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

NEONATAL MORBIDITY AND MORTALITY PATTERN IN THE SPECIAL CARE BABY UNIT OF BIRDEM

To identify the main causes of neonatal morbidity and mortality a retrospective study was carried out at the Special Care Baby Unit (SCABU) of the Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) for a period of 1 year from January to December 2005. A total of 361 neonates were included in this cohort. The ratio of male (200) and female (154) neonates was 1:0.7. Most of the babies (300) were born in this hospital. Major causes of morbidity were prematurity (60.7%), LBW ( 48.2%), jaundice (23.3%), severe perinatal asphyxia (10.8%), transient tachypnoea of newborn (10.8%), respiratory distress syndrome (6.4%) and sepsis (6.4%). Most deaths were associated with prematurity (71.1%), LBW (65.8%), intrauterine growth retardation (23.7%), respiratory distress syndrome (36.8%), severe perinatal asphyxia (18.4%) and sepsis/pneumonia (15.9%). Outcome of babies born in this hospital was better than those referred from other hospitals (p &lt; 0.001)

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

Risk factors associated with microalbuminuria in children and adolescents with diabetes in Bangladesh

Introduction: Diabetic nephropathy is leading cause of morbidity and mortality of type 1 diabetes mellitus (DM). Microalbuminuria is the first clinical sign of nephropathy. Methods: This was a cross-section study with longitudinal evaluation of urinary albumin xcretion in 199 children with type 1 diabetes attending CDiC Clinic in BIRDEM over a period of two years. The aim of the study was to assess the frequency of microalbuminuria and to determine other risk factors. We collected blood and early morning spot urinary sample and analyzed for HbA1c by Clover A1c and urinary microalbumin by a DCA analyzer. Children had urinary microalbumin 30-300 mg/L on at least two occasions were categorized as having persistent microalbuminuria. Demographic and clinical data were recorded including age at onset of diabetes, age during registration, gender and duration of diabetes which were compared between patients without microalbuminuria and with microalbuminuria. Result: Microalbuminuria developed in forty nine children and adolescents (25%). Among them 24% were Type 1, 27% were with Fibrocalculous pancreatic diabetes (FCPD) and 68% were Type 2 diabetes. Median HbA1c was higher 10.8 [9.4-12.4] vs 9.5 [8.0-11.2] (P.006) in adolescents with microalbuminuria. On logistic regression univariate analysis independent predictors of microalbuminuria were older age, systolic blood pressure, BMI SDS and mean HbA1c which remained significant in multivariate analysis as predictors of microalbuminuria. Conclusion: We found high prevalence of microalbuminuria which was associated with higher age, systolic blood pressure, BMI SDS and HbA1c

Risk factors and outcome of neonatal jaundice in a tertiary hospital

Neonatal jaundice is a common cause of newborn hospital admission. The risk factors, the characteristics and outcomes related to neonatal jaundice in Bangladesh has not been studied so far. This study addressed the outcomes, characteristics and risks of the jaundiced newborn admitted into hospital. The babies who had significant jaundice and required phototherapy and /or exchange transfusion were investigated. A detailed history of delivery with gestational age was noted and clinical examination of the admitted newborn was done. Birth weight was recorded. The investigations included complete blood count, ABO and Rh compatibility, serum bilirubin, glucose 6 phosphate dehydrogenase (G6PD), thyroid stimulating hormone (TSH) and ultrasonography (USG) of brain. The newborns were closely monitored for the prognosis. The requirement of individualized phototherapy and exchange transfusion were also noted. Finally, the outcomes were recorded. Overall, 60 (m v. f = 58.3 v. 41.7%) newborns were found who developed significant jaundice and were investigated. Of them, 35% had gestational age less than 32wks and only 32% had equal to or greater than 35wks. Regarding delivery, 83.3 % had the history of caesarean section. ABO- and Rh– incompatibilities were found in 13.3% and 3.3%, respectively. Septicemia was diagnosed among 26.7% though blood culture yielded growth only in 20%. Compared with the higher gestational age-group ( 35 wks) the lower group (<32 wks) showed significantly higher rate of septicemia (12.5 v. 68.8%, p<0.005). G6PD deficiency was found in only one (1.7%) case. Birth asphyxia was found as a concomitant factor in three patients. Exchange transfusion was done only in 2 (3.3%) babies. Among them one was preterm IDM with septicemia and other had G6PD deficiency. None of these babies developed kernicterus. Five (8.3%) babies died, all of them had septicemia and one baby also had intraventricular hemorrhage (IVH) with PDA. The study revealed that a substantial number of neonatal jaundice had the history of lower gestational age in Bangladeshi newborns; and the lower gestational age is significantly associated with septicemia and possibly with hyperbilirubinemia. More study is needed to establish the study findings. Ibrahim Med. Coll. J. 2010; 4(2): 70-7

Fasting during Ramadan in adolescents with diabetes

Background: Fasting (Sawm) during Ramadan, one of the five pillars of Islam is obligatory for all healthy adult and adolescent Muslims from the age of 12 years. Some children with diabetes, despite their exemption insist on fasting in Ramadan. We evaluated the safety of fasting among children with type 1 diabetes. Materials and Mathods: A prospective observational study was designed for diabetic children and adolescents who wish to fast during Ramadan 2012. Patients with their caregivers were given intensive education and instructions were provided by diabetic educators, dieticians and physicians on insulin adjustment, home blood glucose monitoring and dietary adjustments prior to Ramadan. Results: A total of 33 children and adolescents were included in this study. Of these, 16 were male and 17 were female. Majority (60.6%) of the patients could complete their fasting during the Ramadan. Patients were divided into two groups, those who completed fasting were considered as Group-I, whereas patients who broke the fast were in Group-ll. Blood glucose, hemoglobin A1c weight, and insulin dose before and after Ramadan in two groups showed no significant difference. Conclusion: Children older than 11 years of age with type 1 diabetes mellitus with conventional twice-a-day regimen can fast safely during Ramadan provided they have proper education and intensive follow-up during Ramadan

Lipid profile in relation to glycemic control in Type 1 diabetes children and adolescents in Bangladesh

Introduction: Dyslipidemia and hyperglycemia are metabolic abnormalities commonly found in young patients with Type 1 diabetes mellitus (T1DM) and both increase the risk of cardiovascular disease. Methods: This cross-sectional study was aimed to evaluate the pattern of dyslipidemia and its relationship with other risk factors in children and adolescents with T1DM. A total of 576 T1DM patients aged 10–18 years who attended Changing Diabetes in Children, a pediatric diabetes clinic in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders over 1 year period from July 2015 to June 2016 were included in this study.Results: The overall frequency of dyslipidemia was 65%. The high triglyceride, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein were found in 50%, 66%, 75%, and 48%, respectively. Compared to patients without dyslipidemia, patients with dyslipidemia had significantly lower mean body mass index (kg/m2) (18.4 [interquartile range; 16.2–21.4] vs. 19.5 [17.3–21.5] (P = 0.005)); significantly higher median fasting blood sugar (12.7 [9.9–15.2] vs. 10.6 [7.9–12.6] (P < 0.0001)) and higher median glycosylated hemoglobin (9.8 [8.4–11.8] vs. 7.9 [9.3–10.5] (P < 0.0001)). Hypertension was significantly higher in dyslipidemic patients (9.4% vs. 2.5% P < 0.002). Conclusion: More than half (65%) of our children and adolescents with T1DM had dyslipidemia, among them high LDL was the most common. These findings emphasize the screening of lipid profile in T1DM children and adolescents

Shigella dysenteriae Type 1-Specific Bacteriophage from Environmental Waters in Bangladesh

Shigella dysenteriae type 1 is the causative agent of the most severe form of bacillary dysentery, which occurs as epidemics in many developing countries. We isolated a bacteriophage from surface water samples from Bangladesh that specifically lyses strains of S. dysenteriae type 1. This phage, designated SF-9, belongs to the Podoviridae family and has a 41-kb double-stranded DNA genome. Further screening of water samples for the prevalence of the phage revealed 9 of 71 (12.6%) water samples which were positive for the phage. These water samples were also positive in PCR assays for one or more S. dysenteriae type 1-specific genes, including ipaBCD and stx1, and live S. dysenteriae type 1 was isolated from three phage-positive samples. The results of this study suggest that phage SF-9 may have epidemiological applications in tracing the presence of S. dysenteriae type 1 in environmental waters