Childhood constipation as an emerging public health problem

Functional constipation(FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence(0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.

Colorectal cancer in the young,many questions,few answers

At a time where the incidence of colorectal cancer,a disease predominantly of developed nations,is showing a decline in those 50 years of age and older,data from the West is showing a rising incidence of this cancer in young individuals.Central to this has been the 75% increase in rectal cancer incidence in the last four decades.Furthermore,predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030-a statistic that calls for collective global thought and action.While predominance of colorectal cancer(CRC) is likely to be in that part of the large bowel distal to the splenic flexure,which makes flexible sigmoidoscopic examination an ideal screening tool,the cost and benefit of mass screening in young people remain unknown.In countries where the incidence of young CRC is as high as 35% to 50%,the available data do not seem to indicate that the disease in young people is one of high red meat consuming nations only.Improvement in our understanding of genetic pathways in the aetiology of CRC,chiefly of the MSI,CIN and CIMP pathway,supports the notion that up to 30% of CRC is genetic,and may reflect a familial trait or environmentally induced changes.However,a number of other germline and somatic mutations,some of which remain unidentified,may play a role in the genesis of this cancer and stand in the way of a clear understanding of CRC in the young.Clinically,a proportion of young persons with CRC die early after curative surgery,presumably from aggressive tumour biology,compared with the majority in whom survival after operation will remain unchanged for five years or greater.The challenge in the future will be to determine,by genetic fingerprinting or otherwise,those at risk of developing CRC and the determinants of survival in those who develop CRC.Ultimately,prevention and early detection,just like for those over 50 years with CRC,will determine the outcome of CRC in young persons.At present,aside from those with an established familial tendency,there is no consensus on screening young persons who may be at risk.However,increasing awareness of this cancer in the young and the established benefit of prevention in older persons,must be a message that should be communicated with medical students,primary health care personnel and first contact doctors.The latter constitutes a formidable challenge.

Sympathetic dysfunction as a cause for hypotension in dengue shock syndrome

Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including 500 000 dengue hemorrhagic fever cases and 22 000 deaths, mostly among children.1 The main features of severe infection are hypotension, fluid leak and shock. Management of dengue shock syndrome and its pathophysiology are not fully understood. We reported two patients with dengue who developed hypotension without considerable fluid accumulation in the third space and explaining an alternative cause for hypotension in these patients.

Cytogenetic analysis of chromosomal abnormalities in Sri Lankan children

Background: Cytogenetic analysis is a valuable investigation in the diagnostic work up of children with suspected chromosomal disorders. The objective of this study was to describe the prevalence of various types of chromosomal abnormalities in Sri Lankan children undergoing cytogenetic analysis. Methods: Cytogenetic reports of 1554 consecutive children with suspected chromosomal disorders who underwent karyotyping in two genetic centers in Sri Lanka from January 2006 to December 2011 were reviewed retrospectively. Results: A total of 1548 children were successfully karyotyped. Abnormal karyotypes were found in 783 (50.6%) children. Numerical and structural abnormalities accounted for 90.8% and 9.2%, respectively. Down syndrome was the commonest aneuploidy identifi ed. Other various autosomal and sex chromosomal aneuploidies as well as micro-deletion syndromes were also detected. Conclusions: The prevalence of chromosomal abnormalities in Sri Lankan children undergoing cytogenetic analysis for suspected chromosomal disorders was relatively higher than that in Caucasian and other Asian populations.