Clinical features of systemic lupus erythematosus (SLE) have been described from different geographical regions in the world, with some clinical differences among different racial groups. Although data on the characteristics of SLE in Pakistan is scarce, it is not uncommon in the South East Asian region. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and to compare it with international data on lupus patients. A total of 196 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted to the hospital between 1986 and 2001 were studied by means of a retrospective review of their records. Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is consistent with worldwide data. The mean age of presentation was 31 years (range 14-76) and the mean duration of follow up was 34 (4-179) months. Generally, there was less cutaneous (46%), arthritic (38%), serositis (22%) and renal involvement (33%) but more neuropsychiatric symptoms (26%) in our population. Eighty-six percent of patients were ANA positive, whereas anti dsDNA was positive in 74% of patients. Infections, renal involvement, seizures and thrombocytopenia were associated with poor prognosis (P < 0.05). This study is the first of its kind in Pakistan. The clinical and laboratory characteristics of SLE patients in our study place our population in the middle of a spectrum between the Caucasians and other Asian populations. It has shown that the clinical characteristics of SLE patients in this country may be different to those of its neighbors.

Objective: To compare the safety and efficacy of isotonic versus hypotonic maintenance fluid in children. Design: Randomized controlled trial.Setting: Tertiary-level teaching hospital.Participants: 60 children (age 0.5 to 12 years) who were admitted and anticipated to receive intravenous fluid for the next 48 hours.Intervention: Hypotonic fluid (Standard maintenance volume as 0.18% NaCl in 5% dextrose) or Isotonic fluid (60% Standard maintenance volume as 0.9% NaCl solution in 5% dextrose).Outcome measures: Primary: Incidence of hyponatremia. Secondary: Serum sodium, serum osmolality, blood sugar, blood urea, serum creatinine, serum potassium, serum chloride, pH, urine output, change in weight, morbidity and death. Results: At 24 hours, hyponatremia was noted in 7 (24%) patients in the isotonic and 16 (55%) in hypotonic group (P=0.031). At 48 hours, hyponatremia was noted in 4 (14%) and 13 (45%) patients in isotonic and hypotonic group, respectively (P=0.02). There was significant change in sodium levels in both isotonic (P=0.036) and hypotonic (P<0.001) intervention groups. The peak fall in mean serum sodium level was noted at 24 hours (-6.5, 95%CI: -3.5, -9.6 mEq/L; P<0.001) in hypotonic group. In isotonic group, there was significant increase between 24 and 48 hours R R R R R E E E E E S S S S S E E E E E A A A A A R R R R R C C C C C H P H P H P H P H P A A A A A P P P P P E E E E E R R R R RR ecommendation for the use of a hypotonic saline solution (0.18% saline in 5% dextrose) in children is still a debated subject despite half a century of its practice [1]. Reports of symptomatic hyponatremia in hospitalized surgical and non-surgical pediatric patients -caused primarily by various non-osmotic release of vasopressin, but contributed by electrolyte-free water input in a proportion of cases -have fueled these debates [2][3][4][5]. Use of conventional volume maintenance isotonic saline has been shown to reduce the incidence of hyponatraemia [6]. Using indirect calorimetric measurements, energy expenditure in critically ill children may be as low as 50-60 kcal/kg/day [7]. Consequently, fluid requirement, which is directly proportional to the actual energy expenditure, is much less than previously assumed in critically ill children for a variety of reasons such as physical immobility, the use of muscle relaxants and sedatives, mechanical ventilation, and additional factors such as nonessential or facultative metabolism [8]. Therefore, we hypothesized that use of reduced volume isotonic maintenance fluid would decrease the incidence of hyponatremia in sick children, when compared to hypotonic fluid. We compared the efficacy and safety of isotonic fluid (0.9% NaCl in 5% dextrose) at the rate of 60% of daily fluid requirement versus hypotonic fluid (0.18% NaCl in 5% dextrose) at the rate of standard maintenance volume in sick children.Accompanying Editorials: Pages 963-66.

Single case reports have described movement disorders including parkinsonism, dystonia and chorea, but not corticobasal syndrome as a consequence of central pontine and extrapontine myelinolysis. We report a case of a 61-year-old woman who developed progressive asymmetric parkinsonism with ideomotor apraxia and cortical sensory deficits following central pontine myelinolysis.

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