It is known that children escaping political violence are likely to be vulnerable. This study provides early evidence concerning recently displaced children in refugee camps within Bangladesh.Large proportions of children had emotional symptoms and peer problems. The most vulnerable were those without parents.As well as urgent needs for shelter, food and preventive healthcare, children require immediate psychosocial support in emergency situations.

Introduction: Copy number variations (CNVs) play a critical role in the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh.Methods: We have conducted chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare CNVs. To identify candidate genes within the rare CNVs, gene constraint metrics [i.e., “Critical-Exon Genes (CEGs)”] were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using the R package.Results: Of all the samples assayed, 12.26% (26/212) and 57.08% (121/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. While 2.83% (6/212) patients’ pathogenic CNVs were found to be located in the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs compared to males (OR = 4.2; p = 0.0007). We have observed an increased number of Loss of heterozygosity (LOH) within cases with 23.85% (26/109) consanguineous parents. Our analyses on imprinting genes show, 36 LOH variants disrupting 69 unique imprinted genes and classified these variants as VOUS. ADOS-2 subset shows severe social communication deficit (p = 0.014) and overall ASD symptoms severity (p = 0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (<1 MB) focal CNVs in our NDD cohort and we identified PSMC3 gene as a strong candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability.Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis, therapy and management of NDD patients.

This study explored the physical and clinical phenotype of Bangladeshi children with autism spectrum disorder (ASD). A total 283 (68 females) children were referred for screening. Assessments were conducted using a semi-structured clinical interview along with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). Overall, 209 (45 females) children reached the ADOS-2 algorithmic cutoff for ASD. A trend for greater weight and head circumference was observed in children with ASD versus non-ASD. Head circumference was significantly (p<0.03) larger in ASD males compared with non-ASD males. A trend was also observed for symptom severity, higher in females than males (p=0.06), with further analyses demonstrating that social reciprocity (p<0.01) and functional play (p<0.03) were significantly more impaired in ASD females than males. Response to Reviewers:Reviewer 1 comment 1.No additional comments on the manuscript. However, I suggest that in the future, when these authors submit manuscripts for peer review and they are asked to respond to comments from reviewers, that the authors specifically note the changes that have been made in the manuscript so it is easier for peer reviewers to identify the revisions. For example, instead of stating in the response to the reviewer's comment, "We have added a sentence to clear the number of participants," the authors should state the exact sentence that was added and where it was added in the Methods section. When the authors don't help the peer reviewers by stating exactly what was revised and where it was revised in the manuscript, it makes it extremely challenging for the peer reviewers to re-review the manuscript and appreciate the changes that have been made in response to the reviewer's comments.Response: We are very grateful to the reviewer for the thoughtful comments and efforts toward improving our manuscript. In future we will definitely note the specific changes made in the manuscript.Reviewer 2 comments 1.The first sentence of Discussion could read, "This study set out to examine the characteristics of a consecutive series of children referred to a developmental clinic in Bangladesh for ASD assessment, including only those who were nonverbal or speaking mainly in single words (i.e., those administered Module 1 of the ADOS-2)."Response: Thanks and the first sentence of the Discussion section has been changed according to suggestion.2.Table 2, 3, and 4 should be integrated -there is a lot of data that is redundant across these tables.Response: We have integrated Table 3, and 4 and presented the data in Table 3 only. 3.Figure 2 Y axis should mention domain rather than relying on the figure note. Response: We have mentioned domain in Figure 2 Y axis.

Background : Hepatitis A virus infection is endemic in many developing countries including Bangladesh. Children infected with Hepatitis-A virus typically have asymptomatic disease.Objective : To observe the anti-HAV positivity in children & to determine any relation between anti-HAV positivity & socioeconomic condition.Materials & Methods : A cross sectional observational study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital & Dhaka Shishu (Children) Hospital (DSH) from July 2008 to June 2009. Serum samples from 254 children aged between 1-15 years were tested for antibody (IgM & IgG) against hepatitis A virus (HAV) and detailed history was taken to find out the associated risk factors like residence, family income, source of drinking water, sanitation facility etc.Results : Hepatitis A virus antibody was positive in 141 (55.5%) of 254 children. Among all children anti-HAV positivity was significantly higher (p=0.004) in lower income group (64.8%) than higher income group (47.0%). Anti-HAV positivity was significantly higher (93.8%) in non-sanitary latrine users & in those who used unsafe drinking water.(p=0.006)Conclusions : Majority of children were found sero-positive against HAV by 15 year of age. Anti-HAV positivity was significantly higher in lower socioeconomic group.Northern International Medical College Journal Vol.6(1) 2014: 12-14

Background : Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disorder of the central nervous system (CNS) occurring predominantly but not exclusively in children. The presence of severe disturbance of consciousness together with multifocal neurological symptoms and signs especially in a child under 10 years of age; favours a diagnosis of ADEM. Neuroimaging is essential investigation for establishing the diagnosis of ADEM. High-dose steroid treatment frequently results in a dramatic clinical improvement. Objective: This study aimed to describe our experience with Acute Disseminated Encephalomyelitis (ADEM) focusing on the clinical features, neuroimaging, and outcome after treatment with high-dose steroid. Method: This retrospective observational study was conducted in children who were admitted as inpatients in Paediatric Neurosciences Department of Dhaka Shishu Hospital (DSH) with the diagnosis of ADEM during the period of 2017- 2019. All patients got high dose IV methylprednisolone for 5 days followed by 2 weeks tapering dose of steroid. Outcome was observed on the 7th day of treatment and 6 months after discharge from hospital. Result: A total of 16 patients who were diagnosed as ADEM were included in this study. Twelve children (75%) had a recent upper respiratory tract illness. Patients presented most often with motor deficits (88%) and secondly with altered consciousness (63% ) followed by seizure ( 50% ). MRI brain was the preferable neuroimaging which mostly (41.7%) showed multifocal symmetrical demyelination patch. On the 7th day of steroid treatment, significant improvement in motor function and level of consciousness occurred (p values were 0.001% and 0.014% respectively). After 6 months of discharge from hospital; no motor deficit, age-appropriate cognitive level and no seizure in 71%, 57% and 71% respectively. Conclusion: High dose corticosteroid treatment in ADEM is significantly effective in improvement of motor impairment and consciousness level on immediate follow up. Northern International Medical College Journal Vol.11 (2) Jan 2020: 468-470