BackgroundNephrotic syndrome (NS) is characterized by dyslipidemia which is a well-known risk factor for atherogenesis. Atherosclerosis in childhood is mostly subclinical and endothelial dysfunction is known to precede this. Evidence for screening for endothelial dysfunction and cardiovascular risk factors and early identification of premature onset of atherosclerosis in childhood NS remains tenuous in the absence of well-designed prospective studies addressing cardiovascular comorbidity in NS. The objective of our study is to examine endothelial dysfunction and short-term cardiovascular outcomes in a carefully phenotyped cohort of patients with Nephrotic syndrome as compared to healthy controls.MethodsIn a multi-centric prospective cohort study, 70 Steroid Resistant NS (SRNS), 70 Steroid Sensitive (SSNS) patients along with 70 Healthy Controls are being recruited. After a baseline assessment of functional and structural status of heart (2D Echocardiography), arteries (Carotid Doppler and Intima Media Thickness measurements) and microcirculation [a combination of 2D Echocardiography, Laser Doppler Flowmetry (LDF) and Brachial Artery Flow mediated dilation (FMD) and Nail Fold Capillaroscopy (NFC)], the patients are being investigated for endothelial dysfunction. Venous blood sample (15 ml) is being collected for routine investigations and assay of biochemical endothelial markers through Flow Cytometry. The patients will be followed up at 12 months and 24 months after the recruitment to look for any change from baseline period.DiscussionThis study will able to provide a better understanding of the epidemiology of endothelial dysfunction and associated subclinical cardiovascular co-morbidity in childhood NS. Findings on characterization of prevalence of endothelial dysfunction and subclinical markers may be used to design future randomized controlled trials for evaluating the efficacy of preventive and therapeutic interventions in reducing the incidence of cardiovascular disease.

Coronavirus-2019 Disease (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was declared as a global epidemic by World Health Organization (WHO) on 11 March 2020. 1 Lockdown was an unprecedented, emergency measure, which was adopted across several countries to prevent the exponential spread of the disease. India was placed under lockdown from 24 March 2020, which was extended till 31 May 2020 with subsequent gradual relaxation of restrictions. At the time of submission of this article (16 August 2020), a partial lockdown was in vogue in India. Lockdown is having profound repercussions on day-to-day functioning of people from all walks of life, including children. Children with neurodevelopmental disorders (NDD) constitute a sizeable segment

Background: Children with autism spectrum disorder (ASD) have a high prevalence of bladder bowel dysfunction (BBD), with symptoms including urinary incontinence, dribbling, voiding postponement, constipation, and encopresis. BBD is, however, underdiagnosed and has been studied prospectively in few studies. Methodology: All children, aged 2–14 years, diagnosed with ASD using the Childhood Autism Rating Score (CARS), were reviewed in the outpatient department and objectively evaluated for lower urinary tract symptoms using the dysfunctional voiding and incontinence symptoms score, and presence of constipation using the Rome IV criteria. The presence of voiding dysfunction and/or constipation was correlated with the severity of ASD. All children with BBD were advised standard urotherapy and followed up for improvement over the next 3 months. Adherence to the prescribed urotherapy was assessed using the Brief Adherence Rating Scale (BARS) adapted for children with ASD. Results: Of 54 children included, 40 (70.1%) were boys. The mean ± standard deviation of age was 7.5 ± 2.5 years. ASD was mild to moderate in 24 children and severe in 30 children. Nineteen (35.2%) patients had constipation, including four with mild-to-moderate ASD and 15 with severe ASD. Seventeen (31.5%) patients had voiding dysfunction, including nine who could not be toilet trained, and 12 of these patients had moderate-to-severe ASD. Ten (18.5%) patients had both constipation and voiding dysfunction. The presence of voiding dysfunction and/or constipation correlated with the severity of ASD (correlation coefficient 0.55). Adherence to urotherapy correlated inversely with CARS. Children with BARS score >70 showed improvement in constipation and/or voiding dysfunction. Conclusions: Children with ASD have a high prevalence of BBD, and the presence of BBD correlates strongly with the severity of ASD. Children with ASD should be evaluated for BBD and managed appropriately to prevent associated morbidity.