Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Background and Aim: Idiopathic nephrotic syndrome or nephrosis causes massive protein leakage in the urine. Its treatment requires steroids (prednisone, methylprednisolone), often for a prolonged period, notably in case of steroid-dependence or steroid-resistance. In children, long-term use of steroids can lead to several side effects such as statural growth retardation/ stunting. This study evaluated the frequency of stunting in idiopathic nephrotic syndrome in children on steroids and identified the associated factors. Material and Methods: This was a retrospective, descriptive cohort study carried out in children aged 0 to 16 years treated at the paediatric nephrology unit of Aristide Le Dantec Hospital in Dakar, between 1 December 2017 and 31 May 2020. All records of nephrotic children treated in outpatient or inpatient setting were included. These children had to be on corticosteroid therapy for at least 30 months and have a height taken regularly during follow-up consultations. Results: Of 259 children followed for idiopathic nephrotic syndrome, 93 were included in the study. The median age was 96.5 months and the sex ratio was 1.9. The mean height of the children at the beginning of the follow-up was -0.26 DS, at the end it was -0.88 DS. At the beginning of the follow-up, 8 children had already stunting. At 12 months follow-up, 72 children (77.4%) had a decrease in z-score; and at 30 months, there were 7 more children (84.9%) who had a decrease in z-score. Methylprednisolone boluses were given to 17 children (18.3%). Calcium supplementation was done in 91 children (97.8%). Vitamin D supplementation was given to 91 children (97.8%). The mean number of relapses was 1.8. Factors associated with stunting were number of relapses ≤3 (p=0.03), duration of corticosteroid therapy >6 months (p<0.0001) and cumulative doses of prednisone >100 mg/kg (p=0.04). Conclusion: In prolonged nephrotic syndrome in children, corticosteroids can cause stunting.

Covid-19 and Routine Vaccination Programme: Did it Affect Badly?

Background: The impact of COVID-19 on general health care delivery systems has been huge including the immunization services. Several measures were taken by most of the government all over the world to prevent the spread of infection such as lockdown, wearing masks, social distancing, etc. People have suffered a lot during the pandemic, not only due to the burden of the disease but have also faced difficulties in other domains of life. One of the important concerns is the interruption of routine immunization services. The consequences of interrupted immunization services may be life-threatening, as chances of outbreaks of vaccine-preventable diseases (VPD) in susceptible children could be high. Aim: To find out delay in routine immunization services during covid-19 and also to determine the factors associated with delay in immunization. Materials and Methods: This study was a cross-sectional hospital-based observational study at Career Institute Of Medical Sciences And Hospital, Lucknow, India. We collected the vaccination record after lockdown from Well-Baby Clinic and telephonically from the parents, starting from 1st June 2020 till 31st December 2020. We checked the records of vaccination of infants to find out delay in the vaccinations, as per the National Immunization Schedule. The records of a total of 265 infants were enrolled. Out of which, 33 did not fit the inclusion criteria and therefore were excluded from this study. Results: Findings of our study pointed that there was significant delay in routine immunization among infants. The factors responsible for delay in different vaccination observed in this study were, Phobia of COVID-19- 20%, lockdown- 22%, interruption of routine health services-15%, social myths-8%, poor transport facility- 10%, illness of child- 8%, did not notice- 3% and multiple factors- 13%. Conclusion: COVID -19 pandemic has affected the routine immunization services that results in delay of different vaccines at different ages which may lead to outbreak of vaccine preventable diseases, so it is need of the hour to intervene at the earliest to prevent such outbreaks among children.

Maternal Experiences of Home-based Kangaroo Mother Care Following Discharge from a Rural-Urban Health Facility, Nsawam Government Hospital, Ghana

Background: Preterm birth (PTB) is the leading cause of child mortality worldwide and Sub-Saharan Africa is disproportionately affected. Inadequate access to cost-effective interventions in most poor resource areas threatens to increase preterm birth related mortalities. Kangaroo mother care has proven to be a cost-effective intervention and has reduced death as a result of complications of PTB by half. Purpose: This study therefore sought to explore and document the experiences of mothers regarding KMC following discharge from Nsawam Government Hospital. Methods: An exploratory descriptive design was used to collect data from mothers who had preterm births and their experiences of practicing kangaroo mother care at home. Fourteen participants in the Nsawam municipality were purposively selected to participate in the study. Data was analyzed using inductive thematic analyses. Findings: The findings of the study indicated that mothers are encouraged to practice KMC based on the benefits of KMC like provision of warmth, bonding and improvement in growth and development. The study also indicated that support systems available to mothers at home included family, churches, community and healthcare providers. Recommendations: The study recommended that; proper follow-up care should be undertaken by clinicians on mothers practicing KMC especially in their respective home environment to ensure adherence KMC practice experiences in the home.

Assessment of Thoracic Abnormalities in Premature Infants

Background: There is a large incidence of congenital thoracic abnormalities that manifest as deformities and or defects of anterior chest walls. Thoracic abnormalities in preterm infants may also be associated with malpositioning in the incubator in the presence of respiratory disease and prolonged mechanical ventilation. Immaturity of respiratory and musculoskeletal system need to compromise biomechanical function of thorax. Thus, the purpose of the study is to access the thoracic alteration and the factors associated with its abnormalities in the infants born prematurely. Objective: Assess thoracic alteration in premature infants. Methods: This was an observational study with infants in first year of age, born prematurely with birth weight < 2000g. Exclusion criteria were: major congenital malformations as defined by the centers for disease contol and prevention, grade III/IV intraventricular hemorrhage or preventricular leucomalacia. Physical examinations were performed independently to assess shoulder elevation and thoracic alterations. Results: 34 infants born prematurely were included for the study according to the inclusion criteria from which 20 infants (58.8%) showed thoracic abnormalities and remaining 14 infants (41.1%) were without abnormalities. Conclusion: The prevalence of thoracic abnormalities was high in infants born prematurely, and was associated with pulmonary disease, and may also have compromised the growth rate of these infants during the first year of life.

Neonatal Morbidity Pattern among Infants Born to Diabetic Mothers at Jamhouria Hospital, Benghazi- Libya

Introduction: Diabetes has long been associated with maternal and perinatal morbidity and mortality. The infant of a diabetic mother have higher risks for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risks of abortions and stillbirths. Abnormal fetal metabolism during pregnancy complicated by maternal diabetes mellitus results in multiple neonatal sequallae, including abnormalities of growth, glucose and calcium metabolism, hematologic status, cardio- respiratory function, bilirubin metabolism, and congenital anomalies. The causes of the fetal and neonatal sequallae of maternal diabetes are Multifactorial. However, many of the perinatal complications can be traced to the effect of maternal glycemic control on the fetus & can be prevented by appropriate periconceptional & prenatal care. Objective: to describe the morbidity pattern among infants of diabetic mothers (IDMs) either gestational or preconception diabetes mellitus. Methods: A cross sectional study was conducted in Jamhouria hospital/ neonatal ward & enrolled 120 consecutive infants born to diabetics mother either gestational or preconception diabetes mellitus over one year period. Results: 120 babies were diagnosed as IDMs and were admitted to Neonatal intensive care unit, male, female, 74(60.8%) were gestational diabetes, and 46 (38.3%) with preconception diabetes, full term comprise 98 cases (81.6%) while premature were 22 cases (18.3%). For birth weight 20 case [16.7%} were low birth weight, macrosomia represent 16 case (13.3%). Most common congenital anomalies was cardiac lesion 36 cases, for GDM 18 case =24.3% were PCDM 18 case around 40.0%. Central nervous system 11 case (9.1%) all of them dilated ventricular system& only 2 of them need surgical intervention with shunt. Gastrointestinal anomalies 4 cases {3.4%} 2 of them ectopic anus & 2 short bowel syndrome. Most common metabolic disturbance was Hypocalcemia 17 case (14.1%), followed by hypoglycemia 11 case (9.1%), followed with hyper bilirubinemia 3 cases (2.5%) Followed by Respiratory distress syndrome 26 case (21.6%), 17 case hyaline membrane disease (14.1%) ,transient tachypnea of neo born 9 cases (7.5%) , Birth trauma 3 cases Erb,s palsy one of them birth asphyxia. Conclusion: Most common type of diabetes in pregnancy is gestational diabetes, and most common congenital anomalies is the cardiac lesion & the most common metabolic disturbance is the hypocalcemia. Macrosomia associated with large birth weight as well as birth trauma. Large for gestational age and hypoglycemia associated mainly with poor maternal glycemic control.

A Case Series of Cyclic Vomiting Syndrome in Children at Pediatric Gastroenterology Clinic in Benghazi Medical Center

Background: Cyclic vomiting syndrome (CVS) is a functional disorder characterized by repeated episodes of sudden onset of intense vomiting that is followed by symptom-free periods. The diagnosis is based on the fulfillment of Rome IV criteria. The Cyclic vomiting syndrome shares similar features to migraine headaches. It is under-recognized and often misdiagnosed with significant delays in therapy. Aims: To evaluate the clinical characteristic of pediatric patients diagnosed with cyclic vomiting syndrome in our institution and their response to treatment. Patients and Methods: A prospective case series of 13 pediatric patients with cyclic vomiting syndrome seen between period of November 2018 to November 2020 at pediatric gastroenterology outpatient’s clinic in Benghazi medical center. All relevant data including; age and sex, age of presentation, duration of symptoms, age at diagnosis, presence of aura or prodromal symptoms, patient or family history of headache, treatment and their response to treatment were collected. Results: The mean age for diagnosis was 112.2 ± 37.7 months. 46.2% of patients had recognizable prodromal symptoms. Patients with CVS had intense nausea and persistent vomiting that requiring hospitalization. In 44.4% of patients had stopped the episodes as a response to propranolol. Conclusion: Cyclic Vomiting Syndrome (CVS) is a functional, an under-recognized, and misdiagnosed episodic. The illness is characterized by stereotypical pattern of vomiting leading to frequent hospitalizations.

Echocardiographic Findings in Children of Chronic Kidney Disease

Background: Patients with Chronic Kidney Disease (CKD) are at significantly increased risk for both morbidity and mortality from cardiovascular disease (CVD). Determining the spectrum of echocardiographic abnormalities in these patients can help in reduction of morbidity and mortality from CKD. Materials and Methods: This cross-sectional study was held on department of Pediatric Nephrology, Dhaka Shishu Hospital, Dhaka, during July 2018 to December 2018 (Six months). A total of thirty-six children with chronic kidney disease with creatinine clearance <60ml/min/1.73 m2 and age ranged from 2 to 16 years on supportive treatment and hemodialysis were included. In control group equal number of age and sex matched healthy children without any preexisting renal or cardiovascular diseases were included. Both study group and control group were assessed for cardiovascular findings by echocardiography. Results: The mean age was 9.09±3.01 years (mean±SD) in case group and 7.85±3.69 years (mean±SD) in control group. Regarding sex, 22 patients (61.1%) in the case group were male and 14 (38.9%) were female. In this study, in CKD patients significant (p<0.001) difference was observed in following cardiac parameters, left ventricular end diastolic diameter (LVEDD) (38.34 vs 34.52), left ventricular end systolic diameter LVESD (26.64 vs 20.75), interventricular septal thickness (IVS) (9.34 vs 7.27), left ventricular posterior wall thickness (LVPWT) (8.36 vs 7.46), ejection fraction (EF) (56.68% vs 70.36%), fractional shortening (FS) (31.88% vs 38.30%) and peak early diastole velocity/peak atrial filling velocity (E/A ratio) (1.15 vs 1.45) when compared to control group. Most common cardiac abnormality in children with chronic kidney disease were left ventricular systolic dysfunction (44.4%), mild pulmonary hypertension (30.6%) and left atrial dilatation (27. 8%). Conclusion: Left ventricular systolic dysfunction was the commonest echocardiographic findings in CKD children. There was also significant difference in diastolic function between study and control group.

Caregivers' Knowledge, Attitude and Practice Regarding Diarrhoea in Children under Five Years Old in Sub-Saharan Africa: An Integrative Narrative Review

Background: Diarrhoeal diseases constitute a significant burden on the health and growth of children the world over. Globally, diarrhoeal conditions remain the second leading cause of death among children under 5. Knowledge, attitudes and practice of caregivers are at the heart of diarrhoeal disease prevention and proper management. Objective: This review aimed to assess caregivers' knowledge, attitude, and practice regarding diarrhoea in children under five years old in sub-Saharan Africa, as discussed in the literature. Design: Integrative narrative review Data Sources: The review saw an extensive search on two electronic databases. Search results were screened using inclusion and exclusion criteria. At the end of the screening, 37 studies were included in the review. Review Methods: Inclusion criteria: Only studies whose focus was on caregivers’ knowledge, attitude and practice relating to diarrhoea in children under five were included. Also, only publications reported in the English Language were considered, and publications must have been between 2010-2020. Additionally, the methodological quality of studies was assessed using the Down & Black (1998) checklist for quality evaluation in a systematic review. Results: In this review, it emerged that studies in Sub-Saharan Africa indicate that caregivers display poor overall knowledge about diarrhoea. Also, the attitudes of caregivers towards diarrhoea prevention and treatment was low in many studies. On care practices, prevention practices, and management/treatment practices, including ORS and Zinc usage, were mainly reported to be quiet. Conclusions: The review concluded that there are poor levels of knowledge, attitude and practice of managing diarrhoea among caregivers of children under five (5) years of age in sub-Saharan Africa. The researchers recommended continuous health education to address knowledge gaps of mothers about diarrhoea, its prevention and treatment according to international standards.

Cross-Cultural Differences in Temperament Between the United States and the People’s Republic of China: A Longitudinal Comparison

Aims: The present study assessed cross-cultural differences in temperament and temperament stability between children from the United States (US) and the People’s Republic of China (PRC). Goals of the study include examining differences in three temperament factors (surgency, negative affectivity, and regulation/effortful control), conducting comparisons on fine-grained dimensions of factors demonstrating significant cross-cultural differences, and comparing temperament stability from infancy to toddlerhood. Methodology: The US sample (N = 147) and PRC sample (N = 128) consisted of children whose temperament was longitudinally assessed in infancy and toddlerhood using the Infant Behavior Questionnaire-Revised Short Form (IBQ-R SF) and the Early Childhood Behavior Questionnaire Short Form (ECBQ SF). Primary analyses involved evaluating mean differences in the three temperament factors: surgency, negative affectivity, and regulation/effortful control, with additional statistical tests conducted to investigate fine-grained distinctions. Results: Findings revealed main effects of culture for each factor with culture x time interactions indicating negative affectivity significantly differed in toddlerhood, t(273) = -8.27, P < .001, d = 1.00, 98.75% CI [-0.70, -0.37], and regulation in infancy, t(273) = -5.17, P < .001, d = 0.62, 98.75% CI [-0.62, -0.22]. Specifically, the US sample exhibited higher surgency at both time points, lower negative affectivity in toddlerhood, and lower regulation in infancy. In addition, little difference was noted in temperament stability between the US and Chinese samples. Conclusion: Our findings support previous reports identifying cultural differences in temperament and highlight that differences are not constant across early childhood, but rather that as development unfolds, their nature is subject to change.

Predicting Factors among Healthy Lifestyle Beliefs, Behaviors and Mental Health Indicators in Taiwanese Adolescents

Aims: The prevalence of overweight adolescents in Taiwan has dramatically increased in recent years. A survey shows that 66.6% of adolescents do not get the recommended amount of vegetables and fruit (i.e., two portions of fruit and three portions of vegetables per day each week). The purpose of this study was to explore relationships between individual understanding of activity and nutrition, healthy lifestyle beliefs, perceived difficulty of efficacy in reaching health goals, mental health variables, and healthy lifestyle behavior on BMI in Taiwanese adolescents. Study Design: This is a theoretically-based and cross-sectional research study. Place and Duration of Study: Data were conducted from two middle schools in Taiwan between Sep 2011 to November 2011. Methodology: We used a convenience sampling to recruit 453 adolescents with a mean age of 13.42 years. The instruments used were demographics, Beck Youth Inventory II (Depression, Anxiety, Self-concept), Healthy Lifestyle Belief Scale, Healthy Lifestyle Behavior Scale, Perceived Difficulty Scale, Nutrition and Activity Knowledge Scales. We conducted path analysis to test our theoretical model by using Mplus 5.21. Results: Fit indices included χ2 (23, 453) =33.75, P= .05, CFI=.98, and RMSEA=.03, indicating that the model fit the model well. Healthy lifestyle beliefs had a significant positive effect on healthy lifestyle behaviors (β= .41, P= .01). Moreover, there was a significant negative relationship between perceived difficulty and healthy lifestyle behaviors (β= -.54, P= .01). Conclusion: Our findings suggest that promoting positive beliefs about healthy lifestyle among adolescents may facilitate healthy lifestyle changes and help them perceive less difficulty in maintaining a healthy lifestyle. School nurses and health professionals in Taiwan need to coordinate essential resources and implement theoretical-based educational program that address issues on increasing adolescents’ healthy lifestyle beliefs.