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   Table of Contents - Current issue
Coverpage
May-August 2017
Volume 30 | Issue 2
Page Nos. 45-83

Online since Wednesday, January 17, 2018

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ORIGINAL ARTICLES  

Effect of erythropoietin as adjunctive therapy with whole-body cooling for treatment of hypoxic-ischemic encephalopathy in newborns p. 45
Mohamed M Badr-El Din, Ahmed M.S.H Abougabal, Khalid M Saad, Hanan R Abdel-Salam
DOI:10.4103/AJOP.AJOP_14_17  
Background Hypothermia induced by whole-body cooling (WBC) and/or selective head cooling reduces brain injury after hypoxia-ischemia in newborns. Despite differences in approach (head cooling vs. total body cooling), there is a general agreement that hypothermia improves outcomes of moderately asphyxiated infants, decreasing the combined outcome of death and neurologic dysfunction from 60 to 45%. Subsequently, the search for adjuvant therapies that may provide long-lasting neuroprotection was mandatory. Aim of the present work The present study aimed to evaluate the short-term effects of erythropoietin (Epo) as a neuroprotective agent in adjunction with WBC to treat newborn infants with hypoxic-ischemic encephalopathy (HIE). Participants and methods This is a true interventional randomized controlled hospital-based study. A total of 33 full-term and late preterm newborn infants, delivered at El-Shatby Alexandria University Maternity Hospital, Egypt, were enrolled in the study. They fulfilled the criteria of HIE and received WBC during the first 6 h of life, in addition to the standard intensive care measures. Of the 33 studied babies, 11 received 500 IU/kg Epo every other day for 2 weeks as adjunctive therapy to WBC. Results The Epo plus WBC group (group I) had a significantly shorter period of hospital stay in comparison with the other group managed by WBC solely (group II), [mean hospital stay in days±SD: 6.20±2.39 and 8.40±3.94, respectively (P=0.039)]. The incidence of seizures was insignificantly lower among babies in group I. Extensive white and gray matter brain lesions were observed more among group II neonates, although the difference was statistically insignificant. Clinical and neurological improvements, as guided by Thomson score, were better achieved among group I babies, despite the difference being statistically insignificant. Conclusion Epo as an adjunctive therapy with WBC for treating asphyxiated neonates is a safe mode of therapy, which significantly shortens the period of hospital stay as well as it (marginally) improves their short-term outcome, both radiologically and clinically. WBC plus Epo lowers the rate of occurrence of clinically detectable seizures in the 1st week of life among asphyxiated neonates.
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Psychometric properties of a translated arabic version of cerebral palsy-quality of life questionnaire: primary caregiver form p. 53
Heba M.T El-Weshahi, Mona K Mohamed, Hayam M Abd-Elghany, Tarek E.I Omar, Alaa E Azzawi
DOI:10.4103/AJOP.AJOP_15_17  
Background In the context of child rehabilitation, quality of life (QOL) is an important health-related outcome measure that has a great clinical utility as it can guide practice. Study objectives The aim of this study was to develop a translated Arabic version of primary caregiver form of cerebral palsy QOL questionnaire for children aged 4–12 years (CP QOLـChild) and to assess its validity and reliability to be readily used in Arabic and Egyptian cultures. Patients and methods The original English version of CP-QOL questionnaire was translated into Arabic language using forward–backward translation method, and then a cross-sectional survey was conducted including 200 children with cerebral palsy aged 4–12 years and their caregivers. Caregivers of children were interviewed to collect data about their demographic characteristics, age, and sex of their children. They were asked to fill the translated Arabic version of QOL questionnaire. Assessment of psychometric properties including test–retest reliability, internal consistency, and item internal consistency was conducted. Results The translated questionnaire showed excellent test–retest reliability and good internal consistency as the intraclass correlation ranges from 0.88 to 0.97 and Cronbach’s α exceeds 0.7 except for the domains of family health and emotional well-being. The majority of the items have moderate to good correlation with their domain scores. Four out of seven domains showed significant correlation with Gross Motor Function Classification System. Conclusion The translated Arabic version of CP-QOL questionnaire (caregiver form) is valid and reliable and could be used to assess quality of life of children with cerebral palsy in Arab-speaking population.
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Organizational skills training, neurofeedback, and/or pharmacotherapy in the treatment of school-aged children with attention-deficit hyperactivity disorder p. 61
Hanan G Azouz, Faten I Abdel Latif, Tarek E.S Omar, Mona Khalil, Marwa S Abdel Maksoud
DOI:10.4103/AJOP.AJOP_18_17  
Background Attention deficit hyperactivity disorder (ADHD) is the most common developmental and neurobehavioral disorder in childhood. It is characterized by hyperactivity, impulsivity, and/or inattention. Objective To study the efficacy of implementation of different interventional modalities including medication (MED; atomoxetine) either alone or in combination with behavioral therapy (organization skills training; OST) or cognitive training (neurofeedback training; NFT) in alleviation of the core symptoms of ADHD and its comorbid conduct problem among school-aged children with ADHD. Participants and methods This was a multigroup design study with preassessment and postassessment with the Arabic form of Conners’ Parent Rating Scale short form (CPRS-48). Participants were 45 school-aged children (age range from 6 to 10 years) with a diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria. Children were recruited from the Pediatric Behavioral Outpatient Clinic of Alexandria University Children Hospital, Alexandria, Egypt, and they were allocated into the groups: group OST and MED (n=15); group NFT and MED (n=15); and group MED (n=15). Results Combined OST and MED showed a significant decrease in hyperactivity/impulsivity (P=0.011) and comorbid conduct problem scores (P=0.030) on postinterventional assessment with CPRS-48. However, no statistically significant difference was found among the other studied groups, groups NFT and MED or group MED, either on ADHD core symptoms or its comorbid conduct problem. Conclusion Combined OST and MED showed significant efficacy in the alleviation of ADHD core symptoms and comorbid conduct problem.
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Risk factors for febrile seizures in Benghazi, Libya: a case–control study p. 68
Amenh B Yousif, Lamia M Hafez, Fatma S Benkhaial
DOI:10.4103/AJOP.AJOP_21_17  
Background Febrile seizures (FS) are the most common seizures of childhood, occurring in 2–5% of children at 6 months to 5 years of age. The risk factors for FS include developmental delay, delayed discharge from the neonatal ICU, viral infections, a family history of FS, possibly iron deficiencies, and nonexclusive breastfeeding. Aim This study was carried out to identify and quantify the risk factors for FS in Libyan children. Patients and methods A case–control study was carried out including one hundred patients with FS aged 6–60 months, admitted to Benghazi Paediatrics Hospital, Libya, who were matched with another 100 children with fever, but without seizure of the same age as the control group. The control group was enrolled randomly and the study was carried out over 8 months from 1 October 2016 to 31 May 2017. Data were collected using a pretested questionnaire. Blood samples were collected from both cases and controls and a complete blood count was performed. χ2-Test was used to assess the significance of the risk factors. Univariate and multivariate logistic regression analyses were carried out to determine the strength of associations at a 5% level of significance. Results The majority of cases and the children in the control group were between 6 months and less than 25 months of age. It was found that 93% of the cases and 87% of the children in the control group had a temperature higher than 38°C. The most common types of FS for cases were simple FS, which was recorded in 86% of cases, and complex FS, recorded in 14% of cases. A positive family history of FS was reported in 48% of cases compared with 22% of the children in the control group [odds ratio (OR)=3.27, 95% confidence interval (CI): 1.77–6.05, P<0.001]. Iron-deficiency anemia was reported in 73% of cases compared with 33% of controls, and this was found to be a strong significant risk factor for FS (OR=5.48, 95% CI: 2.99–10.07, P<0.001). Furthermore, nonexclusive breast-feeding was reported in 66% of cases compared with 32% of controls (OR=4.12, 95% CI: 2.28–7.43, P<0.001); prematurity was reported in 29% of cases compared with 11% of children in the control group (OR=3.30, 95% CI: 1.54–7.07, P<0.001). Conclusion The results of the present study indicated that iron-deficiency anemia, nonexclusive breast-feeding, and a family history of FS and prematurity were the most important risk factors for FS. This study recommends educational programs for modifiable risk factors, encourages exclusive breast feeding in the first 6 months, and early diagnosis and treatment for iron-deficiency anemia in children.
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Implementation of ventilator associated pneumonia prevention bundle in the neonatal intinsive care unit at Alexandria University Children’s Hospital, Egypt p. 74
Reem M.A Tayel, Abd El Haleem A Badr El Din, Soad F Hafez, Bahaa S Hammad
DOI:10.4103/AJOP.AJOP_19_17  
Introduction Ventilator-associated pneumonia (VAP) is a nosocomial lung infection that develops at or later than 48 h after mechanical ventilation (MV). It is the second most frequent hospital-acquired infection in neonatal intensive care units (NICUs). It results in high morbidity, mortality, prolonged NICU length of stay, and increased cost of hospitalization. Egypt and other developing countries report higher VAP rates compared with developed countries. Furthermore, studies monitoring VAP rates and success of intervention strategies in Egyptian NICUs are few. Aim The aim of the present study was to estimate the incidence of VAP during the implementation of the prevention bundle and also to identify the causative agents and significant risk factors in the NICU at Alexandria University Children’s Hospital. Patients and methods A nonrandomized clinical trial with historical control was conducted. All neonates admitted to the NICU in the period from July 2015 till March 2016, who spent more than 48 h on MV, were subjected to a VAP prevention bundle. Eligible neonates who spent more than 48 h on MV were monitored closely for VAP development. A thorough assessment of history, clinical examination, routine investigations, and chest radiography were carried out on all enrolled infants. Neonates who developed clinically suspected VAP were further subjected to nonbronchoscopic bronchoalveolar lavage for bacteriological confirmation of the clinical diagnosis. A review of records was performed to determine the incidence of VAP in the 9 months before intervention. Oral swabs were taken to study the pattern of oral colonization in ventilated neonates to trace its role in VAP development. Also, cultures of residual gastric volume and water traps inserted into the ventilator circuits were studied. Results A total of 108 episodes of VAP were diagnosed, with a cumulative incidence of clinically diagnosed VAP equal to 37.6% (34.2 VAP cases/1000 ventilation days). The incidence of bacteriological-confirmed VAP in this study was 19.97/1000 ventilation days. The most important risk factors for the occurrence of VAP were prematurity, low birth weight, prolonged duration of ventilation, re-intubations, and enteral feeding. Gram-negative bacteria were the predominating cause of VAP in the NICU and Klebsiella was the most common pathogen isolated from nonbronchoscopic bronchoalveolar lavage cultures. Conclusion VAP is a severe complication of MV as it significantly increases neonatal mortality. The VAP preventive bundle implemented in the present work was associated with a reduction in the VAP rate in the NICU.
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