Systemic lupus erythematosus complicated by a Gitelman-like syndrome in an 8-year-old girl.

An 8-year-old girl with recently diagnosed Systemic Lupus Erythematosus (SLE) (class 4 lupus nephritis with autoimmune hemolytic anemia) presented to the pediatric nephrology clinic with polyuria, tiredness and cramps; laboratory investigations revealed refractory hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria and hyperchloriuria. There was no history of diuretic administration. These features were consistent with the Gitelman syndrome. She required large doses of potassium and magnesium supplementation along with spironolactone, for normalization of the serum potassium and magnesium levels. Immunosuppressive therapy was continued with cyclophosphamide pulses administered on a monthly basis. The doses of potassium and magnesium supplements were tapered off over the next 6 months. The clinical exome sequencing was negative for any mutations in the SLC12A3 gene. An 'acquired' form of Gitelman syndrome has been reported earlier in association with Sjogren syndrome and systemic sclerosis. Though tubular disorders such as renal tubular acidosis have been reported in association with SLE, a Gitelman-like syndrome has not been reported earlier. This case adds Gitelman-like tubulopathy to the clinical spectrum of tubular disorders complicating SLE.

A survey on internet usage and online learning behaviour among medical undergraduates.

AIM: To determine the magnitude and pattern of internet usage by undergraduate medical students to retrieve medical information. MATERIALS AND METHODS: A pretested questionnaire-based survey was conducted among undergraduate medical students who were willing to participate. The institute ethics committee approved the study. The responses of students to the questionnaire were analysed using VassarStats online statistical programme. Categorical variables were expressed as proportions. To determine the significance of the difference between proportions, the χ2 test or Fisher's exact test was used. Log-linear analysis was performed for significance of association among interacting variables. A p value <0.05 was considered significant. RESULTS: A total of 115 undergraduate medical students participated in the survey. The response was 100% and involved mainly IX and VIII semester students. Internet usage was found to be 97.4%. Of the students interviewed, 35.7% were frequent internet users and 57.4% used their mobile phones to access the internet. The majority (60.9%) had their own portable 3G internet connection. Monthly expenditure for the majority (82.6%) was less than 1000 Indian Rupees per month. The most popular medical site accessed by students was Medscape, followed by Wikipedia and WebMD. Of the students studied, 8% had attended one or more online continuing medical education programmes. On log-linear analysis, a linear relationship was found for medical time and social time. CONCLUSIONS: An encouraging trend is seen in the use of the internet by medical students to access medical information, but this has not translated into improved online learning behaviour.

Scrub Typhus Co-infection in an Adolescent Girl with Varicella.

BACKGROUND: Co-infections with scrub typhus have been described quite frequently in adults but less frequently in children. CASE CHARACTERISTICS: An adolescent girl with varicella infection who had persistent fever. Associated clinical features like pain abdomen, vomiting, and features of third space losses made us suspect a co-infection. IgM and IgG antibodies by ELISA in acute and convalescent serum were suggestive of scrub typhus. OUTCOME: She recovered following a course of oral doxycycline. MESSAGE: In unexplained prolonged fever or atypical clinical manifestations not explainable by the primary disease process, co-infection needs to be considered.

Antenatal counseling on breastfeeding -- is it adequate? A descriptive study from Pondicherry, India.

BACKGROUND: Antenatal counseling on breastfeeding and postnatal lactation support are likely to improve rates of exclusive breastfeeding. This descriptive study was undertaken to assess whether antenatal visits were utilized for promotion of exclusive breastfeeding in addition to the routine obstetric services. METHODS: This descriptive study was conducted at a tertiary hospital in Pondicherry, India. Every third primigravida mother admitted in the maternity ward from June to December 2005 was recruited. Among these 144 primigravida mothers, 108 who had a minimum of three antenatal visits ("booked") were included in the study. These 108 mothers were administered a pre-tested semi-structured questionnaire on breastfeeding in the local language, Tamil, within 24 hours of giving birth. Appropriate flash cards with pictures were also used while administering the questionnaire. The awareness among mothers (both "counseled" and "not counseled") regarding health information pertaining to breastfeeding was assessed. RESULTS: Of the booked mothers, 21% (n = 23) had received some antenatal counseling about breastfeeding while 79% (n = 85) had not received any such counseling. Four percent had undergone breast examination during antenatal visits. Awareness related to breastfeeding among mothers in the "counseled" group was better than those in the "not counseled" group. Even in the "counseled" group, awareness among mothers with regard to correct breastfeeding technique and concept of continuing breastfeeding during illness in the baby was no different from those in the "not counseled" group. CONCLUSION: Existing antenatal counseling on breastfeeding is inadequate in the population studied and needs to be strengthened. Informing all pregnant women about the benefits and management of breastfeeding should be a priority during antenatal visits.