Secondary haemophagocytic lymphohistiocytosis in a child with brucellosis

Human brucellosis is a zoonotic infection, mostly caused by B. melitensis and usually presents as an acute febrile illness. Once considered rare in children, it is now recognized that brucellosis can affect persons of all ages, especially in areas where B. melitensis is the predominant species. Complications may affect any organ system. On the other hand Secondary Hemophagocytic lymphohistiocytosis (SHLH) can occur due to systemic infections, immunodeficiency, and underlying malignancies. (SHLH) is histologically characterized by excessive proliferation and activation of histiocytes or macrophages. Brucellosis associated with SHLH should be suspected whenever there is a prolonged fever along with hepatosplenomegaly and pancytopenia.

Role of urinary nitrites in predicting steroid responsiveness of nephrotic syndrome: a study conducted in tertiary care center

Background: Nephrotic Syndrome (NS) is a common chronic disorder, characterized by alterations of selective permeability at the glomerular capillary wall, resulting in its inability to restrict the urinary loss of protein. Urinary nitrite excretion serves as a useful investigation in differentiating between steroid responsive and steroid resistant nephrotic syndrome. The aim of the study was to assess the relation between urinary nitrite levels and steroid responsiveness in nephrotic syndrome in children.Methods: 76 children were enrolled in the study suffering with nephrotic syndrome of which 58 children were Steroid Sensitive (SSNS) and 18 were Steroid Resistant (SRNS). 25 children were enrolled as controls. The urinary nitrites were estimated in these subjects and the results were analyzed.Results: All the control subjects were tested negative for urinary nitrites. After achieving remission with steroids, out of 58 SSNS subjects' 27 subjects tested positive for urinary nitrites, remaining 31 tested negatives for the same. Of the 18 SRNS subjects 1 subject tested positive for urinary nitrites remaining 17 subjects were tested negative for the same.Conclusions: The findings of present study suggest that urinary nitrite excretion is increased in patients with steroid responsive nephrotic syndrome. The urinary nitrite estimation has low NPV and high PPV in predicting steroid responsiveness.

Serum magnesium levels in attention deficit hyperactive disorder in 6-17 years age group: a study in tertiary care center

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and one of among the most prevalent chronic health conditions affecting school-age children. Magnesium is a crucial mineral and appropriate levels in the body are essential for normal cognitive function and mental health. Seventy-two to 96% of those diagnosed with ADHD have been found to be significantly deficient in magnesium. Studies have shown that in these patients, supplementation with magnesium improves attention and working memory and decreases anxiety, depression and emotional dysregulation. Objective of the study was to measure the serum levels of magnesium in children with attention deficit hyperactive disorder and to assess the relation between serum Magnesium levels and Attention deficit hyperactive disorder (ADHD).Methods: The study was conducted at Niloufer Institute of Child Health, which is tertiary care referral hospital and a teaching institute, affiliated under the esteemed Osmania Medical College, Hyderabad. Ethical committee clearance was taken before conducting the study, 50 cases of ADHD are selected from the outpatient department of the Psychiatry clinic for children and adolescents. And 50 controls are also selected for this study. Serum magnesium levels are assessed in both groups.Results: In ADHD group children with serum Magnesium level <1.5 meq/L are 24% whereas in control group it is 6%. When subgroups were analyzed, 25% of hyperactive ADHD group, 18.75% of inattentive ADHD group and 27.27% of combined ADHD group had serum magnesium levels of less than 1.5 meq/l.Conclusions: The study suggest that there is deficiency of magnesium in ADHD children when compared to healthy controls. Further, the study also recommends that further research is needed to help to identify the etiology, impact, and possible therapeutic implications of magnesium status in ADHD.