[Nasal glucagon (Baqsimi®), new treatment for hypoglycaemic coma]

Patients with insulin-treated type 1 diabetes (T1D) are exposed to hypoglycaemia, which may be serious. Serious cognitive impairment (including coma and seizure) that requires the help of a third party is a medical emergency. Besides the intravenous injection of glucose by a health care provider, its treatment consists of the subcutaneous or intramuscular injection of glucagon which may be performed by a family member. However, such an injection is not easy and puts off some people, which retards the initiation of a potentially life-saving therapy. The intranasal administration of 3 mg glucagon has been shown as efficacious as the subcutaneous or intramuscular injection of 1 mg glucagon in controlled studies carried out in both adult and youth patients with T1D. Stimulation and real-life studies among caregivers, patients and acquaintances showed a preference for nasal glucagon because of its easy and quick use. The launch of nasal glucagon (Baqsimi®) offers new perspectives for the ambulatory emergency management of severe hypoglycaemia and hypoglycaemic coma with a special obvious advantage in children.

[A somatic disease causing a child psychiatric disorder]

Psychiatric disorders in children may be the expression of underlying organic conditions. These are numerous and varied. The clinical presentation is often frustrating : psychiatric signs can remain isolated for years before other more specific organic signs appear. More recently, new treatments have been developed, making it possible to improve the prognosis of some of these organic diseases; screening them is therefore a daily concern for the child psychiatrist. This literature review discusses various paediatric treatable organic disorders that may have an isolated psychiatric presentation, to finally propose a decision tree algorithm based on somatic and psychiatric complaints reported.

Correlation between Auditory Spectral Resolution and Speech Perception in Children with Cochlear Implants

Background:

Variability in speech performance is a major concern for children with cochlear implants (CIs). Spectral resolution is an important acoustic component in speech perception. Considerable variability and limitations of spectral resolution in children with CIs may lead to individual differences in speech performance. The aim of this study was to assess the correlation between auditory spectral resolution and speech perception in pediatric CI users.

Methods:

This cross-sectional study was conducted in Shiraz, Iran, in 2017. The frequency discrimination threshold (FDT) and the spectral-temporal modulated ripple discrimination threshold (SMRT) were measured for 75 pre-lingual hearing-impaired children with CIs (age=8-12 y). Word recognition and sentence perception tests were completed to assess speech perception. The Pearson correlation analysis and multiple linear regression analysis were used to determine the correlation between the variables and to determine the predictive variables of speech perception, respectively.

Results:

There was a significant correlation between the SMRT and word recognition (r=0.573 and P<0.001). The FDT was significantly correlated with word recognition (r=0.487 and P<0.001). Sentence perception had a significant correlation with the SMRT and the FDT. There was a significant correlation between chronological age and age at implantation with SMRT but not the FDT.

Conclusion:

Auditory spectral resolution correlated well with speech perception among our children with CIs. Spectral resolution ability accounted for approximately 40% of the variance in speech perception among the children with CIs.

Do uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

Objectives:

To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE).

Material and methods:

Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response.

Results:

In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response.

Conclusions:

In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

[Update on developemental dyspraxia in children]

After having explained what is dyspraxia, we will briefly talk about narcissistic issues related to school term. Indeed, the defensive tools used by children to deal with learning disabilities are varied and not much specific, which will complicate the medical approach. Then we will describe the symptoms that are specific to search in the history and the first clinic appointment in cases of suspected dyspraxia. Finally, we will give details of how we must consider the exploration and the multidisciplinary taking over of the disorder.

Factors Affecting Oral Hygiene and Tooth Brushing in Preschool Children, Shiraz/Iran

STATEMENT OF PROBLEM

Inadequate tooth brushing and inappropriate oral hygiene can lead to dental caries, the most common chronic diseases of childhood with several side effects.

OBJECTIVES

To evaluate factors affecting on preschool children's oral hygiene and tooth brushing in Shiraz, Iran.

MATERIALS AND METHODS

In this cross-sectional study, we selected 453 children registered in Shiraz kindergartens in 2013 by randomized cluster sampling. The children's tooth brushing and oral hygiene were assessed using a reliable and valid questionnaire and Simplified Debris Index (DI-S), respectively. A dental student examined all the children in each kindergarten to determine their DI-S. The relationship between the children's demographic variables and their oral hygiene and tooth brushing status were evaluated.

RESULTS

Tooth brushing for 272 children (71.2%) had been started after the age of 2 years. The teeth in 96 children (24.2%) had been brushed lower than once daily. The mean of the children's DI-S was 1.19 ± (0.77). The DI-S of only 126 children (31.8%) was found to be good and very good. After controlling the effect of confounding factors, we found that the children's tooth brushing frequency was significantly associated with the number of children in the family and mothers' employment status. The age at which tooth brushing had been started was significantly associated with the fathers' education. Furthermore, the DI-S was associated with children's age, number of the children in the family, and their mothers' education.

CONCLUSIONS

Oral hygiene and tooth brushing of the preschool children were not in a desirable status. Interventional procedures, especially educational programs, are recommended for children and their parents. These programs seem to be more necessary for older children, low socioeconomic families, and families with more than one child.