Introduction: Systemic Lupus Erythematosus (SLE) is an auto immune disorder affecting mainly adolescent females and young women of reproductive age. The disease is characterised by widespread inflammation of blood vessels and connective tissues due to the presence of anti-nuclear antibodies (ANA). There are limited number of studies from South India on paediatric lupus. Our objectives were to study the clinical and immunological features of childhood SLE along with treatment modalities and its outcome at the end of one year follow up. The correlation between various auto-antibodies and systemic involvement was also assessed. Methods: This was a retrospective observational study carried out in paediatric unit at a tertiary care centre in South India. Data was obtained through patient’s medical records. From April 2003 to April 2019, 32 children were diagnosed to have SLE as per the American college of Rheumatology 1997 criteria. Results: The study population included 32 children fulfilling the criteria. Female to male ratio was 4.3:1. The mean age at diagnosis was 11.52 years. The most common clinical manifestations were renal (87.5%) followed by haematological (81.3%), musculoskeletal (59.4%), mucocutaneous (53.1%) and nervous system (31.3%) involvement. All patients were positive for anti-nuclear antibodies. Anti-double stranded DNA (78.1%) was the most common auto-antibody profile followed by anti-ribosomal p protein (37.5%) and anti-nucleosome antibody (37.5%). During the follow up, 13 (40.6%) children attained complete remission, 10 (31.2%) went into partial remission and nine (28.1%) had persisting active disease. Conclusion: The clinical spectrum and outcome of paediatric SLE depends upon the age of presentation and number of organ systems involved at the time of diagnosis. Our study throws light on various aspects of SLE in children from developing countries like India.

Introduction: Influenza viral infection in children can range from subclinical illness to multi system involvement. The morbidity associated with influenza B viral infection is often overlooked. India being the second most populous country, accounts for 20% of global childhood deaths from respiratory infections. There is paucity of data on the clinical features and complications of influenza B viral infections in children from the Indian subcontinent. Our objective was to study the clinical profile, seasonality, complications and outcome associated with Influenza B viral infection in children < 18 years of age. Material and Methods: We conducted a retrospective observational study at a tertiary care hospital in South India. Children less than 18 years of age admitted to our paediatric unit were included in the study. We reviewed the case sheets of 56 patients who tested positive for influenza B virus during the study period and recorded their clinical and laboratory data. Throat swab obtained from cases were tested by RT-PCR. The illness was classified as upper respiratory tract infection, pneumonia and severe pneumonia. Outcome measures analysed were- mortality, need for oxygen supplementation or assisted ventilation, duration of oxygen support, duration of ICU/ hospital stay and time for defervescence following initiation of oseltamivir therapy. Results: The mean age of the study population was 6.98 years. Majority of the affected children were > 5 years of age in the school going category with a male to female ratio of 3:2. The diagnosis based on clinical and radiological findings included upper respiratory tract infection (URTI) in 44 (78.5%) cases followed by pneumonia in 11(19.6%) and severe pneumonia in one (1.7%) child. The peak incidence was in the month of March. Malnutrition was the most common risk factor affecting 22 (39.3%) cases followed by history of asthma in eight (14.3%). Three children required oxygen supplementation at admission. The median duration of hospital stay was seven days. The median duration for defervescence following initiation of oseltamivir therapy was 24 hours. Mortality was recorded in one infant who died of acute respiratory distress syndrome. Conclusions: Influenza B virus should be screened in all children having underlying high risk medical condition, presenting with pneumonia or upper respiratory tract infection. Oseltamivir therapy should be initiated early in the management of influenza B viral infections to prevent complications.

Background: Globally, pharmacovigilance, rationality of drug prescription studies, and adverse drug reaction (ADR) in children affected with ailments are an understudied topic. Children are a vulnerable age group and reports suggest that over 10% of hospitalized have adverse reactions to therapy and up to 2.9% of all hospital admissions are the consequence of ADRs. In lieu of these observations, the present study was undertaken in a tertiary care hospital to ascertain the bad prescribing habits and ADR in children. Methodology: This was a prospective study and was carried out in the department of pediatrics at a tertiary care hospital for 6 months. The prescription orders of the children on medical treatment for various common ailments were analyzed. The drug prescribing pattern, safety profile of the drug/s alone and in combination was analyzed in accordance with the standard pharmacovigilance method. Results: In the study, a total number of 212 drugs were prescribed for 646 study participants. Most of the study participants were male child, and respiratory infection was the prevalent ailment affecting the children during the study period. With regard to the drug prescription, the average number of drugs per prescription was 3.96. Drugs prescribed by generic name were 6.9%, while 97.21% of the drugs prescribed were observed to be essential for the medical condition. Among the classes of drugs prescribed, antipyretics and antibiotics were the major classes of drugs administered in children admitted in inpatients facility, while among the outpatients (OPs), respiratory drugs and antipyretics were the most common prescribed drugs. Most importantly, polypharmacy was common in inpatients compared to OPs and also that 5.1% had some form of ADR. Conclusion: The present study showed rational prescribing pattern but poor standard pharmacovigilance technique.

Hypothyroidism in children causes delayed puberty. However longstanding untreated hypothyroidism can lead to precocious puberty which may be secondary to hyperprolactinemia or increased levels of thyroid stimulating hormone (TSH), enhancing the sensitivity of ovaries to circulating gonadotropins. Here we report a seven and half years old girl with hypothyroidism presenting with precocious puberty and multicystic ovaries which responded well to thyroid hormone supplementation but subsequently developed left ovarian torsion requiring surgical intervention.