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   Table of Contents - Current issue
Coverpage
September-December 2017
Volume 30 | Issue 3
Page Nos. 85-129

Online since Friday, April 20, 2018

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ORIGINAL ARTICLES  

Intervention program to improve feeding, swallowing, and nutritional problems in children with cerebral palsy p. 85
Omneya M Omar, Mona Khalil, Hayam M Abd El-Ghany, Aya M Abdallah, Tarek E.I Omar
DOI:10.4103/AJOP.AJOP_22_17  
Background Most children with cerebral palsy (CP) have feeding problems, which lead to long-term malnutrition and respiratory disease, decreasing the quality of life of children and caregivers and causing early mortality. In developed countries with sufficient resources, high-cost and low-cost medical interventions, ranging from gastrostomy tube feeding to parent training, are available. In Egypt, the former is not widely available, and the latter is both scarce and its effectiveness not evaluated. Aim The study aimed to design and implement a training program to evaluate the effectiveness of a training program, to improve the feeding practices of caregivers of children with CP, to observe the effect on the level of nutritional status, feeding skills, and distress caused during feeding. Patients and methods From Alexandria University Children’s Hospital and its outpatient clinics (neurology and physical medicine), 20 caregivers and their children aged 1–5 years with moderate-severe CP (Gross Motor Fine Classification System III–V) and feeding difficulties were invited to a 10-session training program over 5 days (two sessions/day). Before and after training measures (quantitative and qualitative) were taken during the evaluation session of all children in addition to giving brief advice for caregivers, and follow-up for 3 months was done to evaluate the effect of education on performance and skills of the caregivers. Results The percentage of children with appropriate feeding position was significantly higher in final evaluation (66.7%) compared with preliminary evaluation (5%), and the median meal time was significantly shorter in final evaluation (42.5 min) compared with preliminary evaluation (60 min). The percentage of children and their caregivers gaining new feeding skills was significantly higher in final evaluation (38.9%) compared with preliminary evaluation (0%) (P=0.016). The percentage of children using the utensils appropriately was significantly higher in final evaluation (66.7%) compared with preliminary evaluation (15%) (P=0.004). There was no significant difference in the number of feeding problems, eating and drinking ability classification system level, and the mean weight for age Z score between studied children in preliminary and final evaluations. Conclusion The training program has a beneficial effect on improving feeding practices of children with CP and their caregivers after ten training sessions, with positive consequences for both child and caregiver. Methods of providing cheap food supplementation need to be studied, and further steps must be taken to ensure that services have the motivation and capacity to address this area of need.
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Prevalence of latent pulmonary tuberculosis in children with diabetes mellitus attending a Tertiary Care Hospital in Mansoura: a cross-sectional study p. 94
Mahmoud M Bakr, Ashraf A Elsharkawy, Yahya M Wahba, Nermin Y Abo Elkheir
DOI:10.4103/AJOP.AJOP_23_17  
Aims Tuberculosis (TB) and diabetes mellitus are closely associated with each other. We conducted a cross-sectional study to assess the prevalence and pattern of latent pulmonary TB in diabetic children using a combined screening tool. Settings and design A cross-sectional study was carried out in a Tertiary Care Hospital, Mansoura, Egypt, during the period from January to December, 2016. Materials and methods The study enrolled all diabetic children with the inclusion criteria who were available during the study period and attending the endocrinology outpatient clinics or admitted in the inpatient ward. A total of 70 diabetic patients completed tuberculin skin test (TST) reading, and their results were compared with those of 70 healthy controls. All patients were subjected to detailed medical history, complete physical examination, and laboratory and radiological evaluation. TB screening was done for both groups using TST, sputum microscopy and culture, and chest radiography. We used TST induration diameter more than 6 mm as the cut-off value to determine test positivity. Results A total of 53 (75.7%) patients of the studied diabetic group were poorly controlled. TST was positive in 30% of the screened diabetic patients. Test positivity was significantly higher among diabetic group when compared with control group. TST positivity was significantly higher in poorly controlled diabetic cases. There was a statistically significant negative correlation between TST induration diameter and HBA1C. Conclusion Diabetic patients are more vulnerable to latent pulmonary TB. The association between poor glycemic control and latent pulmonary TB among diabetic patients was evident. Combining TST with sputum culture and chest radiography did not improve screening results.
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Bacterial healthcare-associated infection rates among children admitted to Pediatric Intensive Care Unit of a Tertiary Care Hospital, Egypt p. 100
Azza A Moustafa, May M Raouf, Mona S El-Dawy
DOI:10.4103/AJOP.AJOP_2_18  
Background Healthcare-associated infections (HAIs) are life-threatening complications especially in pediatric ICU (PICU). Objective This study aimed to calculate the incidence of HAIs and device-associated infections (DAIs), as well as HAIs and DAI incidence density rate in a Alexandria University Children Hospital PICU, Egypt. Patients and methods A prospective cohort study was carried out over a period of 1 year. Personal, clinical, and laboratory data were recorded. HAIs were identified according to Centers for Disease Control and Prevention and National Healthcare Safety Network CDC/National Health Surveillance Network case definitions. Standard microbiological techniques were adopted. Results A total of 195 patients (of 282 admissions) who stayed more than 48 h in PICU were included. Overall, 16 patients developed bacterial HAIs, with a total of 25 episodes. HAIs incidence rate was 12.8/100 PICU admissions and incidence density was 15.6/1000 PICU days. All HAIs detected were DAI. Ventilator-associated pneumonia accounted for 72%, followed by central line (CL)-associated bloodstream infections at 24% and catheter-associated urinary tract infections at 4%.The rates of the DAI per 1000 device days were as follows: ventilator-associated pneumonia 12.4/1000 ventilator days, CL-associated bloodstream infections 4.2/1000 CL days, and catheter-associated urinary tract infections 0.69/1000 urinary catheter days. Gram negative bacteria were the most common isolated pathogens (n=18/25, 72%). All isolates were multidrug-resistant organisms. Conclusion and recommendations HAIs and DAI incidence rates in the current study were close to those of developed countries and lower than those of developing countries. Presence of an invasive device has a high risk for acquiring HAIs, resulting in higher mortality. The key to prevent HAIs is continuous education of infection prevention and control practices including an adoption of a surveillance program.
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Short-term prognostic value of serum cardiac troponin I levels in neonates with perinatal asphyxia p. 108
Mohamed H Gouda, Bahaa S Hammad, Mohamed A Amen
DOI:10.4103/AJOP.AJOP_3_18  
Background Neonatal hypoxic–ischemic encephalopathy (HIE) is a neonatal brain injury caused by perinatal asphyxia and is a major cause of neonatal morbidity and mortality. Cardiac dysfunction forms a part of the clinical spectrum of multiorgan dysfunction in asphyxiated newborns. The more cardiac dysfunction the patients have, the more severe encephalopathy they would suffer. Cardiac troponin I (cTnI) is one of neonatal HIE-related biomarkers that can aid the diagnosis of perinatal asphyxia and anticipate the severity of associated myocardial dysfunction. Aim The current study was designed to assess the serum cTnI concentration and to evaluate its short-term prognostic value in newborns with HIE. Patients and methods The present study is a prospective observational study conducted on 100 full-term newborn infants in the period from May 2016 to May 2017. Enrolled newborns were divided into two groups: the case group (50 full-term newborn infants with evidence of perinatal asphyxia) and the control group (50 full-term newborn infants without evidence of perinatal asphyxia). Quantitative estimation of serum cTnI concentrations was done in all enrolled newborns within 12 h of birth using direct chemiluminometric technology performed on ADVIA Centaur Immunoassay System (TnI-Ultra). Serum levels of creatine kinase-MB (CK-MB) were also measured to assess its sensitivity and specificity as a marker of perinatal asphyxia. Additionally, echocardiography was done to exclude structural heart diseases. Left ventricular fractional shortening (LVFS) was also measured to assess cardiac involvement. Results Serum concentrations of cTnI were statistically significantly higher among the case group when compared with the control group. Additionally, serum levels of cTnI were found to increase with increasing severity of HIE. Serum levels of CK-MB were also statistically higher among the case group. However, pairwise statistical comparison of serum CK-MB concentrations in different stages of HIE revealed no statistical significant difference. No statistical significant difference was found between the two studied groups regarding LVFS. Moreover, LVFS did not differ significantly between the different stages of HIE. Among the different markers of myocardial dysfunction assessed in the current study, cTnI was found to be the most sensitive and specific predictor of poor short-term outcome in newborns with perinatal asphyxia. When comparing serum concentrations of cTnI and CK-MB in both surviving and nonsurviving newborns in the asphyxia group, it was found that serum concentrations of cTnI were statistically significantly lower in the group of survivors. In contrast, there was no statistical significant difference regarding serum concentrations of CK-MB between surviving and nonsurviving asphyxiated newborns. Conclusion Serum concentrations of cTnI were elevated in asphyxiated newborns with respect to healthy infants and increase with increasing severity of HIE. cTnI can also be used as an excellent early predictor of mortality in newborns with perinatal asphyxia.
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Challenges and adjustments of mothers having children with autism p. 120
Tarek E.I Omar, Wafaa M Ahmed, Nehad S Basiouny
DOI:10.4103/AJOP.AJOP_4_18  
Background Children with autism and their families especially their mothers face numerous and pervasive challenges. In addition to the expected concerns with behavior, communication, and morbidities, mothers expressed deep apprehension about their child’s isolation and meaningful integration into daily life. Difficulties to access a quality care, financial burden, issues of adulthood, and their child’s challenging behaviors may produce significant stressors to mothers. Healthcare providers should take these challenges into consideration when providing care to those children and their mothers. Aim The aim of this study was to assess the challenges and adjustments of mothers having children with autism. Patients and methods A convenient sample of 76 mothers who have children with autism represented the participants. They were recruited from the Neurological Outpatient Clinic of Alexandria University Specialized Children’s Hospital at Smouha, Egypt. Three tools were used to collect the data as: (i) Mothers’ Sociodemographic Data Interview Schedule, (b) Stressors of Mothers who have Children with Autism Interview Schedule 3. Parent and Family Adjustment Scale. Results Overall, 71.4% of the mothers who were in the age 40 to <50 years had moderate stressors percent score. More than half of mothers sometimes had feelings of anger and nervousness. Furthermore, they had anhedonia and were unable to do anything alone. There was a statistically significant difference between mothers’ total percent score of stressors and their adjustment regarding psychological, social, and management-related stressors. Conclusion Mothers who have children with autism were confronted with multiple stressors. The most perceived stressors were physical, psychological, financial, community-related, and management-related stressors followed by social and marital stressors. Adjustment pattern were affected by various factors, such as mother’s age, social support, and family income related to employment of mothers. Recommendations Regular periodic meetings should be conducted between mothers and hospital personnel to promote proper communication.
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