Journal of Comprehensive Pediatrics
Volume:10 Issue: 3, Aug 2019

Age at menarche is the key indicator of puberty in females and the reflector of populations’ health that different hereditary and environmental factors can affect it. This study was conducted to determine the age at menarche and its relationship with body mass index (BMI) and demographic factors among students of Qaen, Eastern Iran. This cross-sectional study was conducted on 400, 10 - 16-year-old students of Qaen located at the East of Iran, in 2016. The participants were selected by the random multistage sampling of students in elementary and secondary schools that were eligible to participate in the study. Data collection was carried out through interviews and a checklist including demographic and menarche information as well as height and weight measurements in schools. The data were analyzed using SPSS V. 18 by Pearson’s correlation, t-test, and multiple linear regression. The mean age of students was 13.86 ± 1.10 years, mean BMI was 20.38 ± 2.72 kg/m2 and the mean age at menarche was 12.78 ± 1.23 (95% CI: 12.66 - 12.90) years. There was an inverse correlation between the age at menarche and BMI (r = -0.123, P = 0.014) while the height (r = 0.195, P = 0.0001), maternal age (r = 0.223, P = 0.0001), and sleep duration (r = 0.156, P = 0.002) were directly related to age at menarche. No significant relationship existed between age at menarche and weight of students (P = 0.86). The mean age at menarche of students was as average as Iranian studies. Lower age at menarche was significantly correlated with higher BMI.

One of the main aspects of the treatment in patients with cystic fibrosis (CF) is the effective clearing of airway secretions. Inhaled hypertonic saline (HTS) and mannitol are among drugs used for this purpose. There are two forms of mannitol, including dry-powder and soluble form. We used soluble mannitol in this study. The aim of this study was to evaluate the effect of inhaled soluble mannitol on the pulmonary function of patients with CF as well as its comparison with 5% HTS. This clinical trial study was performed on 30 children with CF ≥ 5 years of age who referred to the CF clinic in Mofid Children’s Hospital. Patients were divided into two groups, including soluble mannitol and 5% HTS group. At baseline and two weeks after the treatment, a spirometry test was done and forced expiratory flow in 1 second (FEV1), forced vital capacity (FVC), and Forced expiratory flow between 25% and 75% of forced vital capacity (FEF25 - 75%) were measured. The mean of FEV1, FVC, and FEF25 - 75% in the mannitol group before the treatment were 96 ± 30.5%, 99 ± 27%, and 76.3 ± 36.3%, and after the treatment were 100.5 ± 29%, 103.5 ± 23.7%, and 79.9 ± 37.3%, respectively. The difference of FEV1 before and after mannitol was statistically significant (P = 0.031). The mean of FEV1, FVC, and FEF25 - 75% in 5% HTS group were 96.2 ± 25.5%, 99 ± 19.8% and 77.8 ± 35.6% before the treatment and 95.2 ± 20.1%, 99.3 ± 19.2%, 74.2 ± 29.5% after the treatment. There was no significant difference in 5% HTS group. Inhaled soluble mannitol improved pulmonary function of patients with CF and its effect was better than 5% HTS.

There is a shortage on studies concerned with electroencephalogram (EEG) abnormalities in neurologically asymptomatic children with acute hepatitis A virus (HAV) infection. In the present study, we evaluated EEG patterns in HAV infected children who had no symptoms of overt or minimal hepatic encephalopathy (HE). Forty-five children infected with HAV infection along with 45 healthy children were studied. EEG was acquired in resting condition with closed eyes. Statistical analysis was performed in SPSS V. 19 software. Abnormal EEG patterns were recorded in 16 (35.6%) children with HAV infection while no subject showed EEG abnormality in healthy subjects (P = 0.02). Irregular spike along with alpha wave was the most frequent pattern (13 out of 16, 81.2%). One patient (6.3%) showed delta wave, and two patients (12.5%) represented tri-phasic wave. The mean age of the patients with irregular EEG was significantly higher (89.6 ± 35.2 months) than patients with normal EEG (60.7 ± 36.2 months, P = 0.01). Although a considerable number of patients with abnormal EEG had abnormally high AST (15/16), and ALT (14/16) levels, the means of neither AST nor ALT were significantly different when comparing patients with normal (535.9 ± 571.8 and 660.1 ± 649.8 IU/L, respectively) and abnormal (666.4 ± 834.7 and 982.1 ± 1230.7 IU/L, respectively) EEG patterns. Abnormal EEG is a relatively common finding in children with acute HAV infection representing no signs of HE. Higher age and elevated hepatic enzymes levels may predict abnormal EEG patterns in these patients.

Despite the presence of various reports regarding the association between iris color and some ocular diseases in adults, there is little evidence of such relation in children. Determine the distribution of iris color in seven-year-old children in Iran and its relation with refractive errors, amblyopia, and strabismus. In this cross-sectional study, 3414 seven-year-old school children were selected from six cities through multistage random sampling. The iris color in this study was classified into dark brown, medium brown, light brown, yellow, green, gray, and blue. All subjects were examined for visual acuity, refraction, and binocular vision assessment. Of the 3414 selected samples, 3030 children participated in the study (89% response rate). The prevalence and 95% confidence intervals (CI) of myopia, hyperopia, and astigmatism was 3.03% (2.30 - 3.99), 6.20% (4.40 - 8.65), and 17.42% (13.30 - 22.48), respectively. Amblyopia was detected in 1.85% (1.10 - 3.12) and the prevalence of strabismus was 2.50% (1.86 - 3.35). Dark brown was the most common iris color at 52.50% (50.06 - 54.93) in boys, 46.07% (43.49 - 48.68) in girls, and 49.50% (47.72 - 51.28) in the total sample population. According to logistic regression results, the odds ratio (95% CI) of hyperopia was 0.3 (0.15 - 0.6) in those with medium brown iris color and 0.23 (0.1 - 0.47) in those with dark brown eyes compared to the group with yellow or green iris colors. Approximately 90% of the studied subjects had dark or medium brown eyes. Given that people with yellow or green eyes are at a higher risk of hyperopia, it is recommended that these individuals be given attention in this regard during screening, and the presence of hyperopia be taken into consideration during refraction examinations for these children.

Smoking and alcohol consumption have been common among adolescents in recent years, both of which are risk factors of cardiovascular disease. They may be associated with unhealthy dietary habits that can add to cardiovascular risks in adults. This study aimed to evaluate the association between smoking status, alcohol consumption, and dietary habits in adolescents. In this study, 4,372 adolescents (2,223 males and 2,149 females) aged 13 to 18 years were enrolled from randomly selected schools in Northern Thailand. They were asked to complete the Thai Youth Risk Behavior Survey regarding smoking, alcohol use, and dietary habits. The mean age of the participants was 15.4 (1.7) years and 15.0 (1.6) years in males and females, respectively. The prevalence of smokers and alcohol drinkers was 21% and 28.3%, respectively. Among alcohol drinkers, 52.4% were also smokers. Besides, 11% of the participants were current smokers. The proportions of adolescents with healthy dietary habits, defined as drinking 100% fruit juice, drinking milk, fruit/vegetable consumption, and having regular breakfast, were significantly higher in the non-smoking/non-drinking group (P ≤ 0.05 to P ≤ 0.001). Adolescents who were smokers and alcohol drinkers were less likely to have healthy dietary habits. This can affect cardiovascular risks and associated diseases in the future. The proper advice for dietary and lifestyle modification among these high-risk groups may be needed from an early age.

Cirrhotic ascites is frequently complicated with spontaneous bacterial peritonitis (SBP). Here, we assessed the diagnostic validity of some inflammatory markers in children with SBP. This cross-sectional study was performed in the Pediatric Gastroenterology Ward of Namazi hospital of Shiraz. SBP was considered as ≥ 250 polymorphonuclear cell (PMN) /µL ascetic fluid (AF). Out of 150 liver cirrhotic patients with ascites, 41 (27.3%) were diagnosed with SBP. Mean WBC count and PMN per µL of AF were significantly higher in SBP patients than non-SBP (P < 0.0001). The highest specificity for the diagnosis of SBP was recorded for AF smear test (100%). Positive AF smear and culture tests rendered the highest positive predictive values (PPV, 100% and 88.2% respectively). The highest negative predictive value (NPV) was related to AF leukocyte esterase test (94.2%). The highest area under the curve (AUC) for diagnosis of SBP belonged to WBC count (0.956), total cell count (0.817), and LDH concentration (0.814) of AF. A cut off value of 290 WBC per µL AF resulted in respective 95.1% and 88.1% sensitivity and specificity. Trespass of WBC count and lactate dehydrogenase (LDH) level of AF higher than cutoff values (290 cells/µL, and 175 (u/L), respectively) resulted in 82.9%, 92.7%, 81%, and 93.5% sensitivity, specificity, PPV and NPV, respectively. Total cell and WBC counts of AF strongly correlated with ascetic PMN count. Ascetic LDH, alone or in combination with WBC count of AF can be used as a potential surrogate for PMN counts in diagnosis of SBP

The physiologic status of an infant at birth and at the time of admission to hospital is influential in determining the infant outcome, which can be evaluated through scoring systems. The current study aimed at predicting the mortality risk of preterm infants with a birth weight less than 1500 g hospitalized in the neonatal intensive care unit (NICU) of Vali-e-Asr Hospital, Tehran, according to SNAPPE-II (score for neonatal acute physiology with perinatal extension-II) score. The study was conducted on 343 neonates with a birth weight less than 1500 g and a gestational age less than 32 weeks hospitalized within the first 12 hours after birth. The infants’ background data was collected through a demographic characteristics questionnaire. SNAPPE-II scoring system was also completed including items such as the lowest blood pressure, the lowest arterial oxygen pressure, the lowest body temperature, the lowest serum pH, the incidence of seizure and its frequency, and urine output. Then, the final score was calculated for each infant. The cutoff point, the area under the curve, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of the system were also calculated. The correlation between neonatal variables and the outcome neonatal mortality were evaluated. Totally, 252 infants survived 24 hours after birth, and 91 passed away within this time (26.4%). The total SNAPPE-II score was 16.94 ± 16.46 in the survivor infants and 51.6 ± 22.98 in the non-survivors. The area under the receiver operating characteristic (ROC) curve with the cutoff point of 27.5 was 0.89; the sensitivity and specificity of the system were 79% and 85%, respectively. PPV and NPV of the SNAPPE-II system were 58.9% and 93.4%, respectively. A significant correlation was observed between the outcome of neonatal death and the variables of birth weight, temperature, and mean blood pressure (P = 0.00). Since the sensitivity and specificity of the SNAPPE-II system as well as its cutoff point were appropriate in the current study, and considering the simplicity of the system and the short time it takes to be completed within the first 12 hours after the birth, this system was considered a proper predictor of death in infants with neonatal mortality risk and can be routinely implemented, while providing health and medical care for Iranian infants.

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease with major anesthetic implications, as it is characterized by recurrent life-threatening alveolar hemorrhage, fibrosis and restrictive lung disease. IPH anesthetic management case reports are scarce. The case of a child previously diagnosed with IPH, which was candidate for an elective urologic procedure under general anesthesia is presented in this paper. We describe our experience and anesthetic approach, with particular emphasis on the airway approach and management, and highlight possible contributions for future similar cases.

Alveolar hypoventilation is defined as insufficient ventilation. The primary feature of this disorder is insufficient sleep-related ventilation. The differential diagnosis of pediatric hypoventilation includes congenital central hypoventilation syndrome (CCHS), ROHHAD syndrome, Chiari malformation, Prader-Willi syndrome (PWS), and neuromuscular disorders (e.g. congenital myopathy, brain trauma, and central nervous system tumors). In this article, we report two cases of hypoventilation in the first decade of life with abnormal presentations (e.g., arterial and venous thrombosis). We also present a case of hypoventilation with an uncommon etiology and compare the therapeutic strategies for these patients. The aim of this case report was to raise awareness of this unusual presentation of ROHHAD syndrome. Due to the low incidence of this syndrome, further studies are warranted to collect more information about its pathophysiology and symptoms. In addition, we noticed a rare etiology of hypoventilation (brain trauma)