Asunto(s)
Adulto , Niño , Cuidados Críticos , Urgencias Médicas , Femenino , Fluidoterapia , Humanos , India , Lactante , Recién Nacido , Lesión Renal Aguda/etiología , Masculino , Embarazo , Terapia de Reemplazo Renal , Clima TropicalRESUMEN
A total of 106 renal biopsies were examined. Each biopsy was processed for routine paraffin sectioning and frozen sectioning. Direct immunofluorescence was done by the conventional method. The immunofluorescence patterns were correlated with histopathological changes and clinical presentation. Fourteen biopsies revealed weak to strong IgA staining and out of these, 11 seemed to fulfil the criteria of primary IgA nephropathy. These cases were diagnosed in a brief period of eleven months and there had not been any earlier published series from India.
Asunto(s)
Adolescente , Adulto , Biopsia , Niño , Femenino , Técnica del Anticuerpo Fluorescente Directa , Glomerulonefritis por IGA/diagnóstico , Humanos , MasculinoRESUMEN
This prospective study evaluated the frequency, clinical characteristics and causes of hyponatremia (serum sodium < 130 mEq/L) in 727 children upto 12 years of age, who were brought for emergency care, and needed hospitalization. Hyponatremia was found in 29.8% and was more frequent in summer (36%; 123/341) than in winter (24%; 94/386) (p < 0.001). Acute lower respiratory infections (pneumonia) and acute diarrhea each accounted for 20% cases of hyponatremia; others were accounted for by meningitis/encephalitis (12%) septicemia (8%), and renal, heart and liver diseases (6-7% each). Clinical evaluation and concurrent plasma and urinary osmolality and urine sodium suggested that hyponatremia associated with pneumonia, meningitis/encephalitis, septicemia, seizures and miscellaneous diseases was of hypotonic-euvolemic (dilutional) type in more than 80% patients while in all children with acute diarrhea it was of hypovolemic type. The study has shown that hyponatremia occurs frequently in sick children requiring emergency care, especially in summer months, and should receive appropriate attention in the management plan.
Asunto(s)
Niño , Preescolar , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Hospitales Pediátricos , Humanos , Hiponatremia/sangre , India/epidemiología , Masculino , Estudios Prospectivos , Estaciones del Año , Factores SexualesRESUMEN
To study the association between hyponatremia (serum sodium < or = 130 mEq/L) and the final outcome of the illness, we correlated serum sodium concentration at the time of hospitalization with the length of hospital stay and mortality in a prospective study of 727 sick children aged upto 12 years, who sought emergency care. The mean +/- SE duration of hospital stay (7.7 +/- 0.4 days) among 217 children with serum sodium < or = 130 mEq/L was about 30% longer than that of 510 children with serum sodium > or = 131 mEq/L (5.9 +/- 0.3 days) (p < 0.01). This remained unaffected by the sex and the age group, but was further prolonged in children with hypotonic--euvolemic type of hyponatremia as compared to those with hypovolemic hyponatremia. The mortality rate in 510 children with normal serum sodium concentration (> or = 131 mEq/L) was 5.3%. In contrast, it was 17% in 47 children with serum sodium < 125 mEq/L (Relative Risk 3.2; 95% Confidence Interval 1.6-6.7) and 9.3% in 170 children with serum sodium between 126-130 mEq/L (Relative Risk--1.8; 95% Confidence Interval 1.1-3.7) (p < 0.01). Hyponatremia in acutely ill children at admission indicates a poor prognosis.
Asunto(s)
Niño , Preescolar , Países en Desarrollo , Femenino , Humanos , Hiponatremia/etiología , India/epidemiología , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Riesgo , Sodio/sangre , Tasa de SupervivenciaAsunto(s)
Adulto , Femenino , Humanos , Masculino , Linaje , Uréter/cirugía , Vejiga Urinaria/cirugía , Reflujo Vesicoureteral/genéticaRESUMEN
A case of invasive pulmonary aspergillosis and nocardiosis following high dose prolonged steroid therapy given for suspected rapidly progressive glomerulonephritis is reported. A favourable response was achieved with a combination of amphotericin B and cotrimoxazole. A high index of suspicion and aggressive investigations are necessary for confirmation of diagnosis and early institution of appropriate therapy.
Asunto(s)
Anfotericina B/uso terapéutico , Aspergilosis Broncopulmonar Alérgica/complicaciones , Glomerulonefritis/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Masculino , Metilprednisolona/efectos adversos , Persona de Mediana Edad , Nocardiosis/complicaciones , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
The incidence and significance of class specific antinuclear antibodies (ANA), specially with relevance to clinical manifestations of arthritis, renal disease and serositis was studied in 40 patients of systemic lupus erythematosus by the indirect immunofluorescent method. Clinical activity was scored by Morimoto's scoring system. A significant correlation was obtained between IgD ANA and clinical activity of the disease and IgG ANA exhibiting lupus pattern of immunofluorescence and serositis.
Asunto(s)
Anticuerpos Antinucleares/análisis , Especificidad de Anticuerpos , Técnica del Anticuerpo Fluorescente , Humanos , Inmunoglobulina D/análisis , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Lupus Eritematoso Sistémico/diagnóstico , Nefritis Lúpica/inmunologíaRESUMEN
Wegener's granulomatosis is being recognised with increasing frequency in India. Our 18, histologically confirmed, patients had a clinical profile similar to that described from developed countries. Delayed diagnosis led to the death of nine patients, usually within days of hospital admission, due to extensive vasculitis and renal failure. Tuberculosis was the most frequently considered diagnosis and 12 patients had been treated for it in spite of progressive clinical deterioration. Those who could be adequately treated with low dose daily cyclophosphamide and corticosteroids did well. Six of seven such patients are alive and well 1-8 years later. We believe that if prompt lung biopsy and ANCA determination are resorted to in patients with "resistant tuberculosis", it will greatly expedite case detection, diagnosis and optimum treatment of this remediable disease.
Asunto(s)
Adolescente , Adulto , Anciano , Niño , Ciclofosfamida/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Estudios Retrospectivos , Tuberculosis Pulmonar/diagnóstico , Granulomatosis con Poliangitis/diagnósticoRESUMEN
We report a renal allograft recipient who developed disseminated cryptococcosis, which was treated effectively, with oral fluconazole, a new triazole antifungal agent. The patient is doing well on maintenance therapy with fluconazole and immunosuppressive agents.
Asunto(s)
Administración Oral , Adulto , Cryptococcus neoformans/efectos de los fármacos , Fluconazol/administración & dosificación , Humanos , Trasplante de Riñón , Masculino , Meningitis Criptocócica/tratamiento farmacológico , Infecciones Oportunistas/tratamiento farmacológicoRESUMEN
Acute renal failure developed in a young female having puerperal sepsis due to beta-haemolytic streptococci. The patient succumbed to her illness and an autopsy revealed extensive crescentic glomerulonephritis. The association between chronic visceral sepsis and glomerulonephritis is discussed.
Asunto(s)
Adolescente , Femenino , Glomerulonefritis/complicaciones , Humanos , Lesión Renal Aguda/etiología , Embarazo , Infección Puerperal/complicaciones , Infecciones Estreptocócicas/complicacionesRESUMEN
Spontaneous rupture of the oesophagus presenting as a pyopneumothorax in an elderly male is described. Delayed presentation of the patient led to serious complications to which he succumbed.