Childhood diabetes in alexandria: mode of presentation and progress

This study was designed to characterize clinical and autoimmune features in all children with newly diagnosed IDDM diagnosed between 1994 and 1998 as well as to follow up their clinical progress. The study was performed on all newly diagnosed children with IDDM presented to the Alexandria University Children's Hospital between 1994 and 1998 [60 children]. After the primary diagnosis and management, the patients were followed up every 2-3 months in the IDDM clinic. The details of any medical problem during the period of study were recorded during the visits. A questionnaire was completed for each newly diagnosed child. This questionnaire was divided into 4 sections and focused on demographic and family characteristics, family history of diabetes, previous medical history of the child and manifestations before diagnosis. Details of clinical and laboratory data at diagnosis were recorded. The clinical features evaluated were the duration of symptoms before admission to the hospital. All blood samples were obtained before initiation of insulin therapy to measure blood glucose, hemoglobin A[1c], venous blood gases, serum electrolytes and ketones. During each clinic visit, the children were examined with emphasis on nutritional and growth data and their anthropometric measurements recorded. The height standard deviation score, body mass indices and growth velocity per year were calculated and recorded. Hemoglobin A[1c] was estimated every clinic visit. Hormonal evaluation for all children included measurement of free thyroxine [FT4], and IGF-1. The results included family history of autoimmune diseases, symptoms occurring within 3 months prior to diagnosis. Polyuria was the most common presenting symptom present in 87%, followed by fatigue/lethargy/malaise [53%], febrile illness [23%], nausea and vomiting [20%], and abdominal pain [15%]. Secondary nocturnal enuresis occurred in [23%]. Mumps was reported in 2 children while chicken pox was reported in 1 child 3-5 weeks before diabetes was diagnosed. The plasma glucose level was 22.3 +/- 5.6 mmol/L, it was related neither to age nor to duration of symptoms. The HbA[1c] concentration was 15.5 +/- 2.9%. Levels of HbA[1c] were correlated with serum glucose concentration. The frequency of DKA, its degree at presentation and associated biochemical changes is presented. As regards the progress of the disease, insulin was withdrawn in two of the 60 children in whom remission lasted 6 and 14 weeks respectively. The risk of readmission was 0.2 per patient during the first year and 0.12 during the second year. Re-admission for poor glycemic control was more common in young children. Children with good glycemic control had better linear growth compared to those with bad glycemic control. With follow up, 3 children developed hypothyroidism, 1 developed vitiligo, 1 developed chronic active hepatitis, 2 developed significant proteinuria. One child died of hepatorenal failure at the age of 5 years. In conclusion, children diagnosed as having diabetes below 5 years seem to present acutely and have highest risk of developing hypoglycemia during the first year after diagnosis

Bacterial coinfections in infants with bronchiolotis

Although bronchiolitis is a viral infection of the lower respiratory tract in children, yet, antibiotics are widely prescribed in the treatment of those patients. This study investigated the frequency of bacterial co-infection in infants with bronchiolitis, in relation to the clinical signs, X-Ray findings and total and differential leukocytic count. The overall aim was to try to find out simple clinical and/or investigation criteria to rationalize antibiotic therapy in such patients. Sixty-nine patients with clinical diagnosis of bronchiolitis [34 boys and 35 girls] with age range of 1 - 15 months, mean 5.09 +/- 2.84 months were included in the study. Bacterial coinfection was diagnosed by culture of sputum obtained by tracheal aspirate done under direct laryngoscopic visualization, using sterile mucous extractor. Bacteria was isolated from 37.6% of the studied children, Staphylococci, pneumococci, beta hemolytic streptococci were the most common invaders. High and prolonged fever, toxic look, wide spread crepitations on chest auscultation, were more frequently encountered in patients with concomitant bacterial infection, and the difference was statistically significant. Radiological picture of wide spread infiltrates and/or consolidation was a characteristic feature of patients with positive bacterial culture 61.4%, compared to 4.6% in those with no bacterial isolates. Meanwhile, higher total leukocytic count was observed in patients with bacterial coinfection [mean 11.7 +/- 3.8] compared to those with negative culture [9.89 +/- 3.1]. Patients with bacterial coinfection required significantly longer duration of in-patients treatment [7.6 '2.9 days] compared to those without [4.7 +/- 1.9]. Among the above mentioned clinical and investigations criteria, X Ray findings showed high specificity [95.3%], positive and negative predictive values [88.8%, and 80.3%], but is less sensitive in diagnosis of bacterial coinfection [61.5%]. The presence of wide spread crepitations is more sensitive [79.9%], carries high negative predictivity [85%], but less specific [79%]. The presence of both together is highly specific [97.6%], but less sensitive and predictive. It was concluded that careful clinical assessment of patients with bronchiolitis can help to identify candidates for antibiotic therapy, particularly so, if radiological facilities are available

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