Clinical profile and outcome of children with scrub typhus from Chennai, South India.

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. We prospectively studied the clinico-laboratory profile and outcome of 358 children aged 1 day to 18 years diagnosed with scrub typhus from Chennai, South India. All children (100%) had fever. Eschar was seen in 67%. All children were treated with oral doxycycline and those with complications were treated with intravenous chloramphenicol/azithromycin. Rapid defervescence (within 48 h) after initiation of doxycline was seen in 306 (85%) and 52 (14.5%) developed complications. Multivariate logistic regression analysis revealed that children who had an elevated aspartate amino transferase (> 120 IU/L) and the presence of thrombocytopenia (platelet count less than 1 lac cells/mm3) at admission had high risk of developing complications. The overall mortality rate in this series was 0.8%. CONCLUSION: Our 4-year study highlights the clinico-laboratory profile of Scrub typhus in children from Chennai, South India. Early recognition and prompt treatment reduces the complication and mortality. What is Known: • Scrub typhus is endemic to tsutsugamushi triangle, a geographical triangle extending from northern Japan in the east to Pakistan and Afghanistan in the west and northern Australia in the south. • There is paucity of data regarding its clinico-laboratory profile in neonates as well as its predictors of outcome. What is New: • Children who had an elevated AST and the presence of thrombocytopenia at admission had high risk of developing complications.

Attention-deficit/Hyperactivity Disorder in Children: Clinical Profile and Co-morbidity.

BACKGROUND: To study the clinical profile and co-morbidity in Indian children with attention-deficit/hyperactivity disorder (ADHD). MATERIALS AND METHODS: A prospective analytical study of 2 years duration at the Child Guidance Clinic of a pediatric tertiary care hospital in a south Indian city using Diagnostic and statistical manual of Mental Disorders-1V based questionnaires. RESULTS: Of the 251 referrals, 51 (20.3%) children met the inclusion criteria for the diagnosis of ADHD. M:F ratio was 6.3:1. The mean age was 5.7 years. A majority of the children belonged to middle and lower socio-economic class and were first-born children. Most children were brought up in nuclear families. History of delayed speech and language development was commonly seen in these children. Combined type of ADHD was the most common type. At least one co-morbid diagnosis was seen in 86.3% of children, and learning disability was the most common co-morbid diagnosis. The mean IQ was 90 (SD±12). CONCLUSION: Early markers of cognitive dysfunction like delayed speech, language and social and adaptive development may be a pointer towards the diagnosis of ADHD in children. Knowledge about their sociodemographic profile and other co-morbid conditions that are associated with ADHD is necessary to fully understand the magnitude of the problem and to plan effective therapy for them.

Evaluation of chronic abdominal pain--a test of "patience".

A 4 year old girl with chronic abdominal pain of 6 months duration was provisionally diagnosed as eosinophilic gastroenteritis based on endoscopic biopsy This case is reported for its rarity.

Facially disfigured children--dedicated approach and rehabilitation.

Facial disfigurement following congenital anomalies or acquired defects due to accidents or scars results in mental trauma and other related consequences. A multidisciplinary team approach with special importance to rehabilitation is required in handling such patients.

Paediatric rehabilitation in a developing country--India in relation to aetiology, consequences and outcome in a group of 459 burnt children.

Age, aetiology of burn, percentage body surface area burnt and post-burn sequelae have a direct relationship to the rehabilitative necessity in burnt children in a developing country--India. In spite of the gross disfigurements and sequelae, only adolescent children required psychosocial rehabilitation. These are the results following a retrospective analysis of 459 paediatric burn patients in Madras, India.

Joint acceleration during gait in relation to age.

Forty-four male and female subjects with no history of falling and whose ages ranged from 10 to 68 years participated in a series of experiments to assess movement at the joints during gait while walking in a straight line, in pivot turns and in turns of 0.33 and 0.66 m diameter. Acceleration at the joints in the forward and side-to-side direction was measured by dual-axis accelerometers placed at the ankles, knees, hips, shoulders, and on the head. Eye movement was assessed from electrodes placed on the sides of the eyes. The results of the experiments showed that for people whose age was above 40 years, significant increases in the forward-back and side-to-side movements occurred at all joints and progressively increased with age. By age 60, adverse movement of the joints as much as quadrupled in many subjects when compared to people whose age was 20-30 years. The increase in joint acceleration occurred equally in the front-back and side-to-side planes. The mechanism of the increased joint movement may be due to tendon laxness, peripheral neuropathy or loss of central control of gait due to age. Accelerometry may be a much more sensitive technique to analyze abnormalities in gait than standard video or observational gait analysis. Results are given as mean (SD) unless otherwise stated.

Pattern of interleukins in minimal-change nephrotic syndrome of childhood.

Assays of interleukin-1 (IL-1) and IL-2 were done in supernatants from phytohaemagglutinin-activated lymphocyte cultures from 10 children suffering from minimal-change nephrotic syndrome (MCNS) to assess their role in the aetiopathogenesis of this disorder. Increased levels of IL-1 and IL-2 had been found in supernatants from patients having MCNS compared with controls, suggesting a significant role of these cytokines in the immunopathogenesis of proteinuria in this syndrome.

Immune status of children suffering from minimal change nephrotic syndrome.

Twenty five children suffering from minimal change nephrotic syndrome were studied for immunological alterations at different stages of this disease i.e., onset, relapse and remission. Changes were found mainly at onset and during relapse in the form of altered helper and suppressor cell ratio, depressed delayed cutaneous hypersensitivity reaction, decreased S-IgG bearing lymphocytes with low serum IgG concentration, and increased S-IgM bearing lymphocytes with high serum IgM concentration. Majority of these parameters returned to normal values during remission. Serum IgE was found high at all stages of this. These alterations suggest defects in cell mediated immunity resulting in secretion of some substance which modifies the glomerular anionic charges.

Low serum immunoglobulin G--a predictor of frequent relapses in idiopathic nephrotic syndrome.

Serum immunoglobulins were measured in 25 children at the onset of nephrotic syndrome, in 20 during remission and in 19 during relapse. On follow up, 10 of them were frequent relapsers (FR). As compared to children who were infrequent relapsers (IFR), frequent relapsers had significantly lower levels of IgG at onset (p less than 0.001) which persisted during remission. IgG in FR at onset and at remission were 27.2 and 42.5% of normal mean as compared to 70.0 and 74.4% of normal mean observed at onset and remission, respectively in IFR. Very low levels of IgG may help predict onset of a tendency towards frequent relapses in children with minimal change nephrotic syndrome.

Pure mesangial proliferative glomerulonephritis. A clinicomorphologic analysis and its possible role in morphologic transition of minimal change lesion.

Renal biopsies from 45 children with idiopathic nephrotic syndrome were analysed. A clinicopathologic correlation has been attempted in 19 children with mesangioproliferative glomerulonephritis. Mesangial hypercellularity is found to have a direct correlation with the clinical presentation, response to therapy and final outcome. The presence of diffuse mesangial IgM or IgM with C3 is of no significance and lacks specificity.