Cost benefit of the routine urinalysis

In the present health care environment, cost-benefit analysis is extremely important. In this screening program, the minimal cost of screening dipstick urinalysis in 1601 asymptomatic school children was determined. The process of screening was similar to all the studies. The minimal cost utilizing 3 general physicians was calculated. Costs were determined by using current charge for supplies ordered to perform tests, charges for tests performed by a commercial laboratory, and the cost of a final evaluation by a pediatric nephrologist. Initial abnormal urinalysis was found in 4.7% [76/1601] of patients. Upon retesting 1.37% [22/1601] of patients were calculated to have a persistent abnormality. The calculated cost was 1/530/000 Rials [164.5 $] to initially screen all 1601 patients with a dipstick urinalysis or 850 Rials [0.09 $] per patient. The calculated cost to evaluate the 22 patients with any persistent abnormality on repeat dipstick urinalysis was 246/840 Rials [26.5 $] or 11.220 Rials [1.2 $] per patient. This is the calculated cost for a single screening of 1601 asymptomatic pediatric patients. Multiple screening dipstick urinalysis in asymptomatic pediatric are costly and should be discontinued. We purpose that a single screening dipstick urinalysis be obtained at school entry age, between 6 and 7 years old, in all asymptomatic children

Breath-holding spells: an analysis of 43 cases

Breath holding spells, very often misinterpreted as epileptic seizures, are most common in children aged 6 months to 6 years of age. In this investigation, we sought to prospectively document the natural history of breath holding spells [BHS] among children with cyanotic, pallid and mixed type BHS referred for neurological consultation. This was a cross-sectional study in which a total of 43 children [23 boys, 20 girls] with BHS, admitted to the out patient clinic of the Children's Hospital Medical Center, between Sept 1998 and June 1999, were enrolled. A structured interview was under taken at the time of initial consultation to confirm BHS and its type, associated phenomenon, family history, sex and age at initiation of spells. Laboratory, electroencephalographic and electrocardiographic tests were done. Patients were between 1.7 and 42.8 months [mean age 18.4 months]. In 76.8% of cases, BHS began during the first 12 months of age. Anger and pain were the most common triggering factors [65.1%].A positive family history of BHS was identified in 51% and parental consanguinity was found in 30% of cases. The spells were cyanotic in 79.1% [34 children]. 78% of cases were iron deficient and 53% of cases had iron deficiency anemia. The results of this study emphasize the role of genetic factors in BHS; measurement of hemoglobin and serum ferritin is recommended all such cases