers. JCMCTA 2019 ; 30 (2) : 81-85

Background: Fever in severe chemotherapy induced neutropenic patients is the most frequent manifestation of a potentially lethal complication of current intensive chemotherapy regimen. Objective: The aim of this study is identification of risk factors of fever in neutropenic children with acute lymphoblastic leukemia. Methodology: This observational study was carried out in the department of pediatric haematology and oncology department during the period of 1st February 2013 to 31st January 2014. Patients detailed history and behavioral pattern regarding the supportive management (neutropenic diet, use of acriflavine solution, nystatin oral solution, mouth wash with povidone iodine), total duration of hospital stay, duration of neutropenia, number of attendants during hospital stay were recorded. Blood, urine and wound swab culture was done. Result: Out of 40 patients most of the studied child were in induction phase of therapy. The mean hospital stay was 8.56±6.75 days and mean number of attendants with each patient was 2.02±0.65. Majority of the patient were on neutropenic diet and freshly cooked food (87.5%). This study shows a large portion (52.5%) of the studied population did not use acriflavine as per advice. It also revealed majority of the child did not use povidone iodine mouth wash (52.5%) and nystatin (47.5%). as per advice. A total of 10 patients (25%) revealed growth of pathogens. Among them blood culture was positive in 4 patients, urine culture was positive in 3 patients and wound swab culture was positive in 3 patients. This study showed that major portion (65%) of the febrile neutropenic child suffered from malnutrition. Conclusion: This study showed that majority of the patient did not properly follow the advice regarding behavioral and supportive management. Duration of hospital stay and number of attendants were also high. Malnutrition was present in a large portion of the child.

Objective: To investigate fertilization, blastocyst formation, and implantation rates in recurrent pregnancy loss patients when Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) enriched media is used for embryo culture and Frozen Embryo Transfer (FET). Methods: Embryos from 48 IVF cycles were cultured in either G-TL or Sage 1 Step GM-CSF with HSA prior to vitrification on day 5 or 6. On the day of FET, all embryos were thawed and placed in Sage 1 Step GM-CSF with HSA for 2 hours prior to transfer. Implantation was determined two weeks after each FET through serum hCG tests, with levels > 5mIU/mL considered successful implantation. Results: The implantation rate of embryos cultured in G-TL and transferred in GM-CSF enriched media was 51.85%. When embryos were placed in GM-CSF enriched media for embryo culture and transfer, fertilization rate, blastocyst formation, and implantation rates were 80.2%, 46.6%, and 71% respectively. Conclusion: The results of this study suggest that the use of GM-CSF media for embryo culture and transfer lead to promising implantation rates.

Introduction: Brucellosis is a recognized public health problem and one of the major causes of morbidity both in humans and animals. It causes abortion and infertility in women and livestock as well. Objective: The research was carried out to know the prevalence and to identify the risk factors of brucellosis in humans and cattle in study areas in Bangladesh. Materials and Methods: The study areas were all Upazilas of Mymensingh, Jamalpur, Rangpur, Kurigram, Bagerhat and Gaibandha district and the Government owned Central Cattle Breeding and Dairy Farm (CCBDF) in Savar, Dhaka for cattle and human samples were collected from Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total livestock samples collected were 1043 and human samples were 460. Besides doing all the tests in Bangladesh Agricultural University, Mymensingh Medical College and Hospital laboratory Bangladesh, it was done also in Office International des Epizooties (OIE) world reference Laboratory in Jena, Germany. Results: Out of 1043, 28 milk samples (2.68 %) and 23 serum samples (2.21 %) were positive by MRT and RBT respectively. The highest prevalence was 3.05% in the Holstein Friesian cross using MRT, while 2.49% in the Holstein Friesian cows using RBT. Age-wise prevalence of brucellosis by MRT and RBT were 2.06% and 1.23% respectively in 1-4 years age group. On the other hand prevalence of brucellosis based on MRT and RBT were significantly higher (2.88% and 2.50%) in > 5 years age group (p≤0.01) than those of other age groups. Based on parity, significantly higher prevalence 3.07% and 2.58% of MRT and RBT were obtained respectively in parity 3-5 in comparison to other parity group (p≤0.01).In case of human brucellosis 460 blood samples were tested with RBT, SAT, CFT, iELISA, conventional PCR and real time PCR but were negative in all tests. In case of livestock and human brucellosis bacteria were cultured in OIE Reference Laboratory, Federal Research Institute for Animal Health, but bacteria were not isolated. Conclusion: The prevalence of brucellosis is asserted in human and cattle in this study although MRT is 1st-line screening tests for brucellosis. Whereas no human samples were found positive for brucellosis in this study. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 33-36

Background: Rhabdomyosarcoma (RMS) is a malignant tumor of mesenchymal origin, is the most common form of paediatric soft tissue sarcoma. It is the third most common solid tumor comprising 4.5% of all childhood cancer with an annual incidence of 4.5 cases per million children. There is so no statistical data on RMS in Bangladesh because no study has done in Bangladesh. Objective: To evaluate the clinical characteristics and treatment outcome of children with rhabdomyosarcoma among tertiary care. Methods: A retrospective study carried out analysing the medical records of 39 patients with rhabdomyosarcoma from the BSMMU tumor registry. Medical records of children with rhabdomyosarcoma were reviewed over a period of 6 years from June 2011 to May 2017.  Most patients received multimodality therapy (chemotherapy, surgery, radiotherapy). Results: The male female was ratio 1.2:1. More than half of cases presented with a mass at varying sites The predominant complaint 12.0% was pain. The primary site of disease was the head and neck in 46.0% followed by pelvis 40.0%. Pathologically most frequent histological subtype was in 46.0% embryonal rhabdomyosarcoma followed by alveolar rhabdomyosarcoma 23.0%, botryoid type 5.0%, spindle cell type 5.0% and unspecified 21.0%.  At the time of diagnosis 64.0% of patients were TNM stage 3 next frequency is stage IV 23.0%. The survival rate from diagnosis to subsequent demise was poor – between 13 days and 3.5 years. The overall 5-year survival rate was 41.0% which is may be due to advanced stage of disease. Conclusion: The majority of presentations were in the advanced stages of disease but sensitive to multimodality therapy. Poor survival rate is correlated with the advanced stage of the disease. The clinical characteristics of rhabdomyosarcoma at BSMMU Hospital are similar to worldwide countries, but not like developed countries. Further multicentre studies are needed to report our experiences with rhabdomyosarcoma. Bangladesh Med Res Counc Bull 2020; 46(1): 17-21

In children, primary malignant tumors of the gastrointestinal (GI) tract are rare and accounts less than 5% of all pediatric neoplasms.1 Non-Hodgkin’s lymphoma (NHL) remains the most common malignancy of the GI tract in children.2 Moreover small intestine (PLI) is very uncommon. They are different in anatomic distribution and histologic appearance compared to common patterns in adult cases. The disease is rare and having variable clinical presentation that delayed early detection when the possibility of cure exists. The common presentations of PLI are bowel obstruction and intussusception.3,4 NHL of the gastrointestinal tract usually arises in the submucosal lymphoid tissue of the ileocecal region, extendtransmuraly, and involve local mesenteric lymph nodes extensively, forming a bulky abdominal mass. NHL most frequently involved the ileocecal valve (35.8%), followed by the small bowel (31.3%), large bowel (19.4%) and multiple gastrointestinal involvements (13.4%).5 Here we present a case report to show the scenario of a patient suffering from NHL where diagnosis was delayed. The child was suffering from recurrent abdominal pain (RAP) and various treatment was offered but he could not improve. Finally, he was diagnosed as a case of primary non-Hodgkin's lymphoma of the small intestine (PLI). Though PLI is a very uncommon malignancy in childhood. Northern International Medical College Journal Vol. 11 No. 1 July 2019, Page 438-439