فهرست مطالب

Pediatrics - Volume:13 Issue: 1, 2020
  • Volume:13 Issue: 1, 2020
  • تاریخ انتشار: 1398/12/06
  • تعداد عناوین: 13
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  • Yasin Sahin*, Meltem Didem Cakir, Derya Aydin Sahin Page 1
    Background

    Type 1 Diabetes Mellitus (DM), autoimmune disorders, relatives of celiac patients have higher risk of developing celiac disease (CD) because they share the same HLA type. Celiac disease and type 1 DM are autoimmune and common in children. According to international guidelines, serological screening for CD in children and adults with type 1 DM is recommended but there is no consensus on how often it will be performed.

    Objectives

    We aimed to investigate the prevalence of CD in children with type 1 diabetes mellitus (DM).

    Methods

    This current study was carried out between 01 March 2017 and 15 December 2018. 273 children with type 1 DM were included in the study. Tissue transglutaminase antibody IgA (tTG IgA) and total IgA levels were measured in all patients. The patients with tTG IgA positivity underwent gastroduodenoscopy.

    Results

    Of the 273 patients (139 girls), the mean age was 11.61 ± 3.73 years. tTG IgA was positive in 23 patients, and 2 of them refused the process of endoscopy. Gastroduodenoscopy was performed on other patients. 11 patients with Marsh 3, 2 patients with Marsh 2, 4 patients with Marsh 1, and 4 patients with Marsh 0 were detected in the present study. In other words, 12 patients were diagnosed with CD. Nine of 12 patients diagnosed with CD were diagnosed within the first 5 years after the diagnosis of type 1 DM.

    Conclusions

    We found that the prevalence of biopsy-proven CD in children with type 1 DM was 4.4%, which was approximately 9 times higher than the prevalence of CD in the general population. In the current study, 9 of 12 patients diagnosed with CD were diagnosed within the first 5 years after DM. According to our results, we recommend that screening tests for CD should be performed at least once a year for 5 years in children with Type 1 DM, even if the patients are asymptomatic.

    Keywords: Type 1 Diabetes Mellitus, Celiac Disease
  • Sedat Isikay*, Ilhan Bahsi, Mustafa Orhan, Seval Kul, Nese Kizilkan, Halil Kocamaz, Murat San Page 2
    Objectives

    To examine the craniofacial morphologic features of children with celiac disease and to investigate the presence of specific features in this disease.

    Methods

    Totally 100 celiac patients between the ages of 3 and 17 years who were diagnosed with celiac disease by biopsy and 100 healthy age- and sex-matched children were included in the study. Photographs of the children were taken using a SLR digital camera by one and the same person at a natural head position. The parameters specified on the photograph were measured with ImageJ 1.50b software. Twenty eight landmarks were identified on the photos. Using these landmarks, 41 distances and 5 angles were measured. Thirty eight anthropometric ratios were calculated.

    Results

    Twenty seven distances, 1 angle and 9 ratios were determined shorter; 3 distances, 2 angles and 7 ratios were determined larger in patients with celiac disease compared with the healthy individuals. These differences were statistically significant.

    Conclusions

    There were significant alterations in some craniofacial morphometric parameters in children with celiac disease when compared with healthy controls. However, since the data is limited, a clear conclusion could not be achieved about a morphological feature directly associated with celiac disease in children. Further prospective studies with longer follow-up periods are warranted to determine the effects of celiac disease on craniofacial morphological measurements.

    Keywords: Celiac Disease, Craniofacial Morphometry, Facial Analysis
  • Hassan Boskabadi, Majid Ghayour, Mobarhan, Fatemeh Bagheri, Nafiseh Pourbadakhshan* Page 3
    Background

    Jaundice can be observed in two-thirds of infants. Bilirubin prevents damage to the DNA from the oxidative stress of reactive oxygen species (ROS). Moreover, bilirubin has anti-inflammatory and anti-apoptotic roles in addition to antioxidant properties.

    Objectives

    We decided to compare pro-oxidant-antioxidant balance (PAB) in physiologic and pathologic jaundice.

    Methods

    This cross-sectional study evaluated 171 infants more than 35 weeks of gestational and > 2 days of postnatal age who were admitted to the Ghaem Hospital with jaundice from 2017 to 2019. Infants with bilirubin levels less or equal to 14 mg/dL on the jaundice meter were put in the physiologic jaundice group and infants with bilirubin higher than 15 mg/dL on the jaundice meter were entered into the study as the pathologic jaundice group. A questionnaire containing data regarding neonate’s characteristics and the mother’s medical history was filled out for each infant. Bilirubin levels, hematocrit, direct and or indirect Combs, reticulocytes, and PAB were evaluated in the case group.

    Results

    The average age of the enrolled neonates was 7.3 ± 4.11 days and 52.4% of them were male. Between two groups of physiologic and pathologic jaundice, gestational age (P = 0.010), parity (P = 0.001) and PAB (P = 0.000) were significantly different. Overall, the amounts of the mentioned parameters in the pathologic jaundice group were less than the physiologic jaundice group.

    Conclusions

    A pathological increase in bilirubin levels irrespective of its neurotoxic properties can change the pro-oxidant-antioxidant balance in favor of antioxidants. It seems that neurotoxic mechanism of bilirubin in pathological amounts differ with its antioxidant effects.

    Keywords: Hyperbilirubinemia, Infants, Physiologic Jaundice, Pro-Oxidant-Antioxidant Balance (PAB), Pathologic Jaundice
  • Cheng Yi Wang*, Chao Min Song, Shi Biao Wang, Guang Hua Liu Page 4
    Background

    Serum prealbumin (PA) levels have been found to have prognostic value in patients with infectious diseases.

    Objectives

    We aimed to determine the relationship between PA levels and clinical outcomes in children with severe Mycoplasma pneumoniae pneumonia (MPP).

    Methods

    We retrospectively reviewed the data of 163 children with severe MPP who were treated in our hospital from January 2015 to December 2017. The demographic and clinical data of the subjects were collected and statistically analyzed.

    Results

    Our cohort was divided into quartiles by PA level. The average D-dimer level, pediatric risk of mortality (PRISM) III score, total length of stay in hospital (TLSH), C-reactive protein/PA ratio, and proportion of patients with invasive intubation significantly decreased as the serum PA level increased. In addition, the PRISM III estimated mortality and the procalcitonin/PA ratio significantly differed among the four PA groups. Binary logistic regression analysis showed that PA level (odds ratio [OR]: 0.846, 95% confidence interval [CI]: 0.773 - 0.926, P = 0.000) and invasive intubation (OR: 4.581, 95% CI: 1.730 - 12.124, P = 0.002) were independently correlated with PRISM III scores. Multiple linear regression analysis showed that PA level (β = -0.025, 95% CI: -0.048 to -0.002, P = 0.032) was negatively associated with the normal score of TLSH calculated using the Blom formula.

    Conclusions

    The present study demonstrated that in children with severe MPP, low PA levels correlated with increased PRISM III scores and prolonged TLSH, suggesting that low PA levels contribute to the progression of severe MPP and possibly lead to poor outcomes.

    Keywords: China, Severity, Mycoplasma pneumoniae, Retrospective, PRISM III, Prealbumin
  • Nahid Ramazani *, Shamim Mollaei Nezhad Page 5
    Background

    Maintaining an adequate coronal sealing is of a great importance and is the necessary prerequisite to maximize the long-term success rate of pulpotomy.

    Objectives

    To compare the clinical and radiographic success of pulpotomized primary molars restored with stainless steel crown (SSC) versus glass ionomer (GI)-SSC.

    Methods

    In this clinical trial, 47 children with age range of 4 - 8 years, requiring pulpotomy for both primary mandibular second molars were recruited. Teeth were randomly treated either with one of the two procedures including pulpotomy-SSC or pulpotomy-GI-SSC using a split mouth design. For each tooth, formocresol pulpotomy was performed and hard-setting zinc oxide eugenol was used as pulp dressing material. The whole for each tooth was completed in one session. One week interval was scheduled between two sides. Clinical and radiographic success rate was evaluated 6 months post-operatively. The date was analyzed using Fisher’s exact test at the significant level of 0.05.

    Results

    At the end of evaluation, no clinical failure was observed in both treatments. Among the two, no significant difference was detected in terms of radiographic success rate (P = 0.198).

    Conclusions

    Due to no significant difference between two restoration techniques, longer period of follow-up is recommended to evaluate the role of restoration on the outcome of the primary teeth pulpotomy.

    Keywords: Glass Ionomer Cements, Primary Molars, Pulpotomy
  • Asadolah Tanasan, Hossein Esfahani*, Saeede Shirdel, Abbas Moradi Page 6

    Down syndrome (DS) or trisomy 21 is the most common type of trisomy among children. Almost half of these patients are at risk for congenital heart disease, and a minority of them may suffer from leukemia. The association of congenital heart disease and leukemia may be life threatening. It is important to determine the factors that increase leukemia in CHD. In this descriptive cross-sectional research, all patients with Down syndrome who referred to Neonatal, Pediatrics, Pediatric Cardiology, and Hematology Departments of Besat Hospital of Hamedan from 2010 to 2017 were included. Patients’ data were obtained from paper and electronic records or phone calls (if needed), and then the data was analyzed. We used odd ratio and confidence interval to study the risk increase of leukemia. Total number of patients diagnosed with Down syndrome was 118 cases. 98 (83%) cases had congenital heart disease, among them 33 cases (33.6%) had history of angiography. The most common cardiovascular diseases were AVSD (30.6%), TOF (16.3%), ASD 2 (16.3%), and VSD (15.3%), PDA (14.2%). The most common type of leukemia was ALL. Among CHD (congenital heart disease) patients, 92 (78%) cases suffered only from congenital heart disease, and 6 (5.08%) of them had leukemia and congenital heart disease simultaneously, among them 4 (66%) patients had history of angiography (P = 0.078). Two cases had leukemia without CHD. The odds ratio of leukemia in patients with DS, in association of congenital heart disease was 1.70, and in patients who had history of angiography it was 3.93 with 95% confidence interval (0.686 - 22.63) (P > 0.05). Although angiography didn’t statistically increase risk of leukemia in DS (P = 0.078), this risk increase can be clinically important.

    Keywords: Leukemia, Down Syndrome, Congenital Heart Defect (CHD)
  • Jose de Jesus Loeza, Evangelina Montes, Ilse Andrade, Elizabeth Cortes, Diana Reyes, Jenny Vazquez, Carlos Pérez* Page 7
    Background

    Cancer is the leading cause of death in children around the world. The highest incidence of cancers in children belongs to leukemia and germ cell tumors (GCT); on the other hand, some studies point out that GCT occupies the ninth place of prevalence. Due to their peculiar features and the frequency found in this study, the research on GCT is a matter of great importance.

    Objectives

    To study and describe the epidemiological features of GCT in a tertiary hospital in Veracruz, Mexico.

    Methods

    Descriptive statistics of GCT in a Mexican hospital, arranged by gender, residence area and diagnosis year, and implementation of a Bayesian network of risk factors for this population.

    Results

    Out of 801 pediatric cancers recorded in the study period, 87 were germ cell tumors, ranking this tumor as the second most prevailing cancer in this hospital. The most frequent histological type for these tumors was mixed germ tumor (31.58%). The region of the state of Veracruz presenting the highest number of patients with GCT in this hospital was the central zone with 56.72%. The Bayesian network showed that the location of the tumor had a probabilistic relationship with the histological type and the histological type with patient gender. Also, the geographical zone is directly related to the GCT stage.

    Conclusions

    In this study GCT ranked second in prevalence at this hospital. This number is the highest ever reported in the world. In 2012, 6 cases of GCT were recorded, while in 2015, 11 cases were reported. These numbers show an increase in the GCT prevalence in the population during that time frame. Risk factors, like tumor location and geographical zone, were pinpointed, which, as a whole, can be useful for diagnosis, treatment, and monitoring of patients suffering from this pathology.

    Keywords: Prevalence, Germ Cell Tumor, Bayesian Network, Cancer
  • Asadolah Tanasan, Fatemeh Eghbalian*, Mohammad Kazem Sabzehei, Alireza Rastgoo Haghi Page 8
    Background

    Some of the severe diseases in the neonatal period lead to a myocardial injury that, if not detected promptly, would affect prognosis. Detection of acquired myocardial injury in the early stages of the diseases may be possible with simultaneous examination by echocardiography and determination of serum troponin I levels.

    Methods

    In this cross-sectional study, between December 2016 and December 2018, myocardial function of 60 (33 males, 27 females) term neonates with a mean birth weight 3175.5 ± 441.18 grams who were at least 72 hours under ventilation, was studied using conventional and tissue Doppler echocardiography and measuring serum troponin I levels by ELFA method.

    Results

    Mean and standard deviation of serum troponin I level, left and right MPI in neonates under study were 0.22 ± 0.64, 40.11 ± 0.11, and 0.41 ± 0.13, respectively. The correlation coefficient between serum troponin I level related to right MPI was +0.502 (P < 0.001) and left myocardial performance index was +0.524 (P < 0.001), and other criteria correlated to troponin I on right side of heart were Em, Sm, TAPSE, TR gradient in patients with PH was related to troponin I levels (P < 0.001).

    Conclusions

    Serum level of troponin I is helpful in determination of right and left myocardial dysfunction especially in the presence of pulmonary hypertension in the neonates under mechanical ventilation.

    Keywords: Mechanical Ventilation, Neonates, roponin I, Myocardial Function
  • Gülşah Duyuler Ayçin* Page 9
    Background

    Local anesthetics are used to provide effective analgesia for many dental, surgical, and dermatologic procedures. Local anesthetics constitute the most commonly used drug group in dentistry.

    Objectives

    The aim of this study was to evaluate the results of skin tests with local anesthetics and to investigate the factors associated with these results in patients in the Faculty of Dentistry who were referred to allergy specialists due to a history of allergy. We aimed to evaluate the results of the test with local anesthetics in patients with a history of atopy.

    Methods

    The results of prick and intradermal tests with local anesthetics of patients in whom surgery could not be performed due to their or their relatives’ allergic disease and who were sent to allergy outpatient clinic for testing with the local anesthetics that were planned for use in the Faculty of Dentistry between December 2017 and December 2018 were analyzed.

    Results

    Eighty-two patients were tested with local anesthetics. In 71 (86.5%) of these patients, no allergy was detected as a result of prick test and subsequent intradermal test. In the study group, prick test was positive in 1 patient (intradermal test was also found positive in this patient), and the intradermal test was found positive with 1:100 concentrations in 11 (13.4%) patients.

    Conclusions

    Test positivity with local anesthetics was not significant in patients with history of drug allergy, and history of allergy with local anesthetics. Intradermal test positivity was found to be statistically significant in asthma patients. Treatment should be initiated before dental intervention in atopic patients after having the necessary consultations, and treatment should be initiated with local anesthetic agents associated with fewer reactions in emergency situations in risky patients.

    Keywords: Child, Anaphylaxis, Allergy, Local Anesthetics
  • Guojun Kang, Qi Kang, Xiaojing Zhu, Rixin Li, Shangchao Zhang, Yaoyao Sun, MIngyuan Zhang, Xin Chen, Yueying Wang, Huiyi Jiang, Yaqin Yu, Qiong Yu * Page 10
    Objectives

    The aim of this study was to investigate the association between 2 single-nucleotide polymorphisms (SNP) of HLA-B and autism spectrum disorder (ASD).

    Methods

    We enrolled 84 ASD and 182 healthy children in case-control study, and 67 family trios in family-based study. Two tag SNPs (rs1058026, rs2770) in gene HLA-B were selected to determine the association with ASD. Chi-square test was used in case-control study, haplotype relative risk test (HRR) and transmission disequilibrium test (TDT) analysis were performed in family-based study.

    Results

    SNP rs1058026 was found significantly associated with ASD in family-based study (P = 0.016 for HRR; P = 0.020 for TDT), but not in case-control study. Conversely, SNP rs2770 did not show association with ASD in both studies.

    Conclusions

    The association observed from this study indicates that gene HLA-B might play a role in ASD in Chinese population.

    Keywords: Autism Spectrum Disorder, Human Leukocyte Antigen, Single-Nucleotide Polymorphisms, HLA-B
  • Mohammad Reza Mirzaaghayan, Azin Ghamari, Ehsan Aghaei Moghadam*, Amir Salimi Page 11
    Background

    Patients with congenital heart disease (CHD) are susceptible to mild malnutrition up to failure to thrive. The prevalence of malnutrition among patients with CHD is higher in developing countries. Many factors are considered to affect the nutritional status such as cyanosis.

    Objectives

    This study aims to assess the prevalence and severity of malnutrition in patients with CHD prior to the surgical corrective or palliative repair.

    Methods

    This study was performed by reviewing inpatient medical records and cardiac surgery databases of children with cyanotic CHD who underwent palliative or corrective surgery between March 2011 and March 2017. Patients’ age and height at the time of surgery, birth weight, duration of intensive care unit (ICU) stay and 30-day mortality were extracted and weight for age z score (WAZ), weight for length z score (WLZ) and length for age z score (LAZ) were calculated. Z scores above -1 were considered as normal, between -1 and -2 as mild, between -2 and -3 as moderate and below -3 as severe malnutrition.

    Results

    In a total number of 639, the average age, weight and height were 16.688 ± 24.859 months, 7.509 ± 5.629 kilograms and 73.759 ± 95.869 centimeters, respectively. The average length of ICU stay was 8.36 ± 6.254 days and the 30-day mortality was 36 (5.7%). The average WAZ, LAZ, WLZ and BMI Z was -1.5 ± 1.69, -0.9 ± 2.38, -1.2 ± 3.97 and -1.4 ± 2.11, respectively. Regarding WAZ, LAZ, WLZ and BMI Z, 62.2%, 46.1%, 72.3% and 70.9% of patients had mild to severe forms of malnutrition, since the rate of malnutrition based on WAZ (P = 0.001), LAZ (P < 0.0001), WLZ (P < 0.0001) and BMI Z (P = 0.007), was significantly higher than normal subjects.

    Conclusions

    The prevalence of mild to severe forms of malnutrition, based on different growth indices, for both cyanotics and acyanotics are higher than those reported in the other previous studies. These findings reflect the fact that cultural, genetic and racial differences of Iranians compared to others, cause malnutrition to be more frequent in Iranian CHD children. This calls for higher requirement of nutritional support for these patients.

    Keywords: Malnutrition, Growth, Cyanosis, Congenital Heart Diseases, Non-Syndromic CHD
  • Neda Pak *, Bahar Allahverdi, Sare Moslemi, Parastoo Rostami, Mehrzad Mehdizadeh, Fatemeh Zamani, Azadeh Sayarifard Page 12
    Background

    Childhood obesity is a risk factor for cardiovascular diseases, hypertension, diabetes and non-alcoholic fatty liver. Early diagnosis of obesity complications in children can be helpful for more effective treatment.

    Objectives

    The present study aimed to evaluate the relationship of body mass index (BMI), fatty liver, lipids profile, carotid arteries intima-media thickness and thickness of subcutaneous visceral fat by using the ultrasound.

    Methods

    Sixty one obese children (BMI > 95th) were enrolled in the study. The ultrasound was performed to evaluate the presence and degree of fatty liver in all cases and also for measuring the subcutaneous tissue which was measured in the middle regions of the abdomen and the right flank and visceral fat thickness along with carotid arteries intima-media thickness. The lipids profile (TG, Chol, LDL, HDL) was measured after 12-hour fasting in all cases.

    Results

    A significant increase in the degree of fatty liver was observed with increasing subcutaneous and visceral fat thickness (P < 0.001), but these correlations were not considerable for carotid arteries intima-media thickness. A linear relationship with a positive trend was seen between the BMI and degree of liver steatosis. The visceral fat thickness showed a significant correlation with lipids profile.

    Conclusions

    The present study revealed significant relationships between thickness of visceral and subcutaneous fat, grade of fatty liver, and lipids profile in children.

    Keywords: Pediatrics, Obesity, ntima-Media Thickness, Fatty liver, Subcutaneous Fat
  • Marieh Honarmand* Page 13