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Background: The clinical course of juvenile idiopathic arthritis (JIA) is unpredictable and characterised by periods of disease inactivity followed by active disease states with on or off medication. Objectives: To assess the disease activity state of JIA patients in our centre and compare them with other available reports. Methods: A retrospective cohort study carried out in the department of paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2010 to December 2019 . A total of 1782 JIA patients, fulfilling ILAR criteria, who have completed at least three years of follow-up were enrolled in this study. Disease activity states were assessed according to Wallace’s criteria. Results: The mean age at presentation of disease was 8.33±4.8 years and M:F ratio was 1.4:1. Enthesitis related arthritis (ERA) was the commonest (38.0%) subtype, followed by systemic arthritis and RF–ve polyarthritis. Eighty-three percent of the JIA patients were treated with MTX followed by sulfasalazine (30.0%) and leflunamide (13.0%). Only 12.0% received biological agents and other drugs including thalidomide and tofacitinib. At 3 years follow-up, 39.2% had active disease and 60.7% had non-active disease states. Inactive disease states, clinical remission on medication (CRM) and clinical remission off medication (CR) were maintained by 27.1%, 20.1 %, and 13.3% of JIA patients respectively. Conclusion: Most (60.7%) of the JIA patients maintained CRM, CR and inactive disease states. Active disease was found in 39.2% of JIA patients. The highest rate of remission was achieved in persistent oligoarthritis cases. RF+ve polyarthritis patients had the lowest remission rate. Bangladesh Med Res Counc Bull 2022; 48(1): 41-47

Precocious puberty is commonly defined as puberty that starts before age 8 years in girls and 9 years in boys. The causes of it may range from a variant of normal development to various pathologic conditions. The etiology of precocious puberty is classified by the underlying pathogenesis into gonadotropin dependent central precocious puberty and peripheral precocious puberty which is independent of gonadotropin but due to different other causes. Variants of precocious puberty include premature thelarche, premature puberche and isolated premature menarche which imply onset of isolated changes without any other signs of sexual development. Precocious puberty might have an impact on final stature owing to premature epiphyseal fusion and also it has got influence on psychosocial wellbeing. Evaluation includes a detailed history, physical examination, biochemical testing and imaging directed towards suspected etiology. Gonadotropin releasing hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the specific cause. Pubertal variants are usually non-progressive and need no treatment but should be monitored carefully. BIRDEM Med J 2022; 12(1): 62-69

Introduction: Dog bites in humans are a major public health problem. Globally, millions of people are bitten by dogs but most of the fatal cases occur in children. Dog bites in human are a serious public health problem and have been well documented worldwide. As rabies is not a notifiable disease in Bangladesh and most deaths occur in rural areas where surveillance is poor. Objectives: To determine the pattern of dog bite injuries and associated health problems among children. Methods: The study was an observational retrospective study carried out at the Dept. of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh. The study reviewed the clinical data of patients managed for dog bite related injuries and rabies over a four and half year period between January 2016 and June 2020. A proforma was designed to extract relevant clinical data from the case records. Information extracted included the age, sex of the victims, site of the bite, time of presentation in the hospital, pre-hospital treatment, hospital treatment including post-exposure prophylaxis and complication. Results: In all, 200 cases of dog bite injuries were managed constituting 0.89% of the total consultations; 5 (2.5%) had rabies. Most of the victims were aged 6-12 years (55.0%) and majority (67.0%) was boys. Eighty two percent of the victims presented within 24hrs of the injury. 92 (46.0%) had WHO grade 3 dog bite injury at presentation and the lower limb was the commonest (56.0%) bite site. Use of herbal preparation was the most common pre-hospital treatment 60%. Although 95.0% received anti-rabies vaccine, only 55.5% of them completed the vaccination schedule. The case fatality rate for dog bite was 5.0%. The 5 that died all presented late, had no post exposure prophylaxis and died within 24 hours of admission. Conclusion: There is need for public enlightenment on dangers associated with dog bites and also for the government to ensure vaccination for cost of post exposure prophylaxis treatment for children free of cost

Background The incidence of dystocia in cats is relatively low compared to that in other pet and farm animals. However, when dystocia occurs in cats, manual, medicinal or surgical intervention is required. Objectives Here, we report a caesarean section (C‐section) in a Bangladeshi domestic cat that suffered from dystocia due to partial primary uterine inertia. Methods A Bangladeshi domestic queen cat was presented to the Veterinary Teaching Hospital (VTH) with signs of dystocia. The queen had given birth to one kitten 36 hr earlier; however, newborn died 30 min after birth. She was unable to deliver the remaining fetuses. The cat had gone off feed, appeared depressed, had a severely enlarged abdomen and showed no straining efforts. On palpation, bony‐like structures were felt in both sides of the abdomen. Ultrasonographic (USG) examination was carried out, which confirmed the presence of two fetuses, one fetus in each uterine horn. No fetal movements could be detected. The cat was diagnosed with dystocia due to partial primary uterine inertia. Results A C‐section was performed, and two emphysematous, putrefied and large dead kittens were removed. The uterus was found to be severely decomposed and foul smelling; therefore, an ovariohysterectomy was carried out to prevent development of maternal toxaemia and septicaemia. The queen recovered fully. Conclusion To the best of our knowledge, we report here, for the first time, a successful C‐section followed by an ovariohysterectomy in a Bangladeshi domestic cat, suffering from severe dystocia due to partial primary uterine inertia for >36 hr., The incidence of dystocia in cats is relatively low compared to that in other pet and farm animals. However, when dystocia occurs in cats, manual, medicinal, or surgical intervention is required. To the best of our knowledge, we report here, for the first time, a successful C‐section followed by an ovariohysterectomy in a Bangladeshi domestic cat, suffering from severe dystocia due to partial primary uterine inertia for >36 hr.

Background: Despite the wide acceptability of fasting lipid profile in practice, emerging evidence suggests that random lipid profile might be a convenient alternative for lipid measurement. The objective of the present study was to compare the fasting and random lipid profile among subjects with T2DM.Methods: The present cross-sectional study included 1543 subjects with T2DM visiting several endocrinology outpatient clinics throughout Bangladesh from January to December 2021. The fasting lipid profile was measured in the morning following 8-10 hours of overnight fasting, and the random lipid profile was measured at any time of the day irrespective of the last meal. The values of fasting and random lipids were compared using the Wilcoxon signed-rank test and Spearman rank correlation coefficients.Results: In this study, a good level of correlation was observed between fasting and random lipid levels [r = 0.793, p Conclusions: Random lipid profile correlates significantly with fasting lipid profile with little difference. Hence, it might be a reliable alternative for fasting lipid profile in T2DM patients.

Background: Although the frequencies of getting drug naive type 2 diabetes patients among all the diabetic patients are very low, nowadays it claims more attention in the treatment procedures of drug naive diabetic patients. But in Bangladesh, we have very few research-oriented data regarding the demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients. The aim of this study was to determine the demographic clinical and biochemical characteristics of drug naive type 2 diabetes patients of Bangladesh. Methods: This was an open label observational real-life study which was conducted in the chambers of the investigators in several places of Bangladesh as outdoor setting during the period from August 2020 to December 2020. In total, 250 patients with drug naive type 2 diabetes mellitus were enrolled as the study population. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patient data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. Result: Two hundred and fifty (250) participants were selected as study population. The male-female ratio of the participants was 1.4:1. The highest number of participants was from 51 - 60 years’ age group (31.20%). The highest number of participants (41%) was with overweight (BMI: 25 - 30 kg/m2). Majority (65%) of the patients of this study suffered from diabetes for ≤5 years. The mean (±SD) SBP of the participants was 137.25 ± 17.50 mmHg and the mean (±SD) DBP of the participants was 85.16 ± 13.39 mmHg. We found the mean (±SD) fasting blood sugar (mg/dl), post prandial blood sugar (mg/dl), total cholesterol (mg/dl), triglycerides (mg/dl), HDL-Cholesterol (mg/dl), LDL-cholesterol (mg/dl), VLDL-cholesterol (mg/dl), uric acid (mg/dl), creatinine (mg/dl), urea (mg/dl), total bilirubin (mg/dl), direct bilirubin (mg/dl), SGOT (IU/L) and SGPT (IU/L) were 251.51 ± 112.08, 349.72 ± 128.68, 219.59 ± 68.25, 196.44 ± 94.34, 35.14 ± 11.85, 145.72 ± 64.33, 40.88 ± 18.12, 3.45 ± 1.51, 0.86 ± 0.37, 29.16 ± 9.81, 0.87 ± 0.4, 0.48 ± 0.4, 37.15 ± 10.9 and 35.83 ± 23.04 respectively. Conclusion: Obesity and hypertension demand more attention of diabetologists in diagnosis and treatment of patients or suspected patients of diabetes. Patients aged ≥ 50 years are most vulnerable and suspicious for diabetes. Besides age consequence habits of tobacco smoking, family history, smoking and HTN, alcohol intake and presence of nitrites in the urine may be considered as the most potential comorbidities for diabetic patients. Diagnosis of demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients may play a vital role in proper treatment.

Background: Decrease in bone mass in JIA patients is multifactorial. By assessing the level of vitamin D and other associated parameters we can identify the deficiency earlier and can predict the risk of osteoporotic bone fracture & give appropriate supplements. Objective: To determine the status of serum 25(OH)D, calcium, inorganic phosphate, alkaline phosphatase and parathormone in patients with JIA. Materials and methods: It was a cross sectional study. Thirty newly diagnosed cases of JIA attending the pediatric rheumatology clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from October 2015 to September 2016 were included. Thirty age and sex matched control were also selected. Serum 25(OH)D, calcium, inorganic phosphate, alkaline phosphatase & parathormone were assesed in both cases and controls. Results: Hypovitaminosis D was present in 60% of JIA and 33% of controls. In JIA group the mean level of all biochemical parameters were significantly lower than control group except serum 25 (OH) D. Level of calcium, inorganic phosphate and alkaline phosphatase was decreased with the decrease of 25 (OH) D levels and there was no change of parathyroid hormone level. Conclusion: More than half of JIA patients had hypovitaminosis D. There was positive relationship between 25(OH)D level and other biochemical parameters except PTH. Bangladesh J Child Health 2019; VOL 43 (3) :145-151

Spinal muscular atrophy (SMA) type 3 is a relatively stable genetically determined chronic neuromuscular disorder caused by degeneration of motor neurons of spinal cord. Patients with type 3 SMA may gradually experience decline in muscle strength and motor function. However functional progression is difficult to document and mechanisms remain poorly understood. A five years old boy presented with proximal muscle weakness, generalized hypotonia, absent deep tendon reflexes and features of neuropathy and labeled as SMA type 3. Bangladesh J Child Health 2019; VOL 43 (3) :183-187

The present study aimed to investigate the conceptus-related changes during early pregnancy in the Black Bengal breed of goat. A total of 22 gravid genitalia of the Black Bengal goats were collected from local slaughterhouses. The crown-rump lengths (CRL) of the conceptuses were determined to estimate the gestational age (GA). The length and diameter of uterine horn and amniotic sac were measured, and volume of amniotic and allantoic fluid formed by individual conceptus were recorded. The results reveal that the CRL is positively correlated with GA of the conceptus (R2 = 0.89, p < 0.05); however, CRL was not influenced by number of conceptus. Both the left and the right uterine horn gradually increased in size with the advancement of pregnancy irrespective of conceptus number present in the horn. The size of the amniotic sac of conceptus gradually increased with the conceptus age but maintained spherical shape from 5 to 7 weeks of pregnancy. The amniotic fluid formed by individual conceptus rapidly increased from 5 weeks (3.4 ± 0.3 mL) to 7 weeks (21.0 ± 2.0 mL) and 9 weeks (111.5 ± 4.0 mL). The volume of allantoic fluid formed by individual conceptus was steadily increased until 7 weeks (60.0 ± 5.0 mL) and began to decline slowly thereafter (50.0 ± 5.0 mL at 9 weeks). Notably, there was no effect of conceptus number per pregnancy on individual amniotic and allantoic fluid volume. The cotyledons have first appeared on the allanto-chorionic surface from 4 to 5 weeks of pregnancy. The closed eye, nostril and hooves of the conceptus became visible at 7 weeks of pregnancy. The present study has shown the basic information on conceptus-related developmental changes during early pregnancy up to 9 weeks in Black Bengal goat.

This study aimed to characterize proteins and exosomal microRNAs (miRNAs) in the uterine flushings (UF) of cows associated with Day 7 (D7) pregnancy using the embryo donor cows of the embryo transfer program. Superovulated cows either were inseminated (AI cows) or remained non-inseminated (Ctrl cows). UF was collected on D7 in the presence of multiple embryos (AI cows) or without embryos (Ctrl cows) and subjected to isobaric tags for relative and absolute quantification protein analysis. A total of 336 proteins were identified, of which 260 proteins were more than 2-fold higher in AI cows than Ctrl cows. Gene ontology analysis revealed that many differentially expressed proteins were involved in “neutrophil-related” and “extracellular vesicular exosome-related” terms. In silico analysis of proteins with higher concentrations in the UF of AI identified 18 uniquely expressed proteins. Exosomes were isolated from the UF, from which RNA was subjected to miRNA-seq, identifying 37 miRNAs. Of these, three miRNAs were lower, and six miRNAs were higher in the UF of AI cows than those of Ctrl ones. The principal component analysis displayed a close association in miRNA and protein between bta-miR-29a, bta-miR-199b, SUGT1, and PPID. In addition, the receiver operating characteristic curve analysis showed that SUGT1 was the best predictor for the presence of embryos in the uterus. These findings suggest that the presence of multiple D7 embryos in the uterus can lead to significant changes in the protein composition and exosomal miRNA contents of UF, which could mediate innate immunological interactions between the pre-hatching embryo and the uterus in cows.

not available Bangladesh Journal of Infectious Diseases, April 2020;7(suppl_1):S45-S47

An outbreak of a COVID-19 pandemic disease, caused by a novel coronavirus SARS-CoV-2, has posed a serious threat to global human health. Bangladesh has also come under the attack of this viral disease. Here, we aimed to describe the responses of Bangladesh to tackle the COVID-19, particularly on how Bangladesh is dealing with this novel viral disease with its limited resources. The first case of a COVID-19 patient was detected in Bangladesh on March 8, 2020. Since then, a total of 263,503 peoples are officially reported as COVID-19 infected with 3,471 deaths until August 11, 2020. To combat the COVID-19, the government has taken various steps viz. diagnosis of the suspected cases, quarantine of doubted people and isolation of infected patients, local or regional lockdown, closure of all government and private offices, increase public awareness and enforce social distancing, etc. Moreover, to address the socio-economic situations, the government announced several financial stimulus packages of about USD 11.90 billion. However, the government got 3 months since the disease was first reported in China, but the country failed in making proper strategies including contact tracing, introducing antibody/antigen-based rapid detection kit, and also failed to make multi-disciplinary team to combat this disease. Further, limited testing facilities and inadequate treatment service along with public unawareness are the major challenges for Bangladesh to tackle this situation effectively. Along with the government, personal awareness and assistance of non-government organizations, private organizations, researchers, doctors, industrialists, and international organizations are firmly required to mitigate this highly contagious disease. Significance for public health A novel coronavirus, named SARS-CoV-2, causes COVID-19 disease. This has emerged as a serious threat to human health and economy of the whole world. Bangladesh is one of the densely populated countries in the world, which also has come under attack of COVID-19. The first case of COVID-19 patient was detected in Bangladesh on March 8, 2020. Since then, a total of 30,205 peoples are officially reported as COVID-19 infected with 432 deaths. This lethal COVID- 19 drastically hit the economy of Bangladesh, with 170 million of inhabitants. The local and regional lockdown has already suspended almost all economic activities. However, limited health care service facilities of the country along with public unawareness are the major problems for Bangladesh to tackle this situation effectively. Of note, a large number of low-income workers, day-laborers need to go outside to earn daily income for their livelihood that causes mass transmission. Moreover, many hospitals, some doctors, nurses and other health officials are reluctant to provide treatment to COVID-19 patients and also non- COVID-19 patients. This report described the responses of Bangladesh to tackle the dreadful COVID-19 and discussed prevailing challenges, and how to mitigate this highly contagious disease with limited resources.

An outbreak of a pandemic COVID-19 disease caused by a novel coronavirus SARS-CoV-2 has posed a serious threat to human health and the economy of the whole world. Bangladesh is one of the most densely populated countries in the world, which has also come under the attack of this viral disease. This perspective report aimed to describe the responses of Bangladesh to tackle the COVID-19, particularly on how Bangladesh is dealing with this novel viral disease with limited resources. The first case of a COVID-19 patient was detected in Bangladesh on March 8, 2020. Since then, a total of 2,144 peoples are officially reported as COVID-19 infected with 84 deaths. To combat the COVID-19, the government has taken various steps to tackle the epidemic outbreak of it such as diagnosis of the suspected cases, quarantine of doubted people and isolation of infected patients, local or regional lockdown, grant general leave from all offices for staying home of people, increase public awareness and enforce social distancing and so on. In addition, to address the socio-economic situations, the government announced several financial stimulus packages of about USD 11.17 billion. However, very limited diagnostic facilities, health workers, resources such as hospital beds, personal protective equipment, intensive care unit, and ventilators in the hospitals along with limited public unawareness are the major challenges for Bangladesh to tackle the situation effectively. This report described the responses of Bangladesh to tackle the COVID-19 and discusses prevailing challenges to mitigate this highly contagious disease with limited resources.

The first 7 days post-insemination are critical for establishment of pregnancy. The pre-ovulatory luteinizing hormone (LH) surge induces ovulation through disruption of the follicle structure that elucidates pro-inflammatory (Th1) responses. Various types of immune cells are recruited into the corpus luteum (CL) to regulate luteal angiogenesis and progesterone (P4) secretion into the circulation to establish pregnancy. The active sperm-uterine crosstalk also induces Th1 responses, mainly via Toll-like receptor (TLR) 2/4 signaling pathway in vitro. The endometrial glands serve as sensors for sperm signals, which trigger Th1 responses. Conversely, the sperm-oviduct binding generates anti-inflammatory (Th2) responses to support sperm survival until fertilization. It is well-established that embryo-maternal crosstalk starts after the embryo hatches out from the zona pellucida (ZP). However most recently, it was shown that the 16-cell stage bovine embryo starts to secrete interferon-tau (IFNT) that induces Th2 immune responses in the oviduct. Once developing embryos descend into the uterine horn, they induce Th2 responses with interferon-stimulated genes (ISGs) expression in the uterine epithelium and local immune cells mainly via IFNT release. Likewise, multiple embryos in the uterus of superovulated donor cows on D7 post-insemination induce Th2 immune responses with ISGs expressions in circulating immune cells. These findings strongly suggest that the maternal immune system reacts to the embryo during the first 7 days post-insemination to induce fetal tolerance. It became evident that the innate immunity of the developing CL, oviduct, and uterus works together to provide optimal conditions for fertilization and early embryonic development during the first 7 days post-insemination.

Recent studies suggest that Day-7 bovine embryo starts to communicate with the uterine epithelium through interferon-tau (IFNT) signaling. However, immune modulatory role of IFNT in the uterus just after the embryo moves from the oviduct is unclear. We aimed to examine the hypothesis that Day-7 bovine embryo secretes IFNT in the uterus, which induces anti-inflammatory response in immune cells. The uterine flush (UF) with multiple embryos was collected from Day-7 donor pregnant cows and peripheral blood mononuclear cells (PBMCs) were then cultured in UF. Transcripts detected in PBMCs revealed that UF from pregnant cows down-regulated pro-inflammatory cytokines (TNFA, IL1B) and up-regulated anti-inflammatory cytokine (IL10) expression, with activation of interferon-stimulated genes (ISGs; ISG15, OAS1) as compared with UF from non-pregnant cows. An addition of specific anti-IFNT antibody to the UF inhibited the effect on PBMCs, indicating that IFNT is a major factor for such immune modulation. The observation that conditioned media from bovine uterine epithelial cells both stimulated with IFNT in vitro and supplemented with fresh IFNT induced similar PBMCs gene expression, confirming that IFNT directly acts on this immune crosstalk. This study shows that IFNT secreted from Day-7 embryo in vivo generates anti-inflammatory response in immune cells, which may provide immunological tolerance to accept the embryo.

application/pdf, Recent studies indicate that communication between the bovine embryo and the mother begins in the oviduct. Here, we aimed to investigate the effect of embryos on bovine oviducts for their immune responses using an in vitro model. First, zygotes were cultured with or without bovine oviduct epithelial cells (BOECs) for 4 days, when embryos had reached the 16-cell stage. At that time, we detected interferon-tau (IFNT) in embryos co-cultured with BOECs, but not in embryos cultured alone. Next, peripheral blood mononuclear cells (PBMCs) were incubated either in media from embryo alone cultures or from co-cultures of embryos with BOECs. The medium from embryo alone cultures did not modulate PBMCs gene expression; whereas the embryo-BOEC co-culture medium increased interferon-stimulated genes (ISGs: ISG15, OAS1, MX2), STAT1, PTGES and TGFB1 but suppressed IL17 expression in PBMCs. Both IFNT-treated BOEC culture medium and IFNT-supplemented fresh medium alone without BOEC, modulated PBMCs gene expressions similar to those by the embryo-BOEC co-culture medium. Further, specific antibody to IFNT neutralized the effect of embryo-BOEC co-culture medium on PBMCs gene expression. Our results indicate that BOECs stimulate embryos to produce IFNT, which then acts on immune cells to promote an anti-inflammatory response in the oviduct. © 2018 The Author(s).

Background: There are several forms of pulmonary manifestations in Paediatric Rheumatic Diseases (PRDs), not only by the disease itself, but also by infections and toxicity of medications used for treatment. Objectives: To evaluate the pulmonary manifestations and to identify their pattern in PRDs including Systemic Lupus Erythematosus (SLE), Juvenile Idiopathic Arthritis (JIA), Systemic Sclerosis (SSc), Juvenile Dermatomyositis (JDM) and Polyarteritis Nodosa (PAN) patients. Methods: It was a cross-sectional analytical study. PRDs with pulmonary problems who attended the Paediatric Rheumatololgy follow up clinic of BSMMU from January 2010 to December 2014 were enrolled in this study. All patients having PRDS with pulmonary symptoms were investigated by chest x-ray. High regulation CT scan of Chest (HRCT) and pulmonary function tests (PFTs) were done in some of the feasible cases. Results: Total 20 cases were identified as paediatric rheumatic diseases with pulmonary manifestations. Out of them 8 patients were diagnosed as SLE, 6 patients as SSc, 4 patients as JIA, and 2 patients as JDM and PAN respectively. Mean age of the patients were 8.5 years. Fever (86.8%), prolonged cough (65%), dyspnoea (29%) and chest pain (3%) were the common pulmonary features. Pneumonitis (35%), pleural effusion (29.3%), consolidation (23.5%) were important radiological findings. Chest CT were done in 5 patients and features of brochiectasis (75%), thickening (25%), pleural effusion (50%) and pneumonitis (50%) were found. The higher rate of pulmonary involvement was found in Ssc (100%). Spirometric analysis were done in only 7 patients and found restrictive pattern of defect and most of them were SSc. Conclusion: Pulmonary manifestations in PRDs were not uncommon. SLE, JIA and SSc were the predominant PRDs who had pulmonary manifestations obsevered in this study. So timely intervention of this issue could minimize morbidity and mortality of these diseases in the long run. Bangladesh J Child Health 2017; VOL 41 (2) :96-100

Background : Systemic JIA (sJIA) is the most severe sub type of JIA with limited treatment option and responsible for most of the disability and morbidity in JIA. Objective: To assess the efficacy of Tocilizumab (TCZ) in refractory sJIA patients according to disease activity score in 28 joint criteria. Methodology: This interventional study was carried in the department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU). A total number of 22 sJIA patients who were refractory to traditional DMARDs were offered TCZ. Among them 15 patients agreed to take TCZ (cases) and 7 patients did not (controls). All the cases and controls were assessed according to DAS 28 criteria at enrollment, 12 weeks and 24 weeks of TCZ therapy. DAS 28 scores during assessment were compared. Results: After TCZ therapy systemic features subsided and laboratory features improved in 100% cases. Among cases 93.3% and 92.3% had moderate response at 12 and 24 weeks respectively according to DAS 28 criteria. Among controls 71.5% and 85.7% had moderate response at 12 and 24 weeks respectively (p0.001). Among cases 40% and 60% patients achieved remission at 12 and 24 weeks, where as among controls none achieved remission. Dose of steroid was significantly reduced among cases but was increased significantly among controls. Few side effects like pharyngitis, Varicella, septicemia, anaphylactoid reaction and raised ALT were observed. Conclusion: Tocilizumab therapy was effective according to DAS 28 criteria refractory sJIA. Bangladesh J Child Health 2015; VOL 39 (3) :129-134

application/pdf, Recent observations suggest that the bovine uterus starts to react to the early embryo immediately after its arrival from the oviduct. The present study aimed to investigate the effect of the early developing embryo on the immune-related gene profile in bovine uterine epithelial cells (BUECs) in vitro, and to further examine the impact of conditioned media (CM), either from embryo-BUEC co-culture or embryo culture alone, on gene expression in peripheral blood mononuclear cells (PBMCs). First, BUECs were co-cultured with morulae (n = 10) for D5-D9 (D0 = IVF), and gene expression in BUECs was analyzed. Subsequently, PBMCs were cultured in CM from embryo-BUEC co-culture or D5-D9 embryo culture, and gene expression was evaluated. In BUECs, the embryo induced interferon (IFN)-stimulated genes (ISGs: ISG15, OAS1, and MX2), a key factor for IFN-signaling (STAT1), and type-1 IFN receptors (IFNAR1 and IFNAR2), with suppression of NFkB2, NFkBIA and pro-inflammatory cytokines (TNFA and IL1B). The embryo also stimulated PTGES and PGE2 secretion in BUECs. In PBMCs, both CM from embryo-BUEC co-culture and embryo culture alone induced ISGs, STAT1 and TGFB1, while suppressing TNFA and IL17. Similarly, interferon tau (IFNT) at 100 pg/ml suppressed NFkB2, TNFA and IL1B in BUECs, and also stimulated TGFB1 and suppressed TNFA in PBMCs. Our findings suggest that the bovine embryo, in the first four days in the uterus (D5-D9), starts to induce an anti-inflammatory response in epithelial cells and in immune cells. IFNT is likely to act as one of the intermediators for induction of the anti-inflammatory response in the bovine uterus. c 2017 by the Society for Reproduction and Development.

We have recently shown that the conditioned media from bovine oviductal epithelial cell culture suppress sperm phagocytosis by neutrophils, suggesting that the oviduct around oestrus supplies the anti-inflammatory microenvironment. To investigate the immune response of neutrophils toward the sperm at ovulation in the buffalo oviduct, we examined (a) a detailed distribution of neutrophils in the oviduct in buffaloes, (b) the effect of ovulatory follicular fluid (FF) and oviductal fluid (OF) on sperm phagocytosis by neutrophils, and (c) the interaction of the ovulatory FF with OF on sperm phagocytosis by neutrophils in vitro. Buffalo oviducts were collected from healthy reproductive tracts at a local slaughterhouse. A detailed observation by histological examination and transmission electron microscopy revealed that neutrophils exist in the oviduct epithelium and lumen throughout the oestrous cycle in buffaloes. The number of neutrophils at the oestrus stage was higher in ampulla compared with those in isthmus, whereas they remained relatively constant at the dioestrus stage. Two hours of preincubation of neutrophils with FF enhanced sperm phagocytosis through the formation of neutrophil extracellular traps (NETs) together with H2 O2 production, whereas OF around oestrus (eOF) suppressed sperm phagocytosis, NETs formation, and H2 O2 production and relieved the above FF-induced inflammatory response. Our findings show that neutrophils exist in the healthy cyclic oviduct across bovine species, and the OF supplies a strong anti-inflammatory environment that could minimize the inflammatory effect of the FF that flows into the oviduct lumen after ovulation and supports the occurrence of fertilization.

Since emergence, coronavirus disease-19 (COVID-19) has extensively spread to >210 countries. Till date, no specific drug or vaccine has been developed against this deadly disease. Thus, all affected countries have been struggling to manage their COVID-19 patients. Here, we aimed to report impact of health service facilities on outcome of COVID-19 patients. As of June 28, 2020, the highest number of COVID-19 patients was reported in USA, which sum up to 2,617,847 with 4.9% death. Likewise, Spain, Italy, UK and France were greatly affected by COVID-19 with 10.0 to 18.0% death. Notably, Germany has been affected by COVID-19 in similar to UK and France with a total of 194,771 confirmed cases; however, recovery rate is very high (91.3%) with only 4.6% death. Alternatively, India and Bangladesh reported positive cases of 548,817 and 137,787, respectively. The comparison of health service facilities among different countries shows that Germany and also Russia have the highest number of doctors, hospital beds, ICU and ventilators in proportion to their people, which might contribute to restrict death rate only 1.4 to 4.6% with excellent recovery. USA has better health system with compared to that in China, India and Bangladesh; however, the recovery rate is 41.3 %, because the country is dealing with large number of patients. The limited health service facilities in Bangladesh might result in relatively lower recovery rate (40.4%) of COVID-19 patients. Thus, health service facilities of the nations are likely to be associated with successful management of COVID-19 patients. [ J Adv Biotechnol Exp Ther 2020; 3(4.000): 36-41]

Introduction Diabetes mellitus is highly prevalent in Bangladesh and insulin is often needed for diabetes control. We lack sufficient data on the insulin injection technique and injection-related complications. Methods The Bangladesh Insulin Injection Technique Survey (BIITS) was conducted in 2018 in 18 centres throughout Bangladesh, involving 847 patients taking insulin for at least 6 months. All of the study subjects were interviewed using a structured questionnaire focusing on key insulin injection parameters. Results The mean duration of insulin use by the study subjects was 3.84 (± 4.05) years and the mean daily dose of insulin was 41 (± 25) units. A total of 71.6% participants performed ≤2 injections/day and premixed insulins were the most commonly used insulins. Mean glycated haemoglobin (HbA1c) was 9.5% (± 2%). The proportion of syringe users and pen-device users was 68.1% and 31.9%, respectively. Most of the participants injected in the abdomen and rotated the injection site(s). The majority lifted the skinfold correctly and inserted the needle at a 90-degree angle, but their dwell times after injections were not adequate. A total of 9.2% of the subjects had injection-site lipohypertrophy (LH) and among them, 38.5% injected into the lesion. Patients with LH had higher HbA1c. Higher duration of insulin use (≥5 years), reusing needles more often (>10 times), and injecting at angles other than 90 degrees were independent predictors of LH. The incidences of hypoglycaemia (36.7%) and hyperglycaemia (67.4%) were very high, and subjects with LH had higher chances of both hypoglycaemia and hyperglycaemia. Though most (92.1%) of the patients received education about insulin injection initially, it was not repeated in the recent follow-up and was found to be ineffective. Conclusion A huge gap between the insulin administration guidelines and current practice was observed in this study. Complications of insulin injections were also common. Healthcare providers should pay more attention to insulin education and re-evaluate injection practices from time to time.

Problem Recently, we demonstrated both in vitro and in vivo that an immunological crosstalk between Day-7 embryo and immune cells exists locally in the uterus in cows. The peripheral immune response to early embryos at Day-7 of pregnancy in cows remains largely unknown. Thus, we aimed to investigate the response of peripheral blood immune cells in the presence of multiple Day-7 embryos in the uterus in donor cows of embryo transfer program. Method of study Superovulated cows were either inseminated (n = 13) at 12-18 hours post-estrus or remained without inseminations (n = 6). Blood was collected following insemination (Day-1) and immediately after uterine flushing (Day-7). Polymorphonuclear neutrophils (PMNs) and peripheral blood mononuclear cells (PBMCs) were isolated from whole blood for analysis of gene expression. Results Interferon-stimulated genes (ISGs: ISG15 and OAS1) were increased in both PMNs and PBMCs, with up-regulation of PTGES and anti-inflammatory cytokines (TGFB1 and IL10) expressions at Day-7 of post-inseminations in cows, when compared to those at Day-7 in non-inseminated cows. Conclusion The findings indicate that the presence of multiple embryos in the uterus generates an anti-inflammatory immune response in peripheral blood immune cells at Day-7 of pregnancy in cows, which might help to accept semi-allogenic embryo in the uterus.

Background: Systemic lupus erythematosus in children (Paediatric SLE / pSLE) may have a great variability in disease presentation. Any organ system can be involved in pSLE leading to protean clinical manifestations.To evaluate the clinical and serological presentation of pSLE in tertiary renter Bangladesh and to compare it with other populations. Methodology: It was a retrospective cohort study carried out in the department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of January 2005 to December 2013. A total of 70 patients fulfilling the 1997 revised ACR classification criteria for SLE were enrolled in the study. Data was collected in a pre-designed questionnaire. Results: Age range was 2.5 years to 16 years, female: male ratio was 7:1. Duration of disease was 1 month to 18 months. Common clinical presentation included general weakness/fatigue (91%), fever (83%), arthralgia/arthritis (74%), oral ulcer (73%) and skin rash (71%). All the patients were anemic. ANA was positive in 97% cases and anti-ds DNA in 91% cases. More than 65% cases had evidences of renal involvement at the presentation. Among the patients who underwent kidney biopsy, 40% had diffuse proliferative lupus nephritis (WHO class IV) followed by class III in 26% cases. Conclusion: Pediatric SLE patients in our country, compared to other countries had much higher incidence of fever and non-specific complaints such as, general weakness and malaise as presenting symptoms. Thus, a strong index of suspicion should be maintained for early diagnosis of pSLE especially among adolescent girls. DOI: http://dx.doi.org/10.3329/bjch.v38i3.22819 Bangladesh J Child Health 2014; VOL 38 (3) :124-129

This study was aimed to determine the biometry of genital organs, incidence of gynecological disorders and pregnancy loss in Black Bengal goat (Capra hircus). Genitalia of 118 does were collected from local abattoirs. Biometric parameters of genital organs were measured and gross and histopathological examinations were carried out for detection of abnormalities. For gravid uterus, age of the fetus was determined by measuring crown-rump length. There was no significant difference in the length, width and weight of right and left ovaries (P>0.05). However, the number of follicles between left (5.3 ± 2.3) and right ovaries (7.4 ± 2.7) varied significantly (P

In the cow, cryopreserved semen is inseminated into the uterus, and most of sperm are removed by backflow and phagocytes. Nevertheless, the mechanism responsible for sperm phagocytosis is unclear. Here, we used cultured bovine uterine epithelial cells (BUECs) to investigate the uterine response to sperm and the mechanism that activates polymorphonuclear neutrophils (PMNs). BUEC monolayers were co-cultured with different numbers of washed sperm obtained from cryopreserved semen (104 , 105 , and 106 sperm/ml) for 3 hr. Sperm dose-dependently up-regulated IL8 (Interleukin 8). Sperm at 106 /ml increased mRNA expression of TNFA (Tumor necrosis factor alpha), IL1B (Interleukin 1B), NFKB2 (Nuclear factor kappa B2), and C3 (Complement factor 3), as well as PGES (Prostaglandin E synthase) expression and PGE2 release. Live sperm, but not dead sperm, attached to BUECs, and dead sperm did not induce an acute inflammatory response. Time-dependent effects were evaluated by co-culture of 106 /ml washed sperm with BUECs for 0, 1, 3, and 6 hr. The number of detached sperm increased gradually toward 6 hr. Maximum mRNA expression of IL8, TNFA, IL1B, and NFKB2 was induced at 3 hr, while C3 continued to increase toward 6 hr. Sperm did not stimulate mRNA expression of anti-inflammatory cytokines TGFB1 (Transforming growth factor beta 1) or IL10 (Interleukin 10). Medium conditioned by sperm co-incubated with BUECs stimulated PMNs phagocytosis of sperm in vitro. Fresh media supplemented with low levels of IL1B, TNFA, and PGE2 up-regulated sperm phagocytosis by PMNs as well. In conclusion, our findings strongly suggest that the active sperm attach to BUECs and trigger uterine local innate immunity with induction of a pro-inflammatory response that enhances sperm phagocytosis by PMNs.

Introduction Polyarteritis nodosa in children is a rare necrotizing vasculitis affecting mainly small and medium-size arteries. Objective To describe the different clinical patterns and laboratory profiles of polyarteritis nodosa patients in a tertiary care hospital. Methodology This was a retrospective cohort study carried out in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period January 2007 to December 2012. A total of 13 patients fulfilling the European League Against Rheumatism/Paediatric Rheumatology International Trial Organization/Paediatric Rheumatology European Society (EULAR/PRINTO/PRES) classification criteria were enrolled in this study. Data was collected via a predesigned questionnaire. Results Age range was 3–12 years, male : female ratio was 9 : 4. The duration of symptoms was 2–16 weeks. All the children had fever, anorexia and generalized weakness. Subcutaneous nodules were present in 77% of cases followed by arthritis and rash (69%), muscle pain (54%) and abdominal pain (38%). Impaired peripheral pulses were present in 54%, ulceration and gangrene was present in 31% and auto-amputation was present in 15% of cases. All the patients had high erythrocyte sedimentation rates followed by neutrophilic leukocytosis and thrombocytosis (85% and 62%). Skin biopsy was positive in 77% of cases and angiographic abnormalities were present in 23% of cases. Conclusion Most clinical and laboratory profiles of polyarteritis nodosa in our center, such as age, sex, fever, rash, arthritis and abdominal pain, were mostly similar to other reports; however some late cases were found in this series with complications such as gangrene and auto-amputation.

DOI: http://dx.doi.org/10.3329/bjch.v36i3.14277 BANGLADESH J CHILD HEALTH 2012; VOL 36 (3) : 139-145

Hyposidra talaca (Walker) is a recent host range-expanded major insect pest of tea in Northeastern India. We studied the egg-laying pattern of H. talaca in tea plantations with an aim to take suitable measures to disrupt egg hatching and to manage the pest. Egg clutch distribution in different heights (0–8 m) of 49 shade trees of seven species was studied. Stems and foliage of a total of 400 tea plants growing close to the shade trees were also subjected to the survey. Female moths deposited eggs underneath the scales of shade tree bark, lichen cover and the root mantles of parasitic plants that are growing on all shade tree plants, except Melia azaderach L. The shade tree bark of M. azaderach and tea plants had no egg deposits. Overall, 1785 egg clutches, comprising 84–302 eggs/clutch (average 258 eggs), were located. An average of 45.77 (± 7.06 SD, range 0–183) egg clutches was found per tree. The mean number of egg clutches was high in Acacia lenticularis Buch.-Ham. (95.4 ± 24.78 SD, range 40–183), and was low in Lagerstroemia speciosa (L.) Pers. (23 ± 6.42 SD, range 4–46). Overall, the number of egg clutches reduced with the height of shade trees. This study suggests that the oviposition of H. talaca is typical for an outbreak species and that the management of shade trees, including the choice of species, has an important role in controlling the pest in tea plantations.