Background: Inflammatory Bowel Disease (IBD) encompasses two related but unique disorders of as yet unknown cause. The incidence has increased substantially in recent years-2.2 to 6.8/100 000 in paediatric/adolescent population worldwide.Current therapeutic goals in children and adolescents are to diagnose/ treat relapses early, improve clinical management and reduce morbidity.

BACKGROUNDChildhood ocular trauma is an important cause of disabling ocular morbidity. One third of the ocular trauma causing loss of vision is limited in the first decade of life. Children are more commonly affected because of their underdeveloped motor skills and high curiosity. Visual prognosis of severe ocular trauma is really challenging in paediatric age group. We wanted to study the causes and types of paediatric ocular injuries clinically. We also wanted to study the causes and types of ocular injuries in different ages, sexes, with an urban-rural distribution. among two hundred (n=200) number of patients up to 15 years of age. A detailed clinical and ophthalmological examinations were done in every patient. RESULTSFall from a height (40%) and fingernail (19%) trauma were the most common causes of ocular injuries, followed by blouse hook (17%) injuries during breastfeeding, pencil and pen related trauma (11%) and fall on the rocks (13%). Other findings were corneal abrasion (28%), eyelid swelling (23%) and bruise (21%). Fracture of orbital wall (7.5%), sub conjunctival haemorrhage (19%), corneal perforation (6%), hyphema (4%), iris injury (6%), intraocular foreign body (10%) and globe rupture (3%). Posterior segment involvement was rare. CONCLUSIONSChildren should be away from the traumatic agents as much as possible. Parents should be trained properly for early management before coming to the hospital. Creation of more referral centers for ocular emergency should be far from the urban areas for giving early management to the traumatized children to avoid visual morbidity as much as possible.

BackgroundCoeliac Disease (CD) is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individual. Recent NICE guidelines sets out the guidance for the diagnosis and management of CD. It recommends that all patients should be seen by a specialist, require dietician input and be annually reviewed.Children from the entire the county of Lincolnshire are referred to Lincoln County Hospital (LCH) for their diagnosis and are managed by a single consultant paediatrician with an interest in gastroenterology.Aims1) To compare our practice for the diagnosis and management of children with coeliac disease over a 5 year period from 2009 to 2014 with the current NICE guidelines.2) To look at any change in presentation/practice from the previous audit.(1999–2004)MethodsRetrospective review of the patients diagnosed with coeliac disease over a 5 year period from 2009–2014 in LCH was undertaken and compared with the previous audit (1999– 2005). Age of presentation, duration of symptoms, clinical presentation, serology, biopsy findings, management, follow-up and sibling screening data were collected and compared.Excluded diagnosed elsewhere.Results65 children (23M,42F) were diagnosed with CD in 2009–2014 vs 41 (19M,22F) in previous audit. Mean age of diagnosis 8.1 yr vs 6.1 years, Duration of symptoms was same in both 6–8months, 65% presented with gastrointestinal symptoms vs 49%, Associated disorder 5% vs 7%, Asymptomatic 7% vs nil, Latent celiac 8% vs 12%, EMA and TtG 100% vs 100% and 7% in previous audit, HLA typing 4% vs 14%, Biopsy done in 97% in both audit, Dietician reviewed 100% in both audit, Sibling screened 55% vs 100%, Follow up in Coeliac clinic 83% vs 87%, First Degree relative 21% vs 14% in previous audit. Associated conditions see included type-IDDM, Down’s syndrome, Addison’s disease, Skeletal dysplasia.ConclusionWe noted that there was a significant increase in the number of patients with CD and that they presented at a slightly older age. More patients had gastrointestinal symptoms.Only 5% less than3rd centile. 7% were asymptomatic. The incidence of CD in first degree relative was high at 21%.Our practice is compliant with the NICE guidelines and ESPHAGAN.

BACKGROUNDAnkylosing spondylitis (AS) is a chronic inflammatory systemic disorder affecting the axial skeleton with chronic pain and stiffness in the lower back or buttocks region and progressive limitation of spinal movements. Many patients exhibit extra-articular manifestations and anterior uveitis is a common form of extra articular manifestation of AS. Other findings are episcleritis, scleritis, peripheral ulcerative keratitis, retinal vasculitis, dry eye, cataract and secondary glaucoma. Sometimes ocular signs are the only presentation. It is very challenging for an ophthalmologist to carefully examine the patients of AS so that permanent bony deformity is minimised. We wanted to evaluate the magnitude of ocular manifestations in patients suffering from AS and establish the statistical significance of age of patients and determine the frequency of ocular manifestations for epidemiological purposes. METHODSThis is a cross sectional observational study done among one hundred and forty-four patients (n=144) with AS conducted between December 2018 and July 2019. Slit lamp biomicroscopy with 90 D Volk lens was done for anterior and posterior segment examination. Gonioscopy, Applanation Tonometry, Automated Perimetry and Indirect Ophthalmoscopy were done. Schirmer's and TBUT tests were done. RESULTSAnterior uveitis (30%) was the most common ocular manifestation followed by vitritis (18%), cataract (15.2%), episcleritis and scleritis (7.6%), dry eye (6.2%), retinal vasculitis (8%) and peripheral ulcerative keratitis (5%). Males are more commonly affected. The duration of disease was found to be statistically significant (p<0.001) when correlated with age groups with patients in the age group of >60 years and with respect to unilateral/bilateral presentation of ocular manifestations (p=0.016). CONCLUSIONSOphthalmologist has a great role for diagnosing of AS. Patients usually come to ophthalmology OPD for management of ocular symptoms with undiagnosed AS and physician must be cautious while assessing ocular signs and symptoms for suspecting AS. As a result, irreversible bony deformities can be minimized as much as possible.HOW TO CITE THIS ARTICLE: Babu SS, Maiti P, Islam MN. Ankylosing spondylitis: ophthalmologist plays a major crucial role!.