RESUMEN
PURPOSE: Early detection and intervention for developmental dysplasia of the hip (DDH) is important for normal hip development. Previous studies have shown disparities in access to paediatric specialty care among different racial and socioeconomic backgrounds. This study aims to identify whether these factors are related to timely referral for infants with DDH. METHODS: A retrospective cohort study of patients seen and treated for DDH between July 2006 and June 2011 at a single institution were reviewed. The patients were divided into early-presenting (seen before six months of age) and late-presenting patients (seen at six months of age or later). RESULTS: A total of 457 patients met the eligibility criteria. There were 378 early and 79 late presentations. Late presentations were significantly more likely to be vertex at birth (85% vs 41%, p < 0.001). Bivariate analysis also demonstrated that late presentations were more likely to be non-white (65% vs 45%, p = 0.004), non-English speaking (20% vs 8%, p = 0.003), from lower income areas ($70 769 vs $61 591, p < 0.001) and hold public insurance (25%, p = 0.001). However, a logistic multiple regression analysis showed that only vertex birth presentation (p = 0.000), absent family history of DDH (p = 0.047) and affected right side (p = 0.001) were significantly associated with late presentation. CONCLUSION: Despite screening algorithms to facilitate early diagnosis of infants with DDH, better research is needed to understand how different demographic and socioeconomic factors play into the delayed access to paediatric orthopaedic care for DDH so that we may ultimately improve rates of early treatment.
RESUMEN
Schönlein-Henoch's syndrome is particularly seen between the ages of two and eight years and is twice as frequent in boys as in girls. In up to 80%, symptoms in the form of skin rash, arthritis and abdominalia are observed. The pathognomonic symptom is the skin lesion which most often is confined to the region below the waist and is the first symptom in more than 50%. Incorrect diagnosis particularly of abdominal symptoms may result in unnecessary laparotomy. The etiology and pathogenesis are not yet completely elucidated but it is believed that SHS is caused by an IgA-mediated immune response to a variety of foreign antigens. The treatment and the prophylaxis, particularly concerning the nephropathy, of SHS is still very deficient today. Depending on the nature and the degree of difficulty the treatment is: salicylates, NSAID, prednisone, cytotoxica, plasmapheresis, substitution with factor 13-concentrate and, in terminal renal failure, allotransplantation renis. The course and the prognosis is usually good in cases without nephropathy. In mild cases, the disease lasts a few days, in more serious cases 4-6 weeks with subsequent exacerbations and remissions. Patients who have had SHS-nephritis ought to be followed for at least five years with an annual examination of the blood pressure and urine test for protein and blood. SHS ought to be considered as differential diagnosis in acute cases of abdominal pains, arthralgia, hematuria and CNS-symptoms even if the characteristic skin symptoms are missing.
