Annals of Tropical Paediatrics最新文献

{"title":"Haemophagocytic lymphohistiocytosis: a case series from Mumbai.","authors":"R Joshi,&nbsp;A Phatarpekar,&nbsp;Z Currimbhoy,&nbsp;M Desai","doi":"10.1179/1465328111Y.0000000009","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000009","url":null,"abstract":"<p><p>A retrospective review of ten patients (8 girls, 2 boys) admitted over a 9-month period with haemophagocytic lymphohistiocytosis (HLH) is presented. Presenting features included fever and hepatosplenomegaly (10), bleeding manifestations (7), lymphadenopathy (4), skin rash (4), shock (4), jaundice (3), CNS disorder (3), renal failure (2) and arthritis (2). Three infants had familial HLH (FHL) while the other seven patients had acquired (secondary) HLH. Two patients with FHL had very low perforin levels (0 and 0.05%). There was secondary HLH owing to systemic onset juvenile idiopathic arthritis in two patients, and one each had anaplastic large cell lymphoma, measles with pneumonia, disseminated tuberculosis, dengue hemorrhagic fever and lymphoproliferative disorder. Cytopenia affecting two or three lineages in peripheral blood was present in all while haemophagocytosis in bone marrow was documented in nine patients .Other important laboratory parameters were raised ferritin (9), raised LDH (9), hypertriglyceridaemia (7) and hypofibrinogenaemia (5). The patients were treated according to the HLH2004 protocol. Diagnosis of HLH should be considered early in patients presenting with unremitting fever, hepatosplenomegaly and cytopenias as without appropriate treatment HLH is usually fatal.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 2","pages":"135-40"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29885574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda.","authors":"A Bagenda,&nbsp;L Barlow-Mosha,&nbsp;D Bagenda,&nbsp;R Sakwa,&nbsp;M G Fowler,&nbsp;P M Musoke","doi":"10.1179/1465328111Y.0000000025","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000025","url":null,"abstract":"<p><strong>Background: </strong>Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric anti-retroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy.</p><p><strong>Aim: </strong>To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations.</p><p><strong>Methods: </strong>HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University-Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ≥95% of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA(®) version 10.0.</p><p><strong>Results: </strong>A total of 129 HIV-infected children were initiated on HAART with 14.7% on syrups and 85.3% on tablet formulations at enrollment. According to caregiver self-reporting, 99.2%, 100%, 100% and 99.2% achieved ≥95% adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89.9%, 95.4%, 93.8% and 93.0% and for unannounced home visits were 89.8%, 92.4%, 88.9% and 86.2%, respectively. Median adherence to syrup formulations (97%, IQR 93-98) was significantly lower than for tablets (100%, IQR 97-100, p = 0.012, n = 28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data.</p><p><strong>Conclusion: </strong>The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 3","pages":"235-45"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30025422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranial nerve palsies in typhoid fever: report of three cases.","authors":"N Joshi,&nbsp;M Bhattacharya,&nbsp;S Yadav,&nbsp;D Rustogi","doi":"10.1179/1465328111Y.0000000023","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000023","url":null,"abstract":"<p><p>Neurological manifestations of enteric fever are well known. However, isolated cranial nerve palsies are rare. A 4-year-old boy and two girls aged 5 and 11 years with culture-proven typhoid fever are described, two of whom developed palatal palsy and the other sixth cranial nerve palsy. Following treatment, there was complete resolution of the cranial nerve palsies within 5-7 weeks. While palatal palsy is reported rarely, isolated sixth cranial nerve palsy associated with typhoid has not been reported previously.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 3","pages":"255-8"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30025425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal bronchiolitis obliterans complicating Stevens-Johnson syndrome following treatment with nimesulide: a case report.","authors":"S Dogra,&nbsp;D Suri,&nbsp;A G Saini,&nbsp;A Rawat,&nbsp;K S Sodhi","doi":"10.1179/1465328111Y.0000000019","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000019","url":null,"abstract":"<p><p>Nimesulide is a frequently used non-steroidal anti-inflammatory drug with analgesic and antipyretic effects in children. In view of fatal adverse drug reactions, however, its safety has been questioned. A 5-year-old boy developed Stevens-Johnson syndrome following use of nimesulide which was later complicated by rapidly progressive fatal bronchiolitis obliterans.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 3","pages":"259-61"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30025426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute disseminated encephalomyelitis (ADEM) after pertussis infection.","authors":"B Budan,&nbsp;B Ekici,&nbsp;B Tatli,&nbsp;A Somer","doi":"10.1179/1465328111Y.0000000028","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000028","url":null,"abstract":"<p><p>Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder of the central nervous system which is usually precipitated by a viral infection or vaccination. A 3-month-old boy is reported who developed ADEM a week after full recovery from pertussis. MRI detected a high-intensity lesion extending from the pons to the mesencephalon, compatible with ADEM. Following the administration of intravenous immunoglobulins, the patient's clinical symptoms improved. This case report demonstrates that pertussis is capable of inducing an immune-mediated demyelinating disorder of the central nervous system.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 3","pages":"269-72"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30025428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal tuberculosis.","authors":"J B S Coulter","doi":"10.1179/146532811X12925735813760","DOIUrl":"https://doi.org/10.1179/146532811X12925735813760","url":null,"abstract":"In this issue there are two case studies on perinatal tuberculosis (TB) comprising six infants. The paper by Parakh et al. describes the value of fibre-optic bronchoscopy in two infants for the diagnosis of Mycobacterium tuberculosis infection by detection of acid-fast bacilli (AFB) in the broncho-alveolar lavage (BAL) and subsequent positive culture. Only local anaesthetic was used. The authors also emphasise the difficulty in developing countries of diagnosing congenital TB using Cantwell et al.’s criteria because of limited diagnostic technology. The paper by Basu et al. demonstrates the effect of immunosuppression (corticosteroids and HIV infection) on the development of perinatal TB. The same authors recently reported Cushing syndrome in two infants associated with inappropriate use of corticosteroids by parents owing to lack of education. The paper demonstrates the value of PCR both in serum and CSF for diagnosis of TB in infants. Both reports emphasise the value of routine CSF examination in infants suspected of perinatal TB and, where indicated, endometrial biopsy in the mother. They also point out that in developing countries many infants may die from perinatal TB without the diagnosis having been made and thus the condition is underreported.","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 1","pages":"11-3"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/146532811X12925735813760","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29621469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal Bartter syndrome: a rare cause of unexplained severe polyhydramnios.","authors":"Y R Bhat,&nbsp;G Vinayaka,&nbsp;R Vani,&nbsp;K A Prashanth,&nbsp;K Sreelakshmi","doi":"10.1179/1465328111Y.0000000006","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000006","url":null,"abstract":"<p><p>A woman presented with polyhydramnios at 22 weeks of gestation with a structurally normal fetus and placenta. Biochemical analysis of amniotic fluid detected a very high level of chloride (582 mmol/L), which led to the diagnosis of Bartter syndrome. With serial amniocentesis and indomethacin therapy, the pregnancy continued to 36 weeks. Neonatal and subsequent investigations further supported the diagnosis of Bartter syndrome. The infant was well at birth and now, at 5 months of age, is gaining weight normally on indomethacin.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 2","pages":"153-7"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29885577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent bilateral orbital myositis: case report and review of the literature.","authors":"R Abd-Rashid,&nbsp;A Hussein,&nbsp;R Yunus,&nbsp;V-R Naik,&nbsp;I Shatriah","doi":"10.1179/1465328111Y.0000000004","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000004","url":null,"abstract":"<p><p>Orbital myositis in children is uncommon. Recurrence is a major challenge in management. An 11-year-old Malay girl who presented with bilateral orbital myositis with recurrent attacks of diplopia is reported.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 2","pages":"173-80"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29885581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic diaphragmatic hernia masquerading as left-sided hydropneumothorax: a case report.","authors":"O I Oyinloye,&nbsp;M A N Adeboye,&nbsp;A A Abdulkarim,&nbsp;L O Abdur-Rahman,&nbsp;O A M Adesiyun","doi":"10.1179/146532810X12637745452077","DOIUrl":"https://doi.org/10.1179/146532810X12637745452077","url":null,"abstract":"<p><p>Traumatic diaphragmatic rupture (TDR) is rare in children and can be easily overlooked because of lack of awareness of late presentation and concomitant injuries. A 4-year-old girl presented with respiratory distress 2 months after a road traffic accident. The initial differential diagnosis was pneumonia or pulmonary tuberculosis with associated pleural effusion. On further assessment, a diaphragmatic hernia was suspected. The initial radiograph showed left hydropneumothorax. Fluoroscopy, follow-up chest radiographs and barium swallow confirmed the diagnosis of left TDR. Surgery was undertaken but unfortunately she did not survive. Awareness of delayed presentation of TDR is essential for prompt management.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"30 1","pages":"57-60"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/146532810X12637745452077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28749794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probiotics for acute diarrhoea?","authors":"S J Allen","doi":"10.1179/146532810X12858955921078","DOIUrl":"https://doi.org/10.1179/146532810X12858955921078","url":null,"abstract":"As 2015 approaches, tracking progress towards Millennium Development Goal 4 has sparked renewed interest in diarrhoea. It is estimated that there are 2.5 billion cases of diarrhoea annually in children under 5 years of age. Despite the long-established effectiveness of oral rehydration fluid (ORF), diarrhoea remains the third leading cause of under-5 mortality after neonatal death and pneumonia. Diarrhoea causes 15% of under-5 deaths globally, rising to 18% in low-income countries. Over half of diarrhoea cases and 80% of deaths occur in Africa and South Asia. Zinc supplementation during diarrhoea significantly reduces the severity and duration of the illness. Anti-diarrhoeal agents such as loperamide and codeine are contraindicated because of the risk of life-threatening ileus. Might probiotics also be a useful adjuvant therapy? A widely adopted definition of probiotic organisms is ‘live micro-organisms which, when administered in adequate amounts, confer health benefits on the host’. Organisms selected as potential probiotics are usually those isolated from the commensal gut flora of healthy individuals. They must also withstand manufacturing processes and passage through the upper gut to remain viable in the small and large intestine. Most organisms are lactic acidproducing bacteria (for example, strains of Lactobacillus) or Bifidobacterium species. However, organisms which are not normal human commensals are also included, such as the yeast Saccharomyces. The main rationale for using probiotics in diarrhoea is that they strengthen the commensal gut flora and thereby promote colonisation resistance. Here, ‘healthy’ organisms secrete a variety of anti-microbial products and compete with pathogens for available nutrients and binding sites. Probiotics may have additional anti-diarrhoeal effects by acidifying the gut contents, increasing specific and non-specific immune responses and enhancing the integrity of the gut mucosal barrier. Several systematic reviews of probiotics in children with acute diarrhoea have reported beneficial effects. Szajewska et al. reported that the proportion of children with diarrhoea lasting 3 or more days was reduced by 60% in the probiotic compared with the placebo group [95% confidence interval (CI) 43–72%; 8 trials/731 children] and probiotics reduced the duration of diarrhoea by 18.2 hours (95% CI 9.5–26.9 hrs; 8 trials/773 children). In a meta-analysis of adequately randomised and blinded trials of lactobacilli, Van Niel et al. reported that probiotics reduced the duration of diarrhoea (0.7 days, 95% CI 0.3–1.2; 7 trials/675 children) and the average number of bowel evacuations on day 2 (1.6, 95% CI 0.7–2.6 fewer evacuations; 3 trials/122 children). To better inform clinical practice, some reviews have pooled data from trials of specific probiotic organisms. Szajewska et al. analysed trials of Lactobacillus casei strain GG which achieved good follow-up. Lactobacillus GG reduced the duration of diarrhoea by 1.1 day","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"30 4","pages":"283-6"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/146532810X12858955921078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29502787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}