An open comparative study of dispersible piroxicam versus soluble acetylsalicylic acid for the treatment of osteoarticular painful attack during sickle cell crisis.

We compared the efficacy and tolerability of oral piroxicam 1 mg/kg/day with soluble aspirin given at 100 mg/kg/day taken four-hourly in 58 patients with sickle cell anaemia and severe ostcoarticular painful attacks requiring hospitalization in a randomized, paralleled study. Main investigational criteria were pain relief, limitation of movement, fever, and insomnia or agitation. Both groups were well-matched at the commencement of therapy but most patients on piroxicam showed remarkable and significant pain relief and improvement in other parameters within 24 h. Unwanted effects were absent in the piroxicam-treated group whereas those treated with aspirin experienced nausea and vomiting. There were no significant changes in liver function tests with both forms of treatment. Oral piroxicam is an effective and safe treatment in the management of the osteoarticular painful crisis in sickle cell anaemia. It might prevent the use of parenteral analgesics and hospitalization and reduce the loss of school hours in patients who are being treated for bone pain crises that characterize sickle cell anaemia.

Renal disorders in children: a Nigerian study.

A 5-year prospective study of 699 children with various renal disorders from around the Rivers State, which is in the eastern part of Nigeria, was carried out to investigate the prevalence and significance of renal disorders in a third world country with no facilities for paediatric dialysis and transplantation. Renal disorders accounted for 1.1% of the total outpatients and hospital admissions. The commonest renal disorders were urinary tract infection (UTI, 68.9%); nephrotic syndrome (NS 14.6%) and acute post streptococcal glomerulonephritis (11.4%). Patients with UTI had no vesico-ureteric reflux (VUR); 22.5% of NS patients were steroid sensitive. Wilms' tumour (1.6%) was the second commonest childhood malignant tumour; 8 of 17 cases of obstructive uropathy were secondary to meatal stenosis following circumcision. Fifteen children developed end-stage renal failure (ESRF), mainly due to chronic glomerulonephritis, giving a prevalence rate of 7.5 children per year per million childhood population. Hence, renal disorders are common in Nigeria and although VUR is rare, ESRF may approximate figures seen in the western world. This highlights the need to improve the country's socioeconomic conditions, make medical facilities more available to children and prevent renal diseases that may lead to ESRF.