Introduction: Lower respiratory tract infection (LRTI) is one of the major causes of mortality in children with estimated 1 million deaths every year. Hyponatremia is the most common electrolyte abnormality seen in LRTI. The objective of study was to find association of hyponatremia (serum sodium<135meq/l) with severe LRTI. Prospective cross sectional study design was used for study. Settings: Pediatric Emergency, Ward and Pediatric Intensive Care Unit of Tribhuvan University Teaching Hospital (TUTH). Subjects: Children between 2 months to 16 years presenting with cough for less than 3 weeks, fast breathing and chest in drawing. Methods: Children between 2 month to 16 years of age having cough, fast breathing and chest in drawing admitted in emergency, ward or PICU of TUTH were screened and among them, children having pediatric respiratory severity score of 4-5 were enrolled in the study. Serum sodium was sent during admission and collected within 2 hours. Daily follow up was done to find need of respiratory support, duration to resolve hypoxia, total duration in hospital and final outcome of patient. Statistical test applied were Chi-square test and Fisher exact test. Results: 47.5% of study population had hyponatremia, of whom 65.79% had mild hyponatremia 26.31% had moderate and 7.89% had severe hyponatremia. Association of hyponatremia with need of non rebreathing face mask (p=0.001), ventilatior (p=0.009), duration of hospital stay (p=0.047) were significant. The study also found the association of severity of hyponatremia with need of non rebreathing facemask (p=0.001), ventilator (p=0.01), outcome (p=0.001), duration of stay (0.002). Mean time to resolve hypoxia in children with hyponatremia (4.5 days) was longer compared to normal sodium (2.58 days). Four patients died during the study period and all of them had hyponatremia. Conclusion: Association of hyponaremia and severity of hyponatremia in severe LRTI with need of non-rebreathing face mask, ventilatior, outcome, duration of stay was significant.

Background: In a gastrointestinal emergency, neonatal surgery is a very challenging and difficult task causing high morbidity and mortality. In Bangladesh, the frequencies of such emergency management are not very available. For this reason, we do have not enough research-based information regarding the outcomes and effectiveness of major neonatal gastrointestinal emergency management. Aim of the study: The aim of this study was to assess the outcomes and effectiveness of major neonatal gastrointestinal emergency management. Methods: This prospective observational study was conducted in Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh during the period from January 2018 to December 2018. In total 35 neonates with gastrointestinal emergency treated in the mentioned hospital were included as the study subjects for this study. A predesigned questionnaire was used in data collection. All data were processed and analyzed and disseminated by using MS Office and SPSS version 23 programs as per need. Results: In this study, as palliative procedures, Sigmoid colostomy, Transverse colostomy, Gastrostomy, Ileostomy were applied in 26%, 17%, 14%, and 6% of participants respectively. Besides these, as definitive surgical procedures Perforation repair and Exploratory lap with release of the band were applied in 20% and 14% of patients respectively which were noticeable. In outcome analysis, we observed, as the incidences of postoperative complication sepsis, wound infection, anopia, and anal stenosis occurred in 14%, 11%, 6%, and 3% respectively. Finally, in this intervention occurrence of death was found at 26%. Conclusion: Now a day, pediatrics surgery has evolved as a specialty within the province of general surgery. But till now, the management of neonatal gastrointestinal emergencies is a very complex and difficult task for any physician or a team of physicians in any part of the world. Prompt patient transportation, earlier primary diagnosis and the arrangement of modern treatment facilities, and arranging high-tech medical equipment can save a lot of babies from such health issues as gastrointestinal emergencies.

Leydig cell hypoplasia illustrates a rare category of 46, XY DSD "disorders of sex development". We report a case of a patient assigned to the female sex carrying a DSD with 46 XY karyotype on Leydig cell hypoplasia associated with pituitary stalk agenesis. This association has not been described yet in the literature. The patient was first admitted at the age of five for failure to thrive (FTT) with an abnormality of sexual development. The FTT was related to complete GH deficiency on pituitary stalk agenesis. Upon investigation, the patient was diagnosed as carrying a DSD 46, XY. The endocrine evaluation revealed low testosterone, FSH, and LH levels with a negative HCG test. The abdominopelvic ultrasound objectified two testicles in the inguinal folds. ²After discussing the case in a multidisciplinary consultation meeting, and taking into account the wishes of the family and the psychiatric expertise, the selected sex that was assigned to the patient was female. At the age of 19, the patient underwent a bilateral gonadectomy and the anatomopathological examination confirmed the diagnosis of Leydig cell hypoplasia. Leydig cell hypoplasia is a rare autosomal recessive syndrome, diagnosed by clinical, biological, radiological, histological, and genetic evidence. Its association with pituitary stalk agenesis has not been described in the literature. This syndrome is characterized by the inability of the chorionic gonadotropin luteinizing hormone receptor in Leydig cells to respond to luteinizing hormone, thereby causing feminization of a male fetus. The treatment has three components: hormonal treatment, surgical treatment, and psychological care.

Background: A covid-19 pandemic is an unprecedented event, which has a profound impact on the lives of children with neurological and neurodevelopmental disorders besides other people. In Bangladesh, the effects of the Covid-19 pandemic on children with neurological and neurodevelopmental disorders have not been adequately studied. Aim of the study: The aim of this study was to assess the diseases status of children with neurological and neurodevelopmental disorders during the Covid-19 pandemic. Methods: This voluntary prospective observational study was conducted during the period from June 2020 to August 2020 with an attachment of the department Paediatric Neuroscience, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh, and Neurogen Health Care, Dhaka, Bangladesh. A total of 78 children with at least one symptom of neurological and/or neurodevelopmental disorders were included as the study subjects of this study. Both previously diagnosed and newly recruited patients were accumulated as the study subjects. Both physical and online (With telephonic communication) consultation and follow-up were arranged for all the patients during the study period. All data were collected, processed, and analyzed by using MS Office and SPSS version 23 programs as per need. Results: In this study, the mean (±SD) age of the participants was 9.87±2.59 years. The male-female ratio was 1.4:1. The majority of the participants were from rural areas (55) and only 2 were from Covid-19 affected. About half of the participants (49%) were with epilepsy. Besides this, ‘impairment in social interaction, communication and behavior problem’, CP with global developmental delay, syndromic child, and ‘hyperactivity and inattention were found in 22%, 13%, 10%, and 6% participants respectively. The majority of the patients (53%) of this study were under antiepileptic therapies. Besides this, 9%, 13%, 5%, 14%, and 6% of participants were taking Immunosuppressive therapies, physical or occupational therapies, psychotherapy, combination therapy, and some other therapies respectively. Conclusion: Epilepsy is the most common disorder among children with neurological and neurodevelopmental disorders who saught for online consultation. Online consultation followed by subsequent physical consultation may be considered as an effective approach in managing patients with neurological and neurodevelopmental disorders during any pandemic situation like Covid-19.

Gastrointestinal stromal tumors are mesenchymal tumors that represent 0.1% to 0.3% of all malignant tumors. Their clinical presentation is nonspecific but presentation by massive hemorrhage with hemodynamic instability is rare. We report the cases of 02 young patients who presented a fulminant digestive hemorrhage with hemodynamic instability and whose endoscopic exploration did not reveal any obvious etiology. That’s why we involved interventional radiology and surgical team in order to localize and confirm the diagnosis of a hemorrhagic jejunal GIST and then to ensure the hemostasis by small bowel resection taking away the jejunal tumor.

Background: Iodine is a necessary element of the hormones produced by the thyroid gland. Basically, thyroglobulin (Tg), a thyroid-specific protein, that reflects the size of the thyroid gland, is usually considered a biomarker of urinary iodine status of several patients. But in Bangladesh, we do have not enough information regarding the sensitivity, specificity, and predictive value of thyroglobulin in determining iodine deficiency among simple diffuse goiter patients. Aim of the study: The aim of this study was to evaluate the sensitivity, specificity, and predictive values of thyroglobulin in determining iodine deficiency among simple diffuse goiter patients. Methods: This cross-sectional observational study was conducted at the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), and Dhaka Bangladesh. The study was conducted during the period from May 2014 to March 2016. The targeted sample size of this study was between 39 and 90 and the final sample size was finalized as 87. A purposive sampling technique was used to select 87 patients with simple diffuse goiter attending the outpatient department of the mentioned hospital. Results: In this study, we did not find any statistically significant difference in urinary iodine between the different cut-off values of serum thyroglobulin at 14.46 (ng/ml). Similarly, there was not any statistically significant difference in urinary iodine levels at different cut-off values of thyroglobulin. Thyroglobulin had a high negative predictive value and comparatively low positive predictive value in determining iodine deficiency, at 98.51% and 30% respectively. Serum thyroglobulin had 85.71% sensitivity and 82.50% specificity. Thyroglobulin also had a high negative predictive value at 98.51%, but a low positive predictive value at 30%. The overall accuracy of thyroglobulin as an indicator for iodine deficiency was 82.76%. Conclusion: Thyroglobulin seems to have an inverse association in iodine deficiency state and a positive association in over sufficient state with UI. The overall sensitivity of thyroglobulin was satisfactory but the specificity was found very low. Considering the urinary iodine as the gold standard, basically, the positive predictive value of thyroglobulin was found very low but the negative predictive value was found very high.

Endoscopic per-oral myotomy (POEM) is innovative an endoscopic technique for treatement of achalasia. This new technique has recently introduced in Morocco. It was performed on 7 patients at our institution. We collected patients data, the duration of the procedure, the location of the myotomy and patients follow-up. Results: Per-oral endoscopic myotomy was successfully performed in all patients, with adverse events observed in only one patient. Two months after POEM, significant reductions in symptom scores (Eckhardt Score 7.5vs 3) and this persisted at 3 years after POEM. Gastroesophageal reflux was observed in 16.8% of patients at 1 month and 21.3% at 3 years of follow-up. Per-oral endoscopic myotomy was successfully performed in all cases. Complications were rare (1.4%) and there was no mortality. Significant improvements in Eckhardt score were observed at 2 months, 1 year after POEM. Conclusions: Based on our series, POEM is a safe and effective treatment for achalasia, there are relatively few contraindications, and the procedure can be used as first- or second-line treatment.

Rhabdoid meningioma is a rare aggressive variant of meningioma. Histopathologically, it is particular and distinctive type having abundant eosinophilic cytoplasm with eccentrically placed nuclei. It has been included in the revised WHO classification of tumours of the CNS as a subtype of meningiomas with high risk of recurrence, more aggressive growth and poor survival, corresponding to WHO grade III.

Background: Thyroid diseases and diabetes mellitus are common endocrine disorders and Euthyroid Sick Syndrome is very common in uncontrolled type2 Diabetes Mellitus. As of thyroid hormones; the catabolic hormone Leptin is thought be closely linked with Diabetes Mellitus and Euthyroid Sick Syndrome. Objective: To evaluate the thyroid hormone pictures in absence of clinical thyroid diseases among type2 diabetic subjects in a Bangladeshi population. To see the baseline serum leptin concentration in a group of Bangladeshi adult population and to document how the leptin is related to glycemic status and Sick Euthyroid syndrome in the setting of uncontrolled type 2 Diabetes Mellitus. Method: This case and control study was carried out in the Endocrinology Department in collaboration with the Bio-Medical Research Group (BMRG), Research Division, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrinology and Metabolism (BIRDEM)), Dhaka, Bangladesh during the period of January 2000 to December 2002. A total of 100 type 2 diabetic subjects, 30-50 years of age, irrespective of glycemic status, duration of diabetes, Body Mass Index (BMI) and sex were recruited from the outpatient department (OPD) of BIRDEM hospital. Control subjects (n=30) were selected from friends and family of the patients within 5 years of age band without diabetes or impaired glucose regulation {Impaired Fasting Glycemia (IFG), Impaired Glucose Tolerance (IGT)} determined according to American Diabetic Association (ADA) criteria [37] and having no clinical thyroid diseases or other evident systemic diseases documented on clinical evaluation. Results: It was observed that mean± SD of the thyroid hormone pictures in diabetic and control subjects were; TT3 (ngm/dl) {in controls (88.91±15.88) and in diabetic subjects (84.27±22.29)} was not statistically significant to each other (p=0.209). Mean±SD of TT4 (µgm/ dl) in control subjects was 8.32±1.64 and in the diabetic subjects was 9.26±1.44, which is almost similar in both the groups (p= 0.589). FT4: (pgm/ml) in control subjects was 2.60±0.54 and in diabetics was 2.53±1.72 (p= 0.830). FT4. (µgm/ dl) in control subjects was 1.43±0.22 and in diabetics subjects 1.36±0.25. (p 0.179). TSH (µlu/ml) in control subjects was 1.34±1.00 and in diabetic subjects 1.54±1.21 (p: 0.411). FT3; FT4 and TSH showed no significant difference between control and diabetic subjects. Thyroid hormones (TT3, TT4, FT3, FT4) and TSH were reanalyzed according to HbA1c and BMI category and showed no significant differences. But when the FPG and HbA1c goes beyond 12 mmol/l and 10% respectively there was more worsening thyroid hormone pictures in comparison to groups whose FPG and HbA1c were below 12mmol/l and 10%. It was also noticed that there was a tendency to develop lower thyroid hormone pictures and more deteriorating glycemic status in patient with low and normal BMI groups in comparison to higher BMI groups of patients. Insulin and leptin were found to have strong positive correlation with BMI and other indices of obesity. Serum leptin was also found to be positively correlated with FPG and HbA1c upto a certain limit, but HbA1c went beyond 10%; serum leptin concentration tended to be declined. Serum leptin and Insulin showed strong positive correlation to each other’s. Thyroid hormones and TSH were re-analyzed and its relationship to FPG, HbA1c, fasting serum Insulin and Leptin were explored. Fasting serum Insulin and Leptin showed no significant differences among the different thyroid hormones groups. Conclusion: Uncontrolled type2 diabetes mellitus is associated with alteration of thyroid hormone pictures particularly affecting TT3, FT3 and TSH. This biochemical feature is more evident if the BMI of the Diabetic subjects is low or within the normal range and also the more worsening the glycemic status, there were more deteriorating serum thyroid hormone pictures. Serum leptin was not found to have any relation with these changes.