فهرست مطالب

Pediatrics - Volume:6 Issue: 52, Apr 2018

International Journal of Pediatrics
Volume:6 Issue: 52, Apr 2018

  • تاریخ انتشار: 1397/01/06
  • تعداد عناوین: 15
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  • Areege Al-Omrani, Abdul-Karem Al-Bahadily *, Enas Reyadh Pages 7433-7442
    Background
    Type one diabetes mellitus (Type 1 DM) is the most common type of diabetes in children and adolescents, arising through a complex interaction of immune, genetic and environmental factors. Autoimmune thyroid disease is the most frequent disorder associated with Type one diabetes mellitus. This study aimed to evaluate incidence of autoimmune thyroid disease in children and adolescents with type I diabetes mellitus.
    Materials And Methods
    Cross sectional case control study was made on forty diabetic children with regular attending to the Endocrinology clinic and patients from pediatric ward in Al-Imamain Al-Kadhimain Medical City, Eraq, and forty healthy children matching in aged (1-15 years) and gender were taken as control. History taking, clinical examination, measurement of hemoglobin A1C, serum thyroid peroxidase autoantibodies and serum thyroid stimulating hormone levels were carried out. Serum thyroxine and triiodothyronine were measured.
    Results
    Serum thyroid peroxidase antibodies was positive in 15 % of diabetic patients, while it was negative in controls. In those with positive thyroid peroxidase antibodies 100% had subclinical hypothyroidism, 50% had hyperthyroidism. Risk of autoimmune thyroid disease was more in patients older than 5 years and it was neither related to the degree of control of diabetes nor to the duration, but it was more common in females.
    Conclusion
    There is higher incidence of autoimmune thyroid disease in children and adolescents with type one diabetes compared with normal children and this risk is not related to duration of diabetes, but it is more common in those older than 5 years. The risk of hypothyroidism is double the risk of hyperthyroidism in these patients.
    Keywords: Autoimmune thyroid disease_Children_Type I diabetes mellitus
  • Irma Dzambo, Lutvo Sporisevic, Haris Memisevic * Pages 7443-7450
    Background
    Preterm born children are at an increased risk for having cognitive and motor impairments at preschool age. In addition to this, children born preterm have a number of deficits in executive functioning. Although there are numerous studies examining executive functions (EF) in preterm born children, few used ecologically valid measures of EF. The goal of the present study was to examine EF in preschool children born preterm.
    Materials And Methods
    The sample for this study consisted of 40 preschool children aged 5 – 6 years old born preterm, both sexes (21 boys, 19 girls). EFs were measured with Behavior Rating Inventory of Executive Function- Preschool Version, an ecologically valid instrument for EF assessment.
    Results
    The results of this study revealed that the greatest EF deficits were in the area of emotional control and working memory. There were no gender differences in EF except for the domain of emotional control, with boys having larger deficits.
    Conclusion
    Given the high rate of EF deficits in preschool children born preterm, it is of utmost importance to provide them with adequate therapeutic modalities early in preschool period. Pediatricians, psychologists and early education specialists should work together in identifying the potential EF problems in preterm born preschool children and in making the programs for ameliorating EF deficits.
    Keywords: Bosnia, Herzegovina, Executive functions, Preterm born children, Preschool children
  • Gian Maria Pacifici * Pages 7451-7465
    Quinine is the best studied drug for treating severe malaria in very young children. Quinine may be administered in pregnancy and, at therapeutic doses, malformations have not been reported. Some strains of quinine from Southeast Asia and South America have become resistant. Quinine is the treatment of choice for the drug-resistant severe Plasmodium falciparum. The antimalarial mechanism of quinine is the binding to heme preventing its detoxification. The dose of quinine is 10 mg/kg every 12 hours, and it may be administered orally, intramuscularly or intravenously. When it is administrated intravenously it must be infused slowly over 2 to 4 hours. The treatment of severe/complicated childhood malaria appears to be evolving, and in 2005, the Indian Academy of Pediatrics Guideline recommended quinine, suggesting that artesunate/artemether was the less preferred alternative. In 2008, the Infectious Diseases Chapter, Indian Academy of Pediatrics recommended quinine with tetracycline/doxycycline/clindamycin in line with the WHO 2006 statement. In 2010, the WHO recommended aresunate for treating malaria infection, positioning quinine as an alternative. Malaria is caused by three parasites namely: Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale. Plasmodium falciparum is the most common and virulent parasite. These parasites are present in different areas of the sub-Saharan African countries and Asia. In 2010, there were estimated 219 million cases of malaria resulting in 666,000 deaths and two-thirds were children. Children are more vulnerable than adults to malaria parasites. The aim of this study is to review the published data on the clinical pharmacology of quinine in children.
    Keywords: Antimalarials, Children, Infants, Malaria, Quinine
  • Sinem Sarig., Ouml, Kay *, Hayri Levent Yi, Lmaz, Ri, Za DinCer Yi, Ldi, Zda, Ouml, Zden, Ouml, ZgUr Horoz, Ouml, Zlem Tolu Kendir, Tu, Ce, Ccedil, Elik Pages 7466-7472
    Poisoning with calcium channel blockers and beta blockers are associated with high mortality and morbidity rates, especially in children. Treatment of poisoning with these drugs includes administration of atropine, glucagon, calcium and inotropic agents as clinically needed; and newer approaches like hyperinsulinemic euglycemia and intravenous lipid emulsion therapies. We herein present two refractory cases of calcium channel blocker and beta blocker poisoning that underwent hyperinsulinemic euglycemia and intravenous lipid emulsion interventions.
    CASE 1
    A 17-year-old female patient has been brought to our setting unconscious and recalcitrantly hypotensive and bradycardic after taking 8 tablets of 90 mg diltiazem hydrochloride. The patient was given saline, atropine, repeating doses of calcium gluconate, dopamine, noradrenaline, hyperinsulinemic euglycemia treatment, hemodiafiltration, and lipid administration. She achieved a full recovery during follow-up, and was discharged with cure.
    CASE 2
    A 17-year-old girl, who developed an unresponsive hypotension after ingesting 12 tablets of 12.5 mg carvedilol, 6 – 7 tablets of 450 mg diosmin 50 mg hesperidin, and 6–7 tablets of 10 mg metoclopramide hydrochloride, was treated with saline, glucagon, calcium gluconate, dopamine, noradrenaline, and administration of hyperinsulinemic euglycemia and lipid. The patient responded well to the treatment, and was discharged with cure.
    The newer treatment modality of lipid emulsion has been reported to achieve promising results by several reports in the literature; however, there are a limited number of published cases regarding its use in children. Further studies to assess the pediatric utilization of these treatment approaches are needed.
    Keywords: Beta blockers, Calcium channel blockers, Child, Lipid, Poisoning
  • Vasudha Nikam *, Pramod Nagure Pages 7473-7478
    Pulmonary agenesis is a rare congenital anomaly in which there is absence of pulmonary parenchyma as well as its bold vessels. It is an unusual cause of respiratory distress in newborn. Unilateral agenesis of lung is often associated with other congenital anomalies. The condition may lead to diagnostic difficulties.
    Right pulmonary agenesis has poor prognosis. Here we present a case of female child of one year with a history of recurrent chest infection, fever and respiratory distress and on investigations was diagnosed with right pulmonary agenesis.
    Keywords: Congenital anomalies, India, Pulmonary agenesis, Opaque hemithorax
  • Naghi Dara, Farid Imanzadeh, Saleheh Tajalli, Amirhossein Hosseini *, Seyed Mohsen Dehghani, Aliakbar Sayyari, Katayoun Khatami, Pejman Rohani, Roxana Azma, Mitra Khalili Pages 7479-7488
    Introduction
    As a standard measure in some chronic liver disorder, liver transplantation (LT) has performed for about 3 decades in pediatric populations. Post operatively some patients suffering from infectious complications by viral, bacterial and fungal etiologies. Here in we presented 10 children diagnosed as bacterial sinusitis presenting with prolonged fever and upper respiratory tract symptoms post LT and review the literature.
    Case Presentation
    Ten pediatric LT recipients including 7 boys and 3 girls, aged 1.5 to 8 years (4.7±2.34) with mean weight of 15.6 Kg (range; 11.4–27.5 Kg) were diagnosed as bacterial sinusitis during December 2013 to March 2017. Patients were suffering from respiratory symptoms and prolonged fever. After ruling out other diagnosis and by performing through investigation, we confirmed bacterial sinusitis by sputum culture and result of antibiogram and paranasal Computed Tomography (CT) scan. All patients dramatically responded to intravenous broad-spectrum antibiotic.
    Conclusion
    In post LT patients who are, suffering from fever or prolonged fever with upper respiratory signs and symptoms, acute sinusitis should kept in mind. Therefore, timely diagnoses coupled with taking therapeutic measures using broad-spectrum antibiotics could prevent disease progression and complications.
    Keywords: Children, Complications, Liver transplantation, Systematic Review
  • Naser Honar, Haniyeh Javanmardi, Forough Saki *, Azadeh Rezaeefard, Mahdi Shahriari Pages 7489-7494
    Background
    Absence or deficiency in Glucose-6-phosphate dehydrogenase (G6PD) enzyme in patients with G6PD deficiency presents with a wide spectrum of symptoms. This study evaluates the clinical features of acute hemolysis in children with G6PD deficiency.
    Materials And Methods
    Seventy G6PD deficient children younger than 18 years old were included in this cross sectional study in Dastgheib Hospital of Shiraz in South West of Iran. Complete blood count, zinc level, reticulocyte count, peripheral blood smear, liver function tests and coombs test were performed for all patients. Subject were observed for multiple clinical manifestations such as paleness, Yellow sclera, Dark Urine, abdominal pain, back pain, vomiting, diarrhea or constipation, liver tenderness, hepatomegaly, splenomegaly, changes in level of consciousness according to Glasgow Coma Scale.
    Results
    All of the G6PD deficient children developed paleness at the time of admission. The next frequent manifestations in our population were yellow sclera and dark urine that were present in 69 and 68 patients, respectively. The least prevalent features were diarrhea and constipation. Liver tenderness, hepatomegaly and splenomegaly were not found in our population. There were no significant differencesin age distribution between the boys and girls (p>0.05). There were not any significant correlation between each clinical manifestation and the primary Hemoglobin (Hb) level, number of needed transfusion, severity of hemoglobinuria and hospitalization duration (p>0.05).
    Conclusion
    In this study, pallor, icterus and dark urine were the three important symptoms in G6PD patients with acute hemolysis. There was no correlation between the primary clinical symptoms and severity of the hospital course characteristics of the patients such as Hb level, hemoglobinuria and number of needed transfusion.
    Keywords: Acute hemolysis, Children, Glucose, 6, phosphate dehydrogenase deficiency, Iran
  • Armen Malekiantaghi, Ahmad Khodadad, Vajiheh Modaresisaryazdi, Kambiz Eftekhari * Pages 7495-7499
    Background
    Netherton syndrome is a rare autosomal recessive disorder consisting of ichthyosiform dermatosis, hair shaft abnormalities and an atopic diathesis that presents as widespread erythematous skin. The aim of these reports is emphasis on the importance of the examination of hair as a diagnose route.
    Case Presentation
    Case 1: A 6 months old boy with respiratory distress and severe erythematous itchy scaling lesions. He had been under treatment of topical steroid without improvement. Case 2: A 28 days old boy admitted for failure to thrive with presentation of extensive dermatologic involvement, severe dehydration and respiratory distress.
    Findings: Examination of hair under light microscopy revealed trichorrhexis invaginata, highly suggestive for Netherton syndrome.
    Conclusion
    In countries where access to genetic diagnostic tests is difficult, hair examination is the best and inexpensive definitive diagnostic method compared to the expensive genetic tests for diagnose of Netherton syndrome.
    Keywords: Hair, Ichthyosiform dermatosis, Netherton syndrome, Trichorrhexis
  • Singh Ritu, Rao Shivani, Thatkar Vithal Pandurang, Narayanan Rajaram * Pages 7501-7510
    Background
    Malnutrition in children is a major public health problem in developing countries and is one of the common causes of mortality and morbidity in children. We aimed to determine the nutritional status of children aged 2-12 years of age using World Health Organisation(WHO) Z score for Weight for age (WFA)/Body Mass Index (BMI) for age (for children above 108 months), and to evaluate association between underweight and various socio-demographic factors.
    Materials And Methods
    A total of 444 children aged 2-12 years (24-144 months) were enrolled in the study. The children’s anthropometric measurements were taken using the standard operating procedures; the socio-demographic particulars were obtained using a pretested validated questionnaire, after obtaining written consent from their parents. The anthropometric data was analyzed using WHO Anthro and Anthro plus Softwares. Underweight and severe underweight was diagnosed if WFA Z score
    Results
    Overall prevalence of under nutrition among the children 24-144 months of age was 30.8%. Among children in the age groups of 24-59 months, 60-119 months and 120-144 months, the prevalence of underweight/thinness was 27.9%, 31.3% and 26.4%, respectively. Severe underweight/thinness in the same age groups was 7.1%, 10.7%, and 11.3%, respectively. The socio- demographic factors significantly associated with underweight were education status of mother, occupation of father, number of siblings, type of family and religion (p
    Conclusion
    Mild to moderate under nutrition was common among the children of the island and affects boys slightly more than girls, however, severe underweight is more prevalent in girls.
    Keywords: Children, India, Nutritional status, Underweight
  • Saeed Majidi Nejad, Leila Goudarzi, Farhad Heydari * Pages 7511-7518
    Background
    Vomiting is a common side effect of ketamine in children's sedation and there is still controversy about the use of an anti-emetic drug along with ketamine to reduce this complication. The aim of this study was to evaluate the effectiveness of ondansetron in controlling vomiting induced by intramuscular (IM), and intravenous (IV) ketamine for procedural sedation and analgesia in children in the emergency department (ED).
    Materials And Methods
    In a double-blind, randomized, placebo-controlled clinical trial, children aged 1 to 10 years who received ketamine for ED procedures were randomized into four groups receive IV ketamine (1.5 mg/kg), and placebo, IM ketamine (5mg/kg) and placebo, IV ketamine and IV ondansetron (0.15 mg/kg), and IM ketamine and oral ondansetron. The incidence of nausea and vomiting and ED length of stay were compared as the outcome of the study.
    Results
    One hundred eighty children were enrolled and randomized to four groups; 29 patients (15.0%) had nausea and vomiting. The incidence of vomiting was 26.7% in the IV ketamine-placebo group and 8.9% in the IV ketamine/ IV ondansetron group (P = 0.02). The incidence of vomiting was 17.8% in the IM ketamine-placebo group and 11.1% in the IM ketamine/oral ondansetron group (P = 0.17). ED length of stay was similar between groups.
    Conclusion
    According to current results, children administered IV ondansetron before IV ketamine experienced a significantly reduced incidence of vomiting but did not significantly affect length of ED stay and the addition of oral ondansetron to IM ketamine dose not reduce vomiting.
    Keywords: Children, Conscious sedation, Ondansetron, Ketamine
  • Sakineh Dadipoor, Azin Alavi, Arash Ziapour, Ali Safari-Moradabadi * Pages 7519-7527
    Background
    The first year of life is of a great significance in promoting health and the quality of life. The present research aimed to determine the factors affecting the mortality of infants below the age of one year in Bandar Abbas, Iran.
    Materials And Methods
    The present retrospective research was conducted based on a questionnaire developed by the present researchers as well as the analysis of documents along with a phone interview. The data collection method was to review the files in the medical records of Bandar Abbas Children's Hospital in 2017. In case it was needed, visits were paid to the houses of the 342 infant participants who were under one year of age. The data entered SPSS 16.0 software.
    Results
    According to the present results, from 342 case (148 cases occurred in 2016 and 194 cases in 2015), 223 subjects (65.2%) had died during infancy and 119 subjects (34.8%) died between one month to one year of age. The highest frequency of death occurred within the first 7 days. The most important cause of infant death was sepsis and the primary cause of one month to one year children was preterm birth. Data analysis in the present study showed statistically significant relationship between the following variables and infant mortality: birth weight (p˂.001), type of delivery (p=0.045), type of infant nutrition (p
    Conclusion
    The most important cause of infant death was sepsis and the primary cause of one month to one year children was preterm birth. Special attention to infancy particularly preterm infants, advertise natural delivery, and early diagnosis of congenital anomalies, can help to cut down on the rate of infant mortality.
    Keywords: Affective factors, Infant, Iran, Mortality
  • Mahdieh Momayyezi, Hossein Fallahzadeh *, Fatemeh Farzaneh Farzaneh, Mohammad Momayyezi Pages 7529-7542
    Background
    Childhood cancer has very unpleasant side effects on patients. A common problem among patients is sleep disturbance owing to a variety of causes. This study aimed to determine the sleep quality and disturbances in children and adolescents with cancer in Yazd, Iran.
    Materials And Methods
    This study was a descriptive cross-sectional on 101 patients aged 4-18 years who referred to the Shahid Sadoughi hospital in Yazd, Iran, and were treated with the diagnosis of cancer. Sleep quality was assessed via the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS version 16.0 software.
    Results
    The mean age of the patients was 9.54 ± 3.97 years and 59.4% were girls. The mean duration of cancer was 12.82 ± 2.66 months.The mean of PSQI was 6.49 ± 3.14 (of the total score 21). Considering a cutoff point 5, (60.9%) of patients were identified as poor sleeper. The mean of sleep duration was 7.72 ± 1.68 hours and mean of sleep latency was 35.45 ± 29.73 minutes. The mean of fatigue was increased with increasing the average of sleep quality (P =0.000).
    Conclusion
    According to the results, more than half of children with cancer had poor sleep quality. According to frequent waking ups during the night, and sleep duration reduction, it is necessary to set time nursing care during the night to prevent frequent waking during the night.
    Keywords: Adolescent, Cancer, Children, Sleep disorders
  • Leila Valizadeh, Golnar Ghahremani *, Manizheh Mostafa Gharehbaghi, Mohammad Asghari Jafarabadi, Mahni Rahkar Farshi Pages 7543-7552
    Background
    Infants born prematurely experience more self-regulation problems in comparison to term infants. Increasing crying in premature infants can disrupt sleep and awaking pattern and it can increase stress. This study aimed to determine the effects of facilitated fetal tuckingon duration and frequency of crying amongpremature infants.
    Materials And Methods
    This randomized, clinical trial was carried out in the Al-Zahra Hospital of Tabriz, Iran. Thirty-two premature infants (33-36 weeks) were selected for the study. The initial selection of the participants was based on the simple random sampling. Then the participants were allocated to groups using randomized block procedure. Every infant was studied for 4 days and in 12h period every day (8 A.M to 8 P.M) in this sequential study infants were randomly assigned 2 days in free-body posture and 2 days in facilitated fetal tucking posture. Films recorded in the 12 – h periods.
    Results
    The mean of crying time for facilitated fetal tucking group was 17.50 minutes and at the free-body posture was 23.35 minutes. The frequencies of crying in facilitated fetal tucking group were lower than free-body posture group. Also statistically significant difference was observed between durations of crying (p=0.009) and frequencies of crying (p=0.01).
    Conclusion
    It is concluded that the fetal tucking posture reduces duration and frequency of crying during rest times among infants born prematurely which leads to an improvement in sleep and waking cycles and reduces stress in premature infant. It provides to premature infant’s self- regulation and adaptation to the surrounding environment.
    Keywords: Crying, Facilitated fetal tucking, Infants, Neonatal ward
  • Abedin Saghafipour *, Alireza Zahraei-Ramazani, Hassan Vatandoost, Ehssan Mozaffari, Fatemeh Rezaei, Moharram Karamijooshin Pages 7553-7562
    Background
    Head louse infestation is highly common in collective centers such as schools, garrisons and campuses. This study was done to determine the prevalence and risk factors associated with Pediculus humanus capitis in primary school girls in Qom Provincecentral Iran.
    Materials And Methods
    This descriptive –analytic study was conducted among 1,725 feminine primary students from 89 schools of Qom province, Central Iran were randomly selected during 2015 to 2017. Data collection was done using standard check list that was provided by the Iran Centres for Disease Control and Prevention (CDC), and physical exams of the hairby visual scalp examination. Head examinations were performed by medical entomologist experts. Analysis of data was done using SPSS version 20.0 software.
    Results
    The prevalence rate of infestation was 13.28%. The rate of head lice infestation was 13.73% in the urban areas and 10.22% in the villages. According to the multivariable logistic regression analysis, a significant relationship was observed between Pediculus capitis and each of these factors: family size, water source, family income (per month for each family, in US dollars), father occupation, parental education, access to primary health care services, having previous history of Pediculus capitis infestation, number of comb uses per day (p
    Conclusion
    The head lice infestation is a significant public health issue in primary school girls of Qom province. Risk factors associated with head louse among primary school girls were some demographic and socioeconomic factors. Improvement of these status and designing and implementing appropriate educational and preventive programs can be helpful for surveillance of infestation among primary school girls.
    Keywords: Head lice infestation, Iran, Pediculosis, Primary school, Students
  • Masumeh Ghazanfarpour, Elham Arghavani, Talat Khadivzade *, Masumeh Saeidi, Hossein Kareshki, Morvarid Irani, Elahe Heidari, Fatemeh Rajab Dizavandi Pages 7563-7568
    Background
    Childbearing is considered to be one of the main purposes of marriage in Iranian culture. The aim of this study was to assess relationships among age of marriage, religious and educational levels, participation of couples in childbearing and finical status with childbearing motivation using structural equation model.
    Materials And Methods
    This study is a secondary analysis of previous data; 450 young couples attending four healthcare centers of Mashhad, Iran, included in this study. Sampling method was convenience sampling. Structural equation modeling was performed using AMOS version 19.0. Model was tested using maximum likelihood. Goodness of fit of the model was evaluated based on the Chi-square to degree of freedom ratio (χ2/df), goodness-of-fit index (GFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).
    Results
    Mean age for women and men were 22.16±4.84 and 26.02±4.6 year-old, respectively. The result of our study showed that suggested childbearing motivation model was well fit with data (GFI=0.96; CFI=0.96; RMSEA=0.063, and χ2/df=4.51). Marriage age and educational level significantly negatively associated with childbearing motivation, respectively (standardized β =-0.082, p=0.018), and (standardized β= -0.222.p
    Conclusion
    The findings indicated that the couple’s childbearing motivations were influenced by educational level, participation of couples in childbearing, marriage age and religious level.
    Keywords: Childbearing, Couple, Iran, Structural equation model