Iranian Journal of Pediatrics
Volume:17 Issue: 1, 2007

Objective: Tetralogy of fallot (TOF) is one of the most common forms of cyanotic congenital heart disease (CHD). The aim of this study was determination of demography، associated anomalies، peripheral pulmonary stenosis (PPS)، blood grouping، Rh typing، operation results and complications in TOF. Material & Methods: The records of 270 patients were reviewed. These patients were admitted from 1993 to 2003، in Shaheed Rajaei Hospital. Findings: Male patients were 60.37% and females were 39.63%. Incidence of patent foramen ovale (PFO)، Right Aortic Arch (RAA)، coronary artery (CA) anomalies and other anomalies were 44.81%، 21.11%، 9.25% and 36.30% respectively. Single ostium coronary artery (SOCA) was the most common CA anomaly. The most common PPS was bifurcation stenosis. TOF was more common in O blood group patients. The mean age at the first palliative operation was 5.21 years and for TC was 7.19 years. Post surgical mortality rate was about 3% and morbidity rate، 12.18%. Conclusion: Trend toward earlier total correction (TC)، and single stage early TC of TOF should be recommended as the preferred management strategy.

Objective: The aim of this study was to investigate the adverse drug reactions (ADR) in pediatrics and determine the predominant symptoms of adverse drug reactions in children. Material & Methods: This case series study was carried out at the Bahrami Pediatric Hospital، Tehran where the files of 25 admitted patients with the diagnosis of adverse drug reaction 1998 to 2005 were studied. Findings: The average age was 4.6 (±3.7) years and symptoms of adverse drug reactions were observed 12.6 (±14.3) days after initiation of the drug intake. Skin rash was seen in all patients more in form of maculopapular rash followed by urticaria. Arthralgia was the next common symptom observed in 44% of patients. The common abnormal laboratory data was high erythrocyte sedimentation rate which was seen in 40% of patients. The most common ingested drugs were phenothiazine and sulfasalazine (each of them seen in 28% of patients) followed by penicillin (16%)، furazolidone (16%)، cephalosporins (4%) and valproic acid (4%). In 28% of patients poly-pharmacy was responsible for ADR. Conclusion: Awareness of the problem، observation of poly-pharmacy and potential drug-drug interactions، and continuous re-evaluation of the ongoing individual pharmacotherapy is important، especially in children، to reduce ADRs.

Objective: In thalassemia major، extramedulary hematopoiesis results in bony deformities such as sever malocclusion in the head and neck، delayed pneumatization of paranasal sinuses and so on. Also، there are many systemic and iatrogenic problems that may affect the head and neck region. The purpose of this study was to determine otorhinolaryngologic manifestations as clinical diseases in thalassemia major patients. Material & Methods: In a cross sectional study 190 thalassemia major patients were evaluated (by history and physical examination) for snoring، epistaxis، nasal obstruction، sinusitis، temporomandibular joint (TMJ) pain and TMJ dislocation، tinnitus and hearing loss. Radiological studies of the skull and paranasal sinuses and audiological tests were performed. The data was analyzed in different age groups with chi2 test. Findings: Relative frequency of some otorhinolaryngologic manifestations in this population was high. The differences between some clinical diseases as TMJ pain، and epistaxis in different age groups were statistically significant. Conclusion: Thalassemia major increases some clinical diseases in the Otolarygology field. With early diagnosis and early treatment many of them may be prevented.

Objective: Infantile colic is one of the most current problems in the first few months of life. It is suggested that organic or psychologic and behavioral factors can predispose to involve this disorder. Here، we have studied the role of some maternal risk factors including bovine IgG levels in breast milk for appearing the colic in young babies. Material & Methods: This retrospective study was performed on 50 infants as case group and 30 infants aged 3 weeks to 3 months who had normal growth and development as control group for one year in Mashad. Data was analyzed with Pearson Chi-Square and Fisher’s exact tests. Findings: Most colicky infants were male (62% vs 38% female). They were mainly symptomatic at neonatal period. In 64% of cases، it occurred in the first offspring. Infantile colic was more common in babies who delivered normally than by cesarean section and in mothers aged 20-30 years. According to our finding، there was no relationship between bovine IgG in breast milk and infantile colic. It revealed that anxious pregnant women had more colicky babies and paternal smoking seemed to develop colic in young infants. Conclusion: In order to reduce the occurrence of colic in infants، primigravid mothers aged 20-30 years should have a stressfree environment especially during pregnancy and no smoking exposure in this period.

Objective: To asses the frequency، causes and how to increase the awareness of childhood poisoning. Material & Methods: A retrospective study of childhood accidental poisoning was conducted in Tafila Prince Zeid Hospital (PZH) by reviewing the files of 134 children admitted with accidental poisoning in 2003-2005. Findings: This study showed that accidental poisoning was frequent but morbidity was low and there were no deaths. Analgesics and antihistamines were the most frequently ingested drugs. Conclusion: The frequency of accidental poisoning is common in Tafila. Household chemicals and medication were the predominant. So، that merits the introduction of a public awareness campaign and increased use of child-resistant containers is important preventive measures that deserve more attention.

Objective: To determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis and to identify independent predictor for anemia in children on hemodialysis. Material & Methods: A cross sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7−20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan، Iran. Findings: A total of 22 (82%) patients had hemoglobin level of <11 g/dL (anemic) and 12(48%) patients had hemoglobin values < 8 g/dL (severe anemia). The mean age for these patients was 15.5±3.7 years and the mean time on chronic dialysis was 20.44 15.25 months. Anemia was more common and more severe among children who were on dialysis for less than 6 months. There was a inverse relation between severity of anemia and duration of hemodialysis (p=0.019، r=-0.465). Nearly all patients were treated with erythropoietin، Children with more severe anemia received slightly higher dose of erythropoietin (P=0.09، r=0.202). There was a significant difference between serum albumin values in anemic patients and patients without anemia (p=0.023). There was a correlation between serum albumin and hemoglobin level (r=0.511، P=0.01). Parathyroid hormone (PTH) levels was>200 pg/ml in 16 patients (66%) and >400 pg/ml in 9 patients (37.5%). There was a reverse correlation between PTH level>200 pg/ml and hemoglobin level (r=-0.505، P=0.046). Conclusion: The prevalence of anemia in children on hemodialysis in Isfahan appears to be higher than that reported in the other studies in spite of extensive use of rHuEPO and iron supplementation. We found this to be especially true for patients new on hemodialysis (less than 6 months)، low albumin and severe hyperparathyroidism.

Objective: Glucose-6- phosphate dehydrogenase (G6PD) deficiency is an inherited deficiency that may be the cause of neonatal jaundice. Our aim was to study the prevalence of G6PD deficiency without hemolysis in relation to neonatal jaundice. Material & Methods: This prospective descriptive study has been conducted on 272 icteric newborns admitted to the Ekbatan Hospital from October 2002 to September 2004. The dataset included: age، sex، total and direct bilirubin، hemoglobin، reticulocyte count، blood group and Rh of mother and newborn، direct Coombs، G6PD level and the type of treatment. All data was analyzed by using statistical method. Findings: From 272 neonates، 12 neonates (4.4%) were found to have G6PD deficiency. The male to female ratio was 5 to 1 (10 male and 2 female neonates). From 12 neonates with G6PD deficiency، hemolysis was seen in 5 neonates (41.7%) and the rate of G6PD deficiency without hemolysis was 2.6%. There was no difference in the mean bilirubin level، hemoglobin level and also reticulocyte count between patients with G6PD deficiency and those without G6PD deficiency (p>0.05). Out of 12 patients with G6PD deficiency، 2 patients (16.7%) had blood exchange transfusion. Rh and ABO incompatibility were not seen in any of the12 patients with G6PD deficiency. Conclusion: In this study the prevalence of G6PD deficiency in icteric newborns was considerably high and most of them were non hemolytic، so we recommend G6PD test as a screening program for every newborn at the time of delivery.

Objective: Cerebral palsy (CP) is a static encephalopathy. In addition to motor developmental delay، most patients have speech and social developmental delay. Recently، complementary medicine like homeopathy has been used in the treatment of neurodevelopmental disorders. This study has been conducted to determine the effect of adding homeopathic treatment to rehabilitation on speech and social development of children with spastic cerebral palsy. Material & Methods: This study was a double blind clinical trial. Twenty-four subjects were recruited from a clinic in Tehran during 2004. In this study، minimization technique was used and subjects were divided into case and control groups. The routine rehabilitation techniques were performed for 4 months in both groups. The control group received placebo and the case group homeopathy drugs. The subjects were 1-5 years old with spastic cerebral palsy، speech and social developmental delay. Level of speech and social development were assessed by Denver Developmental Screening Test II (DDST II) in the two beginning of the study and 4 months later. Findings: The average age، in the case and the control group was 28 and 28.4 months respectively. The level of speech and social development in the case group in comparison with the control group had no statistically significant difference (PV=0.17 and PV=1 respectively). Conclusion: Adding homeopathy to rehabilitation had no significant effect on the level of speech and social development of CP children. Regarding the proved effects of homeopathy mentioned in different articles on the developmental status of children with CP، it is not possible to reject the effects of homeopathy on speech and social development of children with CP.

Objective: Hepatitis A is one of the most common infections during childhood، especially in developing countries. Regarding the high prevalence of the disease in Iran، this study was performed to detect the rate of the contact of the children of Zanjan/Iran with the virus of hepatitis A (HAV). Material & Methods: In a cross-sectional study، total anti HAV was assayed by ELISA method in serum samples of 300 children، aged 7-10 years، selected by multistage random sampling. The results were statistically analyzed. 27 children did not agree to participate in the study. Findings: Out of 273 samples، including 134 males and 139 females، 121 children (44.3%) had serum antibody against Hepatitis A. Of these children، 42%، 45.4% and 45.3% were 7-8، 8-9 and 9-10 years of age، respectively. No significant difference was found among age groups or between sex groups. Conclusion: According to this study، 44.3% of 7-10 year-old children have had previous contact with hepatitis A virus. This shows a high rate of seronegativity and sensitivity in adult community. Therefore، especially with regard to the high frequency of travels of the people between Iran and neighboring countries، that have high prevalence of disease، revision of national prevention protocol is recommended.

Type 1 diabetic subjects without any complications and with a good control could participate in all levels of sports activities، both recreational and professional. But، there are some limitations for subjects who have chronic side effects of diabetes. A detail pre-participation physical examination is needed to find out these complications. All diabetics should be encouraged to perform suitable exercise and sports. To prevent acute diabetic side effects of exercise، hypo and hyperglycemia، diabetic athletes may need to adjust their nutrition and insulin dosage. Depending on the characteristics of the exercise، the ambient environment and the level of blood glucose before exercise، diabetic athletes need to consume some carbohydrate before، during and after exercise. Also، if the exercise takes more than 30 minutes، insulin should be reduced by 14-50%. Every athlete on the base of scientific recommendations، should find his or her own approach in the management of nutrition and insulin adjustment and integrity of them with exercise and sport. This could be achieved by trial and error.

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare disease characterized by microangiopathic hemolytic anemia، thrombocytopenia، neurologic abnormalities، fever and renal dysfunction. The disease classically spares the lung tissue، but recently some cases were reported that presented with respiratory involvement (adult respiratory distress syndrome or pulmonary-renal syndrome). Presentation with pulmonary-renal syndrome has rarely been reported. Case Presentation: We report a 14-yaers-old boy admitted to the hospital because of a biochemical evidence of renal failure. Two days after admission he developed a high fever، hemoptysis and respiratory distress. Open kidney biopsy was performed and confirmed the diagnosis and finally the patient expired due to neurologic involvement. Conclusion: This case is presented to discuss the need to update the criteria for TTP diagnosis and considering TTP in the differential diagnosis of pulmonary renal syndromes.

Background: Intramedullary spinal cord abscess is a treatable cause of paraparesis. It can rapidly lead to complete paralysis below the lesion. Case Presentation: In this article two cases of spinal intramedullary abscess in pediatric age (3 and 4-year-old males) are presented. Incidence، clinical presentation، neurologic investigation and treatment are discussed. Conclusion: Although intramedullary spinal cord abscess is a rare disease، we should have knowledge of its existence because misjudgment and deferring adequate treatment may lead to an unfavorable outcome.