Cerebral palsy; cross sectional survey

Cerebral Palsy is a disorder of movement and postural balance due to insult to the brain. The injury to the developing brain may be prenatal, natal or postnatal. The diagnosis is clinical mainly. The spastic Cerebral Palsy is classified into monoplegic, hemiplegic, diplegic, and quadriplegic types. There is a difference in the frequency of these types of Cerebral Palsy in different studies. The patterns of various forms of Cerebral Palsy emerge gradually with a delay in developmental milestones. A spectrum of associated developmental disabilities has been found to be common in these children. Management is through a multi-disciplinary approach. To find out the frequency of different types of Cerebral Palsy and degree of associated developmental delay. A cross sectional study was carried out for a period of six months [October 1, 2006 to March 31, 2007] at The Children's Hospital and Institute of Child Health Lahore. 100 Cases diagnosed as Cerebral Palsy on clinical basis were assessed for the type of cerebral palsy and the degree of associated developmental delay. Out of the total 100 patients 54% had quadriplegia, 32% had diplegia, 10% had himiplegia and 4% had monoplegia. The total fifty-four cases of quadriplegic cerebral palsy 54 had developmental delay and amongst them 4 [7%] had mild delay, 16 [30%] had moderate delay while 34 [63%] had severe delay. Amongst the total forty-six other three types of cerebral palsy 12 [26%] had mild delay, 6 [13%] had moderate delay and 28 [61%] had severe delay. The P-value was >0.05. Quadriplegic is the commonest type of CP, associated with the factors [peri-natal more than socio-demographic] and had significant effect on the developmental parameters

Efficacy of steroids, Cyclosporin and cyclophos-phamide in steroid resistant idiopathic nephrotic syndrome

To determine the efficacy of three different treatment protocols in steroid resistant idiopathic nephrotic syndrome, [SRINS]. Interventional study. Department of Nephrology at The Children's Hospital, Lahore, over a period of 3 years from January 2000 to December 2002. Nephrotic children who did not respond to four weeks of steroid therapy [60mg/M2] followed by three pulses of methyl prednisolone [1Gm/1.73M2] over a period of one week were labeled as steroid resistant. Those with histopathological lesions of minimal change disease [MCD], focal segmental glomerulosclerosis [FSGS] and Mes. PGN were divided into 3 groups. Group-I was treated with cyclophosphamide [CPM] and oral steroids, group-II with cyclosporine and oral steroids and group-III with pulse methyl prednisolone [MPP] and oral steroid + CPM. The response to treatment and course of disease were observed in each group. Twenty patients with mean age of 4.4 years were enrolled. On the whole 10 [50%] had complete remission. In group-I, 5 [50%], in group-II, 3 [75%] and in group-III, 2 [33.3%] had complete remission. Depending upon histological lesion 100% [n=2] with MCD, 50% [n=6] with Mes. PGN and 25% [n=1] with FSGS achieved complete remission. Cyclosporine and CPM induced remission in 100% of patients with MCD, while in Mes.PGN response rate in group-I, II, and III was 100% [n=1], 50% [n=1], and 44.4% [n=4] respectively. In patients with FSGS, MPP was the only drug used with limited response of 25% [n=1]. Cyclosporine proved to be a better option for MCD and Mes. PGN, while MPP showed limited response in patients with FSGS