فهرست مطالب

Pediatrics - Volume:24 Issue:6, 2015
  • Volume:24 Issue:6, 2015
  • تاریخ انتشار: 1393/10/22
  • تعداد عناوین: 23
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  • Yousef Veisani, Kourosh Sayehmiri, Shahab Rezaeian, Ali Delpisheh Pages 665-672
    Objective
    Unrecognized congenital hypothyroidism (CH) leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. In this systematic review, the local results of the national CH screening program in different provinces in Iran are reviewed and evaluated.
    Methods
    Literature on the CH screening, the national databases including SID, Medlib, Iran Medex, Magiran as well as international databases including PubMed/Medline, ISI Web of Knowledge and web of science, EMBASE, SCOPUS and Google Scholar. Appraisal was guided by a checklist assessing clarity of aims and research questions. The 95% confidence intervals were calculated by I-square models. Meta regression was introduced to explore the heterogeneity between studies.
    Findings
    We identified 25 samples including 1425124 neonates in our country. Data were Meta analyzed using random-effects models, and we found a TSH levels of 19633 babies in the first sampling were greater than the cut-off level (TSH ≥5mIU/L). The pooled recall rate was 0.014 (95 % CI: 0.013 – 0.015). According to Meta analysis the overall incidence of CH was 2/1000 (95% CI:. 002 –. 002). The incidence of CH did not appear to be increasing over time (P=0.08).
    Conclusion
    Considering TSH ≥5mIU/L as a cut-off point for recalling neonates and low positive predictive value (14%) of this point shows that more investigation and research is needed for establishing accurate level of TSH as a criterion for recalling patients.
    Keywords: Congenital Hypothyroidism, Hypothyroidism, Congenital, Meta Regression, Iran
  • Yadollah Zahed Pasha, Mussa Ahmadpour, Kacho, Reza Behmadi, Tahereh Jahangir Pages 673-678
    Objective
    The objective of this randomized controlled trial was to compare the treatment failure of suspected early onset neonatal sepsis with either 3-day or 5-day course of empirical antibiotic therapy.
    Methods
    Infants with birth weight over 1500 g and/or gestational age over 34 weeks within 7 days postnatal age with clinical symptoms of neonatal sepsis received empirical antibiotics (Ampicillin + Amikacin) in two neonatal intensive care units. After 72 hours if the result of blood culture was negative and symptoms resolved they were randomly allocated to 3-day or 5-day groups. The main outcome was treatment failure which was defined as reappearance of symptoms of sepsis within two weeks after discontinuation of antibiotics. Infants with congenital anomalies, localized infections, asphyxia, those undergoing surgery or when serum C-reactive protein levels remained abnormal despite treatment, were not included. Randomization was accomplished with simple randomization procedure.
    Findings
    Sixty patients were randomized in a 1:1 ratio to either group. Baseline characteristics were similar between two groups. The follow-up period was 2 weeks with no lost to follow-up.One infant in 3-day group had treatment failure compared with no treatment failure in 5-day group (P=0.5). No serious harm was observed due to our empirical antibiotic regimen.
    Conclusion
    The results of this study indicated no evidence that treatment failure differs between 3-day and 5-day course antibiotic therapy for suspected early onset uncomplicated neonatal sepsis in late preterm and term newborns.
    Keywords: Neonate, Sepsis, Treatment Failure, Antibiotics, C, Reactive Protein
  • Happy Sawires, Manal Abd, El Meguid, Marianne Ishak, Mohamed Abd, El Hady Pages 679-684
    Objective
    Although many methods for pain assessment in newborns are available, none of them are widely accepted. Our aim was to answer the question: do newborns respond similarly to different painful procedures?
    Methods
    Sixty term newborns were involved in non-randomized prospective study. They were classified into 2 groups: Group A (n=30) who needed intubation and Group B (n=30) who necessitated umbilical vein catheterization. Close observation prior to and 10 minutes after the painful procedures was performed for recording of physiological and behavioral indicators. Plasma renin activity (PRA) was measured before and 10 minutes after the painful procedures.
    Findings
    There was statistically significant difference between the 2 groups as regards physiological and hormonal responses to pain (P<0.05). Apart from palmar sweating and crying, there was no significant difference in behavioral response (P>0.05). The median pre- and post-intubation levels of PRA were 3.04 and 12.05 ng/ml/hour, respectively. There was significant (P<0.001) increase of PRA after intubation. On the other hand, the median pre- and post-catheterization levels of PRA were 5.21 and 9.19 ng/ml/hour, respectively. There was significant (P<0.001) increase of PRA after umbilical vein catheterization. We found that PRA was the only indicator of pain in group A (P=0.047). On the other hand, we did not find any indicator of pain in group B.
    Conclusion
    We concluded that full-term newborns vary in their physiological and hormonal responses to different painful procedures but their behavioral response is the same.
    Keywords: Pain Assessment, Newborns, Plasma Renin Activity, Intubation, Umbilical Vein Catheterization
  • Kurosh Djafarian, Diane M. Jackson, Zoe Donaghy, John R. Speakman, John J. Reilly Pages 685-691
    Objective
    The present study aimed to determine the validity of simple epidemiological and clinical methods for the assessment of body fatness in preschool children.
    Methods
    In 89 children (42 boys, 47 girls; mean age 4.1 SD 1.3y) measures of body fatness were made using total body water (TBW), dual energy x-ray absorptiometry (DXA), air displacement plethysmography (BODPOD) and skinfold thickness. Methods were compared by Bland–Altman analysis using TBW as the reference method, and by paired comparisons and rank order correlations.
    Findings
    Bias for DXA was +1.8% body fat percentage units (limits of agreement +15.5% to -11.9%), bias for BODPOD was -3.5% (limits of agreement +18.9% to -5.9%) and bias for skinfolds using the Slaughter equations was -6.5% (limits of agreement +10.0% to –23.1%). Significant rank order correlations with TBW measures of fatness were obtained for DXA estimates of fatness (r=0.54, P=0.01), but not for estimates of fat by skinfold thickness (r=0.20, P=0.2) or BODPOD (r=0.25, P=0.1). Differences between both DXA and BODPOD and the reference TBW estimates of body fatness were not significant (P=0.06 and P=0.1 respectively); however, the difference in estimated body fatness between skinfold thickness and TBW was significant (P<0.001).
    Conclusion
    Estimates of body fatness in preschool children were inaccurate at the level of the individual child using all the methods, but DXA might provide unbiased estimates and a means of making relative assessments of body fatness.
    Keywords: Body Composition, Preschoolers, DXA, TBW, Skinfold Thickness, BODPOD, Body Fatness
  • Seyedeh, Fatemeh Khatami, Pouya Parvaresh, Parviz Parvaresh, Sara Sadat Madani Kouchak, Jamshid Khorsandi Pages 692-696
    Objective
    Relatively little is known about the trace elements content of human milk from different countries. This has not been fully investigated especially among Iranian women. This study aimed to assess the concentration of Rubidium (Rb) as a poisonous trace element in transitional breast milk of lactating mothers living in Mashhad.
    Methods
    Forty nursing mothers in early lactation 3 days to 15 days postpartum, free from any medical disorder and/or medication were randomly selected. We have applied Instrumental Neutron Activation Analysis (INAA) to assess the long-lived isotope trace element Rb in transitional milk of these economically moderate 18-39 year old Iranian women.
    Findings
    The average concentration level of Rb was 32.176 ppm dry weight (min 8.660, max 107.210 ppm). No significant correlation was observed between Rb concentration and maternal weight and age (P=0.06, P=0.05 respectively) and newborns’ weight, age and sex (P=0.07, P=0.2, P=0.2 respectively).
    Conclusion
    Although the Rubidium concentration found in this study is among the highest reported in the literature, it could not be compared to other studies because of differences in analytical performance, state of lactation, and unavailable reference ranges, so this finding needs further investigations.
    Keywords: Human milk, Toxic Trace Elements, Rubidium, Newborn
  • Mirhadi Mussavi, Khairollah Asadollahi, Farhad Janbaz, Esmaiil Mansori, Naser Abbasi Pages 697-702
    Objective
    Red reflex test is an effective screening tool in the early diagnosis of neonatal eye abnormalities. The aim of this study was to detect the sensitivity and specificity of red reflex assessment in neonates, performed by pediatricians (or other care providers) in comparison with ophthalmologists. Also association between red reflex findings and neonatal variables is evaluated.
    Methods
    By a prospective study all neonates born from July 2011 until March 2012 in Mustafa Hospital, a general teaching hospital in Ilam city, Iran, were evaluated. Neonates were firstly investigated by pediatrician in substandard conditions at the first day of birth and several days later by ophthalmologist in standard conditions.
    Findings
    Totally 255 neonates including 141 boys and 114 girls were investigated, 144 of whom were born by cesarean section. There was a significant relationship between method of childbirth (72.9% disorders in CS vs 56.8% in vaginal delivery (P<0.007)), duration of delivery (disorders in prolonged: 100% and 11.8% vs no prolonged: 56.8% and 6.3% in standard and non standard conditions respectively (P<0.0001)), difficult delivery (98.6% disorders vs 6.5% in standard and non standard conditions respectively (P<0.01)) and increase or decrease of red reflex sensitivity test. A significant difference (identification of ophthalmic problems) was seen among neonates'' inspections in primary hours and substandard conditions compared to further inspections in standard conditions particularly from 3rd day of birth.
    Conclusion
    Due to a considerable difference between the results of ophthalmic examination of neonates in different conditions, red reflex examination by pediatricians is suggested for all neonates to early identification of ophthalmic problems at the first step. It is also suggested a red reflex screening for all neonates before being discharged from hospital as well as 6 weeks later and in case of any problem to be referred to ophthalmologist.
    Keywords: Red reflex, Neonates, Ophthalmic Disorders
  • Tahereh Falsafi, Nazli Sotoudeh, Mohammad Mehdi Feizabadi, Fatemeh Mahjoub Pages 703-709
    Objective
    Presence of genomic diversity among Helicobacter pylori (H. pylori) strains have been suggested by numerous investigators. Little is known about diversity of H. pylori strains isolated from Iranian children and their association with virulence of the strains. Our purpose was to assess the degree of genomic diversity among H. pylori strains isolated from Iranian-children, on the basis of vacA genotype, cagA status of the strains, sex, age as well as the pathological status of the patients.
    Methods
    Genomic DNA from 44 unrelated H. pylori strains isolated during 1997-2009, was examined by pulse-field gel electrophoresis (PFGE). Pathological status of the patients was performed according to the modified Sydney-system and genotype/status of vacA/cagA genes was determined by PCR. PFGE was performed using XbaI restriction-endonuclease and the field inversion-gel electrophoresis system.
    Findings
    No significant relationship was observed between the patterns of PFGE and the cagA/vacA status/genotype. Also no relationship was observed between age, sex, and pathological status of the children and the PFGE patterns of their isolates. Similar conclusion was obtained by Total Lab software. However, more relationship was observed between the strains isolated in the close period (1997-2009, 2001-2003, 2005-2007, and 2007-2009) and more difference was observed among those obtained in the distant periods (1997 and 2009).
    Conclusion
    H. pylori strains isolated from children in Iran are extremely diverse and this diversity is not related to their virulence characteristics. Occurrence of this extreme diversity may be related to adaptation of H. pylori strains to variable living conditions during transmission between various host individuals.
    Keywords: Helicobacter pylori, Children, Genomic, diversity, PFGE, Iran
  • Relationship between Vitamin D and Childhood Asthma: A Case - Control Study
    Shokrollah Farrokhi, Gissou Hatami, Niloofar Motamed, Ali Movahed, Khadijeh Ghasemi, Saiideh Firoozbakht, Sadegh Golbini Pages 710-714
    Objective
    Studies determining the relationship between serum vitamin D status and childhood asthma have yielded controversial results. Findings indicated that vitamin D deficiency is associated with asthma and airway hyper responsiveness. The aim of this study was to assess the relationship between serum vitamin D status and childhood asthma.
    Methods
    Data were obtained from 200 asthmatic children (age 3-12 years) and 200 healthy controls. Serum levels of 25(OH) vitamin D, total IgE, calcium, phosphorus, parathormone (PTH) and eosinophil count were measured in both asthmatic children and healthy controls. Also, the mean values of 25(OH) vitamin D were compared with asthma symptom severities.
    Findings
    There was a significant decrease in the concentration of serum 25(OH) vitamin D in the asthmatic patients as compared with the controls (20.34±2.8 vs 25.39±4.1 ng/mL, 95%CI: 1.46-3.86, P=0.01). Out of total asthmatic subjects, 40 (20%) were vitamin D sufficient, 48 (24%) were insufficient, and 112 (56%) were deficient. Total IgE concentration was also significantly higher in asthmatic patients having vitamin D deficiency (132.4±20.1 IU/ml, 95%CI: 1.38-3.75, P=0.03). Comparing asthmatic patients with healthy controls, odds of having vitamin D level less than 20ng/mL was 2.47.
    Conclusion
    Our findings suggest that vitamin D deficiency or insufficiency may be positively related to the prevalence of asthma in children.
    Keywords: Vitamin D status, Asthma, Children, Total IgE
  • Elham Olad, Iraj Sedighi, Azim Mehrvar, Maryam Tashvighi, Vahid Fallahazad, Amirabbas Hedayatiasl, Hossein Esfahani Pages 715-722
    Objective
    Timely detection of serious bacterial infections or prediction of sepsis and death is of paramount importance in neutropenic patients especially in oncology settings. The aim of this study was to determine a rapid and secure predictor of sepsis in severe neutropenic cancer children.
    Methods
    In addition to blood culture, we have evaluated serum soluble CD14 on this role and measured it in 39 neutropenic episodes in Mahak pediatric oncology center from September 2012 to January 2013. Fifteen episodes had positive bacterial cultures and 18 had fever. The mean sCD14 values were compared in the presence or absence of fever, positive blood culture and other clinical conditions. Also, mean levels compared in different white cell counts and different four combination settings of fever and blood culture.
    Findings
    It was statistically higher in febrile episodes, in the presence of oral mucositis, indwelling catheter infection, otitis media, and post toxic epidermal necrolysis sepsis and in instances of death within 15 days. Leukocyte count did not affect sCD14 level and in combinations of fever and blood culture, mean sCD14 values were ranked as follow: febrile culture negatives, febrile culture positives, afebrile culture positives and afebrile culture negatives.
    Conclusion
    Although sCD14 was not sensitive in detection of bacteremia, in the absence of clinically detectable source of infection, it was significantly higher in culture positives.
    Keywords: Soluble CD14, Cancer, Neutropenia, Infection, Pediatrics
  • Mehri Najafi, Nooshin Sadjadei, Kambiz Etekhari, Ahmad Khodadad, Farzaneh Motamed, Gholam, Hossain Fallahi, Fatemeh Farahmand Pages 723-728
    Objective
    Celiac disease is an autoimmune disorder in which the risk of autoimmune liver disease is high. Autoimmune hepatitis is a chronic and progressive entity and the risk of its being associated with other autoimmune disorders such as celiac disease is high also. The aim of this study was to determine the prevalence of celiac disease in patients with autoimmune hepatitis and vice versa.
    Methods
    In a cross-sectional study children with autoimmune hepatitis underwent serological screening and endoscopy for celiac disease. In patients with celiac disease, serum aminotransferases were measured and, if abnormal, autoantibodies related to autoimmune hepatitis were checked and needle liver biopsy was performed.
    Findings
    Of the 96 patients, 64 had autoimmune hepatitis and 32 celiac disease. Among patients with autoimmune hepatitis only three (4.7%) were compatible with celiac disease. In the group of patients with celiac disease, autoimmune hepatitis was confirmed in four (12.5%) cases. We consider important to state that 3.1% of this group had celiac hepatitis.
    Conclusion
    Autoimmune liver disease is sometimes associated with latent celiac disease. Serological screening for celiac disease should be routinely done in patients with abnormal serum aminotransferases, particularly those with chronic liver disease. On the other hand, celiac disease is often accompanied by other autoimmune diseases, including autoimmune hepatitis.
    Keywords: Celiac Disease, Autoimmune Hepatitis, Anti Smooth Muscle Antibody, Anti Tissue Transglutaminase Antibody (tTG, IgA), Anti, Nuclear Antibody
  • Naiire Salmani, Abbas Abbaszadeh, Maryyam Rassouli Pages 729-738
    Objective
    Trust is proposed as the necessary foundation to achieve better performance in the nursing of children. In this regard, Pediatric nurses need to achieve a deeper understanding of parents'' experiences, and find out how these experiences are being related to the nursing practice. So to increase nurses'' understanding of this concept based on the experiences of the recipients of nursing, the present study aims to express the factors that affect the formation of trust in mothers of hospitalized children towards the nurses.
    Methods
    In this study, a qualitative design, conventional content analysis, was used. Pediatric Ward of hospitals in Yazd, Iran were the research environment. 14 mothers whose children were hospitalized in pediatric wards were selected through purposive sampling. They were deeply interviewed and data was analyzed with conventional content analysis.
    Findings
    Data analysis led to emerging a major category “nurses’ attempt for professional nursing” which includes sub-categories of commitment and empathetic caring, skill in performing duties, mothers’ participation in the process of caring, being interested in pediatric nursing and establishing effective communication.
    Conclusion
    Findings from the study showed that mothers know different factors involved in establishing confidence in nurses. Managers and people in charge in the field of nursing - regarding these findings - can design and perform necessary training programs to increase knowledge and skills for pediatric nursing, to win the trust of mothers and children in hospital for an effective step towards providing a better nursing care.
    Keywords: Trust, Nurse, Commitment, Participation
  • Raid M.R. Umran, Nabeel Hashim Radhi Pages 739-744
    Objective
    Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis.
    Methods
    45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients).
    Findings
    Serum procalcitonin levels were significantly higher in bacterial meningitis group (637±325 pg/ml) compared with non-bacterial meningitis (380±170 pg/ml); P<0.001. Procalcitonin levels were more sensitive and specific (79%, 81%) than C-reactive protein (76%, 75%) and white blood cell count (72%, 75%) in the diagnosis of bacterial meningitis.
    Conclusion
    Elevated serum procalcitonin level could be a predictor of bacterial causes of meningitis and is more sensitive and specific than other diagnostic predictors.
    Keywords: Bacterial Meningitis, Nonbacterial, Procalcitonon, C, Reactive Protein, White Blood Cell
  • Jafar Soltani, Bahram Nikkhoo, Jabar Khormehr, Pedram Ataee, Mohammad, Saeid Hakhamaneshi, Fardin Gharibi Pages 745-752
    Objective
    Helicobacter pylori (H. pylori) is the most common chronic bacterial infection in humans. Chronic colonization increases the risk of duodenal ulcer and gastric cancer. The risk factors for acquiring the infection have been extensively studied. However, there are conflicting results on the role of breastfeeding in the prevention of H. pylori infection. We conducted a study to evaluate the effects of breastfeeding on the H. Pylori infection in Kurdish children in Sanandaj, IR Iran.
    Methods
    A historical cohort study was carried out from January 2011 through December 2012. Totally 221 children who were going to attain 2 years old during the study period were randomly enrolled. They were divided into two groups, i.e. breastfed and non-breastfed. We used H. pylori stool antigen test to detect infection in the selected group of children after age of 2 years and cessation of breastfeeding. Each group was subdivided into two subgroups, infected and non-infected. The associations of breastfeeding with H. pylori infection was assessed using statistical software.
    Findings
    We found no difference in the odds of infection between breastfed and non-breastfed groups (OR=0.809, 95% CI [0.453-1.444]). An association between age and the prevalence of infection was found (P=0.008). There was an increase in the odds of infection as the family size grew (OR=1.93, 95% CI [1.04-3.6]) as well as increasing housing density (OR=2.12, 95% CI [1.10-4.10]).
    Conclusion
    The data suggests that breastfeeding in infancy does not protect against H. pylori infection for long duration among studied children in Iran. The protective effects of breastfeeding, if any, are at most transient.
    Keywords: Helicobacter Pylori, Human Milk, Risk Factors, Children, Iran
  • Khadijehsadat Najib, Mozhgan Moghtaderi, Zohreh Karamizadeh, Ebrahim Fallahzadeh Pages 753-758
    Objective
    Cyproheptadine hydrochloride (CH) is a first-generation antihistamine which is used as an appetite stimulant. This study was designed to identify the role of CH therapy on weight gain, linear growth and body mass index in children with mild to moderate undernutrition.
    Methods
    Eighty-nine patients were enrolled. The present randomized, double-blinded controlled trial included 77 evaluable patients, aged 24-64 months with undernutrition. The patients were randomized to receive cyproheptadine with multivitamin, or multivitamin over a period of four weeks. The weight, height and body mass index were measured at the baseline, four weeks after intervention and four weeks after discontinuation.
    Findings
    A significant higher body mass index was observed among CH-treated patients after 8 weeks intervention with cyproheptadine compared with the control group (P<0.041). Mean weight gain after eight weeks was 0.11 kg in the control group and 0.60 kg in the CH group. There were no significant differences in changes of weight and height velocity across the study between CH-treated and control group at the end of study.
    Conclusion
    In our study, cyproheptadine promotes increase in body mass index in children with mild to moderate undernutrition after four weeks treatment.
    Keywords: Cyproheptadine, Malnutrition, Weight Gain, Body Mass Index, Clinical Trial, Children
  • Wang Hua, Zhang Wei, Fan Ling, Yu Song, Ma Jian Rong, Wang Ping Pages 759-765
    Objective
    This study aimed to determine the impact of maternal cervical incompetence (with or without McDonald cerclage) on mortality and morbidity of preterm infant with birth weight <2000g.
    Methods
    581 neonates were eligible for this study, 79 with cervical incompetence and 502 without it (control). Incidences of neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), neonatal necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), severe asphyxia,small for gestational age (SGA), early-onset sepsis (EOS), and mortality were compared between the two groups.
    Findings
    Mean gestational age was earlier in cervical incompetence group than in control (30.2±2.1 vs 30.7±1.9, P<0.05). Except lower frequency of SGA, there were no significant differences in the incidences of RDS, BPD, ROP, PVL, IVH, NEC, EOS, severe asphyxia and mortality between the two groups. Infants with no cerclage had a higher prevalence of RDS (21/66 vs 9/13, P<0.05) compared to cerclage group due to lower mean gestational age (30.68±2.1 vs 28.6±1.4, P<0.01) and birth weight (1519.5±274.6 vs 1205.8±204.4, P<0.001), and clinical neonatal outcomes of the elective cerclage were similar to emergency cerclage in cervical incompetence groups.
    Conclusion
    Maternal cervical incompetence was not associated with postnatal adverse neonatal outcomes. Lower mean gestational age was a major risk associated with higher prevalence of RDS in preterm neonates with no McDonald cerclage, and emergency cerclage did not predict poor clinical neonatal outcomes.
    Keywords: Uterine Cervical Incompetence, Neonate, Mortality, Morbidity, McDonald Cerclage
  • Ahmad Jameii Khosroshahi, Ali Kianfar, Behzad Mohammadpour Aharanjani, Keyhan Sayadpour Zanjani Pages 766-769
    Objective
    We studied usefulness of serum B-type natriuretic peptide level as a screening tool for detecting hemodynamically significant patent ductus arteriosus in the preterm neonates.
    Methods
    Sixty admitted preterm neonates with gestational age ≤34 weeks, birth weight ≤2500 gr, and age of >3 days have been enrolled in this study. We measured serum B-type natriuretic peptide levels at the beginning and after completion of drug therapy for ductus occlusion.
    Findings
    Mean±SD gestational age and weight was 31±1.9 weeks and 1680±350 gr, respectively. The peptide levels in the neonates with significant duct (n=13) were significantly higher than in those with insignificant duct (n=17) or no duct (n=30) (1667±821 pg/ml versus 667±666 and 309±171, respectively). The peptide level dropped significantly after ibuprofen administration in the neonates with significant PDA (n=13), (1667±1165 pg/ml to 429±386).
    Conclusion
    At a cutoff point of 450 pg/ml, B-type natriuretic peptide level had a sensitivity of 92% and specificity of 87%, the negative predictive value of 98.5%, the positive likelihood ratio of 6.92 and the negative likelihood ratio of 0.089 for detecting significant patent duct. Levels below this can eliminate the need for echocardiography.
    Keywords: Brain natriuretic peptide, Patent Ductus Arteriosus, Echocardiography, Ibuprofen
  • Rahele Assari, Vahid Ziaee, Zahra Ahmadinejad, Mohammad Vasei, Mohammad-Hassan Moradinejad Pages 770-774
    Background
    Chronic recurrent multifocal osteomyelitis (CREMO) is one of the autoinflammatory bone disorders due to disturbance in innate immune system. Up to now, there is no reported case of caseous granulomas in the CREMO. We report a boy with sterile granolumatous osteomyelitis.
    Case Presentation
    A four-year-old boy presented with swelling and pain in the left wrist, malaise and bilateral erythematous pustulosis on the palmar region which had resolved spontaneously after about 7 days. The histopathology of the lesions showed severe acute and chronic inflammatory process and chronic granulomatous reaction with caseating necrosis (granulomatous osteomyelitis). The direct smear, culture and PCR for the mycobacterium tuberculosis and atypical mycobacteria were negative. About five months after initiation of the anti-mycobacterial treatment, he was referred to the rheumatology clinic with left elbow pain, effusion and decreased range of motion, and bilateral erythematous palmar pustulosis. He was diagnosed as CREMO based on two exacerbations, repeatedly negative cultures, and concomitant acute and chronic lesions in the histopathology and X-ray. Naproxen and pamidronate every 3 months were started and all other medications were stopped. Two months after the first dose of pamidronate, he became symptom-free and forearm X-ray showed disappearance of the osteolytic lesions and periosteal reactions.
    Conclusion
    The diagnosis of CREMO should be considered in the patients with lytic bone lesions. In addition, the clinicians should be aware of the possibility of caseating granuloma in the cases with possible diagnosis of CREMO.
    Keywords: Chronic Recurrent Multifocal Osteomyelitis, Caseous Granuloma, Tuberculosis
  • Seyed-Reza Raeeskarami, Yahya Aghighi, Azadeh Afshin, Abdolreza Malek, Ali Zamani, Vahid Ziaee Pages 775-778
    Background
    Infantile Systemic Hyalinosis (ISH) is a very rare autosomal recessive disorder characterized by connective tissue involvement as hyaline deposition in skin, gastrointestinal tract, muscles, glands and other organs.Cases Presentation: We report eight Iranian children (4 male and 4 female) with ISH referred to our hospital from 1996 to 2013. The illness had been diagnosed by clinical manifestations and disease progression. Six of them died and two are alive but very sick.
    Conclusion
    ISH is a very rare disorder with poor prognosis. Seventy five percent of our 8 patients died before 2 years old due to severe diarrhea, malabsorption and/ or infection.
    Keywords: Infantile Systemic Hyalinosis, Joint Contractures, Skin Thickness, Blond Hair, Hyaline Deposits
  • Seyed-Ahmad Hosseini, Mahmoud-Reza Ashrafi, Morteza Heidari Pages 779-780
  • Hamid Nasri, Mahmoud Rafiean-Kopaie Pages 781-783
  • Negar Azarpira, Mina Heidari Esfahani, Shahram Paydar Pages 784-786
  • Ceren Can, Mehtap Yazicioglu, Gokce Ciplak Pages 786-787