Background: Neonates with Perinatal Asphyxia (PNA) are at higher risk for developing Acute Kidney Injury (AKI). Conventionally, Serum Creatinine (SCr) is used to diagnose AKI but lacks specificity during the first few days of life. Neutrophil Gelatinase-Associated Lipocalin (NGAL) has emerged as a novel biomarker of AKI in such situations, while its value in our setting is yet to be validated. The study aimed to evaluate the role of urinary NGAL (uNGAL) level as a predictive biomarker of AKI in term newborn infants with PNA. Materials and methods: This prospective observational study included 55 full-term neonates with PNA from the Special Care Neonatal Unit of Chittagong Medical College Hospital.The uNGAL was measured by an enzyme-linked immunosorbent assay. Urinary samples were obtained for uNGAL on postnatal day 1(after 6 hours), and on day 3, blood samples for sCr were obtained on postnatal day1, 3 and 6. Results: Among 55 neonates with PNA, 20 (36.4%) had AKI. The mean ±SD uNGAL level was 97.77±17.13 ng/ml in neonates with AKI compared to 25.76±2.19 ng/ml in those without AKI in the first postnatal day. An uNGAL cutoff value of 28.86 ng/ml had 90.0% sensitivity and 82.9% specificity in predicting AKI the same day. The mean value of uNGAL was observed at a lower level, 54.53±14.72 ng/ml vs 15.17±2.18 ng/ml in AKI and no AKI neonates on third postnatal days. The cutoff value for detecting AKI was seen to be 26.43 ng/ml with high validity on this day. Significant differences in sCr were observed between AKI and no AKI measuring on days one and three, whereas the difference was not significant on day six. Conclusion: The study showed that uNGAL might be a valuable biomarker for predicting AKI among neonates with PNA. JCMCTA 2022 ; 33 (1) : 173-177
Background: Measures of peripheral perfusion can be used to assess the hemodynamic status of critically ill patients. The peripheral Perfusion Index (PI) based on analysis of the pulse oximetry signal has been implemented in monitoring systems as an index of peripheral perfusion. The aim of this study was to evaluate clinical state of shock by PI in a Pediatric Intensive Care Unit (PICU) of a tertiary care hospital of Bangladesh. Materials and methods: This prospective observational study was carried out in the PICU of Chittagong Medical College Hospital. Children aged 1 month to 12 years who needed hemodynamic monitoring were included and categorized into five age groups. Demographic data, vital parameters and PI were recorded. Hemodynamic monitoring was started as early as possible within 24 hours of arrival in PICU, then 30 minutes after, then 8 hourly for a total 4 observations. Results: In total, 199 children were included with or without features of shock and 796 hemodynamic measurements were taken and analyzed. Mean/median PIs were significantly higher in patients without shock compared to patients with shock in all age groups except age group 10-12 years of age. Clinical shock can be reasonably detected when PI value was < 1.25 in children <1 year of age, < 2.05 in 1 to 3 years of age, <2.55 in 3 to 5 years, and <1.95 in 5-10 years of age. These values had low sensitivity but high specificity in detecting clinically assessed shock in that particular age group. Overall, PI had good correlation with systolic, diastolic, mean arterial blood pressure and pulse pressure. Children with different features of shock had significantly lower mean PI compared to children without features of shock. Conclusion: PI can be used as a non-invasive, continuous parameter to monitor peripheral perfusion in critically ill children managed in PICU. IAHS Medical Journal Vol 4(2), December 2021; 46-50
Aims: To compare safety and efficacy of diazepam and clobazam. Objectives: This study was undertaken to compare the effectiveness of intermittent clobazam versus diazepam therapy in preventing the recurrence of febrile convulsion and assess adverse effects of each drug. Methods: This is a hospital based randomized controlled trial was performed on neurologically normal children with the history of simple febrile convulsion and normal electroencephalogram without any evidence of acute central nervous system infection, done in Chattagram Maa Shishu-O-General Hospital/CMSOGH between November'12 to April'13. A total of 37 patients were randomly prescribed with oral clobazam and diazepam was given in 35 patients when they developed a febrile disease. All the patients were monitored regarding developing seizure and adverse effects of the drugs. All patients were followed for 12 months. Results: It was observed that 243 attacks of fever occurred during the period, including 116 attacks in the clobazam group and 127 episodes in the diazepam group. Recurrence of convulsion occurred in 2 (1.7%) subjects in the clobazam group, and in 4(3.1%) cases in the diazepam group. Twenty cases (54%) in the diazepam group and 5 (14.2% ) cases in the clobazam group developed drowsiness and sedation during the follow-up period. Conclusion: Intermittent clobazam therapy has better advantage over diazepam with similar efficacy but significantly lower adverse effects such as drowsiness and sedation.
Background : Apert syndrome is a rare autosomal dominant disorder characterized by craniosynostosis, facial dysmorphism and syndactyly of hands and feet. Eugene Apert in 1906 describe the syndrome acrocephalosyndactyly. Case Presentation : The reporting case was a 3 months old female baby presented with early fusion of all cranial bone, facial dimorphism like hypertelorism, cleft palate and syndactyly of both hands and feet. There was some bony defect also found in radioligy. Conclusion : It is a noncurable disease but treat with multidisciplinary approach can reduce the complication and prevention can be done by genetic counselling and antenatal ultrasonography. Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 60-63
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