International Journal of Pediatrics
Volume:2 Issue: 3, Apr 2014

1. The most important challenge in diagnosis of celiac disease is not-performing the diagnostic tests in suspected persons. Because of multi-organ damage and multiple manifestations of disease, diagnosis of celiac disease may be delayed. It seems general physicians should be aware about uncommon presentations of disease and indications of celiac tests. 2. The second most important challenge is in patients with suspected disease but negative serologic tests. In these cases evaluating of Human Leukocyte Antigen (HLA) can be useful. 3. The third challenge is in cases with positive serologic tests but negative histopathological findings. There may be false positive serologic response or consumption of gluten before testing. We recommend introduction of gluten for at least 3 mo and re- endoscopy and if diagnosis is equivocal HLA-typing for DQ8 and DQ2 should be done. 4. The forth challenge is about performing endoscopy. Based on guideline from European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) if there are typical clinical manifestations of celiac disease, Anti-tissue Transglutaminase (Anti-tTG) more than ten times Upper Limit Normal (ULN), positive Anti Endomysial Antibodies (Anti-EMA) and HLA DQ2, performing endoscopy may not be necessary, but many physicians don’t agree with this idea.5. In people who are genetically predisposed to celiac disease antibody levels may be fluctuating thus endoscopy with biopsy should be done in these patients.6. In children lower than 2 years, Anti- tTG and Anti–EMA have low sensitivity. we recommend Anti-tTG and Anti-Deamidated Gliadin Peptide (Anti-DGP) in these patients.7. Resolution of symptoms after gluten free diet is not necessarily a feature of celiac disease. This condition may be seen in patients with Irritable Bowel Syndrome (IBS) or non-celiac gluten sensitivity.

Hearing impairment and hearing loss are kinds of latent handicap in children. Any abnormality in hearing can affect different aspects of life. Otoacoustic emissions have been accepted as an appropriate method for screening of hearing loss in neonates. In this study we assessed the hearing status of infants admitted in Intensive Care Unit (ICU) wards in Yazd. This was a cross-sectional study on hearing status of infants admitted in ICU wards of Yazd hospital in 2012-2013. Data was collected using a questionnaire involving demographic data of the infants and their parents. Data was gathered from infants’ medical files and interview by their parents. Data was analyzed by SPSS- 20, using chi square test. 514 infants were introduced for primary screening. 82 subjects were referred for the second step of Otoacoustic Emissions (OAE) test. Seventy subjects referred for second OAE. Among all 25 infants with hearing impairment, there was no family history of hearing loss, but among the subjects with normal hearing, 5 subjects showed hearing loss. Hearing loss in neonates admitted to Neonatal Intensive-Care Unit (NICU) is more common than general population. Early diagnosis of hearing impairment is essential for prevention of future disabilities and development of their life quality which explains the need to screen all neonates for hearing impairment.

Micronutrients deficiency, especially iron and vitamins, is a common nutritional problem among children under 2 years in Iran. The aim of the present study is to assess the awareness and performance of mothers about the use of iron and vitamin supplements in infants under 2 years. This cross-sectional study was performed on 762 mothers of 6-24 months infants referred to the Children’s Hospital of Tabriz in (Mar 2012-Mar 2013). They completed questionnaire. Data was collected through a three partite questionnaire and analyzed through interviews with mothers about the use of iron and multivitamin supplements. Data were analyzed by descriptive- analytic tests and using SPSS 11.5. The results showed that the number of mothers with high, moderate, and low awareness was 115 (15.09%), 456 (59.84%), and 91 (25.06%), respectively. The number of mothers with good, moderate, and poor performance was 186 (24.4%), 379 (49.74%), and 197 (25.86%), respectively. There was a significant relationship between education level and the performance of mothers (P<0.05). Periodic retraining courses for health staff, technicians, and nutrition and children experts play a key role in increased knowledge, attitudes, and practices of health staff. Such courses will improve the ability of health staff to transmit correct educations to mothers. Most important factor in avoiding the use of vitamin and iron drops is their taste and teeth stain, the production and use of supplements with better taste and fewer side effects can be effective.

Autism spectrum disorders (ASD) belong to the pervasive neurodevelopmental disorders. The prevalence of ASD has increased significantly throughout recent decades, bringing the overall estimated prevalence to 11.3 per 1000 children. ASD is characterized by severe difficulties in reciprocal social interaction, stereotyped patterns of behavior and profound impairments in verbal and nonverbal communication. In this experimental study, 150 children with ASD, who referred to psychiatry clinics of children in two Mashhad Academic Hospitals-Iran, were enrolled. At the first, they divided into 3 groups (n=50 patients in each group). All groups were educated and treated with Holistic Multidimensional Treatment Model (HMTM) method but for different periods: one, two, and three years. Data analysis was done using ANOVA and ANCOVA test. 78% of participants were boys. According to the results, 26% of participants after one year treatment, 44% after two years and 52% after three years treatment improved. The participants’ symptoms of behavioral, cognitive and physical function declined in 3 groups significantly (p<0.05). The results suggest that holistic multidimensional treatment model has been effective in treatment of children with autism spectrum disorders in all the three groups, regardless of the gender and age. Whatever treatment period would be longer, recovery process would be more effective in children with ASD spectrum.

Training medical students and prepare them for diagnosis, treatment and care of diseases, is the main goal of medical education. According to importance of adapting educational content to the needs of society and the high incidence of infectious diseases in the country, decided to study the knowledge of medical students and public health students about Tuberculosis (TB) and Directly Observed Treatment, Short-course (DOTS), because they are the main stakeholders in the field at future. In a cross-sectional study using a questionnaire consisting of 40 questions related to the knowledge necessary measures in prevention, diagnosis and treatment of tuberculosis (DOTS), 90 students of public health and medical students who were taken by the stratified random sampling with Using a reliable and valid questionnaire. The results of the tests were analyzed by descriptive and analytical tests in SPSS11.5 software. Average knowledge of public health students about TB was (9.24+9.091) of total 20 and kowledge of medical students was (8.67+1.954). The mean of knowledge, diagnosis and treatment of Public health students was (16.91+3.168) of total 40 and of medical students was (16.42+3.720). There was a significant linear correlation between general and technical students information about TB (r=0.681, p=0.000). T test showed there is not significant relationship between gender and field of study and students knowledge about TB; however, the infromation level in women was higher than in men. Knowledge of medical and health students about TB and DOTS is not in acceptable level and it is necessary to revise the education of tuberculosis in medical and health school.

It has been recognized that patients with Cyanotic Congenital Heart Disease (CCHD) show significant bleeding tendency which can be secondary to coagulopathies in these patients. Some coagulation abnormalities are thrombocytopenia, factor deficiencies, fibrinolysis and Disseminated Intravascular Coagulation (DIC).According to high prevalence of CCHD and major operations in theses patients, the aim was to evaluate the coagulation abnormalities in children with CCHD.

Unfortunately, we do not know how many perinatally (Human Immunodeficiency Virus) HIV-infected pepole are living in contries today, while knowing these informations is necessary. United Nations Programme on HIV/AIDS (UNAIDS) reports that there are 3.4 million children under 15 years of age with HIV and 2 million adolescents between 10 and 19 years of age. Although the vast majority of children were perinatally infected, older children are combined with behaviourally infected adolescents and youth in global reporting, without disaggregation by sex. The aim of this study is to introduce the prevalence and prevention of HIV/AIDS (Acquired Immunodeficiency Syndrome) in children of worldwide.

McCune-Albright Syndrome (MAS) is a rare, heterogenous, clinical condition caused by a rare genetic mutation. The disorder is more common in females and is characterized by a triad of cutaneous, bone and endocrine abnormalities.We describe a girl patient with MAS having precocious puberty and multiple cafe-au-lait macules and deforming polyostotic fibrous dysplasia of bone. Clinical presentation and X-ray finding were strongly diagnostic for MAS, Patients with McCune-Albright Syndrome reach the adult age with a significant burden of the disease that continuously reduces their quality of life. Skeletal deformities, fractures, hyperthyroidism, and hyperestrogenism are just few of the many challenges in the management of these patients. These disorders with close observation and early detection can be controlled.

Nosocomial Infections (NI) are a frequent and relevant problem, in other hands; those are responsible of mortality especially in pediatric ICU(Intensive Care Unit) and NICUs (Neonatal Intensive Care Unit). Healthcare-associated infections are important in wide-ranging concern in the medical field. The most cause of nosocomial infection include: bloodstream infection, urinary tract infection, pneumonia, and wound infection. The purpose of this study was to determine the epidemiology of the three most common NI in the Pediatric department. We performed a prospective study in a single pediatric department during 12 months. Children were assessed for 3 NI: wound infections, pneumonia and Urinary Tract Infections (UTI), as the same method as Center of Disease Control criteria(CDC). All patients were followed up and individuals who had have NI and their treatment was entered in this study. In this study 811 patients were hospitalized that 60% of them were male and were older than 60 months. The main causes of hospitalization include: toxicity, seizure, respiratory infection and fever. Among them 15 cases had NI (1.87%). The most NI occurred in pediatric intensive care unit (PICU) and it was followed in aspect of intubation. The most cultured organism was pseudomonas that they suspected to ceftazidime and isolate from blood and endotracheal tube. NI presence was associated with increased mortality and length of stay in hospital. This study highlights the importance of NIs in children admitted to a pediatric department especially Pediatric Intensive Care Unit (PICU) in a developing country. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.