Bangladesh Journal of Child Health

Influence of Nutritional Status of Children with Acute Lymphoblastic Leukemia (ALL) on Treatment Outcome after Completion of Induction

Thu, 23 Nov 2023 00:00:00 +0000

Background: Malnutrition and cancer both influences tolerance and response to treatment especially ALL. Malnutrition increases morbidity, mortality, reduces the effectiveness of treatment and impairs the quality of life significantly.

Objective: Assessment of the nutritional status and its influence on treatment outcome children with Acute Lymphoblastic Leukemia (ALL) before and after induction chemotherapy.

Materials & Methods: This prospective observational study included 72 children with ALL, aged 1-15 years, was conducted from January to December 2014 in the Department of Pediatric Hematology and Oncology, BSMMU. The anthropometric measurements (weight-for-age, height-for-age, weight-for-height, MUAC, BMI) hematological and biochemical parameter (serum albumin, total protein) were measured. The children got induction chemotherapy according to the UK ALL 2003 (modified) protocol.

Results: Among the study population, 18(39.1%) were underweight, 8(17.4%) were stunted, 16(34.8%) were wasted, MUAC for age 14(56.0%) and BMI for age 12(57.1%) were malnourished, 10.9% had low total proteins (<5.7g/dl), 37.0% low serum albumin (<3.2g/dL). Mean anthropometric measurements and biochemical parameters were higher among the survivors compared to non-survivors. Significant difference was found between the well-nourished and the malnourished group according to WAZ. Complications like febrile neutropenia, treatment delay, number of transfusion (PRBC) requirement were more in malnourished group.

Conclusion: Malnutrition is widely prevalent in children with ALL and a major determining factor in treatment planning, complications and final outcome.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 3-8

Newly Diagnosed Type 2 Diabetes in Children and Adolescents in Bangladesh- A Cross Sectional Study

Thu, 23 Nov 2023 00:00:00 +0000

Background: Type 2 diabetes (T2D) has become a serious health problem in children and adolescents as the prevalence of obesity is increasing.

Objective: To observe the baseline clinical and laboratory findings and treatment modalities of children and adolescents with newly diagnosed T2D.

Materials & Methods: This cross-sectional study was done from Jan- Dec.2017 in Changing Diabetes in Children (CDiC), Paediatric diabetes OPD clinic in BIRDEM among newly diagnosed T2D children and adolescents.

Results: Among 68 patients majority were female (64.7%). Mean age was 13.1 ± 2.5 years. Ten patients were below 10 years. Most of the patients were from urban & semi urban area and high to middle socioeconomic status. Family history was present in 91.2% and 22.1 % mother had H/O GDM. Forty two patients (61.8%) had typical and 22 (32.3%) had atypical symptoms. Thirty seven children had acanthosis nigricans (54.4%). Majority were found overweight (53/68), and (12/68) were obese. Mean HbA1c was 10.2 ± 2.8. Life style modification was advised to all. Insulin was started along with metformin in patients with high HbA1c and 33.8% patients were given metformin only. While comparing, BMI was found high in basal and metformin group. Lower fasting blood glucose and HbA1c were observed in patients with metformin only.

Conclusion: T2D is emerging in children and adolescents. The screening of children at high risk of T2D is essential for preventive and timely remedial measures.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 9-13

Efficacy of Combined Therapy of ACTH plus Vigabatrin Compared to ACTH Alone for Treatment of Infantile Spasm-A RCT

Thu, 23 Nov 2023 00:00:00 +0000

Background: Infantile spasms (epileptic spasm) is difficult to treat and has a high morbidity. So it’s crucial to initiate an early effective therapy. ACTH, Prednisolone and Vigabatrin have shown better efficacy on cessation of spasms.

Objective: To compare the efficacy and tolerability of combined ACTH and Vigabatrin with ACTH alone in treatment of infantile spasms.

Materials & Methods: This randomized controlled trial was conducted from June, 2017 to June, 2018 at outdoor and indoor, department of Paediatric Neurology of National Institute of Neurosciences and Hospital, Dhaka. Fifty (50) patients aged 2 months to 24 months who had a clinical diagnosis of infantile spasms and hypsarrhythmia (classical or modified hypsarrhythmia) in EEG were enrolled. With parent’s written informed consent, they were randomized (1:1 by lottery method) into two groups, 25 in each. One group got ACTH only and another group got both ACTH and vigabatrin. At the end of the treatment two groups were compared regarding efficacy and safety of the drugs.

Result: The primary outcome was assessed in 50 children at 91st day. The primary outcome was cessation of spasms from 14th day to 42nd day after initiation of therapy. Cessation of spasms (between 14 to 42 days) occurred in 18 children (72%) in combination therapy and 11 children (44%) in hormonal therapy (p=0.045). Treatment response was faster on combination therapy (p=0.001). Treatment was well tolerated in both groups with few adverse effects.

Conclusion: Combination therapy of ACTH plus Vigabatrin was found better than ACTH therapy alone in cessation of infantile spasms.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 14-18

Evaluation of Hearing Status in Various Type of Cerebral Palsy Children in a Tertiary Hospital

Sanchita Biswas, Debashis Saha, Mizanur Rahman, Debatosh Paul — Thu, 23 Nov 2023 00:00:00 +0000

Background: Cerebral palsy (CP) in children are frequently associated with sensorineural pathology.

Objectives: To assess the severity of hearing impairment in children with CP and correlate the auditory impairment with different types of CP.

Materials & Methods: This cross-sectional study was conducted in the Department of Pediatric neurology and Autolaryngiology- Head and Neck Surgery BSMMU, during March to September 2011. Diagnosed CP patients were included consecutively. After taking informed written consent, proper history and clinical examinations was done and severity of hearing loss was assessed.

Results: Among the 50 children with CP, Tympanometry result revealed that negative middle ear pressure was present in 32% in spastic quadriplegia(SQ), 24% in spastic hemiplegia (SH), 16% in spastic diplegia (SD) and 24% in mixed type. Eustachian tube dysfunction was present in 62.5% in spastic hemiplegia. In TOAE result 52% were pass and 48% were referred and ABR were suggested. On the basis of result of TOAE, those were referred, initially they were encountered as hearing impairment in this study. Among them, in SQ were 18%, SH were 12% and mixed. Follow up auditory brain stem response revealed mild, moderate and severe sensorineural hearing loss were 8% in spastic quadriplegic type and the spastic diplegia and athetoid group were 2% only mild, Moderate sensorineural hearing were 2% in spastic hemiplegia group.

Conclusion: Spastic Quadriplegic cerebral palsy patients had the maximum incidence of hearing impairment. Perinatal asphyxia and prematurity were the main risk factor of hearing impairment.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 19-22

Idiopathic Short Stature - A Case Report

Suraiya Begum, Dhiraj Chandra Biswas — Thu, 23 Nov 2023 00:00:00 +0000

Short stature in childhood is the most common reason for referral to pediatric endocrinologists. Idiopathic short stature is defined as ³2 SD below the corresponding mean height for a given age, sex, and population in a child with a normal birth size and normal body proportions and without evidence of any systemic, endocrine, nutritional, or chromosomal abnormalities. ISS children have normal GH responses to stimulation test and GH therapy has approved for the treatment of children with ISS. A six-year-old girl presented with not growing well in comparison to other peers since 6 months of her age. Her WAZ was -4.5 SD, HAZ was -7.7 SD, and projected height is far below parental target height. Bone age was 2-3 year and growth hormone stimulation showed normal growth hormone secretion. Here we reported a six-yearold girl diagnosed as a case of non-familial ISS and treated with growth hormone. Diagnosis of Idiopathic short stature was done by exclusion of other causes of short stature and growth hormone therapy was indicated.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 28-29

Primary Sclerosing Cholangitis in Very Early Age: Two Case Reports

Thu, 23 Nov 2023 00:00:00 +0000

Primary Sclerosing Cholangitis (PSC) is a rare, chronic, progressive cholestatic liver disease which affects intrahepatic and extrahepatic bile ducts. That eventually progresses to end stage liver disease that requires liver transplantation. It mostly occurs in adolescent males and boys. Pediatric disease appears milder in contrast to adult-onset PSC. The diagnosis is made by Magnatic Resonance Cholangiopancreatography (MRCP). Though there is no practical guideline available in pediatric patients for treating PSC UDCA is prescribed chronically in over 80% of patients. There is close association of PSC with inflammatory bowel disease and autoimmune hepatitis in children. So the treatment is complex in case of children. We reported here two cases of PSC, because of rarity of this disease in such a young age.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 30-34

Rasmussen’s Encephalitis in Children: A Case Report

Naznin Akter, Mashura Mushrraf — Thu, 23 Nov 2023 00:00:00 +0000

Rasmussen’s Encephalitis (RE) is one form of chronic and progressive focal encephalitis of children presented with intractable epilepsy and progressive neurologic deficits. The cause of the disease is still unknown but thought to be an immunological disorder following a viral infection. Brain imaging is one of the best tools for diagnosis. We presented a case of Rasmussen’s encephalitis.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 35-38

Dyskeratosis Congenita: A Case Report

Thu, 23 Nov 2023 00:00:00 +0000

Dyskeratosis Congenita (DC) is a rare inherited bone marrow failure disorder characterized by lacy reticulated skin pigmentation, nail dystrophy and mucosal leukoplakia. In DC bone marrow failure is the main cause of premature death with an additional predisposition to malignancy. DC results from progressive shortening of telomeres resulting in DNA replication. X-linked recessive is the main mode of inheritance. Most of the patients respond to Androgen therapy. This is a case report of a 5-year-old boy presented with features of bone marrow failure and had abnormality of skin, oral mucosa and nail. His complete blood count with peripheral blood film showed pancytopenia and no blast cell. Hypocellular marrow was present in his Bone marrow examination. Chromosomal analysis- fluorescence in situ hybridization (FISH) revealed very short telomere of chromosome. Microarray genotyping showed DKC1 gene abnormality.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 39-41

Children’s Environmental Health Awareness

Md Al Amin Mridha — Thu, 23 Nov 2023 00:00:00 +0000

Abstract not available

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 1-2

Anti-tuberculosis Drug-induced Hepatitis

ASM Bazlul Karim, Nadira Musabbir — Thu, 23 Nov 2023 00:00:00 +0000

Among the first line anti-TB drugs, INH, Rifampicin and Pyrazinamide are considered to be the most hepatotoxic drugs and cause drug induced hepatitis. Pyrazinamide causes both dose-dependent and idiosyncratic hepatitis whereas Isoniazid and Rifampicin induced hepatotoxicity are considered to be idiosyncratic. There are several risk factors for hepatotoxicity such as old age, malnutrition, genetic predisposition, HIV infection as well as chronic Hepatitis B and C infections. Anti-TB drug induced hepatitis usually occurs within 2 months after starting treatment. Patient may present with mild symptoms to severe acute hepatitis or even acute liver failure. Various guidelines have been published regarding the management of ATT and restarting anti TB drugs. This article reviews the incidence, risk factors, mechanism, diagnosis and management strategies of anti-TB drug induced hepatitis.

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 23-27

Abstract from Current Literatures Vol. 46(1)

Seikh Azimul Hoque — Thu, 23 Nov 2023 00:00:00 +0000

Abstract not available

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 42-43

Notes & News Vol. 46(1)

Settings Seikh Azimul Hoque — Thu, 23 Nov 2023 00:00:00 +0000

Abstract not available

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 44-45

Cover and Content Page Vol. 46(1)

Seikh Azimul Hoque — Thu, 23 Nov 2023 00:00:00 +0000

Abstract not available

BANGLADESH J CHILD HEALTH 2022; VOL 46 (1)