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Vol 13, No 5
Vol 13, No 5 October 2017 ISSN 1708-8569
 
Review articles
Meta-analysis
Original articles
   
Review articles:
Goldenhar syndrome: current perspectives
  Katarzyna Bogusiak, Aleksandra Puch, Piotr Arkuszewski
 
Background: Progress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques.
Data sources: Based on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia.
Results: The spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed.
Conclusions: Patients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient's age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.
  [Abstract] [Full Text] [PDF]  
Asynchronus bilateral ovarian torsions in girls-systematic review
  Maja Raicevic, Amulya Kumar Saxena
 
Background: Bilateral ovarian torsions with complete loss of ovaries is devastating. This study analyzed the literature on bilateral ovarian torsions in girls to evaluate surgical options and outcomes.
Methods: Literature was searched on Pubmed® (1987-2014) using terms "bilateral", "adnexal", "ovary", "torsion" and "children". Data were collected on age, surgical preference, pathology and outcomes.
Results: Thirteen articles were identified, and 9 met the inclusion criteria (5 case reports, 4 original articles); and analyzed 17 girls (mean age: 8.75 years, range: 1-16). Bilateral oophorectomies (n=4), ipsilateral oophorectomy of severely affected ovary and contralateral oophoropexy (n=10), and detorsion of bilateral ovaries and bilateral oophoropexy (n=3) were performed. One torsion recurrence occurred after two oophoropexies. Laparoscopy and open surgery was done in 2 and 15 girls, respectively. Considering etiology, there were simple tubo-ovarian torsions (n=8), polycystic ovary (n=1), polycystic ovary associated with Down syndrome (n=1) and corpus luteum cyst (n=1). No tumors were reported. Serial ultrasound follow-ups of ipsilateral oophorectomy and contralateral oophoropexy (n=5) confirmed follicular function (n=4) and viability and position of the ovary (n=1).
Conclusions: Though extremely rare, school age girls present bilateral ovarian torsion. Ipsilateral oophorectomy and contralateral detorsion with oophoropexy has been the preferred approach.
  [Abstract] [Full Text] [PDF]  
Meta-analysis:
Effects of CYP3A5 polymorphisms on tacrolimus pharmacokinetics in pediatric kidney transplantation: a systematic review and meta-analysis of observational studies
  Yi-Ping Zong, Zi-Jie Wang, Wan-Li Zhou, Wei-Min Zhou, Tie-Liang Ma, Zheng-Kai Huang, Chun-Chun Zhao, Zhen Xu, Ruo-Yun Tan, Min Gu
 
Background: CYP3A5 genetic polymorphisms have been reported to be strongly associated with the tacrolimus pharmacokinetics in adult kidney transplantation. However, there is no published meta-analysis in the influence of CYP3A5 variants on the requirements of the tacrolimus dose in pediatric renal-transplant recipients (RTRs). We wished to determine the effects of CYP3A5 polymorphisms on tacrolimus pharmacokinetics in pediatric RTRs.
Methods: A literature search was conducted to include relevant articles by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials. Pharmacokinetic-associated parameters such as dose administration, as well as concentrations and dose-adjusted concentrations of tacrolimus were extracted and the meta-analysis undertaken.
Results: The meta-analysis involved four studies and one study series involving 268 pediatric RTRs. A significant difference was observed in the mean trough concentration/dose of tacrolimus between recipients carrying CYP3A5*3/*3 variants (referred to as "non-expressers") and those carrying CYP3A5*1 (referred to as "expressers") [standard mean difference (SMD)=-1.09, 95% confidence interval (CI): -1.92 to -0.25, P=0.011]. Moreover, significance was observed in the mean daily dose of tacrolimus between non-expressers and expressers in pediatric RTRs (SMD=0.44, 95% CI: 0.20 to 0.68, P<0.001).
Conclusion: Our meta-analysis identified a positive correlation between CYP3A5 genotypes and tacrolimus pharmacokinetics in pediatric RTRs.
  [Abstract] [Full Text] [PDF]  
Original articles:
Pediatric nasolacrimal duct obstruction-benefit of a combined therapeutic approach
  Miloš Fischer, Iris-Susanne Horn, Mathias Otto, Mandy Pirlich, Andreas Dietz, Christian Mozet
 
Background: Pediatric nasolacrimal duct obstruction (PNDO) requires therapeutic intervention after conservative procedures failed. As resilient treatment guidelines for the treatment are missing, the aim of this study was to evaluate the advantages of two different intervention techniques in children with PNDO.
Methods: Between January, 2006 and June, 2014, 233 children (0-208 months) were treated either with conventional probing by ophthalmologists only (Group I) or with endonasal endoscopic interdisciplinary approach (Group II). The clinical outcome was analyzed.
Results: The overall success rate of Group I was 93.4% compared to 98.4% of Group II (P<0.05). 50% of all interventions (n=62) of Group II required further surgical procedures in addition to probing/irrigation, particularly with regard to children <6 and >24 months.
Conclusions: Endoscopic control in treatment of PNDO allows exact identification of the stenosis and appropriate surgical intervention with an improved clinical outcome. Endonasal endoscopic surgical techniques should be the standard PNDO treatment.
  [Abstract] [Full Text] [PDF]  
Standards of admission capillary blood glucose levels in cesarean born neonates
  Tatiana Smolkin, Irena Ulanovsky, Pnina Carasso, Imad R. Makhoul
 
Background: Neonatal hypoglycemia (NH) and cutoffs remain undefined. Our center screens all cesarean-delivered (CD) neonates for NH. We sought to define standards of admission capillary blood glucose levels (ACBGLs) in CD neonates who were at the lowest risk for hypoglycemia.
Methods: Of 4947 neonates, 519 met all 14 inclusion criteria. These highly-selected neonates were apparently the healthiest, least-stressed, earliest to be admitted to nursery and at lowest-risk for hypoglycemia. For each CD, cord blood gases and glucose were determined and each infant was screened for blood glucose at nursery admission.
Results: Sampling age was 41.615.3 minutes, a mean ACBGL of 52.310.7 mg/dL, and percentiles as follows: 1st percentile, 29.2; 3rd, 33.6; 5th, 35.0; 10th, 39.0; 25th, 46.0; 50th, 51.0; 75th, 58.0; 90th, 67.0; 95th, 71.0; 97th, 73.0, and 99th, 84.4. ACBGL rose significantly with increasing gestational age (P=0.004), increasing cord blood glucose (P<0.001), decreasing cord blood pH (P<0.001) and decreasing sampling age (P=0.027).
Conclusions: Setting uniform ACBGL cutoffs for NH definition is unachievable due to the enormous heterogeneity among newborns. Hence, we provide group-based ACBGL standards in CD neonates. We propose setting ACBGL cutoffs for use in CD neonates: 1) hypoglycemia: ACBGL <5th percentile (<35 mg/dL); and 2) interventional hypoglycemia: ACBGL <1st percentile (<30 mg/dL).
  [Abstract] [Full Text] [PDF]  
Different cutoff values of methacholine bronchial provocation test depending on age in children with asthma
  Eun Lee, Young-Ho Kim, Seungbong Han, Song-I Yang, Young-Ho Jung, Ju-Hee Seo, Hyo-Bin Kim, So Yeon Lee, Ji-Won Kwon, Soo-Jong Hong
 
Background: Bronchial hyperresponsiveness (BHR) is a fundamental pathophysiological characteristic of asthma. Although several factors such as airway caliber can affect BHR, no study has established age-dependent cutoff values of BHR to methacholine for the diagnosis of asthma in children. We investigated the cutoff values of the methacholine challenge test (MCT) in the diagnosis of asthma according to age.
Methods: A total of 2383 individuals aged from 6 to 15 years old were included in this study. MCTs using the five-breath technique were performed in 350 children with suspected asthma based on symptoms by pediatric allergists and in 2033 healthy children from a general population-based cohort. We determined the provocative concentration of methacholine producing a 20% decrease in forced expiratory volume in 1 second from baseline (PC20). A modified Korean version of the International Study of Asthma and Allergies in Childhood questionnaire was used to distinguish asthmatics and healthy subjects. Receiver-operator characteristic curve analysis was used to assess the cutoff value of PC20 for the diagnosis of asthma.
Results: Cutoff values of methacholine PC20, which provided the best combination of diagnostic sensitivity and specificity, showed an increasing pattern with age: 5.8, 9.1, 11.8, 12.6, 14.9, 21.7, 23.3, 21.1, 21.1, and 24.6 mg/mL at ages 6, 7, 8, 9, 10, 11, 12, 13, 14, and 15 years, respectively.
Conclusion: The application of different cutoff values of methacholine PC20 depending on age might be a practical modification for the diagnosis of asthma in children and adolescents with asthmatic symptoms.
  [Abstract] [Full Text] [PDF]  
Exhaustive mathematical analysis of simple clinical measurements for childhood pneumonia diagnosis
  Keegan Kosasih, Udantha Abeyratne
 
Background: Pneumonia is the leading cause of mortality for children below 5 years of age. The majority of these occur in poor countries with limited access to diagnosis. The World Health Organization (WHO) criterion for pneumonia is the de facto method for diagnosis. It is designed targeting a high sensitivity and uses easy to measure parameters. The WHO criterion has poor specificity.
Methods: We propose a method using common measurements (including the WHO parameters) to diagnose pneumonia at high sensitivity and specificity. Seventeen clinical features obtained from 134 subjects were used to create a series of logistic regression models. We started with one feature at a time, and continued building models with increasing number of features until we exhausted all possible combinations. We used a k-fold cross validation method to measure the performance of the models.
Results: The sensitivity of our method was comparable to that of the WHO criterion but the specificity was 84%-655% higher. In the 2-11 month age group, the WHO criteria had a sensitivity and specificity of 92.0%11.6% and 38.1%18.5%, respectively. Our best model (using the existence of a runny nose, the number of days with runny nose, breathing rate and temperature) performed at a sensitivity of 91.3%13.0% and specificity of 70.2%22.80%. In the 12-60 month age group, the WHO algorithm gave a sensitivity of 95.7%7.6% at a specificity of 9.8%13.1%, while our corresponding sensitivity and specificity were 94.0%12.1% and 74.0%23.3%, respectively (using fever, number of days with cough, heart rate and chest in-drawing).
Conclusions: The WHO algorithm can be improved through mathematical analysis of clinical observations and measurements routinely made in the field. The method is simple and easy to implement on a mobile phone. Our method allows the freedom to pick the best model in any arbitrary field scenario (e.g., when an oximeter is not available).
  [Abstract] [Full Text] [PDF]  
Risk factors for childhood obesity: Do the birth weight, type of delivery, and mother's overweight have an implication on current weight status?
  Aysel Vehapoglu, Nilufer Goknar, Ozden Turel, Emel Torun, Gamze Ozgurhan
 
Background: The aim of this study was to identify risk factors, including the type of delivery, breastfeeding and its duration, birth weight, the timing of solid food introduction, the mother's education level at birth, and smoking status during pregnancy, that are associated with obesity in children living in Istanbul.
Methods: This study involving 4990 healthy children aged 2-14 years, at an outpatient clinic in a tertiary care hospital from June 2012 to July 2014.
Results: The overall rates of overweight and obesity in children were 13.1% and 7.8%, respectively. Results demonstrated that 44.5% of children were delivered by caesarean section. In all age groups, 7.8% of children delivered by caesarean section were obese compared with 7.9% of children born vaginally. No significant association between caesarean section delivery and obesity in childhood was found in our study [odds ratio (OR)=0.98, 95% confidence interval (CI)=0.64-2.87, P=0.454]. There was also no association between duration of breastfeeding and the introduction of solid foods before 4 months or after 6 months of age and childhood obesity (OR=0.95, 95% CI=0.69-1.3, P=0.771; OR=0.99, 95% CI=0.64-1.53, P=0.261). Regression analyses revealed that children with birth weights greater than 3801 g or those with maternal body mass index (BMI) equal to or greater than 30 had an increased risk of being obese or overweight (OR=1.78, 95% CI=1.19-2.65; OR=3.95, 95% CI=1.94-5.81).
Conclusions: This study demonstrated that increased birth weight and maternal BMI are significant risk factors for obesity in children living in Istanbul, Turkey. No relation between caesarean section delivery and childhood obesity was found in this study.
  [Abstract] [Full Text] [PDF]  
Ataxia telangiectasia in Turkey: multisystem involvement of 91 patients
  Hacer Akturk, Murat Sutcu, Ayper Somer, Sanem Piskin, Manolya Acar, Meral Ozmen, Umut Altinoglu, Burak Tatli, Nuran Salman
 
Background: Ataxia telangiectasia (AT) is a genetically based multisystemic disorder. We aimed to make a comprehensive evaluation of multisystem involvement in AT by describing clinical features and outcome of 91 patients.
Methods: Medical records of the patients who were diagnosed and followed by a multidisciplinary approach during a 27-year period (1988-2015) were reviewed retrospectively.
Results: Forty six female and 45 male patients with a mean follow-up period of 39.134.28 months were evaluated. The mean age at the time of symptom onset and diagnosis were 15.41.09 months and 73.614.11 months, respectively. Neurological abnormalities were progressive truncal ataxia, nystagmus, dysarthria, oculomotor apraxia and choreoathetosis. Thirty one patients (34.1%) became dependent on wheelchair at a mean age of 12.12.8 years. Eleven patients (12.1%) became bedridden by a mean age of 14.71.8 years. Cranial magnetic resonance imaging revealed pathological findings in 47/66 patients. Abnormal immunological parameters were determined in 51/91 patients: immunoglobulin (Ig)A deficiency (n=38), lymphopenia (n=30), IgG (n=15) and IgG2 (n=11) deficiency. Occurrence of recurrent sinopulmonary infections (n=45) and bronchiectasis (n=22) were found to be more common in patients with impaired immunological parameters (P=0.029 and P=0.023, respectively). Malignancy developed in 5 patients, being mostly lymphoreticular in origin and resulted in death of 4 patients.
Conclusions: AT is a long lasting disease with multisystem involvement necessitating multidisciplinary follow up, as described in our cohort. Early diagnosis of malignancy and supportive treatments regarding pulmonary and neurological health may prolong survival and increase the quality of life.
  [Abstract] [Full Text] [PDF]  
Performance of QuantiFERON®-TB Gold In-Tube assay in children receiving disease modifying anti-rheumatic drugs
  Francesca Gabriele, Maria Trachana, Maria Simitsopoulou, Polixeni Pratsidou-Gertsi, Elias Iosifi dis, Zoi Dorothea Pana, Emmanuel Roilides
 
Background: To evaluate the performance of the Quantiferon®-TB Gold In-Tube (QFT-IT) interferon (IFN)- assay for the detection of latent tuberculosis infection (LTBI) in children receiving anti-rheumatic treatment in a tertiary referral hospital of Northern Greece.
Methods: A total of 79 consecutive children receiving anti-rheumatic treatment [of which 18 screened prior to antitumor necrosis factor (TNF)- treatment] were tested using Mantoux tuberculin skin test (TST) and QFT-IT. Association of both tests with risk factors for latent tuberculosis and Bacillus Calmette-Guerin immunization was determined. Influence of age, TNF- inhibitors, systemic corticosteroids, conventional disease modifying anti-rheumatic drugs (DMARDs) and total duration of therapy on the QFT-IT mitogen-induced response was evaluated.
Results: Agreement between TST and QFT-IT results was moderate (k=0.38). Frequency of QFT-IT indeterminate results was low (2.5%). In patients with risk factors for LTBI, the odds of a positive IFN- assay was increased by a factor of 27.6 (P=0.002), whereas there was no positive TST. There was a significant difference in the mitogen-induced IFN- secretion among various treatments (P=0.038). TNF- inhibitors were associated with increased mitogen-induced IFN- secretion compared to monotherapy with conventional DMARDs (P=0.008). All children screened prior to anti-TNF- treatment exhibited a negative QFT-IT and no active TB disease was detected during a 2-year follow-up.
Conclusions: QFT-IT may be a more reliable test than TST for detection of LTBI in children with rheumatic diseases receiving anti-rheumatic treatment. Drug regimen might influence the mitogen-induced IFN- secretion and the effect of TNF- inhibitors might vary according to the specific agent administered.
  [Abstract] [Full Text] [PDF]  
Thyroid status of iodine deficient newborn infants living in central region of Turkey: a pilot study
  Osman Bastug, Levent Korkmaz, Hulya Halis, Seyma Memur, Sabriye Korkut, Ahmet Ozdemir, Tamer Gunes, Mehmet Adnan Ozturk, Selim Kurtoglu
 
Background: Iodine deficiency (ID) during the fetal and neonatal periods can lead to neonatal hypothyroidism. This study was conducted to evaluate the effect of ID on the thyroid hormone level of newborns living in Turkey.
Methods: Between 1998 and 2013, 71 newborns with a urinary iodine concentration <100 g/L were recruited into the study. Data on thyroid volume, free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroglobulin (Tg) were collected from all newborns, and on breast milk iodine from their mothers. Infants who were classified as having congenital hypothyroidism (TSH >40 mU/L and fT4 <8.5 pmol/L) were treated with levothyroxine (n=26, T group), while the remaining infants remained untreated (n=45, UT group). Thyroid hormones were subsequently measured 7-14 days later in a sub-sample of both treated and untreated infants.
Results: The average values at the time of admission were as follows [median (min-max)]. fT3: 5.0 (2.8-7.1) pmol/L, fT4: 7.7 (0.13-19.1) pmol/L, TSH: 75 (14-426) mU/L, Tg: 464 (226-1100) ng/mL, urinary iodine concentration (UIC): 30 (0-61) g/L, breast milk iodine levels: 21 (10-150) g/L, thyroid ultrasound (USG): 1.10 (0.24-1.95) mL for the T group; and fT3: 5.7 (1.7-12.7) pmol/L, fT4: 16.2 (9.9-33.5) pmol/L, TSH: 5.4 (0.63-41.8) mU/L, Tg: 171 (15-2124) ng/mL, UIC: 39 (0-90) g/L, breast milk iodine levels: 47 (10-120) g/L, thyroid USG: 0.75 (0.35- 1.72) mL for the UT group. A significant difference was found between groups in respect to fT3, fT4, TSH and Tg levels. No significant difference in thyroid ultrasonography, UIC, and breast milk iodine levels was found between the two groups. The Tg levels of 50 out of 71 patients were measured, 40 (80%) of whom had Tg levels above the normal range (101 ng/mL).
Conclusions: In our country, despite the use of iodized salt, congenital hypothyroidism due to ID remains a problem. The Tg level of newborns can be used as a good indicator of ID.
  [Abstract] [Full Text] [PDF]  
Wernicke's encephalopathy in exclusive breastfed infants
  Javeed Iqbal Bhat, Qazi Iqbal Ahmed, Ambreen Ali Ahangar, Bashir Ahmed Charoo, Mushtaq Ahmad Sheikh, Wajid Ali Syed
 
Background: Kashmir has a population that largely consumes polished rice which is deficient in thiamine. Furthermore, lactating women in this region are prone to severe thiamine deficiency because of their traditional food avoidance practices. Infantile beriberi is common in exclusively breastfed infants of thiamine deficient mothers in Kashmir.
Methods: This was a one year prospective hospital-based study. We included 50 exclusively breastfed infants in our study. All patients were evaluated as per unit protocol including complete septic workup and metabolic workup. Most of our patients belonged to low and middle income group families, and mothers were on customary dietary restriction. Demographic and anthropometric data were collected from all the study participants. In addition, data regarding the treatments received by the study population and overall mortality were collected.
Results: The mean age, male:female ratio, and mean weight of the study population were 3.150.97 months, 1.5:1, and 5.11.1 kg, respectively. Traditional food avoidance practices were followed by 80% of the mothers. Irritability was observed in 40 (80%) patients. Blepharoptosis was observed in 30 (60%). Septic workup including cerebro spinal fluid analysis was normal in all patients. Predominant magnetic resonance imaging finding was bilateral basal ganglia hyperintensity. Whole blood thiamine diphosphate levels showed a drastic decrease (10-49 nmol/L). Ten percent of the study infants died.
Conclusion: In exclusively breastfed infants, we observed acute infantile encephalopathy with epidemiological, clinical, biochemical, and radiological features suggestive of infantile Wernicke's encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.
  [Abstract] [Full Text] [PDF]  
Preliminary identification of key miRNAs, signaling pathways, and genes associated with Hirschsprung's disease by analysis of tissue microRNA expression profiles
  Zhi-Gang Gao, Qing-Jiang Chen, Min Shao, Yun-Zhong Qian, Li-Feng Zhang, Yue-Bin Zhang, Qi-Xing Xiong
 
Background: Hirschsprung's disease (HSCR) is a congenital gut motility disorder of infants, and if left untreated, it is fatal to the affected infants. This study aimed to identify key microRNAs (miRNAs), signaling pathways and genes involved in the pathogenesis of HSCR.
Methods: The miRNA microarray dataset GSE77296 was downloaded. Nine colon tissue samples were available: six from HSCR patients and three matched control samples. Differentially expressed miRNAs (DEMs) were identified after data preprocessing. Target genes of the selected upregulated and downregulated DEMs were predicted. In addition, functional enrichment analyses for the selected DEMs and target genes were conducted. Finally, interaction networks between the DEMs and target genes were constructed.
Results: A total of 162 DEMs (73 upregulated and 89 downregulated) were obtained. A total of 2511 DEMtarget gene pairs for the 40 selected DEMs were identified, including 1645 pairs for the upregulated DEMs and 866 pairs for the downregulated DEMs. The upregulated DEM miR-141-3p and down-regulated DEM miR-30a-3p were identified as key miRNAs by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment and network analyses. Besides, KEGG pathway enrichment analysis revealed that pathways in cancer and the mitogen-activated protein kinase (MAPK) signaling pathway were key pathways. The key genes frizzled class receptor 3 (FZD3) and docking protein 6 (DOK6) were obtained through the DEM-target gene interaction networks.
Conclusion: Two key miRNAs (miR-141-3p and miR-30a-3p), the MAPK signaling pathway and two key genes (FZD3 and DOK6) were implicated in the pathogenesis of HSCR.
  [Abstract] [Full Text] [PDF]  
Parental behaviors and sleep/wake patterns of infants and toddlers in Hong Kong, China
  Xin-Ting Yu, Avi Sadeh, Hugh Simon Lam, Jodi A. Mindell, Albert Martin Li
 
Background: To describe the sleep patterns of children below 36 months in Hong Kong, and evaluate the associations between parental behaviors and childhood sleep/wake patterns.
Methods: Parents of 1049 infants and toddlers completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.
Results: Total sleep duration (P<0.001), frequency (P<0.001) and duration (P<0.001) of nocturnal awakenings decreased with age, whereas the longest sleep duration (P<0.001) and nocturnal sleep duration (P<0.001) increased with age. Children who room- or bed-shared with parents had later bedtimes (P<0.001), but similar sleep duration compared with those who had a separate sleep location. Falling asleep independently was associated with longer nocturnal sleep duration (P<0.001) and less sleep awakenings (P<0.001). Full-time employment of parents was associated with shorter total sleep duration of children (P<0.001). Although breastfeeding was associated with more nocturnal awakenings (P<0.001), no association was detected between breastfeeding and shorter sleep duration in children.
Conclusions: As infants and toddlers develop, their sleep consolidates. Falling asleep independently was associated with longer nocturnal sleep duration and fewer sleep awakenings, whereas sleep location was not. This is an important fi nding, especially for families with limited living space where parent/child room- or bed-sharing cannot be avoided.
  [Abstract] [Full Text] [PDF]  
Health problems among street children seeking care in the Center for Social and Preventive Medicine in Egypt
  Hoda Ibrahim Rizk, Nihal Mohamed El Rifai, Hana Mohamed Aboulghar
 
Background: In Egypt, around 1 million children are on the streets. Street children's health is an issue that is not well researched. The objective of the current study was to determine the health problems of a targeted group of street children seeking medical care and to generate a hypothesis about the positive/negative role of street children care organizations.
Methods: A cross-sectional study was done on 2169 street children who sought medical care at El-Basma clinic at the Center for Social and Preventive Medicine in Cairo University Children Hospital from January 2011 to July 2014.
Results: Respiratory illnesses and skin problems were the most prevalent conditions, affecting 485 (22.4%) and 359 (16.6%) of the patients, respectively. Psychological issues and trauma were significantly higher among the adolescent group. Respiratory and gastrointestinal problems were significantly higher among children aged less than 2 years. Genital and cardiac problems were significantly higher among those referred from organizations whereas trauma was significantly higher among those coming directly from the streets. A significant proportion of children at the extremes of the studied age spectrum were coming directly from the streets. Sexually transmitted infections were rare problems.
Conclusions: Respiratory and skin diseases were the major morbidity problems among street children, especially adolescent males. Organizations afforded opportunities for access to different health care services.
  [Abstract] [Full Text] [PDF]  
   
 
 
 
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