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The purpose of the study was to analyze the relative cost of selective functional posterior rhizotomy (SFPR) and continuous intrathecal baclofen in the treatment of children with severe spastic quadriplegia related to cerebral palsy. No attempt was made to analyze the efficacy of the two types of treatment. Nine children with spastic quadriplegia secondary to cerebral palsy in whom continuous intrathecal baclofen was attempted were matched as closely as possible with a group of 10 patients with spastic quadriplegia out of a total of 100 children who had undergone SFPR in the same time period. Clinical care flow charts were created to identify the various points of contact with members of the health care team, so that cost points could be identified and costs calculated. The cost per patient up to 1 year after treatment averaged CDN$ 64,163.10 for patients with implanted pumps for continuous intrathecal baclofen versus CDN$ 16,913.54 for SFPR. When adjustments were made to exclude costs and savings associated with research protocols, the average for the baclofen group decreased to approximately CDN$ 63,000, with minimal change for the SFPR group. The higher cost per patient on baclofen was related to the cost associated with screening patients who did not go on to have implantation of a continuous infusion pump, and to additional hospitalizations for complications in the baclofen group. It is cautioned that this cost analysis was based on the experience at British Columbia’s Children’s Hospital, and the results may not be generalizable to other institutions or to other patient populations.

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Intestinal and urinary tract infections are the most common infections in malnourished children. In the present study, intestinal infections were surveyed in malnourished children. The present research was a cross sectional study in 12 months. During the study period, all the malnourished children admitted to health center in south of Tehran, were included in the study. Malnutrition was found in children with clinical examinations. Malnourished children and control group were referred to the laboratory for stool screening of ova of worms and protozoa cysts or trophozoite and also stool culture. In a total of 84 cases, 4 children were infected with cysts of Giardia intestinalis, 2 children were infected with Blastosistis hominis, 5 children were infected with Enteropathogenic Escherichia coli and 3 children were infected with Shigella spp. In the control group, one child was infected with G. intestinalis, 2 children were infected with B. hominis cysts and one child was infected with Enteropathogenic E. coli. Statistical analysis showed significantly higher rates of parasitic infection in malnourished children with G. intestinalis as compared to the control group (P<0.05) but there was significantly higher rates of B. hominis infection in the control group as compared to malnourished children (P<0.05). With regards to bacterial infections, statistical analysis showed significantly higher rate of bacterial infection of malnourished children with EPEC and Shigella spp. as compared to control group (p<0.05). The causes of malnutrition are multiple and complex and infections are common precipitating factor. Acute intestinal and respiratory infections are the most important causes of high morbidity and mortality in malnourished children and malnutrition is an important associated factor in these deaths. The present study showed that, parasite and bacterial intestinal infection in malnourished children were significantly higher than healthy children, thereby malnourished children should be tested periodically for detecting bacterial and parasitic intestinal infections and should be treated in first stages of illness.