Iranian Journal of Pediatrics
Year:2014 | Volume:24 | Issue:2|Papers Count:18

Losing hair can create emotions ranging from anger to depression. Some children feel very self-conscious going out in public, and others are concerned that their appearance will affect their relationship with classmates and even loved ones. In one study the children with alopecia were anxious, depressed, withdrawn, aggressive, or delinquent. Girls were more affected than boys.

Objective: The surveillance of acute flaccid paralysis (AFP) is a key strategy for monitoring the progress of poliomyelitis eradication and is a sensitive measure for detecting potential cases of poliomyelitis and poliovirus infection. This study was conducted to describe the characteristics of patients reported with AFP, and to evaluate the performance of the surveillance system in Kurdistan province, western Iran, using indicators recommended by the World Health Organization (WHO).Methods: This observational study was conducted from January 2000 to December 2010 at the Kurdistan Center for Disease Control and the Department of Pediatrics. All children who fulfilled the WHO definition for AFP were included in our study. The stool samples of all the children were sent for poliovirus isolation. All the patients were evaluated for 60 days after the onset of symptoms to identify the signs of residual weakness.Findings: One-hundred thirty nine children aged <15 years were reported to the Center for Diseases Control with AFP. In 138 (99%) stool samples no poliovirus was isolated. None of the patients was diagnosed as having acute poliomyelitis or polio-compatible paralysis. Guillain-Barre syndrome was the most frequent final diagnosis (79 cases) followed by Transverse Myelitis (7 cases) and Encephalitis (6 cases). By detecting 1.3 to 3.6 (mean 3.2) AFP cases per 100 000 population in Kurdistan during the study period, we achieved the WHO target for AFP surveillance. All performance indicators but one consistently met the WHO requirements and therefore demonstrated the effectiveness of the AFP surveillance program in Kurdistan.Conclusion: The effective surveillance system in Kurdistan and its evaluation may serve as a model for the surveillance of other infectious diseases.

Objective: Child abuse is one of the major challenges for health care providers. This study was conducted to determine the burden of child abuse (physical & emotional) and the factors associated with it in an urban city of Pakistan.Methods: This cross-sectional study was conducted in primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan between March to December 2010. Mothers with children aged between 6 and 12 years were included in the study. Those mothers’ suffering from any acute illness like high grade fever, were excluded. A total of 412 mothers were recruited through consecutive sampling and written informed consent was taken. A pre-tested questionnaire was used to seek information about child abuse. Data was analyzed using SPSS version 19 and multivariable logistic regression was used to identify the factors (age, gender of child, family structure, educational status of parents, and mother’s perception of her home environment) associated with child abuse.Findings: Of the total 412 mothers, final analysis was conducted on 379 mothers. In all, 32.5% of children had been abused, 25.5% physically and 17.9% emotionally. Abuse was reported more among children whose mothers had minimal or no schooling (P=0.02), who were abused by their husbands (P<0.001), not satisfied with their marital life (P<0.001), and stressful home environment (P=0.02). In the multivariate analysis, the factors found to be independently associated with child abuse were mothers abused by their husbands (AOR=4.2; 95%CI: 2.2-7.9) and child being a girl (AOR=8.7; 95%CI: 4.5-16.8).Conclusion: The prevention of child abuse can be achieved through comprehensive, multifaceted and integrated approaches requiring joint efforts by the government, policy makers, stake holders, social workers, educationists, and public health practitioners.

Objective: The aim of this study was to evaluate the value of lung ultrasound in the diagnosis of respiratory distress syndrome (RDS) in newborn infants.Methods: From March 2012 to May 2013, 100 newborn infants were divided into two groups: RDS group (50 cases) and control group (50 cases). According to the findings of chest x-ray, there were 10 cases of grade II RDS, 15 grade III cases, and 25 grade IV cases in RDS group. Lung ultrasound was performed at bedside by a single expert. The ultrasound indexes observed in this study included pleural line, A-line, B-line, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, lung pulse etc.Findings: In all of the infants with RDS, lung ultrasound consistently showed generalized consolidation with air bronchograms, bilateral white lung or interstitial syndrome, pleural line abnormalities, A-line disappearance, pleural effusion, lung pulse, etc. The simultaneous demonstration of lung consolidation, pleural line abnormalities and bilateral white lung, or lung consolidation, pleural line abnormalities and A-line disappearance co-exists with a sensitivity and specificity of 100% for the diagnosis of neonatal RDS.Conclusion: This study indicates that using an ultrasound to diagnose neonatal RDS is accurate and reliable tool. A lung ultrasound has many advantages over other techniques. Ultrasound is non-ionizing, low-cost, easy to operate, and can be performed at bedside, making this technique ideal for use in NICU.

Objective: Hematological complications of brucellosis are common. Pancytopenia, although mainly reported in adults, has also been described in children with brucellosis. This investigation was conducted to estimate the relative frequency of pancytopenia in children with brucellosis.Methods: The current study was conducted in Al-Khafji Joint Operations Hospital, Saudi Arabia. Sixty patients with brucellosis were enrolled in the study. Complete blood count (CBC) and blood culture were performed for all cases. Bone marrow (BM) aspiration was considered only in those with pancytopenia. Findings: Out of 60 children with brucellosis, 50 (83%) ingested raw animal milk and 27 (45%) had a positive family history of brucellosis. The common presenting symptoms and signs included: excessive sweating (68%), bone aches (62%), chills (55%), arthritis (32%), hepatomegaly (18%) and splenomegaly (15%). The main hematological manifestations included: anemia (43%), leukopenia (38%) and leukocytosis (20%). Pancytopenia was detected in 11 (18%) patients. Blood culture for Brucella was positive in 38% (23 patients). B. melitensis from 21 patients was cultured in vitro. Out of 9 BM aspirate cultures, 3 were positive for B. melitensis. Out of 11 patients with pancytopenia, 9 (82%) patients had bone aches and weakness, 7 (64%) patients sweating and chills, 6 (55%) patients petechiae and purpura.Conclusion: The current study concludes that although pancytopenia is an uncommon complication of brucellosis in children, it does occur. Therefore, brucellosis should be considered in the differential diagnosis of pancytopenia in children, particularly in endemic areas such as Saudi Arabia.

Objective: Pycnodysostosis is a rare autosomal recessive osteochondrodysplasia resulting from osteoclast dysfunction. Growth hormone (GH) secretion impairment and low insulin growth factor 1 (IGF-I) concentrations have been reported in these patients. The present study aims to describe GH effect on linear growth of eight children with pycnodysostosis.Methods: This study was conducted on 8 children suffering from pycnodysostosis. After evaluating systemic diseases, adrenal insufficiency, and hypothyroidism, bone age, height standard deviation score (HtSDS), body mass index (BMI), and some demographical characteristics were measured. To measure the serum GH, we performed two clonidine tests in two different days with an interval of 24 hours. With initiation of the trial, human GH was injected subcutaneously once a day 6 days a week for a period of 1.5 years. The patients were followed up every 3 months to document their height and BMI until 6 months after the end of the treatment.Findings: All of the patients had growth hormone deficiency. HtSDS at the first visit continued to decrease during the 6 months before starting the treatment; however, HtSDS started to increase after beginning of GH administration. This value again declined after discontinuing the GH. Overall, the mean of linear growth was improved after GH administration in the patients.Conclusion: The present clinical study revealed that GH administration had a positive impact on the linear growth of the children suffering from pycnodysostosis.

Objective: Pathogenesis of Henoch-Schonlein purpura (HSP) is not clearly defined. The present study was conducted to investigate the alterations in erythrocyte deformability and oxidative stress in HSP and to examine the possible relationship between erythrocyte deformability and organ involvement in this disease.Methods: Plasma malondialdehyde (MDA) levels, total antioxidant status (TAS), erythrocyte deformability and aggregation were measured in 21 children with HSP at the disease onset and during the remission period in comparison with healthy subjects.Findings: HSP patients at the active stage had significantly higher MDA and lower TAS levels (P<0.05). Erythrocyte deformability was decreased at the active-stage and increased again at the remission period of HSP (P<0.05). Erythrocyte deformability was significantly decreased at four different shear stresses in patients with gastrointestinal system or renal involvement; and decreased at six different shear stresses in patients with gastrointestinal system, and renal involvement compared to the patients without organ involvement (P<0.05). No significant difference was observed in aggregation parameters (P>0.05).Conclusion: The present findings emphasize the association between impaired erythrocyte deformability and organ involvement in HSP.

Objective: Appropriate treatment of patients with Type 1 diabetes mellitus (T1DM) is necessary to avoid further complications. This study was performed to compare the efficacy of insulin Glargine and Aspart with NPH insulin and regular insulin regimen in a group of children with T1DM.Methods: Forty patients with T1DM were enrolled in this study. During run-in, all subjects were treated with conventional therapy consisting of twice-daily NPH and thrice-daily regular. Following randomization, 20 subjects received Glargine and Aspart and 20 subjects received NPH and Regular insulin.Findings: Mean HbA1c was 8.8% and 8.6% at first and 8.4% and 8.2% at the end of study for subjects randomized initially to Glargine and Aspart and for those randomized to NPH and Regular, respectively (P>0.05). Mean fasting blood glucose (FBS) of the subjects randomized initially to Glargine and Aspart was 217±101 mg/dL, with no significant difference to 196±75 mg/dL for those randomized to NPH and Regular (P=0.48). This was also true at the end of the study. The difference in total cholesterol and triglyceride between the two groups in the beginning of study and at the end did not show any significance.Conclusion: The current study showed no significant difference in glycemic control [Glycated hemoglobin (HbA1c) and FBS] and lipid profile (total cholesterol and triglyceride) between two regimes.

Objective: Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy.Methods: One-hundred fifty infants with post conceptional age (PCA) less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%. Postoperatively, they were monitored for two hours in the recovery room and ten hours in the ward using pulse oximetry and nasal capnography.Findings: Totally, 31 (20.7%) cases of postoperative apnea were reported. By comparing the patients, factors associated with postoperative apnea included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease. Twenty-seven (18%) apnea cases occurred in recovery room in infants with gestational age (GA) of 35.64±2.73 weeks, while only four (2.6%) patients of GA 36.02±2.0 weeks developed delayed apnea).Conclusion: In our study, the incidence of postoperative apnea following inguinal herniorrhaphy under general anesthesia in infants younger than 60 weeks PCA was 20.7%, which is considerable. We recommend longer surveillance and monitoring in recovery room for these infants with high-risk of postoperative apnea. This should be followed by evaluation of risk factors to determine the indication for elective intensive care unit transfer for longer-term monitoring of higher-risk patients.

Objective: Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia.Methods: This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3-7 years that underwent general anesthesia for various elective surgeries at Bou-Ali Sina Hospital in Sari, Iran between January 2010 and January 2011. A non-probability quota sampling technique was used. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium Scale. The factors linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software 16 and independent sample t-test, X2 and binary logistic regression. P-values less than 0.05 were considered as significant.Findings: One hundred thirty-four (17.9%) children had emergence agitation. The most frequent surgical procedures were ENT surgical procedures 315 (42.2%), abdominal surgery 177 (23.7%), orthopedic surgery 137 (18.3%), urology 97 (13%) and ophthalmic surgery 24 (3.2%). Otorhinolaryngological surgical procedures (P=0.001), pain (P<0.05) and induction behavior of children (P<0.005) were associated with higher rates of post anesthetic emergence agitation (P=0.001).Conclusion: This study identified the multiple independent risk factors which are associated with emergence agitation in children. To minimize the incidence of postanesthetic emergence agitation, these risk factors should be considered in the routine care by care providers in postanesthetic care unit.

Objective: To determine whether some clinical parameters can be used to predict the hemorrhage and whether the relationship between these clinical variables and the grades of hemorrhage is linear.Methods: A total of 230 premature infants, born at a gestational age less than 34 weeks were retrospectively reviewed. Germinal matrix-intraventricular hemorrhage (GM-IVH), the grade of the hemorrhage, and clinical data were assessed with a checklist. Variables were analyzed by using Mann Whitney U and Fisher's exact tests and then multiple logistic regression analysis was used to evaluate the independent risk factors.Findings: Resuscitation, gestational age, hypotension, multiple birth, and birth weight were found to be independent risk factors. We determined non-linear relationship between the grades of hemorrhage and the clinical parameters. But when we classified hemorrhages as grade 1, grade 2-3 and grade 4, the relationships were found linear.Conclusion: Premature infants who had resuscitation, low gestational age, hypotension, multiple birth, and low birth weight are more likely to have GM-IVH. The relationship between the clinical variables and the grades of GM-IVH does not seem to be linear.

Objective: Providing a safe and efficient dental treatment for a young patient is a challenge for the dentist and the child. The purpose of this study was to investigate the effectiveness, safety and acceptability of buccal midazolam in dental pediatric patients and to compare it with oral Midazolam.Methods: Eighteen uncooperative healthy children aged 2.5-6 years were randomized to each of buccal midazolam (0.3mg/kg) or oral midazolam (0.5mg/kg) at the first visit, the alternative has been used at the second visit in a cross-over manner. The study took place at pediatric dentistry clinic of Shahed University, Tehran, from November 2011 to June 2012. The patients’ vital signs and behavioral scores were recorded. The patient, the operator and the observer were blinded to the applied medication. Post operatively, patients’ and parents’ satisfaction were assessed by Visual Analogue Score and a questionnaire respectively. The P-value was set at 0.05 for significance level.Findings: There were no significant differences in physiologic factors in the medication groups at time 0, 10, 20, 30 minutes and discharge. There was also no significant difference between the two groups in behavioral parameters. The majority of parents rated both sedative agents as “effective” or “very effective” and their children mostly were without anxiety or with minor anxiety.Conclusion: Buccal midazolam may be safely and efficiently used in sedation of pediatric dental patients.

Objective: The Cox model is the dominant tool in clinical trials to compare treatment options. This model does not specify any specific form to the hazard function. On the other hand, parametric models allow the researcher to consider an appropriate shape of hazard function for the event of interest. The aim of this article is to compare performance of Cox and parametric models.Methods: We used data collected in a prospective clinical trial that aimed to compare performance of nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) treatments in terms of survival of newborn infants who had respiratory distress syndrome (RDS). Performance of Cox, exponential, Weibull, and log-logistic models were compared in terms of goodness of fit.Findings: Fitting the Cox model, we have seen that infants who received NCPAP were 4.23 (Hazard Ratio= 4.23, 95% Confidence Interval: 1.87-9.59) times more likely to fail than those received NIPPV (P=0.001). Adequacy of the exponential model was rejected. We have seen a decreasing hazard rate over time, in both treatment groups. This decrease was sharper in NCPAP group. Akiake information criterion corresponded to the log-logistic model and was lower than all other models followed by Weibull model.Conclusion: Our results demonstrate the benefit of parametric survival models over traditional Cox regression model in terms of modeling of shape of hazard function. We saw a decreasing hazard that confirms the flexibility of parametric models in terms of the modeling of hazard rate.

Background: Throat-operating forceps are an auxiliary tool used for tracheal intubation during general anesthesia as well as for artificial respiration and during airway emergency when tracheal intubation is necessary. These forceps are a commonly used tool particularly for introducing the distal end of the endotracheal catheter into the airway at the epiglottis during difficult airway intubation and nasotracheal intubation. Throat-operating forceps have a required radian for operation at the intraoral epiglottis and have different types (large, medium, and small) that are suitable for patients of different ages. These tools have flexible forceps clamps and target-like, smooth distal ends that do not injure mucous membranes. Given these advantages, throat-operating forceps are used for pediatric endoesophageal foreign-body removal.Case Presentation: Pediatric patients were anesthetized using different methods according to their age. A total of 15 patients five years to nine years of age were recruited. Foreign bodies were successfully removed without any complications.Conclusion: Tracheal intubation forceps successfully removes esophageal foreign bodies in children because of the distinct shape of the forceps. The method is simple, feasible, and safe.

Pediatric tuberculosis (TB) includes asymptomatic primary infection, progressive pulmonary TB and extra-pulmonary disease. Skeletal TB occurs in 1-6% of the extra-pulmonary cases commonly involving spine (50-65%), hip and knee joints. Primary TB involving sternum is uncommon often causing a delay in clinical suspicion and diagnosis. We report a 5 year-old with primary sternal tuberculous osteomyelitis presenting late with discharging sinus.

Among small blue round cell tumors, primitive neuroectodermal tumors (PNETs) are a group of Ewing sarcoma family of tumors that are highly aggressive, poorly differentiated and form a group of tumors defined by their appearance that are thought to derive from postganglionic parasympathetic primordial cells located throughout the parasympathetic autonomic nervous system.

Isolated congenital left ventricular diverticulum is a rare congenital heart malformation with an incidence ranging from 0.05% to 0.4%. This lesion was defined by a protrusion of the three-layer left ventricular free walls, and was first described in 1838.

Malignant adrenocortical tumor (ACT), a rare entity with an incidence of 1-2/million, is uncommon in pediatric population. These tumors are functional with varied endocrine syndromes, most frequent being rapidly progressing Cushing syndrome with/out virilization. In males estrogen-secreting tumors lead to gynecomastia and are invariably malignant.