Immunoglobulin A Vasculitis Nephritis in Children: Experience from a Tertiary Care Hospital, Bangladesh

Background and Aim: Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura (HSP),is the most common vasculitis in children with multiorgan involvement. Renal involvement is one of the important causes of morbidity and mortality. The objective of this study was to evaluate the frequency, clinical profile, and outcome of IgA vasculitis nephritis (IgAVN) in children. Methods:This prospective cross-sectional study was conducted in Dr. MRKhan Children Hospital & Institute of Child Health, Dhaka, over a period of 5years from January 2015 to December 2019. Data were collected using a structured questionnaire form and analyzed by the SPSS software version 20.0. Results:A total of 57cases of IgA vasculitis were admitted of whom 16 (28%) had renal involvement. The mean age was 7.7years. Regarding renal involvement, the majority of the patients (56.25%) had isolated hematuria. All nephritis patients (100%) had purpura and 75% of the patients had severe abdominal pain. The mean hematocrit and the mean platelet count were significantly higher in the nephritis group compared to patients without nephritis (41.49±4.47vs.39.98±5.16, p-value<0.005 and485.51±58.29 vs. 293.89±65.15, p-value<0.001, respectively). The level of complement C3 was significantly lower in the nephritis group compared to patients without nephritis (0.85±0.4 vs. 1.5±0.3, p-value <0.01). The majority (68.75%) of the patients recovered and 18.75% were in remission with immunosuppressant. None of the cases progressed to ESRD. Conclusion:Severe abdominal pain, high platelet counts, high hematocrit levels, and low C3 concentrations are common findings in nephritis. Nephritis resolvespontaneously in most cases but severe nephritis requires treatment with immunosuppressive drugs for remission.   &nbsp

Renal Involvement in Children with Dengue Fever: A Study in Tertiary Care Hospital of Bangladesh

Background and Objective: Dengue has emerged globally as the most relevant viral infection transmitted by a mosquito bite and represents a major threat to public health. Dengue-related renal manifestations such as proteinuria, hematuria, acute kidney injury (AKI), and rhabdomyolysis are not uncommon, and acute kidney injury (AKI) is a serious complication of dengue fever. There is relatively few data on the renal manifestations of dengue fever in children. Hence, this study was conducted to evaluate the incidence, characteristics, and clinical outcome of dengue fever with renal manifestations. Method. This prospective cross sectional study was conducted in Dr. M R Khan Children Hospital and Institute of Child Health, Dhaka, over a period of 1 year from January 2018 to December 2018. The study was approved by the ethical committee of the institute. A total number of 316 patients were admitted with the diagnosis of dengue fever either NS1 positive or antibody IgM positive or both IgM and IgG positive. Data were collected in a structured questionnaire form and were analyzed by SPSS version 20.0. The disease severity was classified according to the World Health Organization criteria. Renal manifestations were divided into AKI groups using pRIFLE criteria. Proteinuria was defined as urinary protein >1+ (30 mg/dL) by dipstick test. Hematuria was defined as red blood cell (RBC) >5/μL in a fresh uncentrifuged urine specimen. Result. Among 316 dengue patients, thirty-one patients (9.8%) had renal involvement. Most of the patients (54.83%) with renal manifestations were aged between 1 and 5 years. A total of 14 patients were found to have proteinuria (4.4%). Nephrotic-range proteinuria was seen in only one patient (0.3%). AKI was defined by pRIFLE criteria and was seen in 13 patients (4.1%); among AKI 6 (46.15%) had risk, three patients (23.07%) had injury and 4 (30.7%) had failure and needed peritoneal dialysis. Death occurred in 3 patients (9.6%) in dengue with AKI who had failure. The incidence of renal manifestations (proteinuria, hematuria, and AKI) is as high as 9.8% among patients with dengue, and those with AKI had significant morbidity and mortality. Conclusion. Renal involvement in children with dengue is not uncommon. Dengue associated with AKI had significant mortality and morbidity

Knowledge and Practice About Blood Pressure Measurement in Children: Healthcare Provider’s Perspective: Knowledge About Blood Pressure Measurement

Background and Aim: Hypertension (HTN) has become more prevalent among youngsters.It is frequently under-recognized due to a lack of routine blood pressure measurement in manyhealth centers, partly owing to a shortage of devices and possibly because of the notion that itis not the foremost disease in children. In Bangladesh, there is a scarcity of data on how doctorsview childhood HTN and their practice of measuring blood pressure in children. Methods: This cross-sectional mailed-based survey was done on pediatricians and approved bythe institutional review board of Dr. Khan Shishu Hospital & the Institute of Child Health fromJune to December 2021. We obtained the email addresses of all pediatricians from the BangladeshPediatric Association. Results: Of the 536 pediatricians in the mailing sample, 257 cases responded and the responserate was 47.9%. The majority of respondents (62.4%) were general pediatricians and only 12.2%were pediatric nephrologists. This survey revealed that 77.2% of pediatricians did not measureblood pressure routinely among children 3-18 years of age, whereas 66% reported measuringblood pressure if children had risk factors. Conclusion: The findings of our study point to a knowledge and practice gap among pediatricians,who are primary health care providers, when diagnosing hypertension in children. For childrenaged 3 to 18 years, most pediatricians reported no regular assessment of blood pressure. Mostpediatricians did not repeat blood pressure measurements for diagnosis, nor did they often useblood pressure cuffs or charts for children. These issues need to be addressed for better diagnosisand treatment of childhood HTN

Implementation research on kangaroo mother care, Bangladesh

10.2471/blt.20.284158Bulletin of the World Health Organization100110-1

Qualitative Analysis of 405 Life Stories from Children Working in the Worst Forms of Child Labour in Bangladesh

The CLARISSA (Child Labour: Action-Research-Innovation in South and South-Eastern Asia) programme is a five-year, action research consortium generating evidence-informed, innovative solutions by children to avoid hazardous, exploitative labour in Bangladesh and Nepal. This paper is based on a qualitative analysis of 405 life stories collected from child labourers in Bangladesh working in the worst forms of child labour in the leather sector or living in leather sector neighbourhoods. Our analysis of their stories provides a rich picture, from children’s perspectives, of the drivers of child labour, views of child labour, working conditions, and their lives outside of work. The paper also explores the complexity, nuance, and interaction within these themes, drawing on and highlighting the diversity of experience articulated in the stories

Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial

Introduction Diarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where the risk of mortality is even higher. At icddr,b Dhaka Hospital, the fatality rate is as high as 69% in children with severe malnutrition and fluid refractory septic shock. To date, no study has evaluated systematically the effects of inotrope or vasopressor or blood transfusion in children with dehydrating diarrhoea (eg, in cholera) and severe acute malnutrition (SAM) or severe underweight who are in shock and unresponsive to WHO-recommended fluid therapy. To reduce the mortality of severely malnourished children presenting with diarrhoea and fluid refractory shock, we aim to compare the efficacy of blood transfusion, dopamine and epinephrine in fluid refractory shock in children who do not respond to WHO-recommended fluid resuscitation.Methods and analysis In this randomised, three-arm, controlled, non-masked clinical trial in children 1–59 months old with SAM or severe underweight and fluid refractory shock, we will compare the efficacy of dopamine or epinephrine administration versus blood transfusion in children who failed to respond to WHO-recommended fluid resuscitation. The primary outcome variable is the case fatality rate. The effect of the intervention will be assessed by performing an intention-to-treat analysis. Recruitment and data collection began in July 2021 and are now ongoing. Results are expected by May 2023.Ethics and dissemination This study has been approved by the icddr,b Institutional Review Board. We adhere to the ‘Declaration of Helsinki’ (2000), guidelines for Good Clinical Practice. Before enrolment, we collect signed informed consent from the parents or caregivers of the children. We will publish the results in a peer-reviewed journal and will arrange a dissemination seminar.Trial registration number NCT04750070