Iranian Journal of Pediatrics
Volume:18 Issue: 4, 2008

Past decade has seen increase in cases of tuberculous meningitis (TBM) and multidrug resistance in such cases. The mortality rate for a mismanaged TBM is very high which increases manifold in presence of associated complicating factors. The present study was thus planned to evaluate the prevalence of MDR-TBM and look for associated complicating factors and carry out drug sensitivity pattern in all culture positive isolates. One hundred cerebro-spinal fluid (CSF) samples from children clinically suspected of having TBM were collected and processed for detection of Mycobacterium tuberculosis by conventional methods like Ziehl-Neelsen (ZN) staining, Lowenstein- Jensen (LJ) culture and newer method like BACTEC 460 TB culture. Antimicrobial susceptibility was performed on all culture positive isolates by BACTEC 460 TB system. Twenty two cases could be diagnosed as definitive TBM based on BACTEC culture. Of these 22 cases, six cases (27.3%) were positive by ZN staining and/or LJ culture. Of all isolates tested for drug sensitivity 18 were sensitive to all four drugs whereas 4 isolates were resistant to more than one drug. Since the prevalence of MDR-TBM is very high we conclude that all CSF samples should be subjected to sensitivity testing to diagnose it at an early time and determine its sensitivity pattern in view of its very high mortality.

In Iran before 2003 and approval of therapeutic abortion law in parliament there was severe restriction in abortion permissions and at that time, after presenting "The Guidelines for Therapeutic Abortion" by legal medicine organization of Iran (from now on known as LMO) presented in 2003 and finally, Islamic consultative assembly voted to approve the indications determined by LMO in 2005. In this study all cases referred to the clinical examination department of legal medicine organization in Tehran central region to get therapeutic abortion permission during one year before approval of therapeutic abortion law (first study from June 1999 to the end of May 2000) and after that (second study from early October 2006 to the end of September 2007), who could get this permission were considered accurately. Information needed to perform this study collected via completion of pre-designated forms and analyzed with SPSS software and the results compared in these two groups. In the second study in 85.36% of cases, fetal disorders and in 14.63%, maternal diseases and in the first study just 126 permission were issued, with 17% fetal disorders (major Thalassemia was the only considered case at that time) and 83% maternal indications were the reason to issue permission for abortion. In the second study the major fetal and maternal indications were: anencephaly and cardiovascular problems. The 2nd study shows that in 202 cases (35.19%), abortion permission was issued after confirmation of three specialists (cases which were forecasted in the Predetermined Abortion Indications List). This study shows that in spite of all efforts made so far to present legal approaches for abortion, it is not still time to stop working on the issue and perhaps some other diseases should be added to the mentioned list in future; but this would definitely needs joint cooperation of different authorities, governmental and judicial organization.

Childhood undernutrition among tribal children is a serious public health problem in India. The present study was conducted to assess the prevalence of undernutrition (underweight, stunting and wasting) among Lodha children of Paschim Medinipur, West Bengal, India. This cross sectional study was conducted in a village of Paschim Medinipur district. A total of 165 (early childhood=74, late childhood=91) children aged 1-14 years were measured and included in the present study following simple random method. The children were further divided into two categories: early childhood: under 6 years (<72 months) and late childhood: ≥72 months. Anthropometric measurements such as height and weight were made following standard techniques. Children were considered underweight, stunting and wasting as weight-for-age, height-for-age and weight-for-height Z-score below –2 standard deviation using the National Center for Health Statistics (NCHS) reference population. The prevalence of underweight, stunting and wasting was 33.9%, 26.1% and 19.4 %, respectively. Of these, 9.1%, 9.7% and 3.6% children were found to be severely underweight, stunted and wasted. Moreover, the prevalence of underweight (47.3% vs 23.1%) and stunting (35.1% vs 18.7%) was significantly higher in early childhood compared to during late childhood. They had 2.05 (RR= 2.05; 95% confidence interval (CI): 1.31– 3.20) and 1.88 (CI: 1.11–3.19) times greater chance to be underweight and stunted than during late childhood. Whereas, the prevalence of wasting was similar in both groups (20.3% vs 18.9%; RR=1.09; CI:0.58-2.02). Similarly, the rates of severe underweight (early childhood vs late childhood: 16.2% vs 3.3%) and stunting (20.3% vs 1.1%) were significantly higher in early childhood. They had 4.92 (CI: 1.44–16.79) fold and 18.45 (CI: 2.49-136.42) fold more risk to be an underweight and stunted compared to during late childhood. The nutritional status of the Lodha children, especially during early childhood was unsatisfactory. There is an urgent requirement to improve the nutritional status of children in this ethnic group.

The objective of this study was to assess the prevalence of hearing impairment by automated auditory brain stem response (AABR) in newborns admitted to an intensive and intermediate care unit and to analyze the associated risk factors. An observational cross-sectional study was conducted between January 2005 and January 2006. 834 newborns (62% boys and 38% girls) were assessed. Newborns had a mean (SD) gestational age of 36 (2.1) weeks with a mean (SD) birth weight of 2950 (1250) grams. The presence of the following neonatal pathologies was investigated: craniofacial malformations, hyperbilirubinemia (total bilirubin 20 mg/dl for all newborns), neonatal asphyxia, congenital infections, septicemia, birth weight (<1500 g), meningitis, consanguinity, family history of congenital hearing loss and history of convulsion. Newborns who died before the age of 3 months and whose stay in the hospital lasted less than 48 hours were excluded. Chi-square test was used to identify the risk factors for hearing loss. Out of 834 neonates, 34 (4.07 %) had sensory-neural hearing loss. The most common risk factors of hearing loss included hyperbilirubinemia (11%), asphyxia (8%), birth weight less than 1500 g (6%), septicemia (6%), convulsion (2%), and meningitis (1%). There was a statistically significant association between hyperbilirubinemia (P=0.001), weight less than 1500 g (P=0.002), cesarean section (P=0.005) and impaired ABR results. There was no relation between family history of congenital hearing loss and craniofacial malformation as risk factors for hearing loss. This study showed statistically a relation between hyperbilirubinemia, weight less than 1500 g, cesarean section and impaired AABR results. The most common risk factors of hearing loss were hyperbilirubinemia, asphyxia, birth weight less than 1500 g, septicemia, convulsion, and meningitis.

Infant mortality rate is one of the most expressive indicators of development in all countries. The aim of this study was to determine the cause of infant mortality and risk factors in rural areas of Birjand in Iran. This population based case-control study covered 156 infants who died when aged less than one-year in health houses of Birjand between January 2004 and December 2005. For each case, two controls were selected matching one-to-one to the case considering variables of residency and their date of birth. The data was collected through interview with mothers and reviewing infants’ files in health houses. 57.7 percent of deaths in under one year old infants happened during the first month of their lives. The most important causes of death in neonates were prematurity and low birth weight (44.4%) later gastroenteritis (30.3%). In addition, the study showed that 9.6 percent of infants had died because of narcotic toxicosis. Moreover, the study showed a significant relationship between infant mortality and parents’ level of education, mother’s addiction, age of mother in the first pregnancy, prematurity, low birth weight, type of delivery and exclusive breast feeding. Special attention to infantile period and special care for infants born to at-risk mothers, as well as providing special health education can cause a dramatic reduction in infants’ mortality rate.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. The exact causes of disease are still poorly understood. It seems that B cells have several functions in JIA, including production of autoantibodies, antigen presentation, production of cytokines, and activation of T cells. Here, we aimed to evaluate B-cell lineage and its precursors in the bone marrow of patients with JIA. Twenty consecutive patients with JIA were enrolled in this study. JIA is subdivided into three groups of Pauciarticular, Polyarticular, and Systemic JIA. Bone marrow mononuclear cells were separated. Then we analyzed the immunophenotype of the JIA patients by flow cytometry. After separation, the mononuclear cells were stained specific for B cell lineage [CD10, CD19 and CD20], T cell lineage [CD3] and non specific lineage [CD34, HLA-DR and TdT]. Flow cytometric study of bone marrow showed that JIA patients had low level of CD10, CD19, and CD20. Polyarticular patients had lower level of D10, CD19, and CD20 than pauciarticular JIA patients and systemic onset JIA patients had lower levels than both of them. Decreasing of B cell precursor in bone marrow is one of mechanisms for pathogenesis of JIA and the more decreased B cell precursors in bone marrow are, the worst severity of the disease is. Significant differences in CD10 content of bone marrow were detected between the polyarticular and pauciarticular groups. So, it seems that polyarticular JIA patients had lower percentage of pre B cell stage.

Bacille Calmette-Guَerin (BCG) vacination is performed as a part of expanded program of immunization (EPI). Lymphadenitis is the most common complication of BCG vaccination. The aim of this study was to determine the incidence and natural course of BCG lymphadenitis vaccinated in Yazd, Iran. In this analytical prospective follow up study a total of 480 (240 females and 240 males) consecutive newborns received 0. 05 ml of BCG vaccine intradermally on right arm within the first week of life during April to July 2003. These babies were followed up when 1. 5, 3, 4. 5, 6 and 9 months old. A total of 26 (5. 8%) cases of lymphadenitis were detected. Lymphadenitis occurred as ipsilateral axillary nodes in 24 (92. 3%) cases, supraclavicular in one (3. 8%) case, and supraclavicular in association with axillary nodes in one case (3. 8%). Infants developed lymphadenitis during 4 wks of life in one (3. 84%) case, between first and fourth month of life in 14 (53. 8%) cases, and between fourth and sixth month of life in 11 (42. 3%) cases. All 26 cases of lymphadenitis were followed up for 9 months. Twenty two (84. 6%) cases were simple or non-suppurative and 4 (15. 4%) cases suppurative lymphadenitis. Eleven (42. 3%) cases of non-suppurative lymphadennitis showed spontanous resolution and eleven (42. 3%) cases had partial regression without progression or drainage. Four (15. 4%) cases developed suppuration with one (3. 8%) case of fistulation and drainage. The greater incidence of lymphadenopathy in our cases can probably be attributed to a more immunogenic vaccine (Pasteur institute, Tehran), young vaccinees (newborn infants), injection in the right arm or improper dilution. Non-suppurative BCG lymphadenitis is a benign condition and regresses spontanously without any treatment.

During the past 20 years identification of lactobacilli isolated from normal flora has received great interest due to their health promoting effects. This study has aimed at characterizing the lactobacillus strains isolated from the fecal flora of Iranian infants based on phenotypic oriented methods. Moreover, the diversity of identified species among tested infants has been looked into. Thirty two strains of lactobacilli were included in this study. The given strains were previously isolated from the fecal samples of 6 infants between 1-19 months of age. They are examined through 14 carbohydrate fermentation tests, growth ability at different temperatures and different concentrations of NaCl. Cell and colony morphology were assessed as well. The examined strains were identified as L. acidophilus (12 strains), L. plantarum (9 strains), L. rhamnosus (7 strains), L. paracasei (3 strains) and L. fermentum (1 strain); 2 strains remained unidentified. Accordingly L. acidophilus was the most predominant species among tested samples. Some biochemical differences were obtained among the strains of L. acidophilus group and some morphological peculiarities were observed among the strains of L. paracasei and L. rhamnosus in comparison to the typical strains of L. casei group. These differences revealed the necessity of application of complementary molecular methods for clear identification of examined Lactobacillus strains.

Takayasu arteritis (TA) is an inflammatory arteritis involving large vessels, predominantly the aorta and its main branches. Angina pectoris or myocardial infarction may occur in 3-5% of patients due to coronary artery ostial narrowing from aortitis or coronary arteritis. We describe the case of an 11-year boy presented with hypertension and severe abdominal pain. After treatment he developed extensive myocardial infarction and died. Takayasu''s disease should figure prominently amongst the causes of coronary artery disease in children and coronary arteriography should be undertaken more often during investigation of the arterial lesions of these patients.

Hypercalcemia is an endocrine emergency that should be diagnosed as soon as possible and managed carefully. For better management multiple causes of hypercalcemia must be taken into consideration. We observed three infants with hypercalcemia and distal renal tubular acidosis at the time of diagnosis during 5 years. The patients were referred with severe dehydration and failure to thrive. There was no reason for hypercalcemia found in these patients except distal renal tubular acidosis. So we suggest distal renal tubular acidosis as a cause for hypercalcemia.

Colocolic intussusception is rare in children and most cases in adolescents are produced by a lead-point. A review of the English-written literature revealed only three cases of colocolic intussusception without lead point. A seven year-old boy with chief complaint of colicky abdominal pain and vomiting for five days, dysentery for 4 days, and no response to antibiotic therapy, increasing pain and abdominal distension was referred to pediatric gastroenterologist. Abdominal x-ray revealed multiple air-fluid levels and gasless colon. Pseudo-kidney appearance was reported in abdominal ultrasound at splenic flexure. Colocolic intussusception diagnosis without any lead point was confirmed in laparotomy and reduced with milk-out procedure. In children with dysentery especially in presence of colicky abdominal pain, abdominal distention and no response to antibiotic therapy, abdominal ultrasound to rule out intussusception is recommended.

We present an unknown case of an 11-year-old boy with mental retardation, microcephaly, prominent ears, unilateral ptosis, long philtrum, prominent and everted lower lip, abnormally shaped teeth and developmental delay. This is an unknown case with special facial features and mental retardation which can probably be the second case of Mehta-Lewis-Patton syndrome.