Pre-diabetes and Type 2 Diabetes Status in Overweight and Obese Children in a Tertiary Care Hospital of Bangladesh

Introduction: Obesity in childhood is associated with many co-morbid conditions; one of them is alteration of glucose metabolism. Materials and Methods:This cross-sectional study was conducted among 100 overweight and obese children aged 5-16 years to determine the status of pre-diabetes (IFG and IGT) and type 2 diabetes mellitus (T2DM), attending the OPD, BSMMU, Dhaka. All overweight/obese children were included according to BMI for age and sex using CDC growth chart. Children taking steroid for any cause or having any endocrine disorder or syndrome was excluded from the study. Anthropometry and blood pressure measurement were done and skin manifestations of insulin resistance were looked for. Fasting lipid profile and oral glucose tolerance test (OGTT) was done for each child. Result: Among the studied children 62% were male and 38% female, 77% were obese and 23% were over weight. Evidence of insulin resistance were found among most of the children and most common evidence was dyslipidemia (80%) followed by acanthosis nigricans(76%). Skin manifestation of polycystic ovary syndrome (PCOS) was found in 3% of children. Impaired fasting glucose (IFG) was found in 4% and Impaired Glucose Tolerance (IGT) was found in 7% of children among them 4% had both IGT and IFT. No child was found diabetic in this study. Conclusion:Altered glucose metabolism was present in overweight and obese children of our children, so screening is recommended. Bangladesh J Child Health 2020; VOL 44 (3) :143-147

CANDLE Syndrome: Case Report of a Rare Type of Auto- Inflammatory Disease

CANDLE syndrome (chronic atypical neutophilic dermatosis with lipodystrophy and elevated temperature) is an autoinflammatory disease/syndrome characterized by recurrent fever, skin lesions, and multisystem inflammatory manifestations. Most of the patients have shown mutation in PSMB8 gene. Here, we report a 9-year-old girl with recurrent fever, atypical facies, widespread skin lesions, generalized lymphadenopathy, hepato-splenomegaly, lipodystrophy, and failure to thrive. Considering the clinical features and laboratory investigations including skin biopsy findings, diagnosis was consistent with CANDLE syndrome. Therefore, it is recommended to consider CANDLE syndrome in a young child who presents with recurrent fever, characteristics rashes, organomegaly and failure to thrive. Bangladesh J Child Health 2020; VOL 44 (3) :174-177

Study on Bacteriological Profile and Sensitivity Pattern of the Organisms in Neonatal Sepsis

Background: Sepsis in neonates by resistant strains remains a significant cause of mortality and morbidity in developing countries. This study attempted to find out the organisms responsible for early onset sepsis (EOS) and late onset sepsis (LOS) and determine their antimicrobial sensitivity pattern. Materials & Methods: This prospective observational single centre study was conducted on 1000 neonates during January to September 2018, that were investigated for rule out sepsis, at the Neonatal Intensive Care Unit of Ad-din Medical College Hospital, Dhaka. Results: Fifty-four neonates were found with culture proven sepsis.Coagulase-negative Staphylococci (CONS) (68.42%)was the commonest and followed by Acinetobacter (18.42%) were found on culture isolates in EOS. In LOS, CONS (75%) is the most predominant organism. Among the gram negative Acinetobacter (50%) was the most prevalent bacteria followed by E.coli (28.57%). None of the gram positive isolates were sensitive to Amikacin. Majority of the gram positive showed susceptibilities to Vancomycin (83%) and Linezolid (78%). Among gram negative isolates 93% were sensitive to Colistin, 63% to Gentamicin & 54% to Levofloxacin. Conclusion: Present study indicated that gram positive species especially CONS continue to be the predominant causative organism in both EOS and LOS and followed by Acinetobacter and E. coli in gram negative species. Bangladesh J Child Health 2020; VOL 44 (3) :133-138

Central Precocious Puberty as a Complication of Congenital Adrenal Hyperplasia in a Boy: Case Report

Precocious puberty has intense influence on physical and psychosocial well-being of affected children and raises a lot of concerns as well as uncertainties in family.Here,we report a case of Central precocious puberty (CPP)superimposed on peripheral precocious puberty (PPP) due to congenital adrenal hyperplasia(CAH). Bangladesh J Child Health 2020; VOL 44 (3) :184-187

Clinical and Laboratory Profiles of Children with West Syndrome: Experience of 50 Cases in a Tertiary Hospital in Bangladesh

Background: West Syndrome (WS) consists of epileptic spasms, hypsarrhythmia on EEG and psychomotor delay or regression in children. Objective: To observe the clinical and laboratory profiles of children with west syndrome. Materials & Methods: This was a cross sectional study and done from July 2017 to June 2018 in Pediatric Neurology OPD, NINS among total 50 cases of WS (age of > 2 month to 2 years). WS was diagnosed by direct observation or video recording of spasm, along with history of developmental delay or regression and EEG change. Collected data regarding demography, detailed of spasm, clinical examination, radiological and EEG findings were analyzed. Results: Mean age of the patients was 12.61 ± 7.11 months. Males (58.0%) were predominant than females (42.0%). Mean age of onset of spasm was 5.88 ± 3.73 months. Type of spasm: Flexor in 88.0% cases, extensor in 6.0% cases, mixed in 4.0% and asymmetric in 2.0%. Microcephaly was present in 90.0% cases and in 64% cases H/o perinatal asphyxia (PNA) was present. In EEG, Hypsarrhythmia was found in 62.0% cases and modified hypsarrhythmia in 38.0% cases. In CT scan of brain, cerebral atrophy was found in 62.5.0% cases, stroke in 6.0% cases. Out of all WS patients 82% were symptomatic and 18% were either cryptogenic or idiopathic. Conclusion: Flexor type spasm was found more commonly in West syndrome. History of perinatal asphyxia (PNA) was present in majority of cases. In EEG findings, hypsarrhythmia was found more than modified hypsarrhythmia. Bangladesh J Child Health 2020; VOL 44 (3) :139-142

Neonatal COVID-19 in A Tertiary Care Hospital of Chattogram: A Case Report

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China in December 2019 and now has led to a global pandemic. The incidence is lower in neonates. A five days old newborn infant got admitted with history of reluctance to feeding and less movement. On admission, the newborn infant was found to be lethargic, icteric, tachypnoeic, afebrile with SPO2 of 90% throughout his hospital stay. Chest x-ray was normal but RT-PCR for COVID-19 was positive. His mother had symptoms of COVID-19 with positive RTPCR. The neonate was isolated and was treated with antibiotics along with supportive care, then improved gradually and was discharged on day 10 of his age. Suspicion about COVID-19 in newborn infants with prompt identification is essential to limit its transmission in the community. Bangladesh J Child Health 2020; VOL 44 (3) :170-173

Notes & News vol. 44(3)

not available Bangladesh J Child Health 2020; VOL 44 (3) :190-191

Nephrotic Range of Proteinuria in Congenital Cyanotic Heart Disease: A Rare Complication

Nephrotic syndrome is a common renal problem in children. But it is an uncommon complication for cyanotic heart diseases. It has been rarely reported in pediatric population with congenital cyanotic heart disease in Bangladesh. We found two cases of congenital cyanotic heart disease those were referred to investigate for nephrotic range of proteinuria. Bangladesh J Child Health 2020; VOL 44 (3) :178-180

Bronchiolitis: State-of-the-art

The commonest cause of respiratory distress in young children is bronchiolitis. Bronchiolitis is an acute viral lower respiratory tract infection which predominantly affects children up to two years of age. It is a seasonal disease, dominating winter months, with a peak over 6 to 8 weeks around the winter solstice. The evidence and guideline recommendations consistently support a clinical diagnosis with the limited role for diagnostic testing for children who present with the typical clinical features of viral upper respiratory infection progressing to the lower respiratory tract. Management is largely supportive, focusing on maintaining oxygenation and hydration. Evidence suggest no benefit from bronchodilator or corticosteroid use in infants with first episode of bronchiolitis. Evidence for other treatment such as hypertonic saline is evolving. In case of severe bronchiolitis, there is some role for high-flow nasal cannula and continuous positive airway pressure use. Bangladesh J Child Health 2020; VOL 44 (3) :161-169

Cockayne Syndrome with ERCC8 Gene Mutation: A Case Report

Cockayne syndrome (CS) is a genetic disorder characterized by growth failure, microcephaly, cognitive delay, visual and hearing disorders. Patients usually present with dysmorphism and global delay. It is an autosomal recessive disorder, mutation of two genes ERCC8 and ERCC6 were observed. We report a 4 year old child who was diagnosed as a case of Cockayne syndrome, based on clinical, neuroimaging and genetic study findings. This case had growth failure, dysmorphism, optic atrophy, global developmental delay, intracerebral calcification and mutation of ERCC8 gene. Bangladesh J Child Health 2020; VOL 44 (3) :181-183