Urodynamic study of children with voiding problems.

Twenty high risk children aged 5-12 years with various voiding problems were studied prospectively by urodynamics to evaluate the function of their urinary bladder and its continence mechanism. None of them had neuropathic bladder or any obstruction distal to bladder neck. Fourteen out of twenty (70%) had abnormal findings on urodynamics evaluation; 8 (40%) had non-neurogenic neurogenic bladder (NNNB); 3 (15%) had small capacity hypertonic bladder (SCHB); 2 (10%) had atonic bladder (AB) and 1 (5%) had hyperreflexic bladder (HB). We conclude that urodynamic abnormalities are as frequent in high risk Indian children as they are in developed countries. The high risk children should be subjected to urodynamic studies more frequently than being done hitherto and be directed to proper therapeutic modality.

Simple predictors to differentiate acute asthma from ARI in children: implications for refining case management in the ARI Control Programme.

There is a considerable overlap in the clinical presentation of acute asthma and ARI. According to the current ARI Control Programme recommendations, a child with cough and rapid breathing is overtreated for ARI (pneumonia) with antibiotics and undertreated for asthma with bronchodilators. The present study, therefore, evaluated simple predictors to differentiate these two conditions to refine the recommended case management. In a case control comparison, children between 6 to 60 months age who presented with cough and rapid breathing due to acute asthma (n = 100) and ARI (n = 100) were evaluated. Only 34% of asthmatics had an audible wheeze. Significant independent predictors on multiple logistic regression analysis were number of earlier similar attacks and fever (or temperature). The best predictor for asthma was two or more earlier similar episodes (sensitivity 84%, specificity 84%) followed by temperature < 37.6 degrees C (sensitivity 73% and specificity 84%). Absence of fever, audible wheeze and a family history of asthma had excellent specificities (98-100%) but low sensitivities (20-34%). It is concluded that simple clinical predictors can differentiate acute asthma and ARI. The recommended case management can, therefore, be refined by either: (i) Prescribing bronchodilators and no antibiotics with two or more earlier similar episodes of cough and rapid breathing; or (ii) To further minimize undertreatment for pneumonia, prescribing bronchodilators as above, but denying antibiotics in such cases only if there is audible wheeze or family history of asthma or no fever.

Desferrioxamine induced urinary iron excretion in thalassemia.

Twenty one children of beta thalassemia major aged between 2 and 14 years of age on regular blood transfusion were given subcutaneous desferrioxamine. Their serum ferritin, 24 hours baseline urinary iron excretion and subcutaneous desferrioxamine induced urinary iron excretion were measured. The result showed a close correlation between serum ferritin and amount of blood transfusions received by the patient. There was good correlation between serum ferritin and desferrioxamine induced urinary iron excretion. A negative iron balance could be achieved in 15 out of 21 children with one dose of desferrioxamine therapy.

Serum enzyme abnormalities in protein energy malnutrition.

Six serum enzymes, alkaline phosphatase, cholinesterase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transpeptidase were studied in 30 cases of protein energy malnutrition (PEM). The mean serum values of alkaline phosphatase, cholinesterase and lactate dehydrogenase in cases of PEM were significantly lower than the controls, lowering being maximum in PEM Grade IV. The mean serum values of aspartate aminotransferase and alanine aminotransferase in patients with PEM were significantly higher than the controls. The mean serum values of gamma-glutamyl transpeptidase showed similar significant rise in all but PEM Grade IV. The degree of increase in the serum values of these three enzymes were maximum in cases with PEM Grade I. These findings suggest that abnormalities in blood levels of these enzymes occur in any form of PEM and these are related to the severity of the disease.

Commercial oral rehydration solutions--pitfalls, knowledge, attitude and practices.

Locally available commercial preparations of oral rehydration solutions (ORS) were analyzed for their composition, package instructions and availability. A survey from 50 chemist stores, revealed that ORS packets available belonged to 28 different pharmaceutical companies. None of the shops stored more than five different brands and alternate preparations were handed over the counter freely. Only 48% of the available ORS formulations had the WHO recommended composition. In about one-fourth preparations, the sodium concentration was 30 mEq or less per litre. Forty-one per cent solutions had glucose concentrations more than 2%. The glucose and sodium ration of 1:1 was maintained in only 48% of the formulae. Bicarbonate and citrate both were used with almost equal frequency in these preparations. Cost, flavor, additional ingredients and package instructions varied widely in different packets. ORS formulations most commonly found in the drug stores had low sodium and high glucose concentration. The attitude of doctors and nurses of Pediatric Department and Chemists towards commercial ORS was also studied. While 92% doctors were aware about WHO-ORS, none of the chemists and only 4% nurses had this awareness. All the respondents could remember only up to 3 or 4 brand names and except 30% doctors, none were aware about the composition of those brands of ORS. Regarding importance of composition, preparations and precautions, practically nobody was up to the mark, but doctors were definitely better as compared to nurses and chemists.