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Objective: To determine the efficacy of subcutaneous methotrexate in patients with juvenile idiopathic arthritis (JIA) who failed to improve with oral methotrexate according to American College of Rheumatology 30 (ACR 30) improvement criteria. Design: Interventional Study. Setting: Rheumatology follow up clinic, Department of paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during the period from July 2006 to December 2008 . Methods: Twenty five patients who failed to improve with oral methotrexate were switched to subcutaneous methotrexate. Dose of methotrexate were same in both oral and subcutaneous route, at a dose of 10 mg/m2/week as a single dose. Results: According to ACR 30 criteria 76% patients improved after switching over to subcutaneous route. Among the core set variables active arthritis had the highest percentage of improvement and laboratory criteria (ESR) showed lowest improvement. Conclusion: From this study it may be concluded that subcutaneous methotrexate could be effective in patients with JIA who failed to improve with oral methotrexate. DOI: http://dx.doi.org/10.3329/bjch.v35i1.10368 BJCH 2011; 35(1): 16-19

not availableBangladesh J Child Health 2015; VOL 39 (2) :108-109

Aim Metabolic syndrome is the constellation of metabolic abnormalities which includes central obesity, atherogenic dyslipidaemia, hypertension, and hyperglycaemia. Insulin resistance is an important feature of type 2 diabetes. It is being increasingly recognized that low testosterone levels in men are associated with reduced insulin sensitivity and type 2 diabetes. Type 2 diabetes mellitus is often associated with male sexual dysfunction. Erectile dysfunction is more common in diabetic males and its prevalence appears to increase with age and duration of diabetes. Low serum testosterone level is one of the important cause of erectile dysfunction is type 2 diabetic men and it is relatively easy to treat than the other causes of erectile dysfunction. Material and Methods In this study carried out in a tertiary level hospital, serum concentration of total testosterone was measured in 170 type 2 diabetic (mean age 44.9 ± 7.9 years) and 40 non-diabetic (mean age 43.3 ± 9.4 years) patients who have erectile dysfunction or other features of hypogonadism. The aim of the study was to assess the parameters of metabolic syndrome among subjects with complain of sexual dysfunction. Results The mean total testosterone concentration in type 2 diabetic and non-diabetic men was 14.4 ± 5.6 and 17.4 ± 5.2 nmol/L respectively ( p = 0.002). Fifty nine of 170 (34.7%) type 2 diabetic and 8 of 40 (20%) non diabetic patients had low serum testosterone levels (≤12 nmol/L). BMI and waist circumference were both negatively correlated with testosterone levels in men, with the association being stronger for waist circumference. Conclusions Considering this finding, patients of MetS were studied which revealed metabolic syndrome was more common in hypogonadal subjects (88% in diabetic vs. 25% in non-diabetic). In diabetic subjects. Metabolic syndrome is also associated with the low serum testosterone levels in men.

Objective: Until recently, management of repeat breeding in cattle remains a major problem to dairy farmers. This study was carried out to improve the fertility in cows, those did not conceive after three or more consecutive services. Materials and methods: Twenty-three repeat breeding cows were selected from the Central Cattle Breeding Station and Dairy Farm (CCBS & DF), Savar, Dhaka, Bangladesh. Data of another 23 repeat breeding cows that conceived after four or more services were collected from the same farm as controls. The repeat breeders were synchronized for estrus with two injections of PGF2α 11 days apart and timed AI (TAI) was performed. Results: Seventeen of 23 cows had uterine infections. Intrauterine infusion of penicillin daily for three successive days from the following day of the first PGF2α injection resulted in 94.1% (16/17) recovery. Of 23 treated cows, four with estrus synchronization and TAI, and one with only AI after hormone treatment were detected pregnant by per rectal examination of the genital tract. By this pregnancy, the treated cows have advanced average of 131.6 days calving interval and days open, and thereby saved neat US $3,045.3 in comparison to control cows. Control group cows incurred losses of US $15,134.0 compared with average days open of the treated pregnant cows. Conclusion: Intrauterine infusion of penicillin can successfully recover the uterine infections, and estrus synchronization followed by TAI resulted in pregnancy in a proportion of repeat breeder cows with economic benefit that had a uterine infection. [J Adv Vet Anim Res 2018; 5(4.000): 454-458]

Objective: To present our experience of juvenile idiopathic arthritis (JIA) patients in terms of clinical presentation and to observe if there is any difference in clinical presentation of our children from that in the Western world. Methodology: A cross-sectional observational study was carried out in the paediatric rheumatology follow-up clinic run by the Department of Child Health, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during the study period of January 2004 to April 2007. A total of 132 patients fulfilling International League against Rheumatism classification criteria were enrolled in the study. Data were collected in a questionnaire containing clinical history, physical findings, relevant investigations and ophthalmologic findings. Results: Among the 132 cases 89 were male and 43 were female, M:F ratio being approximately 2:1. Age range of the patients was 1.5 years to 15 years. Maximum number of patients presented in the age group from 7–8 years (12.10%) followed by 10–11 years (11.36%). Duration of illness was more than 12 months in the majority. Polyarticular rheumatoid factor-negative patients were most frequent (41.70%), followed by persistent oligoarthritis (23.50%). The majority of the patients (51.52%) were diagnosed with rheumatic fever before they reported to us. Conclusion: Late diagnosis with long duration of disease and deformities were common. Wrong diagnosis and wrong treatment was also very common. Clinical presentation of our cases differed from Western JIA cases mainly is terms of sex distribution, subtypes and late presentation.

A total of 65 water buffaloes (groups A, B, and C) at =>60 days postpartum with a body condition score (BCS) of =>2.5 were selected to evaluate ovsynch protocols for timed artificial insemination (TAI). The group A buffaloes (n = 25) were treated with a simple ovsynch protocol (GnRH - Day 7 - PGF2 alpha - Day 2 - GnRH -16 h - TAI). The group B buffaloes (n = 22) received PGF2 alpha treatment 12 days before the initiation of simple ovsynch (PGF2 alpha at Day -12 + simple ovsynch; modified ovsynch). The group C buffaloes (n = 18) were treated with a double ovsynch protocol (GnRH - Day 7 - PGF2 alpha - Day 3 - GnRH - Day 7 - GnRH - Day 7 - PGF2 alpha - 48 h - GnRH - 16 h - TAI). Milk P4 ELISA was used for tracking ovulation and conception rates. Ovulation rates were higher in buffaloes that received the double ovsynch treatment (group C; 83.3%) than those with simple ovsynch (group A; 72.0%; P < 0.05). The group C cows (44.4%) achieved a higher conception rate than the cows of groups A (28.0%) and B (36.4%) (P < 0.05) and multiparous buffaloes having BCS of =>3.5 responded better to the ovsynch treatments than the primiparous ones (P < 0.05). The double ovsynch protocol increases both ovulation and conception rates in comparison to the simple and modified ovsynch protocols and is more effective in multiparous cows than in primiparous ones.

Aims To determine the prevalence of subclinical hypothyroidism (SCH) among subjects with metabolic syndrome and to find out the relationship of subclinical hypothyroidism with different components of metabolic syndrome. Materials and methods The study was conducted in the Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka during the period of April 2008–March 2009. One hundred and seventy three subjects with metabolic syndrome (according to IDF criteria) aged 20–69 years were included in the study. After primary selection, FPG and lipid profile were done. Those who had FPG ≥ 100 mg/dl or dislipidemia were selected for routine investigations such as SGPT, S. creatinine, TC, DC, ESR, HB%, ECG, and Ultrasonography of whole abdomen to exclude liver disease, renal disease, acute illness and cardiac disease respectively. Patients having normal investigations were finally selected for serum level of FT 4 and TSH. Results A total of 173 subjects (105 male, and 68 female,) with metabolic syndrome were studied. Among them 14.3% ( n = 15) of male and 19.1% ( n = 13) of female had SCH. SCH was found more in obese subjects (BMI ≥ 25 kg/m 2 vs. BMI 2 ). There was no significant difference among different parameters of metabolic syndrome in subjects with or without SCH. Although SCH was more prevalent in those who had hypertrigyceridemia and hypertension, there was no association between presence of fatty liver and SCH. Conclusions Among the study subjects 14.3% male and 19.1% female had SCH. SCH is more prevalent in 41–60 years age group. No significant association was found among different parameters of MetS with SCH, however, when they constitute metabolic syndrome; there was a significant association between MetS and SCH.

DOI: http://dx.doi.org/10.3329/bjch.v35i3.10525 Bangladesh J Child Health 2011; Vol 35 (3): 124-126

Objecitve: Maggot wound is common in domestic and pet animals but report on maggot wound treatment in wildlife species is scanty. The study reported here the surgical and conservative management of maggot wounds including anesthetic protocol and postoperative care in two Bengal tigers ( Panthera tigris tigris ). Materials and methods: One female and one male tiger were presented with maggot wounds for treatment at the Bangabandhu Sheikh Mujib Safari Park, Gazipur, Bangladesh. Tigers were anesthetized with combined injection of xylazine (dosed at 1.0 mg/kg bwt, IM) and ketamine hydrochloride (dosed at 3.5 mg/kg bwt, IM). Superficial maggots were removed from wounds using sterile tissue forceps. Gauze soaked in oil of turpentine was allowed to remain in each wound pocket for 5 min for the removal of deep-seated maggots. Finally, wounds were dressed with tincture iodine to clean out the dead tissue debris and to induce inflammation for rapid healing. A single subcutaneous injection of ivermectin (dosed at 200 µg/kg bwt, IM) was given in each tiger. In addition, long acting oxytetracycline (dosed at 10 mg/kg bwt, IM) on 48 h interval for six days, chlorpheniramine maleate (dosed at 1 mg/kg bwt, IM) once daily for three days, and ascorbic acid (dosed at 250 mg/tiger, IM) once daily for seven days were administered in both tigers. Results: The tigers were recovered successfully without any complications in two weeks following treatment. Conclusion: Surgical management using oil of turpentine and tincture iodine along with parenteral administration of ivermectin, long acting oxytetracycline and chlorpheniramine maleate are effective for successful management of maggot wounds in Bengal tigers. http://doi.org/10.5455/javar.2017.d187

Identification of cows with subclinical mastitis (SCM) is an important tool for sustainable dairying and implementing effective mastitis control strategies. A total of 892 quarters milk samples from 228 lactating cows were screened by California mastitis test (CMT), White side test (WST), Surf field mastitis test (SFMT), and somatic cell count (SCC) to study the prevalence of bovine SCM in some selected areas of Bangladesh. Out of 228 cows, 148 (64.9%), 138 (60.5%), 132 (57.9%), and 164 (71.9%) were found positive for SCM by CMT, WST, SFMT, and SCC, respectively. The prevalence of bovine SCM was diagnosed 45.7, 40.2, 36.6, and 29.6% in Chittagong, Sirajgonj, Mymensingh, and Gazipur districts, respectively, based on a combination of all tests. The overall quarter-wise prevalence of SCM was 45.7, 43.5, 41.2, and 55.0% for CMT, WST, SFMT, and SCC. Single quarters and left front quarters were more prone to SCM (P 0.05). Friesian crossbred cows (56.4%), BCS 2.0-2.5 (55.4%), and parity 4-6 (52.4%), the late lactation stage (5-8 months; 64.7%) and high yielding cows (16-20 L/day; 65.3%) were more susceptible to SCM (P 0.05). The sensitivity of the CMT, WST, SFMT, and SCC was 65.8, 57.9, 51.0, and 82.5%; specificity 76.2, 72.4, 69.5, and 89.4%; percentage accuracy 70.0, 64.8, 59.9, and 85.2%; positive predictive value 75.2, 69.8, 64.9, and 92.7%, respectively. The categories of CMT reactions were strongly correlated with SCC (P 0.05). Kappa value of SCC was higher than that of other tests (SCCCMTWSTSFMT). Thus, CMT was concluded to be the most accurate (r = 0.782) field diagnostic test after laboratory test like SCC (r = 0.924). However, the use of any single test may not be reliable in diagnosing SCM, while the result of CMT supported by SCC might be used effectively to pinpoint diagnosis of SCM in dairy animals than alone.

Juvenile idiopathic arthritis (JIA) includes a group of disorders characterized by chronic arthritis. It is the most common chronic rheumatic illness in children and is a significant cause of morbidity, disability and dysfunction. Therefore, the potential for school attendance and academic performance become compromised and these children are often confronted with educational difficulties. Objectives: To assess the impact JIA on academic difficulty, academic performance, potential causes of absenteeism, school failure and relationship between schooling and different types of JIA. Materials and Methods: All school going JIA patients between 6-16 years of age who had at least 2 years of schooling (1 year before disease onset and 1 year during the course of disease) were included for the analysis. Two hundred JIA patients were selected by purposive sampling method. A detailed questionnaire was completed for each participant which included socio-demographic, clinical and laboratory characteristics, data related to schooling, academic difficulties and their causes, absenteeism and causes, sports and cultural activities, school failure and school re-entry if any. Fifty four controls were taken who were the healthy sibs of those JIA patients having at least 2 previous years of schooling. Results: Mean age of JIA patients were 10.8 years, 67% were male and male female ratio was 2:1. Academic difficulties were observed for reading, writing and both due to disease process and deformity. Number of absent days and poor attendance in examination was significantly higher in JIA patients (p value < 0.001). Moreover, in case group, only 18% had improved result than the academic year prior to disease onset, 3% had no change, 57% deteriorated and 22% stopped schooling. There were 44 cases of school failure among JIA patients, 30 had school re-entry. No children had school failure or re-entry among the control group. Multiple causes of absenteeism like flare, hospitalization, side effects of drugs, movement difficulties, parental non-interest and some other factors like rainfall, delayed rising from sleep etc co-existed for most of the cases. In control group, mean percentage of absenteeism was 1.6%, mostly due to some febrile illness, cold weather, rainfall, lack of transport, sickness of caregiver etc. Children who did not participate in sports activities were 9.3% in control group and 48.5% in case group (p value < 0.001). Conclusion: It is evident from this study that JIA has negative impact on schooling characterized by poor attendance and academic performance.

Background: Limb pain in children is a major diagnostic challenge. In majority of cases limb pain are due to growing pain (GP), which is the most common form of episodic childhood musculoskeletal pain. Some standard criteria are being used for diagnosis of GP. Objective: This study was undertaken to identify the frequency of growing pain and to determine its presentation and risk factors in school children. Methodology: This cross sectional study was conducted from January 2014 to December 2014 among school children aged 6-12 years in four Kindergarten schools at Bhairab Thana in Kishoregonj District. Standard criteria given by Peterson (1986) were used in this study for diagnosis of GP. Pretested questionnaires in Bangla were distributed among the children of Class One to Class Five by purposive sampling. After completions by parents or caregiver, questionnaires were collected from the schools and children with limb pain were selected for further history and clinical examination. Age and sex matched healthy children were selected as controls for comparison of risk factors. Results: Among 540 distributed questionnaires 404 (74.8%) responded. Among responders 95 (23.5%) had limb pain of which 78 (19.3%) were diagnosed as GP (40 were male and 38 were female). Highest number of cases was found in 8+ year age group. Site of pain was calf muscle (69.2%) in the majority. Timing of pain was at night in 82.05% cases. In 66.6% of cases pain was improved with massage. GP hampered activities like sleep in 26.9%, sports in 21.7% and schooling in 8.9%. GP was associated with headache in 12.8% and abdominal pain in 6.4% cases. Obesity, overweight, over activity and family history of GP were found significantly higher among GP cases than controls. Conclusion: Growing pain was found to be the most common cause of limb pain. Typical presentation of GP and multiple risk factors like obesity, over activity and family history were identified in this study.

Objective: To investigate the responsiveness of disease activity measures in juvenile idiopathic arthritis (JIA) patients treated with methotrexate (MTX) using the Standardized response median (SRM) and the effect size (ES). Design: Prospective observational study. Duration of the study was from June 2005 to December 2007. Setting: This study was carried out in the department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Participants: A total of 58 consecutive patients were enrolled in the study but 40 patients completed their regular follow-up. All patients received MTX orally along with non-steroidal anti-inflammatory drugs (NSAID) and/or steroid. Results: The subjective variables including physician's and parent's global assessment were most responsive instrument. Among the articular variables, number of joints with limited range of motion was the most responsive. Functional ability was the lowest responsive. Conclusion: While SRM and ES had been used to evaluate the responsiveness, the physician's and parent's global assessment and number of joints with limited range of motion were the most responsive outcome measure in the therapeutic response in JIA patients. Keywords: Standardized response median (SRM); effect size (ES); responsiveness. DOI: 10.3329/bjch.v32i1.5992 Bangladesh Journal of Child Health 2008; Vol.32(1): 1-5

Objective: To investigate the efficacy of subcutaneous versus oral methotrexate in patients with Juvenile Idiopathic Arthritis (JIA) according to ACR 30 improvement criteria. Design: Prospective control trial (Parallel design) study. Setting: This study was carried out in the department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during the period from September 2006 to April 2008. Patients: A total of 40 patients participated in the study. They were divided in 2 equal groups (Group A and Group B) alternatively matching with age, sex, and subtypes of the disease. Methotrexate was given orally in group A patients and subcutaneously in group B patients. Results: Amomg the core set variables active arthritis had the highest percentage of improvement in both the groups and laboratory criteria (ESR) showed lowest improvement. According to ACR-30 criteria, improvement rate was higher in the subcutaneous group than oral group (85% versus 65%). Side effects of MTX were also less in subcutaneous group than oral group. Conclusion: From this study it may be concluded that the efficacy of subcutaneous MTX is more than oral MTX in JIA patients. Key words: Subcutaneous; oral; methotrexate; juvenile idiopathic arthritis. DOI: 10.3329/bjch.v33i1.5671 Bangladesh Journal of Child Health 2009; Vol.33(1): 22-26

DOI: 10.3329/bjch.v31i1.6070 Bangladesh Journal of Child Health 2007; Vol.31(1-3): 22-25