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A 20-yr prospective study of the incidence of primary drug-resistant tuberculosis among children treated at the Kings County Medical Center was undertaken in January 1961 and extended through December 1980. There were 355 strains of Mycobacterium tuberculosis isolated during this time, 56 of which were found to be primarily resistant to one or more antituberculosis drugs, giving an overall resistance rate of 15.8%. The study was divided into five 4-yr periods. The resistance rate to isoniazid was 9.9%, varying from a peak of 15.2% in the third period of study (1969 to 1972) to 4.5% in the last period of study. The changes in the rate were not significant. The overall resistance rate for streptomycin was 9.2%. There were significant increases in the resistance rate in the second (1965 to 1968) and third (1969 to 1972) periods of study, but not in the last 2 periods. The rates for PAS (3.4%), rifampin (1%), and ethambutol (0.7%) were low. The type and severity of disease among those infected with a resistant strain were no different from those infected with a susceptible strain. Life-threatening disease was found in 10 of the 56 patients infected with a drug-resistant strain. There was one fatality in a child with meningitis who was treated early in the study. Our experience suggests that rifampin and ethambutol be included in the initial treatment regimen of all children with a life-threatening form of tuberculosis until the susceptibility pattern of the infecting strain is determined, after which the drug regimen can be modified if necessary.

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Background: Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. Of the 9 million annual tuberculosis cases, about 1 million (11%) occur in children (under 15 years of age). Childhood tuberculosis is a neglected aspect of the tuberculosis epidemic. The objective of the study was to screen the children who are household contacts of TB, HIV and TB -HIV patients and identify the children with the type of tuberculosis (Latent and symptomatic) and treat accordingly there by reducing the transmission of disease, as these children may become open cases in the future.Methods: All the registered cases of active TB, TB-HIV and HIV were traced out from district unit of RNTCP, PHC, CHC in and around Nellimarla town (10 kms radius). These patients were interviewed for medical history, treatment history, duration of treatment and degree and duration of house hold contacts (primarily children between 1 to 14 years.Results: Out of 160 registered patients 91 patients were diagnosed as having symptomatic TB infection and 69 were diagnosed having latent TB infection, with most of the affected children being in the age group of 1 to 5 years). Majority of the symptomatic patients (46.15%) were household contacts of TB- HIV patients and majority of children (40.57%) with latent TB Infection are direct household contacts of open cases of TB alone. Of the symptomatic TB infection 74.72% had pulmonary TB and 25.28% had extra pulmonary TB.Conclusions: Tubercular lymphadenopathy is the most common manifestation of extra pulmonary TB followed by tubercular meningitis and among the tubercular lymphadenopathy the cervical lymphnodes are most commonly involved.

of P e d i a t r i c s , -e, New York.To improve p a t i e n t c a r e and reduce t h e time r e q u i r e d f o r a d m i n i s t r a t i v e f u n c t i o n s , we developed a computerized system f o r our P e d i a t r i c Endocrinology C l i n i c . Using a Hewlett-Packard 9845A mini-computer, we s t o r e background d a t a and add new information accrued a t each p a t i e n t c o n t a c t . We maintain a t a b u l a r record o f p a s t , c u r r e n t , and pending d a t a f o r each p a t i e n t and e n t e r t e s t r e s u l t s a s they a r e received. P r i o r t o each weekly c l i n i c , we e n t e r the names o r h o s p i t a l numbers o f t h e scheduled p a t i e n t s i n t o t h e computer and g e n e r a t e a p a t i e n t l i s t . For each p a t i e n t the computer p r i n t s a customized guide s h e e t by assembling s e l e c t e d s k e l e t o n sentences from a 1 i s t s t o r e d i n memory. The s u b s e t o f sentences chosen f o r each p a t i e n t is r e t a i n e d , b u t can be modified a s d e s i r e d . The guide s h e e t i n s t r u c t s r e s i d e n t s and s t u d e n t s by h i g h l i g h t i n g the p e r t i n e n t a s p e c t s of the h i s t o r y and physical examination and a l s o s e r v e s a s t h e d r a f t o f t h e l e t t e r t o t h e r e f e r r i n g physician. A f t e r t h e p a t i e n t v i s i t , we e n t e r new f i n d i n g s , diagnoses, t e s t s and t r e a t m e n t plans i n t o t h e computer. A preliminary l e t t e r i s p r i n t e d and reviewed before the computer types t h e f i n a l copy on l e t t e r h e a d s t a t i o n e r y . Implementation o f t h i s system has enhanced o u r a b i l i t y t o e v a l u a t e our p a t i e n t s , provided a new teaching instrument and reduced t h e time consumed by a d m i n i s t r a t i v e t a s k s . I t i s a p p l i c a b l e t o o t h e r c l i n i c a l s e t t i n g s and t h e programs, w r i t t e n i n BASIC, can be adapted t o equipment c o s t i n g l e s s than $5,000. ANTIBIOTIC USE IN PEDIATRIC PATIENTS IN A CITY HOSPITALMadu Rao, Vincent Ahonkhai, Minerva S. V i c t o r i a and 683 P F i l T T S t e i n e r . (Spon. by Senih El. F i k r i g A f o u r v e a r oro!oective studv (1977)(1978)(1979)(1980) was done a t Kinss 1 County ~o s p i t a l ; ~r b o k l~n , t o a s s e s s t h e impact o f education-of house o f f i c e r s and a t t e n d i n g s t a f f on t h e a p p r o p r i a t e n e s s o f a n t ib i o t i c usage i n c h i l d r e n on t h e p e d i a t r i c medical wards. During t h e study, i n t h e month o f March every y e a r c h a r t s were reviewed of c h i l d r e n i n whom a n t i b i o t i c s were used. In 1977, 30.9% o f a l l admissions had a n t i b i o t i c s us;d.In t h e s e c h i l d r e n 46.9% were judged a s having a n t i b i o t i c s n o t i n d i c a t e d " . An i n t e n s e educa- t i o n a l program f o r t h e p e d i a t r i c s t a f f ensued c o n s i s t i n g o f l e ct u r e s , c h a r t a u d i t s and v...