فهرست مطالب

Comprehensive Pediatrics - Volume:11 Issue: 1, 2020
  • Volume:11 Issue: 1, 2020
  • تاریخ انتشار: 1398/11/05
  • تعداد عناوین: 10
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  • Hazem Al Azzam, Majd T. Mrayyan *, Khloud Al Dameery, Omar Al Omari Page 1
    Context

    Whether predictive genetic testing should be used on children to detect inherited cancers is one of the common debates in the medical field. This is an emerging and escalating issue related to the advancement of medical technologies and sciences.

    Objectives

    To advocate the predictive genetic testing of children to detect inherited cancers from the ethical and legal perspectives of both proponents and opponents.

    Conclusions

    Various opinions about the predictive genetic testing of children to detect inherited cancers were discussed; this will help healthcare providers to stand on firm ground regarding the current issue. Many of the ethical and legal issues noted by both proponents and opponents were discussed. Common ethical concerns are children’s autonomy versus the parents’ rights to decide, health insurance, genetic discrimination, and whether the benefits outweigh the risks of testing. There are many laws to protect children’s welfare in areas related to genetic discrimination, children’s autonomy, and health insurance; however, many organisations defer the genetic testing of children until adulthood, especially if there are no clear medical benefits. The authors are proponents for the genetic testing of children in order to detect inherited cancers. More efforts are needed in the areas of healthcare procedures, legislation, disease prevention, and community awareness when it comes to fighting cancers.

    Keywords: Predictive, Genetic Testing I, nherited Cancers, Children, Ethics, Laws
  • Mohammad Sobhani Shahmirzadi *, Ahmad Sohrabi Page 2
    Background

    Although initially considered as a digestive tract disease, celiac disease (CD) can cause problems and complications in most other organs. Common serologic tests for the diagnosis of CD include anti-tissue transglutaminase (tTG) and anti-endomysial Ab (EMA). A more recent test includes anti-deamidated gliadin peptide.

    Objectives

    This study aimed to compare the values of tissue transglutaminase and endomysial antibodies in A and G Immunoglobin subtypes in patients with a definitive diagnosis of CD.

    Methods

    Patients suspected of CD referring to a Gastrointestinal Pediatric Clinic were evaluated for CD using IgG and IgA for tissue transglutaminase and endomysial antibodies and total IgA. Endoscopy and biopsy were done based on the CD diagnosis protocol. The demographic data of children were recorded in a questionnaire and then analyzed.

    Results

    Of the 54 patients diagnosed with CD, 29 were females and 25 were males. TTG-IgA had the highest positivity rate. Tests based on IgA were more positive than IgG tests. More than one test was positive in 81.5% of the patients. All four tests were positive in 16 patients. In 18.5 percent of patients, just one test was positive. In the latter group, TTG-IgA was positive in four patients. The coefficient of agreement between EMA-IgA and TTG-IgA was 0.435, which was statistically significant.

    Conclusions

    We suggest tissue transglutaminase and endomysial antibodies in A and G Immunoglobin subtypes for the diagnosis of CD. In this method, the diagnostic sensitivity of CD is high and in the next step, endoscopy and sampling can increase the specificity value. If the tests are not available, preferable tests are IgA subtype antibodies.

    Keywords: Celiac Disease, Children T, issue Transglutaminase, Anti-Endomysial Antibodies
  • Gholamreza Khademi, Mohsen Nematy, Golnaz Ranjbar, Mahdieh Pouryazdanpanah, Rahele Rahimi, Fatemeh Roudi* Page 3
    Context

    Childhood obesity is a serious health problem worldwide and the number of critically ill obese children is rapidly increasing in Pediatric Intensive Care Units (PICUs). Given the importance of optimal energy and nutrient delivery that may lead to improved clinical outcomes in PICUs, we addressed the nutrition support aspects of managing critically ill obese children in PICUs.

    Evidence Acquisition

    This review was conducted on the National Library of Medicine’s PubMed, Scopus, Cochrane, and Embase databases using a combination of relevant MeSH terms and keywords to provide updates on the nutritional management of obese patients in PICUs. The MeSH terms included “Child”, “Pediatrics”, “Infants”, “Obesity”, “Morbid Obesity”, “Obesity Management”, “Complications”, “Nutrition Assessment”, “Diet Therapy”, and “Intensive Care Units”. The keywords were as followed: critical care, critical illness, intensive care enteral and parenteral nutrition, morbidity, and mortality. The reference lists of the relevant articles were also reviewed to ensure adequate study identification. Thereafter, 348 records were identified and screened for eligibility in the title and abstract and duplicate publications were removed. Finally, after assessment for eligibility, 42 relevant articles published in English from 1990 to 2018 were obtained and read thoroughly in the reviewing process.

    Results

    Obese children are at a high risk of nutritional deprivation in PICUs. Obesity, metabolic stress, and inflammation can affect the metabolism of nutrients in critically ill obese children. Screening for potential micronutrient deficiencies, optimal isocaloric feeding with adequate macronutrients, and micronutrients should be considered in critically ill obese children.

    Conclusions

    This review provided recent evidence to help intensivists for initial nutrition assessment and realistic nutrition care planning for critically ill obese children.

    Keywords: Pediatric Obesity, Intensive Care Units, Pediatric, Pediatric Obesity, Nutrition Assessment, Diet Therapy
  • Naeeme Taslimi Taleghani, Minoo Fallahi *, Zahra Soltanttooyeh, Ahmad Reza Shamshiri, Mitra Radfar Page 4
    Background

    Recent advances in medical sciences have increased the survival of premature infants. Long-term follow-up is very important for decreasing the consequences of prematurity.

    Objectives

    The present study aimed at investigating common post-discharge problems of premature neonates.

    Methods

    In this prospective descriptive study, we selected preterm infants with a gestational age of < 34 weeks or birth weight of < 2,000 g referring to a high-risk neonatal follow-up clinic of Mahdieh Hospital from 2016 to 2017. Growth indices and other medical problems were evaluated.

    Results

    Of 140 newborns, 51.4% were males. The mean gestational age and birth weight were 30 weeks and 1,366.99 g, respectively. The mean interval between the discharge and the referral time to the clinic was 6.16 days with a range of 1 to 45 days. The maximum number of visits of a patient to the clinic was 18 times. The first visit occurred at 2 - 3 days after the discharge and the oldest age of patients at outpatient visits was 36 months. Although the growth level of most patients at birth was in the 50th percentile of growth charts, the impairment of growth indices was detected after discharge, particularly in neonates with birth weights of < 1,000 g. The rate of exclusively breastfed infants was 17% while 83% were fed by the formula. Re-admission was observed in 26.4%. Infantile colic, gastroesophageal reflux, respiratory allergy, and hypothyroidism were observed in 25%, 22.1%, 3.6%, and 2.9% of the infants, respectively, and 6.6% needed surgical intervention. The rate of late anemia was 45.7%, with 26.4% requiring packed cell transfusion.

    Conclusions

    Our study revealed that the rate of regular post-discharge follow-ups of preterm infants was low. Regarding growth impairments of preterm neonates, special attention to nutrition is recommended after discharge from the hospital. Given the low rate of exclusive breastfeeding of premature infants, comprehensive planning to raise the rate of feeding with breast milk is very important. Regarding the high rate of anemia and the need for packed cell transfusion, paying attention to good nutrition and iron supplementation is crucial after discharge.

    Keywords: Premature Neonates, Follow-Up, Growth Indices, Neonatal Intensive Care Unit
  • Monavar Afzal Aghaee, Ehsan Mosa Farkhani *, Hamidreza Bahrami Taghanaki, Najmeh Mohajeri, Fatemeh Tavakoli, Sima Barid Kazemi Page 5
    Background

    Exclusive breastfeeding contributes to the health and survival of the newborn. Many factors influence this behavior.

    Objectives

    This study aimed to identify the related determinant factors.

    Methods

    In this case-control study 8130 cases that did not have exclusive breastfeeding at 6 months of age were matched with 53266 people from control group. The two groups were compared in terms of risk factors such as sex, birth rank, weight, height and head circumference, type of delivery, maternal age, hypothyroidism in the infant, mother’s disease, mother’s educational level, job and breastfeeding at night. Bivariate and multivariate logistic regression was applied to determine the association between independent variables and non- exclusive breastfeeding.

    Results

    Ninety % of mothers had exclusive breastfeeding their infants. In multivariate analysis low birth weight (AOR = 2.37; 95% CI: 1.45 - 3.86), head circumferences < 32.5 cm (AOR = 1.84; 95% CI: 1.11 - 3.06), cesarean section (AOR = 2; 95% CI: 1.45 - 2.75), older age (AOR = 1.59; 95% CI: 1.44 - 1.75), being employed (AOR = 1.31; 95% CI: 1.12 - 1.46) and no breastfeeding at night (AOR = 199; 95% CI: 1.48 - 2.69) remained in the final model after adjusting for confounding variables.

    Conclusions

    planning interventions aimed at knowledge promotion, encouraging vaginal delivery, paying attention to employed mothers and mothers without breastfeeding at night could be beneficial in improving exclusive breastfeeding among mothers.

    Keywords: Exclusive Breastfeeding, Case-Control Study, Risk Factors, Infants
  • Naser Honar, Maryam Barkhordarian*, Ahmad Ghanizadeh, Roya Radanfar Page 6
    Background

    The association of the celiac disease with attention deficit hyperactivity disorder (ADHD) is unclear.

    Objectives

    The current study aimed to examine this relationship and the prevalence of the celiac disease in ADHD patients.

    Methods

    From 2016 to 2018, we tested 99 patients aged 4 to 18 years with ADHD diagnosed with clinical interviews for serum IgA and anti-tissue transglutaminase (anti-tTG) antibody for the diagnosis of celiac disease.

    Results

    There was no IgA deficiency in our patients. The prevalence of positive anti-tTG antibody-IgA test was 6.06%, all in boys. The ADHD children with positive test results were significantly heavier and more well-nourished. There was no association between ADHD severity serum anti-tTG antibody positivity.

    Conclusions

    The prevalence of celiac serology was higher in ADHD children than in the general population. Among all symptoms of celiac disease and ADHD, only was body mass index significantly higher in patients with positive serology.

    Keywords: Attention Deficit with Hyperactivity Disorder, Body Weight, Celiac Disease, Immunoglobulins, Prevalence
  • Yazdan Ghandi *, Danial Habibi, Manigeh Kahbazi, Fatemeh Dorreh, Maryam Lotfi Page 7
    Background

    Kawasaki disease (KD) is described as a life-threatening vasculitis, which mostly develops in children below five years of age and is diagnosed according to clinical criteria. It is also a common rheumatologic disorder in Iran.

    Objectives

    The present study aimed at determining the clinical and demographic characteristics of KD patients in Iran.

    Methods

    We retrospectively assessed 69 cases of KD in an Iranian pediatric population from March 2014 to March 2018. The Japanese Kawasaki Disease Research Committee guidelines were used as the diagnostic criteria for typical KD. Incomplete or atypical KD was diagnosed in patients with coronary artery changes, but without all the criteria for KD.

    Results

    In this study, 69 patients were recruited, with a male-female ratio of 1:8. Overall, 64% (n, 44) and 36% of children met the criteria for typical and atypical KD, respectively. Also, echocardiographic abnormalities were reported in eight patients (12%). Coronary artery aneurysm was found in 2% of patients, while other cardiac abnormalities were found in 12% of patients. The male-female ratio of coronary artery anomalies and other cardiac abnormalities was 3:1. Polymorphic exanthema was the most common clinical manifestation. The erythrocyte sedimentation rate ≥ 40 mm/h was the most common laboratory finding, while skin desquamation was the most common complication in other organs.

    Conclusions

    KD is not uncommon in Markazi Province, Iran. In this study, distribution of demographic characteristics was not similar to reports from other countries. Also, clinical findings, age and gender distribution, laboratory findings, and complications in other organs were not similar to previous reports. The incidence of typical and atypical KD was different in this region, especially in terms of complications, such as cardiac and gastrointestinal complications.

    Keywords: Epidemiology, Children, Iran, Kawasaki Disease, Vasculitis
  • Ali Akbar Zeinaloo, Ehsan Aghaei Moghadam, Amir Salimi, Azin Ghamari, Helia Mojtabavi, Amir Bahador Golchin, Shakila Meshkat* Page 8

    Arrhythmogenic Right Ventricular Dysplasia (ARVD) was diagnosed in a nine-year-old boy following the presentation of generalized edema, ascites, and palpitation. Typical signs of ARVD on electrocardiography (ECG) and echocardiography were detected in initial assessments. On echocardiography, severe right ventricle dysfunction, free tricuspid regurgitation, and left ventricle ejection fraction (EF) of 45% - 50% were reported. Cardiac magnetic resonance images showed severely enlarged right ventricle size with severely reduced systolic function. Prolonged episodes of sinus bradycardia and atrial fibrillation were noted at each hospitalization. Severe LV dysfunction and free Tricuspid regurgitation have not heretofore been reported in the medical literature.

    Keywords: Arrhythmogenic Right Ventricular Dysplasia, Cardiomyopathy, Atrial Fibrillation, Case Report, LV Dysfunction
  • Fariba Farnaghi *, Maryam Elyassi, Latif Gachkar, Narges Gholami Page 9
    Background

    Opioid poisoning is a common and fatal poisoning in children in our country.

    Objectives

    This study was designed to compare the effects of intranasal (IN) dribbling with intravenous (IV) injection of naloxone in opioid poisoning in Loghman-Hakim Hospital, Tehran, Iran.

    Methods

    This is a prospective, clinical trial study performed on children between the ages of one to 13 years with opioid poisoning from April 2018 to April 2019 compared to IN naloxone 0.01 mg/kg dribbling versus Intravenous naloxone 0.01 mg/kg injection. Patients with nasal congestion, severe poisoning and co-ingestion were excluded. The main outcomes included GCS, response time, respiratory rate, and O2 saturation. This study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1397.258) and was registered with the Iranian Registry of Clinical Trials (www.irct.ir) (IRCT20180226038869N1).

    Results

    A total of 44 patients (22 IV and 22 IN) with a mean age of 38.2 ± 28.8 months in IV and 36.8 ± 19.7 months in the IN naloxone group, 14 methadone and eight opium poisoning in IV and 13 methadone and nine opium poisoning in the IN group. The male/female ratio was 14/8 in both groups. There were no statistically significant differences between the two groups in RR, GCS, and O2 saturation before naloxone administration. The IV and IN groups had similar average increases in RR, O2 saturation and GCS after naloxone administration. There was a significant difference in the time of response between the two groups (P < 0.008), 3.9 ± 3 minutes in IV group and 5.9 ± 2.9 minutes in the IN group. No complications were observed in this study.

    Conclusions

    This study showed that Intranasal naloxone is safe, effective, and a well-tolerated needleless method for opioid poisoning in children. Although the time to response was longer in the IN groups, if we add the time needed for IV catheter insertion it seems that the IN route is faster.

    Keywords: Poisoning, Children, Opioid, Naloxone, Intranasal
  • Kalenahalli Jagadishkumar *, Nanda Nataraj, Usha Rani Dasappa Page 10

    Co-infections are common in tropical countries and can be present with the overlapping of clinical features. The diagnosis of co-infection poses a challenge to the treating physician. We report a varicella child who was presented with persisting fever even after the formation of scabs along with conjunctival suffusion. Her platelets were persistently less than 50000/mm3 for 3 days and her serology was positive for the dengue infection.

    Keywords: Varicella, Dengue, Co-Infection