Behavior problems in nephrotic syndrome.

OBJECTIVES: To evaluate the adaptive competences and behavioral problems in children with nephrotic syndrome, and whether their mothers also showed features of psychosocial stress. DESIGN: Prospective case-control study. SETTING: Pediatric Out-Patient Department. SUBJECTS: Seventy consecutive patients of nephrotic syndrome, between the ages of 4 to 14 years, and their mothers constituted cases. The control group, matched for age, sex and socioeconomic status comprised of 46 children and their mothers. The mother's description of the child's behavior, on the Child Behavior Checklist (CBCL), was obtained to assess behavioral problems and social competences. The level of anxiety in the mother was assessed using the PGI Health Questionnaire N2. RESULTS: Children with nephrotic syndrome showed features of depressed, hyperactive or aggressive behavior. Somatic complaints, social withdrawal and poor school performance were also observed. These problems did not interfere with compliance to treatment and only 7 patients required psychological interventions. Boys with nephrotic syndrome had more hyperactive and aggressive behavior as compared to girls. The scores on the CBCL were well correlated with the anxiety scores of the mother. CONCLUSIONS: These observations suggest the presence of minor behavior problems in a significant proportion of children with nephrotic syndrome. The severity of these problems may be related to the attitude of the mother towards the child's illness.

Antibiotic associated colitis.

It is a prospective study based on 100 consecutive cases of diarrhea following antibiotic therapy admitted to the pediatric services of J.N. Medical College, A.M.U., Aligarh between January to December 1987. They had C. penicillin (50), chloramphenicol (34), ampicillin (34), gentamicin (34), cephalosporin (4) and cotrimoxazole (4) for 3 days to 3 weeks prior to the onset of diarrhea. Apart from routine and special investigations, naked eye and microscopic examination of stool, its culture for pathogens including Cl. difficile were carried out in all cases. Presence of Cl. difficile cytotoxin was demonstrated by observing the cytopathic. Effect on veru cell culture, 18 grew Cl. difficile (14 cyto toxin positive). Frequency of fever, vomiting, abdominal distension, dehydration and duration of diarrhea was not different (p > 0.05) in the two groups. Purge rate and presence of mucus and blood in Cl. difficile positive patients was significantly higher (p < 0.05). Eight Cl. difficile positive (7 cytotoxin+ve) were subjected to endoscopy. Three of them showed P.M. colitis and 2 non specific colitis. Chloromycetin, gentamicin and penicillin were the main culprits responsible for AAC. None of the patients given ampicillin alone suffered from AAC. The mortality was 5%.

Errors in medication in a pediatric ward.

Iatrogenic errors in medication were studied in a busy pediatric ward. The study was based on voluntary reporting of errors noticed by the doctors and nurses in the ward. The error rate was 6.4%. Prescription errors accounted for 37.7% of the errors and 2 of these were potentially fatal. Dispensing errors and missed dosages were other frequent errors. Overcrowding in pediatric wards is an obstacle to optimum patient care. Adequate number of nurses and support of pharmacists is essential for safe and optimum drug therapy.

Circulating immune complexes in tuberculosis--an indicator of activity.

Circulating immune complexes (CIC) were assayed in 100 cases of tuberculosis and 30 age matched control children. The estimation was done by PEG assay before the commencement of antitubercular therapy. CIC were present in only 3.3% of the control children as compared to 68% of children with tuberculosis. The presence of CIC was observed to vary with the type of tuberculosis. The percentage positivity was highest (100%) in children with miliary tuberculosis. Subsequent estimation of CIC done after one and three months of antitubercular therapy showed a marked decrease in the percentage of positive cases (6.1 and zero percent respectively).

Prognostic value of 'C' reactive protein in tuberculosis.

'C' reactive protein (CRP) levels were determined in 100 cases of tuberculosis and 30 age and sex matched children. Serial estimations, one and 3 to 6 months after initiation of therapy was done in 81 and 41 of these patients, respectively. Mean initial levels of CRP in tuberculosis group was 18.52 micrograms/ml while in the control group it was 2.77 micrograms/ml (p less than 0.001). The elevated CRP levels fell significantly to 5.93 micrograms/ml after one month of treatment (p less than 0.001) and by 3 to 6 months of treatment had fallen to normal values. The fall in CRP levels correlated with clinical response. It is concluded that CRP can serve as a sensitive indicator of activity of the disease and the return to normal values of initially elevated CRP levels may indicate a good therapeutic response.