Outcome and prognostic factors of acute meningoencephalitis in children of Southern Bangladesh.

Objective: To estimate the outcome of acute meningoencephalitis (AME) in children and evaluate the impact of prognostic factors. Design and setting: A prospective cross sectional study was conducted in the paediatric ward of Khulna Medical College Hospital from 2007- 2009. Method: All admitted children, aged 1 month to 12 years, satisfying the case definition were enrolled into the study. Cerebrospinal fluid (CSF) was collected for cytology and biochemistry to categorize AME into pyogenic, viral or normal varieties. CSF was tested for common bacterial antigen and, along with serum was also tested for Japanese encephalitis virus antibodies. Patients were monitored twice daily until the final outcome. Results: One hundred and forty children were inducted constituting 2.5% of admissions. Infants (30%) were the worst sufferers. Twenty one (15%) children with AME died which is 4 times higher than the overall mortality (3.8%) in paediatric ward (p<0.001). Among the 11 bacteria positive cases one died from S Pneumoniae. Low GCS score was associated with higher mortality (p<0.05). Eighteen (13%) cases developed neurological sequelae. Paralysis (27%) was the most frequent followed by hydrocephalus (23%) and involuntary movements (14%). Number of sequelae was significantly higher in pyogenic (44%) meningoencephalitis in comparison to non-pyogenic (14%) variants (OR=3.30, 95% CI: 1.08-10.01, p<0.05). Conclusions: Mortality from AME was 15%. Low GCS score was associated with higher fatality.

Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh

Background: Acute meningoencephalitis is an important cause of morbidity and mortality around the globe. The objective of this study was to examine the distribution of acute meningoencephalitis and its aetiological agents among children admitted to a tertiary hospital in southern Bangladesh. Methods: This prospective study was carried out in Khulna Medical College Hospital from 2007 to 2009. All of the admitted children between 1 month and 12 years of age were enrolled over a 2-year period if they met the inclusion criteria of having an acute onset of fever (≤ 14 days) and any of the following 3 signs: neck stiffness, convulsion, or altered mental status. Cerebrospinal fluid (CSF) was collected within hours and sent to the laboratory for cytological and biochemical analyses. CSF was examined by Gram staining and a latex agglutination test to detect common bacteria. Serum and CSF were also tested for Japanese encephalitis virus antibodies. Results: A total of 140 children were included in the study, which accounted for 2.5% of admissions between 2007 and 2009. The number of acute meningoencephalitis cases was relatively higher (37.9%) during the monsoon season. The CSF report revealed a pyogenic form in 24 (18.5%) and a viral form in 13 (10.0%) cases. Altered mental status was significantly less frequent (P < 0.001) in cases of pyogenic meningoencephalitis (62.5%) than in cases of non-pyogenic meningoencephalitis (93.4%). Bacterial causes were identified in 11 (8.5%) children; the causative agents included Streptococcus pneumoniae (n = 8), Neisseria meningitides (n = 2), and Haemophilus influenzae (n = 1). Three (2.3%) patients were positive for Japanese encephalitis virus. Conclusion: S. pneumoniae was the most common bacteria causing acute meningoencephalitis among the study subjects, and Japanese encephalitis virus was present in few patients.

Hereditary multiple exostoses causing cord compression

Hereditary multiple exostoses [HME] is an autosomal dominant skeletal disorder characterized by the presence of multiple osseous prominences. It can occur sporadically or within families [22 - 56%]. Two genes, EXT1 and EXT2 located respectively at 8q24 and 11p11-p12, have been isolated to cause HME. It can cause gross deformity of limbs and growth disturbance which is quite a common complication. Malignant transformation to chondrosarcoma can also occur. Neurological presentations are rare and usually happened due to direct compression of a peripheral nerve or nerve root or less often the spinal cord. This case is possibly the first case of HME described from Bangladesh, presented with dorsal cord compression. Decompression was done and the complaints of myelopathy were improved

Differences in epidemiologic and clinical features of Nipah virus encephalitis between the Malaysian and Bangladesh outbreaks

Since the initial outbreak of Nipah encephalitis in Malaysia in 1998, the virus has reemerged in Bangladesh and the adjacent Indian state of West Bengal since 2001. To date more than 470 patients have been affected with over 250 fatalities in total. Although the source of the virus is believed to be the Pteropus fruit bats both in Malaysia and Bangladesh, there are also significant epidemiological and clinical differences in the outbreaks occurring in these two regions. Epidemiologically, in the Bangladesh and India outbreaks, bat-to-human transmission through food and animal and human-tohuman transmissions were the predominant modes, the outbreaks were on a smaller scale and they have recurred every year except 2002 and 2006. Clinically, the mortality was higher and respiratory manifestation was more prominent in the Bangladeshi and Indian patients compared with their Malaysian counterparts, which might reflect differences in care and medical practices. There remain however, important differences in clinical manifestations which are likely to be due to some genetic variations in the virus.

A modified formula for defining tissue phantom ratio of photon beams.

Tissue phantom ratio (TPR), for square fields of various dimensions has been determined at varying depths in water. The dose in water has been measured at a fixed source-to-surface distance (SSD) of 100 cm and reference depth of 5 cm for 6 MV photon beam of Siemens Linear Accelerator Primus 11 in German Cancer Research Center (DKFZ), Heidelberg, Germany. A modified formula has been developed to calculate the TPR value for isocentric treatment. The present article describes the conversion of the measured data values into a comprehensive and consistent data set by the modified formula, that gives the TPR from Percentage Depth Dose (PDD) with depth as a function of field sizes from 10 mm x 10 mm upto 300 mm x 300 mm) and depth (from 0 mm to 300 mm).

Tinea capitis: a family problem

To determine the frequency of a positive family history of dermatophytosis and the presence of a separate focus of dermatophytic infection in patients with tinea capitis. A prospective, cross-sectional study. A total of 100 patients with mycologically proven tinea capitis were examined, and a family history was taken of dermatophytic infections in family members. Clinical and mycological examinations of index cases as well as of affected family members were carried out. Department of Dermatology, Mayo Hospital/King Edward Medical College, Lahore. Sixty eight patients [68%] had a positive family history of dermatophytosis and 17 [17%] had a focus of dermatophytic infection other than tinea capitis. A family history of tinea capitis or other dermatophytosis is a frequent accompaniment, in patients with tinea capitis. Also, some patients have another focus of dermatophytic infection in addition to the tinea capitis. These factors may serve as course of infection in the patient as well as in the family and community

reappraisal of the in vitro hair perforation test to differentiate between trichophyton mentagrophytes and trichophyton rubrum

The in vitro test was performed to study the behaviour of Trichophyton rubrum and Trichophyton mentagrophytes. Prepubertal and adult hair from different body sites were used. Trichophyton rubrum failed to produce perforations in any of the exposed hair. Trichophyton mentagrophytes produced perforations in the hair from all the sites tested. No difference was observed between prepubertal or adult hair and between adult hair from different sites