Radionuclide gastro-esophageal scintigraphy was performed on 25 control and 183 children suffering from recurrent lower respiratory tract infection. Gastro-esophageal reflux (GER) of varying grades was observed in 135 patients. The severity of clinical symptoms in the patients was found to be directly related to the severity of reflux observed in the radionuclide study. In some patients an attempt was also made to quantitate GER by calculating the Gastro-esophageal reflux index. The results of the scintigraphic study were correlated with the results of the other commonly used and more conventional Barium swallow and fluoroscopy study. Gastro-esophageal scintigraphy was found to be much superior in terms of sensitivity, specificity and accuracy in detecting GER. It was also possible to objectively evaluate and monitor response to treatment following conservative or corrective surgical therapy using the radionuclide technique. The results of the study demonstrated a remarkably high incidence of GER in the patients. Whether GER is the cause of recurrent lower respiratory tract infection or not is difficult to establish firmly. But within the preview of the study the association seems to be very strong and cannot be easily ignored.

Child↗

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Portal hypertension in north Indian children.

Etiological factors associated with portal hypertension in children influence the decision about therapy and the prognosis. This cross-sectional observational study was performed at a tertiary care centre in northern India from January, 1990 to December, 1994. Children below the age of 14 years with suspected portal hypertension were prospectively assembled into a cohort to determine the etiology and clinical profile of portal hypertension. Of the 115 patients with portal hypertension, 76.5% had extrahepatic portal hypertension (EHPH). Remaining 23.5% of the cases had intrahepatic and post-hepatic causes of portal hypertension. Children with EHPH had a significantly earlier onset of symptoms as compared to those with intrahepatic portal hypertension (p = 0.002) and bled significantly more frequently (p = 0.00). Forty per cent of patients with chronic liver disease (CLD) never had jaundice. History suggestive of potential etiological factors could be elicited in only 7% of EHPH patients. The commonest site of block in splenoportal axis was at the formation of the portal vein. An inverse relation of bleeding rates with duration of illness was seen in EHPH. Of the 10 CLD patients in whom liver biopsy could be done, cirrhosis was present in 6 patients. Understanding the natural history of EHPH and portal hypertension due to other etiologies may have significant implications in choosing the appropriate intervention and predicting the outcome.

Adolescent↗

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Steroids in cerebral malaria.

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Child↗

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Chronic diarrhea in infants and children.

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Child↗

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Are fluoroquinolones safe in children?

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Adolescent↗

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Considerations of HAV vaccine in India.

Currently available evidence indicates that most parts of India still quality to be hyper-endemic regions and hence recommendations for vaccinations developed for low endemicity regions are not applicable. There are however, some pockets which showed evidence of distinct epidemiologic shift. There is need to identify geographic regions like Kerala which have potential for epidemic outbreaks through cyclic sero-epidemiological surveys. With economic development and consequent improvements in the levels of sanitation and quality of water supplies, more such areas will be identified. Efforts to improve sanitation and personal hygiene will remain as the most important and efficient intervention to retard the transmission of HAV. Unless a critical improvement in the living standards of our population is achieved, aim of eradicating HAV infection from the community is not realistic. Presently, the cost of three doses of HAV is exorbitant and the focus of HAV vaccination will have to be restricted to individual protection who are likely to remain unexposed till adulthood and can afford to pay for it. HAV Infection below 5 years is mostly asymptomatic. The most efficient use of resources will therefore be to offer HAV vaccine to high risk individuals beyond this age after screening for antibodies against HAV.

Adult↗

PubMedDate not supplied