Dhaka Shishu Hospital Research Articles

Intrapleural Streptokinase in Parapneumonic / Complicated Pleural Effusion/Empyema: Experience in Dhaka Shishu (Children) Hospital

Background: Parapneumonic effusion/complicated pleural effusion/empyema thoracis in children causes significant morbidity. Standard treatment of pleural effusion includes tube drainage and antibiotics. But the tube drainage often fails. Intrapleural Streptokinase has been used in empyema thoracis as well as complicated pleural effusion with good success rate. Though its efficacy is documented in Western literatures and textbooks, there are no clinical trials in children has been reported from Bangladesh.
 Objectives: We evaluated the efficacy of intra-pleural Streptokinase in the management of Parapneumonic effusion / complicated pleural effusion/ empyema thoracis even in advanced stages.
 Patients and Methods: A total of 3 patients with parapneumonic effusion requiring intercostal tube drainage, aged 4 year 6 month to twelve years were included in the study who were admitted in Pediatric respiratory medicine unit in Dhaka Shishu (Children) Hospital. Intercostal chest tube drain was given in all patients and inj: Streptokinase (10,000 units/kg/dose) was instilled into the pleural cavity and kept the Streptokinase for 4 hour in pleural cavity. Response was assessed by clinical outcome, after unclamping and serial chest ultrasounds and subsequent chest radiography.
 Results: Streptokinase enhanced drainage of pleural fluid and complete resolution of effusion in all the 3 patients.
 Conclusions: Intrapleural Streptokinase is the preferred treatment for treating pediatric empyema/parapneumonic effusion/complicated pleural effusion even in advanced stages and can avoid surgery.
 Bangladesh J Child Health 2020; VOL 44 (2) :104-108

Ocular and extra-ocular complications following long-term steroid consumption in children with idiopathic nephrotic syndrome

Background: High dose of corticosteroids are required by patients with idiopathic nephrotic syndrome for long duration due to repeated relapse. The aims of this study were to analyze the ocular and extra-ocular complications of steroids on children with nephrotic syndrome.
 Methods: This cross-sectional study was conducted at Dhaka Shishu (Children) Hospital from September 2017 to September 2019. Children with nephrotic syndrome between 1-16 years of age, who received steroid for at least three months, participated in this study. Total 70 children were enrolled. Detailed history was taken from parents regarding initial episode, drug history, visual problem, headache, hypertension, weight gain, psychosis, bone pain, epigastric pain and excessive growth of body hair. Comprehensive opthalmologic assessment including visual acquity, intraocular pressure and cataract were performed. Detail of renal histopathology and treatment regimen in each patient was noted.
 Results: A total of 70 patients were included, 61.4% were male and 38.6% were female. Median age at the time of examination was 60 months (range 17 to 216 months). The mean duration of disease was 33.71±21.12 months. The mean cumulative steroid dose at the time of examination was 8485.91±7326.83 mg. Fourteen (20%) patients had posterior subcapsular cataract. Among 70 patients, we could do visual acuity for 25 (35.7%) patients, intraocular pressure (IOP) in mm for 51 (72.85%) patients. Among them raised IOP was found in five (9.8%) patients. In right eye mean IOP was 14.16±3.57 and for left eye 14.77±3.55 mm. Renal biopsy was performed in 15 (21.43%) cases. Among the biopsy report, it was found that mesangial proliferative glomerulonephritis (MPGN) in 8 (53.33%), focal segmental glomerulonephritis (FSGS) in 2 (13.33%) and minimal change in 5 (33.34%) cases. Among all cases, 12 (17.14%) patients developed Cushingoid facies, 3 (4.2%) patients had hypertrichosis, 3 (4.2%) patients had central obesity and 4 (5.7%) patients had buffalo hump but none had hypertension, diabetes mellitus, epigastric pain, bone pain or psychosis.
 Conclusion: Cataract formation was the most frequent ocular complication after large dose of oral corticosteroid therapy. The present study emphasizes the need for regular eye screening. Cushingoid facies was the most frequent among extra-ocular complications.
 Birdem Med J 2021; 11(1): 7-10

Clinical profile of fungal sepsis in new born: a tertiary centre experience from Bangladesh

Background: Candida infections are frequent and major causes of septicemia in neonatal intensive care units and are associated with high morbidity and mortality. Low birth weight preterm infants are especially vulnerable to these devastating infections. Material and methods: A prospective observational study was done from May 2013 to June 2014 in SCABU (Special Care Baby Unit) & ICU (Intensive Care Unit) of Dhaka Shishu (Children) Hospital, Dhaka. All neonates admitted with suspected clinical sepsis were analyzed in the study. Among which 30 culture positive candida cases were identified and included in this study. Outcome measures assessed was the incidence of candidemia in our NICU with clinical profiles and associated risk factors. Results: Out of 30 newborns 18 (60%) were preterms, 20% of study population were having a birth weight of <1 kg, 23.3% with a birth weight of 1-1.5 kg and 23.3% with a birth weight of 1.5-2.5 kg. 73.4% of the study population were hospitalized for >1 week. In the study group 56.7% had feed intolerance, 53.3% needed ventilator support, 56.7% had temperature instability, 73.3% had thrombocytopenia 63.3% had apnea and 73.3% had jaundice. The overall survival was 63.3%. Conclusions Low birth weight, prematurity, use of broad spectrum antibiotics, mechanical ventilation and prolonged hospital stay were important risk factors associated with neonatal candidiasis in this study. Thrombocytopenia, feed intolerance, increased requirement for ventilator support, temperature instability, jaundice and apnea were significant clinical parameters noted in babies with culture proven neonatal candidiasis. The overall survival was 63.3% in the study group.

Clinical Profile and Outcome of Ventilated Children in a Pediatric Intensive Care Unit (PICU): A Study in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh

Clinical Profile and Outcome of Ventilated Children in a Pediatric Intensive Care Unit (PICU): A Study in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh

Blood Culture Profile and Antimicrobial Resistance Pattern: A Study in Intensive Care Unit (ICU) Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh

Blood Culture Profile and Antimicrobial Resistance Pattern: A Study in Intensive Care Unit (ICU) Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh

Short term outcome of epileptic Seizure in children attending at Paediatric Neuroscience Department of Dhaka Shishu Hospital

Background : The optimal response to antiepileptic treatment is the control of seizures. In different studies, it has been shown that childhood epilepsy presents with a variable course, and approximately one-third of epilepsy experience alternating relapse and remission. Some of them do not become seizure-free, despite adequate treatment.
 Objectives : This study aimed to see the short-term outcome of seizures in children with epilepsy (whether the seizure is controlled or not) and to correlate them with different predictors like socio-demographic factors, associated comorbidities, and adherence with antiepileptic drugs.
 Methods : This retrospective observational study was conducted in an Epilepsy Clinic of Paediatric Neuroscience Department of Dhaka Shishu Hospital (DSH) over a period of 3 years from January 2013 to December 2015. During this period 1-year follow-up record of each patient was analyzed. Information on bio demographic data, clinical and developmental assessment done by a multidisciplinary team was analyzed.
 Results : A total of 100 children who had epilepsy were included in this study. Unfavorable outcome (uncontrolled seizure) was found in children <5 years of age, children from the rural area, and those whose parents education were below secondary level (p values were 0.05, 0.03 and 0.04 respectively). Also, the unfavorable outcome was found in children who had H/O perinatal asphyxia (PNA), motor problem, and feeding problem (p-value=0.5, 0.002, 0.05 respectively). After 1 year of regular follow up milestone of development was improved in more than one 1domain in 51children. But there was no improvement found or their condition remained unchanged in 49 children.
 Northern International Medical College Journal Vol. 11 No. 1 July 2019, Page 411-414

Recent Trend of Bacteriological Profile and Drug Sensitivity Pattern of Neonatal Septicemia in A Tertiary Care Hospital in Bangladesh

Background : In Bangladesh about 67% of under-five mortality is neonatal mortality. One of three major causes of neonatal morbidity and mortality is septicemia. Recently there is increasing incidence of multidrug resistant neonatal organisms which is alarming.
 Objective : The aim of this study was to see the bacteriological profile and drug sensitivity pattern of neonatal septicemia.
 Methods : This prospective observational study was done in Dhaka Shishu (children) Hospital over one-year period from June 2018 to May 2019. The admitted neonates were suspected as neonatal septicemia considering the risk factors, clinical profile and investigations (CBC, CRP etc.). Blood from all suspected neonatal septicemia cases were sent for culture and drugs sensitivity along with others necessary investigations. Then data was analyzed with SPSS version-20.
 Results : Among the suspected cases only 111(10%) patients were culture positive. Preterm were 77(69%) and term 34(31%). One hundred six cases (95%) had sepsis with gram negative organisms and 5(5%) had sepsis with gram positive organisms with more predominant of Klebsiella (76,68%) followed by Acinetobacter (16,14%), Pseudomonas (6,5%), Escherichia coli (3,3%). Majority 80 (72%) cases had Early onset neonatal sepsis (EONS). Klebsiella (57, 51%) was more common organism followed by Acinetobacter (11,10 %) causing EONS and in late onset neonatal sepsis (LONS), similar type of causative organism were found. Ampicillin, Gentamicin and Ceftazidime were mostly resistance to gram negative organisms - 104(94%), 99(89%) and 93(84%) respectively. Besides these, Amikacin (104,94%), Imipenem (85, 77%) and Ciprofloxacin (73, 66%) were more resistance. Klebsiella in 17 cases and Acinetobacter in 4 cases were resistant to all commonly used antibiotics.
 Conclusion : Klebsiella followed by Acinetobacter and Pseudomonas are now common pathogens of neonatal septicemia found in this study. Ampicillin, Gentamicin and Ceftazidime are more resistant to most of the organisms causing neonatal sepsis. Imipenem is alarmingly resistant. In 19% cases, the organisms are resistance to all commonly used antibiotics.
 Northern International Medical College Journal Vol. 11 No. 1 July 2019, Page 427-431

Pattern of oral and dental diseases among children attending Dental dept. in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh: A cross sectional hospital based study

Introduction: Oral and dental health isthe standard of the oral and related tissue, which enables an individual to eat, speak, and socialize without active discomfort and embarrassment and which contributes to general well-being of the individual
 Objective: To find out Pattern of oral and dental diseases among children attending Dental Department in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
 Materials and Methods:This was a cross sectional hospital based study carryout among 443 childrens (242 males and 201 females) attending in the Department of Paediatric dentistry in Dhaka Shishu (Children) Hospital.All the new patients attending to Dental OPD with the complained of oral and dental problems were included in this study. Old patients and those who were not willing to participate in the clinical examination for study were excluded from the study. The study period was October 2018 to December 2018
 Results: The study was carried out among (443) children were 242 (54.6%) males and 201 (45.4%) females a male-female ratio of 1.2:1.The age range of children were 224 (50.6%) below the, age of 5 years, 200 (45.1%) at the age of 5-10 years and 19(4.3%) above 10 years (10- 14 years).Out of 443 children 157 (22.7%) showed presence of dental caries, 138 (19.9%) had grossly destructed carious teeth, 79 (11.5%) had dentolveolar abscess, 53 (7.7%) had retained broken root, 52(7.6%) were suffering from pulpitis, 108 (15.7%) of the children presented with stomatitis, 34 (4.8%) had retained decidous teeth,24(3.5%) geographical tongue , 24(3.5%) oral thrush, 7(1.0%) gingivitis 7(1.0%) presented with traumatic injury of tooth, soft tissue and bony tissue, 4(0.5%) had pericoronitis, 1(0.1%) had natal tooth and 4(0.5%) were others like extra oral swelling, apthus ulcer , mucoceale. The total Association of dental disease with different age <5 years 45.5%, 5-10 yrs. 50.1% and > 10 yrs. 4.4%. Among them Caries disease all group average high rate so p-Value (0.010*). So grossly destructed due to caries 49 cases of 5 yrs. 35.5%, 85 cases of 5-10yrs. 54.1%, and 7 cases of under 15yrs. 5.1% significant.
 Conclusion: Dental caries was the most predominant disease in the children followed by dentoalveolar abscess. Oral health promotion and planning programs directed towards the oral health should be conducted at regular intervals.
 Update Dent. Coll. j: 2020; 10 (2): 6-9

Role of Chest X-Ray in Assessing Severity of Pneumonia in Children: A Study in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh

Role of Chest X-Ray in Assessing Severity of Pneumonia in Children: A Study in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh

Prenatal Diagnosis and Screening of Thalassemia Mutations in Bangladesh: Presence of Rare Mutations

Thalassemia is the most common congenital monogenic disorder in Bangladesh. Prenatal diagnosis (PND) and pregnation termination of an affected child is one of the best options to reduce the burden of thalassemic children. This article reports the results of DNA analyses of chorionic villus sampling (CVS) and amniocentesis of fetuses of mothers who came to the thalassemia center of Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. DNA analysis was done by real-time polymerase chain reaction (qPCR) and Sanger sequencing. Maternal contamination was ruled out by variable number of tandem repeats (VNTRs). A total of 232 samples were analyzed. Hb E (HBB: c.79G>A)/β-thalassemia (Hb E/β-thal) was the most common type of thalassemia seen in 32 samples (13.79%) followed by β-thal major (β-TM) in 10 cases (4.31%). Molecular characterization of the most predominant mutation was IVS-I-5 (G>A) (HBB: c.92+5G>C). The analysis also revealed five rare mutations: IVS-II-654 (C>T) (HBB: c.316-197C>T), IVS-II-1 (G>A) (HBB: c.315+5G>A), codon 44 (–C) (HBB: c.135delC), −86 (C>A) (HBB: c.-136C>A) and codons 14/15 (+G) (HBB: c.45_46insG), which have not been reported previously in Bangladesh. This study provides important information for PND and will help in the development of similar diagnostic programs for other DNA centers in Bangladesh.

The Magnitude of Septic Arthritis in Neonates: In a Tertiary Care Hospital in Bangladesh

Background: Septic arthritis is not a common manifestation of neonatal infection but devastating if not detected or treated early. Its initial sign symptoms are nonspecific. Bacteria responsible for septic arthritis are changing from time to time as most of the cases of neonatal septic arthritis arise as a consequence of bacteremia. Aim: To highlight the magnitude of septic arthritis in neonate. Materials and Methods: A retrospective observational study was done in neonatal unit of Dhaka Shishu (Children) Hospital from October 2019 to March 2020. The medical records of those neonates were looked for prenatal, natal and postnatal history and examination findings. The onset of joint involvement, type of joints and number of joint affected was recorded as well as general and local symptoms were also recorded. All investigations were done including X ray and USG of joint. Results: Total 1903 neonates were admitted over 6 months. Among them 18 neonates were diagnosed as septic arthritis. In our study 58.8 % neonates were preterm, mean age of admission was 21.5±5 days and most common risk factor was nosocomial infection. They commonly (17 patients) presented with tenderness and limitation of movements. Among the involved joints 15 were knee, 3 hip and 1 shoulder joint. Twelve patients had positive blood culture, 10 patients had joint effusion evident by USG. Conclusion: All septic neonates should be looked for arthritis as its prevalence is not rare.

Predictors of Mortality in Newborn Admitted in Special Care Baby Unit (SCABU) of Dhaka Shishu Hospital

Background: The current neonatal mortality rate of Bangladesh is very high compared to developed countries.
 Objective: The objective of the study was to find out the predictors that are associated with mortality in newborn admitted in Special Care Baby Unit (SCABU) of Dhaka Shishu (Children) Hospital.
 Methods: This prospective study was conducted in the SCABU of Dhaka Shishu (Children) Hospital from 1st June 2016 to 30 November 2016. A semi-structured questionnaire was prepared before the study. Data were collected from the attendents of each neonate by asking questions who died at the neonatal period after hospital admission. Detail history regarding gestational age, birth weight, place of birth, person conducting delivery, mood of delivery, problem at birth, residence, reasons of referral, vehicle during transport, condition of baby at arrival, time taken during transport and need for any resuscitation was recorded. Data were analyzed by using SPSS version 16.
 Result: Total 970 neonates were admitted during data collection period out of them 98(10.10%) died. Majority (58.16%) of the death occurred in neonate who was admitted before 72 hours of age having gestational age <37 weeks (65.31%). Majority of the neonates were from urban area (56.12%) but from poor socioeconomic status (54.08%) and only 32.65% were on regular antenatal care. Majority were delivered by normal delivery at home and attended by TBA. Among the neonates 30.61% reached hospital only by ambulance and 64.29% were found hypothermic during admission. Majority 70(71.43%) were died within 24 hours of hospital admission. Neonatal sepsis, perinatal asphyxia and prematurity contributed majority of neonatal death.
 Conclusion: Early (age <72 hours) and premature neonates, neonates from poor socioeconomic background, lack of antenatal care, home delivery, lack of facility in local areas, inadequate transport and unstable initial condition contributed majority of neonatal death. Neonatal sepsis, perinatal asphyxia and prematurity contributed most of neonatal death.
 DS (Child) H J 2019; 35(2) : 123-129

Effectiveness of a Multidisciplinary Lifestyle Intervention to Reduce Obesity among Children and Adolescents

Background: Now a days unhealthy lifestyle primarily responsible for the dramatic increase obesity among children and adolescents.
 Objective: The purpose of the study is to see the effects of a multidisciplinary lifestyle intervention to reduce obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were (1) changes in body composition; (2) adherence to a Mediterranean diet; and (3) physical performance.
 Methods: The study involved 64 overweight/obese children or adolescents conducted at Dhaka Shishu Hospital from October 2017 to September 2018. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures height, body weight, body mass index (BMI), waist circumference, and body composition, cardiometabolic risk index waist-to-height ratio (WHTR), and dietary habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures.
 Results: After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance.
 Conclusion: A short term family-based multidisciplinary approach is effective in ameliorating the health status, dietary habits, and physical performance in children and adolescents.
 DS (Child) H J 2019; 35(2) : 111-118

Bacteriological Profile and Antibiotic Sensitivity of Neonatal Septicemia Admitted in Neonatal Intensive Care Unit (NICU) of Dhaka Shishu Hospital

Background: Septicemia in neonates refers to bacterial infection documented by positive blood culture in the first four weeks of life and is one of the leading causes of neonatal mortality and morbidity.
 Objective: To isolate and identify the bacterial etiologic agents responsible for neonatal sepsis and to determine the susceptibility pattern of isolates in A NICU of Dhaka Shishu (Children) Hospital.
 Methods: This is a prospective observational study conducted in the NICU from July 2018 to December 2018. Two hundred ninty blood samples were collected and processed from patients in accordance with standard protocols. Antibiotic susceptibility of the isolates was done.
 Results: Blood culture reports were positive in 9.31% cases. Among the culture positive cases, there were 65.5% males and 34.5% females. Early onset sepsis was present in 74.8% and late onset sepsis was observed in 25.2% of the cases. Best overall sensitivity among Gram negative (Acinetobacter, Klebsiella, Pseudomonas) isolates was to netilmycin (61%), followed by ceftazidim (57%) and amikacin (56%).Gram positive (Staphylococci, streptococci) isolates had sensitivity of 50% to levofloxacin, 50% to ceftriaxon.
 Conclusion: Gram negative organisms are the leading cause of neonatal sepsis in this study and most of them are resistant to multiple antibiotics. Therefore the results of this study suggest that, surveillance of antimicrobial resistance in our hospital is necessary.
 DS (Child) H J 2019; 35(2) : 130-134

Association of Admission Temperature and Outcome among Neonates with Sepsis in a Tertiary Care Hospital

Background: Neonatal sepsis is one of the major causes of mortality in neonates. Hypothermia is also an important contributing factor of neonatal mortality. Neonates with sepsis can present with normal temperature, hypo or hyperthermia.
 Objectives: This study was design to find out the pattern of temperature on admission and its association with mortality among neonates admitted with sepsis.
 Methods: This cross-sectional study was conducted from September 2017 to April 2018 in the Department of Neonatal Medicine and NICU, Dhaka Shishu (Children) Hospital. Neonates up to thirty days of age, diagnosed as probable sepsis were enrolled. On admission, axillary temperature was recorded for 3 minutes and neonates were categorized according to the recorded temperature. Neonates were classified as early onset sepsis (EOS) and late onset sepsis (LOS) according to the age of onset of the sepsis. Outcome was also recorded. Statistical analysis was done by SPSS program version 25. Chi-square (X2) test was done to determine the association and p value, <0.05 was taken as significant.
 Results: Among 493 enrolled neonates, 41.2% neonates were with early onset sepsis (EOS) and 58.8% were with late onset sepsis (LOS). Out of 493 neonates, 89(18.1%) died. Among the enrolled neonates, 54.4% had normal temperature, 16.6% had mild hypothermia, 14.6% had moderate hypothermia and 14.4% had hyperthermia. It was found that mild and moderate hypothermia were significantly more in EOS(p<0.05). Mortality was significantly high in neonates with mild and moderate hypothermia (p<0.05).
 Conclusion: This study found that mortality was associated with mild and moderate hypothermia in neonates admitted with sepsis.
 DS (Child) H J 2019; 35(2) : 150-155

Role of Macronutrient in Better Survival of Critically Sick Neonates Admitted in Neonatal Intensive Care Unit (NICU)

Background: Neonates are considered more susceptible to macronutrient deficits. During critical illness, sick children cannot normally be fed by mouth, and as a result a pronounced macronutrient deficit often develops after a few days. This macronutrient deficit has been associated with weakness, infections and increased risk of mortality. Therefore, macronutrient as energy source is an important key concern to care and for overall to achieve better survival.
 Objective: The present study is intended to evaluate the role of macronutrient such as blood glucose, serum calcium, hemoglobin as iron status, serum albumin, in critically sick neonates admitted in NICU and their outcome.
 Methods: This observational prospective study was carried out at NICU of Dhaka Shishu (Children) Hospital from January 2014 to July 2014. Total 121 neonates were enrolled and analyzed their essential macronutrient profile e.g, blood glucose, serum calcium, hemoglobin, serum albumin and other relevant investigation as complete blood count with film, CRP, blood culture and chest X ray as a part of management as well as to predict their survival.
 Results: Macronutrient of critically sick neonates play important role to predict their better survival. Perinatal asphyxia and sepsis were major diagnosed pathological conditions of these neonates. In sepsis lower value of serum albumin were statistically significant. Lower value of glucose, calcium, hemoglobin and albumin were also statistically significant in Non-survivors than Survivors.
 Conclusion: During critical illness in neonates, emphasis should be paid on of adequate macronutrient as energy source. This is necessary for better optimization survival of critically sick neonates.
 DS (Child) H J 2019; 35(2) : 105-110

Dengue Fever: Clinical Characteristics of A Tertiary Care Hospital Study

Background: Incidence of dengue infection has increased worldwide and has become a significant public health concern. Clinical suspicion based on the frequency of symptoms is very important for early diagnosis.
 Objectives: To observe the clinical characteristics of serologically confirmed hospitalized cases of dengue fever.
 Material and Methods: This cross-sectional study was done among admitted children with dengue infection in Dhaka Shishu (Children) Hospital from July 2018 to October 2018. The diagnosis of dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) were established according to the World Health Organization (WHO) classification criteria. Cases who were NS1 antigen and IgM dengue antibody positive included in this study.
 Results: Among 51 serologically confirmed dengue fever patients, mean age was 6.66 ± 3.69 years. Majority of the cases (74.5%) were less than 10 years of age, 60.8% were male, 39.2% were female, and 88.23% of patients came from urban areas. Classic DF was found in 74.5% of patients, while 25.49% of patients DHF, and 11.7% DSS. Fever was the most common (72.55%) symptom followed by headache, vomiting and myalgia. Hemorrhagic manifestations found in 21.57% of cases. The most common complications were hepatic dysfunction (47.09%) followed by renal impairment, encephalopathy, multi-organ failure, and ARDS.
 Conclusion: The majorities of dengue cases were from urban areas, below ten years of age and classical DF. Besides fever other common symptoms were headache, vomiting and myalgia. The most common complications were hepatic dysfunction, renal impairment and encephalopathy.
 Bangladesh J Child Health 2020; VOL 44 (1) :30-33

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses.
 Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed.
 Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9).
 Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates.
 DS (Child) H J 2019; 35(2) : 100-104

Detorsion Plus Tunica Vaginalis Flap Coverage in the Management of Ischemic Testis Following Torsion: Experience in Dhaka Shishu (Children) Hospital

Background: Testicular torsion leads to devastating consequences in young boys, about 42% undergo an Orchiectomy resulting in reduced fertility, testicular hormonal dysfunction and psychological trauma.
 Objective: The aim was to evaluate the testicular salvage rate after detorsion plus tunica albuginea incision with tunica vaginalis flap coverage with orchiopexy.
 Methods: This was an observational study conducted from January 2016 to December 2017. Data were collected from operation theater and surgery ward register. Data were analyzed using SPSS version 20 statistical software. Continuous data were presented as mean ± SD and categorical data were presented as percentage. Results: Total numbers of patients were 15. Most of the patients presented after 24 hours. Rate of atrophy of testis after orchiopexy was higher in patients presented after 24 hours. Only 4 patients had recognizable testicular atrophy. Surgical site infection was not present in this study. Conclusion: Tunica albuginea incision with tunica vaginalis flap coverage after detorsion with orchiopexy provides more salvage rate in the management of ischemic testis following torsion.
 DS (Child) H J 2019; 35(2) : 141-144

Tramadol suppository poisoning in children of Bangladesh

Background: Tramadol is an analgesic agent utilized in the treatment of different types of pain. Recently it was found that a few cases of tramadol poisoning were observed in hospitalized children. In all cases, it happened due to accidental administration of tramadol suppository.
 Objective: The aim of this study was to determine the clinical manifestations of tramadol suppository poisoning in children and to create public awareness about the prevention of this suppository poisoning.
 Materials & Methods: This was an observational, retrospective, single-center caseseries study of hospitalized children in Dhaka Shishu Hospital during the periods of July 2016 to March 2017. Eleven patients with history of accidental intake of tramadol suppositories were enrolled in this study. Data regarding risk factors and clinical features were recorded and analyzed.
 Results: In this study, 7/11(64%) cases were male and 4/11(36%) female. Mean age was 7.8 month and mean duration of hospital stay was 46.4 hours. Parecetamol in 2/11 (18%) cases and glycerin suppository in 9/11(82%) cases were main drugs that were supposed to be introduced instead of tramadol. Keeping drugs in same containers (11/11), similarities of suppository’s size, shape and color (11/11) were found as causes of mistakes in this study. Main clinical features were drowsiness in 4/11(36%) cases, tachycardia in 3/11(27%) cases and one case died.
 Conclusions: More cautiousness of parents, dissimilarity among different suppository in color size, shape and using of different containers of drugs may be the preventive way of this poisoning.
 Bangladesh J Child Health 2019; VOL 43 (3) :157-160