فهرست مطالب

  • Volume:30 Issue: 5, 2020
  • تاریخ انتشار: 1399/06/29
  • تعداد عناوین: 12
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  • Somayeh Moazami Goudarzi, Ahya Abdi Ali *, Mohammadreza Modaresi, Tooba Ghazanfari Page 1
    Background

    Cystic fibrosis (CF) is an autosomal recessive disease characterized by respiratory, gastrointestinal, and reproductive tract problems. Patients with CF often suffer from chronic pulmonary infections due to the Pseudomonas aeruginosa, which frequently ends in pulmonary exacerbations. With their anti-inflammatory, anti-virulence, and anti-biofilm properties, macrolides such as azithromycin (AZM) play a beneficial role in the treatment of CF.

    Objectives

    We evaluated the ability of biofilm formation among P. aeruginosa isolates from CF patients and compared the anti-bacterial and anti-biofilm effect of the AZM on them.

    Methods

    Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of AZM against 21 P. aeruginosa isolates from Iranian CF patients were determined. Then, we investigated the ability of biofilm formation by P. aeruginosa and also anti-biofilm effect of AZM on biofilm producing P. aeruginosa isolates.

    Results

    The results showed a high level of AZM MIC (≤ 512 µg/mL) and MBC (≤ 2048 µg/mL) against P. aeruginosa isolates. Most isolates (70%) were biofilm producers, 20% being strong producers. The AZM anti-biofilm effect showed that sub-MIC concentration (≤ 64 µg/mL) could inhibit biofilm production.

    Conclusions

    P. aeruginosa isolated from CF patients showed a high level of MIC and MBC for AZM that indicated a weak anti-bacterial effect of AZM. However, AZM inhibited biofilm formation in low doses; this might lead to dangerous chronic pulmonary infection by P. aeruginosa.

    Keywords: Cystic Fibrosis, Biofilm, Pseudomonas aeruginosa, Azithromycin, Anti-Biofilm, Anti-Bacterial Effect
  • Azadeh Sayarifard, Fatemeh Sayarifard *, Maryam Nazari, Morteza Nikzadian, Mona Amrollahinia, Javad Mahmoudi Gharaei Page 2
    Background

    Studies have indicated that diabetic children are at risk of developing other diseases such as depression.

    Objectives

    This study was conducted to determine the prevalence of depression in diabetic children and identify factors that influence it.

    Methods

    This cross-sectional study was performed on 125 diabetic children in the 7 - 16 age range who had attended the Endocrinology and Metabolism Clinic of the Children’s Medical Center affiliated to Tehran University of Medical Sciences. Children’s Depression Inventory (CDI) was used to assess depression.

    Results

    The study showed 44% of the children were nondepressed, 14.4% depressed and 41.6% borderline. Depression in the diabetic children was not significantly associated with age, gender, injection tools, socioeconomic status, body mass index, number of siblings, disease duration, frequency of injections, number of injected units, and frequency of blood glucose monitoring. Depression was significantly associated with the level of mother’s education (P < 0.001), father’s education (P = 0.01), frequency of hospitalization (P = 0.04) and level of HbA1c (P = 0.03).

    Conclusions

    According to the results of the study, metabolic control reduces the HbA1c level and the frequency of hospitalization, thereby mitigating the risk of depression in the diabetic children. The educational level of parents, especially mother, is also effective in minimizing this risk in diabetic children.

    Keywords: Children, Depression, Diabetes
  • MohammadReza Edraki, Reza Dehdab, Nima Mehdizadegan, Hamid Mohammadi *, Hamid Amoozgar, Gholamhossein Ajami, Reza Bahrami Page 3
    Background

    The definite treatment of tetralogy of Fallot (TOF) as the most common cyanotic congenital heart disease is open heart surgery and the operation technique depends on the coronary artery anatomy.

    Objectives

    We aimed to evaluate the sensitivity and specificity of various root Aortogram views to detect abnormal coronary artery configuration and course in these patients.

    Methods

    In this retrospective study, the reports of coronary anatomy in angiography and operation notes of TOF patients since 2005 to 2018 were evaluated. The sensitivity and specificity of the two common root Aortogram views including the left anterior oblique/cranial (LAO/CRA) and left anterior oblique/caudal (LAO/CAU) were determined.

    Results

    Four hundred and fifty one patients with the median age of 28 months (3 - 432 months) were included. All patients had LAO/CRA views and 199 patients had both LAO/CRA and LAO/CAU views. The rate of coronary abnormalities reported by surgery was 8%, and abnormal origin of the left anterior descending artery from the right coronary artery was the most common reported anomaly (4.4%). The sensitivity of the LAO/CAU view was 100%, but LAO/CRA view was about 75% in detecting abnormal coronary configuration. Both of them had excellent specificity (~100%). No significant sex difference was seen between different coronary anatomy abnormalities.

    Conclusions

    The Caudal root angiogram is an essential view to evaluate coronary artery anatomy in TOF patients and it seems that there is no need for other views like lateral view, but relying on LAO/CRA view alone may lead to significant misdiagnosis of the coronary arteries, crossing the right ventricular outflow tract (RVOT).

    Keywords: Tetralogy of Fallot, Angiography, Coronary Artery Anomaly, Cyanotic Heart Disease
  • Tung Yu Lin, Chih Chieh Yang *, Nai Wen Fang, Jenn Tzong Chang, Hsiao Ping Wang, Yee Hsuan Chiou Page 4
    Background

    Detecting early predictors of acute pyelonephritis (APN) is essential for the prognosis, but few studies have focused on young infants specifically.

    Objectives

    The aim of our research was to determine the relationship between APN and laboratory parameters in the age group less than 4 months.

    Methods

    This retrospective study included patients aged less than 4 months with first time febrile urinary tract infection (UTI) between January 2012 and December 2018. White blood cells (WBC), C-reactive protein (CRP), and blood neutrophil/lymphocyte ratio (NLR) were analyzed. Patients were divided into two groups according to the presence of renal defects on dimercaptosuccinic acid (DMSA) scans.

    Results

    In total, 205 patients were screened; 107 patients were in the APN group, and 98 patients were in the non-APN group. Compared with the non-APN group, the APN group showed significant differences in therapeutic response time (TRT), CRP, and NLR (all P values < 0.001). Multiple logistic regression analysis revealed that CRP, NLR, and TRT were independent risk factors for APN (P ≤ 0.001, 0.003, and 0.004, respectively). The area under the receiver operating characteristic (ROC) curve was 0.774 for CRP (P < 0.001). The optimum cut-off value for CRP was 4.27 mg/dL, with the highest sensitivity and specificity (70.1% and 73.5%, respectively).

    Conclusions

    In the age group less than 4 months, without the image diagnosis, we could treat the patients as APN for longer antibiotic duration if CRP ≥ 4.27 mg/dL.

    Keywords: C-Reactive Protein, Infants, Neutrophil, Acute Pyelonephritis, Lymphocyte Ratio
  • Gaoyan Chen, Junhua Li, Yongchao Jiang, Haihua Chen, Rui Pan * Page 5
    Background

    Coronavirus Disease 2019 (COVID-19) has attracted global attention for unexpected rapid transmission among countries. Currently, little is known about the attributes of pediatric patients with COVID-19.

    Objectives

    To describe the characteristics of pediatric patients with COVID-19.

    Methods

    We retrospectively analyzed the epidemiological, laboratory, imaging, and clinical data of pediatric patients with COVID-19 from January 31 to February 24, 2020.

    Results

    A total of eight patients with COVID-19 were enrolled in this study. Two patients had underlying diseases. Seven children (87.5%) belonged to a family cluster outbreak. The most common symptoms were fever (50%), cough (37.5%), expectoration (37.5%), and Sore throat (37.5%). For the laboratory findings, all patients had positive nCoV-RNA results, three patients (37.5%) with abnormal white blood cell counts, and six patients (75%) with higher lymphocyte counts. Chest computed tomography (CT) showed ground-glass opacity or patchy shadows in 7 patients (87.5%). All patients received antiviral therapy. Additionally, four patients (50%) were treated with antibiotics, one with glucocorticoid atomization (12.5%), one with interferon atomization (12.5%), four patients (50%) with traditional Chinese medicine. All patients discharged within three weeks, without poor prognosis or recurrence after 14 days follow-up.

    Conclusions

    Pediatric patients with COVID-19 were mainly transfected through family cluster outbreaks. The clinical manifestations were mild without a typical pattern. High-resolution CT and nCoV-RNA tests have great value for early-stage diagnosis. Antiviral therapy is effective in treating viral pneumonia.

    Keywords: Infection, Treatment, Child, Pneumonia, Coronavirus
  • Mehrzad Mehdizadeh, Nasir Babakhan Kondori*, Vahid Changizi, Zahra Sadeghi Page 6
    Background

    Diagnostic radiology studies in children harbor more radiation hazards than in adults due to their small size and higher cellular proliferation rate. Therefore, reducing the radiation burden to children should be top priority. Measurement of radiation dose is the first step to this goal. Nevertheless, we do not know whether the radiation of portable radiographs at our hospital meets the standards or not.

    Objectives

    This study aims at measuring the primary and scattered radiation at different distances from patients. This eventually would help us to keep the radiation to minimum.

    Methods

    This study was conducted on 84 patients from 4 different wards (U1-U2) in our hospital in 2017. After obtaining ethical approval from ethical committee and also written consent from parents, all patients who needed portable X-ray were included in our study. A thermo-luminescent dosimeter was placed on the patient’s chest to measure the entrance surface dose (ESD), while Geiger-Muller dosimeters located at one and two-meter distances from the X-ray tube used to scale the scattered radiation. Then, data were analyzed in SPSS 16.

    Results

    The average ESD was 0.3873, 0.3867, 0.3700, and 0.4033 millisievert (mSv) in U1 to U4 respectively, whereas the scattered radiation doses measured as 0.00986, 0.00750, 0.01250, 0.1014 at one-meter and 0.00250, 0.00220, 0.00238, 0.00314 mSv at two-meter distances. There was no significant difference in radiation dose between those units (P > 0.05).

    Conclusions

    Radiation received by patients in this study was three to four times higher than the standard dose. Significant scattered radiation was also detected at one and two-meter distances. To reduce radiation, improvement of exposure protocols such as reducing mAs and using proper shielding is emphasized.

    Keywords: Radiation Dose, Entrance Surface Dose, Pediatric Radiation, Portable Radiology, Thermo-Luminescent Dosimeter
  • Mansoureh Shokripour, Bita Geramizadeh, Babak Samizadeh, MohammadSadegh Masoudi * Page 7
    Introduction

    Angiosarcoma, originating from vessels, constitutes about 0.2% to 0.3% of all pediatric soft tissue sarcomas. Prognosis of angiosarcoma is poor and depends on patient’s age, tumor location, size, histological grade and extent of tumor progression.

    Case Presentation

    We report a rare case of a congenital angiosarcoma of scalp with dural and skull bone invasion in a one-month-old boy. His mother noticed the mass 2 days after birth as a very small insignificant nodule, but it grew rapidly afterward.

    Conclusions

    The treatment consisted of only a wide surgical resection. After 15 months there was no sign of local recurrence or metastasis was noticeable and the tumor showed favorable outcome. This case indicates the possibility of a better clinical behavior in congenital angiosarcoma.

    Keywords: Angiosarcoma, Congenital Tumor, Scalp
  • Vahid Ziaee *, Raheleh Assari, Setarh Mamishi, Aliakbar Zeinaloo, Masoud Mohammadpour, Iran Malekzadeh Page 8

    COVID-19 as a viral infection is usually asymptomatic in children, but complication of this disease in children is not rare and may be fatal. Hyper inflammation of COVID-19 is a potential fatal in undiagnosed children. It is very similar to Kawasaki disease but with higher mortality and morbidity. Multisystem inflammatory syndrome in children (MIS-C) and multi-organ involvement was reported in hyper inflammation syndrome following COVID19. Herein we report our algorithmic approach to Kawasaki-like syndromes due to COVID-19 in our center. Based-on this approach we had no mortality during the last 5 months.
     

    Keywords: Children, Kawasaki Disease, COVID-19, Multisystem Inflammatory Syndrome in Children
  • Joanna Hubert *, Maja Gilarska, Małgorzata Klimek, Magdalena Nitecka, Grażyna Dutkowska, Przemko Kwinta Page 9
    Background

     There is a deficit of publications regarding the impact of small for gestational age (SGA) on later neurodevelopment of premature infants and existing results are conflicting.

    Objectives

     The aim of the present study was multifaceted neurodevelopmental assessment of children born prematurely, with particular assessment of SGA as an independent risk factor for impairment in prematurely born children.

    Methods

     Eighty-nine children born with very low birth weight were evaluated at the age of 50 months. Anthropometric measurements and several psychomotor tests (WeeFIM-Functional Independence Measure scale, Leiter Test-Non-Verbal Psychometric Evaluation, DTVP-2-Developmental test of Visual Perception, CAST-Childhood Autism Spectrum test, EAS-C-temperament questionnaire and TSD-children vocabulary test) were performed in each child.

    Results

     SGA appears to be a risk factor for low self-reliance (mean WeeFIM score 89 ± 20 points vs 99 ± 15; P = 0.034), decreased non-verbal intelligence (Leiter score 87 ± 18 points vs 100 ± 18 points; P = 0.022) and low visual perception (Frostig test 81 ± 17 points vs 93 ± 17 points; P = 0.035). Moreover, the incidence of autism spectrum disorders was significantly higher in the SGA group (21% vs 2.8%; P = 0.029). There were no differences in frequency of cerebral palsy diagnosis, vocabulary test results and temper tests scores between SGA and AGA groups.

    Conclusions

     Birth weight small for gestational age seems to be an additional, independent risk factor of neurodevelopmental delay in prematurely born children.
     

    Keywords: Small for Gestational Age, Premature Infant, Behavioral Disorders, Cognition, Neurodevelopment
  • Li Wang, Shuqing Tang, Hui Liu, Juan Ma, Bingyi Li, Li Wu, Zhichun Feng, Yuan Shi * Page 10
    Background

     A diagnosis of neonatal respiratory distress syndrome (RDS) is common among newborns in China. Some late-preterm and full-term (LP/FT) infants with respiratory distress (RD) symptoms but not primary surfactant deficiency are also diagnosed with RDS and given exogenous surfactant replacement therapy (SRT).

    Objectives

     An increasing number of neonatologists have proposed that RD etiologies should be specifically classified to guide clinical treatment.

    Methods

     The therapeutic effects of SRT on infants of different gestational ages (GAs) were compared in a large retrospective multicenter cohort study performed at 26 Neonatal Intensive Care units in China. The cause of RD at different GAs was further analyzed by comparing the different risk factors closely related to RDS severity at different GAs.

    Results

     Analysis of 1240 infants diagnosed with RDS showed that SRT was less effective in LP/FT infants than in early-preterm (EP) infants. GA < 30 weeks and no prenatal corticosteroid use were closely related to RDS severity in EP infants, whereas perinatal infection- and perinatal hypoxia-associated risk factors and a high cesarean rate were closely related to RDS severity in LP/FT infants.

    Conclusions

     The causes of RD might differ between LP/FT and EP infants, and the diagnosis of RDS might be overused in LP/FT infants. RD in LP/FT infants is more likely related to perinatal infection, perinatal hypoxia, elective cesarean and hereditary factors, which are important causes of neonatal pulmonary edema. New strategies for the treatment of refractory RD in LP/FT infants should concentrate more on pulmonary edema and neonatal ARDS.
     

    Keywords: Newborn, Respiratory Distress, Pulmonary Edema, Primary Surfactant Deficiency
  • MohammadReza Mirzaaghayan, Azin Ghamari, Sima Amini, Ali Rabbani, Ali Mohebbi, Ehsan Aghaei Moghadam * Page 11
    Background

     The arterial switch operation [ASO] is the surgical procedure of choice for correction of the TGA. This is one of the most complex cardiac surgeries, with coronary artery transfer being the most important factor determining the success of the surgery.

    Objectives

     This study aims to investigate the outcomes of ASO operated by a single surgeon and assess the accuracy of echocardiography in identifying the coronary artery pattern before the ASO, this may lead to a better familiarization with the ASO.

    Methods

     A retrospective study was conducted by operative and postoperative case note review of 125 patients from March 2015 to 2018. We assessed the outcomes of the arterial switch operation. Concomitant defects as atrial septal defects, patent ductus arteriosus and small ventricular septal defects were defined as the simple TGA and other defects were defined as the complex TGA. Coronary artery pattern determination by echocardiography prior to the surgery and during the operation was investigated, as well. 30-day mortality, post-operative neurologic complications, cardiac anatomic complications, arrhythmia, plasma lactate level and cardiopulmonary bypass time [CPB time] during the surgery were recorded.

    Results

     The mean age and weight of the patients were 29.09 (1 - 180) days and 3506.48 (2400 - 9700) grams. Most of the patients (64%) were male. 105 (84%) of the patients had simple and 20 (16%) had complex TGA. Unusual coronary pattern during echocardiography was observed in 17 (13.6%) subjects and unusual coronary pattern during the operation was observed in 7 (5.6%) patients. The incidence of the major anatomical lesions was not significant. 20 (16%) had neurologic complications, including seizure in 14 (11.2%) patients, brain hemorrhage was found in 5 (4%) patients, as well as chorea and wrist drop in the remaining patients. Post-operative arrhythmia was observed in 16 (12.8%) patients. The mortality rate was 4% (5 patients). The CPB time was 202.73 ± 36.99 minutes.

    Conclusions

     Our post-operative results of the ASO indicate excellent results. This signifies high experience and knowledge regarding this surgery.

    Keywords: TGA, ASO, Transposition of the Great Arteries, Arterial Switch, Coronary Pattern
  • Ali Ihsan Anadolulu *, Cigdem Ulukaya Durakbasa, Muferret Erguven, Itır Ebru Zemheri, Gonca Gercel Page 12
    Objectives

     The aim of this study was to evaluate the effect of amyloid deposition in colon mucosa on the results of anorectal manometry test and the use of ROME III questionnaire in patients with Familial Mediterranean Fever (FMF).

    Methods

     The files of patients diagnosed with FMF were scanned to evaluate the patients at risk for amyloid deposition. Predisposing factors were identified. The patients were sampled using anorectal manometry test, Rome III questionnaire and the rectal mucosa suction biopsy and the test results were compared.

    Results

     17 (63%) of the patients were female and 10 (37%) were male. The mean age was 12.15 ± 2.40 years. The number of patients with amyloid deposition in the rectal mucosa sample was 2 (7.4%). Both of these patients had regularly used colchicine. Amyloid deposition was found to be high in patients with M694V homozygous mutation (P = 0.05). According to the Rome III questionnaire, findings suggestive of irritable bowel syndrome were found in 5 patients and abdominal migraine was found in 3 patients. However, no statistical difference was found when the results of the Rome III questionnaire were compared with the results obtained from the anorectal manometry test (P > 0.05).

    Conclusions

     Amyloidosis can be seen due to various environmental factors, regardless of age, even when colchicine is regularly used. Anorectal manometry is an easy to perform test, helping diagnosis in this patient group. Although it has been shown that in patients with predisposing factors for amyloid deposition RAIR can be detected at lower pressures in anorectal manometry, the clinical significance of this finding is unclear. Since the Rome III questionnaire showed findings consistent with functional abdominal pain disease in one third of the patients, independent of the presence of FMF, it was found that the application of this questionnaire in patients with FMF could be misleading.

    Keywords: Familial Mediterranean Fever, Amyloidosis, Rome III Questionnaire, FMF, Anorectal Manometry Test