Neural tube defect (NTD) is a multi-factorial disorder in which nutritional, genetic and environmental factors are involved. Among the nutritional factors, low level of serum zinc has been reported from different parts of the world. This hospital-based case-control study was conducted with the objective of finding the relationship between serum zinc level in newborns and their mothers and NTDs in a Bangladeshi population. The study was conducted during August 2006–July 2007 at the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka. In total, 32 mothers and their newborns with NTDs were included as cases and another 32 mothers with their normal babies were included as controls. Concentration of serum zinc was determined by pyro-coated graphite furnace atomic absorption spectrophotometer (GF-AAS). The mean age of the case and control mothers was 25.28 years and 24.34 years respectively. The mean gestational age of the case newborns was 36.59 weeks and that of the control newborns was 37.75 weeks. The mean serum zinc level of the case and control mothers was 610.2 μg/L and 883.0 μg/L respectively (p<0.01). The mean serum zinc level of the case and control newborns was 723 μg/L and 1,046 μg/L respectively (p<0.01). In both case and control groups, the serum zinc level of the newborns positively correlated with that of the mothers. The serum zinc levels of the mothers and newborns negatively correlated with NTDs. Mothers with serum zinc level lower than normal were 7.66 [95% confidence interval (CI) 2.5-23.28] times more likely to have NTDs compared to the normal zinc level of mothers. After adjusting for the zinc level of the newborns, parity, and age of the mothers, this risk reduced 1.61 times [confidence interval (CI) 95% 0.24-8.77]. On the other hand, the low serum zinc level of the newborns was 7.22 times more associated with NTDs compared to the newborns with the normal serum zinc level, which was statistically significant (p=0.001). After adjusting for other factors, such as maternal age and parity, newborns with the low serum zinc level was found to be 9.186 times more likely to be associated with NTDs compared to newborns with normal serum zinc level. Based on the findings, it may be concluded that the low serum zinc levels of newborns may be associated with NTDs. To confirm these findings, a further study with a larger sample-size is recommended. Moreover, a follow-up study with zinc supplementation to pregnant women and its impact on NTDs is also recommended.

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.

ANA-IFA is superior to ANA-EIA for detection of ANA in childhood SLE patients. ANA-IFA should be the primary screening test for children with clinical features suggestive of SLE.

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.

Not Available Bangladesh J Child Health 2019; VOL 43 (3) :135-137

Objectives: To assess the different clinical aspects of JIA patients as well as the disease activity status during follow-up period. This study also compared its findings with the previous baseline study done in our country. Methodology: A prospective observational study carried out in the department of pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the study period of January 2004 to December 2012. A total of 415 patients according to ILAR criteria were enrolled in the study. Patients who completed a 2 year follow-up period were assessed for disease activity status according to Wallace criteria. Data was collected in a predesigned questionnaire. Results: Among the 415 cases, M: F ratio was approximately 2:1. Age range of the patients was 14 months to 16 years. Highest number of patients were present in the age group 11-16 years (49%) followed by 6-10 years. The duration of illness was more than 12 months in the majority. Polyarticular RF negetive patients were most frequent (33%), followed by persistent oligo-arthritis (28 %). Among the patients who completed at least 2 years of follow-up, 68% achieved remission, of them 51% maintained remission and 16.3% had relapse. Conclusion: Late diagnosis with long duration of disease was still common. Clinical profile of this study was almost similar to our previous study but differed from western JIA cases mainly in term of sex, subtypes and duration of illness. Majority of the patients went into remission. Wrong diagnosis was gradually decreasing and it seems that awareness about JIA is gradually increasing among the medical professionals in our country.

SummaryBackgroundThe use of rifampicin for cholestatic pruritus is accompanied by concerns over safety, but the availability of real‐world prescribing data is relatively limited.AimWe sought to describe the rate and characteristics of rifampicin‐induced hepatitis in a mixed aetiology cohort of patients with established liver disease and cholestatic pruritus.MethodsRetrospective review of records for out‐patients commenced on rifampicin for pruritus 2012‐2016 inclusive. Rifampicin‐induced hepatitis was recorded where alanine aminotransferase activity (ALT) increased to both ≥5 × baseline and ≥5 × upper limit of normal (ULN), or to both ≥3 × baseline and ≥3 × ULN with concurrent elevation in serum bilirubin to ≥2 × baseline and ≥2 × ULN, in addition to a Roussel‐Uclaf Causality Assessment Method score of “probable” or “highly probable” for rifampicin causality.ResultsAfter exclusions, we reviewed 105 patients who took rifampicin for a median of 131 days. Most had primary biliary cholangitis or primary sclerosing cholangitis; 40 (38.1%) were men and median age was 44 years (IQR: 32‐57). 44 (41.9%) patients had baseline serum bilirubin ≥2 × ULN and 28 (26.7%) ALT ≥3 × ULN. 5 (4.8%) developed rifampicin‐induced hepatitis at a median of 70(range 27‐130) days after drug initiation. No individual or laboratory baseline characteristics were significantly associated with subsequent development of hepatitis. All cases of hepatitis recovered after drug cessation, although one patient was hospitalised and received corticosteroids.ConclusionsGiven the efficacy of rifampicin for an important sub‐group of those with cholestatic pruritus, adult patients, including those with jaundice, can be counselled that 95% of prescriptions are safe, and where hepatitis occurs, including at long latency, drug cessation appears effective.

Prevalence of JIA in this study in a semi-urban area of Bangladesh was consistent with established population-based studies in developed countries. Clinical pattern of JIA patients also had similarities with reports from Western countries.