Journal of Comprehensive Pediatrics
Year:2020 | Volume:11 | Issue:4|Papers Count:9

Background: The previous studies reported conflicting outcomes concerning the prevalence and risk factors of low bone mass. The evaluation of bone mass and its related factors in patients with hemophilia in Southern Iran can help prevent osteoporosis and fracture amongst these patients. Objectives: The present study aimed to evaluate bone mass and its related factors in patients with hemophilia in Southern Iran. Methods: This study was conducted on 111 patients with hemophilia A and B. It assessed anthropometric data, sun exposure, puberty, physical activity, and mineral biochemical parameters. Bone mineral density (BMD) was measured via dual-energy X-ray absorptiometry (DXA). Statistical analysis was conducted by SPSS software V. 21. Results: The prevalence of low bone mass for chronological age (LBM) was 20. 6% in the lumbar area and 23. 7% in the femur. Low lumbar bone mass was merely associated with the severity of factor deficiency (P = 0. 037, beta=0. 896). Low femoral bone mass was associated with severity of factor deficiency (P = 0. 022, beta = 0. 939), BMI/BMI percentile (P = 0. 013, beta =-0. 181), HCV infection (P = 0. 012, beta = 1. 4), and weight (P = 0. 002, Beta =-0. 064). Conclusions: The prevalence of low bone mass was high in patients with hemophilia in southern Iran. The severity of the disease, HCV infection, and body mass index were the most relevant related factors.

Background: Benign esophageal strictures are not rare. Over the past two decades, endoscopic balloon dilatation (EBD) has been used to treat them. Objectives: The purpose of this study was to identify the mostcommoncauses of benign esophageal stricture in children determine the success rate of endoscopic balloon dilatation. Methods: Children younger than 16 years with benign esophageal strictures referred to the endoscopy department during one year (2016-2017) were enrolled. After obtaining written consent from parents, endoscopy balloon dilatation was performed with two types of balloon catheters. Response to treatment was evaluated based on clinical symptoms and was classified according to the Vantrappen table score. Results: In this study, thirty-one (31) children participated including 19 (61%) boys and 12 (39%) girls. The mean age was 5. 1  3. 9 years. The most common causes of esophageal stricture were: achalasia (45%), esophageal atresia (19%), stenosis due to the caustic ingestion (19%), another congenital stenosis (16%). Overall, 27 children (87. 1%) had a good response to treatment. In children with stenosis due to caustic ingestion, the inappropriate response was higher than the rest (33%). However, only in 4 (12. 9%) patients, balloon dilatation failed. No complications were observed. Conclusions: Achalasia, esophageal atresia, and caustic ingestion are the mostcommoncause of benign esophageal stricture in the children. EBD is an effective and safe treatment in these children, even in cases of previous surgery and recurrence. If this procedure is performed by an expert using appropriate balloon catheters, no complications will be created.

Background: Staphylococcus aureus is a gram-positive coccus bacterium responsible for a wide spectrum of human infections. The main colonization site for S. aureus in humans is the anterior nares. Health care workers (HCW) are commonly colonized with resistant microorganisms; however, it is not clear whether close contact with HCW is a risk factor for colonization with resistant microorganisms. Objectives: The aim of the study was the determination of the risk of methicillin-resistant Staphylococcus aureus transmission from colonized parents to their children via daily contact. Methods: This was a cross-sectional study conducted in Hamadan city, the west of Iran, between October 2016 and March 2017. We defined two groups for our investigation. The first group included 1-6 years old children who their mother, father, or both were health care workers (HCW) in university-affiliated hospitals of Hamadan University of Medical Sciences, and the second group consisted of children whose parents were not health care workers. Both groups attended day care centers. One hundred and thirtyfour children were enrolled in this study, from which 67 had HCW parents, and 67 had non-HCW parents. Results: S. aureus colonization rate among children of HCWs was 17. 9 % (12/67), and in children of non-HCWS was 32. 8% (22/67). The colonization rate was not significantly different between these 2 groups (P = 0. 052). Of all the S. aureus isolates, one methicillinresistant isolate and one clindamycin-resistant isolate were observed. The D-test was positive in 12. 1% of clindamycin sensitive isolates Conclusions: We recommend the use of anti-staphylococcal penicillin or first-generation cephalosporins in cases of non-lifethreatening staphylococcal infections and clindamycin for MRSA infections. Regarding to our results, there is no difference in the choice of antibiotic between children of health care workers and other children. We also recommend avoiding switching therapy from erythromycin to clindamycin.

Background: Cystic Fibrosis (CF) is the most fatal genetic disorder among white populations. It is a multi-system disease with various symptoms, which causes many different complications. miRNAs are a class of endogenous small non-coding RNAs of 19-22 nt that regulatemRNAspost-transcriptionally. Different types of miRNAs, including miR-155, are expressed in CF lung epithelial cells. The elevated expression level of miR-155 contributes to the pro-inflammatory expression of IL-8 in CF lung epithelial cells. Therefore, miR-155 may play an important role in the activation of IL-8 in CF. Objectives: The present study aimed to investigate the relationship between miR-155 expression level and the clinical manifestations of CF patients. Methods: The participants of this cross-sectional study included 30 CF patients (according to sweat test and < F508 in the genetic study) with age ranging from 5 to 27 years (M = 17, F = 13) and 30 healthy individuals with age ranging from 8 to 28 (M = 17, F = 13). Using RNA purification Kit, microRNAs, we extracted microRNAs from serum samples, and cDNA was synthesized via the cDNA synthesis kit. Then, the levels of miR-155 were measured by real-time PCR, and the expression levels were compared in different groups of CF patients according to the Shwachman-Kulczycki scoring system. Results: The expression level of miR-155 was elevated in CF patients compared to healthy controls (Fold change: 1. 41, P value = 0. 056). Interestingly, the elevated level of miR-155 in severe and moderate patients (according to Shwachman-Kulczycki score) showed a significant difference compared to the other patients, where age and sex were not an influential factor. Conclusions: Serum expression levels of miR-155 are different in CF patients, along with the severity of the disease. By suppressing the expression of miR-155, more investigations might lead to the development of new treatment strategies for CF.

Kawasaki disease (KD), a systemic inflammatory disorder with medium-sized vasculitis, mostly occurs among children < five years of age. The highest incidence of KD is among the Asian population. The primary treatment of KD is intravenous immunoglobulin (IVIG) administration. Extreme irritability is a common neurologic manifestation among infants, and central nervous system involvement is uncommon and occurs as a result of vasculitis or IVIG administration late in the treatment course. Here, we discussed an eight-year-old girl with a final diagnosis of atypical KD, who was primarily diagnosed as aseptic meningitis. The patient was admitted with a history of fever, headache, and vomiting and later developed strawberry tongue, coronary involvement, and fingertip desquamation during the follow-up period. Aseptic meningitis, as the first clinical manifestation, made the definitive diagnosis of the KD challenging.

Background: Idiopathic Nephrotic Syndrome (INS), which is caused by a defect in the glomerular filtration barrier, is the most common chronic glomerular disease in children. Objectives: The present study aimed to assess the clinical features of INS and some recurrence-related factors in children. Methods: This population-based, cross-sectional study was conducted on 302 children with INS referring to the Pediatric Nephrology Clinic of Imam Reza Hospital of Kermanshah city, Iran, during 1998-2018. Results: The mean age (SD) at the time of diagnosis and the follow-up duration were 4. 87 (2. 89) years and 49. 83 (37. 52) months, respectively. The numbers of boys and girls were 185 (61. 9%) and 114 (38. 1%), respectively. The mean number (SD) of recurrences, annual recurrence rate during the follow-up, and the time to the first recurrence after responding to treatment were 1. 71 (1. 91), 0. 48 (0. 77), and 10. 15 (10. 63) months, respectively. The most common type of INS was steroid-dependent/frequent relapse, with a frequency of 151 (50. 5%). Furthermore, 33 (11. 0%) and 266 (89. 0%) patients were resistant and respondent to treatment, respectively. There was a statistically significant relationship between age at the time of diagnosis and the type of INS (P = 0. 007). Conclusions: This study revealed a statistically significant association between higher age and steroid resistance. However, in steroid responders, there was no relationship between gender, age at the time of diagnosis, and the time to the first recurrence, and the recurrence rate.

Background: Nowadays, parents are paying more attention to the penis size of their children, especially obese children. Objectives: The aim of this study was to investigate the correlation between obesity, testosterone, and estradiol in prepubertal non-obese and obese children with micropenis. Methods: This case-control study was done on 58 non-obese and 86 obese micropenis children aged 8-13 years at Golestan Hospital, Tehran, Iran, from June 2018 to May 2020. The body mass index (BMI), testosterone and estradiol levels, stretched penile length (SPL), and the correlation between these were studied. Results: The mean age of children in non-obese and obese groups was 10. 2  1. 34 and 10. 5  1. 6 years, respectively. SPL in nonobese and obese subjects was 3. 1  1. 3 and 2. 9  1. 22 cm, respectively. SPL in both groups was significantly correlated with height and testosterone (height: r = 0. 239, P = 0. 009; testosterone: r = 0. 344, P = 0. 001) but not with BMI, weight, and estradiol. After the adjustment for age, BMI, weight, and estradiol, adjusted odds ratio with confidence interval 95% for penile length across to height and testosterone levels in non-obese group was 1. 52 (0. 91-1. 83; P = 0. 001) and 0. 56 (0. 36-0. 98; P = 0. 001), respectively and in the obese group was 1. 42 (0. 81-1. 66; P = 0. 001) and 0. 75 (0. 51-0. 87; P = 0. 001), respectively. Conclusions: Penile length is positively correlated with height and testosterone but not with weight and estradiol in non-obese and obese children. It is probably not essential and obligatory to recommend weight loss for this issue and weight loss should not be concerned by children and their parents.

Background: Parasitic diseases are one of the health problems in all societies, especially in developing countries. Infection with parasites, especially in children, can be associated with learning disorders, malnutrition, anaemia, and physical disorders. On the other hand, an abnormal increase in the theta brainwave amplitudemay also be one of the causes of mental slowness and disability in children’ s learning, decentralization, or attention deficit hyperactivity disorder (ADHD). Objectives: In this study, we assessed the possible effects of intestinal parasites on brainwave changes in children in Karaj Health centers. Methods: A stool examination was done to separate healthy and infected children. Then, using a diagnostic interview and electroencephalography, the theta-wave was recorded in both groups. Results: From 69 children who participated in this study, 8. 7% were infected with one or more intestinal parasites. Around 14. 49% of all children had a high theta wave, but the interesting point was that 100% of infected children had a high theta brainwave (P value = 0. 001). In contrast, only 6. 34% of healthy people had high theta waves. Conclusions: In this study, there was a significant relationship between parasitic infection and brain wave changes. Parasitic diseases may alter brainwaves with unknown mechanisms and affect the ability and activities of the brain.

Background: Poisoning is one of the most common medical emergencies in young children. Substantial differences in socioeconomic and cultural situations cause various epidemiological patterns of acute poisoning with different poisonous agents. Objectives: We aimed to determine the extent of pediatric poisoning in a referral teaching hospital in the center of Iran. Methods: The electronic database of Qods Children Hospital in Qazvin, Iran, was searched for children younger than 12 years old and referred for acute poisoning from 2015 to 2018. The cases (n = 184) were classified according to their age, gender, symptoms at the time of admission, the toxins, and their types. Results: The frequency of poisoning in boys was more than girls (M/F = 1. 49). The mean age of the patients was 3. 4 years, and the average length of stay in hospital was 1. 3 days. Children poisoned with petroleum products had the highest average stay (3. 10 days). Although more than 65 agents were identified as the poisoning agents, narcotics were the most common category (n = 62, 33. 7%), and methadone was the mostcommonagent in our study (n = 46, 25%). Central nervous system symptoms were recorded more than other signs and symptoms on admission or during the stay. Only two patients (1. 1%) had been discharged with complications. Conclusions: With predominance for boys, most of the children had toxicity with medications. Methadone, other narcotics, and psychotropic medications were the mostcommonagents that indicate a need for more severe control and education for prevention from poisoning in children.