Pattern of distribution of congenital anomalies in the newborn in damietta general hospital

the study was conducted at Damietta general hospital in the period from 1/ june / 2015 till 31/ may / 2016, 50 cases of neonates borne with dysmorphologic congenital anomalies and 50 control neonates were included in the study, Mothers of cases and controls were interviewed face to face, the pre-performed structured questionnaire was used, information were collected about families socio-demographic characteristics, life style, habits, history of chronic illnesses, long term medications, exposure to expected risk factors [ toxic substances, industrial hazards, environmental factors], consumption of certain foods, through general and systemic examination for included cases and controls, some investigations were done when needed. Results showed that the number of babies borne with dysmorphologic congenital anomalies in Damietta general hospital during the period from 1/ june/ 2015 till 30 may 2016 was 50 cases out of 1823 deliveries [ 1063 cesarean deliveries and 760 vaginal deliveries], this means that the pervalence rate was 2.7%

Systemic distribution of these anomalies was: digestive system anomalies 30% [the most common diagnosis among studies cases was tie tongue representing 28% of cases], musculosketal anomalies 20%, skin anomalies 14%, eye, ear, face and neck 10%, cardiovascular system anomalies 10%, genital organs anomalies 8%, cleft lip and palate 4%, chromosomal abnormalities 2%.the study showed that there is an increased risk of dysmorphologic congenital anomalies as: parental smoking [ active paternal and passive maternal] [OR=6.52], frozen food intake [OR=6.52], fast food intake [OR=3.08]

Some risk factors for neontal sensorineural hearing loss in a neonatal care unit

Background: The sensorineural hearing loss incidence ranges from 1 to 3 per 1.000 live births in term healthy neonates, and 2-4 per 100 in high-risk infants, a 10-fold increase

Objective: To estimate the incidence of SNHL among newborns in NICU at Al Monira Hospital, Cairo, Egypt; The neonates in the study were 710 [401Males and 309 Females] and had birth weight ranging from 680 to 5500 gm and the mean gestational age was 35.8+/-3 weeks. All the cases were screened for hearing loss using the transient evoked otoacoustic emission device, followed by a second stage screninf for those who failed and cases given a refer then undergo an Atomated Aditory Brainstem Response test

Results: In the studied cases, 76.7% had hyperbilirubinemia, 8.73% were of low birth weight [<1500 g], and 15.5% were on mechanical ventilation. In the fist screening phase, 80% were given a Pass response and 20% were given a Refer response for the right ear. In the second screening phase, 91% were given a Pass, 9% were given a Refer

Conclusion: A comprehensive intervention and mangement program must be an integral part of screening programs in the postnatal period. Awarenedd about the value of hearing screening is important. Further assessment of high prevalence of hyperbilirubinemia are needed

model of an evidence- based medicine in the management of pneumonia in a sample of preschool children

Background: Community acquired pneumonia [CAP] is a serious illness with significant costs to the society. Clinical decisions based on evidence based medicine [EBM] improve the outcome of management in an approach for appropriate treatment and prompt referral for care

Objective: Observing cases managed on EBM and comparing the outcomes with cases managed without EBM in a community hospital, providing approach for the clinician in evaluating and treating children

Methodology: A descriptive study on 56 children divided into 28 children EBM group and 28 children Non-EBM group, from June 2015 to May 2016 at Abo El Resh hospital, reviewing demographic, clinical data, observing therapies and outcomes

Results: EBM group showed statistically significant short days [6.8 +/- 2.1 days] for antimicrobial therapy than NEBM group [P=0.001]. outcomes of Non-EBM group who needed admission to ICU for 4.2 +/- 2.6 days, while no children of EBM group need admission [P=0.001]

Conclusion: Effective case management is strategy to reduce pneumonia- related morbidity. Guidelines based on sound evidence are available but used variable

Recommendation: Unifying clinical practice and scientific evidence could rationalize the use of health resources, improving health care quality

Evaluation of effectiveness of adjuvant remedies in treatment of allergic rhinitis in children

Background: Homeopathy is one of the most popular of complementary and alternative therapies

Objective: To evaluate the effectiveness of homeopathic medicine in the treatment of allergic rhinitis in children

Methods: A prospective follow up study was conducted in National Research Center [NRC] from the first of March till the end of February, Patients aged between 6 and 12 years with allergic rhinitis were treated by homeopathic remedies. Pediatric Rhinoconjuntivitis Quality of life questionnaire [RQLQ], Allergic Rhinitis Nasal Symptoms Score [ARSS], drugs usage and nasal smear eosinophils were done for all Patients at baseline and again after three months

Results: Fifty- three patients were screened, of whom 30 met the study eligibility criteria [average age 8.30+/- 2.322]. The mean RQLQ score was 4.44+/- 1.3 at baseline, after 3 months of treatment, the mean had fallen to 2.10+/- 1.66 [P< 0.001]. The mean overall total symptoms score decreased significantly from 9.23+/- 2,07 to 5.57+/- 4.07 [P< 0.001], Also, significant reduction in number of patients with positive nasal smears to 43.3% after homeopathic treatment [P< 0.001]

Conclusions: After homeopathic treatment, patients reported an improvement of their symptoms of allergic rhinitis as reported in Pediatric Rhinoconjuntivitis Quality of life questionnaire [RQLQ], Allergic Rhinitis Nasal Symptoms Score [ARSS] and nasal smear eosinophils

Recommendation: A formal randomized clinical trial is required

Pattern of Sleep Disturbance among children with cerebral palsy

Objective: to describe the pattern of sleep disturbances among children with CP [the age > 3 years] and to evaluate the relationship between sleep disturbances and neurological state

Methodology: This descriptive study included 124 children with CP; [80 males and 44 females] with an age ranging from 4 to 10 years. Children were randomly recruited from Pediatric Outpatient Clinic [1PGCS ]throughout the period from June 2015 till the end of January 2016. All participants were subjected to IQ test [Stanford- Binet Scale V5], EEG, the CSHQ and hemoglobin measurement

Results: Out of 124 children, 92.7% had spastic CP, 6.5% had dyskmetic CP andO.8% had hypotonic CP. Topographically spastic CPs were; 55.6% diplegic, while quadriplegia and hemiplegia were found in 28.2% and 8.9% of studied cases, respectively. Degree of intellectual disability among cases wasO.8% low average [89- 80], 8.1% were borderline [79- 70], 56.5% were mildly impaired, 14.5% were moderately impaired [54-40], 12.1% were severely impaired [39- 25] and 8.1% were profound. Hemoglobin estimation revealed that 8.1% were anemic. Abnormal EEG was found in 70.2% of cases, 81.36% of the epileptic CP children and 60% of the non- epileptics had abnormal EEG findings, 27.4% had focal epileptiform, 18.5% had generalized slow wave, 16.9% had generalized epileptiform and 7.3% had multi- focal epileptiform. Among the epileptic CP children; 52.54% experienced partial seizures and 47.46% experienced generalized seizures. Out of all studied children, 48.38% showed abnormal total CSHQ score indicating a clinically distinct sleep disturbance. There were significant correlation between sleep disturbance score and the degree of intellectual disability and also presence of epilepsy

Conclusion: sleep disturbance was significantly correlated to several co- morbid conditions including the degree of intellectual disability and the presence of epilepsy

descriptive study of diabetes mellitus among school children attending health insurance clinic

Background: Diabetes mellitus in children is a major health problem changing the lifestyle of affected children and their families

Objective: to describe the pattern of diabetes mellitus in the affected children including age, sex distribution, associated risk factors, presenting symptoms, presence or absence of complication, associated medical problems, management plan and therapy

Methodology: This study is a descriptive study, conducted on 83 children seeking for health insurance services for follow up and treatment of diabetes mellitus, their ages ranged from 5 to 17 years old attending Sherbein Health Insurance clinic from January, 2015 to April, 2015. Full history and clinical examination were taken. Laboratory investigation of routine urine, stool analysis, blood sugar, CBC and glycated hemoglobin were performed

Results: Results show that girls were more affected than boys. Increased incidence of onset of diabetes mellitus at age group [11-14] years. The associated risk factors were positive family history 39.8%, positive consanguinity 24.1% and early introduction of cow milk 27.7% of cases. Polyuria occurred in 90.3% of cases. Coma is the most common recurrent complication. School absence found in 21.7% of cases. Only 38.6% of cases have a dietary regimen. Regular activity found in 41% of cases. Results show that 90.4% of cases follow their insulin regimen and 38.6% of cases has a bad glycemic control

Conclusion: Positive family history of diabetes mellitus, positive consanguinity and early introduction of cow milk are considered risk factors for the incidence of diabetes mellitus in children. Lack of healthy diet and healthy life style increase the occurrence of complication

Depressive symptomatology in adults with diabetes mellitus

Diabetes mellitus has a strong association with the presence of depression. Depression occurs at high rates among individuals with diabetes mellitus and several studies suggest that diabetes doubles the risk of depression. The rate of complications in diabetic patients might be increased with comorbid. Authors aimed to assess the severity of depressive symptoms in adult diabetic patients using Beck Depression Inventory [BDI]. This descriptive study consisted of 88 diabetic patients [age 23-72 years] attending the diabetes outpatient center of Derna, Libya from June 2008 to December 2008. Depressive symptoms were measured by using the Beck Depression Inventory, Arabic version [Ibrahem and Alansary, 2001]. The mean age of patients was 52.18 +/- 13.7 years, 59.1% were males. Severe depression score was diagnosed in 16 [18.2%]; moderate depression score in 36 [40.9%]; and mild/ normal depression score in 36 [40.9%] of diabetic patients. More men than women with diabetes reported symptoms of severe to moderate depression [61.5% vs. 35.7%, P < 0.01]. A significant association was found between depression and complications of diabetes [r = 0.29, P < 0.01]. All patients with severe depression score [18.2%]; had retinopathy and neuropathy complications. The prevalence of depression in Derna diabetics is high. There is growing recognition within the medical community that depression has a strong influence on health outcomes. Screening for depression in patients with diabetes is recommended

Morbidity pattern of pre-school children in Derna- Libya [2007]

To assess the current health status and morbidity pattern among preschool children at Derna, Libya during 2007. This study was conducted in all the three kindergartens in Derna between [15/10/2007 and 15/11/2007], the total number of children was 770. In addition, 1000 children [3-5 years old] presented to outpatient paediatric clinic- Derna between [1/6/2007 and 31/12/207] were included in the study. General examination and assessment of all body systems [Eye, ENT, teeth, skin, chest, CNS, abdomen and cardiovascular systems were examined and evaluated]. As regards morbidity pattern in kindergartens in Derna [287 morbidity cases of total 770 children], dental cares was highly frequent at 28.7%. As regards children [3-5 years old] presented to outpatient paediatric clinic- Derna, the mean value of weight was 14.6 +/- 2.7 Kg, height was 109 +/- 5.4 cm. head circumference was 48.7 +/- 8.6 cm, hemoglobin was 10.8 +/- 1.48 gm/dl and total leukocytes was 7.1 +/- 2.4/1000 cc. Fever represented 52.2%, diarrhea 28.2%, colic 23.8%, rash or itching 22.3%, cough, wheeze, rhinitis 19.6%, enuresis 19.6% and poor appetite 13.0% of cases. Respiratory tract infections represented 44.4%, gastroenteritis 22.2%, dental caries 22%, normal for follow up 13.3%, UTI 8.9%, Colic 6.7%, others 4.4% of cases. Results of the present study proved the need of intervention to prevent morbidity conditions as education about dental health, good hygiene and proper nutrition and must be early detection of these cases with early intervention as squint and error of refraction to prevent complication

Driveway motor vehicle and bicycle injuries in children at Alwahda Hospital, Derna-Libya [2005-2006]

To describe the frequency, nature and outcome of driveway injuries in children. A retrospective study of driveway-related injuries in children less than 16 years of age admitted to Alwahda Hospital, Derna-Libya, from January 2005 to December 2006, and deaths reported. Circumstances of injury; type and number of injuries were identified. A total number of 104 children were admitted to Alwahda Hospital with driveway-related injuries [2005-2006], representing 17.3% of all with motor vehicle injuries. Fourteen deaths representing 13.5% of cases were reported. Males were 85 [81.7%] and females were 19 [18.3%]. Head injuries represented 41.3% [43/104] of cases followed by extremities 31.7% [33/104] then extremities with multiple injuries - 16.3% [17/104]. Sprain or contusions represented 43.3% [45/104] of cases, open wound 26.9% [28/104] and fractures 20.2% [21/104]. Cars were involved in 79% of all injuries, light commercial vehicles or bicycles were involved in 21%. About 75% of injuries occurred in the afternoon or night, and 45% of injuries took place in the summer months. Driveway injuries in children account for a significant proportion of paediatric pedestrian motor vehicle injuries and deaths in Derna. Prevention represents the only effective approach to reducing deaths from this cause

Laparoscopic and open cholecystectomy in Alwahda Hospital during 2007, Derna-Libya

Cholecystectomy is one of the most frequently performed operations. Various series have demonstrated that the laparoscopic approach leads to a reduction in postoperative pain and diminished postoperative hospitalization and disability. To evaluate laparoscopic Cholecystectomy [LC] in relation to open Cholecystectomy [OC] in the surgical treatment conducted in Al Wahda Hospital, Derna. Libya, during 2007. Sixty patients undergoing elective Cholecystectomy for symptomatic gallstones were studied. The patients were allocated in the two groups of 30 each by simple random technique. Group-1 underwent OC and Group-11 underwent LC. The patients were then followed up to pick up signs of wound infection. In case of infection, the degree of infection was documented and the results analyzed. The age of patients ranged from 21-80 years with the maximum number in the 4th decade [30] patients. The commonest presentation was chronic cholecystitis in both groups, 15 patients [50%] in laparoscopic and 12 [40%] patients in OC group. There was no wound infection in any case of chronic cholecystitis [zero] out of 27 cases, ail 4 instances of wound infection in occurred in acute cholecystitis / empyema. [4 / 33] representing 6.6%. In case of LC group there was only one of Class-ll wound infection in a patient suffering from empyema. In case of OC there were 3 cases of wound infection. Out of these, one was of class-ll and two of Class -III. Both Class- II infections. The frequency of wound infection was three times as common in OC as compared to LC

Evaluation of a treatment protocol for mastalgia with topical NSAIDs at Alwahda Hospital, Derna, Libya

Breast pain is the most common breast symptom causing women to consult primary care physicians and surgeons. Mastalgia is more common in premenopausal women than in postmenopausal women, and it is rarely a presenting symptom of breast cancer. Many medical treatments have been used to relieve mastalgia, but some medications produce undesirable side effects. The aim is to evaluate the use of topical NSAIDs in the treatment of mastalgia. From January 2006 to December 2006 a total of 176 women underwent breast examination at Alwahda Hospital, Derna, Libya. Subjects were aged between 19 and 54 years old. The experimental protocol included a prospective study of a group of 109 patients suffering from mastalgia with a 3-month follow-up. Patients witli mastalgia who had normal results on routine biochemistry and hormonal testing and negative evaluations for breast cancer were enrolled in the study. Of those admitted to the study, only 100 completed the course. Patients were assigned randomly to use of a topical NSAID preparation [Voltaren gel] every eight hours [50 women] or a topical placebo cream applied to the breast skin [50 women]. All of the patients were advised to decrease their intake of caffeine. Pain was measured using a visual analog scale during the three months of treatment. After three months, the pain score was markedly improved among participants receiving the topical NSAID treatment. Almost 50 percent of the treated participants reported no pain at the end of the study. No side effects occurred among any of the participants. Applying topical NSAIDs over a three-month period can relieve the pain of mastalgia with minimal adverse effects

Nutritional status of children attending first year primary school in Derna, Libya in 2007

School-age children attempt to develop personal independence and establish a scale of values. Individual variations in children become more noticeable in such areas as rates of growth, activity patterns, nutrient requirements, personality development and food intakes. Malnutrition is one of the leading causes of disease. To assess the nutritional status among children attending first year primary school at Derna [2007], The study was conducted between [15/7/2007 and 15/11/2007] which was the time for children to have the clinical Examination and vaccination for school registration. The total numbers of children entered first year primary school in 2007 were 1765 [900 males and 865 females]. Clinical examination was done including: height and weight using standard techniques and general examination of all body. Weight, height, and age data were used to calculate z-scores of the nutritional indicators in comparison to the newly published WHO growth curve. Data were analyzed using WHO Anthro 2005 software and SPSS version 13. The mean value of weight was21.3 +/- 3.3 kgm, of height was 115.7 +/- 5.4 cm, and of BMI was 16.1 +/- 3.1. In girls, the mean value of weight was 20.6 +/- 3.4 kgm, of height was 115.9 +/- 5.6 cm, and of BMI was 15.6 +/- 3.5. Out of 1765 children, 320 [18.1%] of children were underweight, 57 [3.2%] were overweight and 24 [1.4%] were obese. Out of 1765, 1364 [77.3%] of children had normal weight. Undernutrition was more likely to be found in males [19.6%] than in females [16.7%] [OR=1.22, 01=0.95-1.56]. Overweight was found slightly more in males [3.3%] than in females [3.1%]. Obesity was found in males [1.3%] and the same rate in females [1.4%]. We found that 77.3% of children had normal weight, 18.1% of children were underweight, 3.2% of children were overweight and 1.4% of children were obese. Further studies are needed to verify possible regional differences. Combined overweight and stunting is more likely to be associated with central obesity and its metabolic effects. Similar surveys are needed to verify trends of nutritional problems

Study of feeding patterns during the first three months of life in and out maternity wards

Breast feeding promotion and immunization are important interventions of child survival programs, especially in developing countries. To study feeding patterns during the first three months of life and to identify possible factors associated with early termination of breast feeding. A retrospective study consisting of the analysis of all available feed charts of infants born in Princess Mary Maternity Hospital were carried out [between 7/2/1986 and 6/5/1986], 80 were selected according to inclusion criteria. In addition, 60 babies were chosen from Al Wahda Hospital, Derna, Libya [from 1/1/2007 to 31/3/2007]. Bottle feeding is shown to be more associated with the occurrence of diarrhea as opposed to fully breast feeding [P<0.05]. The mean birth weight in Princess Mary Maternity Hospital, U.K was significantly higher than that in Al Wahda Hospital, Derna, Libya [3.58 +0.46 and 3.45 +0.7 Kgms respectively, P<0.001]. Only 53.9% of mothers included in Princess Mary Maternity Hospital sample were fully breast-feeding on discharge from hospital. In Al Wahda Hospital, Derna, Libya, 75% of mothers included were fully breast-feeding on discharge from hospital. there were more cases of diarrhea among those babies who wee bottle fed or partially breast fed cases [46.7%] out of 15 babies who were bottle fed or partially breast fed, contrasted with only 4 cases [8.7%] of diarrhea among those who were fully breast fed. Many reasons were given by mothers for stopping breast-feeding or introducing bottles. The two most important were insufficient breast milk, and problems with breast and/or nipples. Two factors are likely to affect duration of breast-feeding: birth weight and age of the mother

Seroepidemiology and efficacy of a mass hepatitis B immunization program in children in Derna, Libya

Hepatitis B virus [HBV] infection represents a serious public health problem in many countries of the world. Libya was considered as one of the countries with a prevalence of 2.2% infection. A mass hepatitis B vaccination program was conducted to overcome this health problem. To determine the frequency of serological markers of HBV among children born after the HB vaccination program; and to evaluate the immune response to HBV vaccine. A case-control study included 300 children with age ranging from 12 months to 72 months randomly selected from community health center in Derna, Libya, during the year 2006. They were tested for HB markers including Anti-HBs, Anti-HBc. The protection rate among completely HB-vaccinated children [3 doses] was 96.7%, significantly higher than that in incompletely vaccinated children [one or two doses only] 91.3% [P < 0.05]. The infection rate was 3.3% among completely vaccinated children, while it reached 8.7% among incompletely vaccinated children. Two percent and 6% of the completely and incompletely vaccinated children were positive for HBsAg, respectively [P >0.05]. This study indicates the efficacy of HBV vaccination. But to achieve maximum protection it is important to adhere to the complete vaccination schedule

Morbidity and mortality patterns of infection among under five year's children and the effect of intervention by vit. A.

This study aimed to explore the relationship between vitamin A status and frequency of infection among infants and preschool children and evaluate the effect of intervention by vitamin A supplementation and its efficacy in reduction of infant morbidity in preschool children. Seventy children suffering from recurrent infection [46 males and 24 females], their ages ranged between 6 and 60 months, supplemented with an oral daily dose of vitamin A of 30 ug RE/kg/day for eight weeks then followed up for 10 months after supplementation. Results showed that 34 patients out of 70 [48.6%] who suffered from high frequency of infection/year [>12 time/y] significantly declined to 6 [8.5%] after intervention. Highly infected children [with CRP> 24 mg/L] were significantly dropped from 38 [54.3%] to 6 children [8.6%] after intervention. Mean values of plasma retinol was significantly increased after intervention [29.6 +/- 3.7 and 4.1 ug/dl, P<0.001]. Plasma retionol by multiple regression analysis, was the most contributing factor affecting frequency of infection in young preschool children [P<0.01]. So, it could be concluded that severity as well as frequency of infection is proportionate with serum retinol level. Supplementation by vitamin A or its food fortification must be done in less than five years children

Database by meta-analysis: health behavior and health services for cardiovascular diseases in Egypt

Cardiovascular diseases [CVDs] represent major public health problem in many countries including Egypt. There are limited national data about morbidity and mortality of CVDs in Egypt. Purpose: was to evaluate the health behavior changes and health services regarding risk factors of CVDs for all age groups in Egypt through data base by Meta-analysis [Type 3]

Methods: data were collected from the available electronic national data base from available theses, medical and nursing reports, and published research relevant to CVDs from allover Egypt

Results: The total number of persons included in this project was 4110 cases from 104 medical, and 14 nursing studies, hospital and population based. The cardiovascular cases included 2906 males and 1204 females. These studies extended from 1995-2002. Most of studies were at Ain Shams, Cairo and Alexandria University hospitals, and the Ministry of Health and Population hospitals. The studies revealed that, CVDs were higher in the year 1997, among age group 40-60 years and in male group. Also, the study indicated a significant correlation between adverse life-style [increase serum lipids, hypertension, smoking, obesity and inactivity] and occurrence of CVDs. Although more than half of cases attended to the university hospitals for obtaining health services, two thirds of the cases did not receive follow-up services

Conclusion: According to this preliminary study concerning Egyptian data, CVDs are still a presentable problem. There is relative increase of prevalence of CVDs in the exception of the last two years

Recommendations: The study revealed 1] the importance of utilizing the available data from theses and other sources of data related to CVDs to build up an electronic database for these diseases and this procedure can be used similarly in other medical and nursing areas, 2] Governmental commitment is urgently required for the establishment of a national program for prevention and control of CVDs

Comparison of the physical growth among Egyptian children [3-5 years] in two different socio-economic levels

600 preschool children with age ranging from 2,5 lo 5,5 years old were equally selected from Masr El - Gedida [High Socioeconomic level, and Imbale [Low Socioecomic level]. Anthropometric measurements were recorded for height, weight, chest and arm circumference. Results showed steady gradual increase in all poraneters for sex and socio - economic levels as the age increases. There was a significant decrease in low socio economic group as compared to the high one. Girls were more effected by socio - economic condition than boys