فهرست مطالب

Pediatrics - Volume:28 Issue: 3, Jun 2018

Iranian Journal of Pediatrics
Volume:28 Issue: 3, Jun 2018

  • تاریخ انتشار: 1397/04/25
  • تعداد عناوین: 14
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  • Murat Karaoglan, Mehmet Keskin, Seval Kul, Ayhan Ozkur Page 1
    Background
    The diagnosis of patients who present with early pubertal signs can pose a challenge.
    Objectives
    The aim of this study was to design a new diagnostic scoring system based on clinical and laboratory findings to distinguish precocious puberty (PP) from premature thelarche (PT) among girls diagnosed with early puberty.
    Methods
    We enrolled 267 girls (PP, n = 164; PT, n = 103) previously diagnosed with early puberty using GnRH test, retrospectively. A diagnostic scoring model (M) was constructed with five variables and their cut off values were determined for scoring: age of onset (6.5 years), bone age (BA)/choronologic age (CA) ratio (≥ 1.1), estradiol (12 pg/ml), uterine length (32 mm) and ovarian volume (1.09 cm3). Overall score was determined for model. The model was also applied prospectively to a second girls population (n = 86) that showed signs of early puberty.
    Results
    The sensitivity and specificity of model was 89.6% and 87.4%, respectively. In the cohort group, the sensitivity and specificity of model was 90% and 89.4%, prospectively.
    Conclusions
    A diagnostic scoring system, based on clinical and laboratory findings can be an alternative or complementary method for the differential diagnosis of early puberty.
    Keywords: Early Puberty, Precocious Puberty, Premature Thelarche, Scoring
  • Ahmad Reza Rahnemoon *, Leila Koochakzadeh, Shahla Ansari, Anna Boyajyan, Arsen Arakelyan Page 2
    Objectives
    The following observation was primarily based on the study of gene fusion in blood and bone marrow cells taken from 68 Iranian children with acute lymphoblastic leukemia (ALL), to compare with healthy population.
    Methods
    Peripheral blood and bone marrow samples obtained from patients with ALL were immunophenotyped to determine the lineage and the level of differentiation. With reverse transcriptase-polymerase chain reaction (RT-PCR), the RNA molecules were analyzed according to Van Dongen et al. protocol to detect fused genes in cell population.
    Results
    Leukemic cell type was identified by cytochemical stains and classified on the basis of FAB classification. Nonetheless the frequencies of E2A/PBX1, MLL/AF4, BCR/ABL (M-BCR) and BCR/ABL(m-BCR) gene transcripts were 1.5%, 0%, 0% and 4.4% respectively. The positive case of E2A/PBX1 fusion gene had an early pre B and 3 BCR/ABL (m-BCR). Positive cases had an early pre B and pre-B ALL immunophenotype.
    Conclusions
    Early pre-B cells were the most common types in our patients. The RT-PCR was shown to be an ideal method for detecting hybrid transcripts and to estimate the prevalence of the fusion genes in ALL patients. The frequency of these fusion genes in Iranian pediatric ALL patients were found to be similar to some developed countries. Thus, their presence does not seem to be predictive of increasing malignancy, but rather it can challenge the prognostic significance of these rearrangements.
    Keywords: Childhood Acute Lymphoblastic Leukemia, Immunophenotype, Genetic Alterations
  • Fatemeh Aghamahdi, Aria Setoodeh *, Vahid Ziaee, Ali Rabbani Page 3
    Background
    Juvenile Idiopathic Arthritis (JIA) is accompanied by growth failure, mostly occurring due to chronic inflammation and use of corticosteroids for treatment. The aim of our study was to determine the prevalence of short stature in JIA patients and possible systemic disorders which may affect the growth pattern in this group of patients.
    Methods
    In this cross-sectional study erformed from June 2014 to May 2015, JIA patients with a history of more than one-year treatment were examined by an endocrinologist and based on their height standard deviation score (SDS) two groups were determined: Group A > -2SD and group B
    Results
    Of 117 JIA patients who were enrolled, 41 patients were under -2SD (19% of pauciarticular, 62% of poly articular and 33% of systemic onset). The mean height SDS in group B was -3.48 ± 1.28 (compared to -0.9 ± 0.8 in their parents). We found hypovitaminosis D in 73% of our patients. The prevalence of subclinical hypothyroidism was 7.4% (5% of group A and 9.7% of group B). Twenty-four percent (10 patients) of group B did not respond to growth hormone (GH) stimulation test and 14.6% of them (6 patients) were possibly GH resistant. Liver function tests and renal function tests were normal in all the patients. There was no difference between 2 groups in hypothyroidism and hypovitaminosis D but polyarticular type of the disease was associated with short stature (P Value
    Conclusions
    Growth failure is common in JIA patients. So they, especially those with polyarticular type, need to be visited periodically by an endocrinologist.
    Keywords: Juvenile Idiopathic Arthritis_Growth Hormone_Vitamin D Deficiency_Hypothyroidism
  • Bernhard Resch *, Kathrin Leonhardt, Berndt Urlesberger Page 4
    Background
    Aim of the study was to analyze the use of a prophylactic multimodal anti-infective regimen including the probiotic Lactobacillus casei rhamnosus (LCR35) in critically ill term neonates with respect to complications and possible side effects.
    Methods
    This was a retrospective observational STROBE compliant single-center cohort study of all term infants born between 2005 and 2015 that have been admitted within the first 24 hours of life to the neonatal intensive care unit (NICU) and having been hospitalized for at least 7 days. All neonates received a standardized prophylactic anti-infective treatment with enteral probiotics (LCR35), antifungal agents, and oral gentamycin over the study time starting at the first day of life. Perinatal and neonatal data were collected for descriptive analysis. Complications of neonatal intensive care therapy included late-onset necrotizing enterocolitis (NEC), multiple organ dysfunction syndrome (MODS), ventilator associated pneumonia (VAP), antibiotic-associated diarrhea (AAD), and late-onset sepsis (LOS).
    Results
    Out of 2940 neonates admitted to the neonatal wards 403 fulfilled the inclusion criteria and comprised the study population. Median gestational age was 38 weeks and birth weight 3300 grams, median length of stay 10 days; 246 (61%) neonates needed ventilatory support and 334 (83%) received antibiotic treatment. None of the neonates developed NEC, MODS, VAP, or AAD. Sixteen (4.0%) neonates developed LOS. Blood cultures were all negative for LCR. Breast milk feeding was evident in 13% (2/16) of the neonates with LOS compared to 30% (121/387) in those without LOS (P = 0.055).
    Conclusions
    Over an 11-year period use of a standardized prophylactic anti-infective regimen was safe and resulted in a very low incidence of predefined complications in critically ill term neonates.
    Keywords: Term infant, Probiotics, Necrotizing Enterocolitis, Multiple Organ Dysfunction Syndrome, Neonatal Intensive Care, Ventilator Associated Pneumonia, Late-Onset Sepsis, Antibiotic-Associated Diarrhea, Lactobacillus rhamnosus
  • Behzad Barekatain, Amir Mohammad Armanian, Ladan Salamaty *, Armindokht Shahsanai, Ali Safaei Page 5
    Background
    Although heparin may be effective in reducing risk of catheter blockage, there are several concerns about the use of heparin in patients with peripherally inserted central catheter (PICC), including decreasing platelet count and intra ventricular hemorrhage (IVH). There is limited evidence of an association between this risk and dose of heparin. According to the limited studies that have compared high dose and low dose of heparin on PICC patency and complications, this study aimed at comparing the effect of low dose and high dose heparin on central catheter patency in very low birth neonates in Isfahan, the third populated province of Iran.
    Objectives
    The aim of this study was to evaluate the optimal dose of heparin in peripherally inserted central catheter in very low birth weight infants.
    Methods
    This randomized clinical trial was conducted on 106 very low birth weight neonates with PICC. The neonates were divided to 2 groups, including low dose and high dose groups. The low dose group received 1.5 unit/kg/hour of heparin and the high dose group 0.5 unit heparin/1 cc of serum. The primary outcomes were the duration of time that the catheter was open and lack of occlusion. Catheter occlusion was defined as inability to push 1 cc of normal saline 0.9% with a 5 cc syringe. The secondary outcome was incidence of sepsis, catheter related sepsis, phlebitis, thrombocytopenia, skin reaction, IVH, and grade of IVH and death rate.
    Results
    In this study, 106 neonates with mean age of 28.83 weeks participated, 43.4% of which were male. The mean duration of time that the catheter was open was similar in both low dose and high dose groups. The incidence of complications, including sepsis, thrombosis, bleeding, IVH and increasing blood pressure, were not significantly different between the 2 groups.
    Conclusions
    This study suggested that using low dose of heparin is as effective as high dose heparin in reducing catheter occlusion and improving catheter patency and it is better to administer low dose heparin in neonates, who had central catheter to maintain its patency.
    Keywords: PICC, Heparin, Preterm Neonates
  • Ilke Kupeli *, Senol Bicer Page 6
    Objectives
    The aim of this study was to investigate the effect of ilioinguinal/iliohypogastric nerve block (II/IH) only supported by ketamine sedation on intraoperative anesthesia and analgesia.
    Methods
    A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided into three groups: 1) the II/IH block and ketamine group, 2) the II/IH block by inserting the laryngeal mask (LMA) and sevoflurane group, and 3) the LMA and sevoflurane group. Peroperative heart rate (HR), mean arterial pressure (MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, and time required for the first analgesia were recorded.
    Results
    The patients, consisting of 34 males and 26 females had an average age of 4 ± 1.3 years. There was no difference in terms of HR and MAP between the ketamine block applied group and LMA block applied group; however, HRs were higher and MAPs were lower in the group in which no block was added but only sevoflurane maintenance was provided and the amount of sevoflurane used significantly decreased in the group supported by (II/IH) block (P
    Conclusion
    In this study, it was determined that II/IH block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration, and shorter analgesia need in the postoperative period.
    Keywords: Children, Ultrasound-Guided Ilioinguinal, Iliohypogastric Block, Intraoperative Anesthesia
  • Seyed - Mahmoud Tabatabaei_Shahrokh Amiri_Nasrin Forghani_Seyed - Gholamreza Noorazar_Shahin Abdollahi - Fakhim_Habibeh Barzegar_Mir - Mahmoud Mirnasab Page 7
    Background
    Attention deficit hyperactivity disorder (ADHD) as a commonneuro - developmental disorder is associated with inattention, excessive activity, impulsive behavior or a combination of these symptoms. Environmental and genetic factors are involved in this disorder; Dopamine Active Transporter 1 gene (DAT1) is one of these genetic factors. In this study the association between the 10 or 9 - repeat allele of a variable number tandem repeat (VNTR) polymorphism in the 3’-untranslated region (UTR) of the DAT1 gene and ADHD, is examined.
    Methods
    A total of 124 children with ADHD and 129 healthy children, ranging from 5 to 14 years old were selected from the north - western area of Iran as the case group and the control group, respectively. DAT1 gene polymorphism was investigated using the PCR-VNTR technique.
    Results
    Using the Hardy - Weinberg law and chi - square test for analyzing the results of the DAT1 gene, it was observed that the genotypes 9/10 and 10/10 of DAT1 gene were significantly higher among children with ADHD than that in control group (P = 0.002).
    Conclusions
    Based on these finding, it can be concluded that a significant relationship exists between DAT1 gene repeats and ADHD in North - west Iran and this can be used as a diagnostic biomarker in the prognosis of this disorder.
    Keywords: DAT1 gene, PCR, Attention Deficit Hyperactivity Disorder (ADHD), Polymorphism
  • Asma Pourhoseingholi, Alireza Akbarzadeh Baghban *, Ahmad Reza Baghestani, Erfan Ghasemi, Seyed Mohammad Reza Safavi Page 8
    Background And Objective
    The most common index in dental studies is the decayed, missing or filled teeth (dmft)/DMFT. Risk factor evaluation in order to investigate the significant factors that affected this dmft in children has an important role in dental epidemiological studies. This study aims to use a zero inflated binomial model for investigating the risk factors that affected the dmft in children aged 5 - 6 years in Tehran, Iran.
    Methods
    This cross - sectional study was a part of a national survey for assessing the oral health status of Iranian citizens in 2012. The target population was children aged 5 - 6 years. The information and oral examination were collected by the WHO recommended clinical examination form and a trained calibrated dental team (dentists and hygienists). A binomial zero inflated model (ZIB) with random effect was used for evaluating the effect of all variables on dmft.
    Results
    In general, 593 subjects were studied. From the entire subject in this study the frequency of zero was 1071 (45%). The result of ZIB model with random effect in zero part showed that brushing the teeth (OR = 3.5; P value = 0.012) and mothers with university education (OR = 11.24; P value = 0.016) had significant relation with zero dmft. The variance component of random intercept in zero part was significant too (σ2 =4.68, P
    Conclusions
    Zero inflated binomial model with random effect in zero part fitted better to this data. Brushing the teeth and high education of mothers had protective effect for dmft in children aged 5 - 6 years in Tehran.
    Keywords: ZIB Model, Dental Caries, dmft
  • Zeynep Yuruk Yildirim, Bagdagul Aksu, Asuman Gedikbasi, Aysel Kiyak, Gul Ozcelik, Alev Yilmaz*, Cemile Pehlivanoglu, Nurver Akinci, Yasemin Ozluk, Aysim Ozagari, Isin Kilicaslan, Sevinc Emre Page 9
    Background
    The family of heat shock proteins (HSPs) contains several members that regulate the cell response to any hazardous factors to protect protein structure. The aim of the study was to determine whether serum levels of HSPs increase in children with IgA nephropathy/Immunoglobulin A - associated vasculitis nephritis (IgAN/IgAVN) and to assess their relationship with the prognostic factors.
    Patients and
    Methods
    Twenty - nine patients with IgAN/IgAVN, 41 patients with idiopathic nephrotic syndrome (INS) as a patient control group, and 24 healthy controls were enrolled in the study. Renal function was normal in all participants. Serum levels of HSP27, HSP40, HSP60, HSP70, and HSP90 were measured using an enzyme - linked immunosorbent assay (ELISA).
    Results
    Median serum levels of HSP27, HSP40, HSP60, HSP70 and HSP90 were significantly higher in the IgAN/IgAVN group than in the INS group and controls (P
    Conclusions
    Our results demonstrated that serum levels of HSP27, 40, 60, 70, 90 increased in the patients with IgAN/IgAVN considering HSPs might have a role in pathogenesis of the disease. Among these HSPs, HSP60 was a prominent marker because it had no overlap between patients and controls. Explaining the role of these HSPs in IgAN/IgAVN may pave the way for future treatment.
    Keywords: Glomerulonephritis_IgA_Purpura_Schoenlein - Henoch
  • Enayatollah Bakhshi, Sepideh Zare Delavar, Farin Soleimani, Akbar Biglarian * Page 10
    Background
    The interaction of the risk factors is an important focus in medical study. The etiology of CP is multi-factorial and usually arises from a series of causal pathways.
    Objectives
    The aim of this study was to compare four statistical methods to detect the interactions of risk factors of cerebral palsy (CP).
    Methods
    In this cross-sectional study, 225 children aged 1 - 6 years were studied during 2008 and 2009 in Tehran, Iran. Penalized logistic regression (PLR), multifactor dimensionality reduction (MDR), logic regression (LR) and classification regression (CR) methods were used to detect interactions.
    Results
    There was an interaction between the consanguinity factor and gender, asphyxia, preterm delivery, vaginal delivery, previous pregnancies, history of pregnancy, history of illness, sepsis, and small for gestational age (SGA). The methods used in this study were detect two-way (6 terms), three-way (11 terms) and four-way (2 terms) interaction terms. Of these interactions, asphyxia × consanguinity interaction was detected by MDR, LR, and CR methods.
    Conclusions
    Our findings showed that the consanguinity factor had an interaction with most of the risk factors and especially consanguinity × asphyxia term was detected in all methods. So this interaction term is very important for considering by clinicians.
    Keywords: Penalized Logistic Regression, Multifactor Dimensionality Reduction, Logic Regression, Cassification Regression, Cerebral Palsy
  • Azar Pirdehghan, Yavar Rajabzadeh Page 11
    Background
    Child abuse is a main health problem all over the world.
    Objectives
    The aim of this study was to extend our understanding about offenders of child abuse in different domains.
    Methods
    The study was designed as a cross-sectional survey on 700 students in secondary schools using multiple cluster sampling in Yazd, Iran in 2013. We applied 2 self-reported questionnaires: a standard self-reported valid and reliable questionnaire for recording child abuse and DASS (depression anxiety stress scales)-42 for assessing mental disorders and another part about perpetrators (parents, relatives, friends or classmates, school teachers and coaches, strangers). The collected data was analyzed using SPSS software. P values
    Results
    School parents, more than the other groups were guilty in severe forms of all domains. Parents neglected totally 97 (26.7 %) students in a variety of intensity, abused psychologically 90 (28.3%), physically 58 (25.6%) and even sexually in 29 (15.3%) cases. Moreover, parents were also responsible for severe physical abuse of 69 (30.4%) and strangers in severe sexual of 105 (55.5%) students (P value
    Conclusions
    Understanding about offenders of child abuse would reveal findings that could be an alarm for decision makers’ intervention programming aimed at reducing child abuse.
    Keywords: Child Abuse, Child Neglect, Studenta
  • Sung Hoon Kim, Hae Jeong Lee, Ju Suk Lee * Page 12
    Objectives
    To assess the relationship between coronary artery changes and periungual desquamation in Kawasaki disease (KD) and non - KD patients.
    Methods
    This retrospective descriptive study was conducted through a review of records of children with KD from March 2011 to February 2016. We also analyzed non - KD subjects with desquamation.
    Results
    Among 329 patients with KD, 177 (53.8%) had periungual desquamation. Subjects with desquamation had longer duration of fever (6.75 ± 2.43 vs. 5.63 ± 1.78 days), more frequent erythema and edema of hands/feet (72.9% vs. 51.9%), and more frequent rash (94.4% vs. 74.3%) than subjects without desquamation. They also had a higher platelet count (470420 ± 127163 vs. 351240 ± 105836, P = 0.042) and higher levels of aspartate aminotransferase (AST; 91.58 ± 62.89 vs. 55.5 ± 44.72 IU/L, P = 0.031), alanine aminotransferase (ALT; 105.39 ± 71.54 vs. 76.7 ± 91.25 IU/L, P = 0.029), and pro - brain natriuretic peptide (BNP; 1738.24 ± 584.26 vs. 1034.65 ± 754.25 pg/mL, P = 0.042). There was no difference between the two groups in development of coronary artery changes. We also analyzed 47 non - KD subjects with desquamation. These patients had fewer clinical signs (87% had one sign of KD) and shorter fever duration according to parents’ reported history, and had a lower platelet count, AST, ALT, and BNP than patients with KD. These patients had no coronary artery lesions.
    Conclusions
    Presence of periungual desquamation is not helpful for an early diagnosis of KD and is not an independent predictor of coronary artery changes in patients with or without KD.
    Keywords: Kawasaki Disease, Periungual Desquamation, Coronary Artery
  • Ebrahim Espahhbodi *, Hadi Ghadimi, Abolfazl Kasaee Page 13
  • Tuncay Muge Alvur, Nursan Cinar *, Dilek Menekse, Selim Oncel, Ilker Duran, Cemile Dede Page 14