These results suggest that vitamin D levels are low at the onset of T1D, and they strongly support the need for further clinical studies to prospectively evaluate the effect of vitamin D supplementation on T1D rates in this patient population.

To evaluate the efficacy of nebulized budesonide compared to oral prednisolone early in the emergency room management of acute asthma, we conducted a double‐blind, placebo‐controlled trial. Eighty children, 2 years to 12 years of age, with acute moderate attacks of asthma, were randomized into two groups. One group received nebulized salbutamol (0.15mg/kg) and placebo at half‐hourly intervals for three doses, and a single dose of oral prednisolone (2 mg/kg) (prednisolone group) and other group received three doses of nebulized salbutamol and budesonide (800 μg) at half‐hourly intervals and a single dose of placebo tablets (budesonide group). The baseline characteristics of the two groups were similar, but after three doses of nebulization oxygen saturation, respiratory rate, pulmonary index and respiratory distress score were significantly improved in the budesonide group compared to prednisolone group (p < 0.01). The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was significantly higher in the budesonide group than in the prednisolone group (22/ 41, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of nebulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy. □Asthma, budesonide, emergency care, glucocorticoids

SUMMARYA prospective cross sectional analysis of serum lipids was carried out in 20 children aged between 1.3 and 16 years with Kawasaki disease (KD). The controls were siblings of other patients. The mean interval between diagnosis of the disease and time of assay was 2.6 years (range 0.41 to 6 years). Standard biochemical methods were employed for determination of various components of the lipid profiles. There were significant differences in high-density lipoprotein cholesterol (HDL-C) (40.37 ± 12.0 mg/dL versus 53.49 ± 4.31 mg/dL, P < 0.001) and low-density lipoprotein cholesterol (LDL-C) concentrations (77.76 ± 26.25 mg/dL versus 57.7 ± 23.2 mg/dL, P < 0.05) between the cases and controls. Lower HDL-C levels persisted at 1-3 and more than 3 years of disease duration. No significant differences were seen in the values of other parameters in the lipidogram, such as total cholesterol (TC), triglycerides (TG), and very low-density lipoprotein cholesterol (VLDL-C). Premature atherosclerosis that occurs in KD may be secondary to these lipid metabolism abnormalities. ( 1) This endothelial dysfunction is a precursor of atherosclerosis and subsequent coronary artery damage.2,3) There is a paucity of data on the occurrence of KD from developing countries. In India most of the literature pertaining to KD is in the form of case reports and there is no study on factors determining long-term outcomes. 4,5) We have been involved in the care of possibly the largest cohort of KD patients in India. Since no information is available on lipoprotein abnormalities from developing countries, we prospectively studied a group of our patients with a view to characterize lipid abnormalities in these patients on follow-up.From the

Objective: To compare the efficacy of insulin glargine and insulin NPH in terms of glycemic control and risk of hypoglycemia in children with Type 1 diabetes (T1D) mellitus.Design: Prospective, randomized, open label, controlled trial.Setting: Pediatric Diabetes Clinic of a tertiary care hospital.Subjects: Eighty T1D children between 2 to12 years diagnosed for at least six months. Randomization:Computer generated random number table was used to randomize the patients into Glargine (n=40) and NPH (n=40) groups. Intervention:Patients received either once daily insulin glargine or twice daily NPH insulin as basal insulin. Monthly follow up was done for 6 consecutive months. Results:In the glargine group, significant reductions were noted from baseline to endpoint in mean fasting blood glucose (FBG) (152.80 ± 22.92 versus 113.08 ± 14.71, p value < 0.001), mean blood glucose (MBG) (171.0 ± 23.02 versus 126.20 ± 13.29, p value < 0.001), glycated hemoglobin (HbA1c) (8.89 ± 1.48 versus 7.44 ± 0.74, p value < 0.001), mean total insulin dose (0.92 ± 0.37 units/kg/day versus 0.70 ± 0.29, p value < 0.043), mean basal insulin dose (0.78 ± 0.34 versus 0.53 ± 0.23, p value < 0.001) and mean number of all types of hypoglycemic episodes whereas, mean unmodified insulin dose (0.14 ± 0.14 versus 0.16 ± 0.14, p value 1.000) remained unchanged. The changes in all these parameters in the NPH group were not significant. The percentage of patients suffering at least one episode of hypoglycemia was significantly less with glargine in contrast to NPH (2.02 ± 0.43 versus 2.36 ± 0.47, p value 0.001). Conclusion:Glargine was found to be more effective than NPH insulin for glycemic control and incidence of hypoglycemia in children with T1D.

This communication describes a 1.5-year-old girl who presented with multiple episodes of infection since early infancy and stiffening of limbs for 2 months. Biopsy of the involved areas showed features consistent with pansclerotic morphea. Immunoglobulin estimation revealed hypogammaglobulinemia. This unique combination of pansclerotic morphea with hypogammaglobulinemia has not been reported before.