Vol 3 (2021)

Published: 2021-12-31

Abstract views: 471   PDF downloads: 302  

Page 83-93

Who sleeps better? Sleep patterns and sleep disturbances in adolescents with recurrent abdominal pain or inflammatory bowel disease and healthy controls

blankpage Ann-Kristin Manhart, Angelika A. Schlarb

Background: Sleep difficulties play an important role in the maintenance and course of chronic abdominal pain disorders (RAP and IBD). Particularly among adolescents with inflammatory bowel diseases (IBD) or recurrent abdominal pain (RAP), adequate sleep seems to be important, as the diseases self and the associated symptoms can cause distress and impair daytime functioning. Hence it seems adequate to take a closer look concerning the sleep difficulties within the different conditions of abdominal pain especially in comparison to a healthy control. To our knowledge no former study compared sleep problems in youths with RAP and IBD as well as healthy controls. Thus the aim of the present study was to 1) evaluate sleep problems in the RAP and IBD and 2) compare the sleep problems of these abdominal pain diseases with a healthy control group.
Methods: 129 adolescents (14-25 years) took part in the online survey, with 58 suffering from IBD, 23 had RAP and 48 healthy controls. Adolescents completed sleep questionnaires as PSQI, SDSC or NEQ. Data was analysed by conducting MANOVAs to test differences between the three groups followed by a post-hoc analyses.
Results: Significant differences between both patient groups and healthy controls regarding sleep quality as well as sleep disturbances were found. Results indicate that especially young IBD patients suffered more often from poor sleep quality, sleep disturbances as well as daily effects of nightmares than the control group. The comparison of adolescents with RAP and healthy controls showed elevated scores concerning sleep disturbances for RAP patients. However, IBD and RAP adolescents did not differ significantly concerning most sleep measurements.
Discussion: The study at hand was the first to compare adolescents with IBD and RAP regarding sleep difficulties. Adolescents with IBD and RAP have an impaired sleep quality as well as a higher rate of sleep disturbances and suffer from daily effects of nightmares than the control group. Therefore sleep disturbances should be also addressed when treating IBD and RAP patients to prevent further impairments.

Abstract views: 440   PDF downloads: 296  

Page 71-82

Sleep as a mediator in the context of emotional problems in adolescents with IBD: A pilot study

blankpage Ann-Kristin Manhart, Angelika A. Schlarb

Background: Sleep has an impact on daily life. Particularly among adolescents with IBD, adequate sleep seems to be important, as the disease itself and the associated symptoms can cause distress and impair daytime functioning. However, often parental and youth reports differ regarding perceived sleep problems of adolescents. Besides sleep problems, depression and anxiety are often prominent in young IBD patients. To date, the interplay between sleep, anxiety/depression symptoms and IBD is not fully understood. Therefore, the aim of this study was to (1) evaluate sleep problems in adolescents suffering from IBD, (2) compare adolescents’ sleep quality and impairments according to self- and parental reports, and (3) investigate the interaction between IBD symptomatology, emotional problems and sleep disturbances.
Methods: 29 adolescents (age 10 - 22; M = 14.44 , SD = 1.78 ) with IBD and their parents took part in the study. Adolescents and parents completed questionnaires concerning sleep, emotional problems, and IBD symptomatology.
Results: Especially overtiredness, insomnia symptoms, and nightmares play a prominent role regarding sleep problems in youths. Self-rated sleep problems and parental ratings were inconsistent, particularly for nightmares (Z = -2.12; p = 0.034). However, other ratings concerning emotional problems and sleep, especially anxiety and nightmares, were significantly related(r = 0.426, p = 0.034), even though we found no mediation effect for the association between IBD, nightmares and anxiety.
Discussion: The present study revealed the importance of sleep and emotional well-being for adolescents suffering from IBD. Moreover, it became clear that the role of anxiety in youths suffering from IBD and sleep problems is not sufficiently answered yet. Not only emotional behavior but also sleep should be addressed when diagnosing IBD or during treatment of IBD. In addition, these results show the need for further investigation regarding the differences between parental and self-reports concerning sleep problems in young IBD patients.

Abstract views: 766   PDF downloads: 476  

Page 63-70

Risk factors for neonatal sepsis in Lubumbashi, Democratic Republic of Congo: A retrospective case-control study

blankpage Adonis Muganza Nyenga, Olivier Mukuku, Janet Ziazia Sunguza, Amir N'simbo Assumani, Oscar Numbi Luboya, Stanislas Okitotsho Wembonyama

Purpose: Neonatal sepsis (NS) is a major cause of neonatal morbidity and mortality, particularly in developing countries. Delays in the identification and treatment of NS are the main contributors to the high mortality. This study aims to identify risk factors for NS in newborns in the two university hospitals in Lubumbashi, in the Democratic Republic of Congo.
Methods: This hospital-based case-control study was carried out on 486 mother-newborn pairs using the systematic sampling method during November 2019 to October 2020. Data were analyzed using STATA software (version 15). Binary and multivariable logistic regression analyses were computed to identify the associated factors at 95% CI.
Results: A total of 162 cases and 324 controls were included in this study. Multiple logistic regression analysis showed that the possible risk factors for NS in this study were low level of education (AOR = 9.16 [2.23-37.67]), maternal genitourinary tract infections (AOR = 42.59 [17.90-101.37]), premature rupture of membranes (AOR = 19.95 [7.27-54.76]), peripartum fever (AOR = 26.25 [2.31-297.83]), prolonged labor (AOR = 14.16 [3.88-51.71]), cesarean section (AOR = 3.57 [1.48-8.61]), obstructed vaginal delivery (AOR = 13.40 [1.32-136.19]), birth weight <1500 grams (AOR = 70.38 [8.64-572.95]), and between 1500-2500 grams (AOR = 7.90 [3.04-20.52]).
Conclusion: The study found that maternal and neonatal factors were strongly associated with the risk of developing NS. The present study suggests the possibility of routine assessment of sepsis in newborns born with the above characteristics.

Abstract views: 1117   PDF downloads: 621  

Page 52-56

Management of septic arthritis of the pediatric hip

blankpage Jessica L Hughes, Vidyadhar V Upasani, Andrew T Pennock, James D Bomar, Eric W Edmonds

Purpose: The purpose of this study was to compare outcomes and reoperation rate between open and arthroscopic treatment of a suspected isolated septic hip in the pediatric population.
Methods: Retrospective review was performed on two cohorts of pediatric patients who underwent surgical intervention for suspected isolated septic hip arthritis at a single institution. Patients were subdivided into two cohorts based on whether they underwent an open versus arthroscopic approach. Patients were excluded if they received an initial surgery from an outside institution, did not have an acute, active infection at presentation, defined as a hip aspiration leukocyte count <50,000 cells with <75% neutrophils, had extracaspular pathology or osteomyelitis, or had septic arthritis of a joint other than the hip.
Results: Fifty-six hips were included [Open group (n = 36); Arthroscopic group (n = 20)]. Six percent (2/36) of hips in the open group and 26% (5/19) of hips in the arthroscopy group had a positive tissue culture (p = 0.041). Eleven hips (31%) underwent postoperative immobilization in the open group compared to one hip (5%) in the arthroscopic group (p = 0.039).
Conclusions: In the setting of isolated arthritis, arthroscopy is a reasonable treatment modality with no observed additional risk compared to open arthrotomy. However, with concomitant osteomyelitis or soft tissue abscess, open arthrotomy should remain the mainstay approach to address all elements of the infection.
Level of Evidence: Level III

Abstract views: 1215   PDF downloads: 674  

Page 57-62

Melioidosis and sickle cell disease: Description of a rare association

blankpage Mick Ya-Pongombo Shongo, Mimi Mujing Yav, Olivier Mukuku, Gaston Kankolongo, Kumel Kasongo Kumelundu, Aubin Ndjadi Wembonyama Kasongo, Augustin Mulangu Mutombo, André Kabamba Mutombo, Paulo Muntu Bunga, Léon Mwepu Tshilolo, Oscar Numbi Luboya, Stanis Okitotsho Wembonyama

Melioidosis and its germ are increasingly reported on the African continent and particularly in Central Africa, probably due to the increased awareness of clinicians and microbiologists and the growing recognition of the organism. It is called "Great Mimicker" because it produces a wide range of clinical characteristics such as would be found in patients living with sickle cell disease (SCD) in particular. However, to date, no publication presents this association between melioidosis and SCD. The authors describe here 3 clinical cases presenting this very rare association between melioidosis and SCD. These are 3 children with SCD (homozygous SS) residing in Lubumbashi in Haut-Katanga province in the Democratic Republic of Congo. One patient presented with sepsis as a clinical form of the disease. All 3 had presented a pulmonary form. Only one patient was treated specifically after the diagnosis of melioidosis; for the other two, this diagnosis was confirmed after their death. Thus the death rate is 66.67%. This article describes, through these 3 clinical cases, a very rare first association between melioidosis and SCD. This association requires research to establish whether, like Thalassemia, SCD can be considered a risk factor for melioidosis. A screening of cases of melioidosis in the general population should allow us to focus on this.

Abstract views: 491   PDF downloads: 276  

Pages 94-101

Neonatal sepsis: A review of the literature

blankpage Adonis Muganza Nyenga, Olivier Mukuku, Stanis Okitotsho Wembonyama

Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world. Depending on the mode of occurrence, a distinction is made between maternal-transmitted infection and that acquired in the postnatal period. Although the etiologies maternally transmitted diseases are well understood, those of postnatal acquired infections are variable depending on the epidemiology of each hospital environment. On the one hand, risk factors for maternal-transmitted infections are maternal sepsis, prolonged premature rupture of membranes, chorioamnionitis, and bacteriuria in the mother during pregnancy. On the other hand, risk factors for postnatal acquired infections are prematurity, low birth weight, lack of hygiene, and invasive therapeutic interventions. The diagnosis is based on a series of anamnestic, clinical and biological features. Although the positive diagnosis is based on the isolation of the germ by culture on a body sample (blood, cerebrospinal fluid, urine, etc.); its low sensitivity leads to the use of markers of the acute phase of inflammation such as C-reactive protein, procalcitonin and interleukins. New molecular biology techniques are promising and offer precise diagnosis with rapid results. Empirical management is a function of microbial ecology while definitive treatment is guided by the results of microbial culture. This article presents the essential elements for understanding neonatal sepsis and discusses new diagnosis and therapeutic management. It offers a thorough reading based on the issue of infections in newborns.