Shahana A Rahman

Prevalence and clinical pattern of juvenile idiopathic arthritis in a semi‐urban area of Bangladesh

To determine the prevalence and clinical pattern of juvenile idiopathic arthritis (JIA) in a semi‐urban area of Bangladesh.

Detection of anti-nuclear antibody by immunofluorescence assay and enzyme immunoassay in childhood systemic lupus erythematosus: experience from Bangladesh.

Background:  Systemic lupus erythematosus (SLE) is a multisystem, chronic but often episodic, autoimmune disease that is characterized by the presence of antinuclear antibodies (ANA). The criteria set by American College of Rheumatology are widely used for diagnosis of SLE. Elevation of ANA titer is the most sensitive of the ACR criteria. There are different methods for detection of ANA. Indirect immunofluorescence (ANA‐IFA) and enzyme immunoassay (ANA‐EIA) are commonly used methods. The sensitivity of ANA‐IFA using HEp‐2 cell substrate is 90–100% in systemic rheumatic diseases. In Bangladesh most of the laboratories use ANA‐EIA for detection of ANA. As the sensitivity of ANA‐EIA is lower than ANA‐IFA it might be that we are missing many cases of ANA positivity in childhood SLE cases.

Clinical presentation of juvenile idiopathic arthritis in Bangladesh: experience from a tertiary hospital

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.

Increased survival of patients with end-stage hepatocellular carcinoma due to intake of ONCOXIN®, a dietary supplement

BACKGROUND AND AIMS Treatment and management of patients with end-stage hepatocellular carcinoma (HCC) represents a formidable challenge to contemporary branches of medical sciences. The study presented here was conducted to assess the utility of nutrient supplement, if any, for management of patients with end-stage HCC. MATERIALS AND METHODS A total of 19 patients with end-stage HCC (Barcelona Clinic Liver Cancer [BCLC] staging D) were provided with ONCOXIN® for 3 months. Another 10 patients with end-stage HCC (BCLC stage D) with similar clinical conditions received conservative management, but they did not give consent for taking ONCOXIN® (non-ONCOXIN® group). All patients of both groups were followed on regular basis until their death. STATISTICAL ANALYSIS The results were expressed as mean and standard deviation. Comparison between groups was performed using Students t-test or the Mann-Whitney U test. For categorical data, Chi-square or Fisher exact test was applied. RESULTS All patients of the control group (non-ONCOXIN® group) (10 of 10 patients) died within 2 months after study commencement. On the other hand, 10 of 19 patients receiving ONCOXIN® died within 2 months (less than 53% patients) after the start of taking ONCOXIN® (P < 0.05, compared with patients of non-ONCOXIN® group). Five more patients died within 5 months after the start of intake of ONCOXIN®. Four patients receiving ONCOXIN® survived for more than 6 months after study commencement. CONCLUSIONS Although this is a preliminary report, it inspires considerable optimism about safety and efficacy of a food supplement for management of patients with end-stage HCC.

Clinical and laboratory profile of childhood polyarteritis nodosa in a Bangladeshi tertiary hospital

Polyarteritis nodosa in children is a rare necrotizing vasculitis affecting mainly small and medium‐size arteries.

Performance of the preliminary definition of improvement in juvenile idiopathic arthritis patients treated with methotrexate: experience from Bangladesh

Objective:  To evaluate the performance of Preliminary Definition of Improvement (PDI) in juvenile idiopathic arthritis (JIA) patients treated with methotrexate (MTX).

Efficacy and Safety of Thalidomide as Adjunct Therapy in Refractory Systemic Juvenile Idiopathic Arthritis Patients

About 50% of systemic onset juvenile idiopathic arthritis (sJIA) patients run a recalcitrant disease course and resistant to the conventional disease modifying anti inflammatoy drugs (DMARDs), ultimately resulting in permanent disability from joint destructions. Thalidomide has been reported as an effective and safe drug in the management of systemic JIA due to its immunomodulatory properties. This was an interventional study, aimed to evaluate the efficacy of thalidomide in refractory JIA patients. Twenty five systemic JIA patients who were refractory to conventional DMARDs were included in this study. These patients were prescribed thalidomide at a dose of 2-3mg/kg/day for 12 months. Efficacy of thalidomide was assessed by using Wallace criteria at 6th month and 12th month of thalidomide treatment. Active arthritis was improved in 55% and 73% of the patients at 6th and 12th month of thalidomide treatment respectively. Fever and rash subsided in 72.8% and 81.2% of patients respectively at 12th month of follow up. Hepatosplenomegaly and lymphadenopathy regressed in 100% of patients at 12th month follow up. ESR was also improved in 50% and 68.2% cases at 6th and 12th months respectively. Few minor side effects were observed like transient elevation of liver enzyme and somnolence in this study. It may be concluded that thalidomide is safe and effective in refractory JIA patients.

Drug Compliance in Children with Juvenile Idiopathic Arthritis and Reasons for Poor Compliance

Children with chronic disorders are at risk for a higher medication non-adherence. Juvenile idiopathic arthritis (JIA) is a chronic childhood disorder where often medication non-adherence is an issue. The purpose of this study was to assess drug compliance of JIA patients,to find out the proportion of patients having poor drug compliance and to find out possible reasons of poor drug compliance. This was a retrospective study conducted in the Pediatric Rheumatology follow up clinic, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. All JIA patients attending pediatric rheumatology follow up clinic during the study period was included. Data were collected using a structured questionnaire. Among the total 900 registered JIA cases, 116(12.9%) patients had poor compliance. Among 116 poor compliant patients, systemic onset JIA cases were the highest (34.5%), followed by enthesitis related arthritis (30.2%). Among the poor compliant patients, 6.9% patients had regular follow up and 93.1% had irregular follow up. Major reasons of poor compliance were financial crisis, lack of awareness and difficulty in transportation. Poor compliance to treatment of JIA in our setting was common. The most important reason for poor compliance was financial crisis.