Background: Fever of unknown origin is one of the leading etiologies for morbidity and mortality among children worldwide and their spectrum keeps changing constantly from time to time. The objective of this study was to study the clinical profile and etiological spectrum of fever beyond 2 weeks duration in children aged 2 months to 12 years admitted in a tertiary care hospital. Methods: A prospective observational study, done in tertiary care centre over six month period (May 2016 to October 2016). Children aged 2 months to 12 years presenting with fever beyond 2 weeks duration fulfilling the inclusion criteria were included in the study and evaluated further. Initial investigations include complete blood count including peripheral smear for MP/malignancy, urine routine, chest X-ray, mantoux, CRP, blood and urine cultures were done followed by specific serology tests and further relevant investigations. The etiological outcomes were mainly analysed. Results: The etiological outcomes of the study were classified into 5 groups as infections, malignancies, connective tissue disorder, miscellaneous and undiagnosed. Among the study population, infection emerged as the major etiological outcome constituting 69.1% followed by malignancies (16.7%), connective tissue disorder (5%), miscellaneous (5.8%) and undiagnosed (3.4%). Conclusions: Infections, especially enteric fever still remains the leading etiology of fever beyond 2 weeks duration or FUO in children aged 2months to 12 years. Irrational usage of antibiotics has been highlighted in general practice which needs to be amended by periodic discussions and epidemiological surveys to prevent the emergence of drug resistance.

Background: Deficiency of 25 hydroxyvitamin D has been linked with predisposition to autoimmune disorders. Also, vitamin D has been found to be a causal factor in many autoimmune diseases. Objective of the study was to investigate vitamin D status in children with autoimmune thyroiditis attending endocrinology OPD at a tertiary centre in southern India.Methods: It is a case control study done in which 75 children (70 female, 5 male) with age and sex matched healthy controls were chosen. Free thyroxine, TSH, anti TPOAb, anti TGAb, 25 hydroxyvitamin D, serum calcium, phosphorus, alkaline phosphatase levels were estimated in both cases and control subjects. Children with anti TPO or anti TG positivity were divided into four groups based on their level of antibody titers.Results: The mean age in cases was 9.8±0.34 years. 25(OH)D levels were significantly lower in cases (15.07±1.14 ng/ml) compared to controls (17.82±1.13 ng/ml) (p<0.0006). Mean serum calcium levels in cases (9.35±0.16 mg/dl) were significantly lower when compared to controls (9.73±0.14 mg/dl) (p<0.0005). Similarly mean serum alkaline phosphatase level in cases (184.97±11.10 IU/L) were significantly elevated when compared with controls (122.37±6.82 IU/L) (p<0.0001). However, there was no significant difference in serum phosphorus levels between cases (4.42±0.10 mg/dl) and controls (4.43±0.14 mg/dl) (p=0.83). There was no significant difference in vitamin D level among the groups in both anti TPO (p< 0.283) and anti TG (p<0.148).Conclusions: The significant decrease in vitamin D levels in cases signifies that 25(OH)D may be an independent causal factor related to the autoimmunity in thyroid diseases.

Objective: To eliminate iodine deficiency disorders (IDD) in children, the Indian government implemented a universal salt iodization program more than 3 decades ago. Recently, it was identified that excess iodine intake could lead to autoimmune thyroiditis in children. We aimed to measure the level of iodine excretion as well as thyroid profiles as an option to identify autoimmune thyroiditis in school-going children. Materials and Methods: A total of 111 children between the ages of 6 and 12 years were subjected to a blood test to measure free thyroxine, thyroid-stimulating hormone, anti-thyroglobulin, and anti-thyroperoxidase levels. The children were categorized into control and case groups based on the clinical outcome. Biochemical analysis, thyroid gland assessment, fine-needle aspiration cytology (FNAC), and ultrasound sonography were performed. Urinary iodine excretion (UIE) level was measured by the Sandell-Kolthoff reaction method. Results: Approximately 90% of the study population was identified with a higher level of iodine in urine. A positive correlation was observed between the UIE, anti-TPO, and anti-TGO titers among the cases. Out of 61 cases, 21 children showed overt hypothyroidism (34.43%) and the remaining were identified with subclinical thyroid symptoms (65.57%). FNAC confirmed autoimmune thyroiditis in 43 children within the case group. Conclusion: Excess iodine intake may trigger thyroid autoimmunity in children. Children who are having higher levels of anti-thyroid antibodies are at risk of developing thyroid dysfunction if they consume more than the required iodine for metabolism. High levels of iodine in the urine of control children indicate that the IDD program in our nation is running successfully.

Objectives Laron dwarfism is a rare genetic disorder first reported among Israeli jewish children, subsequently about 350 cases cases have been reported worldwide. We aim to describe the clinical profile of nine children with Laron dwarfism from Institute of Child Health, Chennai. Methods Analysis of case records from 2010 to 2018. Results Male:female ratio is 6:3. Mean age of the children at the time of diagnosis was 3 years. All children were extremely short, and mean height Z score (SD) was −7.7(0.8). All children had characteristic facies with no hypoglycaemic episodes. Microcephaly was present in four children out of which two had developmental delay. Three out of six boys had micropenis. All children had low insulin like growth factor-1 (IGF-1) and high basal growth hormone (GH) with a mean (SD) of 39.6 (11.2) ng/mL. Conclusions Suspicion of Laron syndrome should be high when child presents with features of Growth Hormone Deficiency (GHD) with extreme stunting.

Background: The study was conducted to assess the effectiveness of bedtime Levothyroxine administration as compared to morning Levothyroxine administration in thyroid profile, renal and lipid parameters, anthropometric and vital parameters in children attending endocrinology OPD at a tertiary care center in Southern India.Methods: It is an open label randomized control study. 154 children who were diagnosed to have hypothyroidism, on levothyroxine supplementation and in euthyroid state at the start of study were included. Children were randomly allocated into two groups. One group received levothyroxine in early morning (1hr before food) and another group received levothyroxine in bedtime (2hrs after food) up to 3 months. At baseline, 6 weeks and 12weeks, thyroid profile, renal and lipid parameters and vital parameters were measured during follow up. Anthropometric parameters were measured at baseline and 12 weeks.Results: In 6th week analysis, mean TSH level of morning group (2.35±0.38 mIU/L) and bedtime group (2.42±0.40 mIU/L) did not show any statistical difference (p=0.8). In 12th week analysis mean TSH level of morning group (2.18±0.34 mIU/L) and bedtime group (1.90±0.33 mIU/L) did not show any statistical difference (p=0.24). At 6th week analysis, mean free T4 level of bedtime group (1.45±0.08 ng/dl) is higher than morning group (1.33±0.2 ng/dl). This difference is statistically significant (p= 0.03). At 12 th week analysis, mean free T4 level of bedtime group (1.65±0.04 ng/dl) is higher than morning group (1.31±0.06 ng/dl). This difference is statistically significant (p<0.00001). A 12weeks, the difference in mean serum cholesterol of morning group (152.79±4.59 mg/dl) and bedtime group (143.58±3.059 mg/dl) is statistically significant (p=0.001). At 6 and12 weeks, other parameters like serum triglycerides, HDL cholesterol, renal parameters, anthropometry, vital parameters of morning group and bedtime group did not show any statistical significant difference.Conclusions: There is a significant improvement in free T4 level when levothyroxine was taken at bedtime. The efficacy of bedtime regimen of levothyroxine is quite comparable to the efficacy of morning regimen. There is considerable decrease in serum cholesterol level when levothyroxine was taken at bedtime. Bedtime regimen may result in good compliance in school going children. Parents should be allowed to choose either morning or bedtime regimen depending on their convenience.