ABSTRACT
OBJECTIVE: The aim of this study was to assess the validity of the Integrated Management of Childhood Illness (IMCI) algorithm to detect edematous type of malnutrition in Egyptian infants and children ranging in age from 2 months to 5 years. MATERIALS AND METHODS: This study was carried out by surveying 23 082 children aged between 2 months and 5 years visiting the pediatric outpatient clinic, Ain Shams University Hospital, over a period of 6 months. Thirty-eight patients with edema of both feet on their primary visit were enrolled in the study. Every child was assessed using the IMCI algorithm 'assess and classify' by the same physician, together with a systematic clinical evaluation with all relevant investigations. RESULTS: Twenty-two patients (57.9%) were proven to have nutritional etiology. 'Weight for age' sign had a sensitivity of 95.5%, a specificity of 56%, and a diagnostic accuracy of 78.95% in the identification of nutritional edema among all cases of bipedal edema. Combinations of IMCI symptoms 'pallor, visible severe wasting, fever, diarrhea', and 'weight for age' increased the sensitivity to 100%, but with a low specificity of 38% and a diagnostic accuracy of 73.68%. CONCLUSION AND RECOMMENDATIONS: Bipedal edema and low weight for age as part of the IMCI algorithm can identify edema because of nutritional etiology with 100% sensitivity, but with 37% specificity. Revisions need to be made to the IMCI guidelines published in 2010 by the Egyptian Ministry of Health in the light of the new WHO guidelines of 2014.
Subject(s)
Algorithms , Edema/diagnosis , Edema/etiology , Foot Diseases/diagnosis , Foot Diseases/etiology , Nutrition Disorders/complications , Nutrition Disorders/diagnosis , Practice Guidelines as Topic , Child, Preschool , Disease Management , Egypt , Female , Humans , Infant , Male , Sensitivity and SpecificityABSTRACT
Non-classical effects of vitamin D are not surprising in that many tissues, including neurons, possess vitamin D receptors. Thirty school aged children with delayed scholastic achievement and 15 normal ones were enrolled in the current study to identify the serum 25-hydroxy vitamin D [25(OH) D] status in school aged children in relation to their scholastic achievement. Besides estimation of serum 25(OH) D levels, neuro-developmental assessment was done using the Wechsler Intelligence Scale for Children (WISC) and the Benton's Visual Retention Test (BVRT). Serum 25(OH) D was significantly lower in children with delayed scholastic achievement. Picture completion scores were significantly lower in children with deficient and inadequate serum 25(OH) D. There were positive correlations between serum 25(OH) D level and values of WISC. Regarding BVRT results, good memory was associated with adequate serum 25(OH) D. In conclusion, serum 25(OH) D is deficient in children with delayed scholastic achievement causing affection of memory and learning process. Larger scale studies using learning assessment tools are thus recommended to further prove this point and search the impact of vitamin D supplementation on the school achievement in this age group.
Subject(s)
Calcifediol/blood , Cognition Disorders/etiology , Vitamin D Deficiency/complications , Anthropometry , Calcifediol/deficiency , Case-Control Studies , Chi-Square Distribution , Child , Cognition Disorders/blood , Cross-Sectional Studies , Educational Status , Female , Hemoglobins/analysis , Humans , Intelligence Tests , Male , Memory Disorders/blood , Memory Disorders/etiology , Socioeconomic FactorsABSTRACT
Amylin is a neuroendocrine hormone that inhibits food intake and gastric emptying in animal studies. Its role in obese human beings is still controversial. We aimed to estimate the fasting and postprandial amylin levels in obese children before and after weight loss [through weight loss intervention program (WLIP)] and to relate these levels to the lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR) and ultrasonography gastric half emptying time (t1/2). This study was conducted initially on 20 obese children, 10 of them only continued 6 months follow up strategy on WLIP. Ten lean children served as controls. All children were subjected initially and on follow up to dietetic history taking, anthropometric measurements and laboratory assessment oflipid profile, HOMA-IR, fasting and postprandial amylin levels and ultrasonography gastric half emptying time (t1/2). The results showed that IR, significantly increased in fasting and postprandial amylin levels and significant delay in gastric emptying among obese children. After WLIP completion, IR was reversible, fasting and postprandial amylin levels decreased and gastric emptying significantly improved yet still significantly delayed than controls. There was significant positive correlation between fasting amylin levels and body mass index %, fasting insulin and HOMA-IR.
