Anaesthetic management of nesidioblastosis in two infants

Nesidioblastosis is the most common cause of non-transient, recurrent and persistent hypoglycaemia in neonates and infants. It is a disorder of diffuse proliferation of beta cells of the pancreas leading to hyperinsulinemia and hypoglycaemia. The main aim is to prevent the severe episodes of hypoglycaemia which can cause damage to the brain and/or mental retardation. In this case report we present two cases of nesidioblastosis and their perioperative anaesthetic course for near-total pancreatectomy. First case was a 7 months old female who had repeated episodes of convulsions since birth. Second case was a 4-month-old female child who again presented with seizures. The challenges faced in the perioperative period were the management of perioperative blood glucose levels and haemodynamic stability

Significance of Neuropilin-1 (CD 304) Expression in Paediatric B- Lineage Acute Lymphoblastic Leukemia (ALL)

Background: To determine the prognostic significance of NRP-1 (CD304) expression in paediatric B-lineage Acute Lymphoblastic Leukaemia (ALL) patients. Methods: In this comparative study newly diagnosed cases (aged 1-15 years) of B-ALL were selected. Age and sex matched, 21 healthy controls were also included in the study to assess the NRP-1 expression on peripheral blood lymphocytes. A minimum 1ml of blood and bone marrow aspirate samples were taken in EDTA vacutainer and immunophenotyping was done on gated blast cells using an extensive panel of antibodies including myeloid markers (CD13, CD33 and cytoplasmic anti-MPO) and lymphoid markers (CD34, CD2, CD3, CD5, CD7, CD4, CD8, HLA DR, CD10, CD19, CD22; cytoplasmic CD3, CD22, CD79a and nuclear anti-TdT). The sample was considered NRP-1 positive if 20% or more of the gated blast cells expressed it . Man-Witney U test and Kruskal Wallis test were used for non-parametric data. The p value <0.05 was considered significant. Results: Out of 66 B-ALL patients, 53% were males. There were 20 (30%) NRP-1 positive and 46 (70%) NRP-1 negative patients. The prognosis of NRP-1 positive group was poor as compared to NRP-1 negative group with high blast percentage (80%) (p= 0.042), low morphological remission rate (21%) (p=0.004) and low survival rate (29%) (p=0.009). The mean survival days in dead patients was also less (22.75 days). Conclusion: NRP-1 over expression is associated with disease progression and severity in paediatric B-ALL patients

ACC-deaminase producing plant growth promoting rhizobacteria and biochar mitigate adverse effects of drought stress on maize growth.

Availability of good quality irrigation water is a big challenge in arid and semi arid regions of the world. Drought stress results in poor plant growth and low yield; however, the rhizobacteria, capable of producing 1-aminocyclopropane-1-carboxylate (ACC)-deaminase are likely to improve crop growth and productivity under drought stress. Similarly, biochar could also ameliorate the negative impacts of drought stress. Therefore, this pot experiment was conducted to evaluate the role of ACC-deaminase producing plant growth promoting rhizobacteria (PGPR) alone and in combinations with timber-waste biochar in improving maize growth under drought stress. The ACC-deaminase producing rhizobacteria, Pseudomonas aeruginosa, Enterobacter cloacae, Achromobacter xylosoxidans and Leclercia adecarboxylata were studied along with two rates (0.75 and 1.50% of the soil weight) of biochar under three moisture levels i.e., normal moisture, mild drought stress and severe drought stress. The E. cloacae in conjunction with higher rate of biochar produced a significant improvement i.e., up to 60, 73, 43, 69, 76 and 42% respectively, in grain yield plant-1, photosynthetic rate, stomatal conductance, chlorophyll a, total chlorophyll and carotenoids contents of maize as compared to the control under mild drought stress. Similarly, A. xylosoxidans with higher rate of biochar also enhanced grain yield plant-1, photosynthetic rate, stomatal conductance, chlorophyll a, total chlorophyll and carotenoids contents of maize up to 200, 213, 113, 152, 148 and 284%, respectively over control under severe drought stress. In conclusion, combination of ACC-deaminase containing PGPR, A. xylosoxidans and biochar (0.75%) proved an effective technique to improve maize growth and productivity under drought stress

CLINICAL PROFILE OF DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS UNDER EIGHTEEN YEARS OF AGE

A total number of 125 patients with diabetes mellitus (DM) under eighteen years of age were admitted in the Paediartic department of BIRDEM hospital between January 2001 to October 2002. Eighty-eight patients (71%) were newly detected. Female to male ratio was 3:1. Out of the total admission 38 (30.4%) patients had type 1 DM (group 1), 37 (29.6%) patients had fibrocalculous pancreatic FCPD diabetes (group II), 48 (38.4%) patient had malnutrition modulated diabetes mellitus MMDM (group III) and 2 (1.6%) patients had type 2. Mean age of onset was 9±3.9 yrs in group I and 13±2.3 yrs in group II and group III. All groups had very high glucose and HbA1c value at presentation. The mean fasting glucose (mmol/l) was 19±7.14, 22.39±9 and 19.54±7.9 in group I, group II and group III respectively. The Mean HbA1c (%) value in the three groups was 14.4±2.7, 16.72±2.26 and 15.27±3.05 respectively. FCPD patients had poorest glycaemic status. Acute complications were more common in type 1 patients. Twelve (31.5%) patients had diabetic ketoatin DKA and two (5%) patients had hypoglycaemia in group I. Chronic complications were present in all three groups. MMDM patients had highest rate of complications. which was present in 2.6%, 21.6% and 33.3% patients in group I, group II and group III respectively. The rate of microalbuminuria was 5.3%. 10.8% and 18.8% in the three groups respectively. The rate of neuropathy was 2.6%, 16.2% and 20.8% in the three groups respectively. Among the associated problems skin infection, pulmonary tuberculosis and bilateral parotid swelling were common. Malnutrition was present in 66%, 86% and 100% in group I, group II and group III respectively. Majority (50% in group I, 91.6% in group II and 100% in group III) of our patients came from poor socio-economic background. Ibrahim Med. Coll. J. 2007; 1(1): 11-1

DIABETIC KETOACIDOSIS IN CHILDREN – AN EXPERIENCE IN A TERTIARY HOSPITAL

A retrospective study was done in the in-patient department of paediatrics, BIRDEM from January 2002 to November 2006 to determine the clinico-laboratory features, precipitating factors and outcome of diabetic ketoacidosis. Over the five year period, 344 diabetic patients were hospitalized. Among them, 54 (15.6%) had diabetic ketoacidosis (DKA). Among those, 50 were Type I, one was Fibrocalculous Pancreatic Diabetes (FCPD) and 3 were of other specific types. More than half (51.9%) of the patients were newly diagnosed. Amongst the precipitating factors, 28% had missed insulin and 48% had overt infection. Infections, particularly those of the respiratory tract, were the main precipitating cause for the DKA. There was h/o both infection and missed insulin injections in 11.5% patients. The mean age of patients with DKA was 11.2 ± 4.4 years. Those in the age range 10-14 yrs suffered most frequently (p<0.0001) from ketoacidosis (n= 38, 70.4%) compared with those aged 0-4 yrs (9%) and 5-9 yrs. (20%). There was a significant difference between those newly diagnosed (group I) and known diabetics (group II) (p<.029). The frequency of DKA was higher in girls than in boys (66.7% vs. 33.3%; p =.0001). The median duration of polyuria and/or polydipsia was variable between newly diagnosed and known diabetics (3.2 - 25d) (p<.001). All patients presented with altered levels of consciousness and 35 (67.3%) were unconscious of different grades. Mean random blood glucose (RBG) and HbA1c were 27.6mmol/L and 13.4%. Complications noted were acute renal failure (n=2, 3.7%) and cerebral edema (n = 4, 7.5%). The outcome of treatment in the whole group was good, 46 (86.7%) patients recovered without complications, but 7 (13.4%) patients died. Ibrahim Med. Coll. J. 2008; 2(1): 17-2

Rehabilitation on Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Original Article

A total number of 125 patients with diabetes mellitus (DM) under eighteen years of age were admitted in the Paediartic department of BIRDEM hospital between January 2001 to October 2002. Eighty-eight patients (71%) were newly detected. Female to male ratio was 3:1. Out of the total admission 38 (30.4%) patients had type 1 DM (group 1), 37 (29.6%) patients had fibrocalculous pancreatic FCPD diabetes (group II), 48 (38.4%) patient had malnutrition modulated diabetes mellitus MMDM (group III) and 2 (1.6%) patients had type 2. Mean age of onset was 9±3.9 yrs in group I and 13±2.3 yrs in group II and group III. All groups had very high glucose and HbA1c value at presentation. The mean fasting glucose (mmol/l) was 19±7.14, 22.39±9 and 19.54±7.9 in group I, group II and group III respectively. The Mean HbA1c (%) value in the three groups was 14.4±2.7, 16.72±2.26 and 15.27±3.05 respectively. FCPD patients had poorest glycaemic status. Acute complications were more common in type 1 patients. Twelve (31.5%) patients had diabetic ketoatin DKA and two (5%) patients had hypoglycaemia in group I. Chronic complications were present in all three groups. MMDM patients had highest rate of complications. which was present in 2.6%, 21.6 % and 33.3% patients in group I, group II and group III respectively. The rate of microalbuminuria was 5.3%. 10.8 % and 18.8 % in the three groups respectively. The rate of neuropathy was 2.6%, 16.2 % and 20.8 % in the three groups respectively. Among the associated problems skin infection, pulmonary tuberculosis and bilateral parotid swelling were common. Malnutrition was present in 66%, 86% and 100 % in group I, group II and group III respectively. Majority (50 % in group I, 91.6 % in group II and 100 % in group III) of our patients came from poor socio-economic background. Ibrahim Med. Coll. J. 2007; 1(1): 11-1

Characteristics of children and adolescents at onset of type 2 diabetes in a Tertiary Hospital in Bangladesh

Introduction: Recent data show that the prevalence of diabetes among children and adolescents is increasing in some ethnic groups. The worldwide epidemic of childhood obesity has been accompanied by an increase in the incidence of type 2 diabetes (T2D) in youth. Methods: The aim of this study was to describe the baseline characteristics of children and adolescents diagnosed ≤18 years who had features of T2D and presented at  Changing Diabetes in Children, Paediatric Diabetes Clinic at Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine, and Metabolic Disorders. All patients who were newly diagnosed and came to the clinic from March 2011 to March 2015 were included. Results: Among 939 newly registered patients, 77 (8%) had a diagnosis of T2D. The age at diagnosis was 9-10 years in 11 patients (14%), 11-14 years in 46 (60%) and 15-17 years in other 20 patients (26%). Majority of the children had a positive family history of T2D (94%) and 58% were obese. Median fasting insulin (27.9 [17.3-99.3]) was high in 76% patients. Insulin was started initially along with metformin in 40 patients and could be stopped in six patients in 3 months. Conclusion: Our study reflects that T2D is emerging as a problem in children and adolescents in Bangladesh