Handicapping conditions among children under six years in family medicine centers in Alexandria. Part I: screening and detection

Early identification of children with developmental delays is important in the primary health care [PHC] setting. The PHC practitioner's office is mostly the place where the majority of children younger than 5 years of age are seen and is ideal for developmental and behavioral screening by the use of age-appropriate developmental checklists to record milestones during preventive care visits as a part of developmental surveillance. The aim of the present study was to screen children under 6 years in 5 family medicine [FM] facilities in Alexandria, Egypt for the early detection of some handicapping conditions [visual, hearing, speech, and orthopedic] and to review the family files of the screened children to assess the number of suspicious cases missed by the family physicians. Data were collected using a pre-designed screening sheet for the early detection of the above mentioned handicapping conditions among 550 children attending the study FM facilities and by family file review of the screened children. Screening of children under 6 years old had yielded the following results: orthopedic abnormalities represented 14.2%, followed by visual abnormalities [9.3%], speech abnormalities [8.9%], hearing abnormalities [6.2%], and mental retardation [2%]. Risk factors found to affect the occurrence of the study handicapping conditions were found to be mostly positive family history, consanguinity between parents, maternal age at the time of pregnancy, and complications during pregnancy; labour; and in the post natal period. Recording was incomplete as only 11.6% of the screened children had both complete files including growth and development charts. Poor performance of the family physicians in the study facilities was evident regarding detection and referral of handicapped cases in children as only 75 handicapped cases [46.3%] could be detected by the family physicians in the study facilities out of the 162 handicapped cases detected by the researcher. Family physicians in the study facilities referred only 57.3% of the detected. Therefore, screening for risk factors of handicap should be performed by the family physicians during routine daily activity as well as during the well baby clinic schedules. This is best achieved by proper development and application of guidelines and protocols for screening, follow up, and management of handicapping conditions including proper recording and referral

Handicapping conditions among children under six years in family medicine centers in Alexandria. Part II: assessment of resources

Handicap means the disadvantage or restriction of activity caused by disability. It is the practical consequence of disability and impairment. It is estimated that 5% of the world's children population suffer from severe handicaps and an additional 10-15%, may need special attention to overcome less severe handicaps. The aim of the present study was to assess the quality of human and non-human resources necessary for the prevention and control of handicapping conditions among children under 6 years in 5 family medicine [FM] facilities in Alexandria, Egypt. Data were collected using 2 different questionnaires: a checklist was designed to assess the availability of resources required for the early detection of visual, hearing, speech, and orthopedic causes of handicap among children under six in the study family medicine facilities. A self-administered questionnaire was designed to assess the knowledge, attitude, and practice [KAP] of 34 family physicians working in the study FM facilities about the early detection of the previously mentioned handicapping conditions in children. The percentage of registered to the total population was highest at Gohn FM unit [68.8%] and lowest at El-Seiouf FM center [24.6%]. Most of the equipment required for handicap screening was available in the study FM facilities. Child health records, daily registration records, and well baby clinic records were available, but no specific records or reports for handicapping conditions in children were present. About half of the physicians [47%] had no postgraduate studies at all, only 23.5% and 3% of the family physicians were trained about detection of mental retardation, and genetic causes of handicap, respectively and 14.7% did not attend any training course at all. The majority of family physicians had fair knowledge [76.5%], positive attitude [61.8%], and partial practice [70.6%]. The difference in KAP levels between the different study facilities was statistically insignificant. There was a statistically significant direct proportionate relation between the knowledge of the physicians and their practice; i.e., the higher is the knowledge the better is the practice. Therefore, handicap prevention and control should be properly integrated within PHC [Family medicine] services with continuous, proper training of all health team members

Leukotrienes and essential fatty acids patterns in children with severe protein energy malnutrition

The objective of this study is to investigate the roles of leukotrienes [LTs] and essential fatty acids [EFA] in the pathophysiology of severe protein energy malnutrition [PEM]. Plasma cysteinyl LTs [LTC[4], LTD[4], LTE[4]] and plasma EFA levels were measured by ELISA and gas liquid chromatography after plasma extraction respectively, in 40 severely malnourished children with kwashiorkor [n=20] and marasmus [n=20]. Ten well nourished children of matching age served as control. The cysteinyl LTs level was significantly higher in kwashiorkor group than in marasmic or control groups [p<0.05]. The plasma fatty acid patterns in malnourished children indicated changes characteristic of EFA deficiency, with lower linoleic acid [LA], alpha-linolenic acid [alpha LNA], arachidonic acid [AA] and docosahexaenoic acid [DHA] levels, accompanied by significantly higher oleic acid levels in both malnourished groups. The lowest values of LA and alpha-LNA were detected in marasmic group and the lowest levels of AA and DHA were in kwashiorkor group [p<0.05]. There was an inverse correlation between AA and LTs levels in children with kwashiorkor. Clinical problems associated with kwashiorkor such as hair and skin changes, edema, psychomotor alteration and hepatomegaly were significantly correlated directly with LTs and in versely with AA levels. The findings of this study suggest that cysteinyl LTs and EFA deficiency are involved in the pathophysiology of PEM particularly kwashiorkor and that severe PEM is associated with impaired FA desaturation and elongation pathways

Nutritional outcome of appropriate feeding during and after acute diarrhoea in children

A sample of 120 children with acute diarrhoea was divided into two equal study groups. There was no difference between groups in pre-intervention and post-intervention findings during the acute phase of diarrhoea. Upon discharge, Group A patients were supplied weekly with sufficient milk formula and cereal together with adequate nutritional advice while Group B patients were supplied with food or nutritional advice only if requested by the mothers. Forty nine patients from each group were followed each week for four weeks. Group B infants showed a higher incidence of recurrent diarrhoeal attacks and a significantly longer duration of recurrent diarrhoea than Group A infants. Moreover, Group A infants scored a significantly higher weight increment than Group B ones after four weeks of follow up

Clinical, electrocardiographic and echocardiographic study of the heart in children with acute lymphoblastic leukemia

This work aimed at finding out evidences of cardiac involvement in patients with acute lymphoblastic leukemia [ALL], through clinical, electrocardiographic and echocardiographic studies. It included 15 [ALL] children studied before treatment, ranging in age from3.5 - 14 years, 7 of them were re-examined after induction of remission, and 15 age matched normal controls. Neither clinical examination, nor electrocardiographic study showed evidences of myocardial involvement. Electrocardiographic results revealed the following in [ALL] cases. Before treatment: hyperdynamic state of the left ventricle as evidenced by presence of significant rise in the COP index, heart rate, mean Vcf, mean PWV. Norm PWV and the systolic endocardial and septal velocities; normal systolic [contractile function] of the left ventricle and a reduced compliance as evidenced by reduced E-F slope of the mitral valve. Evidence of pericardial effusion was present in 30% of untreated [ALL] cases. After induction of remission, the following changes were found: disappearance of hyperdynamic state evidenced by significant reduction in COP, COP index, the end-systolic septal thickness [IVSTs], the posterior wall excursion [PWE] and the normalized posterior wall thickness during diastole and decreased left ventricular mass. Disappearance of pericardial effusion

Cholestyramine in acute infantile diarrhea: a double-blind, placebo-controlled clinical trial in hospitalized infants

We evaluated the efficacy of oral cholestyramine therapy [2 grams. 3 times daily for 3 days] in a randomized double blind trial in 60 hospitalized well nourished Egyptian children [aged 3-24 months] having acute liquid diarrhea of five days or less in duration with moderate to severe degree of dehydration. Cholestyramine therapy did not have a significant effect on the stool output, the amount of oral rehydration solution [ORS] ingested, nor on the weight gain. However, it caused a significant reduction [=35%] in the duration of diarrheal episode and the frequency of diarrheal stools starting from the second day of treatment. Moreover, the number of patients cured from diarrhea was significantly higher in the cholestyramine group than the placebo one on any given day of hospital stay. Cholestyramine was acceptable by the patients, it did not aggravate vomiting, did not affect serum electrolytes [Na+, K+, and Cl-, and did not precipitate any unpleasant side effects. It was concluded that cholestyramine is a potentially effective and safe drug to be used as an adjuvant to rehydration therapy and adequate nutrition in shortening the duration of acute diarrhea in flavoured cholestyramine preparation to be used in the pediatric age

study of skeletal anomalies in children with Down's syndrome

Twenty five cases of Down's syndrome were studied to detect the prevalence of skeletal abnormalities. They were 18 males and 7 females who ranged between 1 month and 8 years of age. The results of the study showed that different types of skeletal anomalies can be detected in varying frequency among these patients. The most frequently encountered abnormalities were changes in the size and shape of the skull, asymptomatic subluxation of the arlanto-axial joint, characteristic shape of the pelvic bones and deformities of the feet and big toes

Left ventricular performance in children during their first attack of rheumatic carditis: an echocardiographic study

This study aimed at the evaluation of the degree of functional affection of the myocardium in children during their first attack of rheumatic carditis through the use of M-mode echocardiography. It included 24 patients ranging in age from 5-12 years and 20 age-matching normal controls. Sixteen patients had active carditis and mitral incompetence [MR group] and 8 patients had active carditis and heart failure [HF group]. The results proved the presence of left atrial and left ventricular dilatation in both rheumatic groups. A hyperkinetic state of the posterior left ventricular wall and septum was also detected in both groups. Systolic dysfunction of left ventricular myocardium was present in both groups as evidenced by increased PEP/ LVET ratio. Moreover, a reduced left ventricular compliance was also found in both MR and HF groups as evidenced by reduced diastolic E-F slope of the mitral valve. Evidence of pericardial effusion was detected in all rheumatic patients inspite of the absence of clinical signs of effusion

Serum sodium level in children receiving home-mixed oral rehydration solution

This study aimed at studying the serum sodium level in infants receiving home-mixed oral rehydration solution [ORS] for the prevention and treatment of dehydration caused by acute infantile diarrhea. It included 100 infants aged from 2-18 months, having received ORS at home during the last 24 hours. All cases were subjected to full clinical examination and to a questionaire about the amount, the reconstittution of ORS as well as any other food or additional fluids adminestered with it. The questionaire included also an inquiry on the source of knowledge of the mothers about ORS and feeding practice during diarrhea. Measurement of serum sodium proved that it ranged from 120-170 with a mean of 142.2 +/- 10.36 m Eq/Litre a value which though still within normal range was significantly higher than that reported for normal controls of matching age. Only 6% of patients showed a serum sodium level above 150 m Eq/Litre and all were asymptomatic. A positive correlation could be found only between serum sodium level and the degree of dehydration. The results were discussed

Low sodium oral rehydration solution versus the W.H.O. Formula in the correction of dehydration in children

This work aimed at comparing the efficacy and safety of an ORS solution containing 60 mEq/ litre of sodium versus the standard WHO formula [ORS-90]. It included 50 wellnourished infants with mild to moderate dehydration classified into 2 groups of 25 each. Mothers were allowed to give either ORS solution to dehydrated infants ad-libitum and feeding was allowed only after correction of dehydration. The study proved that there was no significant differences between both groups as regards the speed of rehydration the amount of ORS needed for rehydration and the weight gain after rehydration as well as the mean serum sodium and potassium. After rehydration, all cases of hyponatremia were corrected in both groups. Asymptomatic hypernatremia was still present in 12% of cases in the ORS-90 group while the risk of hypernatremia was nil in the ORS-60 group. These results were discussed

Serum level of some trace elements in children with nephrotic syndrome under corticosteroid therapy

Three trace elements, namely copper, zinc and iron were determined in nephrotic children under corticosteroid therapy for variable periods. Serum copper, zinc and iron were significantly decreased in nephrotic children before starting and medication [Group II]. Nephrotic cases with proteinuria receiving corticosteroids for 2 weeks [Group III] showed a significant decrease in serum copper and ceruloplasmin while iron and zinc were not significantly changed. Cases of nephrotic syndrome under corticosteroid therapy for one month with absent proteinuria [Group IV] showed a significant decrease in both copper and iron. Serum zinc increased significantly in nephrotic cases under corticosteroid therapy for two months [without proteinuria] [Group V.]. While copper and ceruloplasmin were still significantly decreased without significant changes in serum iron level. These results were discussed