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03to nalidixic acid by mutation in gyrA gene which replace nalidixic acid from the target site in gyrase A 5,3 . These nalidixic acid resistant Salmonella are also less responsive to ciprofloxacin due to less hydrogen bonding formed between ciprofloxacin and altered gyrase A. Resistance of Salmonella to nalidixic acid is mediated by alteration of amino acid in DNA gyrase which is result of mutation in gyrA and gyrB chromosomal genes and by alteration of amino acid in tropoisomerase which is result of mutation in parE and perC genes or by decreased permeability of drug or over-expression of efflux pump. However, mutation in gyrA gene is more common than gyrB, parE and perC genes 6 . Resistance mutations in gyrA gene is clustered in a region of gene product 67-106 amino acids called quinolone resistancedetermining region and most common mutations associated with quinolone resistance are located in amino acid, serine-83 or aspartic acid-87 7 . Single mutation in gyrA gene (either amino acid serine-83 or aspartic acid-87) is associated with resistance to nalidixic acid and decreased susceptibility to INTRODUCTION Enteric fever (typhoid and paratyphoid fever) is an endemic disease in developing countries 1 . The etiological agent of typhoid fever is Salmonella typhi and paratyphoid fevers are Salmonella paratyphi A, B and C 2 . Among these Salmonella, Salmonella typhi and Salmonella paratyphi A are mainly responsible for enteric fever. Antibiotic is the main therapeutic option for the treatment of enteric fever and mortality rate may reach up to 30% in the absence of effective antibiotic therapy 3 . Since Salmonella are resistant to conventional antibiotics (ampicillin, chloramphenicol and cotrimoxazole), ciprofloxacin and ofloxacin had been the drugs of choice in Bangladesh4. But rampant use of ciprofloxacin made Salmonella typhi and Salmonella paratyphi A resistant Total 323 blood samples were collected from suspected enteric fever patients from medicine and paediatric units of RMC hospital and cultured on brain heart infusion broth for isolation of Salmonella. Detection Of Mutated

<p class="Abstract">A 6 year old boy presented with sign symptoms of cerebral stroke. After clinical and radiological evaluation, a diagnosis of bilateral moyamoya disease was made. An indirect bypass surgery encephaloduroateriosynangiosis was done on the right side at first then on the left side.  Patient was partially improved. At one year follow-up, there was the evidence of occlusion of collateral circulation on the right side and the patient became symptomatic again. It is noted that, although the early indirect bypass surgery is indicated in the pediatric patients for preventing the stroke but the outcome is difficult to judge.</p>

Blue rubber bleb nevus syndrome (BRBNS) is a rare condition that is characterized by malformations of the venous system that significantly involve the skin and viscera.Cutaneous malformations are usually asymptomatic and do not require treatment except cosmetic purpose. The treatment of gastrointestinal lesions is determined by the extent of involvement and severity of the disease.We are presenting a case of BRBNS who was admitted in the paediatric ward of Bangabandhu Sheikh Mujib Medical University(BSMMU) with the complaints of progressive pallor since one year of age, passage of blackish stool for last two years, presence of soft bluish/and swelling all over the body and multiple dark blue to blackish nodule present in palm and sole. She got blood transfusion over one hundred (100) times. Endoscopy showed multiple haemangioma with active bleeding in upper GIT. After possible investigations she was diagnosed as a case of BRBNS and treated with available treatment facility.Bangladesh J Child Health 2017; VOL 41 (2) :125-128

Background: Cerebral palsy (CP) is one of the most common causes of chronic childhood disability. To know the aetiopathogenesis, severity and prognosis of CP, neuroimaging is an important modality of investigation. Objective: This study was done to observe the findings in CT scan of brain in children with CP. Materials and Methods: This is a cross-sectional descriptive study. One hundred and ten patients who were clinically diagnosed as cerebral palsy were enrolled in the study. After selection of the subjects, demographic and clinical characteristics were recorded. All other comorbidities including visual and hearing impairments were identified. CT scan of brain was done in all children and reporting had been done by a single qualified radiologist. Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). Seven types of CP were found in the study group. Among them quadriplegic CP were the most common (39.1%). History of perinatal asphyxia was found in 81.8% children. Cognitive delay was found in 90% children, speech delay was found in 88.2% children, visual impairment was found in 35.5% children and hearing impairment in 31.8% cases. Epilepsy was found in 44.4% among studied subjects. Most common finding on CT scan of brain was cerebral atrophy (62.7%), followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). Abnormal CT scan findings were found in 88.2% of study population. Conclusion: This study showed that most common type of CP was quadriplegic CP. Maximum children had abnormal CT scan findings. Most common CT scan finding was cerebral atrophy. J Enam Med Col 2021; 11(1): 18-23