[Evaluation of the therapeutic efficacy of dexamethasone in meningococcal meningitis] / Avaliação da eficácia terapêutica da dexametasona na meningite meningocócica.

OBJECTIVE: To evaluate the efficacy of dexamethasone as an auxiliary therapeutic tool to the antibiotics in hospitalized children with meningococcal meningitis. METHODS: A retrospective clinical comparative study was undertaken with children from a pediatric ward affected by laboratory proved meningococcal meningitis at a university hospital. Cases of children in state of shock at admission or deceased in the first 24 hours were excluded. During the period from 1987 to 1989 33 children were treated only with antibiotics (group A), while from 1990 to 1993 other 66 children received additionally dexamethasone (12mg/m2/24h) by intravenous route during four days beginning at the admission to the hospital (group B). The two groups were evaluated at baseline through prognostic scores and analysis of their clinical and laboratorial characteristics obtained from data recorded at the admission. The parameters to evaluate dexamethasone efficacy were the comparative number of neurologic and systemic complications detected at the hospital, and the liquoric profile (leukocyte count, glucose and protein content) verified between day 9 and day 11 of hospitalization. RESULTS: The profile of the two groups (A and B) were homogeneously evaluated by the illness severity scores and their clinical and laboratorial characteristics. Nine complications were recognized in group A (27.2%) and 21 (31.8%) among those of group B, difference not significant. Likewise, there were not observed liquoric differences between the two groups related to the chimiocytologic pattern. CONCLUSIONS: No effect of dexamethasone therapy to prevent neurologic and systemic meningococcal meningitis complications was observed during hospitalization. Similarly no favorable effect in relation to the liquoric pattern verified between day 9 and day 11 of hospitalization was recognized.

[Idiopathic primary pulmonary hemosiderosis: treatment with cyclophosphamide and prednisone]. / Hemossiderose pulonmar idiopática tratada com ciclofosfamida e prednisona.

The authors present the case of a child diagnosed as having idiopathic pulmonary hemosiderosis at five years of age who had a good clinical outcome at the age of ten years. Initially the patient was treated with prednisone and chloroquine with poor results. When cyclophosphamide was added to prednisone, the patient demonstrated clinical and radiological remission. To date, the patient has been followed for one year without any medication, and has had only one limited episode of hemosiderosis. The authors also suggest that the therapeutic regimen with cyclophosphamide and prednisone may be useful for some selected cases.

[Evaluation of the establishment of a clinical pediatrics program for the students of 6th year of medicine at the University Hospital of the Universidade de São Paulo]. / Avaliação da implantação do programa de pediatria clínica para os alunos do sexto ano de medicina no Hospital Universitário da Universidade de São Paulo.

The authors present an educational investigation performed with students of the 6th year of the University of São Paulo Medical School. The results of the diagnostic evaluation employed with the fifth grade students in 1984 defining the target-population of the future course; the results of the questionnaire used with the assistants of, the teaching body of the course. The formulation of the terminal objectives of the course and the results of its operation during 1985, are presented. To proceed to the analysis of the results, tests on the program syllabus were applied at the beginning and end of the training period, which are compared in the global sense and according to subjects of the program. A statistical analysis was carried out, by non-parametric tests of Wilcoxon and Mann-Whitney to check the significance of the percentual yield (difference in performance before and after the training period). The result was that at the end of the course most of the students had achieved a satisfactory degree of improvement (higher than 75%). However, the percentual yield was contrariwise proportional to the performance of the students in the pre-evaluation, showing a homogenization of the students at the end of the training period. Among the subjects evaluated, the hydroelectrolytic balance was the one to present a smaller percentual profit for most of the students, without the occurrence of a significative variation of the performance, when compared before and after the course. No difference either was noticed among the groups of students stratified by area of option for medical residence.

[A serological inquiry for the detection of antibodies against human immunodeficiency virus (HIV) in children in a general ward]. / Inquérito sorológico para a detecção de anticorpos contra o vírus da imunodeficiência humana (VIH) em crianças internadas em enfermaria geral.

The results of a serum inquiry for detection of antibodies against the Human Immuno-deficiency Virus in a non selected group of children, patients of a general pediatric ward, are reported. Of the 441 cases, the ELISA test gave a positive result for 1.1% of them. This result was confirmed by the Western-Blot or ImmunoBlot test. None of the five children who tested positive had a previous history of blood transfusion. These children's mothers showed positive results to the ELISA test. Of four cases, at least one of the parents was IV drug addicted. In every case the transmission was vertical. On the basis of these findings, it is suggested that hospital staff should take the necessary precautions when manipulating blood and secretions and it is recommended that serum inquiries be made on the wards of general hospitals in the attempt to establish reliable data on the prevalence of HIV.