Patient-Reported Outcomes of Bladder and Bowel Control in Children with Spina Bifida

Background: The primary aim was to describe patient-reported morbidity from neurogenic bladder and bowel dysfunction in a cohort of children with spina bifida. The secondary aim was to describe the overall surgical burden in these children. Methods: Children with meningocele or myelomeningocele, born between 2000–2016, and followed by a tertiary spina bifida center were evaluated in a cross-sectional cohort study using data from charts and a prospective national follow-up program. Results: In the group of 62 patients, clean intermittent catheterization (CIC) was used by 47 (76%) of the patients, and anticholinergic treatment was used by 36 (58%). More than one third of the patients reported inadequate results with daily urinary leakage. Laxatives and enema were used regularly by 45 (73%) and 39 (63%) patients, respectively. Inadequate results were reported by seven (11%) patients. One or more urogenital or gastrointestinal operations had been performed in 26 (42%) patients, with a total of 109 procedures overall. Conclusions: Despite substantial bowel and bladder management, a significant portion of children suffered from inadequate results concerning bladder and bowel control. Many surgeries were performed in a defined group of the children. Prospective, long-term studies can evaluate if more aggressive medical and/or surgical management could increase bowel and bladder control.

Relationship Between Bowel/bladder, and Sexual Dysfunction With Health-Related Quality of Life in Women With Multiple Sclerosis (MS).

Background: Bladder, bowel, and sexual dysfunction are among common complications in patients with multiple sclerosis (MS). These complications could affect the quality of life. The goal of this study is to assess bowel, bladder, and sexual dysfunction and quality of life in married women with MS. Methods: One hundred and twenty-seven married women with MS were enrolled. They fill the valid and reliable Persian version of the Female sexual function index (FSFI), SF-36, Bladder Control Scale (BLCS), and The Bowel Control Scale (BWCS). Results: Mean age and disease duration were 38±7.9 and 8.4±6.5 years, respectively. There was significant negative correlation between SF-36 and BWCS (r=-0.25, p=0.001) and BLCS (r=-0.36, p=0.001) and significant positive correlation between FSFI and SF-36(r=0.27, p=0.004). There was a significant negative correlation between age and total FSFI (r=-0.34, p<0.001) and also between EDSS and FSFI (r=-0.21, p=0.01). By considering 26.55 as the cut-off point of FSFI, we found that women with sexual dysfunction had a more impaired quality of life and more bowel control problems. Linear regression analysis showed that EDSS and BLCS are independent predictors of SF-36. Conclusion: Bowel/bladder and sexual dysfunction have negative impacts on the quality of life in women with multiple sclerosis.

Pervasive Developmental Disorders in Iraqi Children

Background: Pervasive developmental disorders include five chronic disorders marked by early impairment in socialization, communication and behavior. Little is known about the types of pervasive developmental disorders in Iraq. This is a retrospective clinical study aiming at determining the types of pervasive developmental disorders in Iraqi children observed at the pediatric psychiatry clinic in a tertiary pediatric referral center. Patients and methods: During nine months period (November 18th, 2018 to July 18th, 2019), fifty one patients with a diagnosis of pervasive developmental disorders (30 males and 21 females) were observed at the psychiatry clinic at the Children Teaching Hospital of Baghdad Medical City. Their ages ranged from two and half years to twelve years. Results: Thirty two (17 males and 15 females) patients had autism without significant mental retardation as indicated by adequate urine and bowel control and self care skills particularly spoon feeding. Thirteen patients were considered to have atypical autism or Pervasive developmental disorder not otherwise specified (10 boys and 3 girls), in eleven of them, the disorder was considered atypical because of the lack of adequate urine and bowel control and self care skills particularly appropriate spoon feeding indicating significant degree of mental retardation. In one patient, his condition was considered a typical because of the presence of an acceptable eye contact and response appropriately to name in most instances. Three patients had Asperger syndrome including two girls and one boy. Two boys had childhood disintegrative disorder (Heller syndrome), one of them have changes on brain MRI suggestive of cerebral vasculitis. One girl had Rett syndrome and her case and early treatment was published. Conclusion: In this series, typical autism without significant mental retardation accounted for 63%. Atypical autism (Pervasive developmental disorder not otherwise) was the second most common type of Pervasive developmental disorders accounting for about 25%. Asperger syndrome accounted for only 6% of the cases in this series