Assessment of the effect of inhaled corticosteroids on bone mineral content in asthmatic children

The use of inhaled corticosteroids [ICS] as a prophylaxis is now recommended in international guidelines for all patients using an inhaled bronchodilator more than once a day. We evaluated the effect of long term ICS therapy on bone mineral content of the lumbar spine, and the potential risk of impaired bone density in prepubertal children. The study was performed on two groups. Group I included 40 asthmatic children [mean age 8.3 +/- 0.5 years] on ICS in the form of beclomethasone dipropionate, 200 to 600 micro g/day [mean dosage 392 +/- 53.5 micro g/day]] for at least 6 months [mean 1.3 +/- 0.5 years]. Group II included 40 mild asthmatic children [mean age 8.2 +/- 0.6 years]. They are not receiving regular corticosteroids whether inhaled or systemic, but were treated only with inhaled beta[2]-stimulants whenever needed. The bone mineral density [BMD] was measured by dual energy X-ray absorptiometry [DEXA] densitometer. Measurements for the two groups were performed at the lumbar spine [L[2]-L[4]. Laboratory measurements included serum calcium, phosphorus and bone specific alkaline phosphatase. The study showed significantly higher BMD measurements in group II [mean 0.597 +/- 0.101 g/cm[2]] than group 1 [mean the 0.522 +/- 0.122 g/cm[2]] [P<0.05]. There were no statistically significant differences between level of serum calcium, phosphorus or bone specific alkaline phosphatase in both groups. A significant positive correlation was found between BMD and both weight and height of the children in both groups [r= 0.766, r= 0.859 in group I and 0.789, 0.825 in group II]. Our findings indicated that long term use of ICS slightly reduced the gain in bone mass in mild to moderately severe asthmatic prepubertal children. We recommended the use of lowest effective dose of ICS, the use of ICS with least oral bioavailability and follow up bone density of the lumbar spine at 6 months intervals

Combined ultrasonographic and clinical evaluation of high risk neonates for developmental dysplasia of hip: a prospective study

Developmental dysplasia of the hip [DDH] continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real time ultrasonography is valuable in detection of DDH in the young infants less than three months old. We performed a prospective study to evaluate the use of ultrasound screening that targets a select [high risk newborn] population for DDH aiming to increase the early diagnosis of this condition and decrease the incidence of late cases. From 2121 live births in our hospitals; we identified 188 [8.8%] newborns with risk factors for DDH. We followed these patients by clinical examination and ultrasound at birth, 6 weeks and 12 weeks of age. Initial ultrasound scan showed that 28% of the cases had findings suggestive of dysplastic hip, about half of them were clinically normal during neonatal examination. On subsequent scanning, the proportion of abnormal hip decreased gradually so that by 12 weeks, 80% had normal ultrasound appearance. Abnormality was more common in babies with breech presentation and family history of DDH. One female infant, not diagnosed by clinical examination at birth and with no risk factors, had abnormal clinical examination and ultrasound appearance of DDH by 12 weeks. From our study, we conclude that selective screening with ultrasound for the hip of newborns with specific physical and historical risk factors for DDH is more effective than clinical screening alone. It targets treatment to these infants who need it, and reveals a number of dislocated and subluxated hips that would otherwise be missed. It is better done when they are 4-6 weeks old. Clinical assessment cannot be restricted only to the first 2-3 days after birth but continued during the first year of life

Evaluation of patellofemoral congruence in young adults with painful knees

Sixty one young adults 13 to 35 years of age, complaining of knee pain without a history of trauma or evidence of arthiritis, were examined clinically and radiologically to assess the patellofemoral congruity. The quadriceps angle and patellar height were measured by Insall Salvati ratio and Blackburn and Peel ratio. Merchant technique was used to measure the sulcus and congruence angles. The study showed the presence of a variable degree of patellofemoral incongruity in these patients and so stressed the importance of assessing this articulation whenever knee pain in a young adult is present