Objective The objectives of this study were to determine the prevalence of insulin resistance (IR), dyslipidemia and metabolic syndrome (MS) in children with asthma, aged 10 to 15 years and to determine if these metabolic abnormalities showed an association with asthma symptom control and lung function. Methods We conducted a cross-sectional study at a tertiary centre in north India. Consecutive children with physician diagnosed asthma were enrolled. Asthma symptom control over previous four weeks was assessed as per GINA recommendations. Fasting plasma glucose, serum insulin and lipid levels were estimated. HOMA-IR was used as a marker of IR. Spirometry was performed for assessing lung function. Results Eighty-three children were enrolled. Median (IQR) age was 12.0 (11.0, 13.5) years and mean (SD) BMI z score was -0.42 (1.0). Median (IQR) Homeostasis Model Assessment- Insulin Resistance (HOMA-IR) was 1.65 (1.06, 2.39). Prevalence of IR was 42.3% (95% CI: 31.7-52.9%). Number of children with elevated triglycerides, total cholesterol, and LDL-cholesterol was 4 (4.8%), 4 (4.8%) and 5 (6%), respectively. 67 (80.7%) children had low HDL-cholesterol. Only one subject was found to have MS. Presence of IR and elevation in serum insulin and triglycerides were associated with poorer asthma control, independent of BMI. None of the metabolic parameters were associated with lung function, after adjusting for height. Conclusions A high proportion of children with asthma aged 10-15 years had IR but not MS currently. Increasing serum insulin, triglycerides, and presence of IR were associated with poorer asthma control, after adjusting for BMI.

There is no confirmatory diagnostic test for pulmonary hydatid cyst other than surgical excision and histopathologic confirmation. Imaging is at best suggestive and serology does not have a satisfactory sensitivity. We present a series of children wherein flexible fibreoptic bronchoscopy under conscious-sedation, revealed hydatid membranes in airways. Broncho-alveolar lavage analysis confirmed hydatid in half of them. We propose flexible fibreoptic bronchoscopy with broncho-alveolar lavage as a confirmatory diagnostic test for pulmonary hydatid in children. To the best of our knowledge, this is a completely novel approach to the condition with potential to alter the diagnostic paradigm.

Antiglomerular basement membrane disease is a small vessel vasculitis which affects the lungs and kidneys, causing diffuse alveolar haemorrhage and rapidly progressive glomerulonephritis respectively. It is extremely uncommon in children. Diagnosis requires the presence of specific anti-GBM autoantibodies. Presentation with renal involvement is much more common than pulmonary involvement. However, a small proportion of cases might have isolated pulmonary involvement. Minimal changes on renal biopsy could still be present in these patients. Treatment of antiglomerular basement membrane disease includes plasmapheresis and immunosuppression. We present a case where a 7 year old boy presented with a long history suggestive of pulmonary haemorrhage but no renal manifestations and was diagnosed on the basis of anti-GBM autoantibodies and renal biopsy. He responded well to immunosuppressive therapy alone.