Journal of Comprehensive Pediatrics
Volume:3 Issue: 2, Oct 2012

Circumcision is the most common surgery performed worldwide and about 30% of men are circumcised, of whom 70% are Muslim. The majority of male neonates are circumcised based on religious and cultural practices. Neonatal circumcision has several advantages when compared to an older age group receiving the procedure. There is considerable controversy about circumcision – neonatal or otherwise. The clinical benefits of circumcision include reducing the risk of urinary tract infection (UTI), sexually transmitted disease (STD), HIV infection, phimosis, balanitis and penile cancer. The most common complications of circumcision are infection, bleeding and failure to remove enough foreskin. These complications occur in less than 1% of all performed circumcisions. Neonatal circumcision is a simpler procedure than adult circumcision and has very low rates of complications when performed by an experienced physician on healthy newborn infants. Healing is usually complete within a week. Local analgesia should be administered to all infants undergoing the procedure. Circumcision should be delayed on babies born with congenital anomalies of the penis or if there is the slightest doubt about baby’s health. When parents are making a decision about circumcision, they should be informed about its medical advantages and disadvantages. Key to the ethical discussion is respect of parent’s religious, ethnic or cultural beliefs for which circumcision is practiced.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder stemming from one of the enzymatic defects in the biosynthesis of cortisol from cholesterol. In the majority of instances the disorder comprises deficiency of 21-hydroxylase (21-OHD). This defect causes excessive androgen production from adrenal source, which leads to virilization with varying degrees of severity (Prader grade 1-5) in female fetuses. To determine the frequency of different types of congenital adrenal hyperplasia, rate of consanguinity, family occurrence, birth weight, and final height and weight.Patients and Medical records of patients with CAH between 1968 and 2011 were reviewed. Out of 617 patients, 79.6% had 21-hydroxylase deficiency (21-OHD). In 21-OHD group 94.5% had classical type and 5.5% were non-classic. Among the classic type 78% had salt-wasting form (SW) and 22% simple virilizing (SV). Both 21-OHD-SV and SW were diagnosed more frequently in females. Frequency of other types were as follow: 11-hydroxylase deficiency (11-OHD), 13.3%; 3ß-hydroxysteroid dehydrogenase deficiency (3ß –OHD), 4.1%; lipoid adrenal hyperplasia, 1.1%; 17-hydroxylase deficiency, 1%; hypoaldostronism, 0.6% and Antley-Bixler, 0.3%. Parental consanguinity was present in 62.6% and familial occurrence was reported in 42.6% of the patients. Sixteen girls had grade 5 virilization of Prader staging (SW, 10; SV, 2; 11-OHD, 4). The most prevalent Prader stage was 4 in 21-OHD-SW and 11-OHD. In 21-OHD-SV, 9 patients had Prader grade 4 and 5 virilization. The difference between mid-parental height and final height was highest in 21-OHD-SV; its SDS was (-1.2 ± 1.1). Birth weight of all patients was normal except for 5 patients. The frequency of low and very low birth weight was not significantly different from the general population. All patients were assigned as their genetic gender except for 5 patients with delayed diagnosis or parental opposition. The prevalence of different types of CAH, grade of virilization, final weight, height and birth weight, were recorded from the referral patients..

Nonalcoholic fatty liver disease (NAFLD) is a very common chronic disorder and obesity is thought to be the most common etiology of fatty infiltration of the liver. The objective of this study is to compare the effect of lifestyle intervention alone or in combination with vitamin E therapy in obese pediatric nonalcoholic fatty liver disease (NAFLD)..Patients and In the double-blind placebo study, 33 obese children with NAFLD from 2008 to 2009 were included. Lifestyle intervention (balanced calorie diet, 1300-1800 kcal/d and physical activity) was prescribed to all. The patients were concurrently randomized to receive vitamin E 400 mg/d (n = 17)] or placebo (n = 16).. At the end of six months of therapy there was significant change in body mass index, serum aminotransferases, triglycerides, total cholesterol and low density lipoprotein-cholesterol levels in both groups (P <0.001), but the improvement in all these factors was only marginally different between the two groups. Alanine aminotransferase decreased to normal levels in 8 of 17 patients (47.05%) in the lifestyle and vitamin E group, and 7 of 16 patients (43.75%) in lifestyle and placebo group. Similarly, the improvement in the grade of steatosis on ultrasonography after intervention was the same in both groups. lifestyle intervention with diet and physical exercise in obese children with NAFLD were induced weight loss and was associated with a significant improvement in liver function. Vitamin E did not seem to increase the efficacy of lifestyle intervention.

Abdominal pain and constipation are the most common symptoms in children and because of lacking a well-defined diagnostic criteria for these symptoms various aspect of medical care in these patients are increased.. The current study aimed to evaluate the number and the cost of diagnostic and pharmacologic management of chronic abdominal pain and chronic constipation in children aged less than 18 years managed by general physicians or pediatricians before the patient is examined by pediatric gastroenterologist.Patients and In a cross-sectional study a sample of 91 consecutive patients with chronic abdominal pain and chronic constipation aged less than 18 years managed by pediatricians and general physicians were interviewed, examined and a questionnaires (based on the Rome III criteria) were filled, before they visited a pediatric gastroenterologist in an outpatient gastroenterology clinic. Cost and number of pharmacologic management and paraclinical workups done were calculated in total for the two symptoms separately. There were 91 patients, among which 55 (60.4%) had come with chronic abdominal pain and 36 (39.6%) had come with chronic constipation. The calculated cost per case for general physician and pediatrician visits and paraclinical and pharmacological management for patients with chronic abdominal pain was $ 65.1 and for chronic constipation was $ 53.2. For chronic abdominal pain cost per case for general physician visit was $ 8.6, for pediatricians was $ 26.9, for paraclinical management was $ 27.7 and for pharmacological management was $ 1.9. Similarly for the patients with chronic constipation cost per case for general physician visit was $ 14.8, for pediatricians was $ 28.1, for paraclinical management was $ 7.7, and for pharmacological management was $ 2.6. This study suggests that symptoms like chronic abdominal pain, and chronic constipation seem to put a heavy burden on the economy of the country, so training programs for pediatricians and general physicians that can well train them to handle such symptoms may decrease the number of clinical visits, repetitive investigation procedures, and utilizing multiple prescription drugs. Also media, magazines, booklets in hospitals, clinics and drug stores can help to educate parents and they in turn can cooperate better with the physician and will cope with long term symptoms of such problems in their children better.

Cardiovascular diseases (CVDs) are the leading cause of mortality in Iran; with dyslipidemia as an important contributing risk factor. To assess the early onset of dyslipidemia, our goal was to determine lipids and lipoproteins levels in cord blood and their correlation with maternal age as a first study in Iran.Patients and This cross sectional study was done on the cord blood of 243 healthy, full-term newborn infants (114 females and 129 males). The blood was sampled from the umbilical cord immediately after a normal delivery. The serum was tested in order to determine the lipid profile including total cholesterol (TC), triglycerides (TG) and high density lipoprotein-cholesterol (HDL-C). Low density-lipoprotein (LDL-C) was computed by Friedewald equation. A statistically significant negative correlation was observed between cord blood HDL-C and maternal age (r = -0.18, P <0.01). There was no relationship between other lipids and lipoproteins with maternal age. Our findings also showed the TC, TG and LDL-C mean level were significantly more and the mean level of HDL-C was significantly lower than reference value. Additionally, the mean of TC and LDL-C in female neonates were significantly more than the male (P <0.01). Also, there was no correlation between cord blood lipids and lipoproteins with birth weight and maternal body mass index (BMI). In a current study based on increasing maternal age, the HDL-C level in cord blood was decreased which is an independent risk factor for CVDs in adulthood..

Early Childhood Caries (ECC) is defined as a specific pattern of dental caries in infants and toddlers that may lead to diverse and serious oral consequences as well as an overall detriment to general health. The purpose of this study was to evaluate the association between the mode of mother's delivery and ECC in their children.Patients and The study was conducted as a longitudinal study using 120 mothers and their neonates up to two years of age in Kerman, Iran. Sample selection was according to a pilot study and a sample size formula. The women were examined at the ninth month of pregnancy and their babies were examined on the first day of life, and then every six months on a regular basis by only one examiner. The data was written on checklist and was analyzed by SPSS (version 18) and by Chi-square as well as Sign test. Analysis of the data demonstrated a statistically significant relationship between gender and occurrence of ECC, but no statistically significant relationship between mode of delivery and occurrence of ECC, as well as ABO blood groups and occurrence of ECC were seen. There is not any significant association between mode of delivery and occurrence of ECC, despite the positive association between occurrence of ECC and gender

Cystic fibrosis is a complex progressive disease which assessing its progression and severity is essential. For this purpose there are scoring systems available to evaluate the disease severity. The aim of the present study was to determine the clinical status of CF patients using shwachman score system in the pediatric pulmonary ward of Masih Daneshvari Hospital.Patients and A cross-sectional study was conducted to evaluate the clinical status with shwachman score system. 23 patients ranging from 5 to23 years were enrolled in this study. All data was extracted objectively from Shwachman-Kulczycki scoring system. The overall mean Shwachman-Kulczycki score was 53.48 ± 13.8. Total scores of < 40 (severe), 41-55, 56-70, and 71-85 were detected in 1.7%, 39.1%, 30.4% and 8.7% of patients respectively. None of the patients were categorized in the excellent range. We found no statistically significant correlation between mortality rate and clinical score (p = 0.136). However, the results showed a statistically significant correlation between mortality rate and Shwachman score, (p = 0.02).. Shwachman-Kulczycki score is an easily applied scoring system which can reflect the clinical status of patients objectively. However, concurrent use of other evaluating tools such as pulmonary function test (PFT) and Computed tomography scoring systems provide a more robust monitoring and a reliable evaluation tool

Cleft lip and palate as the most common congenital defect of oral cavity possesses a heavy socioeconomic burden for both the child and parents. Nasoalveolar molding (NAM) has received more attention to enhance future facial appearance and function during recent decades A 21-day old female neonate was referred with a bilateral cleft lip and palate. Parents complained of frequent bouts of cyanosis during feeding. The infant was a type IV cleft patient which was healthy systematically. An acrylic prosthetic obturator was fabricated which covered the palatal defect with a few millimeters extension into the nasal chamber. After a week, an extraoral tension was added to ensure the posterior protraction of upward and anterior displaced prolabium. Frequent adjustments were performed until the cleft lip operation and afterward to follow the centralization of the lateral maxillary segments and muscular tension changes after the cleft lip operation. The parents were highly satisfied with enhanced appearance and feeding and the patient was followed by the age of one year. According to the recent promising outcomes of NAM for cleft lip and palate, this method is encouraged to be applied promptly after the birth and to be continued till further provisional or definite corrective surgeries..