clinical profile of infections in childhood primary nephrotic syndrome

To study the clinical profile of infections in a primary nephritic syndrome. We conducted a retrospective analysis of infections in 98 consecutive children [males 65, females 33] with primary nephrotic syndrome, who satisfied the International Study of Kidney Disease in Children criteria. Their mean age at onset of symptoms was 55 +/- 3.4 months [range: 6 months to 17 years]. The mean duration of follow-up was 38 +/- 3.4 months [range: 12 to 60 months]. A total of 379 episodes of infection were observed in 87 of the 98 children. There was no relationship between age, sex, and severity or frequency of infections. The most common infections were upper respiratory tract infection [30.64%], gastroenteritis [11.08%], urinary tract infection [9.50%], and peritonitis [5.54%]. Other infections included multiple warts, polyoma virus nephropathy, and pneumococcal appendicitis, which were not previously reported. Nephrotic children may get a variety of bacterial and viral infections

Chronic intussusception in children

Chronic intussusception in three children is reported. Review of the literature is given as well as a discussion of the variation in the course of intussusception. Its symptomatology, modes of presentation, and methods of diagnosis are reviewed. The clinical significance of interserosal adhesions has been evaluated and shown to be of no etiologic importance. These adhesions are the result of chronicity and recurrence ultimately leading to resection rather than reduction of the chronic intussusception. Based on the duration of symptoms, intussusception is classified into three variants: 1. Acute intussusception with its triad of abdominal pain, vomiting, and bloody mucous discharge per rectum. 2. Subacute intussusception in which the symptoms continue from four days to as long as two weeks prior to therapy[13]. Chronic intussusception which continues for more than 14 days prior to therapy[1,2].This classification is totally dependent on the duration of symptoms which should not be the only criterion to determine the ultimate outcome of the individual patient[3] In acute intussusception, the clinical picture is so typical that its diagnosis may frequently be made over the telephone[4]. In contrast, the clinical picture in subacute and chronic intussusception is vague and poorly recognized. This atypical vague clinical picture, together with the chronicity of the symptoms are responsible for delay in the diagnosis in the majority of cases[5]. Interserosal adhesions have been observed by many authors, but their clinical significance has yet to be verified. In this paper, we report three cases in which interserosal adhesions have prevented operative reduction of the intussusception and hence primary resection was the only choice

Pneumococcal septicemia and meningitis in an Arab boy with sickle cell disease

A two and a half year old Arab boy was admitted to hospital with overwhelming pneumococcal meningitis and septicemia which led to his death. Following the patient's death it became clear that he suffered from sickle cell disease. The relationship of pneumococcal sepsis to sickle cell disease and hyposplenism is discussed, and available methods of preventing such septic episodes are presented. The relationship of splenectomy to overwhelming septicemia especially with encapsulated organisms such as pneumococcus, Neisseria meningitidis, and Hemophilus influenzae has been amply reported and confirmed[1]. In sickle cell disease autosplenectomy occurs early in life and these patients have been shown to be more susceptible to these infections than other individuals. Immunization of these children with pneumococcal vaccine and the administration of penicillin is currently recommended[1]. For this prophylaxis to be of help, however, the patient's condition must be diagnosed early since the risk of infection is greatest between the ages of six months and five years[2]. Among Jordanian children anemia is relatively common, the etiology of which is primarily nutritional. Hemoglobinopathies due to sickle cell anemia and thalassemia do occur though their actual incidence is unknown. In this brief report on an Arab boy who was admitted to the Jordan University Hospital with pneumococcal meningitis, the diagnosis of sickle cell disease was confirmed after this overwhelming infection led to his death. The implication of the case and the subject of postsplenectomy septicemia will be discussed