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

Of cattle, sand flies and men : a systematic review of risk factor analyses for South Asian visceral leishmaniasis and implications for elimination

Background: Studies performed over the past decade have identified fairly consistent epidemiological patterns of risk factors for visceral leishmaniasis (VL) in the Indian subcontinent. Methods and Principal Findings: To inform the current regional VL elimination effort and identify key gaps in knowledge, we performed a systematic review of the literature, with a special emphasis on data regarding the role of cattle because primary risk factor studies have yielded apparently contradictory results. Because humans form the sole infection reservoir, clustering of kala-azar cases is a prominent epidemiological feature, both at the household level and on a larger scale. Subclinical infection also tends to show clustering around kala-azar cases. Within villages, areas become saturated over a period of several years; kala-azar incidence then decreases while neighboring areas see increases. More recently, post kalaazar dermal leishmaniasis (PKDL) cases have followed kala-azar peaks. Mud walls, palpable dampness in houses, and peridomestic vegetation may increase infection risk through enhanced density and prolonged survival of the sand fly vector. Bed net use, sleeping on a cot and indoor residual spraying are generally associated with decreased risk. Poor micronutrient status increases the risk of progression to kala-azar. The presence of cattle is associated with increased risk in some studies and decreased risk in others, reflecting the complexity of the effect of bovines on sand fly abundance, aggregation, feeding behavior and leishmanial infection rates. Poverty is an overarching theme, interacting with individual risk factors on multiple levels. Conclusions: Carefully designed demonstration projects, taking into account the complex web of interconnected risk factors, are needed to provide direct proof of principle for elimination and to identify the most effective maintenance activities to prevent a rapid resurgence when interventions are scaled back. More effective, short-course treatment regimens for PKDL are urgently needed to enable the elimination initiative to succeed

Solitary rectal ulcer syndrome in a teenage patient, an unrecognized cause of rectal bleeding: A case report

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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

An 8½ year old girl presented with pain abdomen with hypertriglyceremia

This article has no abstract. The first 100 words appear below: A 8 ½ year old girl, 1st issue of non-consanguineous parents, from Norshingdi immunized as per EPI  presented at the outpatient department with the history of abdominal pain for 5 days. The pain was located in the epigastric region and dull in nature. There was no aggravating or relieving factor and no radiation and persisted all the days. The pain had no relation with the food. She had also the history of vomiting for several times for the same  duration which occurred usually after feed and contained food particle and not mixed with blood or bile and it was not projectile

An 8½ year old girl presented with pain abdomen with hypertriglyceremia

This article has no abstract. The first 100 words appear below: A 8 ½ year old girl, 1st issue of non-consanguineous parents, from Norshingdi immunized as per EPI  presented at the outpatient department with the history of abdominal pain for 5 days. The pain was located in the epigastric region and dull in nature. There was no aggravating or relieving factor and no radiation and persisted all the days. The pain had no relation with the food. She had also the history of vomiting for several times for the same  duration which occurred usually after feed and contained food particle and not mixed with blood or bile and it was not projectile

A 15 year old girl presented with rectal bleeding, growth failure, digital clubbing and mental retardation

This article has no abstract. The first 100 words appear below: A 15 year old girl of non-com-sanguineous parents presented at the out-patient department with the history of intermittent rectal bleeding for the last 6 years. Rectal bleeding was painless and there was the passage of a small amount of bright red blood drop by drop after defecation. She also complained of something coming out through the anus during defecation for last one year. Mother also noticed that her child had learning difficulties and not growing well like other peers. Her menarche had not started yet. Her elder two sisters and younger two brothers are healthy. She had no family history of rectal bleeding or colorectal cancer