Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Pediatrics

Congenital heart disease and pulmonary hypertension among Down syndrome pediatric patients

Khaleel Ibrahim ALSUWAYFEE; Mohammed AHMED; Qusay Norry MOHAMMED

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 50-56
DOI: 10.33899/mmed.2020.126534.1017

Background: Down syndrome (DS) is the commonest chromosomal abnormality with high incidence of congenital heart diseases (CHDs). The most prevalent two CHD among DS most studies are complete atrioventricular canal (CAVC) (also called atrioventricular septal) defect and atrial septal defects (ASD). There is high incidence of pulmonary arterial hypertension (PAH) among DS children with CHD compared to non Down syndrome (NDS) children.
Aims: To measure the prevalence of CHD in general and the relative frequency of different types of CHD among DS children as well as the frequency, risk factors and characteristics of PAH in the studied sample.
Methods: It is an echocardiography (echo) based case control study conducted over a 7 months period from the 15th of May to the 14th of December 2019. Information and obtained data were recorded using a special form. Statistical analysis carried out using Microsoft excel 2013 and the statistical package for the social sciences (SPSS) 18 computer programs.
Results: The study involved 76 DS children (mean age in months 19.9±3.7 standard error of mean “SEM” ) and male /female gender ratio of 0.85/1 and 76 NDS children as control group with mean age 9.5± 2.03 SEM and gender ratio of 0.81/1. Congenital heart diseases were significantly higher among DS group 59% (P=0.003). The commonest CHD among DS children were CAVC and ASD .The PAH was significantly higher among DS children with high prevalence (30 %) (P=0.002) and odds ratio of 2.48 (95% CI 0.9-6.83). Complete atrioventricular canal defect, Patent ductus arteriosus (PDA) and age of > 6 months were the main risk factors for the development of PAH among DS children.
Conclusion: There is high prevalence of CHDs and their associated PAH among DS children especially in association with CAVC, PDA and age older than 6 months.

Implementation of Integrated Management of Childhood Illness Strategy's in Al Hadbaa Primary Health Care Center in Mosul City

Ashraf Abdulrahman; Ali M. Saleem

Annals of the College of Medicine, Mosul, 2019, Volume 41, Issue 1, Pages 75-80
DOI: 10.33899/mmed.2019.161297

Background: The World Health Organization (WHO) build up guidelines for the integrated management of childhood illnesses (IMCI) in the health facilities  to improve the recognition and the individual management of the common reasons of death among children under the age of five. The approach used in outpatient clinical settings with restricted diagnostic and therapeutic tools.
Aim of study: To assess the impact of implementation of IMCI strategy, in reducing an inappropriate prescription of antibiotics and raising vaccination coverage.     
Patients and methods: A cross-sectional study design was arranged, where 395 child with age from two months up to below 5 years old attending Al Hadbaa PHCC from 1st of January to 31st of March 2014 suffering from one or more of the following respiratory infection, diarrheal diseases, throat infections, ear infections and fever. The children assessed separately by two clinics, "A" non-adopting IMCI and "B" adopting IMCI guidelines, the Mc-Nemar test was applied and differences  were evaluated.
Results: The attendant children are 239 males and 156 females complaining from fever (39.1%), throat problems (21.4%), ear problems (12.6%), cough (11.6%), diarrhea (11.1%) and pneumonia (4.2%). The overall use of antibiotics is 66.1% in clinic "A" and 21.0% in clinic "B" with p-value 0.000. Regarding the immunization, the outcomes appear to have very high significant difference  54.1% in "A" and 75.7% in "B".
Conclusion: The classification-approach to the sick child using IMCI guidelines has clear effect on decreasing an inappropriate use of antibiotics and raising number of vaccinated children, which justifying the adaptation of this strategy.