Background Pneumococcal infections are common in children with nephrotic syndrome. Knowledge of the commonly available serotypes and antibiotic susceptibility will help in prevention and appropriate management of pneumococcal sepsis, especially in resource-limited countries. Methods Demographic, clinical, and laboratory data on children with nephrotic syndrome and pneumococcal infections were extracted from the electronic medical records. Results Sixty-three isolates of pneumococci obtained from 60 children with nephrotic syndrome, over a period of 14 years, were included in the study. This represented 18% of all pneumococcal infections occurring in children during the same period. Commonly available vaccines covered up to 58% of all the serotypes causing infection. Severe disease, with shock, intensive care admission and/or meningitis, was observed in 38% children and mortality was observed in 10%. Resistance to commonly used antibiotics was not observed, except for erythromycin. Conclusions Pneumococcal sepsis was observed to be common in children with nephrotic syndrome and results in significant morbidity and mortality. Commonly used antibiotics were observed to be effective in management of the infections.

Introduction Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) is a rare phenomenon that leads to concomitant thrombosis and hemorrhage in children with SLE. LAHPS in pediatric SLE (pSLE) has a protracted course requiring long-term immunosuppressive therapy. Due to the rarity of this syndrome and paucity of reported cases, there is lack of standardized management. We herewith report 5 children with pSLE with LAHPS. Methodology: We retrospectively reviewed clinical features, laboratory features, treatment and outcome for 5 children with lupus anticoagulant hypoprothrombinemia syndrome with SLE and a review of literature of similar cases published. Results Mean age of presentation was 10.2 ± 2.38 years (mean ± SD) and female to male ratio was 4:1. All children presented with mild to severe bleeding manifestations like gum bleed, epistaxis, hematuria, menorrhagia and subarachnoid bleed. Coagulation profile revealed prolonged PT and aPTT, with low prothrombin levels and positive Lupus anticoagulant in all children. Mixing studies were characteristic in these children. On comparing laboratory parameters majority had low C3, C4 levels, ANA and anti-DsDNA antibody positivity and three children had anticardiolipin positivity. One child had lupus nephritis along with LAHPS at presentation. All responded well to steroids and supportive measures. Conclusion High index of suspicion is needed when child with lupus presents with bleeding manifestations for early diagnosis and treatment.

Objectives: A retrospective study was carried out to analyse the two wheeler accidents that presented over a one year period to a single institution and to study the pattern of limb injuries according to zones assigned to the limb. The mode of injury in the two wheeler accidents and the differences in limb injuries between the driver and the pillion riding passenger were also studied.Methods: All the road traffic accidents that could be attributed to two wheelers were obtained with the help of trauma records and the nominal registers and ward records. Limb injuries were then assigned to various anatomical zones that were created for the purpose of the study. The upper limb and lower limb injuries were separately analysed for differences between the driver and the pillion rider.Results: There were 242 two wheeler accidents seen between 1st jan 2008 to 31st dec 2008, of these 110 had limb injuries. 96 cases were eventually included and of these 67 were drivers. The most common mode of injury was a skid and fall of the vehicle ( 42%). Pillion riders were injured more often in collisions between two and four wheelers. The commonest injury in drivers was in wrist and hand regions of the upper limb and the tibia and ankle regions of the lower limb. In the pillion rider, lower limb injuries were commonest in the tibia and ankle whereas in the upper limb shoulder and wrist injuries predominated.Conclusion: Two wheeler accidents cause significant morbidity in both the driver and pillion rider, the tibia and ankle are commonly injured in both the populations whereas minor differences in upper limb injury are seen between the two groups.Keywords: Road traffic accidents; epidemiology; pattern of injuries.DOI: 10.3126/ajms.v1i1.2794Asian Journal of Medical Sciences Vol.1(1) 2010 p.14-15

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Angio-Seal is a femoral arterial closure device that is commonly used following coronary angiography and angioplasty, to achieve haemostasis at the access site. It is reasonably well tolerated and is proven to improve the time to ambulation. Nonetheless they are associated with certain complications which can cause significant morbidity to the patients unless intervened in time. Here we describe details of complications that we have encountered over the last year, and discuss the evidence base with regard to the use of these devices.RIGHT