Prevention of mental handicaps in children in primary health care.
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Some 5-15% of children aged 3 to 15 years in both developing and developed countries suffer from mental handicaps. There may be as many as 10-30 million severely and about 60-80 million mildly or moderately mentally retarded children in the world. The conditions causing mental handicaps are largely preventable through primary health care measures in developing countries. Birth asphyxia and birth trauma are the leading causes of mental handicaps in developing countries where over 1.2 million newborns die each year from moderate or severe asphyxia and an equal number survive with severe morbidity due to brain damage. The other preventable or manageable conditions are: infections such as tuberculous and pyogenic meningitides and encephalopathies associated with measles and whooping cough; severe malnutrition in infancy; hyperbilirubinaemia in the newborn; iodine deficiency; and iron deficiency anaemia in infancy and early childhood. In addition, recent demographic and socioeconomic changes and an increase in the number of working mothers tend to deprive both infants and young children of stimulation for normal development. To improve this situation, the primary health care approach involving families and communities and instilling the spirit of self-care and self-help is indispensable. Mothers and other family members, traditional birth attendants, community health workers, as well as nurse midwives and physicians should be involved in prevention and intervention activities, for which they should be trained and given knowledge and skills about appropriate technologies such as the risk approach, home-based maternal record, partograph, mobilogram (kick count), home-risk card, icterometer, and mouth-to-mask or bag and mask resuscitation of the newborn. Most of these have been field-tested by WHO and can be used in the home, the health centre or day care centres to detect and prevent the above-mentioned conditions which can cause mental handicap. (+info)
Secondary adrenal insufficiency caused by adult development of pituitary stalk transection.
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We report the case of a 38-year-old man with secondary adrenal insufficiency due to pituitary stalk transection that may have been caused by birth injury. He was admitted to our hospital with epigastalgia and severe hyponatremia (120 mEq/L). His past history showed fetal distress due to an abnormal delivery, and he received growth hormone replacement therapy for growth hormone-deficient short stature. Magnetic resonance imaging of the brain revealed an atrophic anterior lobe, a pseudo-posterior lobe of the pituitary gland, and a transection of the pituitary stalk. Endocrinological examination revealed secondary adrenal insufficiency due to a suprapituitary lesion, with concomitant impaired secretion of growth hormone, gonadotropins, and thyroid-stimulating hormone. Hyponatremia was improved immediately after administration of hydrocortisone. This is a case of adult development of pituitary stalk transection syndrome, involving the sequential impairment of the secretion of several pituitary hormones, and finally presenting severe hyponatremia caused by secondary adrenal insufficiency. (+info)
Surgical correction of the medial rotation contracture in obstetric brachial plexus palsy.
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The medial rotation contracture caused by weak external rotation secondary to obstetric brachial plexus injury leads to deformation of the bones of the shoulder. Scapular hypoplasia, elevation and rotation deformity are accompanied by progressive dislocation of the humeral head. Between February and August 2005, 44 children underwent a new surgical procedure called the 'triangle tilt' operation to correct this bony shoulder deformity. Surgical levelling of the distal acromioclavicular triangle combined with tightening of the posterior glenohumeral capsule (capsulorrhaphy) improved shoulder function and corrected the glenohumeral axis in these patients. The posture of the arm at rest was improved and active external rotation increased by a mean of 53 degrees (0 degrees to 115 degrees ) in the 40 children who were followed up for more than one year. There was a mean improvement of 4.9 points (1.7 to 8.3) of the Mallet shoulder function score after surgical correction of the bony deformity. (+info)
Childhood blindness in the Republic of Ireland: a national survey.
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We completed a national study of blindness in children under 16. Approximately 80% of the blind children (that is, with vision of 3/60 or less) in the Republic of Ireland (172 children) were seen, 93 males and 79 females. The survey was carried out between July 1989 and June 1990. It is the first such study to be carried out. Ninety seven (56%) children had lesions due to factors acting before the perinatal period. Of these, 28 (16% of the total number surveyed) had lesions due to genetic causes; 69 (40%) had lesions due to factors operating in the prenatal period other than genetic factors. Forty six (27%) had lesions due to factors acting in the perinatal period. Twenty two (13%) had lesions due to factors acting in childhood. (4% could not be categorised in this way). The commonest single primary diagnoses were birth asphyxia in 19 (11%) cases and retinopathy of prematurity in 19 (11%) cases. (+info)
Recurrent postnatal infections are associated with progressive white matter injury in premature infants.
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Detection and treatment of traumatic separation of the distal humeral epiphysis in a neonate: a case report.
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Traumatic separation of the distal humeral epiphysis during delivery is an uncommon injury in neonates and usually mimics elbow dislocation. Emergency medicine physicians and orthopedic surgeons must have a high index of suspicion for distal humeral epiphysis separation when evaluating elbow trauma in neonates. Magnetic resonance imaging (MRI) scan is an important diagnostic tool for this purpose. We report a case in which fracture-separation of the distal humeral epiphysis in a newborn was diagnosed with the help of ultrasonography and MRI scan, which provided a clear delineation of the injury. (+info)