RESUMO
This was a prospective, descriptive, cross sectional study that was conducted in 9 major paediatric hospitals accredited for training of residents in Sudan to assess the knowledge, attitude and practice of residents in paediatrics on issues related to pain assessment and pain management in children A semi-structured and validated questionnaire was distributed to 174 residents working in these hospitals. One hundred and twenty residents, out of 174, responded by filling the questionnaire, with a response rate of 68%. Seventy percent of them said they had never received any kind of training, education, or learning sessions in paediatric pain assessment and management during their training, 60% were not aware of any pain assessment scale/tool. One third of residents thought opioids are contraindicated for chronic pain relief in children, as dependence and/or addiction would occur after short use. While attitude towards importance of pain control in children was generally good among surveyed residents (75%), two thirds of them had never used topical anaesthetic cream/lotion, while 40% of them had never used non-nutritive sucking and/or sucrose in neonates. In addition, more than a third had rarely used lubricant gel for nasogastric tube insertion. In conclusion, Sudanese paediatric residents in training had poor knowledge and training in paediatric pain assessment and treatment, however, the majority of them recognized the importance of pain control in children.
RESUMO
BACKGROUND: Hypertriglyceridemia in association with hypernatremia was reported in a few children; however, studies exploring this association are limited. OBJECTIVE: To determine the pattern of change in serum triglycerides levels in hypernatremia patients. DESIGN AND SETTING: A prospective case-control study done at North West Armed Forces Hospital, Tabuk, Saudi Arabia from April 2008 to March 2011. PATIENTS AND METHOD: serum triglycerides and sodium were measured in 16 patients with hypernatremic dehydration as a study group and 14 patients with isonatremic dehydration as a control group. The trend of serum sodium and triglycerides was followed during treatment in the study group. RESULTS: There were 6 boys and 8 girls in the control group (isonatremic dehydration). Their age ranged between 4 months and five years (M±SD = 1.7±1.3 years). In the study group (hypernatremic dehydration), there were 6 boys and 10 girls. The age range was 2-14 months (M±SD = 0.6±0.4 years). The serum sodium and triglycerides (M±SD = 165.8±9.1 mmol/l, 5.1±8.1 mmol/l respectively) were significantly higher compared with the control group (M±SD = 137.5±3.9 mmol/l, 0.7±0.3 mmol/l and P < 0.001, P < 0.05 respectively). Duration of symptoms in patients with hypernatremic dehydration (M±SD = 2.9±2.4 days) were comparable to control group (M±SD = 2.0±0.9 days, P = 0.18). Four patients from the study group had normal serum triglycerides (M±SD = 1.1±0.1 mmol/l). With treatment, serum sodium was normalized in all patients followed by serum triglycerides. CONCLUSION: Hypertriglyceridemia is present in most children with hypernatremia and it disappears when serum sodium returns to normal.
RESUMO
The occurrence of autoimmune hemolytic anemia and immune thrombocytopenia in the absence of a known underlying cause led to the diagnosis of Evans syndrome in a 9-month-old male. Subsequently, a similar diagnosis was made in two siblings (a 3-year-old boy and a 1-day-old girl). The 9-month-old had a chronic course with exacerbations. He was treated with steroids, intravenous immunoglobulin and colchicine with a variable response. He died of congestive heart failure at the age of 8 years. The brotherâs disease course was one of remission and exacerbation. With time, remissions were prolonged and paralleled an improvement in joint hypermobility. The sister died of sepsis after a chronic course with severe exacerbations. Only two families with Evans syndrome have been reported in the English medical literature. In one report (in a Saudi Arab family), the disease was associated with hereditary spastic paraplegia.
