Cerebral palsy; cross sectional survey

Cerebral Palsy is a disorder of movement and postural balance due to insult to the brain. The injury to the developing brain may be prenatal, natal or postnatal. The diagnosis is clinical mainly. The spastic Cerebral Palsy is classified into monoplegic, hemiplegic, diplegic, and quadriplegic types. There is a difference in the frequency of these types of Cerebral Palsy in different studies. The patterns of various forms of Cerebral Palsy emerge gradually with a delay in developmental milestones. A spectrum of associated developmental disabilities has been found to be common in these children. Management is through a multi-disciplinary approach. To find out the frequency of different types of Cerebral Palsy and degree of associated developmental delay. A cross sectional study was carried out for a period of six months [October 1, 2006 to March 31, 2007] at The Children's Hospital and Institute of Child Health Lahore. 100 Cases diagnosed as Cerebral Palsy on clinical basis were assessed for the type of cerebral palsy and the degree of associated developmental delay. Out of the total 100 patients 54% had quadriplegia, 32% had diplegia, 10% had himiplegia and 4% had monoplegia. The total fifty-four cases of quadriplegic cerebral palsy 54 had developmental delay and amongst them 4 [7%] had mild delay, 16 [30%] had moderate delay while 34 [63%] had severe delay. Amongst the total forty-six other three types of cerebral palsy 12 [26%] had mild delay, 6 [13%] had moderate delay and 28 [61%] had severe delay. The P-value was >0.05. Quadriplegic is the commonest type of CP, associated with the factors [peri-natal more than socio-demographic] and had significant effect on the developmental parameters

Idiopathic thrombocytopenic purpura [ITP]; frequency of clinical features in children

To find the frequency of common clinical features of Idiopathic Thrombocytopenic Purpura [ITP] in children and to see whether bone marrow aspiration needed in every child with typical presentation of ITP. Cross-sectional study. Hematology/Oncology Department, the Children Hospital and the Institute of Child Health Lahore Pakistan. April 2008 to March 2009 [One year]. A total of 30 children presenting with bleeding through any orifice with diagnostic evidence of ITP were evaluated by a cross sectional study. Common clinical features were recorded along with the related hematological parameters. After taking detailed history and thorough examination, relevant investigations like peripheral smear, bleeding time and coagulation screen were carried out in all cases. Bone marrow examination was done only in selected cases. The cases were then managed according to standardized management criteria. Male: Female ratio was 3:2, age ranging from 18 months to 14 years [mean +/- SD of 5.2 +/- years] with median age of 5.2 years. 26.6% [n=08] patients were having preceded history of upper respiratory tract infection. The positive clinical findings were bruises in 30% [n=09] cases; petechiae in 23.3% [n=07] cases; epistaxis in 23.3% [n=07] cases; gum bleeding in 13.3%[n=04] cases and hematuria only in 10% [n=03] cases. Anemia [<9gm%] was noted in 40% [n=12] patients. On peripheral smear examination this was microctic hypochromic in nature. Bleeding time was prolonged in all patients in line with documented thrombocytopenia i.e platelet count < 150,000. PT/APTT was normal in all 30 patients. Bruises, Petechiae and epistaxis are the commonest clinical findings of ITP. Bone marrow aspiration revealed inconclusive results in such cases