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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 6 | Issue 1
Page Nos. 1-58

Online since Wednesday, December 29, 2021

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EDITORIAL  

Urgency for pediatric critical care management in Bangladesh p. 1
Shahana Akhter Rahman, Mujammel Haque
DOI:10.4103/pnjb.pnjb_5_21  
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ORIGINAL ARTICLES Top

Non-compliance in pediatric nephrotic syndrome p. 4
Ranjit Ranjan Roy, Md. Murad Chowdhury, Amit Kumar Datta, Modasseer M Hossain, Tahmina Jesmin, Abdullah Al Mamun, Mst. Shanjida Sharmim
DOI:10.4103/pnjb.pnjb_8_21  
Background: Non-compliance to medications and health advice significantly impact care of patients as well as impose financial burden in nephrotic syndrome (NS) patients. Aim: The aim of this article is to determine the cause and consequence of non-compliance in NS patients. Materials and Methods: This prospective study was conducted between March 2020 and February 2021 in the department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Seventy-seven NS patients were recruited randomly. In-person interviews were conducted with attendents of patients, along with patients if possible. Clinical and laboratory data were collected from medical records. Residence, financial constraints, educational status, health advices (daily bed side urine test), relapses of disease, different types of immunosuppressive medications, etc. were provided for the cause of non-compliance. Consequences of non-compliance were observed through the experience of relapses, asthma attack or infection, and drug toxicity. Data were analyzed using SPSS software version 20. Results: A total of 77 patients were analyzed and among them 74.02% were non-compliant and 25.98% were compliant. Among the non-compliant patients, non-compliance to asthma medication, prednisolone, second-line immunosuppressive drugs, and third-line immunosuppressive drugs were 43.87%, 31.57%, 14.03%, and 10.53%, respectively. About 56.14% of the patients did not do bed side urine for albumin (BSUA). Remote location (63.15%), financial constraints (36.84%), low parental education (35.09%), ignorance (17.54%), and undetermined cause (17.50%) were observed as main contributing factors for non-compliance. Among study populations, 77.19% experienced more relapses in comparison to compliance (10%). Non-compliant patients experienced more asthma attack (70.17%, 40/57), pneumonia (63.2%), and steroid toxicity (36.8%) in comparison to the compliance group (45%, 36.8%, and 10%, respectively). About 31.57% of the non-compliant group had spent 30,000–70,000 taka in comparison to 5% in the compliance group and it was statistically significant (P = 0.031). Conclusion: Poor compliance to medications and health-related advices have diverse effects including frequent relapse, drug toxicity, higher rates of complications and hence increased healthcare cost. Remote location, ignorance, and idiopathic causes were major contributing factors behind non-compliance issue. Appropriate counseling might change this prevailing non-compliance scenario in future.
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Prevalence and outcome of severe acute kidney injury in children in a critical care nephrology unit p. 13
Shireen Afroz, Tahmina Ferdaus, Farhana Yasmin, Umme Tanjila, Sukriti Baroi
DOI:10.4103/pnjb.pnjb_3_21  
Background: This prospective observational study was conducted to see the prevalence, etiology, clinical profile, and immediate outcome of community-acquired acute kidney injury (AKI) in a pediatric critical care nephrology setup in Bangladesh. Materials and Methods: The prevalence, etiology, outcome, and fatality predictors of critically ill children with AKI, aged 5 days to 17 years from January 2016 to June 2018 were studied at Dhaka Shishu (Children) Hospital, Bangladesh. AKIN criteria were used to screen AKI. They were given supportive care and dialysis. Results: The prevalence of AKI among 725 patients was 61%. All the AKI cases were at AKIN stage III. Pre-renal cause accounted for 63%, renal 19% and post-renal 18%. The most common etiology of pre-renal AKI was post-diarrheal hypovolemia (50%), renal cause of AKI includes glomerulonephritis (45%) and among post-renal cause posterior urethral valves was 78%. Hypovolemia and shock were found in 12% of cases. Congestive cardiac failure (10%), hypertensive crisis (7%), severe hypernatremia (24%), severe metabolic acidosis (11%), and dialysis requirement (76%) were found to be associated with the worst outcome. Fifty-one percent improved with normal renal function. Of 441 AKI cases, 201 (46%) improved and among them 102 (51%) regained with normal renal functions. Approximately 99 (49%) with partial renal recovery and most (41) of them were due to renal cause of AKI. The overall worst outcome was observed in 54% and mortality in 40%. The highest mortality was found among neonates (60%) and infants (41%). Glasgow coma scale was <3 in 16% cases. Need for mechanical ventilation (11%) and longer hospital stay >30 days (9%) were the important predictors of fatality in AKI. Conclusion: Higher prevalence of severe AKI was associated with high mortality in neonates and infants in critical-care setup. Longer hospital stay and need for dialysis and mechanical ventilator predicted worst outcome.
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Sonographic evaluation of hydronephrosis in pediatric patients and correlation with intravenous urography p. 21
Dewan Afsana Shomee, Mahmuda Sultana, Md Shahin Reza, Sk Muhammad Atiqur Rahman, Elora Afroz Leema, Kanij Fatema
DOI:10.4103/pnjb.pnjb_4_21  
Introduction: This cross sectional study was carried out with an aim to evaluate the accuracy of ultrasonography (USG) in the evaluation of hydronephrosis (HDN) in pediatric age group. Methodology: The study was carried out from January 2017 to November 2017 in the Department of Radiology and Imaging, Sir Salimullah Medical Collage and Mitford Hospital, Dhaka. Eighty two patients aged from 1-18 years, admitted as suspected HDN were included as study subject. Result: In this study, the mean age of the patients was 6.31 (±3.34) years and 46.3% belonged to 5 years age group. Male and female ratio was approximately 2:1, 55 (67.1%) were male. Regarding the presenting complains, loin pain was most common (81.7%) feature. Recurrent urinary tract infection (URI) was observed in 52.4%, hematuria in 29.3%, flank mass in 18.3%, vomiting in 2.4% of the study patients. In every patient, with proper clinical evaluation, renal function test was done. After admission, in every patient USG and IVU was done in every patient. In IVU, it was found that 25.6% of cases had left sided HDN , 24.4% right sided HDN and 31.7% both sided HDN. In USG, out of 93 HDN cases in IVU, 85 were correctly diagnosed. The sensitivity was 91.4%. Out of 71 non-obstructed kidneys on USG, 68 were correctly assigned as non HDN, the specificity was 95.8%. Conclusion: This study findings showed USG to be a sensitive screening technique for excluding urinary tract obstruction.
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Association of renal scar and vesicoureteral reflux in childhood urinary tract infection in tertiary level hospitals p. 26
Rezwana Ashraf, Ishrat Jahan, Afroza Begum
DOI:10.4103/pnjb.pnjb_6_21  
Background: Urinary tract infection (UTI) is the third most common medical problem in the pediatric population, especially in infants. Vesicoureteral reflux (VUR) is common in children with UTI. Objective: The aim of this article is to assess the relationship between VUR-associated UTI and renal scar in children. Materials and Methods: A cross-sectional study was conducted among children who were admitted in the Pediatric Nephrology Department of BSMMU with UTI during the period of March 2013 to July 2014. A total of 30 UTI patients aged 1–5 years were included in the study. Children with neurogenic bladder or structural abnormality of urinary tract other than VUR were excluded from this study. History of the patients was taken and physical examination was done and recorded. Several investigations such as urinary routine and microscopic examination, culture and sensitivity with colony count, ultrasonogram of kidney, ureter, and bladder with post-void residual urine, micturating cystourethrogram, and dimercaptosuccinic acid (DMSA) renal scan were done. The collected data were analyzed by using SPSS version 12. Results: Mean age of the patients was 2.50 ± 1.18 years within the range of 1–5 years. Boys (80.0%) were predominant than girls (20.0%). Among the right kidneys 10 (33.3%) and among the left kidneys 11 (36.7%) had renal scar. There was a significant relation between increased VUR grading and increased number of renal scars on right and left kidneys (P = 0.013 and P = 0.020, respectively). There was no significant relation between increased number of UTI episodes and increased number of renal scars on right and left kidneys (P = 0.057 and P = 0.951, respectively). There was a positive correlation between VUR grade and renal scar [r = + 0.741 (P < 0.001)]. There was a positive correlation between VUR grade and renal scar [r = + 0.917 (P < 0.001)]. Conclusion: It can be concluded that severity of VUR had a significant correlation with renal scarring on DMSA scintigraphy.
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A clinicopathological study of membranoproliferative glomerulonephritis in the light of new evolving classification p. 30
D. M. Arifur Rahman, Asaduzzaman , Khandkar Tahmina, A. S. M. Selim, Mamun Mahafuzul Huq
DOI:10.4103/pnjb.pnjb_2_21  
Background: Membranoproliferative glomerulonephritis (MPGN) is a progressive disease with poor prognosis. An emerging consensus on classification based on immunofluorescence findings separates MPGN into two groups: immune complex-mediated MPGN and complement-mediated MPGN. This study was undertaken to investigate the clinical, biochemical, and histopathological parameters in-between these two groups histologically diagnosed as MPGN previously. Materials and Methods: We conduct a retrospective cross-sectional study carried out at the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period from June 2016 to December 2017. A total of 67 histologically diagnosed MPGN cases were enrolled in the study. Immunofluorescence evaluations were performed and correlated with retrospective clinical and biochemical data. Results: Immune complex-mediated MPGN and complement-mediated MPGN cannot be differentiated by histopathology. There were no significant differences between clinical (age, sex, clinical presentation) and biochemical (serum creatinine, C3 level, C4 level) parameters between immune complex-mediated MPGN and complement-mediated MPGN. Conclusion: Clinical and biochemical and histopathological parameters in-between these two groups of MPGN show no significant difference.
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Spectrum of postoperative genitourinary (GU) cases in pediatric patients p. 37
Shoheli Alam, Nazrul Islam, Fatema Tul Jannat, K. M. Didarul Islam, Noor Mahammad, Umme Habiba Dilshad Munmun
DOI:10.4103/pnjb.pnjb_7_21  
Background: Genitourinary (GU) disorders may be congenital or acquired. Congenital cases are most often undiagnosed. This study was carried out to find the types of congenital, acquired GU cases and redo surgery from neonate to early adult life and the age of diagnosis of congenital anomalies. Materials and Methods: This retrospective study was carried out from January’2016 to December’2018 in the inpatients of the Paediatric Surgery Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All admitted patients having congenital or acquired GU cases and postoperative complications of these systems required redo surgery were included. The data were reviewed for patient demographics, frequency, and distribution pattern of admitted GU cases and types of redo surgery. Result: A total of 1329 patients were operated in the Paediatric Surgery Department of BSMMU, Dhaka, Bangladesh over a 3 years’ period. Among them, 508 patients (38.2%) were GU cases. The age ranged from 2 days to 18 years (mean age: 5.68 ± 3.77) at diagnosis. The male: female ratio was 5.7:1. Out of the total 508 patients, 432(85%) were boys while only 75 (15%) were girls. Among the 508 GU cases, 355 (69.9%) were congenital cases, 56(11%) were acquired cases, and redo cases were 97(19.1%). In this study, 43.7% of children who had congenital GU anomalies were >5 to 12 years old, and the neonatal age group was in 2.3% of cases. Among the congenital GU anomalies, hypospadias was more common in 141(27.8%) cases. 41(8.1%) had urogenital tumors. Wilm’s tumor was in 18 (3.5%) of children, 9 (1.8%) patients had urethral stricture, 6(1.2%) patients had urolithiasis. In case of redo surgery, urethrocutaneous fistula was found in 42(8.3%) patients. Conclusion: GU cases are more common than the other systemic cases in pediatric surgical patients. Among the GU cases, congenital anomalies are more than the acquired cases in our institution. But most of the congenital anomalies were diagnosed at a later age.
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REVIEW ARTICLE Top

Very early-onset inflammatory bowel disease: A review p. 43
Rubaiyat Alam, Kaniz Fathema, Md. Nazmul Hassan, Mizu Ahmed, Md. Shariful Hasan
DOI:10.4103/pnjb.pnjb_10_21  
Very early-onset inflammatory bowel disease (VEO-IBD) is a genetically and phenotypically unique entity from adult-onset or older pediatric IBD and a growing subset of IBD. In most cases, a child with VEO-IBD presents with similar manifestations like an older patient with IBD, but some may present with a highly aggressive course and some cases may present with features of immunodeficiency. It differs from adult-onset IBD in many aspects such as disease behavior, location of the disease, and disease type and mostly occurs due to genetic causes. Next-generation genome sequencing could be an important tool for diagnosing genetic defects, especially in children with VEO-IBD disease. Most of the children with VEO-IBD do not comply with conventional therapy, and they ultimately need early immunosuppressive therapy that may grossly affect the child growth and development and also may possess long-term risks of cancer and opportunistic infections.
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CASE REPORTS Top

Gastric teratoma in infant: A case report p. 48
K. M. Didarul Islam, Shoheli Alam, Silwal Shirish, Noor Mahammad, Umme Habiba Dilshad Munmun
DOI:10.4103/pnjb.pnjb_11_21  
Gastric teratomas (GTs) are very rare tumors in children. They usually present with a palpable mass in the upper abdomen. We report a case of GT in a 4-month-old male infant who was presented with a palpable central abdominal mass. Ultrasound and computed tomography (CT) scan revealed a huge mass with heterogenous consistency and scattered calcification within the mass, extending from epigastric to hypogastric region. His biochemical marker of alpha-fetoprotein (AFP) was raised (1277 ng/mL). The preoperative clinical diagnosis was suspected teratoma but not specifically gastric one. On laparotomy, the mass was found to be attached with the greater curvature of the stomach and it was excised completely with all layers of the attached part of the greater curvature of the stomach wall. Histopathology confirmed it was a grade-I immature GT. The rarity of the origin of teratoma in addition to its immature variety prompted us to report the case.
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Renovascular hypertension in a 9-year-old boy with primary vesicoureteral reflux p. 52
Md. Murad Chowdhury, Abdullah Al Mamun, Tahmina Jesmin, Mst Shanjida Sharmim, Ranjit Ranjan Roy
DOI:10.4103/pnjb.pnjb_12_21  
Renovascular hypertension is an important cause of secondary hypertension in the pediatric age group. Reflux nephropathy has also been regarded as one of the most common disorders leading to secondary hypertension in children. Secondary hypertension must be appropriately diagnosed and treated. Here we report the presentation, diagnosis, and management of a case of secondary hypertension in a 9-year-old boy due to unilateral diffuse narrowing of the left renal artery along with ipsilateral grade 4 primary vesicoureteral reflux.
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Prolonged cholestatic jaundice as an atypical manifestation of acute hepatitis A virus (HAV) infection in children: Case reports p. 56
Md Shafiul Alam, Md Benzamin, Shariful Hasan, Nadia Haq, Md Wahiduzzaman Mazumdar
DOI:10.4103/pnjb.pnjb_9_21  
This article reports two cases of prolonged cholestatic type hepatitis A, a rare clinical manifestation of hepatitis A virus infection in children. Acute hepatitis A virus infection typically resolves spontaneously in 90% of the cases. In children, complete recovery usually occurs in most of the cases within two months. Occasionally, the cholestatic variety may persist for several months, characterized by intense pruritus and prolonged conjugated hyperbilirubinemia. The diagnosis is based on the presence of IgM anti-HAV, symptoms longer than 8 weeks, bilirubin concentration >10 g/dL in the absence of substantial hepatocellular and biliary damage. Use of only ursodeoxycholicacid (UDCA) rather than the combined use of UDCA and corticosteroid is sufficient.
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