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Rituximab has been extensively used for managing B-cell lymphomas due to its anti-CD20 monoclonal antibody activity. Over the last decade, its application has been extended to manage frequent relapsing or steroid-dependent nephrotic syndrome. Its use has been comparatively safe, but few cases of adverse effects on the lung have been reported in the adult population. These lung injury presentations are rarely reported in a pediatric group with only four cases in the literature. Below is a rare case of rituximab-induced lung injury in a 9-year-old boy with frequent relapse of nephrotic syndrome, which developed after four days of rituximab infusion. Suspecting infection and sepsis, several antibiotics were started, but with no improvement in respiratory complaints, even antifungal and antituberculosis treatments were initiated. Finally, setting up a casual relation with the time of infusion to the development of complaints, association with rituximab was suspected. The patient responded to steroid therapy with complete resolution of respiratory complaints. To our knowledge, this is the first reported case of rituximab-induced cystic lesion in lungs from India. [ABSTRACT FROM AUTHOR]

The concept of cardiorenal syndrome (CRS) is derived from the crosstalk between the heart and kidneys in pathological conditions. Despite the rising importance of CRS, there is a paucity of information on the understanding of its pathophysiology and management, increasing both morbidity and mortality for patients. This review summarizes the existing conceptual pathophysiology of different types of CRS and delves into the associated therapeutic modalities with a focus on pediatric cases. Prospective or retrospective observational studies, comparative studies, case reports, case--control, and cross-sectional studies that include pediatric patients with CRS were included in this review. Literature was searched using PubMed, EMBASE, and Google Scholar with keywords including "cardio-renal syndrome, type," "reno-cardio syndrome," "children," "acute kidney injury," and "acute decompensated heart failure" from January 2000 to January 2021. A total of 14 pediatric studies were ultimately included and analyzed, comprising a combined population of 3608 children of which 32% had CRS. Of the 14 studies, 57% were based on type 1 CRS, 14% on types 2 and 3 CRS, and 7% were on types 4 and 5 CRS. The majority of included studies were prospective cohort, although a wide spectrum was observed in terms of patient age, comorbidities, etiologies, and treatment strategies. Commonly observed comorbidities in CRS type 1 were hematologic, oncologic, cardiology-related side effects, muscular dystrophy, and pneumonia/bronchiolitis. CRS, particularly type 1, is prevalent in children and has a significant risk of mortality. The current treatment regimen primarily involves diuretics, extracorporeal fluid removal, and treatment of underlying etiologies and comorbidities. [ABSTRACT FROM AUTHOR]

Byline: Snehamayee. Nayak, Atul. Jindal Sir, We read the article by Garg SK 'Permissive hypercapnia: Is there any upper limit?' [sup][1] with great interest. The author has rightly focused on [...]

Byline: Snehamayee. Nayak, Atul. Jindal Sir, We read the article 'Rhino-orbito-cerebral mucormycosis in a child with diabetic ketoacidosis (DKA)' by Kumar et al . [sup][1] with interest. The author reported [...]

Children with nephrotic syndrome (NS) develop complications due to either the disease state or its treatment. Infections, thromboembolism and acute kidney injury are the most common complications in children with NS. Several studies in children with NS have reported that urinary tract infections, upper respiratory tract infections, peritonitis and sepsis are the most commonly reported infections. Infection is one of the common triggering factors for relapse, and prophylaxis against infections is required in patients unresponsive to steroids or with frequently relapsing disease. In this review article, we summarize the strategies for prevention of infections in NS. The most commonly studied drug for the prevention of infection in NS is intravenous immunoglobulin G (IVIg), while other drugs include thymosin, oral transfer factor, Bacillus Calmette-Guérin (BCG) vaccine, mannan peptide tablet, polyvalent bacterial vaccine and Chinese herbal medications (Tiaojining and Huangqui granules). Several vaccination programs including pneumococcal, influenza A, varicella and measles have been effective in the prevention of infections in nephrotic children. However, established measures for preventing infections in nephrotic children are lacking, and to draw any conclusion, randomized controlled trials are required. [ABSTRACT FROM AUTHOR]

Pediatric systemic lupus erythematous (SLE) is a multisystem disease chiefly affecting skin, kidneys, joints, and hematologic system. However, no organ of the body is immune to this condition. Ocular manifestations are seen in one third of adult patients. The most common ocular manifestation is keratoconjunctivitis sicca, whereas the most severe forms are optic neuritis and retinal vasculitis. An isolated unilateral ocular manifestation is a rare initial presentation of lupus. Here, we described a 9-year-old girl who presented to us with orbital preseptal cellulitis and was later diagnosed as diffuse proliferative lupus nephritis, which responded well to immunosuppression. [ABSTRACT FROM AUTHOR]

Background: Few single center studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-center studies on the same is lacking including from Indian setting., Methods: This retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤ 15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was mortality., Results: A total of 134 MIS-C cases were included (median age, 84 months; males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 50.7% and 39.6% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Fifteen (11.2%) children died. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were the factors significantly associated an increased mortality., Conclusions: MIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were associated with an increased mortality. No difference in outcome was noted with either steroid or IVIg or both. Coronary artery abnormalities resolved in nearly all cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nayak, Panda, Biswal, Agarwalla, Satapathy, Jena, Gulla, Rath, Mahapatra, Mishra, Priyadarshini, Mahapatro, Nayak, Das and for EICOMISC Study Group.)