Interacting organic and psychosocial factors in children suffering from recurrent abdominal pain

Recurrent abdominal pain [RAP] in Children is a common problem, yet frustrating when unexplained. To estimate the incidence of recurrent abdominal pain in children in Alwahda outpatients clinics, Derna - Libya 1/7/2007 to 31/12/2007, and the possible contributing factors. Out of 2551 [1272 males and 1279 females] children, 437 [200 males and 237 females] were suffering from RAP [17.13%]. Those children were subjected to clinical evaluation, laboratory investigations [urine, stool, complete blood picture], abdominal ultrasonography, psychosocial screening using Pediatric Scale Checklist. The causes of RAP were 44.85% organic, 5.9% psychosocial, 44.39% interacting organic and psychosocial, and 4.81% functional RAP [functional abdominal pain in 52 [12%] children, IBS was diagnosed in 38 [8.7%] children, while nonulcer dyspepsia was diagnosed in 10 [2.3%] children. The most common organic causes of RAP were parasitic infestations in 210 [48%] of children [23.57% oxyuris, 19.22% Giardia lambilia and 11.67% Ascaris], urinary tract infections in 98 [22.43%], and chronic constipation in 57 [13.04%] of children. The results of this study have a bearing on the management of childhood RAP

utility of sonography for blunt abdominal trauma patients

An optimal screening procedure for blunt abdominal trauma should be fast, accurate, portable, and easy to perform. Many believe that ultrasonography [US] meets these requirements. To evaluate the use of abdominal US for detection of organ injury in patients with blunt abdominal trauma, and/or surgical follow-up as the standard of diagnosis. This prospective study was conducted from Jan 2007 to December 2007, at Alwahda Hospital, Derna-Libya. It included 56 patients [45 males and 11 females] with age ranging from 13 to 87 years; all were admitted for suspicion of blunt abdominal trauma. Patients were assessed clinically and followed within 30 min after admission by an abdominal sonography examination. Rigid abdomen was seen in 29 cases [51.8%], stap wound and pneumothorax in 9 [16.1%], tender abdomen in 8 [14.3%], polytraumatic in 7 [12.5%], abdominal blood collection in 1 [1.8%], gun shot in 1[1.8%] and blunt trauma in 1 [1.8%]. US showed that hem. perineum was seen in 26 cases [46.4%], multiple tear in 16 [28.6%], small tear in 10 [17.9%], laceration in 2 [3.6%], rupture spleen in 1 [1.8%] and not shown in 1 [1.8%]. As regard the outcome, 35 [62.5%] were discharged, 13 [23.2%] were complicated, and 8 [14.3%] were died. US is becoming the screening modality of choice in blunt abdominal trauma. US can help determine the need for surgical intervention within minutes of a patient's arrival. The rapidity, noninvasiveness, and portability of US are responsible for its increasing popularity

Psychological impact of chronic liver diseases in children

Care of children with chronic liver diseases is an important part of general practice. While the emphasis of management has traditionally been on the biomedical aspects of ill health categorized by specific medical diagnoses, other dimensions such as psychological manifestations may be important. To describe anxiety and depression in children suffering from chronic liver diseases. This case control study was conducted from January 2008 to December 2008 at outpatient clinic at Alwahda hospital, Derna-Libya. It included 350 children with ages ranging from 6 to 16 years with chronic liver diseases in addition to 700 children matched in age and sex with a rate 2 to 1 from school children of the same areas used as a control group. All children were subjected to full medical history, clinical examination and psychometric measures [I.Q by Goodenough -Harris, Anxiety Scale [CAS] and Depression Inventory [CDI]. The mean score values of IQ in children with chronic liver diseases was significantly lower than controls [82.6 +/- 10and 97.4 +/- 8, respectively, P<0.001] and the mean score values of CDI and CAS in children with chronic liver diseases [82.6 +/- 10, 13.3 +/- 6.4] were significantly higher than controls [11.2 +/- 3, and 7.6 +/- 2.6, P<0.001]. Chronic illness management offers a challenge to general practitioners to take on an expanded generalist role. Important psychological manifestations may be neglected and proposed case management reforms are a stimulus to reappraise the role of general practitioners in chronic liver illness and disease care