Ultrastructural defects of the ciliary epithelium in a child with Kartagener's syndrome.

Kartagener's syndrome is a well known classical triad of presentations consisting of bronchiectasis, sinusitis and situs inversus. It is now recognized that the syndrome is an extreme presentation of primary ciliary dyskinesia, a large group of conditions with ultrastructural ciliary defects, leading to poor ciliary motility in various organ systems. A case of Kartagener's syndrome is presented in an eight year old Thai boy in whom the ultrastructural ciliary defects have been examined and described in detail for the first time in Thailand. Incomplete lack of dynein arms was recognized. In addition, disorientation of ciliary axis was noticed. Due to severe bronchiectatic changes of the right lower lobe and right lingular lobe which did not improve despite adequate antibiotics, these lobes were surgically removed. The child has done well since, but still suffers occasional and recurrent bouts of sinusitis.

The detection of antigen and antibody in cerebrospinal fluid of patients with tuberculous meningitis.

The ultimate diagnosis of tuberculous meningitis can be convincingly made through a positive culture of Mycobacterium tuberculosis from the cerebrospinal fluid (CSF). However, this process requires at least 6-8 weeks. Early diagnosis, preferably at time of presentation, is preferable to avoid the unfavorable sequelae. The detection of tuberculous antigen in the CSF of children with tuberculous meningitis was carried out by an ELISA technique. Anti-PPD in the CSF was detected by latex agglutination or measured by ELISA. CSF anti-PPD was not able to be detected by latex agglutination but was demonstrated by ELISA (titre > 1: 5). The sensitivity of test was 50 percent, with specificity of 94.7 percent and accuracy of 77.4 percent. Tuberculous antigen in the CSF, however, could not be detected by an ELISA technique used in this study (< 0.1 mcg/ml). We concluded that anti-PPD antibody by ELISA could be demonstrated in these children with tuberculous meningitis and this test could potentially be utilized in a clinical situation to aid in the rapid diagnosis of tuberculous meningitis patients.

Breast feeding: The survey in paediatric out-patients.

Two thousand and seventeen guestionnaires were collected from 4 regional university hospitals in Bangkok (Siriraj), Chiengmai, Khon Kaen and Songkhla during November-December 1987. No difference was found in the proportion of the babies who were breast fed (at least for 1 month after birth) and those who were bottle fed among these hospitals. Although almost 80 percent of those babies were breast fed, the figure was lower than that in the community survey, 94 percent in 1984.

Height and weight of Thai children: high socioeconomic group of the some selected urban population.

A total of 4,371 high socioeconomic children, 2,220 boys and 2,151 girls, from Bangkok Metropolis, from 1985 to 1986 was studied. The height and weight were computed according to sex and age, height and weight for age, and weight for height were calculated in different percentiles (P5, P25, P50, P75 and P95). It was found that height and weight for age of a selected population of children are generally higher, they are taller and heavier than the children of previous studies. At 18 years of age, the average boy is 171 cm and 58 kg, while the average girls is 157.5 cm and 47 kg. The growth rate of Thai adults should be better with socioeconomic improvement in the standards of living in the future. Weight for height is not different from the previous studies, this is a more reliable and better parameter to evaluate the growth of children.

The expenditure on health care of pediatric patients at the pediatric out-patient department, Siriraj Hospital.

The expenditure on health care of pediatric patients was carried out at the Pediatric Out-Patient Department, Siriraj Hospital during September and October 1987. A total of 1,082 pediatric cases comprising of infants aged less than 5 (75%) and 6 to 12 years (25%) were studied. The most common illness 60.7%) was respiratory infections. The percentage incidence of the infection, gastrointestinal, dermatologic and allergic disorders was 12.5, 7.7, 7.2 and 6.7 respectively. 95.1 percent of all patients visited the hospital because of these five major illnesses. The average transportation expenditure of patients within the Bangkok Metropolis and out of Bangkok Metropolis was 13.4 and 43 bath per case. 3% went to the public health centers or government hospital, with an average expenditure of 19 baht per case. 97.8% of the patients paid for medications alone with an average expense of 31.7 baht per case, only 2.2 percent of the patients had to pay for laboratory tests. The average expenditure, of patients with dermatological problem paid the highest, 50 baht per case, for the medications, while those with the respiratory infections paid 29 baht per case. All the pediatric patients residing in the Bangkok Metropolis have to pay an average of 45 baht per case for transportation and medications.

Intestinal parasites in pediatric patients with diarrhoeal diseases in Bangkok.

Stool examinations of 147 pediatric patients with diarrhoeal disease were carried out at Siriraj Hospital, Bangkok by using the direct-smear technique. Stool of 27 patients (18.4%) were positive for intestinal parasites. Children under one year of age were free of intestinal helminths and protozoa. Parasites were equally prevalent in males and females and without any age group predilection. The prevalence of intestinal parasites were Entamoeba histolytica 6.8%, Giardia lamblia 6.1%, others were Ascaris lumbricoides, hookworm, Trichuris trichiura and Balantidium coli. Although the incidence of parasitism was not high as to be the main causatic agent of pediatric diarrhoea, the intestinal parasites may increase susceptibility to infection with other intestinal pathogens. The diagnosis of intestinal parasitoses can be determined by a simple direct faecal-smear technique and so that specific therapy can be instituted without delay in management of parasite-related diarrhoeas.

Disappearance of measles antibody in Thai infants after birth.

A seroepidemiology of measles hemagglutination inhibition antibody was studied in infants at birth to 8 months of age. It was found that at birth the antibody was greater than 1:8 in 56 of 64 newborns. At 2 and 4 months of age, 9 of 21 and 12 of 21 respectively had measles antibody titer less than 1:8, while at 8 months of age, only 1 of 6 had the antibody titer greater than 1:8. It shows that the maternal measles antibody can protect the infant at young age and the decrease in antibodies occur as the child grows. The measles vaccine should be given when the maternal passive immunity of measles disappears. This study indicates that the optimal age to recommend measles vaccination should be at the age of 9 months.

Cerebrospinal fluid lactate level in childhood purulent meningitis.

Cerebrospinal fluid lactate was determined in 54 pediatric patients by means of enzymatic method of Marbach and Weil. The mean value of cerebrospinal fluid lactate in 13 purulent meningitis patients was 80.4 mg/dl, in 9 clinical purulent meningitis patients was 72.7 mg/dl, in 18 non-purulent meningitis patients and 14 controls were 17.0 and 11.8 mg/dl respectively. The present study demonstrated that a cerebrospinal fluid lactate level of 35 mg/dl may be used as a cut off point to differentiate bacterial from non-bacterial infection of the central nervous system. It should served as a supplementary aid to clinical examinations and conventional methods to diagnose bacterial meningitis.

Electrolytes, sugar, calories, osmolarity and pH of beverages and coconut water.

Oral rehydration has been recommended in patients with diarrhoea to replace fluid loss from the gastrointestinal tract and reduce the need for intravenous therapy. Beverages (i.e. Cola, Sprite etc.) and coconut water may be used as sources of oral fluid when glucose-electrolyte solution is not available. To evaluate the usefulness and effectiveness of these soft drinks, the basic data such as electrolytes, sugar, calories, osmolarity and pH were determined. The electrolytes of the beverages were significantly lower (p less than 0.001) than the coconut water, especially potassium. The osmolarity of the beverages, which were 693 mOsm/l, was significantly higher (p less than 0.001) than the coconut water (288 mOsm/l); pH of the beverages (3.1) was more acidic (p less than 0.001) than the coconut water (5.4). While the sugar content of the beverages, which were 8.7 gm/dl, was significantly higher (p less than 0.001) than the coconut water (1.1 gm/dl). On comparison, all brands of beverages would give more calories than the coconut water however the coconut water would be absorbed more easily than any brand of soft drink beverage.

Papulonecrotic tuberculid in childhood.

A case of papulonecrotic tuberculids of anterior abdominal wall with active tuberculous cervical lymph gland in a 12-year-old girl was demonstrated. This case illustrated the fact that although the papulonecrotic tuberculid is a rare entity, physicians should be aware of its existance to be considered in the differential diagnosis of dermatological lesions. Lesions, which appear in crops resembling chickenpox, with a longer duration and a strongly positive tuberculin test should lead to the diagnosis of papulonecrotic tuberculid. The investigations should include biopsy and demonstration of an active tuberculous foci. The lesions will regress if the patient receive antituberculosis therapy. Misdiagnosis and postponement of treatment with specific drugs may give rise to unsatisfactory consequences.