Variable phenotypic expression of a MECP2 mutation in a family

We report a three generation family in which five members, three females and two males, demonstrate a 44 bp deletion (1164-1207del44) in the MECP2 gene associated with Rett syndrome, leading to a truncation of the C-terminus of the protein. Two of the three females and both males do not meet RTT criteria whereas the youngest female has classic RTT. Both males demonstrated a clear pattern of progressive involvement including dystonia. The transmitting females do not demonstrate features of RTT as a result of unbalanced X chromosome inactivation (XCI) and were only identified as carriers following the evaluation of the affected males and the girl with classic RTT. As such, accurate assessment of the precise frequency of MECP2 mutations in carrier females with mild cognitive impairment or borderline cognitive function will be under-represented unless an affected offspring is recognized. Strategies for accurate diagnosis in such instances should be considered carefully.

Quality of life for families with spina bifida in Kenya

Spina bifida (SB) affects children worldwide. Studies from developed nations have explored the impact of SB on the quality of life of children and their parents. However, there are no such studies available from developing countries. We have therefore undertaken to document the impact of the disability on the families of affected children in Kenya. A questionnaire was administered to 40 mothers and their children, who were receiving treatment for SB at our institution. The results of this study should indicate where community and governmental resources and educational efforts for the disabled should be directed.

Development of a bladder management protocol as part of a comprehensive care program for spina bifida in Kenya

Most children with spina bifida have neurogenic bladders. Prior to the use of clean intermittent catheterization (CIC) in 1972, approximately 30% of children with spina bifida died of renal failure. In developing countries where CIC is not done, even more children with spina bifida continue to die from renal failure. This article presents data from Kenya collected from a nurse run comprehensive spina bifida program which evaluates bladder function with leak point pressure (LPP) and begins CIC in those children with LPP >30 cm water. 371 children were seen for surgical closure. Urodynamic studies were done in 249 and of these 167 were started on CIC because of high LPP or need for social continence. 99/371 were lost to follow-up. 72 have died. To date, only 3 deaths were from renal complications. Of 59 children age 5 or older, 45 have achieved social continence. We conclude that a nurse run bladder management program including CIC for children with spina bifida can be done in a developing country with good results on renal function and continence.

The quality of life of ventilator-assisted children

Although an increasing number of ventilator-assisted children are being cared for in the home, few studies in the literature evaluate the resulting quality of life from multiple informant perspectives. A questionnaire was used to gather data on 38 ventilator-assisted children from the children themselves and their caregivers about activities of daily living, measures of independence, and psychological state. The majority (79.4%) of ventilator-assisted children were perceived as either satisfied or very satisfied with how they spent their time, and most (77.1%) were rated as having an excellent or good emotional adjustment to the need for mechanical ventilation. Children older than 12 years were reported to be significantly less satisfied with their daily activities than the younger children, but greater activity levels correlated with greater levels of total satisfaction. A higher total satisfaction did not correlate with the age at onset of assisted ventilation, or the amount of time spent in other activities. Adolescents and primary caregivers had similar responses to most activity and independence parameters on the survey. There were no significant differences in parents' perceptions of the adolescents' emotional status as compared to the adolescents' self- assessment of their emotional status in any parameter.