Predictors of Death in Under-Five Children with Sepsis Attending an Urban Diarrheal Treatment Centre in Bangladesh

SETTING: Special Care Ward (SCW) of the Dhaka Hospital of icddr,b, Bangladesh. OBJECTIVE: To evaluate the clinical and laboratory predictors of death in under-five children with clinically defined sepsis presenting with diarrhea. METHODS: We prospectively enrolled all the diarrheal children (n = 151) aged 0 to 59 months with clinical sepsis admitted in the SCW during September’2007 through December’2007. Comparison was made between deaths (n = 23) and survivors (n = 128). Sepsis is defined as presence of inflammation [abnormal WBC count (>11 × 109/L or, 9/L or, band and neutrophil ratio ≤0.10] plus presence or presumed presence of infection with thermo-instability [hypo (≤35.0℃) or hyperthermia (≥38.5℃)], tachycardia, tachypnea, and/or the indications of altered organ function (altered mental status and bounding pulse) in the absence of clinical dehydration or after correction of dehydration. RESULTS: The median (inter-quartile range) age (months) of the children who survived and died was comparable [4.0 (2.0, 12.0) vs. 1.5 (0.8, 10.0);p = 0.703]. In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 -?123.12;p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 - 132.80;p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 157.90;p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1.24 - 46.11;p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.

Seroconversion of Hepatitis B Vaccine in Young Bangladeshi Children: A Tertiary Centre Experience

Background: Hepatitis B virus (HBV) infection is one of the most important global health problems and active immunization is the single most important and effective preventive measure against HBV infection. Several studied show that HBV carrier rate is between 2% - 7% in Bangladesh. Bangladesh introduced hepatitis B vaccination in children through Expanded Program on Immunization (EPI) in 2005 that includes 3 doses which starts from six weeks after birth. Currently booster vaccination is not recommended any more. However, many studies on different countries observed a declined level of HBs-antibody over a period of 3 - 6 years that may even reach to non-protective levels. Objective: To evaluate the status of seroconversion and seroprotection along with non-responders of EPI vaccinated children against HBV and to measure their antibody levels in different age groups. Methods: A cross sectional descriptive study was done in the department of Pediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh on 120 cases of EPI vaccinated children enrolled from January-December 2019 while attending the inpatient department without any liver problem. The development of Anti-HBs titre greater than or equal to 10 mIU/mL is considered as protective immunity and any titre less than 10 mIU/mL as non-protective following HBV vaccination. Results: Age of the children was 1 - 12 years with mean age of 5.6 ± 1.7 years and male: female ratio was 1.1:1. Among the children, 56 (46.6%) were from 1 - 5 years age, 36 (30.1%) children from 6 - 10 years age group and 27 (23.3%) children from 11 - 12 years age group. Out of 120 children, presence of Anti-HBs protective titre was in 63 (52.5%) children and non-protective level in 57 (47.5%) children. Among protective level, 34 (60.7%) children were in 1 - 5 years age group, 18 (50.0%) children in 6 - 10 years age group and 11 (39.3%) children in 11 - 12 years age group. Total 24 (20%) children were completely non-responder (antibody titre 0.00 mIU/mL). Out of 120 mother, 06 (5%) were HBV positive. Among them 05 (83.33%) children had Anti-HBs less than 10 mIU/mL. Conclusion: After primary vaccination, a good immune response was detected against hepatitis B virus but it goes below even up to non-protective level with the increase of age. Half of the studied children had non-protective titre after 5 years and one-fifth children totally non-responder after primary hepatitis B vaccination. A booster dose may be recommended after 5 years for optimum seroprotection.

孟加拉国的对抗生素耐药性增强的b型侵袭性流感嗜血杆菌病的发病情况

Objective: To determine the prevalence, age-group distribution, serotype, and antibiotic susceptibility patterns of invasive Haemophilus influenzae type b (Hib) isolates in Bangladeshi children because data regarding Hib diseases in developing countries are scarce, which has led to delay of the introduction of Hib vaccine in these countries.Methods: Children diagnosed with meningitis (n = 1412) and pneumonia (n = 2434) were enrolled in this surveillance study for Hib invasive diseases.Cerebrospinal fluid (CSF) and blood specimens, and the subsequent isolates, were processed using standard procedures.Results: During 1993 to 2003, 455 H influenzae strains were isolated from patients with meningitis (n = 425) and pneumonia (n = 30), and an additional 68 Hib meningitis cases were detected by latex agglutination (LA) testing.Overall, 35%of pyogenicmeningitis cases were a result of H influenzae, 97.1%of which were Hib.Most (91.4%) cases occurred during the first year of life.Resistance to ampicillin, chloramphenicol, and cotrimoxazole was 32.5%, 21.5%, and 49.2%, respectively.There was a trend toward increasing resistance for all three drugs.Resistance to ampicillin and chloramphenicol was almost universally coexistent and was associated with increased sequelae compared with the patients infected with susceptible strains (31%[23/75] vs 11%[21/183]; P <.001).Conclusion: Hib is the most predominant cause of meningitis in young Bangladeshi children.Resistance to ampicillin and chloramphenicol and the high cost of third-generation cephalosporin highlight the importance of disease prevention through vaccination against Hib.

Bishop Koop conversion of temporary stoma can be an option to establish gut continuity early when primary anastomosis is not safe

background Intestinal perforation and sometimes obstruction in neonates demand diverting stomas which are associated with fluid,electrolytes and nutrient loss.Early establishment of gut continuity is the key to the best outcome,though primary anastomosis is not always safe.The aim of this study was to evaluate the effectiveness of Bishop Koop stoma in establishing early continuity of gut and confirming the function of distal gut.Methods Data of patients who underwent Bishop Koop conversion of diverting stoma from July 2016 to June 2018 were reviewed retrospectively.Demographic and outcome data were recorded and analyzed using Statistical Package for the Social Science(SPSS)V.22 software.Ethical permission was taken from hospital ethical committee.results 29 patients were included(16 male and 13 female).Mean age of conversion was 5.8±2.5 months and mean weight was 4.9±1.6.Normal bowel movement was established in 26 patients.One patient died of sepsis on sixth postoperative day and one had anastomotic leakage.There was no significant difference with respect to outcome between perforation and obstruction group.Bishop Koop stomas were closed after 6 weeks of formation.Conclusions Bishop Koop conversion of temporary stoma was turned out as a good choice for these patients.