A neuroimaging study in childhood autism

Background: Childhood autism is now widely viewed as being of developmental neurological origin. Abnormality in neuroimaging is reported in autism.Objectives: To delineate the proportion of structural magnetic resonance imaging (MRI) and electro encephalography (EEG) abnormality among the children with Autism and to assess any association of MRI and EEG changes with co morbid mental illness.Methods: It was a cross sectional descriptive study done at a child and adolescent consultation centre, Dhaka. The study was Carried out from January 2009 to December 2009. Both boys and girls were included in the study. A total of 42 children with childhood autism aged between two and 12 years partici­pated in this study. Diagnosis of autism was based on ICD-10(DCR) criteria. Results: Abnormalities were found to be 35.7% in MRI and 42.9% in EEG. EEG abnormalities were found in the form of defuse slow waves activities, generalized faster activities, epileptogenic discharge and mixed discharge. The abnormalities in MRI was found in the form of diffuse cortical atrophic changes, focal cortical atrophy in frontal and temporal cortex with widening of major sulci, prominent ventricles, periventricular degeneration and abnormal basal ganglia. EEG changes were significantly associated with increased number of co-morbid illness (mental retardation, epilepsy and others). Conclusion: A number of abnom1alities that observed in the present study indicative of relations between structural and physiological dysfunctions and childhood autism. Further exploratory and in-depth researches are certainly required in this field. Intervention of autism needs to address co morbidities for better outcome

Prevalence of Behavioral and Emotional Disorders among the Orphans and Factors Associated with these Disorders

Background: Orphans are the special group of children who are generally deprived and prone to develop psychiatric disorders even reared in well run institution. Objectives: To find out the prevalence of the behavioral and emotional disorder among the children living in orphanage in Dhaka city, and to assess the possible factors associated with the presence of disorders among this study population. Methods: It was a cross sectional descriptive study conducted in selected orphanages. A Total 342 cases were included. One stage structured assessment of psychopathology was carried out by using a valid Bangla version of DAWBA (The Development and Well-Being Assessment). Data analysis was done by SPSS for windows 16.0 version. Results: The results indicate that overall prevalence of behavioral and emotional disorders were 40.35%, in which Behavioral disorder was 26.9%, Emotional disorder was 10.2% and both Behavioral and Emotional disorder were 3.2%. Higher length of stay and low level of education of foster mother were significantly associated with psychiatric morbidity of the respondents. Conclusions: It can be concluded that behavioral and emotional disorders are highly prevalent among orphan children and adolescents with residential care that needs to be addressed. Moreover, measure for early identification and intervention will improve the quality of life of the orphan population.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10997 BSMMU J 2012; 5(1):29-3

Prevalence of Behavioral and Emotional Disorders among the Orphans and Factors Associated with these Disorders

Background: Orphans are the special group of children who are generally deprived and prone to develop psychiatric disorders even reared in well run institution. Objectives: To find out the prevalence of the behavioral and emotional disorder among the children living in orphanage in Dhaka city, and to assess the possible factors associated with the presence of disorders among this study population. Methods: It was a cross sectional descriptive study conducted in selected orphanages. A Total 342 cases were included. One stage structured assessment of psychopathology was carried out by using a valid Bangla version of DAWBA (The Development and Well-Being Assessment). Data analysis was done by SPSS for windows 16.0 version. Results: The results indicate that overall prevalence of behavioral and emotional disorders were 40.35%, in which Behavioral disorder was 26.9%, Emotional disorder was 10.2% and both Behavioral and Emotional disorder were 3.2%. Higher length of stay and low level of education of foster mother were significantly associated with psychiatric morbidity of the respondents. Conclusions: It can be concluded that behavioral and emotional disorders are highly prevalent among orphan children and adolescents with residential care that needs to be addressed. Moreover, measure for early identification and intervention will improve the quality of life of the orphan population.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10997 BSMMU J 2012; 5(1):29-3

Psychiatric disorders among the children of 5 to 18 years old of 'SIDR' affected areas

Background: Natural disasters give raise a significant amount of physical and mental impairment in human beings. Any sort of disaster acts as a causative and maintaining factor for any psychiatric morbidity. In November 15, 2007, the cyclone "SIDR" intensified to reach peak winds of 215 km/h (135 mph) according to the IMD, a peak of 250 km/h (155 mph) according to the JTWC. "SIDR" officially made landfall around 1700 UTC later that day, with sustained winds of 215 km/h (135 mph). As it intensified to a Category 4-equivalent cyclone and thus coastal districts of Bangladesh faced heavy rainfall as an early impact of the cyclone. The damage in Bangladesh was extensive, including tin shacks flattened, houses and schools blown away and enormous tree damage. The entire cities of Patuakhali, Barguna and Jhalokati District were hit hard by the storm surge of over 5 meters ( 16 ft). The head of the Red Crescent in Bangladesh expects the death toll to reach as high as 10,000. Over 3,000 other fishermen were reported missing on over 500 fishing boats. The "SIDR" left its strong impact on those who survived. Objectives: The Study was aimed to estimate the prevalence of psychiatric disorder among children and adolescents in the "SIDR" affected areas. Method: This was cross sectional, qualitative study done among the children and adolescent groups of 5 to 18 years old to see the effect of natural disaster on the people of southern part of Bangladesh. The whole of the children population who attended in the health camp were included in the study during the study period. Three teams have worked among the four "SIDR" affected districts. Each team consists of Psychiatrists, General Physicians, and Clinical Psychologist.Results: A total of 158 children in four defined areas revealed that the prevalence rate of psychiatric disorder was 48%.Conclusion: This type of study should be done in multi-centers in SIDR affected disti.icts of Bangladesh to find out the actual prevalence rate of child and adolescent psychiatric disorder

An international analysis evaluating frontline bendamustine with rituximab in extranodal marginal zone lymphoma

: Extranodal marginal zone lymphoma (EMZL) is a heterogeneous non-Hodgkin lymphoma. No consensus exists regarding the standard-of-care in patients with advanced-stage disease. Current recommendations are largely adapted from follicular lymphoma, for which bendamustine with rituximab (BR) is an established approach. We analyzed the safety and efficacy of frontline BR in EMZL using a large international consortium. We included 237 patients with a median age of 63 years (range, 21-85). Most patients presented with Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1 (n = 228; 96.2%), stage III/IV (n = 179; 75.5%), and intermediate (49.8%) or high (33.3%) Mucosa Associated Lymphoid Tissue International Prognosis Index (MALT-IPI). Patients received a median of 6 (range, 1-8) cycles of BR, and 20.3% (n = 48) received rituximab maintenance. Thirteen percent experienced infectious complications during BR therapy; herpes zoster (4%) was the most common. Overall response rate was 93.2% with 81% complete responses. Estimated 5-year progression-free survival (PFS) and overall survival (OS) were 80.5% (95% CI, 73.1% to 86%) and 89.6% (95% CI, 83.1% to 93.6%), respectively. MALT-IPI failed to predict outcomes. In the multivariable model, the presence of B symptoms was associated with shorter PFS. Rituximab maintenance was associated with longer PFS (hazard ratio = 0.16; 95% CI, 0.04-0.71; P = .016) but did not impact OS. BR is a highly effective upfront regimen in EMZL, providing durable remissions and overcoming known adverse prognosis factors. This regimen is associated with occurrence of herpes zoster; thus, prophylactic treatment may be considered

Impact of Early Relapse within 24 Months after First-Line Systemic Therapy (POD24) on Outcomes in Patients with Marginal Zone Lymphoma: A US Multisite Study

Progression of disease within 24 months (POD24) from diagnosis in marginal zone lymphoma (MZL) was shown to portend poor outcomes in prior studies. However, many patients with MZL do not require immediate therapy, and the time from diagnosis-to-treatment interval can be highly variable with no universal criteria to initiate systemic therapy. Hence, we sought to evaluate the prognostic relevance of early relapse or progression within 24 months from systemic therapy initiation in a large US cohort. The primary objective was to evaluate the overall survival (OS) in the two groups. The secondary objective included the evaluation of factors predictive of POD24 and the assessment of cumulative incidence of histologic transformation (HT) in POD24 versus non-POD24 groups. The study included 524 patients with 143 (27%) in POD24 and 381 (73%) in non-POD24 groups. Patients with POD24 had inferior OS compared to those without POD24, regardless of the type of systemic therapy received (rituximab monotherapy or immunochemotherapy) at diagnosis. After adjusting for factors associated with inferior OS in the univariate Cox model, POD24 remained associated with significantly inferior OS (HR = 2.50, 95% CI = 1.53-4.09, p = 0.0003) in multivariable analysis. The presence of monoclonal protein at diagnosis and those who received first-line rituximab monotherapy had higher odds of POD24 on logistic regression analysis. Patients with POD24 had a significantly higher risk for HT compared to those without POD24. POD24 in MZL might be associated with adverse biology and could be used as an additional information point in clinical trials and investigated as a marker for worse prognosis

Clinical Profile and Comorbidity of Obsessive-Compulsive Disorder among Children and Adolescents: A Cross-Sectional Observation in Bangladesh

Obsessive compulsive disorder (OCD) is a common disorder characterised by persistent and unwanted intrusive thoughts, images, and urges and repetitive behaviours or mental acts and can cause pervasive impairments. In Bangladesh, the prevalence of OCD among children is 2% which is higher than in previous reporting. This study was aimed at looking into the type, frequency, and severity of symptoms of OCD and comorbidity among children and adolescents. A consecutive 60 OCD cases from a child mental health service with age range of 5–18 years were recruited and divided into below and above 12 years of age group. The assessment was carried out using standardized Bangla version of Development and Wellbeing Assessment and Children’s Yale-Brown Obsessive Compulsive Scale was administered. Of the obsession, contamination was the highest followed by doubt, and of the compulsion, washing/cleaning was the highest followed by checking, repeating, and ordering rituals. More than half of the subjects had severe OCD and comorbidity was present in 58% subjects. Specific phobia, social phobia, major depressive disorder, and tic disorder were more prevalent. These symptoms and comorbidity profile can serve the baseline data for a country like Bangladesh and further large scale study would better generalize the study results