Adolescent Health needs - Special attention and a New Subspeciality - Adolescent Medicine

Not Available Northern International Medical College Journal Vol.11 (2) Jan 2020: 443- 446

Nebulization Practice and use of Antibiotic in the Treatment of Childhood Asthma at the Rural Area

Background : Management of childhood asthma is not optimum in our country especially at the community level. Objectives : The study was conducted to see the nebulization practice in the management of moderate and sever acute asthma in children at the community level. Methodology : This cross-sectional observational study was conducted in different private clinics and pharmacy of Daudkandi Upazila of Cumilla during the period of November 2017 to March 2018. Total 30 doctors’ diagnosed cases of acute exacerbation of moderate and severe asthma between 2-15 years of age were included in this study. Each patient’s treatment advice was followed up to see whether the use of nebulized Salbutamol and Antibiotic in the management of acute asthma was appropriate or not. All data were recorded in to a pretested proforma. Data were analyzed manually, and values were expressed as frequency and percentage. Results : Among the cases 25 (83.33%) cases had moderate and 5 (16.67%) cases had severe exacerbation of asthma. For nebulization, salbutamol was used to all cases and ipratropium bromide was added to 11 (36.7%) cases. Nebulization frequency was as per national guideline but the ratio of salbutamol respiratory solution to normal saline was not appropriate in most of the cases. Antibiotic was given to all cases and among them parenteral Ceftriaxone was given to 22 (73.3%) cases. Conclusion : Frequency of nebulization was appropriate but ratio of Salbutamol respiratory solution to normal saline was inappropriate. Antibiotic was given to all cases. Northern International Medical College Journal Vol.11 (2) Jan 2020: 471-474

Retinopathy of Prematurity – Bangladesh perspective

Retinopathy of Prematurity (ROP) results in severe visual impairment and blindness in newborns. Now a days with the advancement of the technology to save preterm infants, its incidence is also increasing in both developed and developing countries. Appropriate and timely screening program can prevent ROP and reduces the functional impairment of eyes. Many countries have their guideline for ROP screening. Bangladesh national guideline is still in progress. Hope it will be published soon. In Bangladesh practically nationwide ROP screening was started in 2013. But still most of the screening program is limited to the capital city. Vast majority of neonates who stayed in peripheral districts are still out of screening program and failed to have timely referral. The current efforts of screening program are mainly driven by the private, NGO and the Gov’t professional bodies. Northern International Medical College Journal Vol.11 (2) Jan 2020: 447- 452

Apert Syndrome: A Rare Genetic Disorder

Apert syndrome is a rare type I acrocephalosyndactyly syndrome having autosomal dominant inheritance due to mutations in the fibroblast growth factor receptors gene. New or fresh mutations are also frequent. It is characterized by dysmorphic face, craniosynostosis, severe syndactyly of the hands and feet. Apert syndrome affects the first branchial or pharyngeal arch, the precursor of the maxilla and mandible. Disturbances in the development of branchial arches during fetal period create extensive malformation in different parts of the body. Management of Apert syndrome requires a multidisciplinary approach. We, hereby, report a case of a 45-days old baby with Apert syndrome. Northern International Medical College Journal Vol.11 (2) Jan 2020: 475-477

Superficial surgical site infections following stone and non-stone bile duct surgery- A comparative analysis

Background : Superficial surgical site infection (SSSI) is a vital issue after biliary surgery. Surgical site infections remain a major cause of illness in the post-operative period. Objectives : The purpose of the present study was to compare the number of wound infection and the causative organism of surgical site infection of patient of stone and non-stone bile duct surgery. Methodology : This cross-sectional study was carried out in the Department of Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from May 2017 to April 2018 for a period of 12 months. Patients presented with biliary disease of stone and non-stone variety were selected as study population. Patients were divided into 2 groups designated as group A and group B. Patients with the biliary stone disease were enrolled in group A and the biliary nonstone disease patients were in the group B. Patients were followed up in the postoperative period up to 2 weeks to find out the incidence of wound infection and its risk factors, causative agents, and some other variables. Certain variables were closely monitored to find the postoperative outcome as these variables were standard parameters in assessment of the outcome of the study. Results : A total number of 50 patients were recruited for this study of which 25 patients were enrolled in group A and the 25 patients were enrolled in group B. Mean age was 42.48 ± 17.21 years in group A and 40.04 ± 21.37 years in group B. The difference was not statistically significant ( p=0.659). Males were predominant in both groups. Male female ratio was 1.77:1 and 1.08:1 in group A and group B respectively. Inflammatory evidence of gall bladder with pericholecystic collection was found in 5 (20%) and 6 (24%) patients in group A and group B. There was evidence of cholangitis in 8 (32%) and 4 (16%) patients in group A and group B respectively. Evidence of inflammation at the wound site, was found in 14 (56%) patients in group A and 7 (28%) patients in group B. There was statistically significant difference between these 2 groups in the incidence of superficial surgical site infection, ( p value is 0.045). Regarding per operative collected bile, we found E. Coli in 4 cases in group A and 3 cases in group B ( p value is 0.408). Klebsiella spp. was found in 1 patient in group A. Wound swab C/S identified E. Coli in 1 patient in group A. Staph aureus was found in 1 and 2 patients in group A and group B respectively ( p value is nonsignificant). Conclusion : In conclusion, there is a difference in the incidence of occurrence of surgical site infection and causative agents after stone and non-stone bile duct surgery. Stone disease has increased chance of wound infection than nonstone disease of bile ducts. Northern International Medical College Journal Vol.11 (2) Jan 2020: 458-462

Seasonal Pattern of Hand Foot and Mouth Disease in an Out-patient Clinic of a Tertiary Care Pediatric Hospital, Dhaka

Background : Hand, foot and mouth disease (HFMD) is a contagious disease of children, occurs primarily under five years of age, characterized by a history of brief febrile illness and a typical skin rash over hands and feet with or without sores in mouth, caused usually by Coxsackie virus[1]A16 viruses. It is mainly the disease of tropical and subtropical countries and bears a complex-relation with meteorological variables like temperature, rainfall and relative humidity, although no study has yet been done in Bangladesh to explain the complex relationship of the disease with these variables. Objective : This study sought to describe the occurrence of HFMD and its association with meteorological factors in Dhaka city. Methods : The present cross-sectional study collected data of 231 HFMD cases from the records of the daily register of Out-patient Department of Dhaka Shishu Hospital, Dhaka between January 2018 to December 2019. According to the study protocol a child was identified as having HFMD who had a history of brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Total numbers of cases treated monthly at OPD during the period were also recorded. Meteorological data were provided by Bangladesh Meteorological Department, which among others, included monthly average temperature, relative humidity and amount of rainfall. While the outcome variable was monthly number of HFMD cases, the predictive variables were average temperature, humidity and rainfall during the study period. Results : Majority (85.3%) children in the present study was < 5 years old. A male preponderance was observed in the series (60%) with male to female ratio being 3:2. A clustering of HFMD cases was observed to occur between June to October when monthly average temperature, total rainfall and humidity all were at their maximum compared to those found between November to April. The clustering of cases was more intense in the year 2019 than that in the year 2018. During the period average monthly temperature was 29.20C, average rainfall was 62.6% (238 mm) of the total annual precipitation and mean relative humidity was 79%. The proportion of HFMD cases out of total cases treated during the period was 2.2% in 2018 and was 4.1% in 2019, which in the dry season (November to April) was 0.4% and 0.5% in 2018 and 2019 respectively. Conclusions : The study concluded that majority of the HFMD cases occur under five years of age and boys are more likely to have the infection than the girls. A seasonality of HFMD occurrence is observed with a higher number of cases occurring in the monsoon season and fewer cases in the dry season.Clustering of HFMD cases occur between May to October when monthly average temperature, total rainfall and humidity all are at peak compared to those in November to April of the year. Northern International Medical College Journal Vol.11 (2) Jan 2020: 453-457

Immediate and Short-term Outcome of Acute Disseminated Encephalomyelitis (ADEM) after corticosteroid therapy

Background : Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disorder of the central nervous system (CNS) occurring predominantly but not exclusively in children. The presence of severe disturbance of consciousness together with multifocal neurological symptoms and signs especially in a child under 10 years of age; favours a diagnosis of ADEM. Neuroimaging is essential investigation for establishing the diagnosis of ADEM. High-dose steroid treatment frequently results in a dramatic clinical improvement. Objective: This study aimed to describe our experience with Acute Disseminated Encephalomyelitis (ADEM) focusing on the clinical features, neuroimaging, and outcome after treatment with high-dose steroid. Method: This retrospective observational study was conducted in children who were admitted as inpatients in Paediatric Neurosciences Department of Dhaka Shishu Hospital (DSH) with the diagnosis of ADEM during the period of 2017- 2019. All patients got high dose IV methylprednisolone for 5 days followed by 2 weeks tapering dose of steroid. Outcome was observed on the 7th day of treatment and 6 months after discharge from hospital. Result: A total of 16 patients who were diagnosed as ADEM were included in this study. Twelve children (75%) had a recent upper respiratory tract illness. Patients presented most often with motor deficits (88%) and secondly with altered consciousness (63% ) followed by seizure ( 50% ). MRI brain was the preferable neuroimaging which mostly (41.7%) showed multifocal symmetrical demyelination patch. On the 7th day of steroid treatment, significant improvement in motor function and level of consciousness occurred (p values were 0.001% and 0.014% respectively). After 6 months of discharge from hospital; no motor deficit, age-appropriate cognitive level and no seizure in 71%, 57% and 71% respectively. Conclusion: High dose corticosteroid treatment in ADEM is significantly effective in improvement of motor impairment and consciousness level on immediate follow up. Northern International Medical College Journal Vol.11 (2) Jan 2020: 468-470

Role of mass media in disseminating knowledge about Tuberculosis among the attendants accompanying patients of a tertiary care hospital of Bangladesh

Background : Tuberculosis (TB) is a major public health problem in Bangladesh. The use of mass media is one of the important strategies in communicating behavioural change in relation to TB prevention and the treatment. However, most of the mass media public health interventions do not sufficiently engage the people. Due to this, truly little is known about the effects of locally instigated mass media promotion. Objective : To explore role of mass media on knowledge generation about Tuberculosis transmission in Bangladesh. Methods : This cross-sectional study was conducted among 180 adult persons(attendants of patients) of different socio-economic backgrounds attending the outpatient’s departments(OPD) of a tertiary care hospital. Purposive sampling was the process of selecting the subjects. Data were collected using one pretested semi-structured questionnaire through face-to-face interview. Results : A total180 respondents were interviewed. Mean age of the respondents was 28.75 ± 8.55 years. Majority of the respondents were graduate (29.0%).A total of 20.2% respondents had adequate knowledge about TB transmission without any misconceptions. Similarly, regarding the misconceptions on modes of TB transmission, 40.5% replied that TB transmits through utensils,57.6% respondents replied that TB transmits through sharing clothes/bed sheets/towel. About 28.3% respondents had the perception that the cost of TB treatment is high. Among the respondents30.5% had the false perception that it was necessary to go to big hospitals for TB treatment. Highest 140 (77.8%) respondents said television as the source of information in TB prevention. Friends/ relatives/ teachers, newspaper, radio, billboard etc. were the other sources. Twenty did not hear of TB prevention program. Conclusion : The mass media can be effective in getting messages about TB across to the community in developing countries. In this study we found that television, newspapers, and billboards were particularly useful tools for reaching out to them with specific campaigns regarding TB control. Northern International Medical College Journal Vol.11 (2) Jan 2020: 463-467

A study on vitamin D level among the patients attending in a private chamber in Dhaka city

Background: Vitamin D deficiency is one of the most neglected public health issues all over the world. Near about 1 billion people round the world suffer from vitamin D deficiency. Most of the countries in Asia having high prevalence of vitamin D deficiency. Objective: To find the vitamin D level among the patients attending in a private chamber in Dhaka city Methodology: A cross sectional observation study was carried out in a renowned diagnostic center of Dhaka city from July 2017 to June 2018. A sample of 1523 adult patients aged 18 years and above, presented with generalized body aches and pains selected conveniently for the study. Blood samples were taken and serum vitamin D levels were measured. In this study, vitamin D concentration below10 ng/ml was considered as vitamin D deficiency, 20–30 ng/ml as insufficiency, and 30–100 ng/ml as vitamin D sufficient. Data were analyzed by using SPSS version 22. Result: Out of 1523 patients 69.5% were women and 30.5% men. Urban and rural distribution was 63.16% and 36.84% respectively. Among the participants vitamin D deficiency was 54%, 35.8% vitamin D insufficient, and only 9.8% had normal level of vitamin D, regarding age specific deficiency highest 71.8% was in 71-80 years age group. Out of 1058 female 39.5% were vitamin D deficient, 45.6% had insufficient vitamin D level. Only 14.9% female were found normal level. Age specific deficiency found highest 63.8% in 61-70 year age group. On the other hand out of 465 male participants, 24% were vitamin D deficient, 34% were insufficient and 42% had normal level vitamin D. Highest deficiency 42.5% found in age group 61-70years. Conclusion: Considering the study result deficiency was higher among female than male. In female vitamin D deficiency increased after age of 31year. Vitamin D deficiency found highest in old age and middle age group. Over all age specific deficiency found significantly highest in 71 – 80 years. In both male and female Vitamin D deficiency was found highest above 61years of age. Northern International Medical College Journal Vol.10 (2) Jan 2019: 393-396

Salmonella Hepatitis in Children : An Update

Salmonella hepatitis is one of the atypical presentations of typhoid fever and can be defined as reversible involvement of liver during the course of typhoid fever. There have been more than 150 cases of salmonella hepatitis reported both in developed and developing countries. The documented incidence varies widely from 1 to 26% of patients with Typhoid fever. It presents with jaundice and tender hepatosplenomegaly. Investigation shows slightly raised transaminase levels with or without 5 adenosine neucleosidase and or decreased prothombin time index. It complicates into hepatic encephalopathy and bleeding diathesis. A positive culture for Salmonella from blood or stool is essential to differentiate Salmonella hepatitis from other causes of acute hepatitis. Hepatic pathology is characterized by the presence of typhoid nodules with marked hyperplasia of reticuloendothelial system. The ALT/LDH ratio < 9 is suggestive of Salmonella hepatitis which is > 9 in viral hepatitis. The prognosis is usually good as Salmonella hepatitis responses with specific antibiotic therapy and jaundice resolves with clinical improvement. The clinical course can be severe with high mortality (20%) sometime. In our country where enteric fever is endemic, the recognition of Salmonella hepatitis is of clinical importance . Northern International Medical College Journal Vol.10 (2) Jan 2019: 397-399