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   Table of Contents - Current issue
January-June 2022
Volume 7 | Issue 1
Page Nos. 1-43

Online since Tuesday, May 31, 2022

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Is antibiotic prophylaxis mandatory to prevent renal damage or recurrence of UTI? p. 1
Md Habibur Rahman
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Urinary calcium and uric acid excretion in children with UTI having vesicoureteral reflux p. 3
Sufia Khatun, Md Habibur Rahman, Ishrat Jahan, Rezwana Ashraf, SK M Nazmul Hasan, Nayema Afroje, Abdullah Al Mamun, Mohammad Maajharul Islam, Rezaul Karim
Introduction: Patients with urinary tract infection (UTI) associated with vesicoureteric reflux (VUR) are prone to develop hypercalciuria and hyperuricosuria compared with UTI patients without VUR, which may lead to the formation of stones due to stasis, infection, and inflamed urinary mucosa. Objective: To assess calcium and uric acid excretion in children with VUR and without VUR having a history of treatment for UTI. Materials and Methods: This cross-sectional and analytical study was conducted in the Department of Paediatric Nephrology and Urology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Sixty-one children of both sex from 2 months to 12 years were treated for UTI 4 weeks prior to enrollment for the study and evaluated by micturating cystourethrogram taking all precautionary measures to detect VUR. Patients were grouped into Group A (30 patients with VUR) and Group B (31 patients without VUR). Fasting urine was analyzed for calcium/creatinine (Ca/Cr) and uric acid/creatinine (UA/Cr) ratios. Urinary calcium and urinary uric acid levels were determined by the colorimetric test, and urinary creatinine was measured by the clinical risk and error analysis method by using the Dimension RxL Max System (SIEMENS) of both groups of patients in the Department of Biochemistry, BSMMU. Results: Median (min–max) of Ca/Cr ratio was 0.207 (0.034–0.646) and 0.150 (0.090–0.500) in Group A and Group B, respectively, and the difference between these two groups was statistically significant (P < 0.050). Median (min–max) of UA/Cr ratio was 0.972 (0.307–1.951) and 0.616 (0.500–1.390) in Group A and Group B, respectively, and the difference between these two groups was also statistically significant (P < 0.050). Hypercalciuria was significantly higher in Group A (20.0%) than in Group B (3.2%; P < 0.050). Similarly, hyperuricosuria was significantly higher in Group A (33.3%) than in Group B (6.5%; P < 0.05). Conclusion: Children with VUR having UTI may have a higher level of hypercalciuria and hyperuricosuria than those without VUR.
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Intellectual disability in young children with hearing impairment: Study from a tertiary care center in Bangladesh p. 6
Sheikh Mosammat Fatema Ferdousy, Md Mizanur Rahman, Kanij Fatema, Shaheen Akhter
Background: Hearing impairment (HI) is an important disability hampering the overall development, particularly cognitive domain in children. Coexistence of HI with intellectual disability (ID) affects adversely the overall prognosis of a child. To highlight this underdetermined issue, this study has been done to determine the proportion of ID in children of HI. Materials and Methods: This cross-sectional study is held in children with HI of 0–42 months. In the study subjects, psychological assessment was done by Baily Scale of Infant Development III (BSID III). Detailed history was taken; physical examination was done in each patient after taking informed written consent. Hearing assessment was done by an audiologist and was leveled as mild, moderate, severe, and profound. Results: The study subject was 203, and mean age was 27.2 ± 8.7 (3–42) months. There was a slight male predominance. Majority of children mode of birth was lower uterine segment cesarean section. Neonatal seizure was significantly associated with intellectual impairment in the study subject (P <0.001). No significant association of the HI was found in different levels of intellectual status of the children; however, 35% of the study subject had borderline intellectual status and most of them belonged to the profound HI. Conclusion: A significant proportion of the study subjects had borderline intellectual status, although very limited numbers had ID. Moreover, children with profound hearing loss were most affected.
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Neonatal surgery during Covid-19 pandemic: Our experience in a tertiary care hospital in Bangladesh p. 10
Tosaddeque H Siddiqui, Zeba Ahmed, Nazrul Islam, Noor Mahammad, Abu Mohammad Shahinoor, Shahinur Rahman, Mridul P Joshi
Background: The impact of Covid-19 on global health and especially on the low-resource countries’ health system has been serious. The lack of personal protective equipment, masks, sanitizers, and lack of testing has made the surgical delivery even more challenging. These delays in management of these surgical cases are going to stack up in the future and increase mortality and morbidity. However, the emergent nature of some of the neonatal surgical cases cannot be postponed. Materials and Methods: This is a retrospective observational study done from April 2020 to September 2020 in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Surgical neonates were tested for SARS-CoV-2 by using the real-time PCR on oropharyngeal swabs. The reports of the tests were received only 24 h later. Results: A total of 22 neonates with surgical conditions were admitted during the study period. Eighteen were tested for Covid-19, whereas 4 were tested but reports were not awaited for surgery. All the babies tested negative for Covid-19. There were a variety of cases admitted, predominately hydronephrosis, clubfoot, meningocele, intestinal obstruction, cleft lip, and palate. Among the 22 surgical neonates, 6 received the surgical management, whereas 16 were managed conservatively and kept on follow-up. Regarding the outcome, 17 patients (3 managed surgically and 14 nonemergent cases were managed conservatively) were discharged to home. Mortality were 5 in number (3 postoperative patient and 2 while managing conservatively). Conclusion: During the unprecedented times of Covid-19, extreme precaution and protocol must be followed to carry on neonatal surgeries to protect both health workers and children.
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Multidrug-resistant organisms in urinary tract infections in Bangladeshi children: Where are we? p. 13
Md Ziaur R Chowdhury, Md Benzamin, Mohsina Khatoon, Tuhin B Tamal
Background: The incidence of antibiotic-resistant urinary tract infections (UTIs) in children, particularly multidrug-resistant (MDR) UTIs, is increasing day by day. Aims: The aim of this article is to describe the incidence of MDR UTIs in a pediatric population of Bangladesh. Materials and Methods: This retrospective, observational study was carried out by the Microbiology Department of Sylhet Women’s Medical College, Sylhet and Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. We reviewed the data record software of Microbiology Department of Sylhet Women’s Medical College and Popular Diagnostic Centre, Sylhet from April 2021 to October 2021 and collected all the urine culture-positive reports with symptom (UTI) and without symptom (asymptomatic bacteriuria) of children (0–18 years) and antibiotic sensitivity to different organisms. Patients with incomplete data were excluded from this study. A total of 39 patients were evaluated, and data were entered into Microsoft Excel and analyzed by SPSS software. This study got ethical approval from Departmental Review Board of Sylhet Women’s Medical College, Sylhet, Bangladesh. Results: Thirty-nine patients, including 13 (33.3%) males and 26 (66.7%) females, were included in this study, with a 1.92:1 female-to-male ratio. The mean age was 100.5 months (SD 90.5 months). MDR organism was identified in 23 patients (55%). Escherichia coli was the most common organism, found in 23 (59%) of the cultures, with the next being Klebsiella spp. 12 (30.8%), Enterococcus spp. 2 (5.1%), Pseudomonas aeruginosa 1 (2.6%), and Staphylococcus aureus 1 (2.6%). About 48% of E. coli, 75% of Klebsiella, 100% of Enterococcus, and 100% of Pseudomonas were MDR. Imipenem is 100% sensitive and linezolid is 100% resistant. Among the oral drugs, nitrofurantoin had less resistance. Conclusion: The majority of UTIs in children are MDR, with E. coli being the most common organism.
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A contemporary overview of urinary tract infection (UTI) in children p. 19
Ranjit R Roy, Rummana T Tonny, Nadira Sultana, Abdullah Al Mamun, Tahmina Jesmin
Urinary tract infection (UTI) is the most common and serious bacterial infection in the pediatric age group. It is more prevalent in girls than in boys, except in early infancy. Escherichia coli is responsible for 80–90% of cases of pediatric UTI. The occurrence and severity of this illness are largely mediated by bacterial virulence factors and host defense mechanism. The clinical manifestations of UTI in children are highly heterogeneous, and non-specific collection of urine sample to diagnose the condition accurately is quiet challenging for young pre-continent children. Till date, urine culture is the gold standard for diagnosing UTI. Selection of appropriate antibiotic for the treatment of UTI must be guided by the local guideline and current sensitivity pattern. Ideal imaging protocol and use of antibiotic prophylaxis are still a matter of debate. Current trend is less use of antibiotic prophylaxis due to increasing antibiotic resistance. Prophylaxis cannot alter the long-term consequences, like renal scarring in selected patients. The debate on the indication and duration of antibiotic prophylaxis is still ongoing. So, this review aimed to provide a contemporary overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, complications, and preventive measures of UTI including chemoprophylaxis in pediatric population. It also highlights the conflicting recommendations of international guidelines, which reveal the necessity of further research to establish the tailored approach of pediatric UTI.
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Case-based management of nephrotic syndrome: A review and update p. 29
Golam M Uddin, Mst Shanjida Sharmim, Tahmina Jesmin, Abdullah Al Mamun
Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. The most common cause of NS is idiopathic NS (INS). Minimal change NS (MCMS) is more than 80% in patients with favorable outcomes. However, a few children have focal segmental glomerulosclerosis along with secondary causes, which are at risk for complications. Complications may be disease-associated or may be drug-related complications. Disease-related complications include infections (e.g., peritonitis, sepsis, cellulitis, chicken pox), thrombo-embolism, hypovolemic crisis, hypercholesterolemia, acute kidney injury (AKI), anemia and other AKIs, hypothyroidism, hypocalcemia, and bone disease. The majority of children with MCNS respond to corticosteroids or cytotoxic agents, alkylating agents, cyclosporine A, and mycophenolate mofetil. Early detection and management of these complications will improve outcome for these patients with NS. This article provides an update of current available therapeutics strategies and case-based management of common complications of NS.
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Henoch–Schönlein purpura: Simultaneous occurrence in two siblings—Case reports p. 34
Mumtahena Mahmuda, Nusaiba Deen Muhammad, Nita Chowdhury, Deva Pratim Barua, Susmita Biswas, Mohammed Maruf-Ul- Quader
Henoch–Schönlein purpura (HSP) is one of the most common vasculitis in children. Typically, HSP is considered to be self-limiting, although renal involvement (HSP nephritis) is the principal cause of morbidity from this disease. Familial cases of this disease are not common. Only a few cases have been reported. A 7-year-old girl presented with a history of (H/O) abdominal pain, arthritis, and purpuric rash on lower extremities. Laboratory investigations revealed hematuria, proteinuria, and thrombocytosis with a normal IgA level. Renal biopsy revealed mesangial and focal endocapillary proliferative glomerular morphology with partial cellular crescent. Two weeks later, a sister of the first case presented with palpable purpura without any arthritis or nephritis. In both the cases, there was no H/O any upper respiratory tract infection or atopy. Herein, we speculated that the environmental factors may be responsible for the simultaneous occurrence of HSP in a genetically susceptible environment.
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Renal replacement therapy (hemodialysis) in acute pancreatitis with acute tubular necrosis following injury by a cricket ball p. 37
Tahmina Ferdaus, Shireen Afroz, Sukrity Baroi, Umme Tanjila, Farhana Yasmin, Mohammod Hanif
Acute pancreatitis (AP) with severe acute kidney injury (AKI) is rare in children and is associated with high morbidity and mortality rates. We report a case of a 12-year-old boy who presented with upper abdominal pain, vomiting, and anuria following injury by a cricket ball. After resuscitation and investigation of the child, AP with AKI was diagnosed. This severe AKI needs renal replacement therapy (RRT). RRT is used to augment normal kidney function to rapidly remove toxic metabolites. We obtained central vascular access which is appropriate for his body size. We prepared a dialysate solution containing standard bicarbonate-buffered dialysate. Priming the circuit with dilute packed red blood cells was done due to his low hematocrit level. A beneficial effect of using RRT to facilitate recovery of renal function to RRT independence and reduce the long-term risk of chronic kidney disease was observed when used as initial supportive modality. Ultrasound-guided renal biopsy reported acute tubular necrosis and it was performed after recovery from his critical period.
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Hypernatremic dehydration with acute kidney injury in a neonate: A therapeutic challenge p. 41
Azmeri Sultana, Sharmin Afroze, Israt Jahan, Abdul Baten
Neonatal hypernatremic dehydration is not so uncommon and causes high morbidity and mortality if associated with acute kidney injury (AKI). We herein discuss a neonate who presented with serum sodium of 193 mmol/L with AKI, and we successfully treated this neonate with peritoneal dialysis.
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