فهرست مطالب

Comprehensive Pediatrics - Volume:10 Issue:4, 2019
  • Volume:10 Issue:4, 2019
  • تاریخ انتشار: 1398/09/06
  • تعداد عناوین: 10
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  • Masoud Rezagholizamnjany *, Parsa Yousefichaijan, Ali Arjmand Page 1
    Context

    Insulin resistance, hypertension, and other related conditions have been frequently seen in children with obesity. Also, there are greater risks to develop diabetes. Therefore, more attention should be paid to this correlation. Evidence Acquisition: Regarding the relationship between proteinuria and massive obesity, the first description was done in 1974 and mentioned that glomerulopathy, which is related to obesity, is a complication of obesity that may occur in adults.

    Results

    Based on this study, kidney and urinary tract diseases may correlate with obesity in children.

    Conclusions

    We can use this correlation for reducing kidney and urinary tract diseases in children.

    Keywords: Urinary Tract Diseases, Kidney Diseases, Pediatrics, Obesity
  • afar Nasiri *, Akbar Azimi , Mohammadreza Ghazavi , Mortaza Sadinejad Page 2
    Objectives

    Breath-holding spells (BHS) are common in infancy and childhood. The severe episodes are frightening events for the families. The aim of this study was to evaluate therapeutic effects of piracetam in single daily dose and twice-daily dose of 40 mg/kg/day for treatment of severe spells.

    Methods

    In this prospective clinical trial, 50 children with severe BHS referred to our outpatient university clinics of pediatric neurology and were randomized to single-dose and divided-dose groups. The single-dose group received a single daily dose of 40 mg/kg/day piracetam in the morning, and the divided-dose group received 20 mg/kg/dose of piracetam twice daily. Patients were followed for four months. The number of severe attacks/month before and after treatments were recorded.

    Results

    In the single-dose group, 14 cases (60.9%) showed complete recovery, and nine (39.1%) showed relative recovery. In the divided dose group, eight patients (33.3%) showed complete recovery, 11 (45.8%) showed relative recovery, and five cases (20.8%) showed no recovery. This difference was statistically significant at P = 0.03.

    Conclusions

    Our study showed that once-daily administration of piracetam could be more effective than twice-daily dose in the management of severe spells.

    Keywords: Piracetam, Breath-Holding Spells, Treatment, Infancy, Childhood
  • Narges Gholami , Roshanak Hosseini , Ali Naseh * Page 3
    Objectives

    To compare the effects of a single dose of clofibrate on the serum bilirubin level in full-term non-hemolytic icteric neonates when it is administered in addition to phototherapy, and to evaluate its possible side effects.

    Methods

    In a randomized-controlled clinical trial in 2016, 90 term icteric neonates were divided into groups of 30. One group took a single dose of 50 mg/kg while another group took a single dose of 100 mg/kg of clofibrate. All neonates were under phototherapy and were compared to a control group who took a placebo. Serum bilirubin levels were measured at admission and then after 6, 12, 24, and 48 hours of treatment. Clofibrate’s side effects were assessed by measuring hepatic enzymes (AST/ALT) and lipid profiles (TG/Chol) at admission and after 48 hours.

    Results

    In neonates with jaundice who were under phototherapy, a single dose of 100 mg/kg of clofibrate decreased the level of serum bilirubin more rapidly compared to the control group (t (58) = -2.73, P = 0.043), or even the group who took a single dose of 50 mg/kg clofibrate (t (58) = -4.261, P = 0.000). A single dose of 50 mg/kg clofibrate did not decrease the serum bilirubin levels more rapidly compared to the control group. Compared to the control group, in the group who took a single dose of 50 mg/kg clofibrate, after 48 hours, a higher number of neonates showed an increase in serum triglyceride (30% versus 63%) and/or cholesterol levels (27% versus 57%).

    Conclusions

    A single dose of 100 (not 50) mg/kg clofibrate better decreased the serum bilirubin.

    Keywords: Phototherapy, Clofibrate, Icterus, Jaundice, Serum Bilirubin, Randomized-Controlled Trial, Newborn
  • Hamid Mazdak, Abdul Karim Khorrami , Zahra Tolou Ghamari * Page 4
    Background

    In order to ensure maximum recovery, stenosis management of the narrow and fragile tissue of urethra in children should be based on ingenious preserving of adequate urethral caliber.

    Objectives

    Owing to advancements in pediatric surgery that lead to improving the quality and quantity of life in recent years, it is necessary to evaluate urethral strictures and its management. With this respect, we studied the management of children with urethral strictures in two tertiary hospitals in Isfahan, Iran.

    Methods

    After obtaining ethical committee clearance (code number 396454), a retrospective search of the hospital information system was carried out for urethral stricture in children aged up to 15 years from 2008 to 2018. We studied all children who underwent the management for urethral strictures associated with recorded data (ICD-10; n = 35.9). Data were analyzed by SPSS and age, as a continuous variable, was expressed as mean ± standard deviation (SD). A P value of < 0.05 was considered statistically significant.

    Results

    For over a period of 10 years, there were 383 children, including 348 boys and 35 girls, with the mean ± SD age of 5.5 ± 3.4 years old. The management strategies for boys with the disease of urethra ranked as: dilation of urethra (n = 99), urethral meatotomy (n = 82), urethral meatoplasty (n = 75), urethrotomy (n = 7) and unspecified management (n = 85). In girls, the ranked values corresponded to dilation of urethra (n = 14), diagnostic ureteroscopy (n = 7), and unspecified management (n = 12). There was a significant difference associated with age in each subgroup. Statistical analysis based on the Kruskal-Wallis test showed a significant difference between the variables (P < 0.0001). The minimum age for urethrotomy in the population studied was 4 years old.

    Conclusions

    In pediatric, surgical treatment is an optimistic surrogate transaction to take the majority of cases with urethral strictures. As a result, in order to decrease complications such as incontinence, impotency, and surgical risks associated with major reconstructive procedures, proper repair at the appropriate time is recommended.

    Keywords: Urethra, Stricture, Pediatrics, Reconstructive
  • Alireza Eshghi, *, Ghamartaj Khanbabaee , Maryam Hassanzad , Seyed Ahmad Tabatabaee , Mohammad Rezaei Page 5
    Background

    Exhaled nitric oxide (FeNO) in cystic fibrosis (CF) patients is reduced when compared with healthy people, and it has now been found that FeNO has a relative association with airway clearance index. Studies have shown the role of some infections in changing the FeNO level; however, the role of respiratory infections in FeNO has not yet been thoroughly studied.

    Objectives

    The objective of this study was to investigate the possibility of FeNO usage to monitor the infections in CF patients.

    Methods

    This cross-sectional case-control study was conducted on CF patients between the age of five to 18 with positive sputum culture, through simple non-random census method. FeNO levels were measured in 30 healthy children and 30 CF children with positive sputum culture. CF patients were treated by antibiotic therapy for two weeks; in the case offending negative sputum culture, the FeNO level was re-measured. FeNO levels were re-evaluated in 13 patients after four weeks.

    Results

    There was no statistical difference between both groups in terms of age and weight. The level of FeNO in CF patients was significantly lower than in healthy children (22.1 ± 10.1 versus 30.0 ± 11.0 in the control group and P = 0.003). In 27 children, two weeks after administration of antibiotic therapy, sputum culture was negative. The mean of FeNO in these patients was 16.4 ± 5.5 at the time of the negative sputum culture, which was significantly lower than FeNO before starting the treatment. (P: 0.003). The mean FeNO was 13.0 ± 7.41 in 13 patients who were re-measured four weeks after starting the treatment. There was no significant difference between FeNO level two weeks after treatment and four weeks after starting treatment (P: 0.292). Patients with pseudomona sputum culture were not significantly different from those with non-pseudomona sputum culture in terms of primary FeNO and FeNO changes after the treatment (P value: 0.084 and 0.094, respectively).

    Conclusions

    However, in our study, FeNO was decreased after administration of antibiotic treatment in CF patients, but according to the sample size and conflicting or similar results in other studies, currently, FeNO levels cannot be used as a way of monitoring the treatment of infection in CF patients.

    Keywords: Cystic Fibrosis, FeNO, Sputum Culture
  • Avisa Tabib , Maryam Aryafar *, Behshid Ghadrdoost Page 6
    Background

    Congenital heart defect (CHD) is the most common congenital anomaly in infants and is known to be a leading cause of malnutrition.

    Objectives

    This study aimed to provide insights into the prevalence of malnutrition in children with CHD in Iran.

    Methods

    The study enrolled 515 under-five children with CHD. The diagnosis was based on the definitive result of cardiac catheterization report. They were divided into the subgroups of cyanotic with pulmonary hypertension (PH), acyanotic with PH, cyanotic without PH, and acyanotic without PH according to their diagnosis. The degree of growth failure and the severity of malnutrition were evaluated based on the WHO standards (z-score criteria) in three categories as mild (-1.1 to -2.0 SD), moderate (-2.1 to -3.0 SD), and severe (≤ 3 SD).

    Results

    Among the studied groups, the most prevalent CHDs were ventricular septal defect (VSD; 42.9%) and tetralogy of Fallot (TOF; 17.3%). Severe malnutrition was significantly more prevalent in cyanotic patients with and without PH (n = 23; 63.9% and n = 89; 51.1%, respectively). Normal nutritional status was significantly more in acyanotic patients without PH (P < 0.001). Overall, malnutrition in this study was mild in 16.3%, moderate in 24.1%, and severe in 39.8% of cases.

    Conclusions

    The study showed that the prevalence of malnutrition in children with CHD aged under 5 years was noticeably high at this center in Iran. The administration of nutritional requirements such as low-volume and high-calorie diets should be considered for these vulnerable children.

    Keywords: Malnutrition, Congenital Heart Disease, Pulmonary Hypertension, Cyanotic, Acyanotic
  • Alia Jalalodini *, Fereshteh Ghaljaei Page 7
    Background

    A common procedure for the diagnosis of hyperbilirubinemia is the total investigation of total serum bilirubin (TSB); however, this procedure is invasive for neonates. For two decades, transcutaneous bilirubin (TCB) was used as a non-invasive and painless method to assess bilirubin.

    Objectives

    This study aimed to compare the accuracy of TCB versus TSB before and after phototherapy.

    Methods

    This descriptive-analytical study included 85 neonates. Neonates were selected by convenience sampling methods. Neonates had a normal birth weight and physiological jaundice; having no need for blood transfusions. Data were collected using a BiliChek device (APEL, Japan). The researcher, before phototherapy and simultaneously by checking the TSB, pressed the BiliChek three consecutive times in the middle of the neonate’s forehead and then, recorded the results. The correlation between TCB and TSB were determined before and after phototherapy. Pearson, t-test, and ROC were used by SPSS v.18 for analysis data.

    Results

    There was a strong correlation between the TCB and the TSB in neonates weighing 3001 to 4000g before phototherapy (r = 0.74, P < 0.001). Although, there was a low correlation between the TCB and the TSB in these neonates after phototherapy (r = 0.40, P > 0.05), the cut-off value of bilirubin was 6 - 8 mg/dL. The sensitivity was (100%) and specificity was 90% for bilirubin at the levels of 6.7 mg/dL.

    Conclusions

    TCB procedure can be a reliable alternative to the TSB, especially in the initiation of phototherapy with bilirubin levels of 6 - 8 mg/dL. However, it is not a device with a high accuracy after phototherapy.

    Keywords: Hyperbilirubinemia, Transcutaneous, Total Bilirubin, Bilirubin, Neonates
  • Gelareh Biazar , Farnoush Farzi *, Bahram Naderi Nabi , Zahra Atrkarroushan , Yasmin Chaibakhsh , Sepideh Rostami Lima Page 8
    Background

    Recently, general anesthesia (GA)-related neurotoxicity has turned into a big concern. However, it seems that inadequate attention has been paid to the issue in Iran.

    Objectives

    The aim of this survey was to investigate the frequency of elective surgeries in children under the age of three at an academic hospital in the north of Iran.

    Methods

    This retrospective study was conducted at Alzahra Hospital affiliated to the Guilan University of Medical Sciences (GUMS). The records of all children who had undergone surgeries during 2014 - 2017 were examined by a responsible physician. Then, the records of children under three receiving GA were sorted out. After that, questionnaires with items on gender, habitat, age of receiving GA, type and status (elective or urgency) of surgeries were filled out.

    Results

    According to our results, 670 children underwent surgery under GA during the study period, while 50.4% were elective. The mean age of patients was 15.26 months; 9.9% of them were neonates, 42.4% were infants, 80.3% were boys, and 60.7% were from urban areas. The most affected children were urban boys and the most obviously avoidable surgery was circumcision.

    Conclusions

    More attention should be paid to the issue of GA-related neurotoxicity at our hospital. Future studies are welcome to examine the issue and find practical interventions.

    Keywords: General Anesthesia, Neurotoxicity, Pediatrics, Surgery
  • Ali Nazari , Masoumeh Shohani , Hamed Tavan * Page 9
    Background

    Travelling to places where the population density is high often causes the transmission of infectious diseases; thus, not complying with hygiene standards can result in an increase in infectious diseases.

    Objectives

    The current study aimed at investigating contagious diseases and their related risk factors among the pilgrims admitted to Ilam educational and treatment centers on the day of Arbaeen in 2017.

    Methods

    The study population consisted of 105 patients. The research instrument was a checklist including two parts: demographic characteristics and information about infectious diseases; SPSS version 19 was used for data analysis.

    Results

    The sample size consisted of 63 male and 42 female patients. The age groups highly affected by infectious diseases were above 60 and under 20 years including 28 patients (26.7%). The disease associated with the highest mortality rate was acute gastroenteritis with severe dehydration, causing four deaths (30% of mortality rates). There was a significant correlation between age and gender of patients and WBC, urea, and creatin variables (P < 0.05).

    Conclusions

    The study findings indicated that children and elderly were more prone to infectious diseases. Compliance with hygiene standards can help to control and prevent the spread of infectious diseases in communities.

    Keywords: Infectious Diseases, Risk Factors, Hospital
  • Ali Nikfar *, Mojdeh Mansouri, Gita Fatemi Abhari Page 10

    Autosomal recessive cutis laxa type 2B (ARCL2B) is a rare genetic connective tissue disorder characterized by wrinkled inelastic skin, intellectual disability, growth retardation, developmental delay, skeletal abnormalities, and facial dysmorphism. Recently, PYCR1, encoding the pyrroline-5-carboxylate reductase 1, was reported as the first gene involved in ARCL2B. In this study, using whole exome sequencing, we identified a homozygous PYCR1 missense mutation, c.722C>A; p.Ala241Asp, in an Iranian male patient. Our report expands the clinical spectrum of PYCR1 mutations. Furthermore, this study shows that whole exome sequencing could serve as a viable diagnostic approach to identify the etiology of rare genetic diseases.
     

    Keywords: Autosomal Recessive Cutis Laxa Type 2B, PYCR1, Whole Exome Sequencing