فهرست مطالب

Pediatrics - Volume:18 Issue: 3, 2008
  • Volume:18 Issue: 3, 2008
  • 94 صفحه،
  • تاریخ انتشار: 1387/06/28
  • تعداد عناوین: 16
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  • Parviz Shayan Page 213
    Objective
    Juvenile myelomonocytic leukemia (JMML) is a rare myelodysplastic/ myeloproliferative malignancy of early childhood, characterized by monocytosis, hepatos­plenomegaly and an aggressive clinical course.
    Methods
    In semi-solid culture JMML progenitor cells proliferate spontaneously into colony forming units. In order to study the mechanisms of proliferation and differentiation of JMML cells we developed a suspension culture system without additional exogenous growth factor supplement. Mononuclear cells (MNC) from peripheral blood, bone marrow or spleen of 14 patients with JMML and 24 controls were studied.
    Findings
    JMML cells expressed higher levels of the proliferation marker Ki67 (median 24% [7-39%] vs a median of 3.5% in controls). 90% of JMML cells were CD68-positive (vs 35% in controls) and by day 7 all JMML samples contained CD1a- positive cells. Electron microscopy demonstrated cytoplasmic vesicular structures resembling multilamellar MHC II compare­timents, which together with the expression of CD1a - support a dendritic cell (DC)-phenotype.
    Conclusion
    Differentiation into CD1a-positive DC seems to be a frequent phenomenon in cultured JMML MNC, which in vivo may contribute to clinical characteristics such as skin and organ infiltration
  • Gurdeep S. Dhooria (Md), Pediatrician Deepak Bhat (Md), Pediatrician Harmesh S. Bains (Md), Pediatrician Page 222
    Objective
    The number of dengue fever (DF)/dengue hemorrhagic fever (DHF) cases reported in India has risen in recent years. This study was undertaken to evaluate clinical profile and outcome of children admitted with DHF/dengue shock syndrome (DSS), in the 2006 DHF epidemic in Ludhiana, Punjab.
    Methods
    Eighty one children with dengue hemorrhagic fever were hospitalized in the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, India. All patients were diagnosed, managed and monitored according to a standard protocol.
    Findings
    Children between 10-15 years were most commonly afflicted (59%). Infants were the least affected sub-group (3.7%). Ninety two percent of all children were of DHF and 8% cases presented in DSS. The common symptoms seen were fever (91%), vomiting (41%), poor intake (21%), abdominal pain (16%) and significant bleeding (15%). Hepatomegaly was present in 60% of cases. 85% of cases had petechiae alone, 15% had evidence of significant bleeding manifestation. Gastrointestinal bleeding was the commonest observed bleeding. The complications seen were liver dysfunction (14.8%), coagulopathy (3.7%), renal dysfunction (3.7%), and acute respiratory distress syndrome (2.4%) and disseminated intravascular coagulation (1.2%). Mortality in the study was 3.7%. Refractory shock and coagulopathy were seen in all cases with poor outcome.
    Conclusion
    Increased awareness, better transport facilities and case management according to the WHO guidelines, is needed to further reduce mortality of DHF/DSS cases.
  • Kazeem A. Oshikoya, Idowu O. Senbanjo, Fwacp Page 229
    Objective

    A wide range of childhood illnesses are accompanied by fever, many of which are treated at home prior to presentation to hospital. An assessment of mothers’ knowledge and ability to recognize fever in their child, as well as management instituted at home were the focus of this study.

    Methods

    One hundred and forty four mothers whose children were less than 12 years old, had fever as one of the presenting complaints, and admitted to the children emergency room of Lagos State University Teaching Hospital between July and December, 2006, were interviewed with a structured questionnaire. Information sourced were the demographics of the mothers/caregivers and the children, mothers’/caregivers’ knowledge of fever and its management. Mothers that did not give their consents were excluded.

    Findings

    Most of the mothers (83.3%) perceived fever as the hotness of the whole body of the patient. Infection was the most likely cause of fever identified by 43.8% mothers. Malaria was presumptively diagnosed by the mothers in 54.2% children similar to the 53.5% cases of malaria diagnosed on admission. Ninety-six mothers (66.7%) managed the fever at home. Home treatment was majorly by reducing the clothing and exposing the child to air, tepid sponging, and use of paracetamol. Antimalarials (6.0%) and antibiotics (7.8%) group of drugs were rarely used.

    Conclusion

    Home management of fever by mothers had remained symptomatic in Nigeria. In the era of artemesinin combined therapy as the choice of malaria treatment in Nigeria, trend towards not using antimalarial drugs as part of home management of fever in children was observed amongst the mothers.

  • Shahsanam Gheibi, Zahra Fakoor, Mohammad Karamyyar, Javad Khashabi Page 237
    Objective

    A prospective study to determine the prevalent bacterial agents of neonatal sepsis and their antimicrobial susceptibility in Imam Khomeini teaching hospital, Urmia, from Oct 2002 to Nov 2006.

    Methods

    Newborns with clinical signs of septicemia and positive blood culture during fifty months were prospectively studied. Samples for blood cultures, complete blood count, erythrocyte sedimentation rate, C-reactive protein, sugar, electrolytes, cerebrospinal fluid and urine analysis/culture were obtained; ampicillin and gentamycin were started empirically. Results were analyzed by SPSS13 package and cross tabulation was done.

    Findings

    Two thousand three hundred twenty five newborns from 4827 neonatal admissions were screened for septicemia. Two hundred twenty seven episodes of sepsis occurred in 209 newborns. The boys/girls ratio was 1.67:1 and 63.9% of patients were premature. There were 164 (72.2%) cases of EONS and 63 (27.7%) cases of LONS. Coagulase negative staphylococcus (CONS) was the most common (54%) cause of both early and late onset neonatal sepsis and showed high degree of resistance to commonly used antibiotics; ampicillin (100%), ceftriaxon (65%), cefotaxim (67%) and gentamicin (51%), but comparatively low resistance to vancomycine (10%), imipenem (19%), and ciprofloxacine (23%).

    Conclusion

    Neonatal sepsis in our ward is mainly caused by gram-positive organisms, which are developing resistance to commonly used antibiotics. The initial empirical choice of ampicillin and gentamycin appears to be unreasonable for our environment.

  • Peerkhan Nazni, Edward Gnanaraj Wesely, Veerappan Nishadevi Page 244
    Objective

    Autism is a life long developmental disorder that emerges in early childhood and results in significant lifelong disability. The goal of treatment is to promote the child’s social and language development and minimize behaviors that interfere with the child’s functioning and learning. This study evaluated the impact of casein and gluten free diet among selected autistic children.

    Methods

    Three private special schools in Salem District, Tamilnadu, India were selected. A total number of 50 autistic children 10 from SIMEC, 10 from MMIC and 30 from CSI comprised the study sample. Background information, clinical history and nutritional status, dietary pattern were collected from the 50 selected autistic children. Out of 50 autistic children 30 autistic children were selected for the dietary intervention. Diet counseling regarding casein free diet was imparted to Group I (n=10), gluten free diet to Group II (n=10) and both casein and gluten free diet for Group III (n=10). The diet was followed for a period of 2 months. The efficacy of the dietary exclusion of casein and gluten was evaluated using a food and behavior diary on a day to day basis, using observation method.

    Findings

    Results about Group I autistic children who followed dietary exclusion of casein free diet showed that the mean scores before and after casein free dietary intervention depiticted these improvements as, 1 to 1.2 for attention, 2.8 to 2.9 for sleep, 1.1 to 1.3 for hyperactivity, 1.1 to 1.2 for anxiety/compulsion. For Group II autistic children who followed dietary exclusion of gluten free diet showed the improvements as 1.1 to 1.4 for attention 2.5 to 3 for sleep, 1.7 to 1.9 for hyperactivity, 1.1 to 1.2 for anxiety/compulsion. About Group III autistic children who followed dietary exclusion of both casein and gluten free diet showed the improvements as 1.1 to 1.3 for attention, 2.5 to 2.7 for sleep, 1.3 to 1.7 for hyperactivity, and 1.1 to 1.2 for anxiety/compulsion.

    Conclusion

    The impact of dietary intervention made using dietary guide books found to be useful to reduce various behavior symptoms among the selected autistic children.

  • Pedram Niknafs, Neonatologist Abdol, Ali Mortazavi, Mohammad Hossein Torabinejad, Bahare Bahman, Nikoo Niknafs Page 251
    Objective

    Clinical studies comparing intermittent versus continuous phototherapy for reducing neonatal hyperbilirubinemia have produced conflicting results. This study was conducted to compare the efficacy of intermittent with continuous phototherapy.

    Methods

    This study was performed on 114 neonates with indirect hyperbilirubinemia. Inclusion criteria were body weight above 2000 grams, absence of other concomitant diseases, and hyperbilirubinemia neither requiring intensive phototherapy nor exceeding the range of exchange transfusion. The neonates were randomly divided into two groups. Continuous phototherapy group received phototherapy on and off for 2 hours and half an hour respectively and the intermittent phototherapy group on and off for one hour. The phototherapy units were identical and serum total bilirubin levels were measured every 12 hours after starting phototherapy.

    Findings

    Two groups were matched regarding weight and risk factors such as ABO and Rh incompatibility. The difference of total serum bilirubin levels between two groups was insignificant at the start of phototherapy and also after 12, 24, 36 and 48 hours (P>0.2).

    Conclusion

    Intermittent phototherapy defined as one hour on and one hour off is as effective as continuous phototherapy defined as 2 hours on and half an hour off, in reducing total serum bilirubin level in full term babies.

  • Seyed Reza Mousavi (Md), Phd, Faca, Vascular Surgeon Zohreh Mehdikhah (Md), Pediatrician Page 257
    Objective
    Lymphedema is the result of impaired lymphatic drainage from the affected organ. This abnormality can be primary or secondary. Different nonoperative and operative approaches have been introduced to treat chronic lymphedema. In this study, we describe a new surgical technique and compare its results with other more commonplace methods.
    Methods
    Fifty-nine patients with the diagnosis of chronic lower extremity lymphdema who had not responded to nonoperative management for at least 6 months, were included in the study. They were collected during 15 years between March 1987 and March 2002. Doppler ultrasonography of deep venous system to confirm its patency was routinely performed in the most of patients. Then, they underwent surgery and were followed for at least 1 year postoperatively.
    Findings
    All the patients were operated by our new technique which is a modified form of the Homans. The outcome was excellent and 89.2% of patients were devoid of complication. A 10.8% total complication rate was inevitable. The most common complication was wound seroma.
    Conclusion
    According to the difficulties with treatment of chronic lymphedema and variety of surgical options, our method can be an excellent and even the standard operative procedure to treat intractable forms of disease.
  • Ahmadali Nikibakhsh, Abolhassan Seyedzadeh, Hashem Mahmoodzadeh, Zahra Yekta Page 263
    Objective

    Due to worldwide variations, reference values of urinary calcium to creatinine ratio in pediatric population are not yet well established. To determine normal values for urinary calcium to creatinine ratio and its relation to urinary sodium or potassium, a descriptive (correlation type) study was conducted in 7 to 12 years old healthy children in Urmia, Iran.

    Methods

    Primary school children were divided into two sectors and 7 clusters (4 cluster school boys and 3 school girls). The subjects were randomly selected. Random, non–fasting morning urine samples were obtained from 364 healthy children aged 7 to 12 years during fall 2005 and immediately sent to laboratory to determine urine calcium (Uca), creatinine(Cr), sodium (Na) and potassium (K). For data analysis, mean and 95th percentile of UCa/Cr and UNa/K were used. Pearson test was used to determine any relationship between UCa/Cr and UNa/K values. For comparison of UCa/Cr and UNa/K values between males and females, Mann-Withny test was used.

    Findings

    A total number of 364 children were enrolled in the study. There were 208 (57.1%) males and 156 (42.9%) females. The mean and 95th Percentile for UCa/Cr was 0.11 (0.10 and 0.24 respectively. The mean and 95th percentile for UNa/K were 2.30 (1.42 and 5.21 respectively. There was no significant difference in UCa/Cr and UNa/K between two sexes (P>0.05). We found a weak relationship between UCa/Cr and UNa/K (P<0.01).

    Conclusion

    UCa/Cr value may differ according to geographic location. For screening purposes, reference values should be determined in each geographic location.

  • Shahrokh Yousefzadeh, Hossien Hemmati, Ahmad Alizadeh, Ali Karimi, Masoumeh Ahmadi, Haniyeh Mohammadi Page 267
    Objective

    Since the beginning of the 21st century, injury has been the most serious public health problem that children face with. The aim of this study was epidemiologic evaluation of unintentional injury in north of Iran.

    Methods

    In a prospective cross-sectional study between September 2005–July 2006 we studied data of 347 trauma patients aged 14 years and younger, including sex, age, trauma mechanism, transportation facility, anatomical sites of injury, severity of head injury according to GCS (Severe: 3-8, Moderate: 9-12, Mild: 13-15), injury severity score (ISS), and length of hospital stay (LOHS). SPSS 13 and independent t-test were used to analyze of data.

    Findings

    Out of 3605 trauma patients, 353 were 14 years old or younger with a mean age (SD) of 7.6 (4.0); Male to female ratio about 2:1. Most of them (42.9%) were 1-5 years old. In patients younger than 1 year, falling was the most common (52.2%) mechanism of trauma while in other groups, traffic accidents were the leading cause of injury. About half of the patients were transported to hospital by their families or other people. About 77% of them suffered from head injury. Mean (SD) ISS was 4.3 (6.6), about 12% had severe injury and it was more than 25 in about 3%. Mean (SD) LOHS was 5.1 (8.9) days.

    Conclusion

    Occurrence of falling and traffic accidents in children is remarkably high. Mainly traffic accidents are preventable. We suggest paying more attention to safety education in all levels of community.

  • Nona Zabolinejad, Ahmad Bazrafshan, Parya Dehghanian, Naghmeh Zabolinejad Page 273
    Background

    The omental-mesenteric myxoid hamartoma (OMMH) is a very rare lesion, mainly seen in children and characterized by multiple omental and mesenteric nodules, which may be confused with malignant neoplasm. Microscopically, these lesions consist of a richly vascularized myxoid stroma with plump mesenchymal cells. This lesion has a benign clinical course without recurrence during follow up.

    Case Presentation

    We present a 14-month-old boy that was referred with history of abdominal distension, fever and vomiting for 3 months. Enhanced computed tomography (CT) revealed a huge well-demarcated hypodense and spherical mass which displaced bowel loops without obvious penetration to the intestinal walls.Histological and immunohistochemical examinations confirmed the diagnosis of OMMH.No evidence of recurrence was noted during 3 years follow up.

    Conclusion

    OMMH is a very rare lesion and because of its aggressive appearance, differential diagnosis with malignancy is warranted. The clinical picture of our case also led to high suspicion of malignancy. However by consideration of histological and immunohistochemical findings we could achieve the correct diagnosis.

  • Siamak Shiva, Alireza Nikzad, Saeid Aslanabadi, Vahid Montazeri, Mohammad Reza Nikzad Page 277
    Background

    Neonatal primary hyperparathyroidism (NPHP) is a rare disease characterized by marked hypercalcemia, diffuse parathyroid hyperplasia and skeletal demineralization. These patients have symptoms of chronic hypercalcemia such as failure to thrive, irritability, abdominal pain and anorexia. It is often fatal unless parathyroidectomy is performed. Treatment with drugs usually is inadequate and often results in chronic hypercalcemia and death.

    Case Presentation

    A 10-day-old, 2.9 kg male newborn was hospitalized for anorexia, poor feeding, cyanosis, hypotonia, lethargy and severe dehydration. Diagnosis of severe hypercalcemia due to primary hyperparathyroidism was established and surgical approach selected because of failure of medical therapy to control hypercalcemia. The baby was successfully treated by total parathyroidectomy with autotransplantation.

    Conclusion

    Although neonatal primary hyperparathyroidism (NPHP) is a rare disease, it must be considered for differential diagnosis in neonates with severe hypercalcemia. Early diagnosis and total parathyroidectomy with autotransplantation can be life-saving.

  • Gholamhosein Fallahi, Fatemeh Farahmand, Mohammad Sobhani Shahmirzadi Page 281
    Background

    Cytomegalovirus (CMV) is the most common cause of congenital infection. Although most of the involved neonates are asymptomatic but virus can cause a range of problems from mild to severe illness with involvement of different organs like central nervous system, gastrointestinal and liver. Proneness to CMV is very high (up to 1% of neonates). In the other hand trosinemia type I is a rare metabolic disorder with involvement of liver, neurologic, bone and other organs.

    Case Presentation

    A 3-month-old infant, product of twin pregnancy was hospitalized because of jaundice, FTT, hepatomegaly and sepsis. The other twin showed normal growth with no problems. Work up for cholestasis and FTT was suggestive of two different entities. Polymerase chain reaction for CMV in liver tissue and serum was positive. Meanwhile laboratory findings for metabolic disorder led to the diagnosis of type 1 tyrosinemia. The other twin was infected with CMV too.

    Conclusion

    Although coexistence of two causes for cholestasis is very rare, it is sometimes necessary to study more to rule out other entities like metabolic disease including tyrosinemia (if any symptoms exist).

  • Mohammadtaghi Khorsandi Ashtiani, Nasrin Yazdani, Shahin Bastaninejad, Mohammadhossein Dadgarnia Page 285
    Background

    Fourth branchial pouch anomaly (4BPA) is a rare condition that often presents an extreme diagnostic and therapeutic challenge. It usually causes recurrent left thyroid or perithyroid tissue inflammation, but it can be situated in the right side too.

    Case Presentation

    In this case report we present a nine-year-old girl with right sided 4BPA. She was referred for evaluation of recurrent right muscular space mass and fistula that was unresponsive to any medical or surgical procedures. This paper demonstrates the proper technical issues about diagnostic work up and surgical approach that we used to manage her dilemma.

    Conclusion

    In patients with both skin fistula and pyriform sinus opening, external cannulation is more convenient and less traumatizing than internal cannulation.

  • Amit Agrawal (Md), Mch, Neurosurgeon Page 289
  • Rizwan Ahmad Khan, Shagufta Wahab, Rajendra Singh Chana Page 291
  • Page 297