Chronic liver disease in black children in Durban, South Africa

In a prospective study of 130 South African black children with chronic liver disease, it was found that the aetiology differed from that reported from developed countries. The most common cause of chronic liver disease (CLD) was HBsAg (33 of 55 with cirrhosis and 24 of 28 with chronic active hepatitis) and Schistosoma mansoni infestation (41 children). Inherited, auto-immune, iatrogenic and cryptogenic disorders, which are the usual causes in the developed world, were less common. The majority of children seen in this series were in an asymptomatic compensated state in contrast to reports from some developed countries. It is concluded that because infection is a common cause of CLD in the Third World it may be preventable in many cases.     

Aetiology of diarrhoea in adequately nourished young African children in Durban, South Africa

Two inter-related hospital-based studies on the causes of diarrhoea in African children who were not overtly malnourished, were performed over a period of two years in Durban, South Africa. The first study involved 126 inpatients selected for previously untreated diarrhoea of less than 96 h duration. On examination and culture of the stools of these children bacteria were identified in 60%, rotavirus in 20% and parasites in 4%. No pathogens were identified in 33%. The bacteria most frequently encountered were Campylobacter jejuni (21%), enteropathogenic Escherichia coli (EPEC) (18%), enterotoxigenic Escherichia coli (ETEC) (11%) and salmonella (8%). Of those cases having an identifiable cause 16% had more than one organism. The majority of children had mild disease and recovered clinically in 5.4 (1.3) days (Mean (s.d.]. The second study included 352 outpatients with diarrhoea who were randomly selected without regard to duration of disease or prior treatment. The results of faecal investigations were as follows: 28% had bacterial pathogens, 34% rotavirus, 15% parasites and 61% no pathogens. The bacteria most frequently detected were C. jejuni 7%, EPEC 7%, salmonella 6%, and shigella 5%. Ten per cent of positive cases had more than one pathogen. The most likely reason for the higher percentage with no identifiable pathogen is the prolonged duration of diarrhoea in 19% for more than seven days. In 128 control children with diarrhoea, stool samples were investigated during the same period as the two studies: 13% had bacteria, 2% rotavirus and 14% parasites. The bacteria involved were C. jejuni (5%). EPEC (5%), salmonella (2%) and shigella (2%).     

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结核性脑膜炎(结脑)治疗的目的是抢救病人生命,防止和减少后遗症的发生,彻底治愈病人,防止复发。其关键在于早期诊断、早期治疗和坚持全程治疗。结脑治疗包括对症支持治疗和抗痨治疗。1对症和支持疗法正确的对症治疗对防止死亡和避免后遗症的发生至关重要。1.1降低颅压,消除脑水肿不论早期或经治疗后的结脑死亡病例,多数系颅压高和(或)脑疝引起。结脑颅压增高持续时间长而且波动大,比如有的患儿上午颅压在1·47kPa(150mmH2O)以下,下午即可超过4·90kPa(500mmH2O),因此勿因一次脑压正常而放松了颅内压的监测和降颅压治疗措施。结脑开始治…     

儿童结核性脑膜炎的相关问题

结核性脑膜炎 (简称结脑 )是儿童肺外结核病最常见的类型 ,也是最严重的结核病。重庆市儿童医院 1993～ 2 0 0 2年 10年间共收治儿童各类结核病 737例 ,其中结核性脑膜炎为 319例 ,占儿童结核病住院总数 4 3 2 %。在链霉素出现以前 ,结脑的病死率几乎是 10 0 % ,随着近年对结脑的深入研究 ,结脑的诊断和治疗得到空前的发展 ,预后也得到很大的改善。但是 ,在许多地区儿童结脑的误诊、漏诊率仍然很高 ,因此如何不断提高对儿童结脑的认识及诊断水平 ,则成为儿科医务工作者所关注的问题之一。本文就儿童结脑诊断及治疗中容易出现的相关问题进行…     

Growth in early childhood in a cohort of children born to HIV-1-infected women from Durban, South Africa

This study describes growth in a cohort of black South African children born to HIV-1-infected women in Durban. Children born to HIV-1-seropositive women were followed up from birth to early childhood. At birth and at each visit, growth parameters were measured. Mean Z-scores were calculated for weight-for-length, weight-for-age and length-for-age and, if they were low, the children were regarded as wasted, malnourished or stunted, respectively. At the end of the study, there were 48 infected and 93 uninfected children. There were no significant differences between the two groups at birth. Thereafter, the infected group was found to have early and sustained low mean Z-scores for length-for-age and weight-for-age but not for weight-for-length. The means reached significance at ages 3, 6 and 12 months for length and at 3, 6 and 9 months for weight. Infected children who died early had more severe stunting, wasting and malnutrition than infected children who survived. Infected children born to HIV-positive women have early and sustained stunting and are malnourished but not wasted. Children with rapidly progressive disease have both stunting and wasting and are more severely affected. Early nutritional intervention might help prevent early progression or death in HIV-infected children, particularly in developing countries without access to anti-retroviral therapy in state hospitals.