Iranian Journal of Pediatrics
Volume:12 Issue: 3, 2002

How could we actually find the answers to our every day’s practice queries in the era of information overload? We could find the answers thanks to evidence-based practice (EBM). In the following review article I have tried to illustrate an EBM model of approach to one of the greatest concerns of everyday practice of pediatricians (i.e., seizure and fever and febrile seizure). After a case presentation, I have listed some common questions of every day’s practice; Then I have tried to find the answers through common and well-known medical information data systems. After finding the relevant data and research in the literature and doing critical appraisal on them. I have listed some evidence-based recommendations.

Ies are the most frequent causes of mortality in children aged 1-16 years. In an epidemiologic study, all cases of pediatric cancer (Aged 1-16 years) registered by the medical universities in Iran are studied regarding the age, sex and type of the malignancy. This study refers to the cancer cases diagnosed and histopathologically confirmed in 1996. Of the data received from 9 provinces, a frequency of cancer in 420 children (58.3% male, 41.7% female) with a median age of 7.1 years was established. Hematologic malignancies with 20% of all cases were the most frequently encountered cancer types. The next cases consisted of brain (15%), lymph nodes (15%), bone (8%), kidney (7%), ophthalmic (6%), and soft tissue (5%) malignancies.

The expanded global use of vaccines has led to eradication of some contagious diseases in children. This should not lead to forget the fact that these vaccines can be associated by complications and side effects. We studied 450 children, who had received DPT vaccine at the age of under 6 years. 2 to 7 days after the DPT injection we could not observe any seriously dangerous complication, although 82.4% of the children had general and 83% local complications. Fever with a frequency of 73% was the most frequency observed general complication, this was followed by lethargy, loss of appetite, and persisted crying. The most frequency observed local complication consisted of pain at the site of injection with 63% of cases followed by swelling, erythema and induration. By increasing age, local swelling and erythema increases (P<0.001) and induration decreases (P<0.001). General complications decreases with increasing age and vaccinations, which is especially remarkable in 2 to 7 year old children (5th vaccination).

Cystic Fibrosis (CF) is an inherited multisystem disorder of children and adults. Characterized chiefly by chronic obstruction and infection of airways, maldigestion and its consequences. It is the most life limiting recessive genetic trait among whites. A dysfunction of epithelial surfaces is the predominant pathogenic feature and is responsible for a broad, variable and sometimes confusing array of presenting manifestations and complications. This article present an about 11-month old male infant who was hospitalized because of convulsions and hyponatremia of unknown origin. In the 3rd hospitalization a CF was diagnosed. CF treatment leads to resolving of hyponatremia and convulsions.

Epilepsy occurs in 15-60% of children with cerebral palsy (CP). However, its clinical course is not well defined. This retrospective study reviews the prevalence, nature and prognosis of epilepsy in cerebral palsy. 53 of 133 children with cerebral palsy seen in the neuropediatric clinic in Mashhad emam Reza hospital between 1999 and 2001 had epilepsy. A control group of 70 epileptic children with normal neurodevelopment status was seen during the same period. Epilepsy most commonly affected patients with spastic quadriplegia. When compared with controls, children with cerebral palsy had higher incidence of epilepsy with onset within the first year of age (52.8% vs. 18.5%), a history of neonatal seizures (20.7% vs. 4.2%), polytherapy (76.3% vs. 29.1%) and treatment with second line anti-epileptic drugs (79.2% vs. 23.1%). Thus epilepsy is common in children with CP and the use of new anti-epileptic drugs and surgical treatment might eventually improve both seizure control and quality of life in epileptic children with CP.

Urinary and rectal sphincter incontinence is a frequently encountered symptom in mentally retarded children and those with learning disabilities. In addition to the fact incontinence is a very disagreeable problem, on the wide it is of more importance in Islamic societies, as to be “Clean” during religious practices is mandatory. Regarding the fact that 25-50% of mentally retarded children are unable to control urine and feces elimination, families and institutions in charge of these children face much inconvenience. This article discusses the teaching programs and methods of behavioral therapy of the affected patients.

Chloride channel Myotonia is a form of channelopathy, and Myotonia is its manifestation. Myotonia may be defined as delayed relaxation of skeletal muscle after its contraction. Decreased chloride conductance across the transverse tubular system, renders the muscle membrane hyper-excitable and leads to repetitive firing, creating Myotonia. Myotonia congenital is another name for chloride channel Myotonia. Myotonia congenital appears in autosomal dominant type called Thomson disease, autosomal recessive type called Becker disease, and a type with sporadic occurrence. Symptoms appear in the first or second decade of life. Repeated muscle contraction, the so called warm up, result in resolution of the Myotonia stiffness. Muscle stiffness and hypertrophy is another finding at physical examination. In this study we report on 5 patients, which had clinical and electrical signs of Myotonia. Muscle hypertrophy and warm up phenomena were present in all cases. CPK measurement of all cases were normal. 2 patients underwent muscle biopsy that showed only atrophy and increased central nuclei. In three cases autosomal recessive inheritance (Becker), in one case autosomal dominant inheritance (Thomsen) and in one case sporadic occurrence was suggested. With respect to successful results of carbamazepine therapy in 4 patients, and being excellent in one of them, we suggest carbamazepine for the first choice of Myotonia treatment.

Mothers’ lack of knowledge of supplementary nutrition in 6-12 months old children is an important elements causing dysfunction in child nutrition in this period of life and as a result leads to malnutrition and contributes to the high infant mortality. The aim of this research was to determine mothers’ knowledge of child supplementary nutrition in Babol city and the surrounding villages. This is a descriptive and analytic study. The information was gathered by questionnaires completed by 190 mothers in villages around Babol. The average knowledge of mothers in the rural region was good. Mothers, who were 25-29 years old, had an optimum level of knowledge. Working mothers were more informed than non-working mothers. Mothers with more than 3 children had less knowledge than mothers with only one child. 84.7% used to feed supplementary food at 6th month. Mothers living in the rural region had suitable degree of knowledge regarding the supplementary nutrition. 91% of mothers living in rural region had knowledge of more than the average level. The results of this research are similar to those of other region of Iran and also developing countries. It was shown that there are some factors playing a role in mothers’ knowledge to child supplementary nutrition such as the level of education, availability of health houses, and the information provided by media. However, it seems that with training of the health care workers and with more assistance of the media the mothers’ knowledge regarding supplementary nutrition can be improved.

Progressive Pseudorheumatoid Chondrodysplasia a rare disorders. Signs and symptoms of the disease developed between three and eight years of age. Patients show clinically and radiographically continued cartilage loss and destructive bone changes as they age. In this article we report on a 6-year old boy who had been referred to our neuropediatric clinic for neuromuscular survey.

This prospective study was conducted to observe changes in nasopharyngeal (NP) pneumococcal carriage within 4 to 5 days after initiation of commonly used antibiotics for 150 patients who were admitted at infectious disease unit of children’s medical center in Tehran to determine whether a significant increase in the carriage rate of drug (Penicillin) resistant S.pneumonia on NP can be observed within this short interval. Nasopharyngeal culture for S.pneumonia was obtained before (Day 1) and after (Day 4 to 5) initiation of antibiotic treatment. Antibiogram was performed in all isolates and the MIC of penicillin in 20 resistant S.pneumonia. By E-test method among the initial 46 (30%) pneumococcal isolates 28 (60%) were sensitive and 8 (17%) were resistant to penicillin. After 4 to 5 days of antibiotic treatment with various drugs, 20 (13%) pneumococcal isolates in the culture were obtained, of whom 12 patients (60%) were resistant to penicillin and 8 patients (40%) were sensitive. In 4 of 150 patients (2.6%) a new S.pneumonia isolate was recovered 4 to 5 days after initiation of treatment. All of those isolates were penicillin-resistance. A rapid detection of penicillin-nonsusceptible NP pneumococcal isolates during antibiotic treatment is common. This may contribute to the spread of resistant pneumococci.