فهرست مطالب

  • Volume:20 Issue: 3, 2020
  • تاریخ انتشار: 1399/03/13
  • تعداد عناوین: 9
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  • Ahmad Mohammadipour, Mehran Hiradfar, Reza Shojaeian* Page 1
    Background

    Gastroschisis is an abdominal wall defect that is managed by surgical reduction of herniated bowel into the abdominal cavity and abdominal wall reconstruction. Loss of abdominal domain is the main challenge that may complicate the process of gastroschisis management.

    Objectives

    This article is about innovative manure called total bowel washing (TBW) that may improve the outcome of gastroschisis primary repair.

    Methods

    All neonates with gastroschisis who met the study inclusion criteria between 2006 - 2019 were enrolled and divided into two groups of conventional and TBW method of gastroschisis management. In TBW group, bowls were washed with warm saline and after a gentle enterolysis, the whole gastrointestinal tract was irrigated via a gastric tube and evacuated completely from thick meconium until the watery stool started to come out of anus slightly. Primary abdominal wall closure was performed after loop by loop bowel reduction. Gastroschisis management outcome was compared between the two groups.

    Results

    15 neonates were allocated in each group. Demographic and anthropometric variables were compared and any significant difference wasn’t reported between the two groups. We observed a significantly better outcome in terms of faster GI rehabilitation, shorter time to oral feeding tolerance, less need to silo placement and shorter NICU and hospital stay in TBW method. Operation time was slightly longer in TBW group while the difference was not significant statistically.

    Conclusions

    Total bowel washing and complete evacuation of gastrointestinal tract from thick meconium will increase the success rate of primary repair and improve the outcome of gastroschisis management.

    Keywords: Neonate, Pediatrics, Surgery, Congenital Anomaly, Gastroschisis
  • Elif Gudeloglu *, Davut Albayrak Page 2
    Background

    Along with lack of studies that systematically address the transfusion requirements and triggers in acute leukemia, no study to date has addressed the blood product use with respect to ongoing chemotherapy (CT) in pediatric acute lymphoblastic leukemia (ALL) patients.

    Objectives

    This study was therefore designed to evaluate total erythrocyte, random platelet and apheresis platelet suspension requirement in pediatric ALL patients in relation to ongoing CT protocols.

    Methods

    A total of 146 pediatric patients with ALL were included in this retrospective study. Data on patient demographics, CT protocol, amount and efficacy of blood product use (erythrocytes, apheresis platelet and random platelet), and survival during CT were retrieved from hospital records.

    Results

    The average amount of erythrocytes, apheresis platelets and random platelets received by 146 ALL patients from the date of diagnosis were 14 (3 - 78) bags, 9 (1 - 97 bags and 11 (1 - 83) bags, respectively. Protocol 1b augmented was associated with the highest amount of erythrocyte use (P < 0.001), while no significant difference was noted in apheresis platelet and random platelet use with respect to CT regimens. Erythrocyte transfusion was associated with a more marked increase in hemoglobin (Hb), erythrocyte (RBC), leukocyte (WBC), lymphocyte and neutrophil counts as compared with apheresis platelet and random platelet infusions, while protocol 2 was associated with higher Hb (P = 0.017) levels after erythrocyte transfusion.

    Conclusions

    Our findings indicate a great amount of blood product transfusion to be required in children with ALL under CT and emphasize the likelihood of transfusion need and efficacy of transfusion to alter with respect to ongoing CT regimen. The need in patients using augmented BFM protocol 1 b was highest, and albeit the need of blood and blood product transfusions vary within patients, the anticipated median need for blood products at diagnosis and at various blocks of treatment may be helpful for the blood banks, doctors of the respective pediatric hematology-oncology centers to plan as patients are treated.

    Keywords: Child, Acute Lymphoblastic Leukemia, Chemotherapy, Blood Transfusions
  • Mansour Molaeian *, Farid Eskandari, Hojattollah Raji, Maryam Ghavami Adel *, Arash Mollaeian Page 3
    Objectives

    Reconstruction of ventral penile skin, in midshaft and distal hypospadias is problematic in many cases of severe ventral dysplasia. So we plan to use the tailored preputial skin island flap (PSIF) to cover the ventral defect.

    Methods

    In this prospective cohort study 224 boys with midshaft and distal hypospadias associated with sever ventral dysplasia were operated from March 2009 until January 2016. The large U-shaped bare area which exposed on the ventrum after release of curvature was quilted by the PSIF as a patch. In each case, the variable size of the flap was required. The prepuces without the predominant artery were excluded from the study due to poor vasculature. The patients followed for 8 months to 7years.

    Results

    Flap ischemia developed in 7 initial cases (3.125%), all of which subsequently faded. Some degree of ischemic discoloration was encountered at margins of the flap (12 cases, 5.3%), which resolved spontaneously. In 5 out of 224 patients (2.23 %), the flap persisted as a hypertrophied area of skin in the long-term follow-up. All of them needed to be corrected surgically. Near normal appearing penile skin was accomplished in the majority of patients during the follow-up. However, lack of the median raphe in the ventrum was evident in all.

    Conclusions

    Tailored preputial skin island flap, as a native tissue to cover the exposed large bare area on the ventrum in cases of the distal and mid hypospadias with severe ventral dysplasia may improve the appearance and adequacy of the penile skin. It provides room for full erection and improves the patient’ s perception of body image and self-esteem.

    Keywords: Hypospadias, Reconstruction of Ventral Penile Skin, Island Flap, Preputial Flap
  • Alejandra Rodríguez Fernández*, Eduard Maury Sintjago, Julio Parra Flores Page 4
    Objectives

    Adolescent smoking is a major health care concern which calls for a more in-depth study of the factors affecting this pediatric disease. We aimed to determine the prevalence of tobacco use among Chilean adolescents aged 13 - 14 and its association with family and school factors.

    Methods

    This was a cross-sectional analytical study. Data from the Eleventh Chilean National Study of Drugs in the School Population 2015 were used (n = 11,791). School and family variables of parental control were evaluated and analyzed by the chi-Square test and a multivariate logistic regression model. Data were processed with the STATA V. 14.0 software at the α = 0.05 level of significance.

    Results

    The prevalence of tobacco use at some time during life was 36% with onset age of 11.4 ± 3.6 years. Girls smoke proportionally more than boys (40.5% and 31.5%, respectively). Parental monitoring decreased use and acted as a protective factor (OR: 0.41, 95%CI: 0.375 - 0.468); likewise for good school performance (OR: 0.52, 95%CI: 0.475 - 0.584). In turn, running away from school raises the risk of smoking (OR: 2.34, 95%CI: 2.03 - 2.72).

    Conclusions

    There is a feminization of cigarette use, and the risk of cigarette smoking increases considerably among adolescents who run away from school. However, parental control and school performance are powerful protective factors against early tobacco use.

    Keywords: Risk Factors, Adolescents, Smoking, Parental Control, School Performance
  • Seyed Ali Alamdaran *, Marjan Joudi Page 5

    We have completed the study entitled “Ultrasound Guided Wire Localization of Anal Tract in Imperforate Anus” by Alamdaran SA, Joudi M, et al. published in the Iran J Pediatr 2018; 28(4): e65338 (1). We would like to add some commentary to it. Continence in patients with imperforate anus is related to exact anus reconstruction from middle of sphincter complex. We designed this study with purpose to investigate the ability of ultrasound in detection of the location and pathway of sphincter muscle complex in children with Imperforate Anus. Our ultrasound findings in this study included (1) concentric multi-layered structures in subcutis (probably anal pit). (2) Concentric multi-layered structures in depth of pelvic floor (probably anal sphincter complex). (3) Difference in distance of rectal pouch and the surface of skin through probably anal pit and anal sphincter complex pathway with the shortest distance. (4) The ability to differentiate the types of internal fistula. We also found four sonographic diagnostic pitfalls in these patients: 1. Difficulty of differentiation of muscle complex sphincter from other tissues by ultrasound; in adult, hypoechoic muscles is completely differentiable from echogenic fat, but in infants, iso-echogenicity of muscle sphincter complex with perineal fat is problematic and questionable. In addition, decreasing resolution of ultrasound images with increasing depth cause poor visualization of deep muscle sphincter, especially in high type. 2. Similarity of appearance of muscle sphincter complex with ectopic rectal pouch of the high type IA with perineal fistula mimics the gut signature appearance of concentric multi-layered structures and may be wrongly mistaken for low type of anomaly. 3. In literature, there are various cut offs for distance between rectal pouch and the surface of skin: some diagnostic cut off overlaps from 5 mm until 25 mm to determine the level of anorectal malformations (low and high). In addition, different measurement methods (the shortest distance or the distance obtained using anal sphincter complex pathway) render different distances (2-6). 4. Pressure of ultrasound probe or saline infusion through distal colostomy was the cause of underestimating the distance between rectal pouch and the surface of skin. The surgical distance is longer than the ultrasound distance. Although these ultrasound findings could help to determine the level and type of disorder in order to plan and select the less invasive surgical technique, even to choose image guided surgery (6), it has a number of diagnostic pitfalls that can lead to serious diagnostic error. For better understanding these sonographic findings and decreasing of pitfalls further research is proposed.

  • Zhoupeng Wu, Yukui Ma* Page 6
  • Asadollah Kermani, Kokab Namakin *, GholamReza Sharifzadeh, GholamReza Faal Page 7
    Background

    Coronary heart diseases (CAD) and their risk factors are among the major causes of death in Iran. Since these risk factors begin to develop early in life, it is vital to diagnose those newborns at high risk of CAD.

    Objectives

    The present study investigated the umbilical cord blood lipid profile of term and preterm neonates.

    Methods

    In this cross-sectional study, the lipid profiles of 292 neonates, of which 276 were term and 16 preterm, were examined at a teaching hospital.

    Results

    The lipid profile results of total cholesterol, triglycerides, high density lipoprotein, and low density lipoprotein were 69.8, 34.9, 23.6, and 31.5 in term neonates and 80.5, 25.5, 25.1, and 38 in preterm neonates, respectively.

    Conclusions

    According to the current paper, the lipid profiles of eastern Iranian neonates were similar to those reported in global studies. Moreover, except for triglycerides in the female neonates, lipid profiles were significantly higher among the male neonates.

    Keywords: Neonate, Coronary Artery Disease, Lipid Profile, Umbilical Cord Blood
  • Mahtab Mohammadi, Seyed Ali Mohammad Arabzadeh, HamidReza Mollaei *, Seyed Hamidreza Monavari, Najmeh Nikpour Page 8
    Background

    Human coronavirus NL63 (HCoV-NL63) is a new respiratory virus associated with acute respiratory infection in children. Infection with this virus is usually accompanied by upper and lower infections of the respiratory tract in adults.

    Objectives

    In a retrospective study, we investigated the incidence of coronavirus infection in children under the age of five years.

    Methods

    We collected 138 specimens (nasal and throat swabs) from children less than five-years-old with acute respiratory infection from October 2018 to December 2019. Then, HCoV-NL63 was investigated using real-time PCR.

    Results

    Out of 138 samples, 33 (23.9%) were positive for coronavirus NL63, including 21 (63.6%) male samples and 12 (36.4%) female samples. There was no significant correlation between gender and positivity for coronavirus infection (P > 0.05). However, the association of clinical symptoms with the virus was statistically significant (P < 0.05).

    Conclusions

    This study was conducted for the first time in Kerman Province. In this study, the frequency of coronavirus NL63 was evaluated among children with acute respiratory infection with a highly sensitive method, real-time PCR. The prevalence of this virus was 33%, which was more frequent than in similar studies.

    Keywords: Children, Iran, Respiratory Infection, Coronavirus, NL63
  • Seongmin Ro, Jungmin Lee, In Cheol Hwang * Page 9
    Background

    Previous research on sleep debt has neglected considering sleep duration on weekdays as a contributing factor.

    Objectives

    This cross-sectional study investigated the relationship between sleep debt and mental health in school-age adolescents, taking weekday sleep deficits under consideration.

    Methods

    We identified 1,392 students who had provided data on sleep duration from the 2016 - 2017 for Korea National Health and Nutrition Examination Survey (KNHANES). A stepwise multivariate logistic regression analysis was used to examine the independent effect of sleep debt on perceived stress or depressive mood.

    Results

    Individuals with poor mental health sleep less on weekdays, resulting in more sleep debt. Final regression models that were adjusted for potential covariates revealed that poor mental health was associated with shortened sleep on weekdays but was not associated with overall sleep debt.

    Conclusions

    Our result suggests that efforts should be made to lengthen sleep on weekdays, not on weekends, to lower stress or depressive mood among adolescents.

    Keywords: Adolescents, Mental Health, Sleep, Sleep Deprivation, Sleep-Wake Disorders