Current maternal-infant micronutrient status and the effects on birth weight in the United Arab Emirates.

Micronutrient deficiencies exist among women of childbearing age in the United Arab Emirates but the effects of maternal micronutrient deficiency on fetal growth are not well documented. To investigate the association between micronutrients and birth weight, we measured maternal and cord blood micronutrients (vitamin A, C, D, and E) and ferritin in 84 term, singleton infants born to healthy Arab and South Asian women at Al-Ain hospital. Median serum ascorbic acid and 25-hydroxyvitamin D (25-OHD) concentrations were low in mothers and infants. In multivariate analysis, maternal serum 25-OHD correlated positively with birth weight while serum ferritin showed a negative correlation.

Bartter syndrome: an overview.

The term Bartter syndrome denotes a group of renal diseases which share a common denominator of hypokalaemia and metabolic alkalosis. The patch-clamp technique has made possible the analysis of single ion channels, improving our understanding of the molecular physiopathology of all the 'Bartter-like' syndromes. Genetic mapping of each defect has further clarified the mutations involved and the possible modes of inheritance. This improved understanding has opened new avenues for therapy, improving mortality and morbidity in these patients. Another group of illnesses, the 'pseudo-Bartter syndrome', may produce a hypokalaemic metabolic alkalosis without primary renal disease. The underlying illness needs to be identified and treated.

A microcomputer-based interactive cough sound analysis system.

The occurrence and nature of cough sounds, especially those occurring in asthma in young children, is of considerable interest to workers in paediatrics and general practice. To facilitate our research into the characteristics of such sounds, we have developed a microcomputer-based analysis system, which we call COFF. In this paper we discuss the design and implementation of the system, emphasising its user-friendly, interactive features, and the manner in which it efficiently manages the large amounts of data that research into sounds incurs. We illustrate the operation of the system with examples of spectrograms computed from cough sounds recorded simultaneously at the mouth and through the chest wall.

The use of ultrasound in the diagnosis of congenital pyloric stenosis.

Thirty-six infants with pyloric stenosis were studied preoperatively by ultrasound and compared with a control group of 24 normal infants aged one month. Measurement of pyloric muscle diameter and muscle wall thickness was significantly different for each measure between groups and they had a nonoverlapping distribution. Ultrasound has a clear place in the diagnosis of pyloric stenosis.

The severity of asthma in children admitted to hospital: a 20 year review.

A clinical scoring method was used to assess the severity of the presentation of acute asthma in children admitted to hospital over a 20 year period. A significant increase in severity was observed between 1975 and 1985, as well as an overall 29-fold increase in admission numbers between 1965 and 1985. Changes in drug treatment of acute asthma over this period are reported.

Urinary fibrin degradation products in childhood acute nephritis.

Fourteen children with acute post-streptococcal nephritis had daily measurements of urine fibrin degradation products (FDP) excretion during the acute phase of their illness. The amount of FDP excreted daily varied greatly but a general decrease occurred as other parameters showed resolution of the illness. Some children showed no increase in FDP output. We feel, however, this test may help in monitoring the progress of this illness in certain patients. Fibrin degradation products (FDP) are excreted in the urine in many forms of glomerulonephritis (Clarkson and others, 1971). The origin of the FDP is renal and not filtrated from the blood (Ekberg, Pandolfi, 1975). Clarkson further showed that in post-streptococcal glomerulonephritis there is a cessation of FDP excretion at the time of clinical recovery. We have studied a group of children with acute post-streptococcal nephritis in order to further assess the extent and possible value of daily FDP estimations in the management of patients during the acute phase of the disease.

Symptoms frequency and medical implications of severe asthma in children.

The frequency of asthma symptoms, drug therapy and medical intervention have been studied in a group of 200 children with severe asthma attending an asthma clinic. There was wide use of all the common asthma preparations, usually in combination. An average of 6.4 general practitioner consultations per year per child occurred for asthma episodes. Antibiotics were prescribed regularly in 57% for asthma symptoms. Forty-six percent had attended breathing exercises and physiotherapy for an extended period.

A comparative study of the clinical patterns of acute glomerulonephritis from a high and a low incidence area of New Zealand.

Prompted by the marked regional differences in the incidence of acute nephritis in childhood, a comparative clinical study is reported. The features of the disease in a high incidence area, Tauranga, are contrasted with those in a low incidence area, Christchurch. The relative infrequency of the disease in Christchurch has been confirmed. The clinical features and the severity of the disease showed a similar pattern in the two centres. Serological evidence of recent streptococcal infection occurred in the majority of patients from both areas. Prior skin infection was more frequently reported from Tauranga and the significance of this is discussed.

Sequential complement changes after childhood acute nephritis.

A group of 29 children with acute nephritis have been studied in relation to complement changes during and after their illness. Eighty-two percent had evidence of a streptococcal aetiology. C3 levels were initially depressed in 96.5 percent, but by 12 months all children were normal clinically and had normal complement status. The role of complement is discussed in relation to acute nephritis.

Serum ferritin levels in iron deficient children.

A group of 42 iron deficient children had serum ferritin levels in the range of 0-19 micrograms/l, with a mean figure of 7.2 micrograms/l. A control group had levels of 11 micrograms/l to 130 micrograms/l with a mean of 39.8 micrograms/l. The use of this assay has particular relevance whilst iron deficiency anaemia continues to be a common disorder in New Zealand children.

Acute dystonic reactions in childhood to drugs.

Twelve children who exhibited acute dystonic reactions to drugs are described. The frequency of these complications is noted. We would stress the requirements for strict weight/dosage schedules especially with anti-emetic drugs. The indications for the use of these preparations in young children is questioned.

Who comes to a paediatric medical outpatient clinic?

A clinical audit was undertaken of all new patients (first referral) to a paediatric outpatient department over a six month period. There was a total of 542 children, of whom 59% were referred by a general practitioner and the remainder by paediatricians or other consultants. The conditions for which general practitioners most frequently referred children were cardiac murmurs and urinary tract problems, whereas respiratory disease, especially asthma, and hip and orthopaedic conditions were the common referrals from the specialists. Forty-four percent of general practitioner referrals were seen only once and then discharged, and there was a very low level of cross-referral to other disciplines.

Prader-Willi syndrome in New Zealand: a survey of 36 affected people.

The Prader-Willi syndrome consists of infantile hypotonia, failure to thrive, hypogonadism and developmental delay. It was first described in 1956. Later in life hypotonia improves. Between the age of two and four obesity becomes noticeable and between six and ten there is uncontrollable behaviour. A survey has been carried out of the 36 known cases in New Zealand and the pattern of the disease is similar to that elsewhere. In most cases the diagnosis was not established until between the ages of six and 10 when the obesity was marked and uncontrolled behaviour a problem. Early control of the obesity is helpful.

The pattern of acute medical admission to a children's unit.

A study of 607 consecutive acute medical admissions to a children's unit, revealed a dominance of acute asthma and acute respiratory infection. The patterns of illness reflected previous community based studies in the area. These patterns prevailed irrespective of whether the child came from a one or two parent family. Admission tended to be out of normal working hours. The significance of these findings is discussed.

Acute bronchiolitis: a three year study.

Over the period 1986-88, 261 infants and children, with a mean age of six months, were admitted to Christchurch Hospital with acute bronchiolitis. There was a marked seasonal pattern, with peak admission periods occurring during winter and spring. Two hundred and two children (77%) had a nasopharyngeal aspirate performed for respiratory virus identification. Respiratory syncitial virus was identified in 113 (56%) of those who had viral studies performed. Using a score of severity, 150 (57%) of the children had a mild disease, 47 (18%) moderate, while 64 (25%) had a severe or very severe illness. The median stay in hospital was two days. No deaths occurred during the study period, although six infants required assisted ventilation.

The assessment of dehydration in congenital pyloric stenosis.

In a retrospective review of the records of 88 infants who underwent a Ramstedt pyloromyotomy for pyloric stenosis, biochemical and clinical measures were used to determine the most useful guide to the degree of dehydration on admission. The only measure which correlated to the dehydration was the clinical assessment (r = 0.62). Apart from indicating the presence of alkalosis and hypochloraemia, serum chloride and serum bicarbonate levels were not useful measures. While clinical measures show only a degree of linear correlation with dehydration, they do present the most useful baseline to judge fluid requirements. Biochemistry is needed to measure the electrolyte and acid base imbalance found in the condition.

Parental perceptions of paediatric inpatient care.

The parents of 206 children admitted to a paediatric department completed a structured questionnaire, 4-6 days after their child's discharge from hospital. The aim of the study was to assess the parents perceptions of the quality of care given over a range of measures. Overall satisfaction was in the order of 86%. Areas of discontent were in the admission process, information about available hospital facilities and information on the future management of the child's illness.

A complaints management system: strengths and weaknesses.

AIMS: To describe the complaints management process in a base hospital and to outline its guiding principles. METHOD: A review and analysis of the complaints lodged during 1996 with the Complaints Management System of the hospital. RESULTS: There were 146 complaints lodged after 132,400 patient contacts. Overall resolution time was 14 days, but 24 appeals were lodged against the initial opinion and were all subsequently resolved satisfactorily. CONCLUSION: The complaints process should be user friendly, result in a quick response and be seen as a quality rather than a disciplinary tool.

Acute glomerulonephritis: the current role of the streptococcus.

Thirty-one patients who presented with acute glomerulonephritis have been reviewed with respect to the involvement of the streptococcus in their disease. The high incidence of the condition and the fact that 76 percent of the patients had evidence of streptococcal infection, as indicated by a raised anti-streptolysin O-titre is discussed.

Acute nephritis: a local epidemic.

A dramatic increase in the incidence and severity of actue glomerulonephritis in the childhood population of Tauranga is report. The clinical features of the disease and streptococcal aetiology are discussed.