Objective To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment. Methods In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in different treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. ResultsThe data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case definition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred fifty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19-25.0), p < 0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n = 45), and IVIG plus steroid (n = 84) groups (p = 0.515). Conclusion While no significant difference was observed in the frequency of occurrence of the primary outcome in different treatment groups, data from adequately powered RCTs are required for definitive recommendations.

Background Obstructive sleep apnea (OSA) and hypertension are common complications in children with chronic kidney disease (CKD). Progression of CKD can aggravate OSA and hypertension whereas worsening sleep apnea can make hypertension difficult to treat in CKD patients. We, therefore, conducted a prospective study to evaluate the association between OSA and hypertension in pediatric patients with CKD. Method In this prospective observational study consecutive children with CKD stage 3–5 (nondialysis dependent) underwent overnight polysomnography and 24-h ambulatory blood pressure monitoring (ABPM). The detailed clinical features and investigations were recorded in a prestructured performa. Results Twenty-two children completed overnight polysomnography and 24-h ABPM was performed within 48 h of performing polysomnography. The median (IQR) age of the study population was 11 (8.5–15.5) years, with an age range of 5–18 years. Moderate-severe OSA defined as apnea-hypopnea index (AHI ≥5) was seen in 14 (63.6%) children, periodic limb movement syndrome in 20 (91%) and poor sleep efficacy in 9 (40.9%) children. Ambulatory blood pressure was abnormal in 15 (68.2%) children with CKD. Of them, 4 (18.2%) had ambulatory hypertension, 9 (40.9%) had severe ambulatory hypertension and 2 (9.1%) had masked hypertension. A statistically significant correlation of sleep efficiency with nighttime DBP SD score/Z score (SDS/Z) (r = −0.47; P = 0.02); estimated glomerular filtration rate with SBP loads (r = −0.61; P < 0.012); DBP loads (r = −0.63; P < ) and BMI with SBP load (r = 0.46; P = 0.012) was found. Conclusion Our preliminary findings suggest that ambulatory blood pressure abnormalities, OSA, periodic limb movement syndrome and poor sleep efficiency are highly prevalent in children with CKD stages 3–5.

Identification of this syndrome has important therapeutic and prognostic implications.

Background and Objectives: The misuse of antibiotics in recent years has led to an increase in antibiotic associated diar- rheas (AAD). Out of several implicated pathogens, Clostridioides difficile is responsible for causing 15-25% of all cases of AAD. However, it has remained under diagnosed for a long time. The current study is planned to explore prevalence of C. difficile amongst AAD patients and to study clinical presentation and associated risk factors. Materials and Methods: Hospital based cross sectional study conducted in patients above 2 years of age. Diagnosis of C. difficile was done by two modalities i.e. glutamate dehydrogenase test followed by toxin detection using enzyme immunoas- say and stool culture followed by toxin gene detection. Results: Twelve of 65 patients (18.4%) were positive for C. difficile. Maximum cases were found in younger age group. Abdominal pain and fever were most common complaints. 12 (18.4%) out of 65 study subjects were found to be positive by ELISA. 2/65 (3%) patients were positive for culture with presence of only tcdB gene. Ceftriaxone was the most commonly used antibiotic (25%). Conclusion: C. difficile is significant pathogen implicated in AAD with a prevalence rate of 18.4%. GDH antigen detection followed by Toxin A/B ELISA for C. difficile yielded better detection rate as compared to stool culture.

Choroidal tuberculosis may present as multifocal progressive or serpiginous like choroiditis. It is important to recognize these presentations as these eyes show good response to systemic antitubercular therapy. Paradoxical reaction in tuberculosis can occur in patients receiving anti tuberculous therapy (ATT). It consists of clinical or radiological worsening of pre existing tuberculous lesions or the development of new lesions in patients who initially improved on treatment. Intraocular tuberculosis presents most commonly as posterior uveitis, either as choroidal tubercles, choroidal tuberculoma, subretinal abscess or serpiginous-like choroiditis; however, it can also present, in order of decreasing prevalence, as granulomatous anterior uveitis, panuveitis and intermediate uveitis. We report, a case of paradoxical worsening of presumed tubercular serpiginous like choroiditis on antitubercular therapy. Through this interesting case we try to highlight the fact that continued progression of lesions may be noted inspite of ATT and systemic steroids but it is important to be aware of paradoxical worsening, so that one doesn't interrupt ATT.