Detection of Mumps virus of Genotype G in Bangladeshi children suffering from Encephalitis

Although mumps virus (MuVi) is an important agent of encephalitis, however, mumps vaccine has not yet been included in the national immunization programme of Bangladesh. Furthermore, the genotype distribution of this virus in Bangladesh is unknown. Cerebrospinal fluid samples collected from 97 children with encephalitis from April 2009 to March 2010 were subjected to polymerase chain reaction (PCR) test to determine the causative agents. MuVi was detected in two samples, these samples were further subjected to conventional PCR using specific primers, then amplicons were sequenced, and genotype was determined as genotype G. Phylogenetic analysis showed that these strains were clustered with strains from Nepal, India, the UK, Thailand, and the USA. By Bayesian inference, we also determined that the ancestor of Bangladeshi and Indian MuVi were same and segregated only about two decades back. These results will help future surveillance and the detection of invading MuVi strains from other countries

Anti-HBs Titer in Children With Nephrotic Syndrome Admitted to a Tertiary Care Hospital: Anti-HBs Titer in Children With Nephrotic Syndrome

Background and Aim: Nephrotic syndrome (NS) is the most common pediatric renaldisease. Immune dysregulation, prolonged immunosuppressive treatment, and recurrentprolonged proteinuria in NS cause alterations in serum immunoglobulins, especiallyhypogammaglobulinemia. Thus, anti-HBs titer may be reduced in NS patients. We assessedanti-HBs titer among hepatitis B-vaccinated children with NS.Methods: This case-control study was conducted at the Department of Paediatrics of theInstitute of Child & Mother Health, Dhaka, from July 2020 to June 2021. Sixty-one childrenwith primary and recurrent NS previously vaccinated according to the expanded programmeon immunization program were evaluated for anti-HBs titer and compared with 61 age- andsex-matched healthy children.Results: Protective anti-HBs titer was found in 29(47.5%) and 40(65.6%) cases in the case andcontrol groups, respectively. The mean anti-HBs titer was 37.2±35.5 IU/L in the case groupand 55.7±28.3 IU/L in the control group, which showed a significant difference between thegroups. The mean anti-HBs titer was 52.9±35.5 IU/L in the first attack, 33.9±36.8 IU/L in theinfrequent relapse nephrotic syndrome (IFRNS), and 22.2±27.41 IU/L in the frequent relapsenephrotic syndrome (FRNS), respectively. The difference was also significant statistically.The mean anti-HBs titer was lower in the FRNS and IFRNS and significant in the FRNScompared to the first attack. The mean anti-HBs titer was significantly (P<0.05) lower in theIFRNS and FRNS compared to the controls.Conclusion: Anti-HBs titer was found significantly lower than the protective level in the firstattack and relapse cases of NS

Increased serum vascular endothelial growth factor is associated with acute viral encephalitis in Bangladeshi children

Abstract Encephalitis causes significant global morbidity and mortality. A large number of viruses cause encephalitis, and their geographic and temporal distributions vary. In many encephalitis cases, the virus cannot be detected, even after extensive testing. This is one challenge in management of the encephalitis patient. Since cytokines are pivotal in any form of inflammation and vary according to the nature of the inflammation, we hypothesized cytokine levels would allow us to discriminate between encephalitis caused by viruses and other aetiologies. This pilot study was conducted in a tertiary care hospital in Dhaka, Bangladesh. Viral detection was performed by polymerase chain reaction using patient cerebrospinal fluid. Acute phase reactants and cytokines were detected in patient serum. Of the 29 biomarkers assessed using the Wilcoxon rank-sum test, only vascular endothelial growth factor (VEGF) was significantly higher (P = 0.0015) in viral-positive compared with virus–negative encephalitis patients. The area under the curve (AUC) for VEGF was 0.82 (95% confidence interval: 0.66–0.98). Serum VEGF may discriminate between virus-positive and virus-negative encephalitis. Further study will be needed to confirm these findings

Effectiveness, safety and economic viability of daycare versus usual hospital care management of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh: a cluster randomised controlled trialResearch in context

Summary: Background: We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia. Methods: This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2–59 months with severe pneumonia with or without malnutrition received DCA or UC. The DCA treatment settings comprised of urban primary health care clinics run by NGO under Dhaka South City Corporation and in rural Union health and family welfare centres under the Ministry of Health and Family welfare Services. The UC treatment settings were hospitals in these respective areas. Primary outcome was treatment failure (persistence of pneumonia symptoms, referral or death). We performed both intention-to-treat and per-protocol analysis for treatment failure. Registered at www.ClinicalTrials.gov, NCT02669654. Findings: In total 3211 children were enrolled, 1739 in DCA and 1472 in UC; primary outcome data were available in 1682 and 1357 in DCA and UC, respectively. Treatment failure rate was 9.6% among children in DCA (167 of 1739) and 13.5% in the UC (198 of 1472) (group difference, −3.9 percentage point; 95% confidence interval (CI), −4.8 to −1.5, p = 0.165). Treatment success within the health care systems [DCA plus referral vs. UC plus referral, 1587/1739 (91.3%) vs. 1283/1472 (87.2%), group difference 4.1 percentage point, 95% CI, 3.7 to 4.1, p = 0.160)] was better in DCA. One child each in UC of both urban and rural sites died within day 6 after admission. Average cost of treatment per child was US$94.2 (95$184.8 (95% CI, 178.6 to 190.9) for DCA and UC, respectively. Interpretation: In our population of children with severe pneumonia with or without malnutrition, >90% were successfully treated at Day care Clinics at 50% lower cost. A modest investment to upgrade Day care facilities may provide a cost-effective, accessible alternative to hospital management. Funding: UNICEF, Botnar Foundation, UBS Optimus Foundation, and EAGLE Foundation, Switzerland