mohammad kajbafzadeh

Prediction of time to reflux can aid healthcare providers and preparation programs. We constructed a risk prediction instrument for occurrence reflux in children with antenatal hydronephrosis. Methods & Materials: Demographic and clinical information was collected retrospectively in children with the antenatal hydronephrosis and mostly with reflux, followed at least 5 years. Accelerated failure time model of data from 333 children was developed to assess the risk of time to reflux. Likelihood ratio tests of statistical significant were used to identify best fitting predictive function. Variables “gender”, “Sr”, and “severity of ANH (in severe level)” were highly significant (p<0.05) in multivariate model, adjusting for some traditional risk factors. This proposed risk probability model allows prediction of time to reflux for children with antenatal hydronephrosis to better inform parents from possible time of occurrence reflux and treatment strategies.

We aimed to describe a standard survival analysis, so that we can analyze some factors related to the time of occurrence of different types of reflux (unilateral-left, unilateralright, and bilateral) in children with antenatal hydronephrosis (ANH) and to provide an approach taking competing risks into account.
Methods & Materials: We used data of 193 children that was collected from Pediatric Urology Research Center of Children’s Hospital Medical Center, affiliated to Tehran University of Medical Sciences, Iran. The cause-specific and subdistribution hazard were computed. P Among these infants (36 girls, 157 boys), 117 (68%) cases had bilateral reflux as the event of interest. The variables “Sex” and “Direction of ANH (in bilateral level)” were significantly different (P In the competing risks framework, it is inappropriate to use the Cox and Kaplan-Meier methods, which do not take competing risks into account. Multivariate regression model like the subdistribution hazard model besides the cumulative incidence curve are recommended.

Wilm's tumor (nephroblastoma) is the most common renal malignancy of childhood. This cancer is considered as an embryonal neoplasm that arises from nephrogenic blastemal. Despite advances in therapeutic success, survival rate is still not satisfactory in tumors with unfavorable histology and recurrent cases. On the other hand, late adverse effects of chemotherapy threaten the life of Wilm's tumor survivors. The present study aimed to establish a patient-derived tumor tissue xenograft for utilizing in individualized chemosensitivity assay. Fresh tumor specimens of 4 patients with Wilm's tumor were obtained by cytoreductive surgery, and after primary culture and initial purification of neoplastic cells, the cells of each tumor were subcutaneously inoculated to 10 athymic nude mice. Growth characteristics of established models were assessed and the tumors were studied by light microscopy. Tumor take rate was reported 70%. Pathological examination illustrated the presence of all epithelial, stromal and blastemal parts in H&E staining. Immunohistochemical study with CK, desmin, myogenin, WT-1 and vimentin markers confirmed nephroblastoma. Histopathological study approved the validity of patient-derived tumor tissue xenograft model of Wilm's tumor. Since this model has been established for the first time in Iran, thus it can be considered as a useful research tool for personalized treatment of nephroblastoma and chemoresistance assays.

Foreign body insertion is a common and important cause of pre-pubertal vaginal bleeding.. We present a three-year-old girl who referred to our clinic with abnormal vaginal bleeding without any other symptoms. The primary assessment revealed a radio-opaque round solid mass in the pelvic cavity. Following vaginoscopy, the button battery was finally removed under general anesthesia. The vagina was washed by normal saline irrigation and some necrotic tissue was evacuated. Digital rectal exam confirmed intact rectal wall. The patient was asymptomatic in the follow up and there was no sign of recto-vaginal fistula.. Vaginal bleeding in children may have various etiologies such as foreign bodies. Foreign bodies in the vagina lead to severe inflammation and result in vaginal bleeding or blood-stained and foul-smelling discharge. Other sequel may include infections, fibrosis and recto-vaginal fistula..

We examined the preventive effect of probiotic and antibiotics versus antibiotics alone, in children with recurrent urinary tract infections (RUTI) in a preliminary randomized clinical trial. Between March 2007 and April 2011, children with the history of RUTI and unilateral vesicoureteral reflux (VUR) were randomly assigned to receive concomitant probiotic and antibiotics (Lactobacillus acidophilus and bifidobacterium lactis, 107/ml, as 0.25 ml/kg three times a day regimen in addition to Nitrofurantoin, 1mg/kg daily (group I). In group II, all children received conventional prophylactic antibiotics alone (Nitrofurantoin, 1 mg/kg daily). Randomization was performed via using the random numerals table in a 1:1 manner with stratification by sex, age and grade of reflux. The urine examinations were done monthly and the incidence of UTI was evaluated in these two groups. Forty-one children (age: 8.3±3.1 years) in group I and 44 children (age: 8.0±3.0 years) in group II were compared. During the course of three years, 39% in group I and 50% of participants in group II experienced RUTIs (P=0.4). Incidences of UTI - febrile and afebrile - reduced in both groups without any significant differences after two years of prophylaxis. Also, incidence of afebrile UTIs did not significantly differ (0.51±1.30 and 0.81±1.41 respectively, P=0.3); however, the incidence of febrile UTIs in particular were lower in group I (0.00±0.00 versus 0.13±0.40, P=0.03) in the last year. The consumption of probiotic and antibiotics in children with RUTI is safe and more effective in reducing the incidence of febrile UTI in comparison to prophylactic antibiotics alone.