ABSTRACT
OBJECTIVE: To determine the efficacy and safety of oral desmopressin (DDAVP) treatment in Asian children with nocturnal enuresis. METHODOLOGY: This was a multicentre randomized placebo-controlled double-blind cross-over study. Patients were randomized to either active treatment with oral 400 mg DDAVP or placebo, with a 2-week medication-free period between the cross-over. Children with primary monosymptomatic nocturnal enuresis, aged between 7 and 18 years, with a minimum frequency of wetting of 6 nights or more during a 2-week observation period were recruited. Efficacy was measured by reduction in the average number of wet nights per week. RESULTS: Of the 37 children initially recruited, the outcomes for 34 children were included in the final cross-over analysis, as they had complete data for both the treatment periods. Statistical analysis by ANOVA showed that there was no significant difference between the medication-free period and the pretreatment period. However, the average number of wet nights per week for the DDAVP treatment period (2.5+/-2.7) was significantly lower than that of the placebo treatment period (4.5+/-2.1) (P < 0.0001). In terms of the safety profile, there was no significant change in bodyweight, blood pressure, serum sodium, serum osmolality, and urine osmolality following DDAVP treatment. CONCLUSION: Oral DDAVP is a safe and efficacious drug for the short-term treatment of children with primary nocturnal enuresis.
Subject(s)
Deamino Arginine Vasopressin/therapeutic use , Enuresis/drug therapy , Renal Agents/therapeutic use , Administration, Oral , Adolescent , Analysis of Variance , Asia , Child , Cross-Over Studies , Deamino Arginine Vasopressin/administration & dosage , Double-Blind Method , Female , Humans , Male , Renal Agents/administration & dosageABSTRACT
Primary monosymptomatic nocturnal enuresis (PMNE) is often not openly discussed in Asian societies. We report the parental view of PMNE in Singapore, its impact on patients and their families and the traditional beliefs and its influence on subsequent management. A screening questionnaire was used in evaluating 30 children enrolled in a clinical trial on the use of oral Desmopressin for the treatment of PMNE. Primary monosymptomatic nocturnal enuresis was familial in 56.7% of patients. Fifty per cent of them were previously unevaluated. Earlier remedial attempts included bedtime fluid restriction and voiding (100%), incentive measures (43.3%), traditional practices (26.7%), punishment (20%), drugs (16.7%), psychotherapy (100%) and bladder training (3.3%). Perceived causes of PMNE were maturational delay (50%), deep sleep (50%), familial (43.3%), behavioural problems (43.3%) and excessive fluid intake (26.7%). Reasons for seeking treatment included restricted outdoor activities (90%), parental fatigue (86.7%), disrupted sleep for the household (46.7%) and fear of underlying pathology (26.7%). Perceived adverse effects on patients included social stigma (83.3%), disrupted sleep (33.3%) and impaired school performance (13.3%). Primary monosymptomatic nocturnal enuresis can thus be a chronic distressing problem in Asian communities.
Subject(s)
Attitude to Health , Enuresis/psychology , Parents/psychology , Adolescent , Asia/ethnology , Child , Chronic Disease , Deamino Arginine Vasopressin/therapeutic use , Enuresis/drug therapy , Enuresis/ethnology , Enuresis/etiology , Female , Humans , Male , Renal Agents/therapeutic use , Singapore , Surveys and QuestionnairesABSTRACT
Spinal involvement in alkaptonuria is common. Patients usually present in the third or fourth decade with spondylosis or acute intervertebral disc prolapse. Alkaptonuria with root canal stenosis has however hitherto not been reported. We wish to report one such patient.
Subject(s)
Alkaptonuria/diagnostic imaging , Nerve Compression Syndromes/diagnostic imaging , Ochronosis/diagnostic imaging , Spinal Nerve Roots , Adult , Alkaptonuria/surgery , Diagnosis, Differential , Humans , Laminectomy , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Male , Nerve Compression Syndromes/surgery , Ochronosis/surgery , RadiographyABSTRACT
71 febrile neonates admitted to the Paediatric and Neonatal Department in 1988 and 1989 were studied. Septic work ups were done for 84% of patients & 80% had lumbar puncture. These infants were subdivided into 5 groups in order to identify the significance of the various stages of septic work up. It was found that 48% of patients with significant infections were only diagnosed after some stage of septic work up. 14% had meningitis and diagnosed only after CSF examination. Only in 13% of patients the diagnosis could be made confidently without a septic work up confirming that the diagnosis of infection in the neonate is difficult and often missed without a septic work up. Clinical impression by paediatricians reduced the number of patients requiring unnecessary investigations and receiving empiric therapy. We recommend maintaining our present cautious policy of admitting neonates with pyrexia.
