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Causes, Prognostic Factors and Treatment Results of Acute Renal Failure in Children Treated in a Tertiary Hospital in South Africa
The aim of this study was to determine the causes, prognostic factors and treatment results of acute renal failure (ARF) in children admitted to the Pretoria Academic Hospital from 1986 to 2002. A retrospective chart review of 102 children (mean age 37 months) was done. Various factors were analysed including age, sex, causes of ARF, morbidity, mortality, dialysis requirement and outcome. Peritoneal dialysis was the only form of dialysis available. Patients were categorized as those who survived without dialysis or in whom renal function recovered without the need for continuing dialysis (Group I, termed ‘survivors’), and those who died or remained dialysis dependent (Group II, termed ‘non-survivors’). The most common causes of ARF were haemolytic uraemic syndrome (35.3%), acute tubular necrosis (31.4%) and acute glomerulonephritis (15.7%). There were 77 patients in Group I of whom 38 required dialysis, and 25 in Group II of whom 16 were dialysed. Fifteen patients in Group II died and 10 remained dialysis dependent (‘renal deaths’). Only four patients with ‘renal death’ received long-term dialysis. Coma (P < 0.001), liver dysfunction (P < 0.009), a clotting deficiency (P < 0.001), respiratory failure (P < 0.001) and multi-organ failure (P < 0.001) were significantly associated with poor outcome. These factors should be taken into account before initiating dialysis in children in countries where available resources for long-term dialysis are limited.

Serum Total Homocysteine Concentrations in Children and Adolescents in Jos, Nigeria
Background: Although the elevation of circulating total serum homocysteine (tHcy) concentration in a fasting state is associated with an increased risk of occlusive vascular disease in adults, the levels in children in Nigeria are not known. Aim: The goals of this study were to describe the distribution of tHcy among a representative sample of children and adolescents in Jos, Nigeria, and to test for differences in tHcy among sex and age categories. Methods: The sampling scheme, which included persons aged 10 to 19 years, was a stratified, multistage probability design. This cross sectional study involved 182 school children drawn from secondary schools in Jos, Nigeria between January and July 2003. Fasting venous samples were collected and assayed for tHcy, Total protein and Albumin. Anthropometric measurements were taken. Result: The mean tHcy concentrations were 2.7 2.4 (95% CI 2.4–2.9), 3.5 3.2 (3.3–3.8) and 3.6 3.2 (3.3–4.1), 4.1 3.6 (4.0–4.4) mol/l for the girls and boys aged 10–14 and 15–19 years, respectively. Albumin levels correlate positively with plasma total homocysteine, tHcy (r = 0.45, P = 0.03). Conclusion: This study provided age-specific data regarding tHcy concentrations between 10–19 years population in Jos, Nigeria. The tHcy concentration increased as a function of age in both sexes.

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Prevalence of Orphans among HIV Infected Children–a Preliminary Study from a Pediatric HIV Centre in Western India
The aim of this study was to determine the prevalence of orphaned HIV-infected children in Mumbai, India and analyze whether orphanhood affects care of these children. This study is a retrospective analysis of prospectively collected data of 147 HIV-infected children referred to our pediatric HIV clinic at B. J. Wadia Hospital for Children (Mumbai, India). All children underwent a detailed history and clinical examination. Transmission of HIV was determined by parental HIV status, history of blood transfusion or sexual exposure. Orphan status was determined by verbal autopsy of parent death (either mother or father or both). Factors affected by orphan status such as follow up, caregiver, antiretroviral treatment and age of the child when orphaned was determined. Fifty nine (40%) HIV-infected children were orphans. In 28 children (19%), father had died; in 20 children (13.6%), mother had died; in 11 children (7.5%) both parents had died and in 2 children (1.4%), parents death status was not known. Cause of death was AIDS in 19 parents (38%) and TB in 21 parents (42%). The mean age of the child when mother had died was 5.6 2.2 years; when father had died was 7.08 3.5 years and when both parents had died was 10.9 2.4 years (p

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Risk Factors of Childhood Asthma in Sao Jose do Rio Preto, Sao Paulo, Brazil
Background: Epidemiological studies have shown increased prevalence of asthma over the last decades and a considerable variation in these rates between different countries, mainly developed. Changes in lifestyle of different populations could explain the increasing prevalence of asthma and its different rates in different communities. Objectives: A case-control study was conducted to investigate some risks factors associated to asthma in schoolchildren in S o Jos do Rio Preto, S o Paulo, Brazil. Casuistic and Methods: A total of 3793 self-administered written questionnaire (WQ) was filled in by parents of 6–7-year-old schoolchildren, applying the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Additionally, was added a supplementary WQ evaluating risk factors: gender, personal history of rhinitis and atopic eczema, familial history of atopy, older siblings, day care, breastfeeding, and exposure to pets and to cigarette smoking. Children whose parents responded affirmatively to question ‘Has your child had wheezing in the past 12 monthsquest;’ were identified as having current asthma. Results: The prevalence of current asthma was 18.3%. In multivariate analysis the following risk factors were associated with asthma: rhinitis (OR = 10.6; 95% CI = 8.27–13.56), atopic eczema (OR = 1.54; 95% CI = 1.00–2.35), father with asthma (OR = 3.49; 95% CI = 1.83–6.67), mother with asthma (OR = 1.84; 95% CI = 1.11–3.05), current exposure to pets (OR = 1.83; 95% CI = 1.45–2.32) and passive tobacco smoking exposure (OR = 1.43; 95% CI = 1.12–1.83). Conclusions: Our results show that genetic background, environmental factors and the presence of co-morbidities such as rhinitis and atopic eczema are associated to the genesis of asthma in Brazilian schoolchildren.

Brucellar Meningitis in an Infant–Evidence for Human Breast Milk Transmission
Brucellar meningitis is relatively uncommon, especially in children younger than 1 year. We present another case of meningitis due to Brucella melitensis biotype 1 in a 11-month-old infant transmitted by breast milk. This is the first report of successful isolation of B. melitensis from the breast milk in the literature. Babies of infected nursing mother should be monitored closely for evidence of infection since the breast milk is the source of transmission of brucellosis. It would be prudent to abstain from breast feeding until infection of nursing mother has been eradicated. One should be aware of this in endemic areas.

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