children

Several circumstances, including the etiology of epilepsy, its early onset, recurrent seizures, and the use of anti-seizure medications (ASMs), can lead to cognitive impairment in people with epilepsy. Studies indicate that the etiology of epilepsy may be more closely associated with cognitive problems than the ASMs. However, considering long-term treatment in pediatrics and their developing nervous systems, it is critical to understand the cognitive effects of each anti-seizure medication. Significant methodological challenges exist in studying the cognitive effects of ASMs. Accordingly, this review aims to give a broad overview of recent studies on cognitive impairment caused by first- and second-generation ASMs

Ataxiatelangiectasia (A-T) is an infrequent genetic neurodegenerative disorder inherited autosomal recessively. It is mainly characterized by early-onset progressive cerebellar ataxia and dilated capillaries in the oculocutaneous regions especially conjunctivae so-called telangiectasia. A-T is a multisystem disorder and requires multi-disciplinary approach to management. Diagnosis is difficult in some cases because presentation is not in the same manner and showing a phenotypic spectrum. In atypical cases serum immunoglobulins and alfa fetoprotein are normal and telangiectasia is absent. We present a 5.5-year-old boy with progressive cerebellar ataxia and history of repeated sino-pulmonary infections that was homozygote for ataxia-telangiectasia mutated gene and had a giant arachnoid cyst in left hemisphere. It is important to keep in mind those cases with ataxia and repeated sino-pulmonary infections may be ataxia telangectasia patients. Genetic study is helpful and confirms the diagnosis by showing ataxia-telangiectasia mutated gene.

Vitamin B12 (VB12) is a water-soluble vitamin, deficiency of which causes an extensive heterogeneous spectrum of neurological symptoms including vision disturbances, paresthesia, tremor, and seizure. The aim of this investigation is to determine the effect of serum VB12 levels on pediatric patients with febrile seizure (FS).

In this meta-analysis, case-control studies that evaluated the effect of serum VB12 levels in pediatric patients with FS were included. Web of Science, PubMed, Scopus, and Google Scholar were searched until August 13, 2024. The PICO criteria for this meta-analysis were as follows: Population/Patients (P: pediatric patients with febrile seizures); Issue of interest (I: serum levels of VB12); Comparison (C: control); Outcome (O: occurrence of febrile seizure). Quality assessment was assessed according to the Newcastle-Ottawa Scale (NOS) tool for case-control studies. The outcome assessment scales, study groups, and serum VB12 levels were extracted.

Of 435 initial articles, eventually 6 studies remained in the meta-analysis. Existing evidence indicated that serum VB12 concentrations were insignificantly lower in FS patients than controls (WMD= -1.09 pg/ml; 95% CI: -2.23, 0.04; P= 0.06), although a significant between-study heterogeneity was observed (I2 = 98.10%, P< 0.001).

The results of our study pointed out that there is low serum VB12 concentrations in FS patients compared with controls. Despite the fact, one of the best ways to prevent FS in children can be VB12 supplementation and proper diet therapy.

Vesicoureteral reflux (VUR) is one of the most common underlying urologic abnormalities in children with acute febrile urinary tract infection (UTI). Therefore, evaluating VUR in all patients with acute pyelonephritis (APN) is necessary to prevent further complications.

The purpose of this study was to investigate the value of laboratory and imaging findings in children with acute febrile UTI in determining the need for cystographic examinations for VUR.

A total of 424 children with their first febrile UTI were evaluated in two groups: Those with VUR (n = 204) and those without VUR (n = 220). Patients with secondary VUR were excluded from the study. Variables such as acute phase reactants, serum creatinine (Cr), and urine culture were obtained at the time of admission and before antibiotic treatment.

Vesicoureteral reflux was significantly more common in males (P = 0.001), in those with higher serum Cr at admission (P < 0.001), in patients with abnormal renal bladder ultrasound (P < 0.001), and in cases with the growth of non-Escherichia coli organisms compared to those without VUR. Serum Cr and abnormal ultrasound showed a significant correlation with VUR in multivariate analysis. Additionally, serum Cr and abnormal ultrasound were moderately accurate predictors of VUR, with moderate sensitivity and specificity.

Investigation of primary VUR among children with acute febrile UTI is recommended for those with increased serum Cr and abnormal renal bladder ultrasonography.

Guillain-Barré syndrome (GBS) involves the peripheral nervous system developed by infections or immune conditions. Cerebrospinal fluid (CSF) analysis and electrodiagnostic tests are essential diagnostic methods for GBS. However, limited data are available on how the findings from these methods relate to each other. This study aimed to evaluate changes in CSF analysis and electrodiagnostic tests in pediatrics with GBS.

The present study retrospectively evaluated electrodiagnostic tests and CSF changes in pediatrics with GBS who were admitted to Tabriz Hospital, Iran, from 2010 to 2020 due to CBS. Patients’ data, including age, gender, CSF analysis, and electrodiagnostic test results, were recorded from the patients’ files. Electrodiagnostic data included pace and amplitude of tibial, median, peroneal, sural, ulnar nerves, nerve conduction velocity (NCV), F-wave, and motor unit action potential (MUAP). The significance level was considered less than 0.05.

The mean age of patients was 4.83±2.72 years, and 54.6% were boys. The most common type of GBS involvement was demyelinating type. No gender differences were found between involved nerves unless the ulnar nerve was significantly more involved in girls (P-value: 0.012). The obtained findings indicated no significant relationship between electrodiagnostic tests and CSF protein (P-value: 0.439).

No association was observed between electrodiagnostic results and CSF changes in pediatrics with GBS.

Glycogen is the stored form of glucose and acts as a buffer to regulate glucose levels in all tissues. Various defects in glucose and glycogen metabolism have been discovered, all resulting from mutations in genes responsible for the expression of proteins involved in the synthesis, degradation, or modulation of glycogen. These defects are known as glycogen storage diseases (GSDs). In this study, we investigated the clinical and paraclinical findings in patients with GSD.

In this cross-sectional survey, 140 patients with GSD who were referred to the Department of Pediatric Gastroenterology at Shiraz University of Medical Sciences from 2016 to 2022 were studied. The inclusion criteria required a definitive diagnosis of GSD. Data were collected using a researcher-designed questionnaire.

The mean age of the participants was 7.8±5.5 years. The male-to-female ratio was 1.12:1. The most common clinical finding among the patients was hepatomegaly, observed in 80.7% of cases. The mean levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and creatine phosphokinase (CPK) were 263.9±416.8, 193.1±215.5, 652.4±372.9, and 456.6±925.8, respectively. Sonography was performed on 77.1% of the patients, revealing that 87.9% had hepatomegaly or splenomegaly. There was a significant difference between the mean age of patients with normal ultrasound results (6.47 years) and the mean age of those with hepatosplenomegaly (11.54 years) (P=0.036). Among the patients who underwent liver biopsy, only 5.4% (3 out of 55) had normal liver tissue.

The findings of this study indicate that it involves all kinds of diseases. Types of GSD that affect the liver are more common than the types that affect skeletal muscles. Additionally, the serum levels of CPK and also the possibility of hepatosplenomegaly increase with age. In addition, it can be concluded that ultrasound is not a reliable method for diagnosing this disease in children, and it is better to use biopsy as a diagnostic method.

Although the recent pandemic›s impact on adults has been extensively studied, little research has been done on its impact on children, despite the harmful effects COVID-19 has on them. We aim to understand the protective function of Indian joint families for the perceived life outcomes of children (9-12 years) in the early stages of the recent pandemic.

Using a qualitative research design, 25 full-time mothers from joint families with children (age range = 9-12 years) were chosen through convenience sampling. The data were collected through a semi-structured telephone interview and the transcriptions were analyzed using the thematic analysis method.

The qualitative study revealed six themes: perceived distress, the diversity of relationships, harmonious relationships, involvement in household activities, supportive roles of the elderly and collective values and practices. The uncertainty and fear enhanced the perceived distress of family members and concern for the children. The abundant supportive relational resources, involvement in household activities, warmth, optimism and cooperation of the elderly, as well as interdependence and religious practices, were the resources described to protect the children from the negative effects of the pandemic.

Indian joint families hold collectivist values that may have enabled greater support, cooperation, caring, interdependence, discipline, cultural knowledge, and conflict resolution mechanisms. Integrity, emotional stability, and caring from the elderly may have significant protective powers. Research, practice and policy implications are discussed.

Research in pediatric dentistry (PD) has often prioritized quantitative analysis, ignoring qualitative factors that limit our understanding of children’s emotions and experiences regarding dental treatment. Qualitative research offers insights into the experiences of children and families, highlighting shared concerns and assisting dental professionals in crafting better communication strategies to enhance engagement with children.

Hypotonia in children is an important and common clinical symptom that can manifest in various neurological disorders. It often poses a serious diagnostic challenge for physicians, frequently leading to inaccurate evaluations and unnecessary investigations. The purpose of this study was to investigate the causes of hypotonia, various diagnostic methods, and the final outcomes of these patients. 

Children with hypotonia who were hospitalized in the pediatric intensive care unit (PICU) of Bahrami Children's Hospital and Children's Medical Center during a two-year period (2017-2018) were enrolled. All relevant information, including key points from their medical history, clinical examinations, and paraclinical data that could lead to diagnosis, were recorded. The patients was followed up for two years after hospitalization through phone calls or visits to the neurology clinic. 

Out of 65 children examined, 28 patients (43.07%) had peripheral nervous system involvement, 20 (30.76%) had central nervous system involvement, and 4 (6.17%) had both central and peripheral nervous system involvement. The most common causes for peripheral and central involvement were spinal muscular atrophy (SMA) and syndromic causes, respectively. In 20% of cases however an,  specific underlying cause  was  found. The most common diagnoses were SMA (16.9%) and Guillain-Barre syndrome (13.8%). Finally, 15 children (23.1%) recovered, 31 (47.7%) had neurological sequelae, and 19 (29.2%) died. 

Understanding the underlying causes and outcomes of patients hospitalized with hypotonia in the PICU enhances physicians’ diagnostic skills. It is also useful for selecting effective treatment strategies and avoiding the complications associated with delayed diagnosis.

To Dear Editor, Autism spectrum disorder is a developmental neurological disorder that in most cases begins in childhood. Its prevalence in childhood is 1%, and this proportion is about 4.2 times higher in boys than in girls.

This article has no abstract regards to the type of article

Due to the widespread use of play doughs among children and the ability to absorb heavy metals and transfer contaminants through the skin, it is essential to determine the level of chemical and microbial contamination of these products to provide a clear picture of their quality. This descriptive cross-sectional study was conducted in the Reference Laboratory of Food and Drug Administration of the Ministry of Health and Medical Education of Iran. For this purpose, 12 samples of play dough were examined. A flame atomic absorption spectroscopy was used to evaluate the concentrations of heavy metals in different samples of play dough. Bacterial isolates were cultured in nutrient-rich microbial culture media and then used for phenotypic isolation and differential detection of bacteria. Based on the results, arsenic was observed in all samples and its mean concentration was 0.12 ppm. Cadmium and lead were present in all samples with mean concentrations of 0.06 and 0.12 ppm, respectively. According to the results, heavy metal concentrations did not exceed the threshold in any of the samples, and all concentrations were within the safe range. The results demonstrated that no microbial contamination related to Escherichia coli, coliforms, Salmonella, Staphylococcus aureus, molds, and yeasts was observed in the dough samples. Therefore, play dough products can be used as safe children’s toys in Iran. However, due to the possibility of microbial contamination over time and repeated use, hygiene practices should be taught to children regarding the use of play toys such as frequent hand washing before and after use.

Context: 

As a common disorder, convulsive status epilepticus (CSE) in adults is second common and in children is most common neurological emergency. Morbidity of this condition such as difficulties of learning, de-novo epilepsy and neuro-disability, could be more than twenty two percent. The higher CSE duration led to higher difficulty to terminate this condition, and increase risk of morbidity.

Evidence Acquisition: 

Convulsive status epilepticus is often managed by specific local or national algorithms. Treatment in first line is used when a focal motor clonic or tonic clonic seizure has duration more than five minutes (premonitory or impending CSE). In casese who CSE persisted with 2 first-line doses (difiened as CSE that is established), the second-line is administered. Different evidence of randomised clinical trial (RCT) supports benzodiazepines use as first-line drug. In addition alternative drugs, with less data of RCT studies, are intravenous clonazepam and intramuscular midazolam.

Up until 2019, phenytoin and phenobarbital were preferable second-line drug, but there are not significant RCT data about it. Also, lacosamide is alternative second-line agent but without supporting evidence from RCT studies. Current data showed that first, intravenous lorazepam or intranasal or buccal midazolam are most effective first-line drug to manage premonitory or impending CSE there are not diversity between effectiveness of phenytoin, sodium valproate or levetiracetam, for management of established CSE.

In present review study, we give a general overview of status epilepticus and evaluate algorithms therapy in Iran.

Constipation is a prevalent issue among children and is generally treatable with simple therapeutic approaches. However, a considerable proportion of these children experience severe constipation that necessitates more invasive treatments, including surgical interventions. This study is designed to examine the effects of administering the Bowel Management Program (BMP) in the treatment of fecal incontinence and soiling among children with chronic refractory constipation.

The research involved 24 patients who presented at the Children’s Medical Center exhibiting symptoms of functional constipation and fecal incontinence. Each patient was enrolled in the study after a thorough review of their medical history, a physical examination, and other paraclinical measurements like barium enema or rectal manometry, ruling out the organic causes of constipation. The bowel management program was subsequently established for these patients.

This study examined 24 children, including 14 girls (58.3%) and 10 boys (41.7%), with a mean (SD) age of 4.8 (1.2) years for the girls and 5.4 (1.2) years for the boys. The analysis revealed that there was no significant correlation between symptom duration and treatment duration in relation to gender, as indicated by a p-value greater than 0.05. Spearman's correlation test showed a significant relationship between the children’s age and their treatment duration (p˂0.001, r=0.54) and also between their age and their clinical symptom duration (p˂0.001, r=0.59).

The results showed that the children’s age was significantly correlated with their treatment duration and clinical symptom duration. The bowel management program can be an effective treatment for overflow incontinence in children with chronic refractory constipation.

Diabetes is one of the most common chronic illnesses in children, affecting various organs, including the heart.

The present study aimed to evaluate the effect of age and Body Mass Index (BMI) on aortic elasticity in children with diabetes mellitus type I (DMTI) and healthy children.

This case-control study was conducted on 186 children aged 4 to 18 years, equally divided into healthy and DMTI groups, at Aliasghar Pediatric Hospital in Zahedan, southeast Iran, from April 2020 for one year. Consent forms were obtained following study approval. Doppler and tissue Doppler imaging (TDI) measures, aortic elasticity parameters, blood pressure (BP), and anthropometric measures were evaluated in the participants. Data were analyzed using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). A P-value ≤ 0.05 was considered statistically significant.

The study compared heart indices between children with DMTI and healthy children. The analysis revealed that height (P < 0.001), weight (P < 0.001), and BMI (P < 0.001) were lower in children with DMTI. Elasticity parameters, including ASβI (P < 0.001) and PSEM (P = 0.039), were higher, while AS (P < 0.001) and AD (P < 0.001) were lower in children with DMTI. Elasticity parameters varied with age and BMI in both groups, with some exceptions. None of the cardiac findings differed in children with DMTI who had HbA1c < 7 compared to those with HbA1c ≥ 7.

The study concluded that aortic strain and aortic distensibility (AD) decreased while the aortic stiffness beta index and pressure strain elastic modulus increased in children with DMTI. Normal BMI and younger age were two important factors associated with accelerated stiffening in children with DMTI. The level of HbA1c did not affect cardiac parameters, particularly stiffening, in these children.

Dehydration is a significant cause of mortality in children under 5 years of age worldwide. Various factors contribute to dehydration in children, making it essential to understand its associated risk factors.

The aim of this cross-sectional study was to investigate factors related to dehydration in children admitted to the emergency department.

In this cross-sectional study, all children under 18 years of age with moderate to severe dehydration who were referred to the emergency department of Amirkola Hospital in Babol, located in the northern region of Iran, were assessed from May 1 to September 15, 2023. Participants were included in the study if they met the inclusion criteria. The data were gathered from the patients' medical records using a three-part questionnaire consisting of demographic characteristics, basic factors, and associated clinical symptoms. After data gathering, the data were entered into Stata 17 software and analyzed using statistical tests at a significance level of P < 0.05.

Of the 141 children studied, 61% visited the emergency department 48 hours after the onset of diarrhea symptoms. Approximately 71% used home remedies to manage diarrhea symptoms. Notably, 60% of parents were unaware of oral rehydration solution (ORS) treatment. Most children had symptoms of fever (71%), vomiting (69.5%), abnormal skin turgor (61.7%), lack of tears (95.7%), oliguria (35.7%), paleness (48.2%), and abdominal distention (30.5%). Children with a history of travel (adjusted OR, 3.74; 95% CI, 1.13 - 12.34) and those with underlying medical conditions (adjusted OR, 4.41; 95% CI, 1.09-17.75) were at a higher risk of abdominal distention. Moreover, children whose mothers did not wash their hands before preparing food were at increased risk of diarrhea (RR, 1.48; 95% CI, 0.98 - 2.33) and abdominal distention (RR, 0.39; 95% CI, 0.15 - 0.95).

The findings of this study indicate that the majority of children go to the emergency department late to receive treatment. Factors such as a history of travel, underlying medical conditions, and poor hand hygiene practices before preparing food are significantly associated with dehydration in children. Therefore, it is recommended to include preventive educational interventions to prevent dehydration and encourage early referral in family educational programs.

Constipation in children is a serious problem that affects both children and their families. We aimed to compare the clinical efficacy of lactulose and polyethylene glycol in the treatment of constipation in children.

This randomized clinical trial was performed on 92 patients referred to a private gastroenterology clinic in Shahrekord, Iran. The patients were randomly assigned into two groups receiving polyethylene glycol or lactulose. Defecation patterns and complications were assessed 0, 3, 7, and 21 days after the intervention. Data were analyzed using the chi-square test, repeated measures test, Mann–Whitney U test in SPSS version 16.0. P<0.05 was considered statistically significant.

No difference was found between the two interventional groups in terms of the frequency of painful defecation (P=0.31), fecal incontinence (P=0.50), hard stools (P=0.69), fear of defecation (P=0.09), poor appetite (P=0.29), straining at stool (P=0.50), and abdominal pain (P=0.07) within a follow-up period of 21 days. There were significant differences in the frequency of defecation on days 7 and 21 (P=0.02). The mean frequencies of abdominal cramps were significantly higher in those who received lactulose (P=0.001). The rate of nausea and vomiting was 10.6% in the lactulose group and 4.3% in the polyethylene glycol group, indicating no difference between the two groups (P=0.221).

The administration of polyethylene glycol and lactulose had no significant difference in reducing the symptoms of chronic functional constipation in children. However, it seems that polyphenol glycol played a role in increasing the frequency of defecation.