Specific language impairment: effect on later language development: a literature review.

BACKGROUND: Children with specific language impairment (SLI) are at considerable risk for later language development. However there has not been a good literature review to provide understanding and to get information relative to parental counseling and decision making for further management. OBJECTIVE: To summarize the literature review on SLI and effect on later language development. MATERIAL AND METHOD: Longitudinal studies were systematically explored to seek evidence- based information to confirm the lasting effect of SLI in later language development. RESULTS: Natural history data indicated that approximately 50% of children with specific expressive language delay spontaneously remitted or outgrew it at age 5-8. However, long-term follow-up studies showed their language problems emerged later at age 15. The rest of the children's (50%), language impairment persisted and had a high risk for SLI later. CONCLUSION: The results suggest that active intervention should be performed as soon as possible for children with persisting SLI.

Risk factors associated with language development problems in childhood--a literature review.

BACKGROUND: Children with language problems are found to have a higher risk for future academic difficulties and learning disabilities. Conclusions from related literature were in many ways inconsistent. OBJECTIVE: To identify systematically, the existing literature, and factors that influence language development in children. MATERIAL AND METHOD: Databases of scientific literature were screened through the internet for publications that involved factors effecting language development in childhood. Hard copies of related scientific journals were also sought for relevant topics by the authors, making use of reference lists of publications, and citation search. Studies were included if they were published since 1984 and investigated factors that affect language development in children. They were excluded if they were not original research articles. RESULTS: Fifteen studies were included for this review--a case-control study, a cross-sectional study, and thirteen longitudinal studies. Most studies demonstrated that the following factors affect language development--antenatal care, Apgar scores, birth weight, premature delivery, birth order, parental education, environmental factors, gender of the children, and family history with specific language impairment. CONCLUSION: Perinatal/postnatal and environmental factors influence language development. Such factors should be taken into account as confounding factors in further language development studies.

Randomized trial of atorvastatin in improving endothelial function in diabetics without prior coronary disease and having average cholesterol level.

OBJECTIVE: The aim of this study was to determine whether HMGCoA reductase inhibitor with atorvastatin can modulate endothelial function in type II diabetics having average cholesterol and no prior cardiovascular disease. MATERIAL AND METHOD: Type II diabetics, with no prior cardiovascular events and total cholesterol at admission of < or = 200 mg/dl or LDL < or = 140 mg/dl, were randomized to placebo (n = 20) or atorvastatin 20 mg daily (n = 22) for 30 weeks. Brachial artery endothelium-dependent dilatation or flow-mediated dilatation (FMD) and endothelium-independent dilatation or nitroglycerine-mediated dilatation (NTGMD) were measured at baseline and after thirty weeks of treatment. RESULTS: Baseline clinical characteristics were similar at admission in both groups. After thirty weeks of treatment, the FMD did not significantly change in either the atorvastatin or placebo group (4.11 +/- 1.05% to 3.01 +/- 1.27% vs 5.75 +/- 1.93% to 6.45 +/- 1.41%, respectively; p = 0.46 by analysis of covariance). Similarly, the NTGM did not change in either group. CONCLUSION: The addition of HMGCoA reductase inhibitor with atorvastatin did not improve endothelial function in type 2 diabetes having average cholesterol with no prior cardiovascular disease, despite an improvement of the lipid profile.

Incidence of febrile seizures in thalassemic patients.

BACKGROUND: Febrile seizures are the most common seizures in children. Their incidence is 2-5% or 4.8/1000 person-years. To date, the pathophysiology of febrile seizures is unknown. But several hypotheses have been proposed that it may relate with plasma iron level. Such low incidence in thalassemic patients whose plasma iron level is high could give some clues to this hypothesis. PATIENTS AND METHOD: Four hundred and thirty thalassemic patients from the hematology clinic at two hospitals in Northeastern Thailand were consecutively enrolled between Febuary 2003 and January 2004. The authors reviewed all the medical records of the patients and interviewed their parents for occurrence of febrile seizures. RESULTS: The patients included 208 males and 222 females with an age ranged of 6 months to 10 years (mean = 6.36 years). Twenty patients (4.7%) had siblings who had febrile seizures. There were 3 episodes out of 2,734 person-years. The incidence was 1.10 per 1,000 person-years (95% CI: 0.23 to 3.20). This was statistically lower than that of the general population (p-value = 0.002). Therefore, the rate in thalassemic patients was 4.4 times less than that of the general population (95% confidence interval: 1.4 to 22.6). CONCLUSIONS: The incidence of febrile seizures in thalassemic patients was very low compared to that of the general children population. Thus, iron overload may be a major factor involving the brain metabolism that prevents febrile seizures.

A controlled trial of a new treatment for galactocele.

BACKGROUND: Needle aspiration, followed by excision should it recur, is the standard method of treating galactocele. Villagers in Northeast Thailand traditionally treat galactocele by probing the obstructed duct with double strands of pleated human hair. The aim of the study was to mimic this method in order to scientifically assess its effectiveness. PATIENTS AND METHOD: Sixteen patients were consecutively enrolled between 1995 and 2001. They elected either standard needle aspiration (Group A) or treatment by 6-0 nylon probing (Group B). The results were compared using the Fisher's exact and Mann-Whitney tests at p-value < 0.05. RESULTS: The two groups were similar regarding the children's age, first para, mass size, and duration of symptoms, but patients in the aspiration group were considerably younger than the nylon probing group. Both methods reduced the symptoms completely. Pain from treatment was reported by all patients in the aspiration method while there were none in the nylon probing method (p < 0.001). The aspiration method took 14.8 minutes less time than the nylon probing method (p < 0.001). Recurrence was found in 2 out of 5 patients in the aspiration method, whereas there was none in the 11 patients with the nylon probing method (difference = 40%; 95% CI: -3% to 83%; p = 0.083). CONCLUSIONS: The new treatment of galactocele by nylon probing took longer than aspiration but removed the protein plug that caused obstruction of the duct without pain and had a tendency to reduce the recurrence rate.