Screening of microhematuria in school children

Microhematuria [MH] is present in 0.5 - 2% of children. A renal or urologic disorder may present with symptom obviously pointing to the urinary tract as hematuria or the kidneys may be involved in several different systemic diseases including the vasculitis syndromes, collagen vascular diseases and the thrombotic microangiopathic diseases due to variable etiologies. Each of these diseases has important renal manifestations that may symptomatise as hematuria. We aimed to detect and depict any eventual correlation that might make microhematuria a useful tool on the predictive level on renal participation in medical disorders. More especially so in tropical settings, where specific diseases are expected to have an insulting impact upon the kidney if not the whole organisms and to determine the prevalence of microhematuria in healthy school aged children the study was conducted on 100 children with MH detected by dip- sticks and confirmed microscopically, the age range from 6 to 12 years either symptomatic or not. It was conducted among healthy children attending the outpatient clinic of the National Hepatology and Tropical Medicine Research Institute [NHTMRI] and in 2 primary schools, through screening of 5342 children by dipsticks for microhematuria. Cases were compared with 20 healthy children of the same age and sex matched as a control. All cases were subjected to full history taking, clinical examination and laboratory studies including complete urinalysis, urine culture and sensitivity, urinary Ca/creatinine ratio, blood urea nitrogen, serum creatinine, serum complement C3, CBC, retics, ASOT, CRP, ESR and coagulation profile [PT, PTT, BT and CT]. Pelvi-abdominal ultrasonography was done for all cases. In selected cases, 1VU, voiding cystourethragraphy, DMSA scan and renal biopsy were done The prevalence of MH was 1.9%. Glomerular group represented 14% and included, acute post streptococcal glomerulonephritis, APSGN [9%], IgA nephropathy [3%] and membranoproliferative glomerulonephritis [2%], non-glomerular group represented 42% of the studied cases and included UTI [24%], hypercalciuria [14%], renal stone [2%], UPJ obstruction [1%] and VUR [1%] and group of unidentified cause of MH [44%] who had no MH after 6 months of follow up Dipsticks can be used as a useful screening test for MH; however this should be confirmed by microscopic examination of the urine. The most common glomerular cause of MH in the event study was APSGN whereas the most common nonglomerular cause was UTI and hypercalciuria. Follow up is recommended for cases of MH with unidentified origin. MH is positively suggested as reliable simple, however preliminary tool in clinical diagnosis of renal and urological disorders

Functional abdominal pain

The most widely used diagnostic term for chronic abdominal pain in children is "recurrent abdominal pain" [RAP]. Recurrent abdominal pain is a broad descriptive term to define a heterogeneous group of patients who experience at least 3 episodic attacks of abdominal pain over a period of at least 3 months. The great majority of patients who seek medical attention for RAP have a functional disorder thought to be triggered by a motility or sensory disturbance of gastro intestinal tract provoked by a variety of physical and psychological stimuli. When evaluated critically there are three distinct clinical presentations: Functional paroxysmal abdominal pain, functional dyspepsia and irritable bowel syndrome. There are adequate data to support the view of medical history, physical examination and selected laboratory, radiological and endoscope evaluation allows a positive diagnosis of each type of functional disorder to estimate the magnitude of the problems. Clinical approach to children with RAP. Estimate the morbidity of RAP and its effect on daily activities of the children The study was conducted on two hundred fifty six children aged 4-12 years attended out patient clinic and inpatient of national hepatology and tropical medicine research institute [NHTMRI] during the period from July to December 2003 through careful examination and investigation of 800 children with RAP 256 fit our criteria for functional abdominal pain the children had normal physical Examination and normal laboratory investigation and experienced at least 3 episodic attacks of abdominal pain over a period of at least 3 months. All the children subjected to investigation to exclude organic causes. All children were subjected to a structured questionnaire designed specially for the study. Medical history was reviewed thorough clinical examination was carried out. The following laboratory tests were done for all the children: CBC., Routine and microscopic stool and urine analysis, ESR, urine culture and psychosocial evaluation Showed that out of 800 children attended NHTMRI suffering from RAP. 256 [32%] of them were have functional abdominal pain. Female represented 53.1% and males only 46.9%. The children between [4-6] years having RAP were 38.3% females and 30% males, while in group between [6-12] years females were 61.7. Functional Isolated abdominal pain represented 60.5% of our patients. Functional dyspepsia were 21.5% and irritable bowel syndrome was only 18%. Clinical presentation of in RAP. Showed Symptoms associated with functional Isolated abdominal pain were headache 19% pallor 13% fatigability 22.5% In group having functional dyspepsia epigastric pain were 54% children suffering irritable bowel syndrome had constipation in 65% diarrhea in 32% and sense of incomplete evacuation in 21%. The duration of pain in the studied subjects ranging between 1-3 hours less than I hours account for 55.5% of children and less than 3 hours in 40% of cases, continuous pain represented only 4.5%. Periumblical and mid epigastric were the most frequent location in RAP represented 58.9 and 23.9 respectively. 16.8% of children had positive psychosocial dysfunction. The pain interfere in daily activities of children in 68.3 Chronic abdominal pain is the one of the most commonly encountered symptoms in childhood. The great majority of patients who seek medial attention for RAP have a functional disorder thought to be triggered by a motility or sensory disturbance of gastro intestinal tract provoked by a variety of physical and psychological stimuli. There are adequate data to support the view of medical history, physical examination and selected laboratory, radiological and endoscopic evaluation allows a positive diagnosis of each type of functional disorder. Most children who are brought to primary care physicians for chronic abdominal pain are unlikely to require diagnostic testing