فهرست مطالب

Comprehensive Pediatrics - Volume:3 Issue: 1, Nov 2012

Journal of Comprehensive Pediatrics
Volume:3 Issue: 1, Nov 2012

  • تاریخ انتشار: 1391/09/09
  • تعداد عناوین: 11
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  • Seyed Moayed Alavian, Kamran B. Lankarani Page 1
  • Mohammad Reza Bolursaz, Soheila Khalilzadeh, Amirali Khodayari, Shahin Hakimi Page 3
    Background
    In spite of recent advents, and novel improvements in the diagnosis and treatment of pulmonary tuberculosis (TB), definitive diagnosis of pulmonary TB in children is problematic. Therefore, measurement of the serum level of adenosine deaminase (ADA) was later introduced as a helpful marker for the diagnosis of TB.
    Objectives
    The purpose of this study was to determine the usefulness of the ADA testin the diagnosis of pulmonary TB, and compare enzyme activity between patients with pulmonary TB and those with other pulmonary infections. The sampling strategy was randomized, and the design of study was case-control diagnostic descriptive, we used IBM SPSS V-16.0.2 software for analyzing our data.Patients and
    Methods
    This study was performed at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Tehran, IR Iran. In all, 49 children, divided into 3 groups, were examined. Of these, 22 had pulmonary TB, 17 had other pulmonary infections, and the remaining 10 children were normal and were assigned to the control group.
    Results
    Serum ADA levels were higher in the pulmonary TB patients than in the control group (P < 0.05), however, these levels did not differ significantly between TB patients and patients with other pulmonary infections (P = 0.391). Our evaluation revealed that ADA level in TB patients with a positive smear of gastric washing were higher than those in patients with a negative smear (P = 0.006)..
    Conclusions
    Similar to the other studies, this study showed higher serum ADA level in pulmonary TB patients than in normal individuals. However, ADA was not found to be a suitable marker for differentiating between pulmonary TB and other pulmonary infections.
    Keywords: Adenosine Deaminase, Tuberculosis, Lung
  • Fariba Shirvani, Parviz Tabatabaee, Reza Shiari, Farideh Shiwa, Mohammad Hossein Soltanzadeh Page 7
    Background
    In spite of vaccination, outbreaks of measles occur in many countries, and measles remains the most frequent cause of death among vaccine preventable diseases..
    Objectives
    To compare anti-measles antibody titer between revaccinated and non-revaccinated medical students 2 years after the National MR (Measles, Rubella) Vaccination Program, which was implemented in 2002-2003 for individuals aged 5 to 25 years in Iran.Patients and
    Methods
    This stratified cross-sectional study was conducted on 78 revaccinated and unvaccinated for national MMR vaccination (2002) medical students aged 22-25 years, who attended our Markaz Tebi Children Hospital in Tehran for their pediatric rotation from summer to winter in 2005. The revaccinated group was selected by simple random sampling from a list of names of the students and the non-revaccinated group included all the non-revaccinated students. Serum IgG and IgM anti-measles antibody titers of the subjects were measured using indirect enzyme-linked immunosorbent assay (ELISA), and the levels were compared between the 2 groups of students. Data were analyzed using chi square test and independent samples t test. Statistical significance was defined as P values of < 0.05 by SPSS ver.13 Software..
    Results
    Overall, we recruited 45 subjects with a mean age of 23.7 ± 0.12 years in the revaccinated group and 33 subjects with a mean age of 24 ± 0.25 years in the non-revaccinated group (P = 0.2). The mean anti-measles IgG antibody titer was 31.8 ± 21.2 IU/mL (range, 1-190 IU/mL) in the revaccinated group and 6.12 ± 8.8 IU/mL (range, 1-45 IU/mL) in the non-revaccinated group (P < 0.001). The mean anti-measles IgM antibody titers were 2.6 ± 6.7 IU/mL (range, 1-45 IU/mL) and 1 ± 0 IU/mL (range, 0-1 IU/mL) in the revaccinated and non-revaccinated groups, respectively (P = 0.1). Anti-measles IgG was present (serum titer ≥ 13 IU/mL) in 46.7% of the individuals of the revaccinated group and 6% of the individuals of the non-revaccinated group (P < 0.001)..
    Conclusions
    The results of this study indicate that although the percentage of individuals with protective levels of anti-measles antibody increased to 46.7% after revaccination, the protection was inadequate in more than 50% of vaccine recipients, thereby, emphasizing the need for checking antibody levels after revaccination
  • Parviz Ayazi, Abolfazl Mahyar, Azam Rasoli Page 12
    Background
    Brucellosis, a multisystem infection that may imitate other conditions, shows a low incidence during childhood and may be misdiagnosed. Brucellosis has become a major medical problem in a number of the provinces in Iran.
    Objectives
    To study the epidemiology, clinical and laboratory features, and management of brucellosis.Patients and
    Methods
    We reviewed the charts of all patients who were diagnosed with brucellosis and showed an agglutination titer of 1:160 or more for Brucella at the Department of Pediatric Infectious Diseases, Qods Hospital from March 1995 to March 2004. We collected information on the age, gender, history of unpasteurized milk or milk-product ingestion, presenting symptoms, and physical signs of the patients. We also collected results of routine laboratory tests, treatment, and treatment outcome.
    Results
    Patients younger than 12 years of age constituted all cases of brucellosis admissions. One hundred seventy-five patients (107 male and 68 female, 1.6:1 ratio) were diagnosed with brucellosis and had a Brucella titer of 1:160 with an odds ratio (OR) of 1:160. Eighty-seven patients (50%) were 1-6 years of age, 86 patients (49%) were 7-12 years of age, and only 2 patients were 1 year of age. One hundred (57%) patients were from rural areas, and 75 (43%) were from cities. The most frequent seasons of disease occurrence were summer (76, 43%) and spring (52, 30%); there were fewer cases in winter (24, 14%) and autumn (23, 13%). One hundred fourteen cases (65%) had a history of consuming unpasteurized milk or milk products. The most frequent symptoms were arthralgia (79%) and fever (78%). The most common physical findings were fever (51%) and arthritis (26%). Of the cases, 157 (89.5%) were acute, and 17 (9%) were chronic. A normal white blood cell count was found in 123 cases (71%); anemia, in 33 (19%); increased erythrocyte sedimentation rate (ESR), in 92 (53%); positive C-reactive protein (CRP), in 85 (48%), and positive radiologic changes, in 20 (11%). The most common antibiotics used were cotrimoxazole plus gentamycin in 83 cases (47.5%) and cotrimoxazole plus rifampin in 72 cases (41%).
    Conclusions
    Brucellosis presents in various ways and should be differentiated from arthritis in countries where Brucella is endemic. Symptoms, signs, and first-line laboratory findings are not distinguishing; accordingly, agglutination tests and, if possible, blood culture should be performed in any child with prolonged fever. Treatment is effective, but disease prevention by education of high-risk families is indicated.
    Keywords: Brucellosis, Epidemiology, Child
  • Shahla Afsharpaiman, Fatemeh Bairaghdar, Mohammad Torkaman, Zohreh Kavehmanesh, Suzan Amirsalari, Mehran Moradi, Mohammad Javad Safavimirmahalleh Page 16
    Background
    Recent studies on bacterial pathogens causing urinary tract infection (UTI) in children have shown high levels of antibiotic resistance in clinical settings.
    Objectives
    We determined the common bacterial pathogens causing UTI and their antimicrobial resistance patterns in Iranian children.Patients and
    Methods
    The study subjects were 114 children (female subjects, 58.8%) with culture-proven UTI categorized in the following 3 age groups: neonates (< 28 days,n = 45), infants (28 days to 2 years, n = 41), and children (> 2 years, n = 28). Sensitivity testing was performed using the disc diffusion technique.
    Results
    The most frequently cultured pathogens included Escherichia coli (71.7%) and Enterobacter (28.9%). UTI caused by Enterobacter was more commonly detected in neonates (60.6%) than in infants (21.2%) and children (18.2%). Imipenem was the most activeagent against E. coli isolates (susceptibility, 97.3%), followed by ciprofloxacin (90.4%) and amikacin (82.9%). Trimethoprim-sulfamethoxazole, cefalotine, and cephalexin were the least active agents, with 76.3%, 75.0%, and 73.7% of E. coli isolates exhibiting resistance,respectively. Imipenem and ceftizoxime were the most effective antimicrobial agentsagainst Enterobacter, with sensitivity rates of 85.2% and 71.4%, respectively. Nitrofurantoin,ceftazidime, and cefalotine were the least active antimicrobial agents against Enterobacter,with resistance rates of 92.3%, 66.7%, and 62.5%, respectively.
    Conclusions
    The low susceptibility of common UTI pathogens to cephalosporins may be because of their high rate of administration to children with UTI in our population. A change in empiric therapy should be considered, especially in neonates.
  • Mohamadreza Modaresi, Touran Mahmoudian, Omid Yaghini, Roya Kelishadi, Homayoun Golestani, Alireza Tavasoli, Davood Mosayebi Page 21
    Background
    Febrile seizures (FS) are the most common type of convulsion in young children. The predisposing factors are still under investigation; however, iron insufficiency might play a role in this regard..
    Objectives
    Our objective was to determine the association between iron status and febrile seizure..Patients and
    Methods
    This prospective case-control study was conducted among 109 children aged 6 months to 6 years and hospitalized for the first episode of FS. The case group was compared to a group of 70 age- and sex-matched controls admitted to the same ward with the same diagnosis of infection. The control and case groups were matched based on family history of FS, age, sex, temperature, cause of illness, erythrocyte sedimentation rate (ESR), white blood cells (WBC), and platelets. Venous blood samples were examined for complete blood count (CBC), serum iron, serum ferritin, and total iron-binding capacity. The CBC included measurements of red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), WBC, and platelets..
    Results
    There were no significant differences between the study groups in terms of temperature, ESR, WBC, and platelets. The mean Hb, HCT, ferritin, iron, and MCH were significantly lower in the case group than in the control group. The mean level of MCV in the FS group was lower than the mean level of MCV in the control group, but the difference was not significant.
    Conclusions
    Low levels of serum ferritin and iron might play a role in the pathogenesis of simple febrile seizure. Further longitudinal studies are clearly needed to confirm our findings..
    Keywords: Seizure, Child, Ferritin
  • Soheila Khalilzadeh, Mohammad Reza Bolursaz, Nooshin Baghaie, Elaheh Heydarian Fard, Maryam Hassanzad, Habib Emami Page 25
    Background
    Cystic fibrosis (CF) is a genetic disease with an autosomal recessive pattern of inheritance. CF caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and characterized by impaired transport of chloride ions across the cell membrane. Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia have been identified in the cultures of respiratory secretions of CF patients, and infections of these microorganisms are associated with high rates of morbidity and mortality. In patients with CF, severe inflammation of the airway can cause advanced bronchiectasis, which may result in respiratory failure and death.
    Objectives
    This study aimed at evaluating the clinical findings of laboratory tests, bacterial colonization, and drug resistance in children and young adults with CF who hospitalized at the Pediatric Pulmonary Department of Masih Daneshvari Hospital, Tehran, Iran.Patients and
    Methods
    This cross-sectional study was conducted on 22 children and young adults with CF who were hospitalized at the Pediatric Department of Masih Daneshvari Hospital between 2006 and 2011, with convenient sampling. All analysis performed with SPSS V 11.5 and P values less than 0.05 considered as statistically significant..
    Results
    A total number of 23 patients evaluated, including 12 (52.2%) girls and 11 (47.8%)boys. Patients had a mean age of 14.5 ± 6.7 years. The sputum cultures of 10 (43.5%) (95%CI, 23.2-63.7%) patients [5 female (41.7%) and 5 male (45.5%)] were positive for P. aeruginosaand those of 2 (8.7%) (95% CI, 0-20.2%) were positive for S. aureus [1 female (8.3%) and 1 male (9.1%)]. The sputum cultures of 2 (8.7%) (95% CI, 0-20.2%) other patients were positive for nontuberculous mycobacteria (NTM). The purified protein derivative (PPD) skin test yielded negative results in 10 male (46%) and 12 female (55%). Based on the antibiograms obtained from sputum cultures, we found that P. aeruginosa had the highest susceptibility to ciprofloxacin (71.4%), followed by amikacin (50%), ceftazidime (30%), and ceftriaxone (18%). In this study, the annual prevalence of respiratory infections in patients who given nebulized antibiotic prophylaxis was significantly lower than that in patients who did not receive this treatment (P < 0.05).
    Conclusions
    Our study results (43.5% cultures positive for P. aeruginosa and high resistance to antipseudomonal drugs) suggest that the use of inhaled medications for prophylaxis in CF patients could result in a decreased rate of hospitalization and reduction in CF-related complications..
    Keywords: Cystic Fibrosis, Child, Pseudomonas Aeruginosa, Drug Resistance
  • Mohammad Pedram, Morteza Heidari, Bijan Keikhaei, Reza Azizi Malamiri, Behzad Poopak, Kiavash Fekri Page 29
    Background
    Neuroblastoma is the most common extracranial malignant solid tumor in children under 5 years, and it is characterized by wide clinical and biological heterogeneity. N-myc oncogene amplification is considered to be one of the most important prognostic factors used to evaluate survival in these patients.
    Objectives
    The aim of our study was to determine amplification of the N-myc oncogene using real-time quantitative polymerase chain reaction (PCR) and to show the influence of N-myc amplified tumors on the overall survival rate.Patients and
    Methods
    This study is an analytical historical cohort study of forty children with neuroblastoma admitted to the Shafa Hospital, Iran from 1999 to 2010. Paraffined blocks of tumoral tissue were analyzed for N-myc amplification by a PCR. The degree of N-myc amplification was derived from the ratio of the N-myc oncogene and the single copy reference gene, NAGK. In the statistical analysis, a Kaplan-Meier survival analysis was used.
    Results
    We found a variable degree of N-myc amplification, from 3 to 2 200, in 32 of the 40 neuroblastomas (80%). NMYC amplification was seen more frequently in patients older than 2.5 years (71.9%), stage 4 (65.6%) and female (53.1%). Median survival time in the males was significantly longer than in the females (P = 0.03). The overall median survival for N-myc amplified tumor patients was 20 months, and 30 months for the non amplified tumors..
    Conclusions
    The N-myc amplified tumors may increase the probability of more aggressive behavior and rapid tumor progression, especially in advanced stages of neuroblastoma. This study confirmed the importance of obtaining correct measurements of oncogene amplification in the early evaluation of neuroblastomas in order to target more aggressive therapies in patients with a higher risk of cancer progression.
    Keywords: Polymerase Chain Reaction, Neuroblastoma
  • Aliasghar Halimiasl, Amir Hossein Hosseini, Reza Shiari, Parviz Ghadamli, Saeed Mojtahedzadeh Page 34
    Introduction
    Kawasaki disease (KD) is an acute systemic vasculitis, of unknown etiology, that mainly affects infants and young children. Although originally thought to be a benign illness, KD may prove fatal, especially if the diagnosis is delayed due to a nonclassic presentation..
    Case Presentation
    Here, we present the case of a 4-year-old girl with a history of prolonged fever. Her physical examination and echocardiography revealed aneurysmal dilatation of the coronary arteries and myocarditis in the absence of other principal features of KD. This patient was diagnosed as having KD and responded very quickly to a high dose of intravenous immunoglobulin therapy.
    Discussion
    This case study highlights congestive myocarditis as an atypical presentation of KD and the need to maintain a high level of awareness of this problem, in order to diagnose and treat this potentially life-threatening condition promptly.
    Keywords: Mucocutaneous Lymph Node Syndrome, Coronary Aneurysm, Echocardiography
  • Shahla Afsharpaiman, Parviz Tabatabaee Page 37
    Isolated tuberculosis (TB) liver abscesses have rarely been documented in the literature.This report describes the challenging diagnosis of primary liver TB. We report on the case of a 10-year-old girl with Down syndrome, who had symptoms of fever and chills, anorexia and intermittent vomiting. The ultrasound and computed tomography (CT)revealed multiple abscess-like lesions in the liver. A diagnosis of TB should be considered in patients with hepatic abscesses, particularly in those patients who have possible immunodeficiency,such as Down syndrome.
    Keywords: Tuberculosis, Liver, Hepatic, Down Syndrome
  • Fariba Shirvani, Anahita Sanaei, Abdollah Karimi Page 41
    Cutaneous eruptions and arthralgia in children can occur after infections, drugs and immunologic processes via different mechanisms. This is a report of a 7 years old girl with a history of maculopapular rashes that changed to target-shaped lesions and pruritus with non-pitting edema of ankles, strawberry tongue and periungual scaling of extremities, with no history of any drug usage. She had elevated liver enzymes and positive anti-viral capsid antigen (VCA) (IgM and IgG), and depressed C3, C4 and CH50, that returned to normal after 3 months. Here we explain the states that could cause similar clinical scenario and discuss them briefly.
    Keywords: Exanthema, Child, Fever