Goel Km

Paracetamol Overdose in Children

The severity of paracetamol poisoning varies but in general, children are considered less susceptible to its toxic effects compared to adults.1 In this report we describe the relatively benign ingestion of paracetamol in children and also highlight a case of intrauterine exposure to a potentially toxic dose of paracetamol.

Dermatomyositis-polymyositis in children.

Sixteen cases of dermatomyositis-polymyositis in children (dermatomyositis 15; polymyositis 1) have been reviewed. Proximal muscle weakness with a characteristic skin rash was vital for diagnosis in the majority of children. The positive laboratory tests such as creatine phosphokinase (CPK), electromyography (EMG) and muscle biopsy were helpful but results were normal in some cases even in the acute phase of the illness. All but one had been treated initially with high dose corticosteroids followed by a low dose maintenance for a prolonged period. Two in addition had had cytotoxic agents. Thirteen of the sixteen were currently in remission. In the other three cases, one with polymyositis only, the disease remained active and the two with dermatomyositis died. Only three of the patients were incapacitated by residual fixed contractures and extruding calcinosis. On the whole the prognosis of dermatomyositis is good.

Ocular complications in juvenile chronic arthritis (JCA).

Fifty-six children with JCA have attended the Rheumatology Clinic at the Royal Hospital for Sick Children, Glasgow, over the past five years. Eleven have monoarthritis, 21 pauciarthritis and 24 polyarthritis. Seven children with pauciarthritis and one with monoarthritis developed ocular complications. Of these six were girls. In six children the arthritis preceded the uveitis. In one child arthritis and uveitis presented at the same time and in another the uveitis preceded the arthritis by one year. All were treated with steroids (7 topically, I systemically) and topical mydriatic agents. After an initial response the uveitis persisted as a low-grade inflammation gradually leading to secondary complications and increasing loss of vision. Only two patients enjoy normal vision at present. The importance of routine slit-lamp microscopy in all children with JCA is stressed, especially in those with pauciarthritis and antinuclear antibodies.

Cimetidine in primary duodenal ulcer in children.

Of 16 children with primary duodenal ulcer, 11 had complete relief of symptoms with initial full dose cimetidine therapy. After stopping cimetidine two of these 11 relapsed, six are in remission and three occasionally complain of abdominal pain requiring antacids. The remaining five children showed no improvement al all. Only one out of the 16 children showed side-effects due to cimetidine. Although there was wide variation in dosage of cimetidine and duration of therapy, no significant difference was noted in the dosage regimen of responders and non-responders to cimetidine. We suggest, full dose cimetidine 20 to 40 mg/Kg/dayfor 4 to 8 weeks, followed by 8 mg/Kg nocte daily for another 4 to 8 weeks.

Tuberculous Meningitis in Children: A Review of 15 Cases

Tuberculosis meningitis (TBM) is the most serious form of infection with Mycobacterium: tuberculosis. Between 1968 and 1986 15 children (five boys and 10 girls) were seen at the Royal Hospital for Sick Children, Glasgow, because of TBM. Fourteen children were Caucasian and one was Asian. The mean age at presentation was two years. None had been given BCG vaccination. In 12 children close contact with other cases of tuberculosis was reported. The signs and symptoms which helped in the diagnosis are discussed together with the initial CSF findings, results of mantoux testing and chest X-rays. Three children had unusual modes of presentation. All children were treated with chemotherapy though the drug combinations, route of administration and therapy varied from case to case. Steroids were used in nine children. Five children required neurosurgical intervention. Two children died and of the survivors six had serious sequelae. Five children made a complete recovery. The outcome of TBM depended on the duration of symptoms prior to the onset of therapy, on the neurological status reached at the time of diagnosis and the age of the child. The roles of chemotherapy, steroids and neurosurgery in the management of TBM are discussed. The need for routine BCG vaccination of all neonates is examined.

Pycnodysostosis in a Pakistani family: case presentation and review.

Pycnodysostosis is described for the first time in a Pakistani family. Two cases are presented and are contrasted with cases of osteopetrosis seen in this hospital over a twenty year period. The possibility of confusion with osteopetrosis is indicated and discussed.

Toxic shock syndrome (TSS) in children.

Toxic shock syndrome is uncommon in the prepubertal age group. Two children presented with pyrexia, macular erythroderma, vomiting, hypotension and rapid deterioration of consciousness. One child had severe neurological involvement. The diagnosis of toxic shock syndrome was established in both cases by the exclusion of other causes and by culturing staphylococcus aureus. We postulate that the neurological manifestations were caused by a direct neurotoxic action of the staphylococcal-produced toxin. Both children made a complete recovery.

Proceedings: Rickets in Asian children in Glasgow.

THE problem of rickets in Asians resident in Britain has been well known since the early 1960s when large scale immigration took place into the U.K. (Arneil & Crosbie, 1963). During the last decade a number of published papers have suggested an increase in the prevalence of florid rickets amongst the Asian population. (Richards et al., 1968; Ford et al., 1972; Holmes et al., 1973; Cooke et al., 1974). For every florid rickets there are almost certainly a number of latent cases. The diagnosis of subclinical rickets in children is difficult and has not been satisfactorily solved. The present survey was conducted to assess the magnitude of the problem in the Asian community in relation to pre-school and school-age children. Of 200 Asian children surveyed, 10 were found to have florid rickets and 22 showed radiological evidence of subclinical disease. Six cases of florid rickets were from one family. Two families with a single child with florid rickets showed 4 other subclinical cases. The demonstration of one case of rickets in a family should therefore automatically lead to the screening of all siblings for Vitamin D deficiency disease. Thirty-two cases of rickets (16%) in those surveyed suggests widespread Vitamin D deficiency in the Asian community. They continue to be from a poor social background as 24 came from social class III homes and 8 from social class IV. Most affected children were Moslems (75%). In this survey the calculated average vitamin D intake was <100 i.u. per day in 46 per cent of 200 children and 32 per cent were receiving <50 i.u. per day from dietary and supplementary sources other than ultraviolet light. All were chappati eaters and 85 per cent extraction flour was used in cooking. Only 8 families used margarine and the remaining 46 used ghee and butter for cooking and frying purposes. Forty-six mothers had stopped giving vitamins to their children by the age of 1 year. This serious problem undoubtedly warrants further action and its solution lies in

Uncommon connective tissue disorders in childhood.

Nineteen cases of the rarer connective tissue disorders diagnosed between 1948 and 1972 have been reviewed. Of these 6 were of systemic lupus erythematosus (SLE), 3 of dermatomyositis and 5 each of progressive systemic sclerosis (PSS) and polyarteritis nodosa (PAN). Of the 6 cases of SLE, 4 were of true SLE, one of ethosuximide induced lupus syndrome and one newborn with placental transfer of lupus erythematosus factor. Three cases of true SLE died of renal failure. None of the patients with dermatomyositis or PSS died. Of the 5 cases of PAN, 2 died and one could not be traced. The disease is quiescent in the other two.