Background: Total anomalous pulmonary venous return (TAPVR) is an uncommon congenital cardiovascular anomaly with poor natural prognosis without proper intervention. It has been detected more frequently in recent year due to the advent of echocardiography. The aim of this study is to evaluate the clinical manifestations, age at diagnosis and short term outcomes in TAPVR patients. Methods: From 1st January 2013 to 31st December 2013, a total of 34 cases with TAPVR were admitted in pediatric cardiac centre at Dhaka Shishu Hospital, Dhaka, Bangladesh. All of them were evaluated with 2-dimensional (2-D) and color Doppler echocardiography examination. CXR and ECG were also done. Patient's sex, age at diagnosis, types of TAPVR, clinical manifestations, radiological finding, ECG findings and outcomes were compiled and analyzed. Results: In 34 patients with TAPVR, 23 (67.6%) were male and 11 (32.4%) were female with male to female ratio of 2.09:1. Most of the patients were diagnosed between 0-6 months of age that is 13 (38.2%) cases were in 0-2 month's age group, 14 (41.2%) cases were in more than 2 month's to 6 month's age group. Tachypnea and cyanosis were more common symptoms. The types of TAPVR was supra-cardiac 18 (52.9%), cardiac 11 (32.4%), infra-cardiac 3 (8.8%) and mixed in 2 (5.9%) cases. Pulmonary hypertension was present in 31 (91.2%) of 34 cases. Among them, 20 (58.8%) patients had severe pulmonary hypertension. The most common associated intra-cardiac lesions of TAPVR patients were ASD 13 (38.2%) and PFO 13 (38.2%). ECG findings of TAPVR, 18 (52.9%) patient had right axis deviation (RAD), right ventricular hypertrophy (RVH) and 14 (41.2%) had right axis deviation (RAD), right ventricular hypertrophy (RVH), right atrial enlargement (RAE). X-ray findings of TAPVR patients, 32 (94.1%) patients had Cardiomegaly and increased pulmonary vascularity. Among admitted patient, 3 (8.8%) patients died due to pneumonia and intractable heart failure, 31 (91.2%) patients referred to advanced cardiac centre for operative treatment. Conclusions: Tachypnea and Cyanosis were an obvious clinical symptom of TAPVR. 2-D and color Doppler echocardiography can provide quick and accurate diagnostic information of TAPVR. Death rate is high in TAPVR patient in spite of adequate medical management. So, early detection and definitive surgical treatment of TAPVR is much needed.

Objectives: This study was conducted to a) find out and compare the period prevalence of HBsAg in children attending outdoor and indoor of an urban and a rural hospital b) determine the risk factors for Hepatitis B surface antigen positivity. Materials and Methods: Three hundred and twenty three children were included in this study. Among them 162 attended an urban hospital and 161 attended a rural hospital. Collected sera were examined for HBsAg by ELISA method in a standard laboratory. Results: Among the 162 urban children 17 (10.5%) were found to be HBsAg positive and among the 161 rural children 6 (3.7%) were found to be HBsAg positive. This difference is statistically significant (P value < 0.05). In urban area, 12 (16.2%) school aged, 3 (6%) pre-school children and 2 (5.5%) infants were found to be HBsAg positive. In rural area, more pre-school (6%) than school children (2.8%) were found to be HBsAg positive. In urban area, 11.5% male children and 9.5% female children were found to be HBsAg positive and in rural area, 5.2% male and 2.8% female children were to be HBsAg positive. Among 17 HBsAg positive cases who attended urban hospital, 11 (19.6%) had past history of jaundice and 6 (5.6%) had no past history of Jaundice (P value < 0.05). Among those 17 HBsAg positive cases, 13 (14.6%) had past history of inoculation within last 6 months and 4 (5.5%) had no such history. This difference is also statistically significant (P value < 0.005). Conclusion: Prevalence of positive HBsAg marker is fairly high in urban children (10.5%). Prevalence of HBsAg has no age and sex prediction. More sero-positive children in urban area have previous history of jaundice and history of inoculation in last 6 months, but no one in rural area had history of jaundice or inoculation within last 6 months. Key word: Serosurvilance; Hepatitis B virus. N.B. This publication is based on a dissertation DOI: 10.3329/bjch.v30i1.6178 Bangladesh J Child Health 2006; VOL 30 (1/2/3): 17-21

Background : Down’s syndrome (DS) is the commonest genetic cause of malformation with congenital heart defects.Objectives : This study was conducted to evaluate the frequency of various congenital heart defects in children with clinically diagnosed Down’s syndrome in Dhaka Shishu Hospital.Material & Methods : This prospective study was conducted at Pediatric cardiology department of Dhaka Shishu Hospital from 1st February 2013 to 31st January 2014. Admitted Seventy four phenotypically Down’s syndrome patients were included in this study. After taking detailed history and physical examination, all these patients were subjected to Color Doppler echocardiography in addition to routine laboratory investigations.Results : Total 74 down’s Syndrome patients were admitted at cardiology department during the study period. Among them 35 (47.29%) were males and 39 (52.71%)were females with male to female ratio of 1:1.12. Atrioventricular septal defect was the commonest defect 15(20.27%), followed by Ventricular septal defect 12(16.21%), Patent ductus arteriosus 11(14.86%), Atrial septal defect 7(9.46%), Tetralogy of Fallots 3(4.05%), Pentology of Fallots 2(2.70%), Dextrocardia with D _ TGA 1(1.35%), Total anomalous pulmonary venous drainage 1(1.35%) but Multiple congenital heart disease were 22(29.72%) cases. Along with congenital heart disease 3(4.05%) patients had GIT abnormality, 4(5.4%) patient had congenital hypothyroidism and 3(4.05%) patients had Eye problem.Conclusion : Congenital heart defects are common in children with Down’s syndrome. The commonest one is Atrioventricular septal defect in our set-up.Northern International Medical College Journal Vol.6(1) 2014: 18-20

Abstract

Background: The increasing trend in multisystem inflammatory syndrome in children (MIS-C) during Covid-19 pandemic is alarming. Understanding the clinical course and outcome will give the clinical and public health implications of this syndrome. Objectives: This study was conducted to find out the clinical presentation, course of the disease and outcome of the children and adolescents of MIS-C. Methods: This observational study was conducted in the department of Pediatric Nephrology, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh, from August 2020 to October 2020. Total 12 children of MIS-C diagnosed according to WHO diagnostic criteria of MIS-C were included after taking written informed consent from the parents. Mean, median and standard deviation were calculated for the continuous variables. Results: The age ranged from 17 days to 13 years, 56% were male, 17% were positive for SARS-CoV-2 by RT-PCR and 4(33%) had history of the COVID-19 exposure. Organsystem involvement included bilateral pneumonia in 92%, myocarditis in 78%, swollen hands and feet in 67%, mucocutaneous involvement in 50%, diarrhea in 50%, musculoskeletal involvement in 50%, acute kidney injury (AKI) in 33% patients and acute pancreatitis in 25% patients. The median duration of hospitalization was 11 days and ICU stay was 5 days. Mean duration of fever was 8.66 days. Kawasaki’s diseaselike features were documented in 50% patients and 4 of them had elevated level of procalcitonin and troponin I. Markedly elevated C reactive protein (CRP), Ferritin and D dimer in all patients were present. All patients with cardiac involvement had left ventricular dysfunction and ejection fraction was as low as 38.5%. Coronary-artery dilatation was documented in 33%. About 67% received intensive care with oxygen support by low flow nasal cannula or face mask, 33% received vasoactive support and systemic glucocorticoid, 50% received intravenous immunoglobulin (IVIG) plus methyl prednisolone. Antiplatelet and anticoagulant therapy was given in 75% and 33% patients respectively. Out of 12 patients 2 died, the contributing cause of death included complications like hypotension, shock, myocarditis, coagulopathy and AKI. Conclusion: MIS-C led to serious and life-threatening complications especially when there are cardiac involvement, hypotension and acute kidney injury. DS (Child) H J 2020; 36(2): 87-94