The treatment of enteric fever at St. Mary's will be discussed under the following headings: (1) The hygienic and dietetic treatment; (2) the treatment by stimulants and drugs ; (3) the treatment of the pyrexia; (4) the treatment of the complications. 1. The Hygienic and Dietetic Treatment.?The patient is put to bed in a large and airy ward, the temperature of which is maintained at about 60 deg. F. The bed should be firm, and is so arranged that the patient can be reached from either side. The coverings should be light, but at the same time adequate, to protect the patient from changes of temperature in the ward. The patient is under no circumstances allowed to get out of bed, and the bed pan and urine bottle are used throughout the whole attack, so that the recumbent position is maintained, a point of considerable importance. The stools are examined daily by the house physician

The treatment of enteric fever

Background: Nephrotic syndrome is the most common glomerular disease affecting children, characterized by heavy proteinuria, edema, hypoalbuminemia, and hyperlipidemia. The mainstay treatment is with prednisolone, whose response is of prognostic significance. Steroid response rates vary across geographical regions, which may be due to the role of genetic and environmental risk factors among different ethnic groups. There is a paucity of data on response to treatment with prednisolone in pediatric patients with nephrotic syndrome in the Tigray region, Northern Ethiopia. Objectives: To assess the pattern of response to prednisolone in pediatric patients treated for nephrotic syndrome at Ayder Comprehensive Specialized Hospital from 2014 to 2019. Methods: A record-based retrospective study was conducted at Ayder Comprehensive Specialized Hospital Mekelle City, Ethiopia. Data was collected and recorded on a predesigned form. Sixty-three patients fulfilled the inclusion criteria, whose data was entered, coded, and analyzed using the statistical software package (SPSS) version 20. Variables of interest included age, gender, blood pressure, presence of hematuria, acute kidney injury, biopsy, secondary causes of nephrotic syndrome, and response to steroid therapy. Data was presented in tables and graphs. Results: The age of the patients ranged from 1 - 17 years, with a median age of 3 years. Fifty-one patients (81%) were males, with a male to female ratio of 4.2:1. Hematuria was present in 66.7%, whereas hypertension was seen in 49.2% of the patients. Thirty-nine patients (61.9%) were responsive to prednisolone, 24 cases (38.1%) were resistant, 8 (20.5%) were steroid-dependent and 19 (48.7%) had relapses. Younger age (AOR 16.671, 95% CI: 1.645 - 168.904 P = 0.017) and high cholesterol values (AOR 1.013, 95% CI: 1.005 - 1.021 P = 0.01) were independent factors associated with steroid responsiveness. Conclusions: The steroid response rate in this study is similar to that in Asian and some African countries. Most patients in our hospital had atypical features of nephrotic syndrome. Younger age and high cholesterol levels were independent factors affecting steroid response.

Steroid Response Pattern Among Children with Nephrotic Syndrome in Northern Ethiopia

Background & objective: Impact of Nephrotic syndrome due to relapse on children and their families is so diverse and extreme that causes serious physical and mental health problems for a long time. Repeated Hyperlipidemia and frequent long term steroid treatment in relapsed cases add more burdens on already fragile health of these children. Materials & Methods: This descriptive, observational study was carried out in the Department of Pediatrics, Rajshahi Medical College Hospital over a period of 24 months from July 2015 to June 2017. If a child’s age at presentation was between 2 to 8 years of age group of either sex having typical features of nephrotic syndrome(first attack), such asgeneralized swelling which started from the face, having abnormal urinary finding ( proteinuria 3+ or more and UTP >1gm/m/24hrs hypoalbuminemia, hypercholesterolemia but responded to steroid was included in the study. When the child was in remission, serum Lipid profile was done following 10 hours of fasting once again. Then the child was followed up fortnightly for a period of six months from the initial attack for generalized edema and bedside urinary albumin 3+ or more. Results were tested with independent ‘t’ test and χ test to find out the association between high lipid profile during remission with the relapse . A two-tailed P value of 0.05 was considered statistically significant. Results: All 50 children were divided into two groups on the basis of lipid profile during remission. Group-1 consists of 20 children who had normal lipid profile during remission and group-2 consists of 30 children who had abnormal lipid profile during remission. Both group-1 & 2 had higher mean levels of serum cholesterol, LDL, and TG levels during initial diagnosis. During remission, group-2 patients showed higher mean serum cholesterol (364.60±64.00 mg/dl vs. 189.25±9.02 mg/dl), serum LDL (241.53±58.42 mg/dl vs. 146.65±3.60 mg/dl), and serum TG (225.10±43.79 mg/dl vs. 138.90±8.15 mg/dl). All these differences in lipid profile between these group were statistically highly significant (p=<0.001).Only 2(10%) cases underwent relapse from group-1 out of 20 cases, whereas 16(53.33%) cases underwent relapse out of 30 cases from group-2 within six (6) months follow-up. The difference between group-1 & group-2 was statistically significant (p=0.002).Among the relapsers, mean cholesterol (394.18±43.03 mg/dl vs. 329.50±67.81 mg/dl; p= 0.004) was significantly higher than that of non-relapsers of group-2 patients. Conclusion: Elevated lipid level, especially serum cholesterol during remission phase may be associated with subsequent relapse in idiopathic childhood nephrotic syndrome. TAJ 2020; 33: No-2: 69-75 1 Assistant Registrar, Department of Pediatrics, Rajshahi Medical College Hospital, Rajshahi. 2 Assistant Professor (Neonatology), Department of Pediatrics, Rajshahi Medical College, Rajshahi. 3 Professor and Head, Department of Pediatrics, Rajshahi Medical College, Rajshahi. 4 Registrar, Department of Pediatrics, Rajshahi Medical College Hospital, Rajshahi. 5 Assistant Professor, Department of Pediatrics, Pabna Medical College, Pabna. 6 Assistant Professor, Department of Pediatrics, Rajshahi Medical College, Rajshah

Role of Persistent Hyperlipidaemia in Relapse of Idiopathic Nephrotic Syndrome

Background: Nephrotic syndrome in children is characterized by dyslipidemia, which is an indirect risk factor for cardiovascular diseases, progressive glomerulosclerosis, and related complications. The objective is to determine the range of lipid profile abnormalities in relation to onset, relapse, and remission, as well as to determine if there is any relationship between dyslipidemia and the frequency of relapses. Methods: One hundred and two diagnosed cases of nephrotic syndrome in the age group of less than 12 years were included, out of which 64 patients belonged to the first episode of nephrotic syndrome and 38 patients were relapse cases. Steroid-resistant nephrotic syndrome cases or patients with a history of diabetes mellitus, hypothyroidism, familial hypercholesterolemia, children with chronic kidney disease, and edema due to other causes were excluded from the study. Results: There was a statistically significant increase in lipid parameters except for high-density lipoprotein (HDL) cholesterol at the disease onset when compared to remission in cases of the first episode as well as relapse cases of nephrotic syndrome. There was a positive correlation between relapse frequency and dyslipidemia. Dyslipidaemia was also associated with low serum albumin, with a p-value <0.001, which is statistically significant. Conclusion: Dyslipidemia is significantly higher in relapse cases of nephrotic syndrome and remains higher even during remission. Dyslipidemia is a directly associated risk factor for atherosclerosis and coronary heart disease (CAD), along with progressive glomerulosclerosis. Early identification and treatment of hyperlipidemia is therefore justified so that along with longevity, we can also improve the quality of life of children suffering from nephrotic syndrome.

A Study of Dyslipidemia and Its Clinical Implications in Childhood Nephrotic Syndrome

Introduction The aim of this study was to investigate lipoprotein particle distributions and the likelihood of achieving cholesterol homeostasis in the remission phase of nephrotic syndrome (NS) in paediatric patients. We hypothesized that lipoprotein particle distributions moved toward less atherogenic profile and that cholesterol homeostasis was achieved. Materials and methods Thirty-three children, 2 to 9 years old with NS were recruited. Blood sampling took place both in the acute phase and during remission. Serum low-density lipoprotein particles (LDL) and high-density lipoprotein particles (HDL) were separated using non-denaturing polyacrylamide gradient gel (3-31%) electrophoresis. Serum non-cholesterols sterols (NCSs), desmosterol, lathosterol, 7-dehydrocholesterol (7-DHC), campesterol and β-sitosterol were measured by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Results All patients had desirable serum HDL cholesterol concentrations during remission. The dominant lipoprotein diameters and LDL subclass distribution did not change significantly during follow-up. In contrast, HDL lipoprotein particle distribution shifted towards larger particles. The absolute concentration of desmosterol was significantly lower during remission (P = 0.023). β-sitosterol concentration markedly increased during remission (P = 0.005). Desmosterol/β-sitosterol (P < 0.001) and 7-DHC/β-sitosterol (P = 0.005) ratios significantly declined during disease remission. Conclusions Favourable changes in the serum lipid profiles, HDL particle subclass distribution and cholesterol metabolism in paediatric patients with NS during remission took place. For the first time, we found that cholesterol homeostasis changed in favour of increased cholesterol absorption during disease remission. Nevertheless, complete cholesterol homeostasis was not achieved during disease remission.

https://www.biochemia-medica.com/assets/images/upload/xml_tif/bm-32-2-020706.pdf

Lipoproteins and cholesterol homeostasis in paediatric nephrotic syndrome patients

Background: Nephrotic syndrome (NS) is an important chronic renal disease in children, characterized by minimal change disease in the majority of cases. The objective was to study the levels of serum cholesterol, serum triglycerides, LDL VLDL and HDL in nephrotic syndrome at the onset and during remission in first episode and relapse cases. 
Methods: A prospective study which included 50 children with steroid sensitive nephrotic syndrome, aged between 2-12 years. Out of which 35 children were presented as first episode, and 15 children as relapse cases. They were clinically examined and lipid profile was done at the onset and during remission. 30 age matched controls without liver and kidney disorders were taken as controls. 
Results: There was statistically significant increase in serum cholesterol, triglycerides, LDL and VLDL in nephrotic syndrome patients when compared to controls (P ≤0.005), but HDL value was not significant (P = 0.234). In first episode of nephrotic syndrome cases serum lipids decreased significantly during remission, but HDL was increased during remission and it was not statistically significant, whereas in relapse cases even during remission serum lipids were significantly higher but HDL increase was not statistically significant. There was an inverse correlation between albumin and cholesterol. The correlation was statistically highly significant (P = 0.000). 
Conclusions: The present study shows that in nephrotic syndrome, there is generalized hyperlipidemia (except HDL). This was significantly higher in relapse cases compared to first episode. Lipid profiles reaches normal during remission in first episode, whereas in relapse cases it was significantly higher even during remission. Hence there is a rationale for treatment.

/pdf/comparative-study-of-lipid-profile-abnormalities-in-first-12rsbysi5u.pdf

Comparative study of lipid profile abnormalities in first episode and relapse cases of childhood nephrotic syndrome

Objectives: To compare the clinical effectiveness of oral azithromycin versus intravenous (IV) ceftriaxone for treating uncomplicated enteric fever. Methods: Children aged 2-17 years with uncomplicated enteric fever and positive blood cultures for Salmonella typhi were included in the study. These were grouped as Group A (50 cases) and Group B (50 cases). Group A was given oral azithromycin 10 mg/kg/day once a day (azithromycin group) and Group B was given IV ceftriaxone 100 mg/kg/day in 2 divided doses (ceftriaxone group) for 6 and 7 days, respectively. Every day the child was examined, and the study results were assigned as a clinical and microbiological cure or failure. Results: A total of 100 patients in sex ratio of 1.2:1 (male:female) with uncomplicated enteric fever were enrolled in the study. Mean duration to become afebrile was less with azithromycin (2.72 days) as compared to ceftriaxone (5.52 days) treatment (p=0.000). 96% of the cases treated with azithromycin attained defervescence by the 5th day of treatment, but only 27% of cases treated with ceftriaxone attained defervescence by the 5th day of treatment. A clinical cure was earlier with azithromycin than with ceftriaxone treatment (p=0.027). Microbiological cure was achieved in 100% and 98% cases treated with azithromycin and ceftriaxone, respectively (p=0.5). Conclusion: Oral azithromycin was more efficacious in the treatment of uncomplicated enteric fever in children as compared to IV ceftriaxone.

/pdf/to-compare-the-effectiveness-of-oral-azithromycin-versus-2pw5uaa63w.pdf

To compare the effectiveness of oral azithromycin versus intravenous ceftriaxone for treating uncomplicated enteric fever

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Comparative study of lipid profile abnormalities in first episode and relapse cases of childhood nephrotic syndrome

To compare the effectiveness of oral azithromycin versus intravenous ceftriaxone for treating uncomplicated enteric fever