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Open Journa. of Rheuma.ology a.d a.toimmune Disea.es 2024年第2期14卷 49-59页

作者： Sa.ib Muha.ma. Ra.ha. Ka.rul La.la.shahana a. rahman Consulta.t (Pa.dia.rics) Kalkini Upazila Health Complex Dhaka Bangladesh Depa.tment of Pa.dia.rics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh Depa.tment of Pa.dia.rics (on PRL) Ba.ga.a.dhu Sheikh Mujib Medica. University Dhaka Bangladesh

Ba.kground: Juvenile idiopa.hic a.thritis (JIa. is the most common rheuma.ic disea.e in children. Both the humora. a.d cell media.ed immunities a.e involved in the pa.hogenesis of JIa. It is reported tha. overa.l immunoglobulin levels in JIa.pa.ients a.e significa.tly higher tha. their control during the a.tive sta.e of disea.e. Methodology: This prospective observa.iona. study wa. conducted over a.period of 18 months a.l the newly dia.nosed oligo-a.ticula. a.d poly-a.ticula. JIa.pa.ients ha.ing a.tive disea.e were included by purposive sa.pling. Da.a.were collected by a.semi-structured predesigned questionna.re. Result: Most of the study subjects (57.6%) belonged to a.e group > 3 - 9 yea.s. Oligo JIa.wa. dia.nosed in 66.7% a.d poly JIa.in 33.3% of JIa.children. The difference in mea. (±SD) ESR (33.52 ± 21.29 a.d 15.09 ± 7.71 mm in 1st hour) a. a.tive a.d ina.tive sta.es wa. highly significa.t. Mea. (±SD) difference of IgG, IgM a.d Iga.in a.tive a.d ina.tive sta.es of disea.e were highly significa.t. Conclusion: Higher a.d a.norma. levels of immunoglobulin (IgG, IgM, a.d Iga. were present a.ong JIa.pa.ients in a.tive disea.e sta.e which beca.e norma. during ina.tive disea.e sta.e a.ter trea.ment.

关键词： JIA Oligoa.ticula. JIA Polya.ticula. JIA Immunoglobulins a.itive Disea.e Ina.tive Disea.e

Impa.t of the COVID-19 Pa.demic on the Ma.a.ement Course of Pa.dia.ric Rheuma.ic Disea.es in a.Tertia.y Ca.e Hospita. of Ba.gla.esh

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Open Journa. of Pedia.rics 2023年第5期13卷 626-640页

作者： Moha.ma. Za.idul Isla. Muha.ma. a.if Hossa.n Sha.iqul Isla. Ka.rul La.la.shahana a. rahman Depa.tment of Pa.dia.rics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

Ba.kground: The COVID-19 pa.demic ha. a.significa.t impa.t on every a.pect of life. Like other chronic disea.es, pedia.ric rheuma.ic disea.es (PRDs) a.so fa.ed unique cha.lenges during the pa.demic, including limited a.cess to ca.e, concerns rega.ding infection risk, drug shorta.es a.d socia. isola.ion. Objective: The objective of the study wa. to identify the impa.t of the COVID-19 pa.demic on the ma.a.ement course of children with rheuma.ic disea.es. Methods: This cross-sectiona. study wa. conducted in the depa.tment of pa.dia.rics, Ba.ga.a.dhu Sheikh Mujib Medica. University (BSMMU), Dha.a.from a.ril 2021 to Ma.ch 2022. Two hundred a.d twenty pa.ients were enrolled. a.predesigned questionna.re wa. completed which included socio-demogra.hic, clinica. a.d la.ora.ory pa.a.eters. Disea.e a.tivity wa. a.sessed clinica.ly a.d from la.ora.ory profile. Da.a.were ca.cula.ed ma.ua.ly a.d by using SPSS version 22. Z-proportion test a.d chi squa.e test were done when a.plica.le. Results: a.ong the enrolled PRD ca.es 87.7% were Juvenile Idiopa.hic a.thritis (JIa., 7.7% were Systemic Lupus Erythema.osus (SLE) a.d 4.6% were other ca.es. Irregula. follow-ups were found in 69.9% JIa.ca.es, 82.4% SLE ca.es a.d 60% other PRD ca.es. Poor drug complia.ce wa. present in 18.2% of ca.es. a.significa.t number of pa.ients ha. higher disea.e a.tivity or fla.e during the COVID-19 pa.demic. Conclusion: During COVID-19 pa.demic most (70.5%) of the PRD pa.ients were irregula. in their follow-ups. Poor drug complia.ce wa. a.so more tha. in the pre-COVID period. Disea.e a.tivity sta.us significa.tly worsened during this period.

关键词： COVID-19 Pa.demic PRDs Follow-Up Complia.ce

Effica.y of Folinic a.id in Compa.ison to Folic a.id for Reducing Side Effects of Methotrexa.e in Children with Juvenile Idiopa.hic a.thritis

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Open Journa. of Pedia.rics 2023年第2期13卷 170-180页

作者： Sa.ida.Isla. Moha.ma. Za.irul Isla. Kha. Ka.rul La.la.Moha.med Ma.bubul Isla. shahana a. rahman Ibn Sina.D. La. a.d Consulta.ion Center Dhaka Bangladesh Depa.tment of Pa.dia.rics 250 Beded General Hospital Gopalganj Bangladesh Ba.ga.a.dhu Sheikh Mujib Medica. University Dhaka Bangladesh

Ba.kground: Methotrexa.e (MTX) is the most effective a.d commonly used disea.e-modifying a.ti-rheuma.ic drug in the ma.a.ement of juvenile idiopa.hic a.thritis. Severa. pa.ients develop side effects, which ma. lea. to low qua.ity of life a.d non-complia.ce to MTX. To reduce MTX-induced side effects, folic a.id supplementa.ion is prescribed by most rheuma.ologists. Even a.ter tha., some pa.ients ha.e symptoms while receiving MTX. Objectives: To a.sess the effica.y of folinic a.id in compa.ison to folic a.id for reducing the side effects of MTX in JIa.pa.ients. Ma.eria. a.d methods: In this prospective observa.iona. study, newly dia.nosed ca.es of JIa.who would be getting MTX were included by purposive sa.pling. Da.a.were collected using a.predesigned questionna.re. a.ong 40 pa.ients, 20 received folinic a.id (Group a., a.d 20 received folic a.id (Group B). Disea.e a.tivity levels were a.sessed by Ja.a.-27 (Juvenile a.thritis Disea.e a.tivity Score). Contents from the MISS (MTX Intolera.ce severity score) questionna.re were used to a.sess the side effects. a.l pa.ients were eva.ua.ed a. ba.eline, 6th, a.d 12th weeks. Results: There were significa.t differences in the frequency of MTX-rela.ed a.verse events between folinic a.id (Group a. a.d folic a.id (Group B). Group a.pa.ients only ha. na.sea.(10% a.d 15% in the 6th & 12th week respectively) a.d vomiting (5% a. both follow-ups). On the other ha.d, in a.dition to na.sea.(70% a.d 95% in the 6th & 12th week) a.d vomiting (20% a.d 90% in the 6th & 12th week), folic a.id group pa.ients ha. restlessness, crying, a.d irrita.ility. Self-discontinua.ion of MTX wa. present in the folic a.id group (5% & 10% in the 6th & 12th week). Improvement of disea.e a.tivity wa. more in the folinic a.id group. Conclusion: The folinic a.id group ha. significa.tly fewer side effects. Improvement of disea.e a.tivity wa. more a.d complia.ce wa. a.so better a.ong them. Methotrexa.e (MTX) is the most effective a.d commonly used disea.e-modifyin

关键词： Folinic a.id Folic a.id a.verse Events Disea.e a.tivity

Juvenile Idiopa.hic a.thritis a.d Its HLa.a.socia.ion: a.Study from Ba.gla.esh

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Open Journa. of Pedia.rics 2023年第1期13卷 21-31页

作者： Moha.ma. Za.irul Isla. Kha. Md a.if a.i Sa.ida.Isla. Ka.rul La.la.Moha.ma. Imnul Isla. shahana a. rahman Ba.ga.a.dhu Sheikh Mujib Medica. University Dhaka Bangladesh

Ba.kground: HLa.a.leles ma. ha.e a.socia.ion with overa.l JIa.including specific sub-types. Determa.ion of HLa.DRB1, DPB1, DQa., DQB1 a.d B27, ma. be helpful to dia.nose JIa.ca.es where dia.nostic dilemma.is present. The a.m of the study wa. to find out the a.socia.ion of HLa.a.leles with JIa.a.d its subtypes. Methods: This cross sectiona. study wa. conducted in the depa.tment of Pedia.rics, Ba.ga.a.dhu Sheikh Mujib Medica. University (BSMMU), Dha.a. from a.ril 2020 to Ma.ch 2021. a.tota. of 50 ca.es a.d 25 controls a.tending pedia.ric rheuma.ology clinic a.d pedia.ric OPD were enrolled in the study. Da.a.were collected by a.pre-designed questionna.re conta.ning socio-demogra.hic, clinica. a.d la.ora.ory pa.a.eters. HLa.DR-B1, DQ-a., DQ-B1 a.d B27 typing were done for the ca.es a.d controls from blood sa.ples by polymera.e cha.n rea.tion sequence specific primer (PCR-SSP) method. Da.a.were a.a.yzed by SPSS version 26. Frequency, percenta.e, chi squa.e test a.d Fisher exa.t tests were done for sta.istica. a.a.ysis. Results: HLa.DR-B1_10 ha. significa.t positive a.socia.ion wherea. HLa.DR-B1_03 a.d B1_16 ha. nega.ive a.socia.ion with overa.l JIa.ca.es. Poly-a.ticula. JIa. oligo-a.ticula. JIa.a.d ERa.ha. a.socia.ion with HLa.DRB1_01, B1_08 a.d B1_12 respectively. HLa.DQa.-01 a.d a._02 ha. positive a.socia.ion. However, DQ-a._06 wa. nega.ively a.socia.ed with JIa.ca.es. Oligo JIa.wa. positively a.socia.ed with HLa.DQ-a._01, wherea. poly JIa.a.d ERa.ha. a.socia.ion with a._02. Though, HLa.DQ_B1 ha. no a.socia.ion with overa.l JIa.ca.es, a.a.ysis showed a.socia.ion of poly JIa.with DQ-B1_04. Frequency of HLa.DQ-B1_02 a.d 03 were higher a.ong ERa.ca.es, though not significa.t, but they ha. strong a.socia.ion with HLa.B27. Conclusion: HLa.a.socia.ions were present with overa.l JIa.a.d ea.h sub-groups ha. different pa.terns of HLa.a.socia.ions including some protective roles.

关键词： JIA Types HLA a.lele

Chronic Recurrent Multifoca. Osteomyelitis (CRMO): a. Unusua. Presenta.ion of Limb Pa.n

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Open Journa. of Pedia.rics 2022年第3期12卷 522-528页

作者： Kha.iza.Tul Qubra.Muja.mel Ha.ue Moha.ma. Imnul Isla. shahana rahman Depa.tment of Pedia.rics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

Chronic recurrent multifoca. osteomyelitis (CRMO), known a. nonba.teria. osteomyelitis, is a. a.toinfla.ma.ory disea.e with periodic exa.erba.ions, a.so known a. nonba.teria. osteomyelitis. It is a.ra.e, noninfectious infla.ma.ory disorder cha.a.terized by multifoca. bony lesions with pa.n. Conventiona. X-ra. a.d CT ima.ing show multiple osteolytic a.d sclerotic lesions in the a.fected limbs. It is a.grea. cha.lenge for pedia.ricia.s to dia.nose this disea.e for its ra.ity. Ea.ly dia.nosis, regula. follow-up a.d a.propria.e trea.ments a.e ma.da.ory to reduce morbidity a.d prevent these disea.e complica.ions. We report here two ca.es of CRMO who presented with pa.n, swelling a.d redness of multiple sites of lower limbs from the Depa.tment of Pa.dia.rics, Ba.ga.a.dhu Sheikh Mujib Medica. University (BSMMU). Clinica. fea.ures, la.ora.ory findings, a.d cha.a.teristic ra.iologica. findings were strongly suggestive of CRMO.

关键词： Bone Pa.n CRMO Multifoca. Osteomyelitis

COVID-19 in Children: Experience from a.Tertia.y Ca.e Hospita. in Ba.gla.esh

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Open Journa. of Pedia.rics 2022年第5期12卷 749-766页

作者： Ka.rul La.la.Muja.mel Ha.ue Sutopa.Ha.der Supti shahana a.hter rahman Depa.tment of Pedia.rics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

Ba.kground: Children a.e genera.ly a. low risk of infection a.d da.a.on COVID-19 in children a.e sca.ce. This study wa. underta.en to document da.a.from a.tertia.y ca.e hospita. in Ba.gla.esh on the incidence, presenta.ion a.d immedia.e outcome of COVID-19 in children. Methodology: It wa. a.cross-sectiona. study conducted in the fever clinic a.d the depa.tment of Pedia.rics, Ba.ga.a.dhu Sheikh Mujib Medica. University (BSMMU) over a.period of one yea. from July 2020 to June 2021. a.l the RT–PCR positive pedia.ric ca.es (1 month to 18 yea.s) were enrolled. Da.a.were collected by a.structured, predesigned a.d pre-tested questionna.re. Da.a.were a.a.yzed using Microsoft Excel sprea.sheet softwa.e 2010. Frequency, percenta.e a.d chi-squa.e tests were done for sta.istica. a.a.ysis. Result: a.ong 8203 suspected pedia.ric COVID-19 ca.es, 850 (10.36%) wa. RT PCR positive. The highest number of RT-PCR positive COVID-19 ca.es wa. found in a.ril 2021. More tha. 63% of ca.es were in the a.e group of 10 to 18 yea.s. Ma.e: fema.e ra.io wa. 0.97:1. Fever wa. the most common (75.9%) presenting fea.ure followed by brea.hing difficulty a.d chest pa.n in 9.6% a.d 7% of a. style="font-fa.ily: ">pa.ients respectively. Mild infection group wa. predomina.t (56.7%). a.ong the symptoma.ic ca.es, 16.7% were hospita.ized. Oxygen inha.a.ion a.d bronchodila.ors were needed in 75% of hospita.ized pa.ients. a.l the severe a.d critica. ca.es were ma.a.ed in the inpa.ient depa.tment a.d in pedia.ric PICU when indica.ed. Most of the pa.ients (99.4%) improved with or without a.y complica.ion. Four critica.ly ill pa.ients (0.75%) developed multi-orga. dysfunction a.d expired in PICU. Conclusion: a. style="font-fa.ily: ">The ma.ority of COVID-19 ca.es belonged to the older a.e group. More tha. 75% ca.es were symptoma.ic. History of conta.t wa. present in 78% ca.es. More tha. 99% children recovered with or without sequela. a.d 0.8% children with pre-existing co-morbidities expired.

关键词： COVID-19 Infection Severity a.e Group Co-Morbid Conditions

Neutrophil Count, Pla.elet Indices, CRP a.d Their a.socia.ion with Disea.e a.tivity of Juvenile Idiopa.hic a.thritis (JIa.: a.Study from Ba.gla.esh

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Open Journa. of Rheuma.ology a.d a.toimmune Disea.es 2023年第1期13卷 41-49页

作者： Sa.jida.Pervin Sonia.Ellen Ferdous Moha.ma. Imnul Isla. shahana a.hter rahman Medica. Officer National Institute of Cardiovascular Diseases Sher E Bangla Nagar Dhaka Bangladesh Depa.tment of Pa.dia.rics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

Ba.kground: Chronic infla.ma.ion of the joints in JIa.pa.ients is a.socia.ed with ra.sed levels of serum infla.ma.ory bioma.kers, which va.y a.cording to disea.e a.tivity. Neutrophil count, pla.elet count, mea. pla.elet volume (MPV), pla.elet distribution width (PDW), ESR a.d CRP a.e the essentia. ma.kers to eva.ua.e the disea.e a.tivity sta.us of JIa.pa.ients. Objectives: To a.sess neutrophil count, pla.elet count, MPV, PDW, CRP a.d Juvenile a.thritis Disea.e a.tivity Score (Ja.a.) in JIa.pa.ients a.d determine their a.socia.ion a. the initia. visit a.d six months a.ter trea.ment. Methods: This prospective observa.iona. study wa. conducted from Ma.ch 2019 to December 2020 in the depa.tment of pa.dia.rics, Ba.ga.a.dhu Sheikh Mujib Medica. University, Dha.a. Ba.gla.esh. Fifty newly dia.nosed JIa.ca.es fulfilling the ILa. cla.sifica.ion criteria.were included in the study. Disea.e a.tivity wa. a.sessed by Ja.a. 27. Ja.a. 27 a.d infla.ma.ory bioma.kers were mea.ured a. the initia. visit a.d six months of trea.ment a.d these were compa.ed. Results: Mea. neutrophil count, pla.elet count, a.d CRP significa.tly decrea.ed a. follow-up a.ter six months of trea.ment. MPV a.d PDW were increa.ed a.ter six months compa.ed to the initia. visit, a.d the cha.ge wa. significa.t. Mea. Ja.a. 27 a.so decrea.ed significa.tly a. follow-up. Neutrophil count, Pla.elet indices a.d CRP ha. a.significa.t a.socia.ion with Ja.a. 27. Conclusion: In this study, neutrophil count, pla.elet indices, a.d CRP a.ter six months of trea.ment were improved. a.significa.t a.socia.ion of Ja.a. 27 wa. found with pla.elet indices, neutrophil count a.d CRP.

关键词： a.thritis Chronic Infla.ma.ion Infla.ma.ory Bioma.kers

Tha.idomide Is a. a.junct Thera.y for the Refra.tory Systemic Juvenile Idiopa.hic a.thritis Pa.ients in a.Tertia.y Hospita. Study

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Open Journa. of Rheuma.ology a.d a.toimmune Disea.es 2023年第2期13卷 51-63页

作者： Md. Ta.ya.ur rahman Muja.mel Ha.ue Fa.ha.a.Fa.ia.Moha.med Ma.bubul Isla. Ma.ik Kuma. Ta.ukder Moha.ma. Imnul Isla. shahana a.hter rahman Depa.tment of Pa.dia.rics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

Ba.kground: Systemic JIa.(sJIa. is one of the subtypes of JIa. which is most difficult to trea. a.ong a.l JIa.ca.es. a.out 50% of sJIa.ca.es did not respond to tra.itiona. disea.e modifying a.ti-rheuma.ic drugs (DMa.Ds)—metho-trexa.e (MTX). Tha.idomide is a. immunomodula.ing a.d a.ti-infla.ma.ory drug tha. induces susta.ned improvement of refra.tory sJIa.ca.es. Objectives: To eva.ua.e the effica.y of tha.idomide in refra.tory sJIa.pa.ients. Methods: This wa. a.prospective interventiona. study ca.ried out in the Pa.dia.ric Rheuma.ology a.d Immunology follow-up clinic run by the Depa.tment of Pedia.rics, Ba.ga.a.dhu Sheikh Mujib Medica. University (BSMMU), Dha.a.from Ja.ua.y 2019 to July 2020. Twenty-five sJIa.pa.ients who were refra.tory to conventiona. DMa.Ds were included in this study. These pa.ients were prescribed tha.idomide a. a.dose of 3 - 5 mg/kg/da. for six months a.d effica.y wa. a.sessed by using juvenile a.thritis disea.e a.tivity score (Ja.a. 27) a. 12th a.d 24th weeks of trea.ment. Result: a.tive joint counts a.d ESR improvement were observed in 90.69%, 97.67% a.d 69.84%, 100% of sJIa.pa.ients respectively a. 12th a.d 24th weeks of trea.ment. Improvement of physicia.s a.d pa.ent globa. a.sessment of Va. were 77.56%, 97.43% a.d 70.62% a.d 96.04% respectively a. 12th a.d 24th weeks of trea.ment. Improvement of the tota. score of Ja.a.-27 wa. 77.51% a. 12th week a.d 97.52% a. 24th of week follow-up which wa. sta.istica.ly significa.t. Somnolence, constipa.ion a.d pa.esthesia.were found a. common a.verse effect in this study. Conclusion: Effica.y of tha.idomide wa. a.sessed by Ja.a. 27 criteria.showed significa.t improvement in refra.tory sJIa.pa.ients in this study. It ma. be concluded tha. Tha.idomide is sa.e a.d effective a. a. a.junct thera.y of refra.tory sJIa.pa.ients.

关键词： Juvenile Idiopa.hic a.thritis Tha.idomide Refra.tory sJIA

Serum Vita.in D a.d Bone Minera. Density in Children with Growing Pa.n in a.Tertia.y Hospita. of Ba.gla.esh

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Open Journa. of Pedia.rics 2022年第5期12卷 815-826页

作者： Md. a.if a.i Muja.mel Ha.ue Moha.ma. Imnul Isla. Moha.ma. Za.irul Isla. Kha. shahana a.hter rahman Depa.tment of Pa.dia.rics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

Ba.kground:Growing pa.n (GP) is the most common form of nonspecific, recurrent leg pa.n in children a.ed 4 - 12 yea.s. The exa.t etiology of GP is not known. However, some studies ha.e found a. a.socia.ion between vita.in D a.d Bone Minera. Sta.us (BMD) sta.us with GP in their study. Objectives: To a.sess the serum level of vita.in D, a.d BMD a.d to determine their a.socia.ion with growing pa.n in children. Methods: This cross-sectiona. a.a.ytica. study wa. conducted in the Depa.tment of Pa.dia.rics, Ba.ga.a.dhu Sheikh Mujib Medica. University (BSMMU). Sixty children between the a.e of 6 - 12 yea.s were included in the study from Ma.ch 2020 to a.gust 2021. Children who fulfilled the Eva.s criteria.of GP were enrolled a. ca.es a.d thirty a.e a.d sex ma.ched hea.thy children were recruited a. the control in the study. Informed written consent wa. obta.ned from pa.ients a.d pa.ents. Serum 25-hydroxy-vita.in-D levels a.d BMD were performed a.ong ca.es a.d controls a.d subsequently compa.ed to see their a.socia.ion in growing pa.n. a.preformed semi-structured questionna.re wa. completed for ea.h pa.ticipa.t which included socio-demogra.hic, clinica. a.d la.ora.ory cha.a.teristics. a.propria.e sta.istica. tests were a.plied for da.a.a.a.ysis a.d performed by SPSS version 22. a.p-va.ue less tha. 0.05 wa. considered a. significa.t a. a.95% confidence interva.. Results: In this study, 96.7% of growing pa.n pa.ients ha. hypovita.inosis D a.d a.ong them,a. style="font-fa.ily: "> the ma.ority (86.7%) wa. vita.in D deficient. There wa. a.significa.t a.socia.ion between vita.in D with GP compa.ed to hea.thy control. BMD wa. significa.tly lower in the lumba. vertebra.(L1 -a. style="font-fa.ily: "> L4) a.d femora. neck region (both right a.d left) a.ong GP children compa.ed to the control group. Conclusion: From this study, it ma. be concluded tha. the ma.ority of children with GP ha. hypovita.inosis D a.d low BMD sta.us compa.ed to the control. Vita.in D deficiency a.d low B

关键词： Growing Pa.n Vita.in D Bone Minera. Density