Lupus nephritis in children

To determine the clinicopathological pattern of lupus nephritis in paediatric nephrology patients. Case series study. The department of paediatric nephrology at the Children's Hospital and Institute of Child Health, Lahore, Pakistan, over a period of five years from January 2001 to December 2005. Twenty six patients upto the age 16 years of either gender, with a mean age of 12.4 _ 1.90 years having primary SLE with renal involvement in the form of oedema, hypertension, haematuria and proteinuria were included. Twenty one were females. Percutaneous renal biopsy was performed. Histological lesion was classified according to WHO classification. Patients were treated with immunosuppressive therapy and their clinical course was followed for at least one year. The mean duration of follow up was 1.77 years. Renal involvement was seen in 92.30% within 2 years of the onset of primary disease. Diffuse proliferative glomerulonephritis was the commonest histological lesion [n=14] followed by membranous nephropathy [n=6]. The commonest clinical manifestation was oedema [80.76%] followed by hypertension [46.15%]. Proteinuria was present in 100% of cases, haematuria in 38.46% and azotemia in 19.33% of patients. Nephrotic range proteinuria was more common in class III and IV, while azotemia was observed only in class IV. The disease was well controlled in 73.07%, relapse was seen in 3.8% of patients, 15.38% died of infections and uremic encephalopathy while 7.69% were lost to follow-up. Diffuse proliferative glomerulonephritis is the commonest histological lesion in our set-up. Renal involvement is mostly seen within first two years of the primary disease which can be controlled satisfactorily with immunosuppressive therapy

Diagnostic role of EEG in children having unprovoked seizures, experience at the neurophysiology department, The children's hospital, Lahore

Although advances in imaging technology offer ever-increasing diagnostic accuracy, the electroencephalogram [EEG] retains its importance and is the cornerstone for the diagnosis and treatment of epilepsy. A cross-sectional descriptive study was conducted at Neurophysiology Department of The Children's Hospital, Lahore. Our aims were to find out the different types of epilepsies diagnosed on EEG in children referred for interictal EEG with recent clinical diagnosis of epilepsy. Out of 645 children referred for EEG after seizures, 415 [64%] were males and 230 [36%] were females, 21% had their first seizure before one year of age, 54% of them were between the ages of 1-5 years and 46% of them were more than 5 years of age. We found normal interictal EEGs in 54% whereas 46% children had abnormal EEGs. So in addition to supporting the diagnosis of epilepsy, EEG has significant potential to classify epileptic seizures

Early predictors of intractable epilepsy in children: a case control study

Case control, Hospital based. Site: Epilepsy Centre, The Children's Hospital, Lahore-Pakistan. From 1st Sept 05 to 30th Nov 06 Knowing the prognosis of epilepsy in children would undoubtly influence the treatment strategy. All the children, age 1 year to 16 years receiving anti-epileptic drugs for their idiopathic or cryptogenic epilepsy were the study population. After six months of commencement of treatment various factors associated with well control the ["controls"] and intractability the ["cases"] were analyzed and a univariate comparison was done between various factors for these two groups. Over a period of 14 months, 520 children, 33% the "control" and 67% the "cases" among these patients were enrolled for this study. Statistically, male gender history of birth asphyxia, initial seizure type, past head trauma, previous CNS infection and family history of epilepsy are not the risk factors, whereas seizures starting in infancy, seizures episodes >10 before commencing treatment, neonatal seizures and neurological deficit present at presentation were the risk factors for intractable epilepsy. Myoclonic seizures, status epilepticus before starting treatment and infantile spasm were seen in the "case" group only. We conclude children having risk factors for intractable epilepsy have poor prognosis and recommend that such children should be referred to epilepsy centre as soon as possible

Histiocytosis in children: Five years experience at a tertiary care hospital

Histocytosis is a diverse group of illness of monocyte- macrophage cell lineage. Diagnostic criteria and management protocols are not precisely defined due to cases. Study was conducted to review the clinical features at admission and outcome of histiocytosis following chemotherapy [DALHAX 83 protocol was used]. It was a retrospective study, carried out from March 2000 to February 2005, at department of hematology- oncology, The Children's Hospital and the Institute of Child Health, Lahore. From 01-03-2000 to 28-02-2005, total 36 cases with histocytosis disorders were admitted. It comprises 2% of total admissions, class 1 langerhan cell disease was the most common [24/36], followed by class II [8/36] and class III [4/36] cases among this group of illness. Fever and hepatosplenomegaly was present in all classes. Soft tissue swelling, jaundice and lymphadneopathy were also seen in class I, II and III histiocytosis respectively. Nineteen patients died/ left treatment and absconded with incomplete treatment. Seventeen patients responded to chemotherapy again. Histiocytosis class I is a chemosensitive disease. If the functional deterioration of the involved organ has not set in, class I disease has good prognosis