Clinico-pathological study on the nephrotic syndrome in Jamaican children

A review of eleven years of hospital admission for childhood nephrotic syndrome is presented. Forty-two children were studied between January 1971 and December 1981. There were no significant sex differences, but 28 of the 42 children (67 percent) were 6 years of age or less, with a peak age incidence in the 2-3 years group. Children aged 6 years or under were significantly associated with responsiveness to corticosteroids, while more none-responders were over 6 years of age (P<0.0001). Seventy-five per cent of those treated with a 2-month course of corticosteroids responded within one month of treatment. Five children had a spontaneous remission of symptoms, at least 3 of whom may have had a resolving post-streptococcal glomerulonephritis (PSGN). Selective renal biopsies were performed in 24/42 (57 percent). Of these 24, minimal change disease (MCD) was present in 6, mesangial proliferative glomerulonephritis (MPGN) in 6, focal glomerulosclerosis (FGS) in 4, diffuse proliferative glomerulonephritis (DPGN) in 3 and one each of focal proliferation, membranous glomerulopathy and mesangio-capillary glomerulonephritis MCGN). As expected, biopsied children had more relapses and were more often treated with cytotoxic drugs (AU)

Severe acute rheumatic fever: recent trends in the severity of the disease - abstract

Acute rheumatic fever remains a common disease in Jamaica. Between August, 1973 and July, 1978, there was only one death recorded among children under 12 years admitted to the University Hospital of the West Indies with this disease. There were 38 - 48 annual admissions for the disease during this period. Between August, 1978 and July 1979, there were 26 admissions for rheumatic fever. Five of these children presented with an unusually severe form of acute rheumatic fever which led to a fatal outcome in four cases. Only one of these children had previous admissions for the disease and he had received no penicillin prophylaxis for the preceding four months. The only surviving child developed frank pulmonary oedema within a few hours of admission and required ventilation for 5 days. Post-mortem findings in 4 cases showed rheumatic pancarditis, oedema and congestion of the lung and congestion of the liver. Decline in the incidence and severity of acute rheumatic fever has been reported from several centres since the 1920s. These recent cases of severe acute rheumatic fever may represent an incidental clustering of cases or may indicate that the severity of the disease is increasing in this population (AU)

Oral rehydration using high and low sodium and potassium solutions in dehydrated Jamaican children with diarrhoea - abstract

The indications and pathophysiological principles underlying the use of glucose electrolyte solutions for treating diarrhoea with dehydration are well understood. The exact composition for the Caribbean is disputed, because the WHO recommended solution which contains 90mmols/L of sodium was developed for cholera and may produce hypernatremia. To establish the value of this solution in Jamaican children, we studied 84 cases of diarrhoea in children aged 5 to 18 months attending Bustamante Children's Hospital, Kingston. The children were assessed clinically and body weight, blood samples, urine and stool samples were studied at 0, 6 and 24 hours. Treatment was with oral rehydration solution given at a rate of 200 mls per hour. Cases were divided at random into two groups, one given a solution containing 90 mmols Na, the other, 60 mmols of Na. In both groups, clinical and biochemical indices improved rapidly, weight increased, serum specific gravity fell and bicarbonates rose. In the high sodium group, 5 cases developed hypernatremia at 6 hours and persistence of hyponatremia was seen in a few cases in the low sodium group. In a second study, 25 children were given standard GE solution, but the potassium was increased from 20 to 35 mmols/1 and the cases divided randomly into high and normal potassium groups. The GEsol was given as 2 volumes of solution to 1 of water. In this study the high potassium group showed no cases of hypokalemia whereas 19 - 33 percent of the low potassium group had this problem at 24 hours. It was concluded that the standard oral rehydration fluid containing 90 mmols/1 of sodium, given as 2 volumes of water to 1 of water is safe and effective in the cases seen in Jamaica and that a higher potassium concentration of 35mmols/1 would be more effective in correcting hypokalaemia than the present 20 mmol/1 solution. This regime is now standard practise in both Bustamante Children's Hospital and at the University Hospital of the West Indies and has led to dramatic reductions in hospitalization rates, use of drip sets and of intravenous therapy (AU)