Hepatitis A virus vaccination strategy and pre-immunization screening of Bangladeshi children.

Background: HAV infection is endemic in many developing countries like India, Pakistan, Nepal etc. Several seroprevalence studies show high rates of sero-positivity among children by sub-clinical infection. Therefore mass vaccination against HAV has not been recommended in endemic countries. Objective: To determine whether routine hepatitis A vaccination is indicated for all Bangladeshi children & also to know whether pre-vaccination screening is necessary. Materials & Methods: Serum samples from 254 children aged between 1-15 years were tested for antibody (IgM & IgG) against hepatitis A virus (HAV) to determine the seroprevalence of HAV antibody and do a cost-benefit analysis for decision making about vaccination against HAV among the children of Bangladesh. Results: Hepatitis A virus antibody was positive in 141 (55.5%) of 254 children. Age-specific sero-prevalence was 13 (23.2%) of 56 in 1-3 year,64 (55.2%) of 116 in 3-5 year, 39 (70.9%) of 55 in 5-10 year & 25 (92.6%) of 27 in 10-15 year age group. Cost benefit analysis showed that the total cost of screening followed by vaccination was almost 1.8 times less than the total cost of vaccination of all children without screening. Conclusions: Majority of the children were found sero-positive against HAV around 15 year of age. Therefore mass vaccination against HAV may not be required for Bangladeshi children.

Management of Patient with Sturge-Weber Syndrome: a Case Report.

Sturge-Weber syndrome sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder. This is case report of 7 years old mentally disabled boy, with long-standing seizures, with a portwine nevi on the right side of the face along the distribution of trigeminal nerve. Interictal encephalogram showed bilateral slow activity, pronounced in the right hemisphere, with epileptogenic activity in the right fronto-parietal region. Computerized tomography and magnetic resonance imaging showed intracranial calcifications and atrophy of the right hemisphere of brain. Professional counseling and support in addition to drug treatment provide help to patients and their family to overcome their problems and improve the treatment outcome.

Management of Hepatitis C Virus Infection - New Era Has Been Started.

Hepatitis C virus is a major cause of chronic hepatitis and is responsible for majority of liver transplantation worldwide. It has got no vaccine for prevention. Interferon containing regimen was the only management options for treatment of Hepatitis C virus till last year. Due to side effect profile and treatment cost this treatment options was not reachable for general population. Besides, response rate was not so satisfactory (Genotype 1, 40-50%, Genotype 2 & 3, 70-80%). New oral antivirals were introduced in 2014 which has got little side effect profile as well as good treatment response rate (80-95%). These new drugs with their different combination regimens along with indications, contraindications and treatment monitoring of Hepatitis C virus are discussed briefly in this review.

Death due to Poisoning - a Medicolegal Study at Dhaka Medical College, Dhaka.

Self destruction or suicide by pesticide poisoning is a burning problem of Bangladesh. Rapid development in science and rapid growth in agricultural activities has led to the increase in the incidences of poisoning. The objective of this study was to find out the incidences and pattern of poisoning in an urban area, different aspects of poisoning along with demographic pattern, social factors related and other related perimeter, and modality to prevent loss of precious life due to poisoning. This retrospective cross sectional study was conducted among victims of poisoning at Dhaka Medical College, Dhaka Morgue during the period of January 2008-December 2009. Specific identification of poisons was made from Chemical Examiner's report. All the data were later on analyzed. A total of 5114 medico legal post mortems were performed during this study period. Among these 300 (5.87%) cases were suspected poisoning. Out of these cases specific poisons were identified in 131 (43.66%) cases. Among the detected poisoning cases OPC was the commonest agent 103 (78.63%) followed by alcohol/rectified spirit 12 (9.16%) and barbiturate 7 (5.34%). No poison was detected (Negative results) in 116 (38.66%) cases and no reports from chemical examiner were received in 53 (17.66%) cases during the study period. Out of 300 victims 174 (58%) were male and 126 (42%) were female. Highest incidence of poisoning was observed in 21-30 years age group 117 (39%) followed by age group of 31-40 years 84 (28%). Most of the victims were agricultural workers/ farmers 108 (36%) followed by housewives 51 (17%). Among the study subjects 178 (59.33%) were illiterate and 198 (66%) were married. Considering manner of death 274 (91.33%) victims committed suicide by poisoning and rests 26 (8.67%) were due to accidental poisoning. To reduce poisoning cases proper emphasis should be given for safe use of pesticides and consciousness should be created among the population about poisonous compounds. Detail study regarding death due to poisoning is required to be carried out in this country.

Evolution of disease and potential biocontrol activity of Trichoderma SP. against Rhizoctonia solani on potato / Potencial do biocontrole por Trichoderma em relação à evolução da doença causada por Rhizoctonia solani em batata

Black scurf and stem canker disease cause by the fungal pathogen of Rhizoctonia solani and it is an economical important disease of potatoes in Bangladesh and throughout the world. This study evaluated the black scurf and stem canker disease development in potato and antagonistic activity of Trichoderma spp. against R. solani. The artificial infections were carried out using the inoculums of R. solani. The treatments (%inoculum) were: T1 (0% inoculum), T2 (5% inoculum), T3 (10% inoculum), T4 (20% inoculum), T5 (50% inoculum), and T6 (100% inoculum). The infection of stem canker and black scurf on progeny tubers increased with increase in inoculum levels. The highest disease incidence and severity was found in T6 (100% inocula). T6 showed the maximum black scurf infected tubers (russet, deformed and sclerotia). The lowest germination percentage, plant height and tuber yield were also obtained in the same treatment (100% inocula). Trichoderma spp reduced the growth of R. solani and the highest growth suppression was noted in isolate TM12. According to antagonistic activity, Trichoderma spp. reduced the growth of R. solani but was not able to stop the pathogen development. This finding showed management of this disease or R. solani invasion requires an integrated approach compared to Trichoderma single approach.

A rizoctoniose ou crosta negra causada por Rhizoctonia solani é a mais importante doença nos campos de batata em Bangladesh, bem como em várias regiões do mundo. Este trabalho avaliou o potencial do biocontrole com Trichoderma spp. e sua ação antagonista contra R. solani em batateira. Realizou-se as avaliações do potencial antagonosta usando inoculação artificial de R. solani. Os tratamentos (% de inóculo) foram: T1 (0% de inóculo), T2 (5% ), T3 (10%), T4 (20%), T5 (50%) , e T6 (100% de inóculo). A infecção de rizoctoniose na haste e crosta negra nos tubérculos aumentou proporcionalmente com o aumento do nível de inóculo. A maior incidência e severidade da doença ocorreu no tratamento 6 (100 % de inóculo), o qual apresentou maior quantidade de tubérculos infectados e deformados com escleródios em sua superfície. A menor porcentagem de germinação e produção de tubérculos também foi encontrada no tratamento 6, o qual também apresentou menor altura de planta. Trichoderma spp reduziu o crescimento de R. solani e a maior atividade de supressão do crescimento foi encontrada pelo isolado TM12. Foi detectada a atividade antagonista de Trichoderma spp. em reduzir o crescimento de R. solani, mas este não inibiu o crescimento total do patógeno. Conclui-se que o manejo da rizoctoniose da batateira por colonização de R. solani necessita táticas de manejo integrado em detrimento do uso isolado do manejo ou biocontrole com Trichoderma spp.

Helicobacter Pylori Eradication Therapy in both Erosive and Non-erosive Gastritis — A Prospective Study.

Background: Infection with Helicobacter pylori (H. pylori) is a recognized cause of peptic ulcer and gastritis. Persistence of infection is a definite risk factor for gastric malignancy. Healing of gastritis after eradication of H. pylori reduces the risks of peptic ulcer disease and gastric malignancy. Objectives: To find out the relationship of H. pylori with erosive and nonerosive gastritis, the effect of anti-H. pylori therapy and to compare the effects of anti-H. pylori therapy between two types of gastritis. Materials and Methods: This prospective study was done in the Gastroenterology department of Bangabandhu Sheikh Mujib Medical University, Dhaka from June 2008 to May 2009. One hundred eighty dyspeptic patients were enrolled for the study. Patients with gastritis diagnosed by endoscopy underwent rapid urease test (RUT). RUT positive patients were considered to have H. pylori infection and were treated with triple therapy (omeprazole, amoxycillin and metronidiazole) for 14 days. Treatment responses were assessed by clinical history and also by endoscopic biopsy and RUT. Results of endoscopic findings and RUT after treatment were compared with pretreatment status. Results: Seventy patients completed the treatment and finally could be assessed. Endoscopic findings of 70 patients revealed that 56 (80%) patients had erosive gastritis and 14 (20%) patients had nonerosive gastritis. After treatment, 47 (67.1%) lesions became normal, 16 (22.9%) remained erosive and 7 (10%) non-erosive as before. Out of 14 non-erosive diseases, 7 became normal, while out of 56 erosive diseases 40 became normal. The erosive group responded significantly better than the non-erosive group (c2=32.766, p<0.001). Fifty nine (84.3%) patients with gastritis showed negative urease test after treatment. Conclusion: Strong relation between H. pylori infection and gastritis was found. Majority were antral erosive gastritis. Erosive group responded better than non-erosive group.

A Study of Snake Bite Cases in Faridpur Medical College Hospital, Faridpur.

Snakebite is one of the important cause of mortality in our country. This study was carried out to see the common type of snakes in local area with clinical presentations, complications and outcome of snake bite patients inFaridpur. Fifty cases of snakebite patients in medicine wards of Faridpur Medical College Hospital from 1st January 2012 to 31th April 2013 were studied. Among 50 snake bite patients 35 (70%) were male and 15 (30%) were female. Among them 30 (60%) were venomous and 20 (40%) snake bite cases were non-venomous.The common victims were farmers (53%) and housewives (13%). The bites were commonly encountered during rural foot walking (32%) followed by sleeping (15%). 55% were bitten during outdoor and agriculture related activities. 65% had sustained bite in lower limbs. The majority (82%) of the snakebites were observed during the month. Total 98% patients applied multiple tight tourniquets in the affected limb. A common local practice (seen in 85%) was to receive pre hospital treatment from 'Ohzas'. Among 30 poisonous cases, drooping of the upper eyelid, external ophthalmoplegia and brocken neck were the common features of poisoning. Among the 30 venomous snake bite cases 21 (70%) recovered completely after getting polyvalent antivenom serum and 9 (30%) died after admission. Total 80% cases recovered with 10 vials of polyvalent antivenom serum but others required upto 30 vials depending on severity of symptoms and its duration. No reaction to anti-snake venom was noticed.

Treating Asthma in Pregnancy - An Update.

Asthma is one of the most common chronic medical conditions affecting the lungs during pregnancy. At any given time, up to 8% pregnant women have asthma. During pregnancy, asthma not only affects the woman, but it can also cut back on the oxygen to fetus. But this does not mean that having asthma will make pregnancy more difficult or dangerous to fetus. Pregnant women who have asthma that is properly controlled generally have normal pregnancies with little or no increased risk to pregnant women or their developing babies. Currently available national guidelines for the treatment of asthma during pregnancy emphasize the objective measurement of control, patient education, motivation, caution and medication adherence. The article reviews the available literature highlighting the appropriate selection of medications in the treatment of asthma during pregnancy, and to identify those factors which may influence the asthma care provider's ability to successfully manage this condition, and also illustrate that maintaining asthma control with long term medications in pregnancy is safer than the risk of uncontrolled asthma or untreated exacerbations for both the mother and the fetus. Women's drug treatment during pregnancy should be regularly assessed in the light of asthma control criteria.

Antimicrobial Sensitivity Pattern of Helicobacter pylori Isolates among Subgroup of Bangladeshi Patients.

This cross sectional study was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU) and International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009. Aim of the study was to find out the antimicrobial susceptibility profile of Helicobacter pylori isolates from dyspeptic patients. Total 224 dyspeptic patients from Out Patient Department (OPD) of BSMMU were initially enrolled after informed written consent. After upper GI endoscopy 157 patients were finally included who had erosions, ulcers or atrophic changes in the stomach or duodenum. Two biopsy samples were taken from each of them. Samples were incubated at 370C in a double gas incubator with 5%O2, 10%CO2 and 85%N2. Total 82 (52.23%) samples were found positive for H. pylori. Isolated organisms were then tested for sensitivity to Amoxicillin, Clarithromycin, Tetracycline, Levofloxacin and Metronidazole by Agar dilution method. Among 82 patients 51(62.2%) were male and 31(37.8) were female with a male:female ratio 1.6:1. Patients were categorized into two groups one having gastric or duodenal ulcer (30.5%) and other having no ulcer (69.5%). Among these isolates 92.7% were sensitive to Amoxicillin, 89% to Clarithromycin, 81.7% to Tetracycline, 80.5% to Levofloxacin and only 26.8% to Metronidazole. Beside these, 81.7% isolates were sensitive to both Amoxicillin and Clarithromycin, 74.4% to Amoxicillin and Tetracycline, 73.2% to Amoxicillin and Levofloxacin, 72% to Clarithromycin and Tetracycline, 59% to Clarithromycin and Levofloxacin and 51% to Tetracycline and Levofloxacin.

Management of Inflammation in Chronic Obstructive Pulmonary Disease-Update.

Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory condition, the earliest manifestation of which is airway obstruction which is only partially reversible and the treatment rationales are provided accordingly. Research has shown that COPD-inflammation involves multiple inflammatory cells and mediators and the underlying pathology differs from asthma inflammation.For these reasons, therapeutic agents that are effective in asthma patients may not be optimal in COPD patients. COPD exacerbations are intensified inflammatory events compared with stable COPD. The clinical and systemic consequences believed to result from the chronic inflammation observed in COPD, suggest that inflammation intensity is a key factor in COPD and exacerbation severity and frequency. Although inhaled corticosteroids are commonly used and are essential in asthma management, their efficacy in COPD is limited, with only a modest effect at reducing exacerbations. The importance of inflammation in COPD needs to be better understood by clinicians, and the differences in inflammation in COPD versus asthma should be considered carefully to optimize the use of anti-inflammatory agents. Current COPD management focuses predominantly on symptom relief by optimizing bronchodilatation. The role of phosphodiesterase type 4 inhibitors (PDE4), statins, angiotensin converting enzyme inhibitors, theophylline and tumor necrosis factor inhibitors in COPD management will be reviewed. Targeting COPD inflammation with the goal of reducing exacerbations is a major focus of current clinical practice & outcome research.

Outcome of Upper Gastro Intestinal Haemorrhage - a Hospital Based Prospective Study.

Upper GI bleeding is a common medical emergency with a significant mortality, outcome of which depends upon the cause, appropriate and early intervention in a specialized center. This study was carried out to see the outcome of patient with Upper GI haemorrhage. Fifty cases with episode of upper gastrointestinal haemorrhage, admitted into medicine units of Faridpur Medical College Hospital from January 2011 to December 2011, were studied. Duodenal ulcer was the commonest cause of haematemesis and melaena followed by oesophageal varices, gastric ulcer and erosive gastritis. The peak incidence was among 35 to 45 years of age. Over all male female ratio was 4.55:1 but in case of duodenal ulcer it was 9:1. During hospital stay recurrent bleeding was noted in 10% of patients and during subsequent follow up it was 10% of the total and 50% in case of variceal bleeding group. Over all hospital mortality was 4% .

Efficacy of Different Laboratory Tests to Diagnose Helicobacter pylori Infection.

Helicobacter pylori is a Gram negative bacteria which causes chronic gastritis, peptic ulcer disease, primary B-cell gastric lymphoma, and adenocarcinoma of the stomach. There are a set of laboratory tests to diagnose H. pylori infection with a variable accuracy, they are divided into non-invasive tests and invasive tests. Non-invasive tests include serology, urea breath test (UBT) and stool antigen test (SAT). Invasive tests include rapid urease test (RUT), histology and culture. This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and H. pylori laboratory of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009 to evaluate the efficacy of RUT, SAT and Culture as a diagnostic tool for H. pylori. Dyspeptic patients were collected from outpatient department of BSMMU. Out of 224 dyspeptic patients 149 patients had ulcers or erosions in the stomach or duodenum. Stool sample could be collected from 139 patients. RUT has sensitivity of 100%, specificity 80.28%, positive predictive value 85% and negative predictive value 100%. Regarding culture, sensitivity is 100%, specificity 94.37%, positive predictive value 95% and negative predictive value 100%. Stool antigen test has sensitivity 95.94%, specificity 92.31%,positive predictive value 93% and negative predictive value 95%.

Hyperinfection with Strongyloides stercoralis in an Immunosuppressed Patient.

Strongyloides stercoralis is a common intestinal parasite in tropics and subtropics. In Bangladesh, prevalence is likely to be high due to poor sanitation. Clinical presentations are frequently nonspecific. However, in immunosuppressed individuals, infection becomes overwhelming and may disseminate and results in high rates of mortality. Unless a high index of suspicion, this readily treatable disease may be missed. Here we report a case of hyperinfection with Strongyloides stercoralis in a patient who was on corticosteroid treatment. A 45 years old male was admitted in Gastroenterology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) with the complaints of abdominal pain, vomiting and diarrhea for 2 weeks. He was on prednisolone 60 mg with omeprazole 40 mg daily for 4 weeks for his eyelid drooping prior to the development of abdominal symptoms. Physical examination revealed a severely malnourished, moderately anemic patient with muscle wasting, angular stomatitis, desquamated skins of feet and hands. Abdominal examination revealed generalized tenderness with moderate ascites. Investigations revealed Hb-7.4 gm/dl with normal WBC count (eosinophil-11% before steroid therapy), S.albumin-19gm/l with prolonged prothrombin time and hypokalemia. USG of abdomen revealed moderate ascites. Endoscopy of upper GIT showed congestion and multiple erosions in the stomach and also in the duodenum. Biopsy from the duodenum revealed adult Strongyloides stercoralis on the surface, larva and ova in the duodenal crypts. The patient was treated with 10 days of oral ivermectin along with blood transfusion, correction of nutritional status and electrolyte imbalance. Patient was discharged home after a total of 20 days of hospitalization.

A Case Report on Recurrent Lepra Reaction-Type 2.

Lepra Reactions (LR) comprises immunologically mediated inflammatory states that cause considerable morbidity. Type-2 LR occurs exclusively in patients with the lepromatous end of the leprosy spectrum (BL-LL). In 90% of the cases it follows during or after completion of chemotherapy, generally within 2 years. Here we report a case of type-2 LR. He is a twenty years old fisherman with history of hypopigmented skin lesion 3 years back and was treated as a case of lepromatous Leprosy (LL). After six months of completion of treatment he developed type-2 LR presenting with recurrent bouts of fever, polyarthritis, erythema nodusum, orchitis, mononeuritis multiplex and was treated in Faridpur Medical College Hospital (FMCH) on three occasions within last one and half years.

EPI Coverage among Under 5 Children Attending Pediatric Department of Dhaka Medical College Hospital.

This cross-sectional study was carried out among 1000 children between 10 months to 5 years of age during November 2004 to February 2005 attended in the department of pediatrics, Dhaka Medical College Hospital (DMCH) with different childhood illness. Aim of study was to know the Immunization (EPI) coverage, dropout rate and factors influencing dropout. According to parent's statement, 82.5% of the children were fully, 16.1% were partially and 1.4% were non-immunized. Specific immunization coverage revealed that, 97.3% were immunized with BCG, 96.7% with DPT1/OPV1, 92.9% with DPT2/OPV2, 91% with DPT3/OPV3 & 84% with measles vaccine. Among the BCG vaccinated children 91.77% had BCG scar. Drop out of DPT1-DPT3 was 5.78% & DPT1- measles was 12.88%. The main reason found for non-immunization were lack of faith in programme (57.1%), lack of awareness (21.4%), and fear of side effects (21.4%), whereas lack of awareness (41.6%) and illness of child (32.9%) played role behind drop out. Drop out cases were found to be associated with female sex, parent's illiteracy, higher number of children in the family and father's occupation (p<0.001), whereas mothers occupation had no independent effect on coverage (p>0.05). The study findings suggested that despite the effort taken by Government and NGOs to expand coverage, dropout rates are unacceptably high. To combat this challenge counseling and motivation on EPI, improvement of information system, health education and training of health workers are required.

Evaluation of Prescribing Pattern of the Private Practitioners in Bangladesh.

A prescription order is a written instruction of doctors to pharmacist to supply drugs in particular form to a patient and the directions to the patients regarding the use of medicines. This study was undertaken to observe the prescribing patterns of the private practitioners in Bangladesh, 430 prescriptions were collected randomly from Dhaka city and analyzed using WHO/INRUD indicators. There were average 3.40 drugs per prescription. Drugs were prescribed in generic name only in 0.20%. About 46.31% drugs were prescribed from the Essential Drug List, only 19% of prescriptions were complete in respect to patient medication information. Antibiotics were prescribed in 70.33% of the prescriptions; injections were prescribed in about 8.35% of the prescriptions.

Cutaneous Manifestations of Chronic Kidney Disease-An Observational Study in 100 Cases.

Chronic Kidney Disease (CKD) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of haemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. This cross sectional study was performed in 100 cases of CKD admitted in nephrology department of Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2008 to August 2008 to evaluate the prevalence of dermatologic problems. Among them most belong to 2nd to 5th decade, 68 are male and rests are female. Glomerulonephritis (44%), Diabetes mellitus (22%), Obstructive uropathy (13%) and Hypertensive nephropathy (12%) are found common causes of CKD. Among these patients 38% patients were treated with conservative treatment, 31% with intermittent peritoneal dialysis (IPD), 19% with haemodialysis and 12% with some form of immunosuppressive therapy. Total 88% of study population had some form of skin disorder; pallor was the most common (82%), while xerosis (61%), pruritus (53%), pigmentation (37%) and bacterial infection (37%) were other common problems. Purpura and fungal infection was 29% and 27% respectively. Viral infection (9%), dermatitis (4%), gynaecomastia (1%), kyrle's disease (3%) are relatively less common findings. Lindsay's nail was seen in 23% of patients and was more prevalent in glomerulonephritis and diabetic patients with prevalence of 13% and 9% respectively. Other nail changes included koilonychia (4%), subungual hyperkeratosis (1%), splinter hemorrhages (3%) onychomycosis (8%) and Beau's lines (1%). So, CKD is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment.

Gender Disparity in Autopsy Findings: How Much is It.

Bangladesh is densely populated country where male and female ratio is closer to each other. This descriptive study investigates the gender disparity of postmortem examination findings among 7 districts in the Rajshahi division of Bangladesh. Postmortem (PM) examination stations were located in Rajshahi, Rangpur, Bogra and Dinajpur Medical Colleges & Pabna, Natore and Chapai Nawabganj Sadar Hospitals. The findings of the autopsy reports (Total 3164) over the two years (2004 & 2005) were collected retrospectively from the register book of the authority. In this study we wanted to find out gender disparity - if exists in PM examination findings and, to what extent. Manually verified data were analyzed employing SPSS/WIN V-11.5. An obvious gender disparity existed in overall occurrence of unnatural deaths, male predominate female victims (M: F ratio = 1.51:1). A significant association existed in death circumstances & gender (p<0.0001); male (634) outnumbered female (250) in homicidal deaths, in suicidal deaths female (612) outnumbered male (364) and in accidental deaths male (583) outnumbered female (135). This classical gender difference in death circumstances remains similar to our national context. Findings of this study revealed an obvious gender difference in the overall numbers of cadaveric PM examination. Males were more victimized than females in majority of medico-legal aspects analyzed, except in suicidal cases.

Risk Factor for Relapse in Childhood Nephrotic Syndrome - A Hospital Based Retrospective Study.

Nephrotic Syndrome (NS) is a common childhood illness characterized by massive proteinuria, hyperlipidemia, hypoalbuminemia & edema. NS is a disease of relapse and it is a major problem to manage the cases with frequent relapse. So it is very important to find out such children who are prone to develop frequent relapse. This retrospective study was conducted in the paediatric department of Dhaka Medical College Hospital (DMCH) from January to December 2005.Total 100 children with relapsed NS of them 50 had Frequent Relapse NS (FRNS) and 50 had Infrequent Relapse NS (IFRNS) were included in the study with a view to find out the risk factors for relapse. Data were collected from previous medical and hospital records. Data were analyzed by using SPSS program. Chi-squared test and Student's t-Test were used as statistical test and p value < 0.05 was taken as significant. NS was more common among 2-6 years of age (67%) with male to female ratio roughly 2:1. Most of patient with frequent relapse had age <5 years, came from rural area and belongs to poor social class compared to that of infrequent relapse. The mean age at first onset was significantly less in frequent relapse group than that of infrequent relapse group. Majority of atopic child belongs to frequent relapse cases. Low serum albumin level, low serum total protein level, culture positive Urinary Tract Infection (UTI) at initial attack were observed to be statistically significant in case of frequent relapse group.