manijeh tabrizi

The measles, mumps, and rubella (MMR) vaccine is associated with known complications, such as salivary gland involvement and aseptic meningitis. Isolated reports of epididymal orchitis following MMR vaccination have also been reported, but no reported case of testicular torsion in infancy has been explicitly attributed to the MMR vaccine.

Here, we report an 18-month-old male infant presented with a history of gradually worsening painful left scrotal swelling following a booster dose of MMR that finally led to orchiectomy with the diagnosis of testicular torsion.

An 18-month-old male infant presented with a one-day history of gradually worsening painful left scrotal swelling following a booster dose of MMR. No evidence of blood flow was detected in the left testicle in color Doppler sonography, which was compatible with testicular torsion. In surgical exploration, the left testicle seemed firm and dark in color. The spermatic cord vessels were thrombotic in appearance, and the testicular appendix seemed completely necrotic. The nonviable left testicle was removed.

Although testicular torsion after MMR vaccination is rare, in the case of any pain, swelling, and redness of the scrotum, the patient should seek an urgent medical consultation. Physicians should be aware that testicular swelling after the MMR vaccine might not be just epididymal-orchitis but really a medical emergency.

 Gestational diabetes mellitus (GDM) can cause diastolic dysfunction and asymmetric ventricular septal hypertrophy in infants of gestational diabetic mothers (IGDMs). Ventricular thickness can affect QT interval and other QT parameters.

 This study aimed to evaluate and compare the duration of QT, corrected QT (QTc), QT dispersion (QTD), and echocardiographic indices in two groups of neonates of mothers with and without GDM.

 In this case-control study, 76 term neonates were enrolled. The case group (n = 38) included IGDM, and the control group (n = 38) included neonates born to healthy mothers. The QT, QTD, and QTc were calculated based on electrocardiographic results. Ejection fraction (EF), interventricular septal thickness at the end of diastole (IVSTD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular posterior wall thickness (LVPWT) were evaluated by performing echocardiography, and the two groups were compared regarding them. Data were analyzed using SPSS version 21.

 In this study, neonates' mean age and weight were 4.18 ± 1.3 days and 3418.16 ± 549.24 grams, respectively. As for the gender of neonates, 68.4% in the case group and 47.4% in the control group were female. The two groups had no significant difference regarding age, weight, and sex (P > 0.05). Minimum QTc (QTc min) was significantly higher in the case group (P = 0.046). Considerably lower EF and higher IVSTD were found in the case group (P = 0.011 and P = 0.05 respectively). In univariate analysis, echocardiographic parameters were not the predictors of QTD (P > 0.05); in multivariate analysis, however, QTD was significantly correlated with LVEDD (P = 0.001) and LVESD (P = 0.015).

 A higher proportion of septal hypertrophy was detected in IGDMs compared to infants of the healthy mothers without any correlation with ECG indices. This involvement was accompanied by relatively decreased EF verified by echocardiography. Most ECG findings, including QTD values, had no linear relationship with echocardiographic parameters except for LVEDD and LVESD.

Childhood type 1 diabetes mellitus (T1DM) is an autoimmune disease which is increasing in incidence, but little is known about the events that trigger the autoimmune process. Most of the time, these processes begin in prenatal and natal periods; therefore, this study aimed to investigate the prenatal and neonatal risk factors of T1DM in childhood.

This case‑control study has been performed on children with T1DM who referred to the 17th Shahrivar children’s hospital. The control group consisted of healthy siblings of the case group. Data were gathered using a form that included maternal and neonatal characteristics. Data were reported by descriptive statistics in SPSS 19. To investigate the effect of quantitative and qualitative variables on the development of T1DM, logistic regression and Chi‑square tests were used, respectively.

Birth weight, birth height, and maternal weight gain during pregnancy had a significant relationship with T1DM (odds ratio [OR] = 1.23, 2.57, and 1.14, respectively). In addition, there was a significant relationship between gestational hypertension (OR = 5.27), neonatal jaundice (OR = 3.42), cesarean section (OR = 2.06), and being non–first‑born child (OR = 2.32) and T1DM. Also, premature rupture of membrane, maternal urinary tract infection, and nonexclusive breastfeeding had a significant association with T1DM (OR = 4.37, 3.94, and 2.30, respectively). There were no statistically significant differences between maternal age, sex, neonatal respiratory disease, prematurity, and neonatal infections and T1DM (P > 0.05).

Prenatal and neonatal risk factors can have a significant role in the occurrence of TIDM. Therefore, considering these risk factors can have a preventive effect on T1DM.

Bedside teaching is a concentrated form of small-group teaching that takes place in the presence of the patient. Improvement in communication skills in a sympathetic manner with the patient and the ability to provide a purposeful history description and earning skills in clinical examinations is a goal that can only be achieved at the patient’s bedside. Bedside teaching has declined in recent years despite all its benefits; however, there are strong recommendations to continue this teaching modality for its valued benefits. In this context, we aimed to deal with the importance of bedside teaching and the challenges ahead in the covid epidemic as well as its alternatives for teaching medical students. 

Evidence acquisition: 

This study was conducted through a literature search on articles in English with the relevant keywords (((((((“students, medical”[Mesh]) AND (“COVID-19”[Mesh])) AND (“education”[Mesh])) AND (“patient-centered care”[Mesh])) AND (“patient care team”[Mesh])) OR (“teaching rounds”[Mesh])) OR (“education, distance”[Mesh])) AND (“Physical examination”[Mesh]) using PubMed, Scopus, Web of Sciences, Cochrane, and Embase databases from 2001 to 2022.

In our search, 22 related articles were found, 3 of which were clinical trials) and 4 were review articles. This study summarized the following important issues related to bedside teaching: 1- We discussed the definition, importance, benefits, and difficulties of bedside teaching on the way to education; 2- We deliberated the causes of reluctance to carry out education at the bedside and the ways to deal with the reduction of its implementation; 3-we also noticed alternative methods for medical education in periods of special contact restrictions with patients such as the COVID-19 epidemic in this review.

Bedside teaching has a fundamental role in medical education. In particular circumstances, such as covid 19 epidemy, in which the bedside teaching courses were suspended, it is necessary to allocate other educational arrangements and design a distance learning curriculum, including virtual teaching, uploading videos to view clinical procedures on social media platforms, interview with a virtual patient, and simulation.

Atherosclerosis is an important cardiovascular disorder in beta-thalassemia major patients. The present study aimed to predict factors of atherosclerosis in children with beta-thalassemia major.

This cross-sectional study was conducted on 36 patients with beta-thalassemia major and 36 healthy children as the control group. The carotid intima-media thickness (CAIMT) and osteoprotegerin (OPG) were compared between groups.

The mean age of the patients in the case and control groups were 13.5 ± 3.7 and 13 ± 3.1 years old, respectively. Significant differences in CAIMT in the right (P = 0.001) and left (P = 0.001) arteries were recorded between the two groups. The mean serum OPG in the beta-thalassemia group was significantly higher than the control group (3.9 ng/ml and 1.4 ng/ml, respectively, P=0.001).

CAIMT is a non-invasive method for diagnosing atherosclerosis. According to the significant difference between groups, serum OPG could be helpful in the diagnosis of early atherosclerosis in beta-thalassemia major.

Neuronal ceroid lipofuscinoses (NCL) is a rare progressive neurodegenerative disorder caused by more than 530 mutations of at least 13 different genes (CLN 1-14). NCL is a part of the lysosomal disease characterized by the presence of neuronal and extraneural autofluorescent lipopigment accumulations that leads to motor and mental deterioration, developmental regression, seizure, vision loss, and premature death. NCL is classified into four main groups based on the different clinical manifestations and age of presentation. In this study, we aimed to report an unusual presentation of NCL with CLN6 mutation without retina involvement.

We reported a 10-year-old boy with mixed types of seizures, developmental delay, cognitive problems, unsteady gait, and speech disorders. Although after a thorough assessment, CLN6 mutation was diagnosed, he had all symptoms of this mutation, except the visual impairment.

According to recent NCL case reports from Asia, full familiarity with its presentation by pediatricians and neurologists is obligatory. Children with developmental regression or refractory seizures, who also have visual or other neurological symptoms such as ataxia and other cerebellar symptoms, even at older ages, should be evaluated for NCL. Attention to ophthalmological examinations and neurological signs and confirming the diagnosis by biopsy or genetic analysis is desirable to prevent missed diagnosis.

Over the past three decades, the prevalence of overweight and obesity in children and adolescents has increased up to 3 times. Obesity is a multi-systemic medical problem affecting all socioeconomic statuses and increases the risk of other severe comorbidities even in childhood. In 50% of cases, there is a persistence of obesity from childhood into adulthood. This narrative review aimed to define the etiology, risk factors, prevention, and management of obesity in children. 

This narrative review was conducted through a literature search on articles in English with the keywords of pediatric obesity, child, overweight, and bariatric surgery in PubMed, Scopus, ISI Web of Sciences, Cochrane, and EMBASE databases from 2001 to 2021 for 4 categories of etiology, risk factors, prevention, and management of obesity in children. Scientific articles, systematic reviews, meta-analyses, consensus, recommendations, and international and national guidelines published on pediatric obesity were considered.

In this narrative review, we first assessed relevant articles to define childhood obesity and mention its etiologies. We then discussed the probability of persistent obesity from childhood into adulthood and intergenerational and perinatal transmission risks. We also noticed syndromic obesity, evaluation of childhood obesity, and its complications along with medical/surgical interventions.

Metabolic programming in particular periods of life, such as before and during pregnancy, infancy, and at the age of rebound adiposity (5.5 years old), is necessary to prevent childhood obesity. Lifestyle changes, diet modifications, promoting exclusive breastfeeding, and increased activity are the main principles of preventing and managing obesity. It is prudent to rule out syndromic and endocrinologic causes of obesity in suspicious patients along with their management.

Hyperbilirubinemia is a common neonatal problem that occurs in about 60% of term and 80% of preterm infants during the first week of life. The increase of intestinal enteropathic cycle by intestinal beta-glucuronidase is one of the main mechanisms in the exacerbation of jaundice. Despite the relative lack of bacterial flora in the intestines of neonates during the first week of life and considering the differences in intestinal bacteria in term and preterm neonates, the present study evaluated the therapeutic response to pedilact in two groups of neonates.

This clinical trial study was performed on 97 term and preterm neonates aged 2 to 15 days after obtaining the approval of the Ethics Committee and parental consent. Inclusion criteria included age 3-14 days, serum bilirubin 15-22mg/dl, exclusive breastfeeding, and no risk factor for hemolysis. In addition to phototherapy, all infants received 5 drops of pedilact daily. Phototherapy conditions were the same in both groups. Serum bilirubin checked daily. The variables of sex, gestational age, and daily bilirubin level were recorded and compared.

The minimum and the maximum gestational age of the neonates were 35 and 41 weeks, respectively. There was no difference between median, mean, and standard deviation of bilirubin reduction during hospitalization days between two groups (P= 0.451).

The results of this study indicate that the Micrococcus luteus SEHD031RS strain can be used as an effective microorganism in removing chromium from industrial wastewater or environmental bioremediation.

Meier-Gorlin syndrome (MGS) is a rare autosomal recessive disorder with homozygous or heterozygous mutations in one of the five following genes (ORC1, ORC4, ORC6, CDT1, and CDC6). This syndrome is characterized by the triad of short stature (pre/postnatal), microtia, and patella hypoplasia/aplasia. Special features included microcephaly, microstomia, full lips, micrognathia, narrow convex, and high nasal bridge nose. Also, it may be accompanied by feeding problems, skeletal disorders, urogenital or respiratory anomalies, and intelligence disorders. This case report describes the first Persian MGS accompanied by neonatal seizure, mental retardation, and attention deficit hyperactivity disorder.

Growth impairment is a common problem in Chronic Kidney Disease (CKD) children. Approximately 40% of children with CKD have a reduced final height. Growth impairment affects school attendance, duration of hospitalization, adult height, and even risk of death. 

Various studies have shown that patients with moderate to severe growth failure have higher mortality rates (three folds) than those with normal growth. This narrative review aimed to define the management of growth in pediatric chronic renal failure.

This study was conducted through a literature search with the keywords of chronic renal failure, kidney transplant, Glomerular Filtration Rate (GFR) combined with growth, short stature, and growth hormone using PubMed, Scopus, Web of Sciences, Cochrane, and Embase databases.

Growth impairment in children with CKD occurs due to diverse etiologies, such as uremia, anemia, metabolic acidosis, etc. It becomes more prominent in GFR<75 ml/min/1.73 m2. Growth hormone (GH) therapy seems to be a safe and effective therapeutic modality consequent to the correction of associated metabolic disturbances.

This study indicated that pretransplant GH therapy in children with CKD and its temporary discontinuation at kidney transplantation up to one year after transplantation leads to improved growth velocity. Therefore, it seems that considering GH therapy in children with CKD is mandatory.

Trichorhinophalangeal syndrome (TRPS) is a sporadic autosomal dominant disorder with approximately 200 reported cases worldwide. We aimed to report a 15-year-old girl with TRPS type 1 (TRPS1) and the second reported case with a rare non-ossifying fibroma (NOF) in the distal part of her left femur.

We introduce a 15-year-old girl who presented to the outpatient rheumatology clinic at 17 Shahrivar Children's Hospital, Rasht, Iran, with the chief complaint of osteoarticular pain and bone deformities. She had sparse hair, a recession of the fronto-temporal hairline, and unusually thick eyebrows at the medial and abnormal sparseness of the lateral margins. Physical examination of the limbs revealed short fingers and toes with proximal interphalangeal (PIP) ulnar deviation of the second and third fingers in both hands. Shortness of the fourth fingers, especially in the right hand, and the swelling of the PIP joints of both hands were prominent. Genetic analysis showed deletion mutation in the TRPS1 gene in chromosome 8q24 compatible with TRPS1.

Several symptoms and signs, including distinctive craniofacial features and ectodermal and skeletal abnormalities, are used for proper TRPS diagnosis. A correct and on-time diagnosis is essential to perform supportive care for the patient to prevent morbidities. Bone lesions, such as NOF1, can also be presented in TRPS1 patients and may be correlated with TRPS1 mutation. Further investigations are required on the association of the TRPS gene with NOF bone lesions.

Vascular access and Intravenous Fluid (IVF) administration are essential issues in children who are admitted to the emergency wards. Despite the common use of maintenance IVF, there are a lot of variations in fluid administration methods and no definite guidelines for IVF and electrolyte monitoring. Because hypotonic fluids cause hyponatremia in many children, isotonic fluids are indicated, according to recent studies, as an accepted method in pediatric IVF therapy to prevent hyponatremia. This narrative review aims to provide an evidence-based approach for selecting the most appropriate IVFs in patients aged 1 day to 18 years. Data showed that the basis of fluid therapy in children varies according to the type of disease and the underlying conditions of children. Depending on each case, the clinicians should decide on what and how fluid and electrolytes be used.

Gonadal dysgenesis, the most common cause of primary amenorrhea, is characterized by absent or underdeveloped ovaries. Although the coexistence of gonadal dysgenesis and Mayer-Rokitansky-Küster-Hauser (MRKH) has been reported, it is still quite infrequent. To the extent that authors searched, just one study reported the association between Rokitansky sequence and Dandy-Walker malformation. 

We aimed to report a case with gonadal dysgenesis, MRKH, and the Dandy-Walker variant. In this care report, the authors reported a 15-year-old girl with primary amenorrhea and underdeveloped secondary sexual properties. Her karyotype was 46, XX. The abdominopelvic MRI without contrast demonstrated bilateral ovarian agenesis and no uterus or cervix. Vagina was normal in length. Brain MRI was consistent with the Dandy-Walker variant. 

Although some affected chromosomal regions have been identified, further genetic analyses should be performed to elucidate the probable association between these anomalies.

In pediatric care settings, intravenous cannulation (IVC) is usually needed for diverse purposes. Considering the painfulness and invasiveness of sampling by direct venipuncture (DVP), using a painless and less invasive method would be promising. Therefore, this study aimed to compare the effect of substitution of routine DVP with direct blood sampling through IVC on the accuracy of hematologic results.

This was a cross-sectional study conducted on 5-14-year-old children admitted to the emergency ward of 17th Shahrivar Pediatric Hospital in Rasht, north of Iran. After discarding only one ml of blood, paired-samples were taken from IVC and DVP and analyzed for 30 most frequently requested electrolytes, hematologic, and blood gas tests. The similarity of the obtained results by the two methods indicated the probability of substituting DVP with IVC and was defined by the absence of significant statistical difference (P>0.05).

The comparison between the mean of hematologic factors by two methods showed significant similarity between groups regarding all parameters (P>0.05) except the mean of red blood cell count in the two groups (P<0.05). Assessing the level of electrolytes by two collection methods showed that there was a significant similarity between the mean of all parameters (P>0.05) except for phosphorus (P=.002). Furthermore, assessing the level of electrolytes showed a significant similarity between the potential of hydrogen, partial pressure of carbon dioxide, bicarbonate, and buffer base in the two groups (P>0.05). However, there was a significant difference between partial pressure of oxygen, base excess, and O2 saturation in the two collection methods (P<0.05).

Based on the promising results obtained in this study, it seems that these methods could be interchangeably used, and IVC can be an alternative method for DVP by discarding the minimum amount of blood and less invasiveness in children.

Congenital hypothyroidism (CH) is one of the most prevalent preventable causes of mental retardation. Studies show that the incidence rate of CH is very high in Iran. Disease mapping is a tool for visually expressing the frequency, incidence, or relative risk of illness. The present study aimed to model CH counts considering the effects of the neighborhood in towns and perform mapping based on the relative risk.

In this historical cohort study, data of all neonates diagnosed with CH with TSH level ≥5 mIU/L between March 21, 2017, and March 20, 2018, in health centers in Guilan, Iran were used. The number of neonates with CH was zero in most towns of Guilan Province. The Bayesian spatial zero-inflated Poisson (ZIP) regression model was employed to investigate the effect of the town’s neighborhood on the relative risk of CH incidence. Then, the map of the posterior mean of the relative risk for CH incidence was provided. The analysis was performed using OpenBUGS and Arc GIS software programs.

The relative risk of CH incidence was high in the West of Guilan. Moreover, the goodness-of-fit criterion indicated that it is more appropriate to fit the Bayesian spatial ZIP model to these data than the common model.

Considering the high relative risk of CH in the Western towns of Guilan Province, it is better to check important risk factors in this region.

Poisoning comprises about 7% of accidents in children under 5-year-old and 2% of all pediatric deaths in developing countries. To warn against and prevent future potential poisoning with opioid substances, this comparative study was conducted on pediatric cases referred to the 17th Shahrivar Hospital in Rasht, Iran, in 2006 and 2018.

In this retrospective, cross-sectional study, all hospitalized pediatric cases diagnosed with opioid poisoning in 2006 and 2018 were investigated systematically. The demographic data, such as age, gender, city or village of residence, the poisoning substances involved, and the clinical outcomes were extracted from the medical records and entered on an appropriately-designed form. The data analysis was performed, using SPSS software, version 21.

Fifty pediatric cases were examined with a mean age of 44.38±3.8 months old. Among these cases, 14 children had been poisoned, 13 of whom with opium and one with morphine in 2006; while in 2018, 36 children had been poisoned with methadone and only one with opium.

Comparing years 2006 with 2018, a considerable increase in pediatric opioid poisoning cases was observed with a tendency toward methadone being the substance involved. The occurrences might be due to unsafe access of unaware children to this drug, especially after the initiation of methadone maintenance treatment for opiate addicts, who were mainly the parents or relatives living in the same household.

The current study aimed to assess the need for emergency neuroimaging in children with first CFC.

This is an analytic cross-sectional study which was conducted on children aged 6 -60 months with first CFS.  Data were gathered by a form which assess age, sex, radiology type, temperature, the duration of fever before convulsion, the duration and the frequency of convulsion, family history of febrile seizure. Data were reported by descriptive statistics (mean, standard deviation, frequency, and percent) and analyzed by Fisher Exact Test in SPSS version 19.

In this study, 111 patients with first CFC and mean age of 21.18±11.83 months enrolled. Regarding the type of CFC, results showed that the highest and lowest frequencies belonged to multiple and multiple focal prolonged FC, respectively.  Upper respiratory infection was the most common diagnosis. 2 unimportant abnormal neuroimaging results were noted.

In this study results showed that performing emergency neuroimaging in patients with first CFS was not mandatory in the absence of developmental disorders, abnormal neurologic examination, underlying neurological disorder, and head trauma. This result is more important in our country, according to the lack of access to neuroimaging modalities in many hospitals in our country and due to its irradiation risk in childhood and cost consuming.

Migraine is the most common childhood recurrent primary headache syndrome and infantile colic is a common cause of infantile cry. The pathogenesis of migraine and colic has not been well established and different factors may cause them. There is an association between infantile colic and the occurrence of childhood migraine. We aimed to assess whether infantile colic could be noted as an early life expression of childhood migraine or not.
This retrospective case-control study was conducted on 5-15-year-old children in Rasht, Iran during 2015-2016. Forty-one cases were children with migraine with or without aura. Overall, 123 Control participants were children with the same age referred to the pediatric clinic for routine care. Data were gathered by a checklist including age, sex, birth weight, family history of migraine, the occurrence of colic and type of feeding during infancy. Data were reported by descriptive statistics and analyzed by Fisher exact test using SPSS ver. 19.
Overall, 164 children with the mean age of 8.36± 2.53 yr were enrolled. Seventeen (41.46%) children with migraine vs. 44 (35.7%) children in control group had the positive history of infantile colic and Fisher exact test noted significant relation between migraine and colic. Thirty-three children with infantile colic (46.57%) had the positive family history of migraine, which was significantly higher than 27 children without colic (29.7%). There was a significant relation between infantile feeding and migraine.
There is a probable relation between colic and migraine, therefore, migraine and colic as 2 pain syndromes may have a common pathophysiology and further investigations on this common pathophysiology is justified.

The aim of this study was to investigate the correlation between each parent’s Body Mass Index (BMI) and maternal age with weight status of children. This was an analytic cross-sectional study which was conducted on 12-year-old students from different areas in Rasht, north part of Iran. The checklist included demographic characteristics such as age, maternal age during childbirth, student and maternal height and weight, child rank. Data were analyzed by Pearson correlation analysis, paired t-test and ANOVA test and chi-square in SPSS software 19.0. A P-value less than 0.05 were considered statistically significant. A total of 200 adolescents participated in this study consisted of 106 (53%) boys. Results showed a significant correlation between students’ BMI and parental BMI and father’s weight. Also, there was a significant correlation between students’ weight with parental BMI and father’s weight, and birth rankIn conclusion, the role of the family in changing nutritional habits of children must be considered because through parental education and changing their perceptions we can prevent obesity.

Biotin is a coenzyme composed of four carboxylases. It presents in amino acid catabolism, fatty acid synthesis, and gluconeogenesis. Biotinidase recycles the vitamin biotin. A biotinidase deficiency is a neurocutaneous disorder with autosomal recessive inheritance. The symptoms can be successfully treated or prevented by administering pharmacological doses of biotin. Although, according to neonatal prenatal medicine (2011), a biotinidase deficiency does not manifest during the neonatal period. In this study, we report on a case of biotinidase deficiency in the first week of birth.Case Report:A 3100 g term boy was born via cesarean section. After 3 days, he was referred to the 17th Shahrivar Hospital with the chief complaint of tachypnea and grunting.Laboratory results revealed that liver and renal function tests, serum electrolytes, and blood indexes except ammonia were all normal. Within few days after the administration of oral biotin, the patient showed dramatic improvement and was discharged. However, within 4 months he was admitted two other times with the complaints of diarrhea and pneumonia. Unfortunately, he expired after 4 months.According to our results, it seems that clinicians should accurately assess suspicious patients and even assess infants for biotinidase deficiency.