Abusive head trauma in children: the extent and clinical characteristics

Abusive head trauma [AHT] is the leading cause of death in child abuse. Knowledge about AHT in Bahrain is lacking. The objectives are to identify the extent of AHT in Bahrain, victims' characteristics and the clinical features. Child Protection Unit, Salmaniya Medical Complex. Retrospective review. Abusive head traumas were evaluated between 2000 and 2009. Victims' characteristics, patterns of presentation and result of investigations were recorded. SPSS version 17 for Windows was used for data management and statistical analyses. Twenty-three patients with the diagnosis of AHT were identified. In 18 [78%] the age is one year or below; 16 [70%] were males. No plausible explanation for the head injuries was given in 16 [70%] patients. Vomiting was seen in 13 [56.5%], seizures in 13 [56.5%], altered state of consciousness in 12 [52%], irritability in 12 [52%], difficulty of breathing in 9 [39%], coma in 8 [35%], apnea in 4 [17%], chocking episodes in 3 [13%] and two were dead on arrival. The total death after AHT was four [17%]. Subdural hemorrhage was identified in 9 [39%], cerebral hemorrhage in 17 [74%] and retinal hemorrhage in 13 [56.5%]. Evidence of blunt impact were bruises in 13 [56.5%], skull fractures in 9 [39%], localized scalp swelling in 5 [22%] and subgaleal hematoma in 2 [9%]. AHT is associated with a high morbidity and mortality. The presenting symptoms of AHT are non-specific; therefore, maintaining a high index of suspicion is paramount. All children presenting with a life-threatening event or head injuries without a plausible explanation should undergo a multidisciplinary assessment for AHT. A prospective national study is required

Red cell glucose-6-phosphate dehydrogenase phenotypes in Iraq

We attempted to characterize biochemically glucose-6-phosphate dehydrogenase [G6PD] variants in Iraqi individuals. Thus 758 healthy Iraqi males aged 18-60 years were randomly selected and 46 [6.1%] were G6PD deficient. Although the predominant non-deficient G6PD phenotype was G6PD B [92.6%], G6PD A+ was found in polymorphic frequency [1.3%]. In the deficient group, 31 cases were fully characterized, including 17 cases with features consistent with G6PD Mediterranean variant, while 12 had other biochemical features and were labelled as non-Mediterranean variant. The remaining two deficient cases were characterized as G6PD A- variant. The presence of a significant number of non-Mediterranean variant was unexpected and may be related to the more heterogeneous background of the Iraqi people