Background: Breath-holding spells are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made.

Objective: To familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of children with breath-holding spells.

Methods: A PubMed search was completed in Clinical Queries using the key term “breath-holding spells”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.

Results: Breath-holding spells affect 0.1 to 4.6% of otherwise healthy young children. The onset is usually between 6 and 18 months of age. The etiopathogenesis is likely multifactorial and includes autonomic nervous system dysregulation, vagally-mediated cardiac inhibition, delayed myelination of the brain stem, and iron deficiency anemia. Breath-holding spells may be cyanotic or pallid. The former are usually precipitated by anger or frustration while the latter are more often precipitated by pain or fear. In the cyanotic type, the child usually emits a short, loud cry, which leads to a sudden involuntary holding of the breath in forced expiration. The child becomes cyanosed, rigid or limp, followed by a transient loss of consciousness, and a long-awaited inspiration and resolution of the spell. In the pallid type, crying may be minimal or “silent”. The apneic period in the pallid type is briefer than that in the cyanotic type prior to the loss of consciousness and posture. The episode in the pallid type then proceeds in the same manner as a cyanotic spell except that the child in the pallid type develops pallor rather than cyanosis. In both types, the entire episode lasts approximately 10 to 60 seconds. The spells usually disappear spontaneously by 5 years of age.

Conclusion: Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment. Underlying cause, if present, should be treated. Interventions beyond iron supplementation may be considered for children with severe and frequent breath-holding spells which have a strong impact on the lifestyle of both the child and family.

Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

Diabetes mellitus (DM) is a global health care problem that can impose a substantial economic burden. Diabetic peripheral neuropathy (DPN) is a common microvascular complication of DM that increases the potential for morbidity and disability due to ulceration and amputation. Though there is a significant amount of variation in the primary studies on DM regarding the prevalence of DPN in Africa. Hence, this study was aimed to estimate the overall prevalence of DPN in DM patients in Africa. PubMed, Scopus, Google Scholar, African Journals OnLine, WHO African Library, and the Cochrane Review were systematically searched online to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was followed. Heterogeneity across the included studies was evaluated by the inconsistency index (I2). Publication bias was examined by funnel plot and Egger’s regression test. The random-effect model was fitted to estimate the pooled prevalence of diabetic peripheral neuropathy among patients in Africa. The meta-analysis was performed using the STATA™ Version 14 software. Twenty-three studies which includes 269,691 participants were included in the meta-analysis. The overall pooled prevalence of diabetic peripheral neuropathy was 46% (95% CI:36.21–55.78%). Based on the subgroup analysis, the highest prevalence of diabetic peripheral neuropathy in DM patients was reported in West Africa at 49.4% (95% CI: 32.74, 66.06). This study revealed that the overall prevalence of diabetic peripheral neuropathy is relatively high in Africa. Hence, DPN needs situation-based interventions and preventive strategies, which are specific to the country. Further meta-analysis is needed to identify associated factors for the occurrence of diabetic peripheral neuropathy.

https://link.springer.com/content/pdf/10.1186/s12902-020-0534-5.pdf

Prevalence of diabetic peripheral neuropathy in Africa: a systematic review and meta-analysis

Problem-oriented approach

Underweight and overweight are serious health concerns for many children and could be associated with low physical-fitness levels. This study aimed (i) to evaluate the prevalence of underweight and overweight and (ii) to examine its association with the physical fitness levels in primary male and female schoolchildren. Including 13 government primary-schools, a cross-sectional survey was conducted between 2014 and 2017. Anthropometric characteristics together with the physical-fitness level were measured in 931 schoolchildren aged between 6- and 11-years old. The prevalence of under- and overweight children were 8.49% and 24.06%, respectively. These proportions were not significantly different between males and females and were affected by age (p < 0.001), with a higher prevalence of overweight and a lower prevalence of underweight at 9-11 years, compared to 6-8 years old. Concerning the physical fitness levels, statistical analysis showed a better performance among males compared to females, among participants aged 9-11 years, compared to 6-8 years old, and among underweight and normal-weight, compared to overweight children (p < 0.001). There was a higher prevalence of overweight and lower prevalence of underweight at 9-11 years compared to 6-8 years old. Physical fitness levels were better in (i) males, compared to females, (ii) schoolchildren aged 9-11 years, compared to 6-8 years old, and (iii) underweight and normal-weight, compared to overweight children.

/pdf/prevalence-of-underweight-and-overweight-and-its-association-4rpgnjs50u.pdf

Prevalence of Underweight and Overweight and Its Association with Physical Fitness in Egyptian Schoolchildren.

In sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCDs) is rising disproportionately in comparison to the rest of the world, affecting urban, semi-urban and rural dwellers alike. NCDs are predicted to surpass infections like human immunodeficiency virus, tuberculosis and malaria as the leading cause of mortality in SSA over the next decade. Heart failure (HF) is the dominant form of cardiovascular disease (CVD), and a leading cause of NCD in SSA. The main causes of HF in SSA are hypertension, cardiomyopathies, rheumatic heart disease, pericardial disease, and to a lesser extent, coronary heart disease. Of these, the cardiomyopathies deserve greater attention because of the relatively poor understanding of mechanisms of disease, poor outcomes and the disproportionate impact they have on young, economically active individuals. Morphofunctionally, cardiomyopathies are classified as dilated, hypertrophic, restrictive and arrhythmogenic; regardless of classification, at least half of these are inherited forms of CVD. In this review, we summarise all studies that have investigated the incidence of cardiomyopathy across Africa, with a focus on the inherited cardiomyopathies. We also review data on the molecular genetic underpinnings of cardiomyopathy in Africa, where there is a striking lack of studies reporting on the genetics of cardiomyopathy. We highlight the impact that genetic testing, through candidate gene screening, association studies and next generation sequencing technologies such as whole exome sequencing and targeted resequencing has had on the understanding of cardiomyopathy in Africa. Finally, we emphasise the need for future studies to fill large gaps in our knowledge in relation to the genetics of inherited cardiomyopathies in Africa.

/pdf/genetics-of-inherited-cardiomyopathies-in-africa-53dt1euunq.pdf

Genetics of inherited cardiomyopathies in Africa.

Background: Continually rising prevalence of obesity and overweight in children and adolescents is a major public health concern. This is due to its various and serious health hazards on one side and its preventable nature on the other side. This study aims at identification of prevalence of overweight and obesity and its risk factors among children between 6 - 14 years of age in Sohag, Egypt. Method: A cross sectional study was conducted on 711 school children between 6 - 14 years in four months’ period from February to May 2016. Weight and height of the studied children were measured to calculate BMI, which was compared with standard Egyptian growth charts for determining overweight and obesity. Then a questionnaire containing data about socio demographic, parental obesity, early life and dietary risk factors was completed by the children’s parents. Result: Out of 711 studied children, 117 (16.5%) were overweight and 104 (14.6%) were obese. Residing in urban area, having an obese parent or both of them, low level of maternal education, being on formula feeding during early life and lack of fresh vegetables and fruits in diets were significant risk factors for overweight and obesity in the studied children (P value < 0.05). Conclusion: Improperly educated mothers together with sedentary life style manifested in obesity among the parents and lack of sport practice among children constituted the majors risk factors for childhood obesity. This emphasizes the need for increased health awareness of the community about the importance of proper nutrition and physical activity.

/pdf/prevalence-and-correlates-of-overweight-and-obesity-among-1cxrkpnwu4.pdf

Prevalence and Correlates of Overweight and Obesity among School Children in Sohag, Egypt

INTRODUCTION Cardiomyopathy (CMP) is defined by the World Health Organization (WHO) as a disease of the myocardium associated with cardiac dysfunction. An understanding of CMP is very important, as it is a common cause of heart failure in children, and the most common indication for heart transplantation in children older than one year, but data on CMP in Egypt are scarce. The aim of this study was to determine the number, risk factors, clinical presentation, complications and outcome of different types of childhood cardiomyopathies in Sohag University Hospital. METHODS This cross-sectional hospital based study enrolled fifty children with Cardiomyopathy in Pediatric Departments, Neonatal Care Units, and Cardiac Outpatient Clinics in Sohag University Hospital from March 01, 2014 to February 28, 2015. RESULTS Cases with Dilated Cardiomyopathy (DCMP) were 38 (76%), and those who had Hypertrophic Cardiomyopathy (HCMP) were 12 (24%). Dyspnea was the most common presenting complaint in 71% of cases. In cases with DCMP, the mean EF was 33.8, and FS was 17.11, while in cases with HCMP, the mean EF was 70.75, FS was 37. Fifty percent of cases were found to have moderate to severe PHT. Serum CK-MB was elevated in 3 (6%) cases, while serum Troponin I was elevated in 2 (4.2%) cases who diagnosed as having myocarditis. Viral myocarditis was the most common identified etiological agent responsible for 14 (37%) cases with DCMP. CONCLUSIONS CMP represents a considerable percentage of children with cardiac disorders. DCMP is the most common type, usually presented with congestive heart failure, and the most common cause is myocarditis. L-Carnitine profile was normal in all cases, despite its routine use. Pediatricians need to raise their clinical suspicion to CMPs, as atypical presentations are not uncommon. To do screening for other family members, cardiac enzymes (CK-MB, Troponin I) have to be done in all newly diagnosed CMP cases, along with a revision of the routine prescription of L-Carnitine.

/pdf/childhood-cardiomyopathies-a-study-in-tertiary-care-hospital-9havtcn3ma.pdf

Childhood Cardiomyopathies: A Study in Tertiary Care Hospital in Upper Egypt.

INTRODUCTION Breath-holding spells (BHSs) are involuntary pauses of breathing, sometimes accompanied by loss of consciousness. They usually occur in response to an upsetting or surprising situation. Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. In some children, BHSs may be related to iron deficiency anemia. The aim of the work was to study the clinical and laboratory profile of BPHs in children presented to the Neuropediatric Clinic at Sohag University Hospital. METHODS An observational prospective study was done at Sohag University Hospital over a period of one year on children diagnosed as having BHSs by clinical history and laboratory evaluation, including complete blood count (CBC), serum iron, serum ferritin, total iron binding capacity, and Electroencephalography (EEG). RESULTS During the period of study (one year), we reviewed data of 32 children who had been diagnosed as having BHSs. We found that cyanotic spells (71.88%) predominated over pallid spells. There were positive family histories (31.25%) and consanguinity (53.135) in the studied patients. We found a high incidence of iron deficiency anemia (62.5%) in association with BHS. Abnormal EEGs were found in (65.63%) of studied children. CONCLUSION BHS is a common, important problem associated with iron deficiency anemia, which is, in turn, a common nutritional problem in our country.

/pdf/clinico-laboratory-profile-of-breath-holding-spells-in-2rgojispg9.pdf

Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt

Background Congenital hypothyroidism (CH) may cause alterations in the child's global development. The current study aimed to screen the global development of children with and without congenital hypothyroidism, focusing on communication, and cognitive abilities and to investigate the influence of illness severity, clinical history, and treatment factors in the evaluated results. Materials and Methods A case control study was conducted on 20 children with early-treated congenital hypothyroidism (CH), and controls without CH (n=100), both groups were matched for age and sex. Patients were subjected to a protocol of assessment applied in Pediatric and Phoniatrics Unit Sohag, Egypt. Assessments included detailed history and medical data, language development testing, intelligence quotient (IQ). According to TSH and T4 levels, case group was divided into controlled group and uncontrolled group.  99m pertechnetate scintigraphy of thyroid (Tc-99m TS) was recommended for all CH children.  Results Children’s ages ranged between 3-7 years with a mean age of (4.6 ±1.9year). There were statistically significant differences between study and control group in presence of middle ear effusion, delayed language development, IQ scores (p<0.001). Interestingly, there was a negative correlation between IQ test and total language age with TSH level (r = -0.06, p= 0.004; r =-0.4, p=0.06), respectively. Tc-99m pertechnetate scintigraphy of thyroid confirmed transient CH diagnosis in three cases. Conclusion Despite early treatment in the studied CH children, language and cognitive skills impairments were detected. The magnitude of these impairments significantly related to TSH values and regularity of hormone replacement therapy. TS confirmed transient CH diagnosis in three cases, replacement therapy stopped in those children.

http://ijp.mums.ac.ir/article_12717_535f2b580bebc83623337bb7670ddba1.pdf

Developmental Outcomes in Early-treated Congenital Hypothyroidism: Specific Concern in Tc99m Thyroid Scan Role

Background: Diabetic peripheral neuropathy (DPN) is a common complication among children with TIDM and is related to poor glycemic control. The aim of the study is to determine prevalence and determinants of diabetic neuropathy in diabetic children. Material& Methods: This is a cross sectional study conducted on 50 children having Type I diabetes mellitus for more than year presented to Pediatric Neurology and Endocrinology Outpatient Clinics, Sohag University Hospital, Sohag, Egypt, during one year duration (2017). Children were subjected to detailed neurological examination and electrophysiologic studies in addition to recording of socio demographic and laboratory findings with special regard to level of HbA1c. Results: The mean age of the studied children was 10.5 ± 0.3 years ranging from 5 to 18 years. 22 cases (44%) were younger than 10 years, 27 children (54%) were females. DPN was diagnosed in 12% of the studied children. No significant relation was found as regard age, gender, family history, consanguinity and duration of the diseases. Significant association was found between the HbA1c level and development of DPN in the studied children. Conclusion: Based on the results of this study, 12% of the studied diabetic children had DPN of whom more than 16% had subclinical neuropathy indicating the need for annual screening of neuropathy using Nerve Conduction Study. Moreover strict glycaemic control is needed to prevent rapid development of diabetic among these children.

/pdf/frequency-and-determinants-of-peripheral-neuropathy-in-2njcnc9rch.pdf

Montaser Mohamed Mohamed

Papers

Prevalence and Correlates of Overweight and Obesity among School Children in Sohag, Egypt

Childhood Cardiomyopathies: A Study in Tertiary Care Hospital in Upper Egypt.

Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt

Developmental Outcomes in Early-treated Congenital Hypothyroidism: Specific Concern in Tc99m Thyroid Scan Role

Frequency and Determinants of Peripheral Neuropathy in Diabetic Children in Sohag, Egypt