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  • ISSN: 2373-9312
    A Novel Mutation in the L1CAM Gene: A Tale of Two Brothers
    Authors: Samuel Levi, Leina Alrabadi, Preeti Singh, Angela Flores* and Vijay Tonk
    Abstract: L1 syndrome encompasses a spectrum of conditions that includes a common clinical finding of congenital hydrocephalus and X-linked inheritance. L1CAM is the only gene implicated in this condition. Approximately 247 different mutations have been reported in 300 families.
    Proptosis is a Pediatric Dilemma
    Authors: Altonbary Y, Mansour AK, Sarhan M, Alwakeel AA, Abdelmabood S, Elmahdi HS and Darwish A
    Abstract: Childhood proptosis is quite different from that of the adult. While thyroid orbitopathy is the most common cause in adults, proptosis among children can be caused by: infection, inflammation, vascular and developmental malformation and finally malignancies.
    Latest Articles
    Research Article
    Andrey P. Prodeus*, Olga Vasilievna Shamsheva, Vasiliy F. Uchaykin, Irina Solnyshkina, and Suntje Sander-Struckmeier
    Objectives: This study evaluated the efficacy and safety of racecadotril together with oral rehydration solution (ORS) compared to ORS alone in infants (>3 months), children and adolescents with acute diarrhea. ClinicalTrials.gov Identifier: NCT03463512.
    Methods: A controlled, open-label, parallel-group multicentre study in which a total of 124 children and adolescents aged 3 months to <18 years (n=62 per treatment group), were randomized to treatment with oral racecadotril (1.5 mg/kg), t.i.d. for a maximum of 5 days plus ORS (RACE+ORS) or ORS alone. The primary endpoint was duration of diarrhea from the start of treatment until final diarrheal/watery stool before recovery or end of study treatment.
    Results: The median duration of diarrhea was statistically significantly shorter with RACE+ORS compared to ORS (16.8 h vs 40.6 h; p<0.0001). The overall mean number of stools during the study decreased with RACE+ORS compared with ORS (5.9 vs 8.3), as did the mean number of watery stools (4.2 vs 6.5). All subjects (62/62; 100%) in the RACE+ORS group recovered by Day 6 compared to 58/62 (93.5%) with ORS. The median time to recovery was statistically significantly shorter with RACE+ORS compared with ORS (29.3 h vs 58.2 h; p<0.0001). The median duration of treatment was shorter with RACE+ORS (49.50 h) compared with ORS (67.08 h). No treatment emergent adverse events were reported in either treatment group.
    Conclusions: Racecadotril plus ORS was significantly more effective for the treatment of acute diarrhea than ORS alone in children aged 3 months to <18 years and was well tolerated.
    Review Article
    Maria da Conceicao N. Pinheiro, Saul Rassy Carneiro*, and Carlos Eduardo P. Corbett
    Mercury prenatal exposure can be estimated through mercury concentrations in different maternal/fetal biological matrices. However, questions have been raised regarding the accuracy of umbilical cord matrices as biomarkers of that exposure. The aim of the present study was to verify the potential of umbilical cord matrices as prenatal exposure biomarkers to mercury and their uses in studies of correlation and association with outcome at birth and with neurodevelopment. For such, we have searched different databases for primary scientific articles using the following terms: methylmercury/total mercury and umbilical cord blood, methylmercury/total mercury and umbilical cord tissue; methylmercury/total mercury in umbilical cord and child growth/neurodevelopment. We found 55 articles about that topic, but only 34 articles met the following inclusion criteria. In general, the studies showed that concentrations of total mercury and methylmercury in umbilical cord blood were higher than those found in maternal blood and umbilical cord tissue and that cord tissue concentrations were better correlated with cord blood concentrations than maternal blood concentrations. Methodological differences among the studies were found regarding the collection of umbilical cord blood and the processing of the cord tissue samples for analysis. In the majority studies that used these matrices as mercury, exposure biomarkers have not verified association with anthropometrics or neurodevelopment. Factors inherent to the placenta and differences in the collection and analysis methods among the studies analyzed may explain the uncertainties regarding the definition of the best biomarker of prenatal exposure to mercury.
    Case Report
    Maria da Conceicao N. Pinheiro, Saul Rassy Carneiro*, and Carlos Eduardo P. Corbett
    Purpose: The manifestation of bullous diseases on oral mucoses leadingscarring sequel are widely described in toxic epidermal necrolysis (TEN). These complications cause disfigurement and functional impairment. They are more rarely reported in erythema multiforme (EM). This article aims to describe a case of lip adhesion after EM induced bymycoplasma pneumoniae, where corrective surgery was performed to increase the mouth opening range of a young female patient.
    Methods: Through the 5-flap Z plasty, mucosal flap rotation was performed for better flexibility and better mouth opening.
    Results: The interincisal distance improved by 12 mm and the intercomisural distance increased by 10 mm, with no type of scar that had an aesthetic impairment reestablishing functional improvement.
    Conclusion: Through the microstomy and the choice of using 5-flap Z plasty, there was a significant increase in the patients mouth opening, thus improving the functional and cosmetic condition, with the patients satisfactory evolution over the long term, with no more idea relapse.
    Luke Cielonko*, Dorothee Newbern, and Reeti Chawla
    Noonan syndrome (NS), is a common congenital genetic disorder due to defects in the PTPN11 gene or genes related to Ras/mitogen-activated protein kinase signaling pathway. Common features seen in individuals with NS include characteristic facial features, congenital heart defects, short stature, and developmental delay. Its presentation, however, can be variable with lack of clear genotype-phenotype correlation thus making the diagnosis of a child with NS challenging. In this case report we describe a late diagnosis of NS in a 14 year old male who presented with a normal height, but a predicted adult height discordant with his genetic potential. Furthermore an extensive genetics evaluation as an infant with karyotype and chromosomal microarray returned normal, which likely dismissed the presence of a genetic syndrome. This case highlights the obstacles that resulted in a delay in diagnosis and provides additional considerations for providers who have a clinical suspicion for NS. Early recognition is important for prompt initiation of counseling, monitoring and therapeutic interventions for comorbidities associated with NS.
    Ana Carolina Galvao dos Santos de Araujo*, Thiago Tavares Bernardo, Ana Paula Moura de Almeida, Hudson Dutra Rezende, Andressa de Deus Mateus, and Liana Moura de Almeida
    Munchausens syndrome refers to patients who injure their bodies and repeatedly request medical assistance due to these illnesses or factitious conditions. In the reported case, an 11-year-old girl was referred to the dermatology outpatient clinic, accompanied by her mother, who reported the appearance of red-pink spots on the skin, with a burning sensation, with one month of evolution. The patient has attended a pediatric emergency weekly, where intramuscular promethazine and intravenous corticosteroids were frequently prescribed, with reported improvement of the burning sensation. She was also seen at an allergy outpatient clinic, where she underwent contact examinations and was subjected to various dietary restrictions. On physical examination, red-pink spots were observed on the face, though sparing the mucous membranes. Some lesions were arranged in a linear pattern and pigment of the same color was observed in the hyponychium. Due to the weird clinical presentation, a gauze soaked in saline solution was rubbed in the cervical region and the pigmentation was removed. After 7 days, the patient returned without the stains and was referred to a psychiatrist. Inconsistent aspects of the lesions that were observed on physical examination, pointed to the correct diagnosis. Early identification of Munchausens syndrome helps to avoid iatrogenesis. In this paper we report a case of Munchausen Syndrome in a child, reviewing its main topics, and give awareness about the possible iatrogenesis induced when misdiagnosed.
    Research Article
    Tariku Derese*, Yalelet Belay, and Zerihun Tariku
    Background: Neonate is any infants from the birth to 28 days. Most of the neonatal deaths occur in developing countries particularly in sub-Saharan African and south central Asian countries. The ability to predict Length of stay would be valuable to parents and families, clinicians and service providers. Timely Management and treatment of birth complication are important factors in reducing new born mortality.
    Objective: To assess median Survival Recovery time and associated factors among admitted neonate in intensive care units of Dire Dawa Governmental Hospitals, East Ethiopia, 2019.
    Methods: Facility based retrospective cohort study design was employed to assess median Survival recovery time and associated factors of neonate among a total of 499 selected 0-28 days of neonates from two public Hospitals and validated Checklist were used to assess data. Data were entered in to Epi-data version 3.1 and exported to SPSS window version 21.0. Descriptive data were presented by table and graph. To determine the associated factors, Cox regression model was computed with 95% CI and P-value <0.05 level of significance. Ethical clearance was taken from Dire Dawa University research and technology interchange office and given for all concerned body.
    Result: The overall median survival recovery time of neonates admitted in neonatal intensive care units of Dire Dawa public hospital was 7 Days with 95% CI (6.525-7.475). Among the neonates that admitted in neonatal intensive care units, neonates those who have weight <2500g had 1.648 times higher hazard risks to recovery compared to that neonates who have weight greater than or equal to 4000g with [AHR 1.648 95% CI (1.246-2.179)]. Those neonates who were none intubated had 6.725 higher hazard risks compared to that of intubates neonates [AHR 6.725 95% CI (1.616- 27.978)], and those neonates who were not supply oxygen continuously had 1.336 times low probability of recovery [AHR 1.336 95% CI (1.030-1.733)]. But, the neonates that admitted between 1-6 days after birth had 0.521 times higher probability for recovery compared to the neonate with those admitted between 7-28 days of after birth [AHR 0.521 95% CI (0.355-0.763)].
    Conclusion: Overall median survival recovery time was 7 Days and Birth weight of neonates, Oxygen supply, and Intubation and admission time of neonate between 1-6 days of after birth were factors that significantly associated with recovery time of neonates. Compared to the other study the recovery time of neonates in this study were short and better.
    Mildrid Yeo, Jose Rodriguez Ciancio, Sirisha Penumatsa, Lorenzo Biassoni, Caroline Brain, and Stephanie Grunewald*
    Objective: Classic galactosaemia (CG), due to Galactose-1-phosphate uridylyltransferase (GALT), deficiency presents in neonates after exposure to galactose. On galactose restricted and lactose free diet, the mainstay of treatment of CG, initial symptoms recede but patients still experience long term complications including impaired bone health. Decreased bone mineral density (BMD), has been observed in pre-pubertal children increasing the risk of osteoporosis and fractures later in life. We present longitudinal and individual serial data on bone health in CG patients by retrospective analysis of clinical and biochemical data.
    Patients and methods: A total of 47 CG patients between the ages of 10-18 years old from a single centre were included. Data on clinical presentation, comorbidities, mobility status, BMD, hormone replacement therapy (HRT), and fracture data was collected. In addition, biochemical results including: Vitamin D, calcium, galactose-1-phosphate, alkaline phosphatase and sex hormone levels were collected and analysed.
    Results: There was significant difference (p=0.02), in BMD age matched Z-scores of female and male patients. There was modest improvement in BMD in female patients on hormone replacement therapy. Vitamin D insufficiency was observed and treated in 34% of the subjects. Calcium and ALP remained within normal range.
    Conclusions: Patients in this study demonstrated low BMD median age matched Z-score (-1.7 SD). Impaired bone health is a common feature in children with CG. This occurs despite prompt initiation and good compliance to treatment. The aetiology of reduced BMD in galactosaemia has not been fully elucidated. Understanding the pathogenic mechanism will inform development of improved therapeutic strategies.
    Mrio Cesar Vieira*, Jose Vicente Noronha Spolidoro, Cristina Helena Targa Ferreira, Cristina Palmer Barros, Mauro Srgio Toporovski, Elisa de Carvalho, Ana Paula Beltran Moschione Castro, Jackeline Motta Franco, Ricardo Katsuya Toma, Mauro Batista De Morais
    Background: The diagnosis of non-IgE mediated cows milk protein allergy (CMA) in infants is based on the elimination of cows milk protein from the diet with clinical improvement, followed by reintroduction with relapse of symptoms. Given the potential for reactions to residual allergens in extensively hydrolyzed formula and the lack of real-world evidence on this subject in Brazil, this study aims to determine the role of amino acid formulas (AAFs), in the diagnosis and management of CMA in Brazil using a survey of experts.
    Methods: Interviewees answered a survey regarding when AAF should be the first option in cases of suspected CMA, advantages and limitations of this approach, impact of delayed diagnosis and precautions when prescribing AAFs. Results were compiled and presented to validate responses and to collect additional information.
    Results: Ten pediatric experts from Brazil participated. There was consensus that elimination of cows milk from the diet and oral food challenges are key to diagnose CMA, and that AAF expedites diagnosis. Eighty percent agreed that i) AAF should be the first option for anaphylaxis, multiple food allergies or food protein-induced enterocolitis syndrome; ii) economic burden is the main disadvantage associated with the use of AAF. Most respondents agreed that there is a delay in CMA diagnosis in Brazil that may lead to faltering growth.
    Conclusions: In line with current guidelines, this panel agreed that AAF should be recommended for complex presentations and for patients unresponsive to EHF. However, when the diagnosis is unclear, the use of AAF followed by oral challenge may shorten the time to confirm or exclude the diagnosis and to avoid unnecessary pharmacological and other nutritional managements or diagnostic tests. The panel pointed out that reducing psychological and social burdens must be considered when choosing the best approach for each patient.
    Mini Review
    Carol A Howell*, Elena N Markaryan and Sergey V Mikhalovsky
    Current guidelines for the treatment of acute intestinal infection in children recommend oral rehydration therapy and use of anti-diarrheals is not widely endorsed, as there are reported safety concerns with some and they do not treat the underlying cause of the diarrhea. This article reviews the potential of oral intestinal adsorbents as an adjunct therapy to oral rehydration solution in the treatment of diarrhea in children with acute diarrhea. Oral intestinal adsorbents range from activate charcoal, clays and silicon-based materials, but they all have a common mode of action which is adsorption of the causal agent of diarrhea from the gastrointestinal tract and removal from the body in the stools. Clinical studies have shown the safety and efficacy of several intestinal adsorbents and their benefits over anti-diarrheals in the treatment of acute diarrhea in children. However, more robust studies and education of both health professionals and the general public is required, before inclusion of oral intestinal adsorbent into the guidelines and potential widespread uptake.
    Review Article
    Adekunle Sanyaolu*, Chuku Okorie, Aleksandra Marinkovic, Urooj Jaferi, Stephanie Prakash, Abdul Jan, and Jasmine Mangat
    The diarrheal disease remains one of the leading causes of death in children under the age of five years in developing countries. Extensive measures have been in effect in low-and middle-income countries (LMICs), worldwide, to provide clean water, good hygiene, and sanitary living conditions. However, many survivors continue to deal with persistent diarrhea and nutrient deficiencies, affecting their growth due to their low socioeconomic status. There are over 2.5 billion diarrheal illnesses cases annually, which account for an estimated 1,400 deaths daily, according to the World Health Organization (WHO). The lack of maternal education, insufficiency or early cessation of breastfeeding, poor handwashing technique, improper storage of food and water, and limited access to proper health facilities in developing countries has resulted in children facing severe dehydration and prolonged mucosal injury that ultimately results in their death. For the patients that can access healthcare, diagnosis is achieved by stool microscopy and culture. Furthermore, polymerase chain reaction (PCR), has been used to test for Escherichia coli and norovirus to detect toxin-encoding genes, while enzyme immunoassay is used to detect other pathogens, such as Campylobacter, rotavirus, adenovirus, astrovirus, Entamoeba histolytica, Shigella, Giardia, and Cryptosporidium. Additionally, subsequent septic bacterial infections that result from inadequate care and poor management of diarrheal illness have resulted in the use of oral rehydration and antibiotics with a minimal resolution of persistent diarrhea in some patients. Several interventions that are being implemented in LMICs to combat diarrhea-related mortality, include providing educational resources to caregivers and healthcare providers, training caregivers to be able to detect early signs of deterioration in children, as well as purifying water and sanitation. Additionally, the importance of highly nutritious foods and proper breastfeeding techniques for the first six months of life have been shown to provide children with stronger immune systems to enable them to combat infections.
    Clinical Case
    Ary L Cardoso* and Vanessa C. Rodrigues
    Male patient, 3 years and months, with allergy to cows milk protein and soy (IgE mediated) and deceleration of weight gain.
    Weight and height: 14 kg and 101 cm. The child is eutrophic, but has a weight loss, with a gain of only 300 g in the last 6 months.
    Research Article
    Thais Freire*, Beatriz Dantas Marotti, Aline Roberta Aceituno da Costa, and Patrcia Abreu Pinheiro Crenitte
    The purpose was to stimulate phonological awareness in the school environment and to verify the effects on reading and writing skills. It is a non- randomized (quasi-experimental), double blind case-control clinical study, 69 students from elementary education participated, enrolled in the first grade, aged 6 to 7 grades of both genders. The participants were divided into Experimental (EG=48), and Control Group (CG=21), aiming to verify the intervention effects. The EG attended 60 days (3 months) of phonological awareness activities (syllables and phonemes), following the Response to Intervention (Tier 1), 15 to 25 minutes each day. The participants were evaluated before and after the intervention through standardized tests. Results: the performance of the EG was statistically superior (p<0,05), to the CG in the phonemic awareness skills, reading, and writing levels. Approximately 80% of the students who participated reached the reading and writing alphabetical level, while only 30% of the students in the control group presented this performance. Conclusion: The training of phonological awareness following RTI promoted advances in reading and writing skills, generating positive effects in the literacy process. Replication of the study is recommended with larger samples.
    Simone Fiuza Regacone, Katia de Freitas Alvarenga*, Julia Speranza Zabeu-Fernandes, Adriane Lima Mortari Moret, Eduardo Boaventura Oliveira, Rafaela Cristina da Silva Bicas, and Orozimbo Alves Costa
    This longitudinal study aimed to verify the advantages of simultaneous bilateral stimulation for the development of hearing and oral language skills over unilateral stimulation in children using cochlear implants, in the first year of electronic device use. The study included twenty children divided into two matched groups (n=10): children using unilateral cochlear implant (UCI), and those using simultaneous bilateral cochlear implant (BCI). The IT-MAIS or MAIS and MUSS questionnaires were used for evaluated language and auditory performance at three, six, and twelve months after activation of the electrodes. A gradual increase in auditory speech perception and oral language development was seen over the first year of device use in both groups; however, there was no significant difference between the two groups. In conclusion, in the first year of cochlear implant use, children using UCI and those using simultaneous BCI showed similar development of auditory perception of speech and oral language.
    Pamela Talita Favil, Beatriz Rosana Gonalves de Oliveira Toso, Milene Sedrez Rover, Grasiely Masotti Scalabrin Barreto, Sabrina Grassiolli, and Claudia Silveira Viera*
    Background: Phenotype expression in adulthood is closely related to lifestyle, particularly eating habits in early childhood. In addition, children born prematurely are subject to metabolic complications that lead the early onset of chronic diseases such as hypertension and diabetes.
    Aim: To correlate the dietary profile of premature and term infants and theirrelationship with plasma biochemical parameters from birth to six months of life.
    Method: It is a secondary data analysis study, based on the variables collected at birth (T0) and the 6-month follow-up (T1) of term infants (n=73) and premature infants (n=39).
    Analyzed variables: Weight, type of food intake, adequacy of birth weight, gestational age and, biochemical tests (triglycerides, cholesterol, glucose, and insulin). The study sample consisted of premature and term infants, classified about birth weight and gestational age.
    Results: Glucose and triglyceride values between the two evaluated groups were influenced only by the gestational age (p<0.01). Premature infants have higher triglycerides concentration (T0T1=57.97 87.65) then the term ones (T0-T1==7.97 68.66). Predictors regarding the adequacy of birth weight and dietary types did not influence glucose and triglyceride variation. However, the babys diet based on vegetables (p=0.047), and born prematurely (p<0.01), exerted influence on the variation of insulin and cholesterol in the evaluated period.
    Implication for practice: The intake of vegetable soup showed an increase in insulin and cholesterol concentrations, regardless of a preterm or term birth. Preterm infants are more vulnerable to lipid changes at six months when compared to term babies.
    Aamir Jalal Al-Mosawi*
    Background: Davis Buckley hyperimmunoglobulin E (IgE), recurrent infection syndromes are very rare group of heterogeneous disorders of variable genetic basis and manifestations, but they are essentially characterized by significant elevation of serum IgE levels occurring in association with recurrent infections with or without coarse facial features and eosinophilia. The aim of this paper is to report the occurrence of an extraordinary case of Davis Buckley syndrome associated with associated with IgA deficiency.
    Patients and methods: An Iraqi boy of Turkish origins was referred at the age of 10 years to the pediatric psychiatry clinic at the Children Teaching Hospital of Baghdad Medical City because of poor school performance and poor attention span was studied.
    Results: The boy didnt have coarse facial features or facial dysmorphism .During the previous few years the boy was experiencing urinary tract infections and recurrent ear infections associated with discharge and was being treated with several courses of antibiotics. The boy didnt have growth retardation or bony or dental abnormalities. The parents were health relative, and family history was negative for similar condition. Blood tests showed eosinophilia and reactive thrombocytosis. Serum IgE was significantly elevated at the level of 0.4mg/dL (normal 0.01-0.04 mg/dL).The patient also had very low IgA level which was 18 mg/dL (normal 90-450 mg/dL). Mutation analysis was positive for Stat 3 mutation.
    Conclusion: There has been only one case of Davis Buckley syndrome associated with low IgA levels reported by Mazzone et al (1996). The case in this paper is most probably the second case of the syndrome associated with IgA deficiency.
    Editorial
    Aamir Jalal Al-Mosawi*
    There are now too many of rare clinical syndromes and dysmorphic syndromes including genetic syndromes, and it is difficult for most physicians to equip themselves with adequate professional knowledge that help them to make an early useful diagnosis for many of the syndromes they may encounter [1-5].
    Aamir Jalal Al-Mosawi*
    Syndromes in medicine are generally or traditionally named after the physician or physicians that initially reported them or provided the earliest satisfactory clinical picture or the best description of the syndrome. However, a large number of rare syndromes have been described by doctors through out the world before the era of the internet which has been associated with easier access to medical literature throughout the world. Regrettably, several syndromes have been attributed unfairly and inappropriately to physicians other that those first described them [1-6].
    Research Article
    Saccomanni Bernardino*
    In the current study, age less than or equal to 24 months and visiting ED after 4 hours of the event lead to a longer duration for re-using the affected arm following reduction.
    Anne Karoline Santos*, Valria Cabral Neves, and Nelson Augusto RosrioFilho
    Objective: To describe procedures, indications and contraindications for bag squeezing and manual hyperinflation maneuvers and to propose an algorithm to optimize use of these techniques.
    Methods: A narrative literature review based on searches in the SciELO, ScienceDirect, PubMed and PEDro databases as well as the SECAD online continuing education system. The following descriptors were used: physical therapy modalities, inflation, airway obstruction, respiratory therapy and critical care.
    Bag squeezing: A physical therapy maneuver primarily for airway clearance and lung re-expansion. The maneuver is used with manual hyperinflation and compression of the chest followed by tracheal suctioning.
    Manual hyperinflation: A physical therapy maneuver that can technically be performed by physicians and nurses to ensure bronchial hygiene. The maneuver is characterized by the use of a self-inflating bag and slow manual compression, with a plateau being maintained for 2 to 3 seconds before abrupt decompression.
    Conclusion: Both bag squeezing (BS), and manual hyperinflation (MH), help with mechanical ventilation, oxygenation and airway clearance and re-expansion. However, BS is more effective than MH due to manual compression of the chest.
    Shobha Rao* and Swati Raje
    Background: Identification of mothers at risk, early in gestation is essential In India as both maternal undernutrition and prevalence low birth weight (LBW) is high.Therefore, simple screening tool based on non-invasive early markers of risk for LBW at registration was attempted.
    Method: Mothers registering for antenatal care (ANC), within 20 weeks of gestation at a rural hospital in Maharashtra, India were studied (n=370), for socioeconomic, demographic variables, dietary consumption pattern and anthropometric measurements and were followed up till delivery.
    Result: Mothers were thin (weight 46.0 7.4 kg), and short (height150.8 6.1 cm) and undernourished (BMI<18kg/m2). 9.8 % of mothers were below 38 kg while 8.6 % of mothers were below 145 cmwhich are known risk cut offs for LBW. Among the pre-pregnant factors, significant risk (OR=2.2; CI: 1.1-4.3), for LBW was seen for maternal age (<20 yr); previous abortion (OR=3.0;CI:1.7-5.3), and for low (<42.5 Kg), maternal weight (OR=2.1;CI:1.2-3.6). Among intra pregnancy variables risk was seen for lower consumption (<2/d) of staple food roti (OR=1.7; CI: 1.0-2.9), and no consumption of milk (OR=1.8; CI:1.0-3.1). Receiver Operating Curve (ROC), analysis was used to obtain risk cut off for total score based on five maternal variables, all of which can be recorded at registration by a health worker lowest in hierarchy. This score showed 76% sensitivity in identifying LBW mothers. Risk of LBW was high (OR=3.0, CI: 1.4-6.3) in mothers with score 9 to 12 and was higher (OR=4.4,CI: 1.9-9.8), for score >12.
    Conclusion: Early identification of high risk mothers will help providing them intervention during gestation.
    Priyanka Airi Goyal* and Indu Talwar
    Assessment of nutritional status of a population using most appropriate growth chart is essential to establishitshealth status and for administering timely interventions. This study aimed to assess the nutritional status and its correlates among adolescent girls and to ascertain the suitable growth chart/reference to estimate undernutrition among them. The cross-sectional sample consisted of 1045 adolescent girls of scheduled caste category aged 9 to 17 years of District Yamunanagar, Haryana. Weight and height were measured to calculate Body Mass Index. Hemoglobin level of the girls was measured using Sahlis acid haematin technique. Dietary habits, socio-demographic and micro-environmental variables were recorded using structured questionnaire. Nutritional status was evaluated with the help of BMI using different standards. Anaemic status was assessed using WHO (1968) classification.Correlates of nutritional status were investigated using Chi-square test. According to CDC (2000), classification, 44.3% girls were underweight, 54.4% normal and 1.3% girls were overweight. Using IAP (2015), classification, 82.9% girls were normal; 14.5% thin; 2.3% overweight and 0.3% were obese. According to WHO (2007), reference data, 68.1% girls were stunted while 67.1% girls revealed wasting. 91.1% girls were found to be anaemic. Mothers educational status and consumption of homemade food by the girls showed significant association with the nutritional status of the girls. ROC analysis revealed IAP (2015), to be the most suitable for assessment of undernutrition among adolescent girls as compared to the other two criteria which overestimated the prevalence of thinness among them.
    Mostafa Kamal SM*
    Objectives: This study examines inequalities and changes in under-nutrition of under-five children in Bangladesh.
    Materials and methods: We used data from the Bangladesh Demographic and Health Surveys conducted in 2004 and 2014. Inequalities in under-nutrition were measured by concentration index. Blinder-Oaxaca decomposition method was applied to examine the magnitude and socioeconomic factors contributing to changes in inequalities in under-nutrition.
    Results: Although the prevalence of stunting and underweight has declined and that of wasting has increased, inequalities in under-nutrition have increased between 2004 and 2014. Household wealth and maternal education are the most important determinants of inequalities in childhood malnutrition. Childs age, birth interval, diarrhea, maternal age and education, working status, household wealth and place of residence are important contributing factors of change in inequalities of malnutrition.
    Conclusions: Any program to mitigate inequalities of malnutrition between poor and rich should address the prevailing socioeconomic inequalities in the country.
    Case Report
    Nashaat Elsayed Farara* and Mohamed Zakkaria
    We present a previously normal 15 years old girl with a generalized weakness and coma following convulsive status epilepticus which developed after inferior alveolar nerve blockade through local lidocaine injection by a dentist. The patient was admitted to the pediatric intensive care unit and recovered within several days.
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