Journal of Pediatric Perspectives
Year:2020 | Volume:8 | Issue:2 (74)|Papers Count:17

Background: Neonatal mortality remains a public health concern in developing countries such as Burkina Faso. Improving the survival rate of newborns requires a good knowledge of the current situation. This study aimed at determining the risk factors for neonatal mortality in the Neonatology Department of Saint Camille Hospital of Ouagadougou (HOSCO-Hô pital Saint Camille de Ouagadougou). Materials and Methods: This was a retrospective, descriptive and analytical study that included all newborns hospitalized in the neonatology department, at St Camille Hospital, in Burkina Faso from January 1 to December 31, 2017. Total of 710 records of hospitalized newborns in 2017 were analyzed. Among them our study focused on cases of death. Results: The neonatology department registered 246 deaths out of 710 hospitalizations, representing a mortality rate of 34. 6%, of whom 194 (78. 8%) were preterm infants and 52 (11. 2%) were term newborns. Among the deceased newborns, 88% had a low birth weight and the sex ratio was 0. 8. November was the most fatal period (12. 6%). Prematurity and respiratory distress were the main reasons for referral. Prematurity (76. 4%), asphyxia (51. 2%) and neonatal infection (27. 2%) were the top 3 diagnoses at admission. The leading cause of death was respiratory distress (89. 8%). All the newborns have been hospitalized within 24 hours of life and the average time to death in the unit was 3 days and 54% of deaths occurred within 72 hours of hospitalization. Conclusion: Mortality rate is higher among preterm infants while it is relatively low among full-term newborns in our facility. Prematurity, asphyxia and neonatal infection remain the main risk factors associated with neonatal mortality.

Background: With the establishment of new technologies in the search for a cure for hemophilia, non-pharmacological treatments have had a more important role in increasing life expectancy, quality of life of children suffering from hemophilia disorders. The aim of the systematic review was a comprehensive understanding of Non-pharmacological treatment on Iranian children with hemophilia. Materials and Methods: In this systematic review, articles published in national (Irandoc, Magiran, Medlib, and SID), and international databases (Medline [via PubMed], EMBASE, Web of Science, Scopus and Cochran Central Register of Controlled Trials) were searched without any time limitation till to June, 2019. The keywords of the search include (Child OR Children) AND (Hemophilia OR Hemophiliac) AND (Iranian or Iranian). To assess the quality of the articles intered into the search, we utilized the 5-item Jadad scale. Results: Six studies were included in the systematic review. The achieved results suggested psychological training can alleviate the test anxiety, life expectancy. Yoga has a significant role in lessening the rate of bleedings, referrals to the haemophilia clinic, and the school non-attendance. Body vibration training has some benefits such as quadriceps strength, bone mineral density, and the functional capacity. Program management by nurse or own children have significant improvement on quality of life of children suffering from hemophilia disorders. Conclusion: The achieved results suggested policymakers take heed of this novel treatment and nonpharmacological approaches such as psychological training, yoga, body vibration training and its effects on alleviating non-pharmacological treatment on children with hemophilia.

The growth rate for infants and young children manifests the significant differences between age, sex, regional, and seasonal distributions. The growth rate for infants and young children is a complex process that depends on interaction of the genetic and environmental factors. All genetic and environmental factors jointly contribute to the growth rate for infants and young children, for example heredity, birth weight, gestational ages, nutrition, diseases, assisted reproductive technology, parenting style, living condition, and economic situation. In this review, we report the epidemiological distributions and critical factors contributing to the growth rate for infants and young children.

ackground: Radiation dose about 400 times that of standard thoracic computed tomography (CT) in comparison with chest X-ray resulting in different approaches to decrease radiation dose have been established in the last few years to prevent possible side effects especially in children, such as low dose protocols. The aim of this study was assessment of clinical value of low dose CT in pediatric chest diseases. Materials and Methods: This prospective study was conducted from 2017 to 2019 in the radiology departments of Dr. Sheikh Children's hospital and Imam Reza Hospital, Mashhad, Iran. The low dose CT scans were conducted at 90 kVp and 30 mAs (for 0-6 years age group) in 27 cases or 50 mAs (for 6-12 years age group) in 17 cases. Eventually, the radiologic findings were compared with the confirmed diagnosis by pediatric pulmonologist based on clinical, laboratory and imaging findings. Data were analyzed and Kappa agreement coefficient test was performed to determine agreement between the low dose CT findings and the final diagnosis. Results: Forty-four children were enrolled in this study. 72. 7% (32 cases) of all patients had chronic cough as the most common initial symptom, and hyperactive airway disease (10 patients, 22. 7%), and persistent bacterial bronchitis (9 patients, 20. 5%) were the most frequent chest diseases. There was perfect agreement between the CT-scan findings and final diagnosis (k=1, p<0. 001). Conclusion: The current study revealed that diagnostic findings of the low dose CT-scan was adaptive with clinical needs for the final diagnosis.

Background: Sore nipples are a common problem in breast-feeding women which can cause early cessation of breast-feeding. We aimed to evaluate the effect of Aloe Vera extract, breast milk, Calendit-E, Curcumin, Lanolin, Olive oil, and Purslane on healing of breast fissure in lactating mothers. Materials and Methods: All clinical trials evaluating the effect of Aloe Vera extract, breast milk, Calendit-E, Curcumin, Lanolin, Olive oil, and Purslane on healing of breast fissure in lactating mothers were searched on the online databases of Scopus, EMBASE, Cochrane, Web of Science and Medline with no language or time restrictions using the combination related keywords of Mesh. Study selection was done by two reviews. Results: Six studies were included here with a total sample size of 546 subjects. The results showed that aloe vera gel and Purslane cream are more effective than lanolin ointment for healing sore nipples. Calendit-E cream, and aloe vera gel were more effective than breast-fed milk for treating sore nipples. However, no significant difference was observed between the mother's breast milk group and olive oil. Concerning the limited side effects, as well as greater impact and antimicrobial activity of curcumin in the short term, it was suggested to use curcumin for treating sore nipples. Conclusion: Aloe vera gel and purslane cream, Calendit-E cream, and curcumin can have beneficial effects on improving sore nipples. Usage of these therapeutic methods is suggested to improve sore nipples given their low cost and limited side effects.

Background: Neonatal death is defined as death at any point in time during the first four weeks of life. It is one of the most important criteria used to evaluate the effectiveness of interventions in public areas. We aimed to investigate pre-pregnancy risk factors associated with neonatal death. Materials and Methods: This population-based case-control study was conducted in eight provinces and two cities of Iran in 2, 788 mothers referred to health care centers during 2015 to 2018. Participants were divided into two cases (1162), and control (1626) groups. Expert staff to interview the participants for case and control groups used a structural interview checklist based on the same protocol. We evaluate the association factor between neonatal mortality, the dependent variable, and the maternal demographic and health status characteristics. Data collection was a multi-stage cluster sampling method. Expert staff interviewed parents to collect data based on the same protocol for case and control groups. Results: This study was conducted on 2, 788 participants, 90% of cases (n=1162), and 94% of controls (n=1626) were under 35 years of age. The chance of neonatal death was higher in Kurdish mothers [OR: 2. 02; 95% CI (1. 1-4. 16)], mothers with low level illiteracy [OR: 1. 82; 95% CI (1. 01-3. 27)], mothers with previous stillbirth [OR: 8. 84; 95% CI (5. 88-13. 29)], using contraceptives [OR: 1. 66; 95% CI (1. 33-2. 06)], and passive smokers [OR: 1. 49; 95% CI (1. 20-1. 86)]. Conclusion: Based on the results, maternal educational level, maternal body mass index, ethnicity, using contraceptives, pregnancy intervals, and history of stillbirth, abortion, and passive smoking were associated with neonatal mortality.

Background: The skin of patients with atopic dermatitis has a high susceptibility to staphylococcus aureus (S. aureus) colonization known to produce toxins with super antigen (SAgs) activity which are a family of potent immune-stimulatory exotoxins and may aggravate AD. The aim of this research was to evaluate the role of staphylococcus aureus types and toxin-producing ability in pediatric atopic dermatitis and its association with disease severity. Materials and Methods: In this cross-sectional study, fifty-two patients with AD were evaluated for clinical severity of disease using severity scoring of atopic dermatitis (SCORAD) index. Swabs were taken from their skin and S. aureus was isolated, then the mecA, SCCmec types and agr genes besides exotoxins with super antigen properties, Hla and TSST genes were evaluated by performing polymerase chain reaction (PCR). Results: Staphylococcus aureus was isolated in 38 (73. 07%) out of 52 AD patients. The SCORAD index and AD severity were strongly correlated with S. aureus colonization (P=0. 00). The staphylococcal alpha-hemolysin (Hla) was the predominant toxin gene found in AD patients, Hla was produced in 22 patients (57. 9%). The toxic shock syndrome toxin-1 (TSST-1) gene was found in 12 (31. 6%) isolates and, in 11 patients both TSST-1 and Hla toxin gene were detected. There was no significant relationship between the presence of TSST1 and Hla gene and the severity of the disease Hla (P=0. 11 and P=0. 08, respectively). Conclusion: AD severity based on the SCORAD index was strongly correlated with S. aureus colonization, and the most frequent super antigen gene present in S. aureous isolates was that coding for (Hla).

Background: Hashimoto's thyroiditis (HT) is a common cause of thyroid diseases in children and the role of vitamin D (VD) is controversial. Therefore, the aim of this study was to investigate the influence of VD therapy on HT in children with hypovitaminosis D. Materials and Methods: This randomized clinical trial study was conducted on 30 patients referred to Endocrine Clinic of Amirkola Children's Hospital (ACH) of Babol in Iran. The serum levels of calcium, T4, TSH, Anti thyroid peroxidase antibody (TPOAb), and Anti thyroglobulin antibody (TgAb) were checked, and ultimately the HT was diagnosed based on thyroid sonography and these findings. According to normal range of calcium>8. 4 mg/dl and low level of VD, the patients were divided into deficient (<20 ng/ml), and insufficient (20-30 ng/ml) groups. Results: The mean of anti-Tg and anti-TPO statistically decreased was 801. 63± 1172. 29 vs. 492. 38± 1021. 48 (p=0. 01), and 728. 21± 1004. 28 vs. 441. 57± 603. 26 (p=0. 01) before and after intervention, respectively so that this reduction was higher in 2-12 year-old patients. Moreover, the mean of thyroid volume in both right and left lobes statistically reduced was 3. 97± 3. 18 vs. 3. 21± 2. 67 (p=0. 002), and 3. 32± 2. 94 vs. 3. 21± 3. 96 (p=0. 008) before and after intervention, respectively so this decrease was higher in≥ 13 year-old children (p<0. 05). Conclusion: This study showed that the level of autoantibodies and thyroid volume were decreased, after VD intervention. Thus, it is suggested that the serum VD level should be routinely checked in these patients and when observing hypovitaminosis, an appropriate treatment and prevention with VD should be carried out to avoid recurrent VD deficiency.

Foreign body aspiration may cause airway obstruction, either partial or total, which can be lifethreatening. Delayed diagnosis will increase patient morbidity, especially the occurrence of bacterial infections. This case report discusses chronic foreign body aspiration in a six year-old boy, in which signs and symptoms arise 4 years after foreign body aspiration occurred. The boy was the second child of the family. He came from a Sundanese family, considered as low income family, and the parents were high school graduates.

Introduction: Splenogonadal fusion is a rare congenital anomaly characterized with anomalous fusion of the spleen and the gonad or mesonephric derivatives. Herein, we report the case of a 7-month-old boy with unusual presentation of splenogonadal fusion. Case Presentation: A 7-month-old boy was brought to the Urology Clinic, Imam Reza Hospital, Mashhad, Iran, by his parents complaining of a painless palpable scrotal mass with a sudden increase in the size after a respiratory infection. The patient underwent surgery with a suspicion of testicular malignant tumors. However, pathologic study revealed a benign mass with splenic origin. Conclusion: Preoperative diagnosis of splenogonadal fusion is almost impossible and most cases undergo an unnecessary orchiectomy, especially when the clinical presentation resembles a primary testicular neoplasm. Although surgery is necessary to remove the benign splenic tissue as well, proper knowledge and consideration along with appropriate imaging studies and histopathological examination contribute in avoiding an unnecessary orchiectomy.

Kawasaki disease (KD) is characterized as the leading cause of acquired cardiac disease in children. Accurate and timely diagnosis of KD is of high importance for preventing its cardiac complications. However, diagnosis merely based on clinical findings has a number of challenges and, limitations. Therefore, researchers are investigating to find more objective and accurate diagnostic modalities. Cardiac biomarkers, particularly N-terminal pro b-type natriuretic peptide (NT-proBNP), are the most acknowledged diagnostic biomarkers in this regard. Accordingly, this paper reviewed some recent and related studies to evaluate the advantages and disadvantages of each cardiac biomarker.

Background: Premenstrual syndrome (PMS) is one of the most common problems in women of childbearing age that often interferes with their work and social relationships. The aim of the present study was to evaluate the pharmacological and non-pharmacological strategies in the treatment of PMS. Materials and Methods: Medline, Scopus, Cochrane, EMBASE, and Google Scholar were searched along with SID, Magiran and Irandoc for randomized control trail and non-randomized prospective or retrospective clinical studies published to Dec. 2019 that use Pharmacological and Nonpharmacological treatment for the treatment of PMS in reproductive-age women with PMS. Study selection was done by two reviews. Results: Findings of the present study revealed that pharmacological treatment of PMS include lithium and fluoxetine and non-pharmacological treatment include herbal remedies: ginger, fennel, chamomile, lavender, dietary supplements: omega-3 capsules, turmeric, citrus sinensis essential oil, carbohydraterich foods, soy, behavioral-psychological therapies, exercise activities such as walking and yoga, and minerals (vitamin E, B6, and calcium). Conclusion: PMS treatment includes pharmacological and non-pharmacological strategies. Considering its popularity and fewer complications, non-pharmacological drugs are suggested to improve the symptoms of PMS.

Background: This study aimed to investigate diverse structure of pulmonary blood vessels in patients with combined pulmonary atresia and ventricular septal defect and examine the effect on surgery result. Materials and Methods: This cohort retrospective study was conducted on admittances to Tehran and Sari Hospitals at 20052016 for pulmonary atresia with ventricular septal defect (PA-VSD) with pulmonary artery (PA) anatomical variation. Diagnosis of pulmonary blood vessels in patients with PA-VSD was based on the results of CT Angiography (CTA), MRI, or cardioangiography examinations. Patients were followed up clinically by means of imaging in the course of initial repair, pre-definitive surgery preparation, and post-operative stages. All data sets were analyzed using Stata software version 13. 0. Results: Abundancy of PA-VSD classes A, B, and C was 34 (37. 8%), 51 (56. 7%), and 5 (5. 6%) individuals respectively, while mean age and standard deviation of subjects for each of the said groups was 166. 5± 75. 6, 135. 79± 5. 3, and 108. 4± 152 months respectively. 38 (42. 2%) were 1-year or younger at the time of initial surgery. As regards between-class age distribution, 18 (52. 9%) individuals in group A, 20 (39. 2%) individuals in group B, and the entire 5 individuals in group C were collectively above the age of 1 years old. Conclusion: In view of the recent studies and the present investigation involving 90 patients with PA-VSD, it is easy to apprehend the large-scale applicability of complete-repair surgical interventions for patients suffering from this disease. This holds true specifically for class A patients who enjoy a longer lifespan and a more favorable prognosis.

Background: There is still controversy about the efficacy of paricalcitol in children with chronic kidney disease (CKD). Therefore, the present study was designed to assess current evidence on the efficacy of paricalcitol in CKD children. Materials and Methods: In this systematic review, an extensive search was performed on the databases of Medline, Embase, Scopus and Web of Science up to the end of October 2019. The keywords related to CKD and paricalcitol were combined and searched. Two independent researchers reviewed the papers; data were analyzed in STATA 14. 0 statistical program and the effect of paricalcitol administration on serum levels of intact parathyroid hormone (iPTH), calcium (Ca), phosphorous (P), and Ca × P product ratio were reported as odds ratio (OR), and 95% confidence interval (95%CI). Results: Finally, data from three studies were included in the present study. Paricalcitol administration decreased iPTH levels in children with CKD (OR=0. 12; 95%CI: 0. 05 to 0. 29; p<0. 001). However, paricalcitol administration had no effect on serum calcium level (OR=1. 16; 95%CI: 0. 48 to 2. 80; p=0. 741), serum phosphorus level (OR=0. 87; 95%CI: 0. 38 to 1. 99; p=0. 735), and Ca × P ratio (OR=0. 48; 95% CI: 0. 15 to 1. 50; p=0. 208). No study has investigated the efficacy of paricalcitol on the control of proteinuria following CKD. Conclusion: There is limited evidence on the efficacy and safety of paricalcitol in children with CKD. There are no studies in CKD children that have shown efficacy of Paricalcitol in controlling proteinuria.

Background: A malocclusion is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close. Considering the prevalence of malocclusion and its role in quality of life (QOL), we aimed to investigate the relationship between need of orthodontic treatment and QOL in North Iran students. Materials and Methods: This is a cross-sectional descriptive-analytical study; the sample size was estimated to be 270 students using a two-stage sampling method. After entering the study, the Orthognathic Quality of Life Questionnaire (OQLQ) was completed for each student. Need of orthodontic treatment was assessed based on the dental health component of index of treatment need (IOTN). SPSS software version 22. 0 was used for data analysis. Results: 274 students (133 boys and 141 girls) participated in this study. The mean age was 14. 86 ± 0. 54. The mean QOL scores were 13. 31± 11. 78 and it was not significant statistically in boys and girls (P=0. 893). Mean QOL scores were not statistically significant (P = 0. 306) according to grade of IOTN. Grade 2 had the highest frequency (37. 2%) with the lowest mean score of QOL (11. 65± 10. 31), and Grade 5 had the lowest frequency (2. 6%) with the highest mean score of QOL (15. 83± 7. 78). IOTN was not statistically significant in both groups (P>0. 05). Conclusion: In our study, students with dental malocclusion had the lowest QOL, although no significant relationship was observed. Almost a quarter of students needed orthodontic treatment. The most common malocclusion was displacement of contact points.

Acute Flaccid Myelitis (AFM), a polio-like paralysis in children no older than 21, has recently reemerged and increasing numbers of such cases have been reported worldwide since 2012. Accurate and early diagnosis of this condition could help with better management of the disease. A 9-year-old girl with chief complaint of headache, fever and vomiting was subsequently affected by an acute paralysis in upper left limb followed by lower limb paralysis. An enhanced signal in T2 parallel to C2-C7, involving the central cord section in Magnetic resonance imaging (MRI) of the spinal cord and an asymmetrical neuropathy pattern reported in Electromyography (EMG), and nerve conduction velocity (NCV) tests led to diagnosis of AFM. Lack of efficacy of administered Intravenous immunoglobulin and no evidence of spastic paralysis in the three months follow up of the patient helped with definite elimination of Guillain-Barre' syndrome (GBS) as the possible cause, and confirmed AFM diagnosis. Unfortunately, there is no specific treatment currently available for AFM.

Background: Clinical education is the foundation of medical science education and one of the most important criteria of professional education, which plays an important role in consolidating students’ learned materials. The aim of the present study was to evaluate the views of general medical students on the provision of feedback in clinical education in the pediatric department. Materials and Methods: The present cross-sectional study was performed in the Pediatric Department of Shohadaye-Khalije-Fars Educational Hospital of Bushehr University of Medical Sciences in 2019. Conesus sampling was used to select 58 general medical students spending their internship and apprenticeship in the Pediatric department. Data collection was carried out using baseline characteristics and the standard 21-item feedback questionnaire. Medical students were asked to indicate the importance of the feedback they received during their clinical education in the pediatric department on four-point Likert scale. Data were analyzed using SPSS software version 16. 0. Results: 58 general medical students of Bushehr University of Medical Sciences participated in the present study. Twenty-eight (48. 2%) of the general medical students were interns, 30 (51. 8%) were apprentices, and 35 were female participants (n=60%). Most of the students believed that feedback was as expected (50. 1 7%), clear (43. 1%), fair (36. 2%), and useful in correcting their attitude (44. 8%), performance (46. 6%), and behavior (39. 7%). Majority of the participants received positive feedback (65. 5%). Apart from propositions items 20, 10, 8, and 4, majority of medical students have selected "Often" as an option to answer the remaining statements. Conclusion: More than half of the general medical students were satisfied with the feedback they received during their clinical education in Pediatric department.