Multiple autoimmune syndrome (MAS) is a condition characterised by three or more autoimmune disorders in a same individual. Familial, immunologic and infectious factors are implicated in the development of MAS. Here we report a case of a 32-year-old woman with co-existence of four auto-immune diseases, namely autoimmune hypothyroidism, Sjögren’s syndrome, systemic lupus erythematosus (SLE) and celiac disease which leads to the final diagnosis of multiple autoimmune syndrome type 3 with celiac disease. Patients with single autoimmune disorder are at 25% risk of developing other autoimmune disorders. The present case emphasises to clinicians that there is a need for continued surveillance for the development of new autoimmune disease in predisposed patients.

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Background: Dengue is the most rapidly spreading mosquito borne viral disease in the world. In the last 50 years incidence has increased 30 folds with increasing geographical expansion to new countries and into present decade, from urban to rural setting. Objectives: To study the use of fluid regulator in the fluid management of Dengue Fever in children in a rural tertiary care hospital with a good outcome with no mortality. Material & Methods: This study was conducted on 1537 patients aged (0-16 years) with suspected Dengue Fever and serologically confirmed Dengue fever in the Department of Paediatrics, Akash Hospital, from October 2013 to October 2016. Fluid Regulator (DOSIFLOW) was used in the management of all admitted dengue cases in the pediatric general wards without shifting them to Pediatric Intensive Care Unit (PICU), and without using Infusion pumps. Those with respiratory distress and severe shock requiring ventilator support were shifted to PICU. Otherwise all patients with hypovolemia, severe thrombocytopenia, bleeding manifestation were managed in the pediatric general ward with the help of fluid regulator (DOSIFLOW). Results: Out of 1537 patients, 41 were case of severe dengue (DHF and DSS), 1496 were cases of non-severe dengue (undifferentiated fever, dengue fever with warning signs, and dengue fever without warning signs). The youngest child was 2 months old. All of the cases needed intravenous fluids. All patients with warning signs, with hypovolemia, severe thrombocytopenia, bleeding manifestations were managed in the pediatric general wards with the help of fluid regulator (DOSIFLOW). Fluid could be adjusted and regulated as 10ml/kg, 7ml/kg, 5ml/kg, 3ml/kg very easily with the help of fluid regulator without the use of infusion pump. Dopamine was required in 2% of cases, all of them were severe dengue cases. Platelet concentrate and Blood transfusion were not given to any of our admitted dengue cases. Case fatality rate was 0%, as all cases were discharged successfully after recovery with fluid management. Conclusion: Fluid therapy is very important in the management of Dengue fever which requires a fluid regulator for effective administration of intravenous fluids. We recommend to use Fluid regulator (DOSIFLOW) for fluid management of all Dengue Cases and also routinely in all paediatric cases for fluid administration, as it is very easy to use and regulate fluid volume without causing fluid overload.