Recently, a changing pattern of hepatitis A epidemiology has been reported in the Indian population indicating a rise in the rate of hepatitis A infection among adults. The study's objective was to assess anti-HAV prevalence in voluntary blood donors from middle and high socioeconomic strata. Serum samples collected from voluntary blood donors from Pune city and its suburbs in the years 2002 and 2004-2005 were tested for anti-HAV IgG antibodies. Serum samples collected during 2004-2005 were examined for anti-HAV IgM antibodies. Positive samples were tested for HAV-RNA. Agewise anti-HAV positivity was significantly low in adults aged 18-25 years (90.4%) compared to those aged >25 years (97.4%) (P<0.01). A decline in anti-HAV prevalence was significant in 2004-2005 compared to that in 2002 (96.5% vs. 92.1%) (P<0.01). Overall, in both adult age groups, the proportion of anti-HAV positivity was remarkably low in the high socioeconomic group (HSG) (88.96%) compared to that of the middle socioeconomic group (MSG) (95.86%) (P<0.01). Anti-HAV IgM positivity was not significant (~1%), however, presence of HAV-RNA in one of the samples indicated the possibility of horizontal transmission of HAV. Increase in seronegativity to HAV in HSG implicates a rise in the susceptible pool and indicates the need for vaccination against hepatitis A.

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Epilepsy is a common clinical entity in neurology clinics. The understanding of the genetics of epilepsy has undergone a sea change prompting re-classification by the International league against epilepsy recently. The prevalence rates of epilepsy in India are similar to those of developed nations. However, the large treatment gap is a major challenge to our public health system. Perinatal injuries are a major causative factor in pediatric group. We have discussed a few common etiologies such as neurocysticercosis and newer genetic epilepsy syndromes. We have also briefly touched upon the Indian experience in pediatric epilepsy surgery.

IntroductionThough most tertiary paediatric centres in UK have been running hospital schooling programmes for years, the idea is almost non existent in developing countries. It seems that schooling hospitalised children is either non existent or forgotten, or remains a very low priority for families in the developing world. Even where it does exist, most parents, attending doctors and health care staff seems to be unaware of its benefits. Education is a fundamental right of all children including those in a hospital.Place of studyWe are a tertiary paediatric centre, amongst the first in the sub-continent to start a hospital teaching programme with specially appointed teaching staff.OutcomeThe initial response to this initiative was not very encouraging with an average daily attendance of 5.6% of admitted children. Overtime it has improved but still remains to less than 16% of admitted children. 92% of children attending the classroom are between 4 to 7 years of age. Children above 10 years were reluctant to attend and surprisingly their parents also supported them. When we tried to ascertain the reasons for the reluctance, 71% stated that their child is resting and needs to recover and 62% stated that they do not want to burden their children with studies during illness. When we looked at awareness about the existing hospital teaching programme, 55% of the attending health care workers including doctors and nurses throughout the hospital were not aware of such an initiative provided by the hospital and 85% of parents were unaware about such facilities provided by the hospital. We are now in the process of remedying this deficiency with parental and staff awareness programmes. Till date hospital classroom initiative has helped us to identify 14 cases of learning difficulties.ConclusionAs paediatricians, we should take responsibility to ensure that all children have access to appropriate education, even while they are hospitalised. For children undergoing treatment, school can offer a familiar and reassuring routine, as well as a feeling of being in step with their peers in the outside world. This concept needs to be popularised further specially in the developing world.

Lowe syndrome (LS) is a rare X-linked condition having a clinical triad of congenital cataracts, intellectual disability, and progressive tubular nephropathy. Although the easily recognizable symptom complex usually evolves by infancy, a unifying diagnosis is often missed. We present a young boy with a prolonged history of multisystem affection, finally leading to the clinical suspicion of LS. The diagnosis was confirmed on genetic analysis as well as a previously unreported mutation in the OCRL gene was discovered. A 9-year-old boy with intellectual disability and recent onset seizures was referred for the evaluation of rickets. In addition, there was a significant past history of neonatal cataracts, infantile glaucoma, persistent albuminuria, and severe short stature with growth hormone deficiency. The characteristic involvement of eyes, brain, and kidneys along with a family history of a maternal uncle being similarly affected led to the clinical suspicion of LS. A whole exome sequencing was performed, which not only confirmed a nonsense mutation, c.2530C > T, in exon 23 of the Lowe gene (OCRL) but also revealed it to be a novel pathogenic variant. This case highlights the importance of piecing together the different facets of a complex clinical syndrome in reaching a challenging diagnosis. Also, LS must be kept as a differential in any child with neonatal cataracts and intellectual disability. Genetic confirmation of LS in our patient partly relieved the parental anxiety, and the child continued to remain under follow-up with multiple specialists, only now with a definite diagnosis.