A 10-year-old girl presenting with jaundice, deterioration of school performance and itching

This article has no abstract. The first 100 words appear below: A 10-year-old immunized girl, 6th issue of consanguineous parents, presented with the complaints of jaundice for the last 2 years and deterioration of school performance for the same duration. She also had generalized itching for the last 6 months. She had no history of altered sleep pattern, any gastrointestinal bleeding, surgical or dental procedures, history of blood and blood products transfusion, taking any offending drugs, sib death or family history of such type of illness

Persistence of anti-HBs and immunologic memory in children immunized with hepatitis B vaccine

Background:  We aimed to examine the persistence of anti-HBs in Bangladeshi children aged 5 and 10 years after primary vaccination, and this response to a booster dose. Methods: A total of 100 children were enrolled who were divided into two groups (A and B). Group A comprised of 50 children vaccinated 5 years ago, and group B had 50 children vaccinated 10 years ago. Hepatitis B surface antibody titer was measured, and a booster dose of the vaccine was administered to those who had anti-HBs less than 10 mlU/ml. Seventeen such children from group A and 27 from group B were vaccinated with a booster dose. After one month, 12 children from group A and 18 children from group B were retested for hepatitis B surface antibody levels. Results: After 5 and 10 years of primary vaccination, 66.0% and 46.0% children had protective antibody levels. After one month of booster dose, 91.6% children responded to the increased level of anti-HBs in group A. Among them, 66.6% showed an adequate response. In group B, 88.8% had an increased level of anti-HBs antibody where 83.3% had an adequate response. Geometric mean titre of anti-HBs antibody boosted by 35 and 75 times from pre-booster time to post-booster vaccination in group A and B, respectively. Conclusion: Children had protective levels of anti-HBs antibodies at 5 and 10 years after completion of the primary vaccinations. Anamnestic response to booster vaccination confirmed the persistence of an effective immunological memory in vaccines. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 101-10

Association between severity of chronic liver disease with grading of oesophageal varices in children

Chronic liver disease is a uncommon manifestation in the children and many of them presents with oesophageal varices. The aim of this study was to observe the association between severity of chronic liver diseases determined by Child- Pugh score with grading of oesophageal varices. 62 cases (male, 34) were included in the present study. Mean age of the study population was 9.5±3.3 years. Male to female ratio was 1.2:1. Wilson’s disease was the most common etiology of chronic liver disease (64.5%). Of the 62 children, 30.7% had Child class A, 16.1% had Child class B and the remaining 53.2% had Child class C cirrhosis. Oesophageal varices were found in 43 (69.3%) children. On univariate ananlysis low platelet count and splenomegaly were found to be associated with the presence of esophageal varices. Splenomegaly was found as independent predictor for presence of varices on multivariate analysis (OR; 15.51, 95% CI, 3.7-63.5). Furthermore, splenomegaly was also independent risk factor for large esophageal varices. No association was found between Child-Pugh classification (child A, B, C) with grading of oesophageal varices (Grade - I, II, III, IV). Our study showed no positive association between Child-Pugh classifications with grading of esophageal varices. Splenomegaly predicts the presence of oesophageal varices as well as the presence of large esophageal varices. BSMMU J 2022; 15(1): 29-3

Hepatic involvement in childhood dengue infection

Abstract Dengue or breakbone fever is one of the most important causes of febrile illness in children residing in tropical and subtropical regions. This mosquito-borne viral disease is mediated by the bite of the infected Aedes mosquito. Dengue infection has been expanding rapidly throughout the globe in the past few decades. The virus has hepatotoxic effects. However, the pathophysiology of liver involvement in dengue is still not entirely clear. The reported clinical spectrum of dengue hepatitis ranges from mild asymptomatic elevation in transaminaselevels to acute liver failure in children. This review focuses on hepatic manifestation, the pathogenesis of liver injury, and treatment option of the effects of dengue on the liver in the pediatric population

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN