مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال شانزدهم شماره 5 (پیاپی 66، زمستان 1387)

Febrile seizure is the most common form of childhood seizures that occurs in 3–4% of them. In the approach for convulsive febrile patients, diagnosis of etiology of fever and exclusion of CNS infection is very important. The purpose of this study was to evaluate CNS infection in 100 CSF samples of children with febrile seizures. In a descriptive retrospective study, CSF analysis results of 100 children with febrile seizures admitted between March 2002 and August 2004 to Yazd Shaheed Sadoughi Hospital were evaluated. 59 boys and 41 girls with mean age of 1.9±1.67 years were evaluated. Most of the cases (62%) were less than two years old. Febrile seizures were complex in 15% and simple in 85 %. The most common form of seizure was generalized tonic colonic (90%) and URI was the most prevalent etiology of fever. 3 cases had aseptic meningitis while status epilepticus was seen in one of them. No bacterial meningitis was seen. Routine LP in all children with febrile convulsions should be avoided and limited to cases with clinical evidence of CNS infections in history and physical examination. All infants with first simple febrile seizure should be admitted to the hospital for close observation and lumbar puncture must be done if clinical signs of meningitis are present.

Obesity and overweight are one of the health problems in developed and developing countries that are increasing every day. The purpose of this study was to asses the prevalence of obesity and overweight and their risk factors among preschool children in Yazd. In a descriptive cross sectional study 400 preschool aged 6 years, including 200 boys and 200 girls were selected via random sampling method from among health assessment clinics and evaluated for obesity and overweight and their risk factors in 2005-2006. BMI for age and sex was based on standardized percentile curves for BMI (NHNESIII accepted by WHO). Obesity was defined as BMI >95th and overweigh as BMI in 85-95th percentile. The data of the research was collected through complied questionnaire by interviewing parents and then analyzed and evaluated using SPSS: 11.5 software. The prevalence of obesity and overweight was 3.8% and 4.3%, respectively. Frequency of obesity and overweight was approximately 5.5% and 5% in boys and 2%, 3.5% in girls, respectively. Obesity and overweight had a significant statistical relationship with physical activity, amount of television viewing and consumption of fast food and soda, but no statistically significant relationships were seen with sex, birth order and parental educational levels. In this study, prevalence of obesity and overweight was lower than other similar studies, but obesity risk factors should be considered during decision making on preventive measures.

The most common neoplasm in childhood is acute leukemia and about 30% of all cancers are luekemias. Treatment based on prognostic factors has improved survival rate during the last two decades. As prognostic factors differ in different populations, this study was done to evaluate the factors in Yazd. This descriptive observational study was done as a case series study. The population under study included 56 children in the age range of 0-14 years and all of them were admitted to Shahid Sadoghi Hospital of Yazd. To obtain predicting clinical (age, gender.hepatomegaly…) and laboratory (CBC, LDH, Flow cytometry…) factors in outcome of disease (Relapse and death), statistic technique of Cox Proportional Hazard Ratio and chi-square tests were used. All prognostic factors were with univariate and multivariate analyses. Only WBC count 50000 in both univariate and multivariate analyses was predictive factor for death. (p.v:0.008, HR: 21.77, 95% CI=2.33 -75.11). Patients with WBC count 50000 were 22 times more at risk of death than those with lesser counts. Therefore, these patients should be considered as a high risk group.

A hearing– impaired patient is defined as one with abnormal or reduced function in hearing resulting from an auditory disorder. The goal of any preschool and schools screening program should be to accurately indentify those children whose hearing has been impaired due to conductive and / or sensory– neural pathology. This cross– sectional descriptive study was done on 577 children (299 girls and 278 boys) aged between 3–6 years at kindergartens of Yazd city from September 2005 to January 2006. The otoscopy examination, pure-tone screening and impedance study was conducted after completion of awareness form of the hearing loss existence by the parents. In this study, there were 12.6% abnormal conditions of external ear canal, 34.2% abnormal tympanic membrane, 35.9% abnormal tympanograms and 13.4% hearing loss including 11.5% conductive hearing loss, 1.5% sensory-neural hearing loss and 0.5% mixed hearing loss. With respect to the high prevalence and negative effects of middle ear disorders in learning of preschool children, and also due to the importance of early identification and intervention of hearing loss in aural rehabilitation programs, increasing the awareness and education of people, especially parents about the effects of hearing disorders and its prevention and identification is very important.

The incidence of childhood cancer has been increasing nearly one percent per year for the past two decades. Leukemia and lymphoma are the most common types of childhood cancers. This study was performed to assess the relation between environmental factors (Hydrocarbon, agricultural toxin, insecticide) present in various occupations of parents and cancer in their children. This was a case–control, cross sectional study done on 78 children with leukemia and non-Hodgkin’s lymphoma and 78 healthy children as the control group between the years 2002 and 2005. Information was gathered via a questionnaire and analyzed by suitable software (chi-square test). There were 44.9% girls and 55.1% boys in the case group and most of them (29.6%) were in the 3-5 years age group. 57.7% of the fathers were farmers, 16.7% were either painters or were exposed to hydrocarbons and 6.4% were simple workers. Comparison of case and control group showed a significant difference between the fathers occupation in the two groups. This study identified that rate of malignancy in children whose father’s are painters, exposed to hydrocarbons and farmers are higher than others. Therefore people with these occupations should pay more attention and should be protected against risk factors.

Iodine deficiency disorders (IDD) are the most common epidemiological problems in the world, including our country. In order to prevent IDD and its consequences, iodized table salt is being used in our country since 1989. At present, this program is 18 years old. The surveillance of IDD may be implemented to assess the prevalence of IDD, identify high risk areas for intervention and monitor and evaluate IDD control programs. Aim of this study was to determine prevalence of goiter and urinary iodine rate in 6-11 year old primary school children in Chahak area of Yazd. In this prevalence study, 530 primary school students aged 6-11 were selected by census. Thyroid examination and goiter classification was done according to WHO standards by one trained physician. From one–fourth of the total population, urine samples were taken and the household salt consumed by them was tested for iodine. Urinary iodine was determined by digestion method. Iodine of salt was determined by rapid test kit. Total goiter rate (TGR) was defined as sum of goiter grade I and II. Data was analyzed by SPSS software. TGR, goiter 2 and grade 1 in Chahak areas were 29.1%, 25.1 and 4%, respectively. Prevalence of goiter grade2 in girls and boys was 3.3 and 4.7%, respectively (PV=0.6).TGR in 6, 7, 8, 9, 10 and 11 age groups was 15, 26.5, 27.5, 21.7, 31.1 and 37.9 (PV=0.93), respectively. TGR in Chahak, Shahriyary and Bakhtyary villages was 20.8, 36.9 and 68.7 (PV<0.001), respectively. In general, urinary iodine of 19.3% of population was less than 100 μ/l, 51.3% was in the ideal range and 29.3% was more than 200 μ/l. Overall mean of the urinary iodine was 162.7+56.3μg/l. Mean of the urinary iodine in Chahak, Shahriyery and Bakhtiyary villages was 155+54,185+51 and 149.6+68 μg/l, respectively (PV=0.01). All of the household salt samples had iodine of which 2.7% had 8ppm,68.7.% had 15ppm and 28.6 had above 30ppm. The results of this study indicated that despite the relatively ideal range of urinary iodine in study areas, the TGR was greater than the WHO target value, especially in Bakhtiyary village. Thus, further investigations are needed for finding the other causes of this problem.

Newborns should be evaluated immediately after birth and the traditional way of assessing is to use the Apgar score. The aim of this study was to estimate the Apgar score and evaluate the first 24 hour- clinical outcome of babies born at Yazd hospitals. In a descriptive cross-sectional study, Apgar score was assessed for 462 newborns at the 4 centers of Afshar, Madar, Kargar and Bahman of Yazd. 262 out of 462 babies were born by vaginal delivery and the other 200 babies were delivered by cesarean section. The data was analyzed by using both parametric and non parametric tests. Apgar score of 7 and less was considered as abnormal. In this study, the type of delivery (cesarean section or vaginal delivery), method of anesthesia (epidural or general) and gender of newborn had no impact on Apgar score, but prematurity, low birth weight, premature rupture of membranes, inadequate prenatal care and the level of maternal education had influence on reduction of the Apgar score. Those babies who were in good condition and were kept beside their mothers had the highest Apgar score. Apgar score is a useful measure to assess the general condition of the newborns at birth and for the prediction of their morbidity, mortality and neurologic impairment.

Febrile seizure is the most common type of seizure that occurs in 3– 4% of children below the age of 5 years. The purpose of this study was to determine the frequency of recurrence of febrile and afebrile seizures after the first febrile seizure. In a descriptive prospective study, 139 children (6months to 6years old) admitted between March 2004and August 2005 at Yazd Shaheed Sadoughi Hospital because of febrile seizures were followed up for25.1±5.5 months for seizure recurrence. 76 boys and 63 girls with mean age of 2.03±1.21 year were studied. Febrile seizure was simple in 67% and complex in 33% of them. 37.4 % had febrile seizure recurrence with mean survival recurrence rate of 6.7±5.9, while 6.4% had afebrile seizures with mean survival recurrence rate of 7.8±9.4months. Risk factors for recurrence of febrile seizures included age below one year during the initial seizure and occurrence of seizure within one hour of onset of fever. Risk factors for epilepsy included focal febrile seizure, neurodevelopmental delay, occurrence of seizure within one hour of onset of fever and recurrent febrile seizures. In this study, age of onset in infants below one year was one of risk factors of febrile seizure recurrence and it was more prolonged in infants. It is therefore advisable to seriously consider febrile seizures in this age group.

Febrile seizure is the most common problem in pediatric neurology that occur s in 3– 4% of children. The purpose of this study was to evaluate demographic and clinical characteristics of first febrile seizures in children admitted to the hospital. In a descriptive retrospective study, medical records of children with first febrile seizure, admitted between March 2004and August 2005 toYazd Shaheed Sadoughi Hospital were evaluated for demographic and clinical characteristics of first febrile seizures. 76 boys and 63 girls with mean age of 2.03 ± 1.21 years were evaluated. Febrile seizure type was complex in 33% and simple in 67 %. On the whole, 66 % occurred in less than two year olds and 6 % in more than four year olds. The most common form of seizure was generalized tonic colonic (79cases) and URI was the most prevalent etiology of fever. Mean temperature on admission was 38.5o C. Mean seizure time and hospital stay (days) was 6.7 minutes and 2.3 days, both of which were statistically more significant in complex febrile seizure. There were a significant number of complex febrile seizures in this study that necessitates more aggressive handling. As antipyretic use is ineffective in prevention of febrile seizures, undue stress on parents can be avoided by not emphasizing on antipyretic consumption.

Thiamine Responsive megaloblastic anemia in DIDMOA (Wolfram) syndrome has an autosomal- recessive mode of inheritance. Megaloblastic anemia and sideroblastic anemia is accompanied by diabetes insipidus (DI), diabetes mellitus (DM), optic atrophy (OA) and deafness (D). Neutropenia and thrombocytopenia are also present. We report a 7 month old girl with congenital macrocytic anemia a rare clinical feature of Wolfram,s syndrome with increased plasma levels of blood glucose, both of which dramatically responded to administration of thiamine in large doses. The patient also had neurosensorial deafness, but no improvement was observed in the deafness. We presented the case because thiamine-responsive megaloblastic anemia is a rare clinical presentation of Wolfram syndrome and after institution of treatment with thiamine, the anemia and hyperglycemia returned to normal.

Stroke, though rare in children is among the top 10 causes of death in childhood. Incidence of ischemic and hemorrhagic stroke is the same in children. We report a case of hemorrhagic stroke in a two year old girl who presented with a limp, inability to stand on the left leg and left hemiparesia. Her complaint began 10 days ago after a bout of left clonic seizure. She had been admitted to the hospital for a week due to delayed hemorrhage of the umbilical stump at the age of 18 days. Brain CT scan showed a round, hyper dense area with mass effect in the right supraparietal region. Craniotomy revealed a hemorrhage and report of pathology was hematoma. Considering the delayed umbilical cord bleeding and normality of usual tests for hemostasis and partial deficiency of factor XIII in both parents, the problem was diagnosed as homozygote severe deficiency of factor XIII.

Retinoblastoma is a retinal malignant tumor that occurs in early childhood. The annual incidence of retinoblastoma is approximately one per 14 000 live births. 250 to 300 new cases are reported in the United States each year. It develops due to inactivation of both alleles of the retinoblastoma susceptibility (RB1) gene. All hereditary cases (55%) are with bilateral and multifocal lesions, but in non hereditary cases (45%), retinoblastoma is always unilateral and unifocal. Leukocoria (white reflection of pupil) and strabismus are the most frequent clinical manifestations of retinoblastoma. In funduscopy under general anesthesia, the lesion appears as a white tumor with angiomatous dilatation of the vessels. Treatment approaches include chemotherapy, focal laser, enucleation and radiotherapy. The goals of treatment are eye preservation and improvement in patient survival rate reduction of local tumor relapse and recurrence and development of new tumors. Follow up is by general and complete eye examination in order to diagnose related malignancies, especially in cases of radiotherapy. We report three bilateral retinoblastoma cases (10 months, 5 and6 years old) with strabismus and visual loss. Imaging showed involvement of both globes without CNS involvement. The tumor was controlled by providing adequate treatment for the cases.