فهرست مطالب

  • Volume:6 Issue:4, 2018
  • تاریخ انتشار: 1397/07/02
  • تعداد عناوین: 8
|
  • Narges Nodeh Farahani , Faramarz Masjedian Jazi , Bahram Nikmanesh , , Parisa Asadolahi , Behrooz Sadeghi Kalani , Nour Amirmozafari , * Page 1
    Background
    Salmonella and Shigella infections are important public health concerns among children. The emergence of antibiotic resistance amongst Salmonella and particularly Shigella isolates has posed serious problems in antimicrobial treatment worldwide. Data on local antibiotic resistance patterns are essential to design suitable antibiotic treatment guidelines.
    Objectives
    The aim of the present study was to determine the prevalence and drug susceptibility patterns of Shigella and Salmonella species in addition to the detection of extended-spectrum β-lactamase producing isolates among diarrhea samples of pediatric patients.
    Methods
    A total of 5300 diarrheic samples from children were examined for the presence of Salmonella and Shigella species. Biochemical and microbial tests, as well as specific polyvalent antisera, were used for the identification of the bacterial species. Antibiotic susceptibility tests and extended-spectrum β-lactamase detection were conducted by disc diffusion and combination disc methods, respectively.
    Results
    A total of 371 (7%) and 472 (8.9%) samples were positive for Salmonella and Shigella species, respectively. The most prevalent Salmonella isolate was serogroup D (n: 176, 47.5%). Of the Shigella isolates, 60.8% were found as Shigella sonnei and 39.2% as Shigella flexneri. The highest level of antibiotic resistance was noted among Shigella flexneri isolates. Overall, 35.7% of the Shigella flexneri isolates and 31% of the Shigella sonnei isolates produced extended-spectrum β-lactamases.
    Conclusions
    This study provided information on the prevalence and antimicrobial susceptibility patterns of Salmonella and Shigella isolates in Iran. It also indicated a high-level resistance among Shigella isolates to co-trimoxazole and ampicillin and among Salmonella isolates to nalidixic acid
    Keywords: Prevalence, Drug Resistances, Pediatric, Diarrhea, Shigella, Salmonella
  • Milad Borji , Hamid Taghinejad , *, Reza Sedmohamadi Page 2
    Background
    Frequent experience of pain and anxiety can cause neuro-developmental disorders, reduced learning ability, and behavioral problems in children.
    Objectives
    For this reason, the present study aimed at comparing the effects of drawing pictures and blowing up balloons on the anxiety and pain intensity arising from diphtheria-pertussis-tetanus (DPT) immunization (triple vaccine) in school-aged children.
    Methods
    The present study was a quasi-experimental research conducted on children, who had been referred to Ilam clinics for DPT immunization during year 2016. 120 children, who met the inclusion criteria were enrolled in this study. They were randomly divided to three groups, namely experimental group A (drawing pictures before immunization up to its completion), experimental group B (inflating balloons before immunization up to its completion), and control group C (routine care group). The data collection instruments in this study included numeric pain rating scale, behavioral scale of pain responses (for the assessment of the child’s pain), Pieri’s pictorial anxiety scale, and self-rating scale of clinical phobias (for the assessment of the child’s anxiety). The SPSS version 16 (IBM Corp., Armonk, N.Y., USA) was used to analyze the data through descriptive statistics.
    Results
    The results showed that no statistically significant differences were observed in demographic characteristics of children under the study among the groups (P < 0.05). The results also showed that the practice of distraction technique via drawing pictures reduced the children’s anxiety and pain caused by the vaccine. However, only anxiety decreased in the group that experienced the distraction method through inflating balloons. Additionally, the implementation of this technique did not have a statistically significant effect on the level of perceived pain in patients that inflated balloons (P < 0.05).
    Conclusions
    The implementation of these non-pharmacological and low-cost distraction techniques is suggested to be incorporated in care and treatment routines, particularly in clinical setting. It is also recommended that the personnel receive training in this field and that research be conducted to determine the willingness of health care workers to perform distraction techniques and eliminate the existing barriers
    Keywords: Triple Vaccine, Pain, Anxiety, Distraction
  • Zahra Zahedi , Mojdeh Hakemi Vala , , *, Fatemeh Bagheri Bejestani Page 3
    Background
    Resistance to ciprofloxacin as the most common antibiotic for the treatment of urinary tract infections (UTIs) is increasing. In this study, the role of gyrA and qnrA genes among ciprofloxacin resistant Escherichia coli (E. coli) isolates from UTIs was evaluated.
    Methods
    During September to March 2014, urine samples were collected from patients with UTIs of Imam Khomaini hospital of Tehran. Bacterial identification was done based on standard tests. The antibiotic sensitivity test was performed based on the clinical and laboratory standards institute (CLSI) 2014 protocol and minimal inhibitory concentration (MIC) of ciprofloxacin was determined by E-test strips. DNA was extracted by the boiling method and assessment of gyrA (DNA gyrase (type II topoisomerase)) and qnrA genes was done by the polymerase chain reaction (PCR). Further sequencing was done for PCR confirmation and blasting.
    Results
    All isolates were susceptible to carbapenems (100%) and 98.7% were susceptible to nitrofrontain. The highest resistance was towards piperacillin 85%, ampicillin 83.8%, sulfamethoxazole trimethoprim (SXT) 78.7%, ciprofloxacin 77.5%, and 75% tetracycline. Around 80% of the E. coli isolates were identified as multi drug resistant (MDR). All isolates with MIC of ≥ 4 μg/mL for ciprofloxacin were the candidates for DNA extraction, PCR, and sequencing. The gyrA and qnrA genes were detected in 100% and 39% of isolates, respectively. Mutations were found in the sequence analysis, yet the mean full change was related to change of serine to leucine at position 83 (S 83 L).
    Conclusions
    Finally, contribution of both mutated chromosomal gyrA genes and plasmidic qnrA resistance genes in some of the high ciprofloxacin resistant bacterial strains was found in this study, besides the overuse of antibiotics, which can increase the emergence of resistant strains
    Keywords: E. coli, Ciprofloxacin, Antimicrobial Drug Resistance, DNA Gyrase, qnrA
  • Parsa Yousefichaijan , Ali Ahmad Goudarzi , Masoud Rezagholizamenjany , * , Manijeh Kahbazi , Mohammad Rafeie , Ali Arjmand Shabestari , Fakhreddin Shariatmadari , Hassan Taherahmadi Page 4
    Background
    Urinary tract infections (UTIs) as a urological disorder occur in 1% - 3% of females and 1% of males. This disease can induce severe complications such as pyelonephritis.
    Objectives
    The current study aimed to evaluating the efficacy of vitamin C supplementation on UTI in children.
    Methods
    The current clinical trial study was conducted on 152 female children with UTI admitted to Amir-Kabir hospital, Arak, Iran. The cases were randomly divided, based on blocked groups, into two treatment and control groups (76 patients in any group). The subjects were matched in terms of age, gender, and clinical signs and symptoms. The control group received only routine treatment of UTI, while the treatment group, in addition to the routine treatment received oral vitamin C supplementation tablet, for a 14-day period.
    Results
    Dysuria, urine incontinence, fever, urinary urgency, and dribbling occurred significantly earlier in vitamin C supplemented individuals than the control ones, while abdominal pain, dimercaptosuccinic acid (DMSA) scan, and recurrent UTI were not different between the two groups.
    Conclusions
    Vitamin C supplementation can control the symptoms of urinary tract infections, including fever, dysuria, urinary urgency, and dribbling urine
    Keywords: Urinary Tract Infection, Vitamin C Supplementation, Children, Urinary Symptoms
  • Abdollah Karimi , Mohammad Sakhavi , Negin Nahanmoghaddam , Farideh Shiva , Leila Azimi , Mehdi Shirdust , Shahnaz Armin , *, Ahmad Reza Shamshiri Page 5
    Background
    Febrile seizures (FS) are common in young children. Viral infections that result in high fever are frequent etiologic agents that lead to febrile seizures. Human Herpesvirus 6 (HHV6), Influenza virus, adenovirus, and enterovirus have been named as the most common viruses causing high fevers in young children. Although bacterial infections have rarely been found as causative agents, many children with febrile seizures are treated with empiric antibiotics.
    Objectives
    To determine the epidemiology of the viral (HHV6, Adenovirus, HSV1, Enterovirus) and bacterial infection in children presenting with febrile seizures.
    Methods
    In a descriptive study, data was collected from 93 children, 3 months to 5 years of age, hospitalized with febrile seizures between September 2016 and April 2017. Relevant information was documented on a previously designed questionnaire. Blood samples were collected for culture, Serum 16S rRNA for bacteria, and PCR assay for 4 viruses (HHV6, adenovirus, enterovirus and HSV), in addition to routine investigations.
    Results
    Of the 93 patients, serum PCR results were negative for 73 patients (78.49%) and 15 (16.13%) were positive for viruses (11 for HHV6 and 4 for Adenovirus). Serum 16S rRNA for bacteria was detected in 5 cases and blood culture was positive in 4 cases.
    Conclusions
    Findings of this study indicate a significant prevalence of viruses and a very low rate of bacterial infection in children with febrile seizures, thus, negating the use of empirical antibiotic therapy
    Keywords: Febrile Seizure, Simple FS, Complex FS, Viral Infections, Bacterial Infection
  • Alireza Nateghian , * , Hanieh Radkhah , Niyosha Masalegooyan , Masoumeh Moradkhani , Masoumeh Miradi Page 6
    Background
    There is not enough information about the prevalence of Acinetobacter infection as well as its risk factors, especially in neonatal intensive care units. The present research aimed at conducting a five-year study on Acinetobacter infection and its main factors in neonatal and pediatric intensive care units in Iran.
    Methods
    This cross-sectional survey was conducted on 89 children with positive culture for hospital-acquired Acinetobacter, admitted to intensive care units of Aliasghar Children's Hospital in Tehran, between 2010 and 2015. Besides, 97 patients with similar baseline characteristics without Acinetobacter positivity were enrolled as the control group. Epidemiological information and clinical data were collected by reviewing the hospital recorded files.
    Results
    In the group with positive Acinetobacter culture, complete and partial improvement was observed in 62.9% and 11.2%, respectively, while 25.8% died due to treatment failure. In this regard, complete and partial improvement in the control group was revealed in 85.6% and 11.3% with an overall death rate of 3.1%, indicating significantly higher failure rate in the case group (P = 0.001). To determine the main factors for in-hospital death, all variables with a significant association with positive culture in univariate analysis (considering P < 0.2) were entered in a backward multivariable logistic regression model. In this regard, venous access (OR = 7.80, 95% CI: 1.06 to 57.19, P = 0.043), carbapenem use (OR = 27.03, 95% CI: 1.93 to 377.780, P = 0.014), and ampicillin use (OR = 0.12, 95% CI: 0.019 to 0.739, P = 0.022) were shown as the main determinants for Acinetobacter-related death.
    Conclusions
    Although the study was not a prognostic study and determination of the main determinants of prognosis in children with Acinetobacter infections was not possible yet it seems that the mortality rate due to Acinetobacter infection in the population was about 25.8% in the global range reported in the literature. The main factors for Acinetobacter infection-related death are central venous catheters related to TPN, carbapenem use, and ampicillin use
    Keywords: Acinetobacter, Children, Iran, Course
  • Bobby Sena , Walter Dehority , * Page 7
    Introduction
    We describe the case of a 10-year-old girl with an unusually severe and complicated episode of acute septic arthritis due to Streptococcus dysgalactiae, and systematically review the literature describing osteoarticular infections with this organism.
    Case Presentation
    A 10-year-old girl with hereditary sensory and autonomic neuropathy type 5 and chronic (Charcot) arthropathy of the right knee presented with severe swelling and warmth of the right knee associated with 2 days of fever. She was ultimately diagnosed with septic arthritis of the right knee due to S. dysgalactiae. Her subsequent clinical course was abnormally prolonged and complicated, requiring an 8-week hospitalization, 7 arthrotomies and 8 months of total antimicrobial therapy.
    Conclusions
    Group G Streptococci, including S. dysgalactiae, are unusual causes of septic arthritis. Our patients’ clinical course was more severe than typically seen with more common osteoarticular pathogens. We conducted a systematic review of the literature on this condition, which demonstrated 7 previously reported cases of septic arthritis due to this pathogen in children, and also review the most current nomenclature and classification scheme for the organism
    Keywords: Septic Arthritis, Group G Streptococcus, Streptococcus dysgalactiae
  • Delara Babaie , Mohammad Qaisari , Hanieh Sadat Mirzade , Fatemeh Abdolinejad , Farahnaz Bidari Zerehpoush , * Page 8
    Hyaline fibromatosis syndrome (HFS) is an autosomal recessive (AR) condition featured by abnormal hyaline deposition in the body tissues, primarily skin and mucous membranes. It presents with pearly papules and fleshy nodules on the skin. Additional features include progressive joint contractures, gingival hypertrophy, osteopenia, and osteoporosis. Failure to thrive (FTT) and protein-losing enteropathy (PLE) have also been observed. PLE might lead to some immunodeficiency and infection susceptibility. Herein, we report a 2-year-old girl from consanguineous parents who was first diagnosed as a common variable immunodeficiency (CVID) based on recurrent upper respiratory infections, severe diarrhea, and the decreased level of IgG. Her infections were controlled after monthly IVIG infusions. She developed contracture of shoulders, knees, and hips. She also suffered from gingival hypertrophy, skin nodules, and pearly papules on her face and neck. The histopathological examination of the lesions confirmed the diagnosis of HFS. PLE induced a secondary immunodeficiency due to the low level of IgG, which led to recurrent infections
    Keywords: PID, Infantile Hyaline Fibromatosis, Immune Deficiency, Protein-Losing Enteropathy