Beneficial effects of cyclophosphamide on the relapse rate, duration of remission and the clinical state of the disease in patients with frequently relapsing nephrotic syndrome.

Objective To find out the beneficial effects of oral cyclophosphamide in patients with frequently relapsing nephrotic syndrome. Design Prospective study Setting: University paediatric unit, Galle Method Patients presenting with frequently relapsing, steroid sensitive nephrotic syndrome were included. Patients were given an 8 week course of oral cyclophosphamide (2.5mg/kg/day). Number of relapses before and after cyclophosphamide therapy, duration of remission and state of the disease were recorded. Results There were 17 patients included in the study (male 10, female 07). Mean age of onset of the disease was 35.2 months (SD± 4.3). Mean relapse rate before cyclophosphamide therapy was 4.5 per year (SD±1.2). Mean relapse rate after cyclophosphamide therapy was 1.1 per year (SD± 0.9). This decrease in relapse rate was statistically highly significant

Mycoplasma pneumoniae: An unrecognized cause of pyrexia of unknown origin.

Objective To find out the incidence of Mycoplasma pneumoniae infection in patients with pyrexia of unknown origin. Design Prospective study. Setting University Paediatric Unit, Teaching Hospital, Karapitiya. Method Patients presenting with fever of more than 7 days with no obvious reason for its occurrence (PUO) to University Paediatric Unit, Teaching Hospital, Karapitiya from January to November 2003, were included. Patients with features of lower or upper respiratory tract infections, urinary tract infections, hepatitis, meningitis, myositis and arthritis were excluded. Routine tests for continuous fever viz. full blood count, test for malaria parasites, ESR, urine full report, urine culture, blood picture, SAT, chest x-ray, Paul-Bunnel test, hepatic transaminases and blood cultures were done in all patients. Mycoplasma antibody titre was done in each patient using the particle agglutination test. Results There were 40 patients. Age distribution was 2-12 years. 10 patients had mycoplasma pneumoniae infection, mycoplasma antibody titres ranging from 640-20,480. Conclusion 10 out of 40 (25%) children with PUO were due to mycoplasma pneumoniae infection.

Mycoplasma pneumoniae infections in children presenting with central nervous system manifestations.

Objectives To study the incidence of Mycoplasma pneumoniae infection among children presenting with central nervous system (CNS) manifestations. Design Prospective study. Setting University Paediatric Unit, Teaching Hospital, Karapitiya. Method Children above 1 year of age, presenting with features of CNS infection, from January to December 2001, were included. Serum samples were tested for Mycoplasma pneumoniae infection by using particle agglutination test in addition to the usual laboratory tests. The conventional management protocols for CNS infections were carried out. Anti mycoplasma therapy was started once the dignosis of Mycoplasma pneumoniae infection was established. Results Mycoplasma pneumoniae infection was established in 8 of 35 children presenting with CNS manifestations. Their age range was 2-12 years. Five had meningoencephalitis and 3 had encephalitis. Mycoplasma antibody titres ranged from 160 to 5,120. Conclusions Mycoplasma pneumoniae is an important association in children with meningoencephalitis or encephalitis.

Serum creatine kinase activity in untreated primary hypothyroid children.

Objectives To determine association between primary hypothyroidism and serum creatine kinase (CK) activity in children. Design and Setting Prospective study of patients seen at university paediatric unit, Galle for a period of 4 years starting from January 1998. Method Primary hypothyroidism was confirmed by presence of elevated serum thyroid stimulating hormone and low thyroxine for age. All newly diagnosed patients with primary hypothyroidism were tested for serum CK activity. Levels were compared with serum CK activity in normal euthyroid children. Serum CK levels were repeated 6 weeks after starting thyroxine therapy. Results 19 children presented with primary hypothyroidism during study period. All had elevated serum CK levels. 2 patients showed clinical evidence of muscular hypertrophy. There were 7 neonates with congenital hypothyroidism. Conclusions: Elevated levels of CK activity were seen in all children with untreated primary hypothyroidism in this series. CK activity became normal 4-6 weeks after starting therapy. Hence elevated serum CK could be used as an indicator for diagnosis of untreated hypothyroidism or to assess adequacy of therapy in primary hypothyroidism.

Acalypha indica induced haemolysis in G6PD deficiency.

Four patients who developed acute intravascular haemolysis after ingestion of a broth containing Acalypha indica (Sinhala: Kuppameniya) are reported. All four patients were found to have glucose-6-phosphate dehydrogenase deficiency. It is a common belief that ayurvedic medicines are free of side effects. Our report confirms again the fallacy of this belief.

An outbreak of measles in the Southern Province.

During an outbreak of measles in the Southern Province in 1990, 69 patients were admitted to the Professorial Paediatric Unit of Teaching Hospital Galle. Of these, 13 patients had received the measles vaccination. The commonest complication seen was bronchopneumonia. There were 3 deaths, 2 due to bronchopneumonia and 1 to encephalitis.

Long term survival in subacute sclerosing panencephalitis.

A case of subacute sclerosing panencephalitis (SSPE) with a long survival of 8 years is reported. Long term survival in SSPE has not been previously reported from Sri Lanka.

Wilms tumour associated with unilateral dysplasia of the iris.

We report a case of Wilms tumour associated with unilateral partial aniridia. Although Wilms tumour is known to be associated with bilateral aniridia, there is only one previously reported case associated with dysplasia of the iris.

Changing antibiotic sensitivity patterns in shigellosis.

Over five and a half months stool cultures were performed in 154 patients admitted with suspected bacillary dysentery to the Professorial Paediatric Unit of the Teaching Hospital, Galle. Thirty one patients had a positive stool culture; Shigella dysenteriae type 1 was isolated in 23 patients, and S flexneri in 8. In both groups the antibiotic sensitivity pattern was uniform, the only difference being S dysenteriae type 1 being resistant to nalidixic acid while S flexneri was sensitive. This antibiotic sensitivity pattern was different to that reported from Colombo during the same period. Complications were observed in some patients with S flexneri infection.

Acute liver failure in a patient with hepatitis A infection on sodium valproate therapy.

An epileptic patient on sodium valproate therapy, who developed acute liver failure following acute hepatitis A infection is reported. The hepatotoxic effects of this drug, and the possibility of intercurrent infection precipitating the toxic effects are discussed.