Improving nutritional status of children with cystic fibrosis at Red Cross War Memorial Children's Hospital.

AIM: To determine the nutritional status of children attending a cystic fibrosis clinic in a tertiary hospital in South Africa and compare it to previously reported 10-year rates. METHODS: Weights and heights were measured of 69 (37 male and 32 female) children aged between 1 year and 18 years. Expected weight-for-age, expected height-for-age, expected weight-for-height and body mass index (BMI) were compared with international standards for underweight, stunting, wasting and BMI goal. RESULTS: The nutritional status of the patients has improved over the last 10 years, most significantly for wasting, which decreased from 58.3% in 1996 to 15.9% in 2006 (95% confidence interval (CI), 1.315-14.09, P < 0.05). Fifty-two percent of the children were underweight in 2006, compared with 66.7% in 1996 (95% CI, 0.044-13.96, P < 0.05). Stunting was found in 31.9% of the current sample. Females over 15 years had expected weight-for-age 25.9% lower than those between 10 years and 15 years, while no difference was found between the male age groups. Female height-for-age was 7.06 percentage points greater than males between 10 years and 15 years (95% CI, 2.16-11.96, P < 0.01). Males between 10 years and 15 years had significantly lower BMIs than the corresponding female group. Coloured patients had significantly lower BMIs than white patients in all age groups. CONCLUSIONS: These children demonstrated continuing improvement in nutritional status, although deficits remain. The normalisation of mean weight-for-age and weight-for-height with far fewer wasted patients is encouraging. Interventions are needed in some areas to ensure that all children show progress.

Improvements in lung function of a pediatric cystic fibrosis population in a developing country.

OBJECTIVE: To document the change in pulmonary function of a pediatric cystic fibrosis population managed at the Red Cross War Memorial Children's Hospital, Cape Town, South Africa, between January 1999 and December 2006. METHODS: Retrospective review of the medical records and best spirometry results within 3-monthly intervals. RESULTS: A total of 1,139 pulmonary function tests from 79 patients showed a significant improvement over the 8 years studied. When comparing the first quarter of 1999 with the last quarter of 2006, 78 pulmonary function tests were performed on 65 patients with equal patient numbers in both groups and similar in terms of gender, age, age at diagnosis, ethnicity, cystic fibrosis genotype and number of patients colonized with either Staphylococcus aureus or Pseudomonas aeruginosa. In 2006, 15 patients (38.5%) were on azithromycin treatment compared to one (2.6%) patient in 1999 (p = 0.0003). Median (interquartile range) forced expiratory volume in 1 second, forced vital capacity, and average expiratory flow between 25 and 75% of forced vital capacity increased from 61% (51-73), 63% (52-89), and 40% (27-57), predicted in the first quarter of 1999, to 81% (69-100, p = 0.004), 82% (70-98, p = 0.007), and 62% (41-87, p = 0.01), predicted during the last quarter of 2006, respectively. CONCLUSIONS: Pulmonary function tests increased by 20% over 8 years in comparable patient groups. This likely reflects improved care of South African children with cystic fibrosis.

The utility of computed tomography for recent-onset partial seizures in childhood.

OBJECTIVES: To determine the diagnostic yield of computed tomography (CT) of the head in children presenting for the first time with partial seizures in a region with a high prevalence of tuberculosis and neurocysticercosis. DESIGN: Prospective cohort study. SETTING: The secondary-level ambulatory service of Red Cross Children's Hospital, Cape Town. SUBJECTS: Children aged 6 months-12 years with a first partial seizure. Outcome measures. Abnormal CT findings; clinically unsuspected abnormal CT findings. RESULTS: Of 118 enrolled children, CT findings were available for 94 (80%). Sixteen (33%) of 49 children scheduled to return later for an initial CT scan failed to do so. Thirty-two scans (34%) were reported normal, 45 (48%) showed single or multiple granulomas, and 17 (18%) showed other findings. All 8 children with persistent specific CT findings were suspected of having the condition before CT scan. Of 68 cases with prospectively recorded clinically expected CT findings, normal scans were expected in 2 cases (3%) and occurred in 33 cases (49%). CONCLUSIONS: Routine CT scan for children presenting with a first partial seizure in an area with a high prevalence of neurocysticercosis failed to identify findings other than neurocysticercosis that meaningfully altered clinical management. Assuming a 70% relative reduction of seizures with albendazole treatment for neurocysticercosis, routine CT scanning in the study population would require 11 scans and 5 courses of albendazole to prevent 1 child from having seizures, compared with no CT scans and 11 courses of albendazole with blanket use of albendazole.

Melhoras na função pulmonar de uma população com fibrose cística em um país em desenvolvimento / Improvements in lung function of a pediatric cystic fibrosis population in a developing country

OBJETIVO: Documentar a alteração em função pulmonar de uma população pediátrica com fibrose cística tratada no Red Cross War Memorial Children's Hospital, Cidade do Cabo, África do Sul, entre janeiro de 1999 e dezembro de 2006. MÉTODOS: Revisão retrospectiva dos prontuários médicos e melhores resultados de espirometria em intervalos de 3 meses. RESULTADOS: Um total de 1.139 testes de função pulmonar de 79 pacientes mostrou melhora significativa ao longo dos 8 anos estudados. Ao comparar o primeiro trimestre de 1999 com o último trimestre de 2006, 78 testes de função pulmonar foram realizados em 65 pacientes com números iguais de pacientes em ambos os grupos e semelhante em termos de gênero, idade, idade ao diagnóstico, etnia, genótipo da fibrose cística e número de pacientes colonizados com Staphylococcus aureus ou Pseudomonas aeruginosa.Em 2006, 15 pacientes (38,5 por cento) estavam em tratamento com azitromicina, comparados com um (2,6 por cento) paciente em 1999 (p = 0,0003). Volume expiratório forçado no primeiro segundo mediano (intervalo interquartil), capacidade vital forçada e fluxo expiratório médio entre 25 e 75 por cento da capacidade vital forçada aumentaram de 61 por cento (51-73), 63 por cento (52-89) e 40 por cento (27-57) previstos no primeiro trimestre de 1999 para 81 por cento (69-100, p = 0,004), 82 por cento (70-98, p = 0,007) e 62 por cento (41-87, p = 0,01) previstos durante o último trimestre de 2006, respectivamente. CONCLUSÕES: Testes de função pulmonar aumentaram em 20 por cento ao longo de 8 anos em grupos comparáveis de pacientes. Isso provavelmente reflete a melhora na prestação de cuidados a crianças sul-africanas com fibrose cística.

OBJECTIVE: To document the change in pulmonary function of a pediatric cystic fibrosis population managed at the Red Cross War Memorial Children's Hospital, Cape Town, South Africa, between January 1999 and December 2006. METHODS: Retrospective review of the medical records and best spirometry results within 3-monthly intervals. RESULTS: A total of 1,139 pulmonary function tests from 79 patients showed a significant improvement over the 8 years studied. When comparing the first quarter of 1999 with the last quarter of 2006, 78 pulmonary function tests were performed on 65 patients with equal patient numbers in both groups and similar in terms of gender, age, age at diagnosis, ethnicity, cystic fibrosis genotype and number of patients colonized with either Staphylococcus aureus or Pseudomonas aeruginosa. In 2006, 15 patients (38.5 percent) were on azithromycin treatment compared to one (2.6 percent) patient in 1999 (p = 0.0003). Median (interquartile range) forced expiratory volume in 1 second, forced vital capacity, and average expiratory flow between 25 and 75 percent of forced vital capacity increased from 61 percent (51-73), 63 percent (52-89), and 40 percent (27-57), predicted in the first quarter of 1999, to 81 percent (69-100, p = 0.004), 82 percent (70-98, p = 0.007), and 62 percent (41-87, p = 0.01), predicted during the last quarter of 2006, respectively. CONCLUSIONS: Pulmonary function tests increased by 20 percent over 8 years in comparable patient groups. This likely reflects improved care of South African children with cystic fibrosis.