Journal of Comprehensive Pediatrics
Volume:12 Issue: 2, May 2021

Microalbuminuria is thought to be an early predictor of impending diabetic nephropathy while glycosylated Hemoglobin (HbA1c) is a biochemical marker of long term glycemic control in Type 1 Diabetes Mellitus (T1DM) children. The study aimed to evaluate the prevalence of microalbuminuria and its association with HbA1c on admission and duration of diabetes. Also, the change in HbA1c level on admission and post 3 months of admission were studied to assess diabetic control in T1DM children.

The prospective study was conducted on 38 children (<18 years) diagnosed with TIDM presenting with clinical signs, symptoms, and biochemical parameters of DKA. Presence of microalbuminuria, HbA1c levels and number of past episodes of DKA were recorded. HbA1c levels were again estimated after 3 months. The resultant data was tabulated and analyzed statistically (p<0.05).

Microalbuminuria and poor HbA1c control was observed in 18 % and 60% of the sample population respectively. A significant association was found between HbA1c >9% (P=0.032) and duration of diabetes >4 years (P=0.032) with microalbuminuria. Significant improvement in glycemic control was noted from the time of admission (9.76± 2.77) to 3 months (7.75± 1.28) (P= 0.00012). A significant proportion difference was observed between past DKA episodes according to HbA1c control (P<0.001).

Assessment of microalbuminuria is needed in T1DM children especially with HbA1c >9% and duration of diabetes >4 years to evaluate diabetic nephropathy. Good glycemic control can be brought up with effective insulin therapy accompanied with appropriate counseling and regular follow-up.

This research aimed at analyzing the adverse events reported related to blood transfusion in one of the large vice-chancellorships of Iran University of Medical Sciences in spring 2018.

This descriptive study was performed based on the eight stages of the root cause analysis (RCA) of healthcare events by the National Authority for Health. For classification of the considered concerns, the “classifying nursing errors in clinical management (NECM)” model, failure classification, approved by the UK National Health System, and also a creative problem-solving technique were used for determining the improvement solutions.

Based on the results, 70% of states of blood transfusion error and blood products were placed in the category of care errors, 10% in the communication category, 20% in the category of implementation errors, and 0% in the category of knowledge and skill errors. A total of 38 influencing factors were identified for adverse events of blood transfusion, the most cause of the error was associated with organizational factors (18.4%), and the least reasons for failure were equipment and resource factors (5.3%).

The establishment of advanced systems for the automatic transmission of blood and blood products, due to the lack of proper infrastructure in Iran, is not economically feasible. Therefore, at the level of this deputy, the guideline for managing blood transfusion and blood products in the two areas of "measures required before, during, and after blood transfusion and blood products" and "hemovigilance for physicians" were developed.

To audit the patterns and quality of antibiotic prescription for children in the outpatient department (OPD).

This prospective observational study was conducted on the tertiary care outpatient department of a teaching hospital. One thousand prescriptions for children between 1 month and 15 years of age, who attended the outpatient department of a tertiary care teaching hospital between April 2018 and May 2019, were included. The quality of prescriptions was assessed based on 12 pretest parameters. One score was given to each correctly written parameter, and total scores were categorized as poor (0 - 4), average (5 - 8), and good (9 - 12). The core prescribing indicators presented by the world health organization (WHO) were used to analyze antibiotic prescribing patterns. The data were analyzed using open-source Epidata software.

Out of 1000 prescriptions, quality was average in 490 (49%) and poor in 46 (4.6%) prescriptions. The average number of medicines prescribed per encounter was 3.5 (reference value < 2). The medicines were prescribed by their generic names in 27.3% of the prescriptions (reference value 100%). Antibiotics and injections appeared in 65% (reference value < 30%) and 6% (reference value < 20%) of the prescriptions. The ratio of prescription from a list of essential medicines was 15% (reference value 100%). According to the prescriber profile, the rate of prescribing an antibiotic was 63% by postgraduates in pediatrics, 70% by MBBS, and 90% by AYUSH doctors (reference value < 30%).

More than half of the prescriptions could not attain a good score. There is room for improving prescription writing practice. Antibiotic prescription by health care providers, especially AYUSH doctors, needs to be restricted given the high number of antibiotics per prescription. This will limit the indiscriminate use of antibiotics and may be a big step towards achieving the antibiotic stewardship goal.

 Steroid-resistant nephrotic syndrome (SRNS) is a leading contributor to chronic kidney disease (CKD), and calcineurin inhibitors (CNIs) or monoclonal antibodies are currently the best identified therapy. Meanwhile, some developing countries still use alkylating agents (AA) such as cyclophosphamide (CPA) to treat SRNS due to economic reasons.

 This study aims to determine the employability of soluble urokinase plasminogen activator receptor (suPAR) as a biomarker for monitoring therapy in SRNS children and compare the clinical improvement with those treated with an AA and CNIs.

 This was a retrospective cohort study conducted at Hasan Sadikin Hospital, Indonesia. The data was collected from July 2019 to July 2020 from 70 children with FSGS. Clinical signs were evaluated monthly, and serum suPAR level was measured at the third and sixth months following therapy. Two-way repeated measures ANOVA was carried out to compare the differences in suPAR level at baseline with the third and sixth months in SRNS patients who received AA and CNIs.

 The mean age was nearly similar between the two groups based on the t-test (P = 0.140). Steroid-resistant nephrotic syndrome was more frequent in boys than in girls (P = 0.020), according to the Chi-square test. Baseline serum suPAR level was not significantly different between the two groups. In the third month, the daily urinary protein level was higher in SRNS patients that received the AA compared to the CNIs group (P < 0.001). There was a significant interaction between time and treatment (F(2,138) = 7.203, P = 0.001), with higher suPAR level in SRNS patients that received the AA compared to those administered with CNIs at the 3rd and 6th months, but this difference was not statistically significant (P > 0.05).

 As a noninvasive tool, suPAR is a promising modality in monitoring SRNS therapy, and CNIs have a tendency to achieve faster remission than the AA.

 The congenital intestinal web is a rare cause of small bowel obstruction classified as Type I intestinal atresia. The second portion of the duodenum is the most prevalent site for these webs, whereas the jejunal web is rare.

 Herein, we present a very uncommon late presentation of the jejunal web in an 18-month-old girl complaining of chronic recurrent vomiting, constipation, and failure to thrive (FTT). After thorough investigations, the diagnosis was confirmed by the small bowel follow-through. The surgical procedure resulted in a significant improvement in her quality of life, given the subsequent increase in her weight and height.

 Vomiting that occurs at any age is pathologic and requires careful history taking, thorough clinical examination, and evaluation, especially in patients treated with proton pump inhibitors such as omeprazole for a long time a diagnosis of GERD without any response. In these patients, gastrointestinal abnormalities, including complete or incomplete obstructions such as malrotation and web, should be made in the differential diagnosis.

Circumcision is the most common surgery in male infants in Islamic countries. Therefore, Knowledge of its side effects and appropriate therapies is essential. In this case report, we describe a 12-days neonate with Glans Ischemia, two days after circumcision. We admitted the neonate and treated him with oral Pentoxifylline and antibiotic for three days. Thus Pentoxifylline can be implemented as a treatment in post-circumcision ischemia of the glans penis in neonates.

 Coronavirus disease 2019 (COVID-19) has been identified as an emerging disease in 2019. Complications of the disease remain unknown, and extensive research has been conducted to investigate it. Due to the way the disease is transmitted through ACE2, the virus affects many organs. So far, no cases of hepatic encephalopathy following the virus have been reported.

 A 3-year-old boy referred to Ali-Ibn-Abitaleb Hospital in Zahedan, Iran was hospitalized with icterus and decreased level of consciousness. After examinations and evaluation, the patient was diagnosed with hepatic encephalopathy following COVID-19. Unfortunately, despite the treatments, the patient was finally expired.

 To the best of our knowledge, this is the first case report demonstrating COVID-19 related hepatic encephalopathy. This case is a useful reminder for doctors to be much more vigilant and cautious about possible side effects of COVID-19.

 Enuresis is one of the most common problems in children with physical and psychological complications that can disturb their social relationships. The main objective of this study is to evaluate the relationship between enuresis and its associated etiologies in children aged 5 to 15 years in Zahedan. The study further contributes to an early realization of the parents of children with enuresis-associated problems.

 Following a descriptive design, 200 children (5 to 15 years old) suffering from enuresis referred to nephrology and psychiatric clinics in Zahedan in 2019 were recruited. Data were analyzed using SPSS software.

 Of 200 children with enuresis, 134 (67%) were girls, and 66 (33%) were boys. Also, 174 (87%) were aged 5 - 10 years, and only 26 (13%) were 10 to 15 years old. Birth weight of 172 (86%) children was 2500 - 4000 g, 20 (10%) were < 2500g, and only 8 (4%) were > 4000 g. Fecal incontinence was observed in 99 cases (49%), and 101 (51%) did not have fecal incontinence. Attention deficit hyperactivity disorder (ADHD) was found in 80 (40%) cases. For 144 (72%) children, we found no stress, and 56 children (28%) had stress. Urinary tract infection was observed in 142 children (71%). According to imaging studies, 34 children (17%) with enuresis had congenital kidney abnormalities and 166 (83%) had no kidney problems.

 The significant etiologies typically found in the onset of enuresis and its exacerbation can be controlled or treated. Since the complications of enuresis have not been properly clarified for families, it is of crucial importance to increase awareness about this health problem.
 

 Cognitive development plays an important role in a child’s life. Cognitive development and sleep patterns can interfere with the brain cell growth related to health and nutrition in children. Many children are reported to have eating difficulty in infantile anorexia. Infantile anorexia is an eating disorder during the children’s period of learning (6 - 36 months of age). The disorder is characterized by extreme refusal of eating, deficiency of growth, and loss of typical appetite.

 This study aimed to determine the association of infantile anorexia at 12 - 36 months of age with cognitive development and sleep patterns in children.

 This analytic observational study with a case-control design was conducted on the subjects divided into 40 infantile anorexia children and 40 controls. Infantile anorexia was diagnosed by a trained pediatrician. Cognitive assessment was measured by the Capute Scale test. The Brief Infant Sleep Questionnaire measured the data on children’s sleep patterns. The association of infantile anorexia and children’s cognitive development was analyzed by the chi-square test.

 The result showed a significant association between infantile anorexia and children’s cognitive development (OR: 52.76; 95% CI: 6.58 - 423.0; P < 0.001). A similar association was also observed between children’s sleep patterns and infantile anorexia (OR: 4.88; 95% CI: 1.80 - 13.21; P < 0.002).

 The findings of this study demonstrated that children with infantile anorexia are more likely to have impaired cognitive development and abnormal sleep patterns.

 Steroid-resistant nephrotic syndrome (SRNS) is a leading contributor to chronic kidney disease (CKD), and calcineurin inhibitors (CNIs) or monoclonal antibodies are currently the best identified therapy. Meanwhile, some developing countries still use alkylating agents (AA) such as cyclophosphamide (CPA) to treat SRNS due to economic reasons.

 This study aims to determine the employability of soluble urokinase plasminogen activator receptor (suPAR) as a biomarker for monitoring therapy in SRNS children and compare the clinical improvement with those treated with an AA and CNIs.

 This was a retrospective cohort study conducted at Hasan Sadikin Hospital, Indonesia. The data was collected from July 2019 to July 2020 from 70 children with FSGS. Clinical signs were evaluated monthly, and serum suPAR level was measured at the third and sixth months following therapy. Two-way repeated measures ANOVA was carried out to compare the differences in suPAR level at baseline with the third and sixth months in SRNS patients who received AA and CNIs.

 The mean age was nearly similar between the two groups based on the t-test (P = 0.140). Steroid-resistant nephrotic syndrome was more frequent in boys than in girls (P = 0.020), according to the Chi-square test. Baseline serum suPAR level was not significantly different between the two groups. In the third month, the daily urinary protein level was higher in SRNS patients that received the AA compared to the CNIs group (P < 0.001). There was a significant interaction between time and treatment (F(2,138) = 7.203, P = 0.001), with higher suPAR level in SRNS patients that received the AA compared to those administered with CNIs at the 3rd and 6th months, but this difference was not statistically significant (P > 0.05).

 As a noninvasive tool, suPAR is a promising modality in monitoring SRNS therapy, and CNIs have a tendency to achieve faster remission than the AA.