Behavioral and emotional impact of sickle cell disease in young children with repeated hospitalization

Background: Chronic disease such as Sickle Cell Disease [SCD] in children with a history of repeated hospitalization is distressing for children as well as parents or guardians, leading to anxiety and has bad effects on the psychological slate of children and their families

Objective: The aim of the study was to determine the overall effect of SCD on the behavior of young children age 1[1/2] -5 years old with repeated hospitalization [as an indicator for severe symptoms] compared to a control group of healthy children routine vaccination vaccination

Patients and Methods: Thirty five child with SCD and repeated /hospitalization [group I] were recruited from pediatric clinic and the same number of age and gender matched healthy children [group II] as a control group came for vaccination. Socio-demographic data, child behavior checklist [CBCL] 1[1/2] - 5 years and diagnostic and statistical manual [DSM] oriented scale were collected through a personal interview with parents/legal guardians of children in the two study groups using a structured questionnaire

Results: The children with SCD had significantly higher behavioral changes on CBCL, anxiety/depression. somatic complaint, withdrawn and aggressive behavior and internalizing symptoms [65.2 +/- 14.2. 66.7 +/- 12.6, 63.4 +/- 11.6, 60.4 +/- 10.4 and 64.7 +/- 14.7 respectively] compared to healthy control group [55.1 +/- 4.6, 54.4 +/- 3.1, 53.2 +/- 2.6, 56 +/- 6. 9 and 51.5 +/- 4.4 respectively,], DSM oriented scale showed that children with SCD scored higher in pervasive developmental and oppositional defiant problems [60.90.2 and 60.6 +/- 10.4 respectively, compared to control group [53. 9 +/- 5.4 and 56.7 +/- 2.7 respectively]

Conclusion: Young pediatric patients with SCD and history of repeated hospitalization put kids at risk for behavioral and emotional abnormalities. Good pain control, psychiatric management and support and avoidance of unpleasant experiences can ameliorate these bad effects

Evaluation of homocysteine level in children with cerebrovascular stroke

Cerebrovascular stroke is an important cause of morbidity and mortality in children. Recent epidemiologic data suggest that 3200 cases of stroke occur per year in the population aged between 30 days and 18 years in the US alone. Although outcome for stroke in children is significantly better than in adults, 20% die and 50%to 80% are left with significant disability. Moderately elevated homocysteine status is considered an independent risk factor for occlusive arterial disease in the peripheral arteries and cerebral vessels. Higher homocysteine levels could cause either isehemic stroke by it s procoagulative effects and induces endothelial damage or hemorrhagic stroke by promoting vascular inflammation and plaque rupture. To evaluate the role of homocysteine as a risk factor of cerebrovascular stroke in children. The study was conducted in intensive care and emergency units in Pediatric Assiut University Hospital during the period between October 2005 and September 2006 and included 52 children with stroke [65.4%ischemic and 34.6% hemorrhagic] and contained 34 boys and 18 girls, aged 30 days to 4.5 years after exclusion of stroke due to trauma and tumor as vell as 20 apparently healthy children with matchable age and sex as control group. All cases were evaluated by Pediatric National Institute of Health Stroke Scale on admission as a measure of stroke severity, besides meticulous history taking and thorough clinical examination. Evaluation of plasma levels of homocysteine, random blood glucose, serum sodium and potassium were done for all cases and controls. The annual frequency rate of stroke was 0.3%. The mean +/- SD of random blood glucose was significantly higher in children with ischemic compared to hemorrhagic stroke and in both compared to control. The mean +/- SD of serum sodium was significantly higher in ischemc compared to hemorrhagic and control groups. The mean +/- SD of serum potassium was significantly lower in ischemic and hemorrhagic stroke compared to control The mean +/- SD of homocysteine in children with ischemic and hemorrhagic strokes were more than control group with a statistical significant difference while, no statistical significant difference was detected between the two groups. The odds ratio of homocysteine for ischemic and hemorrhagic stroke were [3.3, CI 2.38-26.9] and [1.9, CI 2.3-46.8] respectively. The mean +/- SD of homocysteine was significantly higher in children with hospital stay more than 2 weeks, in children with PedNIHSS >/= 12 and in non survivors. Hyperhomocysteinemia is significant risk factor of stroke in children

Cardiovascular changes in patients with type I diabetes with and without autonomic dysfunction

Diabetic complications - either microvascular or macrovascular - represent a major cause of morbidity and mortality in diabetic patients[1]. Cardiovascular autonomic neuropathy is one of the complications of type I diabetes mellitus. It may lead to life discomfort or even it may be the direct cause of death in diabetic patients. Early detection of cardiovascular autonomic neuropathy is of major clinical interest that could lead to a more intensive supervision of diabetic patients.[2] Cardiovascular autonomic neuropathy induces different functional cardiac changes, especially a reduction in left ventricular contractility and changes in ventricular repolarization.[3] This study was designed to estimate the prevalence of cardiovascular autonomic neuropathy among a group of children with type I diabetes mellitus, to assess the cardiac function in the same group of patients by echocardiography and to relate the abnormalities to the duration of diabetes, glycemic control and other risk factors

Effect of oral stabilized oxygen on patients with fallot's tetralogy

Fallot's tetralogy is a common congenital cyanotic heart disease affecting 0.2-0.3 per 1000 live births.[1] This study was done to evaluate the effect of oral stabilized oxygen therapy on patients with Fallots tetralogy. The present work included 15 children [10 boys and 5 girls] with an age range from one month to 8 years diagnosed as Fallot's tetralogy. The patients received oral stabilized oxygen for one month, Blood gases were done before, one, two and four weeks while the patient on oral oxygen therapy and two weeks after stoppage of oral oxygen. Echocardiography, complete blood count and hematocrit values were done before starting and after one month while the patient was on oral oxygen therapy. It was found that there was marked rise In SaO[2], and PaO[2] while the patients were on oral oxygen therapy than before initiation and after stoppage of oral oxygen therapy but without any echocardiographic changes, indicating that these changes in blood oxygenation are merely due to gastrointestinal absorption of oxygen. There was highly significant reduction in the level of hemoglobin, red cell count, and Hematocrit after than before oral oxygen therapy

Prevalence and risk factors of nocturnal enuresis in a rural area of Assiut governorate

Nocturnal enuresis is a common problem that can be troubling for children and their families. Nocturnal enuresis is the involuntary and undesirable wetting that occurs during sleep beyond the age of anticipated bladder control. Children are not considered enuretic until they have reached five years of age. Although comparison of studies are difficult because of variation in the definition of enuresis and in the age range of population studied, true geographical differences in prevalence and in natural history of enuresis seem to exist, arising from racial, cultural, or environmental factors. The literatures about the prevalence of enuresis in rural areas of Assiut governorate are limited. The aim of the study is to evaluate the prevalence of nocturnal enuresis among children aged 5-12 years old in a rural area of Assiut governorate, this is in addition to study risk factors associated with nocturnal enuresis among enuretic children in this rural area. A cross-sectional community- based study was carried out in mankabad village. A total of 592 houses were visited. All eligible children [5-12 years] in the selected houses were included. The first house was selected randomly, and then every third house of the village was included. A well-designed questionnaire was used for data collection. The questionnaire sheet was developed to assess the prevalence and risk factors of nocturnal enuresis among children. This study included 1148 children distributed in 592 houses in mankabad village. The prevalence of enuresis was found to be 17.8%. diurnal as well as nocturnal enuresis occurs in 19.6% of the enuretic group. The most frequent cause of nocturnal enuresis expected by the mother was deep sleep [24.5%], followed by urinary tract infection [13.7%]. As regards the dealing of the families with problem of nocturnal enuresis, 15.7% mentioned that they consult others and about 29.4% consult a physician, 30.4% punish their children, while 24.4% do nothing. The prevalence of enuresis was insignificantly higher in males [51.9%] than females [48.1%] [p=0.209]. The mean age of enuretic children [5.9 +/- 2.1] years is significantly lower than that of non-enuretic children [8.7 +/- 2.2] years [P<0.001]. Birth order has no significant effect on the prevalence of enuresis. The prevalence of enuresis was significantly higher among children of illiterate fathers than among those of educated fathers [p