SUMMARY The effect of different treatment regimes on intracranial pressure (ICP), degree of hydrocephalus and clinical outcome was evaluated in 81 children with tuberculous meningitis. 24 children underwent CSF shunting, while 57 with communicating hydrocephalus were randomly assigned to three treatment groups: antituberculous drugs only; or additional intrathecal hyaluronidase or oral acetazolamide and furosemide in addition to antituberculous treatment. The addition of acetazolamide and furosemide was significantly more effective in achieving normal ICP than antituberculous drugs alone. No difference was found in mortality or number of disabled survivors between groups. Of those surviving, nearly two‐thirds with stage II tuberculous meningitis were mildly disabled and nearly one‐half with stage III were severely disabled at follow‐up, emphasising the need for early diagnosis of tuberculous meningitis in the young child. RÉSUMÉ Hydrocéphalie tuberculeuse: une comparaison des effeets de différents traitements concernant la pression intra‐cranienne, la taille ventriculaire et le devenir clinique Les effets de différents traitements sur la pression intra‐cranienne (ICP), le degré d'hydrocéphalie et le devenir clinique ont étéévalués chez 80 enfants présentant une méningite tuberculeuse. 24 enfants bénéficièrent d'un shunt du liquide céphalo‐rachidien, tandis que 57, avec hydrocéphalie communicante étaient répartis au hasard entre trois groupes de traitements: médication antituberculeuse seule; association avec la hyaluronidase intrathécale; et association au traitement antituberculeux d'acétazolamide orale et de furosémide. L'association acétazolamide‐furosémide était significativement plus efficace pour maintenir une ICP normale que la médication antituberculeuse seule. Aucune différence n'a été notée en terme de mortalité ou de nombre de survivants avec séquelles entre les groupes. Parmi les survivants, près des 2/3 au stage II présentaient un handicap modéré et près de la moitié au stage II sont apparus gravement atteints au suivi, ce qui souligne la nécessité d'un diagnostic précoce de méningite tuberceuleuse chez l'enfant. Tuberkulös bedingter Hydrozephalus: ein Vergleich verschiedener Behandlungsprotokolle im Hinblick auf ICP. VentrikelegrösZe und klinischem Outcome Bei 81 Kindern mit tuberkulöser Meningitis wurde der Einfluß verschiedener Behandlungsprotokolle auf den intrakraniellen Druck (ICP), den Schweregrad des Hydrozephalus und den klinischen Outcome untersucht. 24 Kinder bekamen ein Ventil, während 57 Kinder mit kommunizierendem Hydrozephalus willkürlich in drei Behandlungsgruppen eingeteilt wurden: nur antituberkulöse Medikamente; zusätzlich Hyaluronidase intrathekal; und oral Acetazolamid und Furosemid zusätzlich zur antituberkulösen Therapie. Die Normalisierung des ICP wurde signifikant besser durch die Zugabe von Acetazolamid und Furosemid als nur, durch antituberkulöse Medikamente erreicht. Bei der Mortalität und der Anzahl der geschädigten Überlebenden fand sich kein Unterschied zwischen den Gru...

The purpose of the present study was to determine the long-term outcome of 76 children (40 females and 36 males) diagnosed and treated with modern antituberculosis drugs. The median age of the children on admission was 29.5 months and on follow-up 9 years. Antituberculosis therapy consisted of daily isoniazid (20 mg/kg), rifampicin (20 mg/kg), ethionamide (20 mg/kg), and pyrazinamide (40 mg/kg) for 6 months. Twenty-three children received daily prednisone (2-4 mg/kg) for the first month of treatment. Raised intracranial pressure was actively monitored and treated. Patients with non-communicating hydrocephalus received ventriculo-peritoneal shunts shortly after admission while communicating hydrocephalus was treated with oral acetazolamide (100 mg/kg/day) and furosemide (1 mg/kg/day) in 3-4 divided doses. Communicating hydrocephalus that did not respond to this regimen within the first month of treatment also underwent ventriculo-peritoneal shunting. Only 20% of children were functionally completely normal at follow-up. Main areas of functional deficit were cognitive impairment (80%), poor scholastic progress (43%), and emotional disturbance (40%). Twenty-five per cent of children had evidence of motor impairment, but all could walk and only 5 of 76 children (6% of total) were unable to run. One child was blind but no child had sensori-neural deafness. It was concluded that these disabilities in children from mainly deprived socioeconomic backgrounds have serious implications for their future social, academic, and career prospects. A high index of suspicion of TBM in high tuberculosis incidence communities will help prevent the morbidity documented in this study.

This research sought to investigate the role of social networks in coping and adjustment to spousal bereavement. A total of 198 Xhosa-speaking participants, drawn from the rural areas of the Eastern Cape Province, South Africa, took part in the study. Quantitative data analyses revealed significant correlations between perceived social support on Social Support Appraisals scale and the anxiety scores on the Beck Depression Inventory-Second Edition and the problem-solving coping strategy scale on the Coping Strategy Indicator. Regression analyses revealed that depression contributed to increased social support appraisals, while anxiety was a significant negative predictor of the participants' experience of perceived social support. The authors highlight the need for bereavement intervention programs in the rural areas to be geared toward psycho-educating the conjugally bereaved individuals, within the socio-cultural framework, to continuously evaluate their support structures and strengthen ties with social networks that render support, instrumental assistance, and advice in times of need.

The purpose of this study was to investigate the prevalence of attention deficit hyperactivity disorder (ADHD) in children who recovered from tuberculous meningitis (TBM) as part of an ongoing TBM research project. During this study, each TBM group subject underwent a thorough clinical-neurological examination, and a test battery which included the child behaviour check list (CBCL) Teacher's Report Form and Conners Rating Scale. The parents and teachers of each of the 21 TBM group and 21 control group subjects completed the above-mentioned questionnaires. All 21 TBM group subjects displayed symptoms of ADHD. The TBM group was significantly more hyperactive and unable to sustain attention than the control group. Furthermore, TBM group subjects were perceived as being significantly more unpopular, obsessive, compulsive and aggressive than the control group subjects. With regard to the frequency of externalizing behaviour, the TBM group subjects displayed significantly more externalizing behaviours as well as symptoms of attention deficit and hyperactivity. No significant differences between parents' and teachers' ratings were found. We conclude that ADHD is a common long-term complication of TBM.

The purpose of the present study was to determine the long‐term outcome of 76 children (40 females and 36 males) diagnosed and treated with modern antituberculosis drugs. The median age of the children on admission was 29.5 months and on follow‐up 9 years. Antituberculosis therapy consisted of daily isoniazid (20mg/kg), rifampicin (20mg/kg), ethionamide (20mg/kg), and pyrazinamide (40mg/kg) for 6 months. Twenty‐three children received daily prednisone (2–4mg/kg) for the first month of treatment. Raised intracranial pressure was actively monitored and treated. Patients with non‐communicating hydrocephalus received ventriculo‐peritoneal shunts shortly after admission while communicating hydrocephalus was treated with oral acetazolamide (100mg/kg/day) and furosemide (1mg/kg/day) in 3–4 divided doses. Communicating hydrocephalus that did not respond to this regimen within the first month of treatment also underwent ventriculo‐peritoneal shunting. Only 20% of children were functionally completely normal at follow‐up. Main areas of functional deficit were cognitive impairment (80%), poor scholastic progress (43%), and emotional disturbance (40%). Twenty‐five per cent of children had evidence of motor impairment, but all could walk and only 5 of 76 children (6% of total) were unable to run. One child was blind but no child had sensori‐neural deafness. It was concluded that these disabilities in children from mainly deprived socioeconomic backgrounds have serious implications for their future social, academic, and career prospects. A high index of suspicion of TBM in high tuberculosis incidence communities will help prevent the morbidity documented in this study.