Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 8 Articles
Background: As the benefits of patient-centered care have become more widely recognized, it is important to\nunderstand patientsââ?¬â?¢ sentiments regarding aspects affecting their care. In an effort to display more sensitivity to\npatient concerns, the term ââ?¬Å?disorders of sex developmentââ?¬Â (DSD) was proposed in 2006 as new nomenclature\nto replace older terms that were considered to have negative connotations.\nMethods: The objective of the study was to examine the views of congenital adrenal hyperplasia (CAH)\npatients and their caregivers regarding the new nomenclature. The study was observational to evaluate the\nviews of the CAH community, and the primary endpoint was perception of the term DSD. The study was\nconducted as a survey about views regarding DSD nomenclature. The survey was sent via email to eligible\nsubjects. Along with a short introduction explaining the term DSD, the survey was sent to eligible CAH\npatients and their caregivers. 589 CAH patients or family members participated in the survey.\nResults: A total of 589 responses were received (255 classical females, 104 non-classical females, 174 males,\n56 not specified) (547 U.S., 42 international) (128 CAH patients, 408 parents or other family members). 70.6%\nhad never heard the term DSD. 71.0% disliked or strongly disliked the term DSD. 83.6% stated they did not\nidentify with the term DSD. 76.0% felt that the term DSD has a negative effect on the CAH community. There\nwas no significant difference in opinion of DSD between classical females and other CAH patients, between\nUS and international, between surgical and non-surgical patients, or between patients and parents. There was\nno correlation with patient age.\nConclusions: Our results indicate that the majority of parents and patients with CAH are dissatisfied with the\nterm DSD. Our results highlight the challenges within the field of DSD to reach a consensus regarding a\nsensitive topic and to bridge the gap between current medical practice and patient satisfaction. It is the\nauthorsââ?¬â?¢ belief that reconsideration of the current nomenclature and ongoing dialogue between the medical\ncommunity and patients will eventually lead to removal of stigmatization, better management protocols, and\nimproved outcomes....
Background: Juvenile idiopathic arthritis (JIA) is a chronic illness with a high risk of developing long-term disability.\nDisease activity is currently being monitored and quantified by ACR core set. Here, joint inflammation is determined;\nhowever joint function is the crucial component for developing disability. The aim of this study was to quantify and\ncompare dynamic joint function in healthy and arthritic knee joints and to evaluate response to improvement.\nMethods: A single center cohort study of consecutive children presenting to the rheumatology outpatient clinic\nwas performed to measure dynamic knee joint function. Serial measures were performed if possible. Splint\nfixed electrogoniometers were used to measure dynamic knee joint function including ROM and flexion and\nextension torque.\nResults: A total of 54 children were tested including 44 with JIA, of whom eight had to be excluded for non-JIA-related\nknee problems. The study included 36 JIA patients of whom eight had strictly unilateral knee arthritis, and nine controls.\nDynamic joint function ROM and torque depended on age and bodyweight, as demonstrated in healthy joints. ROM\nand torques were significant lower in arthritic compared to unaffected knee joints in children with unilateral arthritis\nand across the cohort. Importantly, extension torque was the most sensitive marker of impaired joint function. Follow\nup measurements detected responsiveness to change in disease activity.\nConclusions: Measuring dynamic joint function with electrogoniometers is feasible and objective. Active ROM and\ntorque during flexion and extension of arthritic knee joints were significant lower compared to unaffected. In dynamic\njoint measurement extension torque is a sensitive marker for disease activity...
Background: Delayed bathing and early initiation of breastfeeding are among the essential interventions\nrecommended to save newborn lives. Although survey coverage reports are key to monitoring these interventions,\nfew studies investigated whether such reports accurately reflect the proportion of mothers and children who\nreceived these interventions. In order to gather accurate data, guidance on how to interview and probe mothers is\nprovided. In this study, we investigated experiences of data collectors when asking mothers survey questions that\nassessed delayed bathing and early initiation of breastfeeding.\nMethods: In November 2013, using a self-administered semi-structured questionnaire, we interviewed data\ncollectors who had taken part in a population-based newborn health household survey in Ethiopia during\nOctober-November 2013. A total of 130 out of 160 invited data collectors completed and returned the\nself-administered questionnaire. Descriptive statistics were used to analyse quantitative data using SPSS software\nversion 19. Qualitative data showing the variety of probes used by data collectors was analysed by listing, screening\nto identify common themes, and grouping by category.\nResults: Most data collectors reported that, in their opinion, mothers were able to understand the meaning of the\nquestion about newborn bathing (n = 102, 79%) and breastfeeding initiation (n = 106, 82%) without the need for\nprobes. However, fewer mothers were able to recall the event for either newborn behaviours and describe it in\nminutes, hours or days without the need for probes. Overall, only 26% (n = 34) and 34 % (n = 44) of all data collectors\nreported that they did not need any probing for the questions related to newborn bathing and breastfeeding initiation\nquestions, respectively. We identified a variety of probes used by data collectors and present examples.\nConclusion: Considerable probing was necessary to facilitate maternal recall of the events and approximate their\nresponses of time regardless of mothers� age, level of education and parity. This could potentially lead to inaccurate\ncoverage reports due to subjective and inconsistent interpretation of the indicators. Therefore, we recommend\ninclusion of standard probes or follow-on questions to the existing survey tools assessing the two indicators. Data\ncollectors also require further guidance in using appropriate probes to gather accurate maternal responses....
Background: Concerns about psychological distress are often used to justify treatment of girls with precocious\npuberty, but there is little evidence to support these concerns. The extent to which psychological problems are\nassociated with central precocious puberty (CPP) compared with other forms of early puberty in girls has likewise\nnot been established.\nMethods: Girls presenting with untreated CPP, premature adrenarche (PA) or early normal puberty (ENP) were\nrecruited from our pediatric endocrine clinic along with their mothers. Child psychological adjustment was assessed\nby child self-report and parent report. Parent self-reported personality, anxiety, and depression were also assessed.\nDifferences between groups were explored using one-way ANOVA and Dunnettâ��s T3 test.\nResults: Sixty-two subjects (aged 7.5 �± 1.4 years, range 4.8-10.5) were enrolled, of whom 19 had CPP, 22 had PA,\nand 21 had ENP. Girls with ENP were significantly older (8.9 �± .9 years) than girls with CPP (6.9 �± 1.1 years, p < .001)\nand PA (6.6 �± 1.0 years, p < .001). Girls with PA had significantly higher BMI z-scores (1.7 �± .8) than girls with CPP\n(1.1 �± .6, p = .01) and ENP (1.2 �± .6, p = .04). More girls with PA and ENP were from racial minorities (47% and 50%\nrespectively) than girls with CPP (32%). No group differences were found for any child measure of psychological\nadjustment. However, mothers of girls with PA scored significantly higher than mothers of girls with ENP on one\nmeasure of depression (p = .04) and stress (p = .01).\nConclusions: While mothers of girls with PA report increased psychological distress on some measures, no\ndifferences in psychological adjustment were found at baseline amongst the girls themselves. Whether these results\nwill change as puberty progresses in the PA and ENP groups or with treatment of CPP is unknown. Long-term\nprospective studies are needed in order to further investigate psychological correlates of early puberty in girls....
Background: Severe acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some\nchildren with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to\ninvestigate socio-demographic, dietary and clinical correlates of oedema, in children hospitalised with severe acute\nmalnutrition.\nMethods: We recruited children with severe acute malnutrition admitted to Mulago Hospital, Uganda. Data was\ncollected using questionnaires, clinical examination and measurement of blood haemoglobin, plasma c-reactive\nprotein and ?1-acid glycoprotein. Correlates of oedema were identified using multiple logistic regression analysis.\nResults: Of 120 children included, 77 (64%) presented with oedematous malnutrition. Oedematous children were\nslightly older (17.7 vs. 15.0 months, p = 0.006). After adjustment for age and sex, oedematous children were less\nlikely to be breastfed (odds ratio (OR): 0.19, 95%-confidence interval (CI): 0.06; 0.59), to be HIV-infected (OR: 0.10,\nCI: 0.03; 0.41), to report cough (OR: 0.33, CI: 0.13; 0.82) and fever (OR: 0.22, CI: 0.09; 0.51), and to have axillary\ntemperature > 37.5�°C (OR: 0.28 CI: 0.11; 0.68). Household dietary diversity score was lower in children with\noedema (OR: 0.58, CI: 0.40; 85). No association was found with plasma levels of acute phase proteins, household\nfood insecurity or birth weight.\nConclusion: Children with oedematous malnutrition were less likely to be breastfed, less likely to have HIV\ninfection and had fewer symptoms of other infections. Dietary diversity was lower in households of children who\npresented with oedema. Future research may confirm whether a causal relationship exists between these factors\nand nutritional oedema....
Background: Myringoplasty can be technically difficult in the pediatric patients due to the narrowness of the\nexternal auditory canal and the generally small size of the ear. Moreover, temporalis fascia grafts and myringoplasties\nfor anterior perforations are more likely to fail in children. Surgical management of anterior perforations requires total\nexposure of the anterior angle however a microscope may fail to provide a view of the anterior edge in most of\nperforations. Recently, different endoscopes are used in the performance of ear surgery in general and myringoplasty\nin particular. Current study aimed to investigate the outcome of transcanal microscope-assisted endoscopic\nmyringoplasty in homogenous group of children.\nMethods: The medical records of 22 children were retrospectively reviewed for age, perforation size and\nlocation, surgical and audiological findings, and outcome. All myringoplasties were performed by first author\nwith a chondro-perichondrial graft that has been harvested from the tragus and placed medial to the tympanic\nmembrane remnants, utilizing the underlay technique and 14-mm length, 3-mm diameter, 0Ã?° and 30Ã?° endoscopes. A\nmicroscope was occasionally used for removal of the sclerotic plaques and releasing adhesions surrounding the ossicles\nwhen bimanual manipulations were needed. Surgical success was defined as a tympanic membrane with no\nperforation, retraction, or graft lateralization for at least 18 months following surgery.\nResults: Thirteen large-, 8 medium- and 1 small-sized perforations (defined as 75, 50 or 25%, respectively, of the\ntympanic membrane area), of which 14 were anterior, 2 central and 6 posterior marginal, were repaired. The edges\nof the defect could not be visualized under a microscope due to bone overhanging or a curved or narrow EAC in\n8 anterior perforations. Intact tympanic membranes and dry ears were achieved in all operated children. The audiometric\nair conduction level (average of 0.5-3 kHz) for the entire cohort ranged between 10ââ?¬â??51.3 dB (mean 32.8) preoperatively\nand between 5ââ?¬â??35 dB (mean 18.2) postoperatively.\nConclusion: The transcanal microscope-assisted endoscopic myringoplasty had a 100% rate of surgical success in\nchildren. This technique can be especially appropriate for patients with narrow external canals, anterior defects and\nbone overhang making the perforation margins barely visible under a microscope....
Background: Nigeria�s efforts to reduce under-five mortality has been biased in favour of childhood mortality to\nthe neglect of neonates and as such the literature is short of adequate information on the determinants of neonatal\nmortality. Whereas studies have shown that about half of infant deaths occur in the neonatal period. Knowledge of\nthe determinants of neonatal mortality are essential for the design of intervention programes that will enhance\nneonatal survival. Therefore, this study was conducted to investigate the trends and factors associated with neonatal\nmortality in Nigeria.\nMethods: This was a retrospective analysis of the reproductive history data collected in the Nigeria Demographic\nand Health Surveys (NDHS) for 1990, 2003, 2008 and 2013. Neonatal mortality rates were estimated as the\nprobability of dying before 28 completed days using synthetic cohort life table techniques. Univariate and multiple\nCox proportional hazards regression models were used to explore the effects of selected maternal and bio-demographic\nvariables on neonatal mortality. The Hazard Ratio (HR) and its 95% Confidence Interval (CI) were estimated to prioritize\nobtained significant factors.\nResults: Nigeria neonatal mortality rate stagnated at 41 per 1000 live births between 1990 and 2013. There\nwere rural-urban and regional differences with more deaths occurring in rural areas and northern regions. In\n1990, antenatal care (HR = 0.76; CI = 0.61-0.95), facility delivery (HR = 0.69; CI = 0.53-0.90) and births interval less\nthan 24 months (HR = 1.67; CI = 1.41-1.98) were significantly associated with neonatal deaths. Factors identified\nfrom the 2013 data were antenatal care (HR = 0.76; CI = 0.61-0.95), birth interval less than 24 months (HR = 1.67;\nCI = 1.41-1.98), delivery at health facility (HR = 0.69; CI = 0.53-0.90), and small birth size (HR = 1.72; CI = 1.39-2.14).\nConclusion: There was little improvement in neonatal survival in Nigeria between 1990 and 2013. Bio-demographic\nand health care related characteristics are significant determinants of neonatal survival. Family planning should be\nintensified while government should improve the quality of maternal and child health services to enhance the\nsurvival of neonates....
Background: The epidemiology of paediatric bloodstream infection (BSI) in Sub-Saharan Africa is poorly documented\nwith limited data on hospital-acquired sepsis, impact of HIV infection, BSI trends and antimicrobial resistance.\nMethods: We retrospectively reviewed paediatric BSI (0ââ?¬â??14 years) at Tygerberg Childrenââ?¬â?¢s Hospital between 1 January\n2008 and 31 December 2013 (excluding neonatal wards). Laboratory and hospital data were used to determine BSI\nrates, blood culture contamination, pathogen profile, patient demographics, antimicrobial resistance and factors\nassociated with mortality. Fluconazole resistant Candida species, methicillin-resistant Staphylococcus aureus\n(MRSA), multi-drug resistant Acinetobacter baumannii and extended-spectrum beta-lactamase (ESBL) producing\nEnterobacteriaceae were classified as antimicrobial resistant pathogens.\nResults: Of 17001 blood cultures over 6 years, 935 cultures isolated 979 pathogens (5.5% yield; 95% CI 5.3-5.7%).\nContamination rates were high (6.6%, 95% CI 6.4-6.8%), increasing over time (p = 0.003). Discrete BSI episodes were\nidentified (n = 864) with median patient age of 7.5 months, male predominance (57%) and 13% HIV prevalence. BSI\nrates declined significantly over time (4.6ââ?¬â??3.1, overall rate 3.5 per 1000 patient days; 95% CI 3.3ââ?¬â??3.7; Chi square for trend\np = 0.02). Gram negative pathogens predominated (60% vs 33% Gram positives and 7% fungal); Klebsiella pneumoniae\n(154; 17%), Staphylococcus aureus (131; 14%) and Escherichia coli (97; 11%) were most prevalent. Crude BSI mortality was\n20% (176/864); HIV infection, fungal, Gram negative and hospital-acquired sepsis were significantly associated with\nmortality on multivariate analysis. Hospital-acquired BSI was common (404/864; 47%). Overall antimicrobial resistance\nrates were high (70% in hospital vs 25% in community-acquired infections; p < 0.0001); hospital-acquired infection,\ninfancy, HIV-infection and Gram negative sepsis were associated with resistance. S. pneumoniae BSI declined significantly\nover time (58/465 [12.5%] to 33/399 [8.3%]; p =0.04).\nConclusion: Although BSI rates declined over time, children with BSI had high mortality and pathogens exhibited\nsubstantial antimicrobial resistance in both community and hospital-acquired infections. Blood culture sampling\ntechnique and local options for empiric antimicrobial therapy require re-evaluation....
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