Postural balance under sensory manipulation predicted fine and gross motor skills in children from five to six years of age

AIM

Our aim was to identify predictors of fine and gross motor skills at five to six years of age using postural balance under sensory manipulation.

METHODS

This study was conducted during the 2021-2022 academic year and focused on 112 children from three preschools in Tunisia, with roughly the same socioeconomic status. Postural balance was assessed with their eyes open and closed on both firm and foam surfaces and motor skills were measured using the short version of Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (Bot-2). Multiple linear regression analysis with stepwise backward selection was used to find a simplified model that best explained the data.

RESULTS

Postural balance accounted for 11% of the total variation in fine motor skills, except for the eyes open firm condition, 10% of the gross motor skills and about 14% of the total Bot-2 score. The eyes open foam condition was the only significant contributor to the gross motor skills model and the overall motor score.

CONCLUSION

Assessing postural balance assessment at five to six years of age may predict motor skills. It may be useful for monitoring early child development and designing physical activity programmes for this age group.

Effects of running exercises on reaction time and working memory in individuals with intellectual disability

BACKGROUND

This study explored the effect of running exercises at low [30% heart rate reserve (HRR)] and moderate (60%HRR) intensities on cognitive performances in individuals with intellectual disability (ID).

METHODS

Participants performed randomly reaction time (RT) tests: visual RT [simple RT (SRT) and choice RT (CRT)], auditory SRT (ASRT) and working memory (WM) (Corsi test) before and after the exercises.

RESULTS

The results showed that after both exercises, SRT decreased significantly (P < 0.001) in both groups with higher extent (P < 0.05) at 60%HRR compared with 30%HRR. CRT decreased (P < 0.01), similarly, after the both exercises in both groups with higher (P < 0.001) extent in the intellectual disability group (IDG). ASRT decreased significantly, at 30%HRR, in IDG (P < 0.001) and in control group (CG) (P < 0.01) with greater extent in IDG (P < 0.001). At 60%HRR, ASRT decreased significantly in both groups (P < 0.001) with greater extent in IDG (P < 0.001). The ΔASRT% was significantly (P < 0.05) higher at 30%HRR compared with 60%HRR in IDG. In CG, no significant (P = 0.21) difference was reported between intensities. The Corsi forward and the Corsi backward scores increased significantly (P < 0.01) in both groups after both intensities with higher extent in IDG (P < 0.01).

CONCLUSIONS

Our results suggest that low and moderate running exercises improve similarly simple and choice visual RT as well as WM in individuals with ID. Furthermore, low-intensity exercise could be more appropriate to enhance ASRT compared the moderate one in these individuals. Therefore, low-intensity exercise seems to be an efficient strategy to improve cognitive performances in individuals with ID.

Designed game situations enhance fundamental movement skills in children with Down syndrome

BACKGROUND

This study aimed to compare the effects of a designed program based on games situations with those of a conventional one, the Adapted Physical Education (APE) program, on the fundamental movement skills (FMS) in children with Down Syndrome (DS), aged 6 to 10.

METHODS

Twenty-eight children (13 girls and 15 boys; age 8.84 ± 1.06) with DS participated in this study. The participants were divided into two groups as the experimental group (EG) with 13 children (3 girls and 10 boys) and the control group (CG) composed with 15 children (10 girls and 5 boys). The EG participated in a conceived training program based on games situations along 10 weeks, while the CG took part in an APE conventional program based on football, long Jump and sprint adapted exercises. The FMS (locomotor and object control skills) were evaluated using the Gross Motor Development-2 Test at pretraining and posttraining for both groups.

RESULTS

The results revealed that both programs improve significantly locomotor skills with significantly better improvement in the EG. However, a significant object control skills improvement was observed only among the EG.

CONCLUSIONS

In light of our findings, a training program based on adapted games situations during 10 weeks may be recommended for FMS improvement, specifically object control skills.

Neuromuscular characteristics in trained vs. sedentary male adults with intellectual disability

BACKGROUND

This study aimed to explore muscle strength production and its underlying neuromuscular characteristics in sedentary and trained individuals with intellectual disability (ID) compared with healthy sedentary individuals.

METHODS

Three adult groups (age: 25.07 ± 0.70) consisting of sedentary individuals with ID (IDSG), trained individuals with ID (IDTG) and a control group (CONT) participated in the present study. Peak torque (PT) during maximal voluntary isometric contraction, voluntary activation level (VAL), surface electromyography (sEMG) recordings, electrophysiological (M_max ) and potentiated twitch torque (PTT responses) of the knee extensor muscles and thigh muscle volume were assessed.

RESULTS

Compared with CONT and IDTG, respectively, IDSG presented significantly lower PT (-48% and -42%), VAL (-24% and -9%), sEMG (-49% and -29%), M_max (-41% and -39%) and PTT (-32% and -28%) values. These deficits were reduced between IDTG compared with CONT (i.e. PT: -10%; VAL: -16%; and sEMG: -28%) or did not differ anymore (PTT and M_max ). Normalising PT to thigh muscle volume and/or computing theoretical PT value overwhelm strength production differences between IDTG and CONT. Training background influences the outcomes with IDTG exhibiting greater PT, VAL, sEMG, M_max and PTT than IDSG.

CONCLUSIONS

Strength production deficit in IDSG was related to both muscular and neural characteristics compared with healthy controls whereas this deficit mainly arises from neural characteristics for IDTG.

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia

Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.

Undernutrition is associated with increased financial losses in hospitals

BACKGROUND & AIMS

Undernutrition is associated with increased hospital costs. Whether these increased costs are totally compensated by third payer systems has not been assessed. We aimed to assess the differences between actual and reimbursed hospital costs according to presence/absence of nutritional risk, defined by a Nutritional risk screening-2002 (NRS-2002) score ≥3.

METHODS

Retrospective study. Administrative data for years 2013 and 2014 of the department of internal medicine of the Lausanne university hospital. The data included total and specific costs (i.e. clinical biology, treatments, pathology). Reimbursed costs were based on the Swiss Diagnosis Related Group (DRG) system.

RESULTS

2200 admissions with NRS-2002 data were included (mean age 76 years, 53.9% women), 1398 (63.6%) of which were considered nutritionally 'at-risk'. After multivariate adjustment, patients nutritionally 'at-risk' had higher costs (multivariate-adjusted difference ± standard error: 34,206 ± 1246 vs. 22,214 ± 1666 CHF, p < 0.001) and higher reimbursements (26,376 ± 1105 vs. 17,783 ± 1477 CHF, p < 0.001). Still, the latter failed to cover the costs, leading to a deficit between costs and reimbursements of 7831 ± 660 CHF in patients 'at-risk' vs. 4431 ± 881 in patients 'not at-risk' (p < 0.003). Being nutritionally 'at-risk' also led to a lower likelihood of complete coverage of costs: multivariate-adjusted odds ratio and 95% confidence interval 0.77 (0.62-0.97). Patients 'at-risk' had lower percentage of total costs in medical interventions, food, imaging and "other", but the absolute differences were less than 2%.

CONCLUSION

Hospital costs of patients nutritionally 'at-risk' are less well reimbursed than of patients 'not at-risk'. Better reporting of undernutrition in medical records and better reimbursement of undernourished patients is needed.

Effects of Ramadan Gasting on Postural Balance and Attentional Capacities in Elderly People

OBJECTIVE

To evaluate the effects of Ramadan fasting on postural balance and attentional capacities in older adults.

SETTING

the Neurophysiology department of a University Hospital.

PARTICIPANTS

Fifteen males aged between 65 and 80 years were asked to perform a postural balance protocol and a simple reaction time (SRT) test in four testing phases: one week before Ramadan (BR), during the second (SWR) and the fourth week of Ramadan (FWR) and 3 weeks after Ramadan (AR).

MEASUREMENTS

Postural balance measurements were recorded in the bipedal stance in four different conditions: firm surface/eyes open (EO), firm surface/eyes closed (EC), foam surface/EO and foam surface/EC using a force platform.

RESULTS

Results of the present study demonstrated that center of pressure (CoP) mean velocity (CoPVm), medio-lateral length (CoPLX) and antero-posterior length (CoPLY) were significantly higher during the SWR than BR. Likewise, values of CoPVm and CoPLX increased significantly during the FWR compared to BR. The CoPLX decreased significantly in the FWR compared to the SWR. Values of CoPVm and CoPLX were significantly higher AR in comparison with BR. In addition, SRT values increased significantly during the SWR and the FWR than BR.

CONCLUSION

Ramadan fasting affects postural balance and attentional capacities in the elderly mainly in the SWR and it may, therefore, increase the risk of fall and fall-related injuries. More than three weeks are needed for older adults to recover postural balance impairment due to Ramadan fasting.

Iatrogenic esophageal perforation in the neonate

BACKGROUND

Esophageal perforation is uncommon and often iatrogenic.

AIM

To report a neonatal case of esophageal perforation.

CASE

A premature newborn boy was admitted with a diagnosis of oesophageal atresia after several unsuccessful attempts to insert an orogastric tube. A chest x-ray showed a "high pouch" with a gasless intestine. At operation, no atresia was found and a large traumatic perforation of the lower cervical segment was identified, requiring cervicotomy and primary closure. Oral feeding was started after 3 weeks. As a result, nosocomial sepsis occurred, causing death in the third month after surgical treatment.

CONCLUSION

Oesophageal perforation in the neonate is often iatrogenic and may mimic oesophageal atresia. The authors highlight the importance of early diagnosis and management.

[Two cases of juvenile primary mediastinal hydatidosis]

Hydatid cyst disease is still a significant clinical problem in endemic regions. The lungs and the liver are most often involved in the child. A mediastinal localisation is rare and represents 0.1 to 4% of all cases of hydatidosis. The authors reports on two cases and provides a review of the literature. In a retrospective review of the last 12 years, the authors treated two cases with a mediastinal localisation out of total of 235 intrathoracic hydatid cysts arising in 222 patients (0.85%). Two girls, one 12 and the other 13 years old, were admitted with a previous history of chest pain. The chest x-ray revealed an homogenous opacity of 150 mm in the first case and 50 mm in the second. Computed tomography in the second case revealed a cyst in the posterior mediastinum. The abdominal ultrasound was normal in both cases. The patients were approached through a posterolateral thoracotomy and the diagnosis was confirmed macroscopically. The cysts were intact and located on the left side of the posterior mediastinum. The operative field was isolated and protected with hypertonic saline solution. Hydatid fluid was aspirated, followed by the extraction of the hydatid membrane and subtotal excision of the residual cavity in both cases. The postoperative course was uneventful without any relapse or other organ involvement during four and three years, respectively. The authors notes that hydatidosis should be considered in the differential diagnosis of a mediastinal cyst mass. Because of the benign nature of the disease, they emphasize that surgical treatment must be conservative.

[Nasal angiocentric T cell-natural killer cell lymphoma with pancreatic localisation in a child]

The nasal angiocentric T-cell-natural killer cell lymphoma is an aggressive tumor, exceptional in Tunisia, which is observed especially in Asia, Mexico and South America. We report the case of an 11-year-old boy, presenting with an exuberant and ulcerative tumor of the right nasal pit. Radiological investigation evidenced a right ethmoïdo-frontal tumor. Evolution was characterized by the installation of abdominal pain and fever, the evidenciation of a mass within the head of the pancreas that compressed the extra hepatic biliary duct and Wirsung's canal and was associated to hyperamylasemia. Biopsy under ultrasound revealed a histiocytic nature. Nasal biopsy found histiocytic and lymphocytic cells and led to a diagnosis of rhinoscleroma. The absence of improvement under antibiotic treatment and the development of fever with leuconeutropenia oriented towards the diagnosis of a non-Hodgkinian malignant lymphoma. Medullary biopsy and immunohistochimic study confirmed a T/NK cells lymphoma, with medullary invasion. The child died from acute respiratory distress syndrome. The authors insist on the rarity of this bipolar location, in particular in children, emphasize the difficulty of the diagnosis and review the literature.