سال:1393 | دوره: | شماره: |تعداد مقالات:9

Background: Diarrhea is the most common pediatric disease. The leading cause of death from acute diarrhea is the loss of water and essential minerals, which can be compensated by oral rehydration solution (ORS). The role of mothers is vital in health promotion, disease prevention and patient care.Objectives: The present research aimed to investigate the knowledge and performance of the mothers of diarrheic children referring to the Children's Hospital, Tabriz, Iran.Patients and Methods: Predesigned questionnaires were used to collect data from the mothers of diarrheic children aged younger than 12 years, referring to the outpatient clinic of the Children's Teaching Hospital in Tabriz. Demographic information of the mother and child, mothers’ knowledge about pediatric diarrheal disease, and their performance in the case of pediatric diarrheal disease, were investigated.Results: A questionnaire was administered to 956 mothers, of whom 3.03%, 21.75% and 75.22% were uneducated, had a university education, high school diploma or less, respectively. Furthermore, 95.5% of the mothers referred to a doctor after the first day following an episode of diarrhea. The knowledge of 37.23%, 44.24%, and 18.53% of the mothers was poor, medium and good, respectively. Moreover, the performance of 51.98%, 30.03% and 17.99% of the mothers was poor, medium and good, respectively. A significant relationship was found between maternal education and knowledge (P=0.000), but no relationship was observed between maternal age and knowledge (P=0.36). There was also a direct relationship between maternal education and performance, which was significant (P=0.001). There was no relationship found between any other variables.Conclusions: The knowledge and performance of the majority of mothers were medium or poor. Training programs are recommended for mothers, medical students, pediatric, internal and infectious residents, in addition, retraining programs are recommended for GPs and related specialists.

Background: Integrons are frequently detected in clinical isolates of Enterobacteriaceae. These elements are able to capture and express gene cassettes encoding antibiotic resistance. Numerous studies have examined the distribution of integrons in Escherichia coli. Despite this, there is a paucity of epidemiological data on the occurrence of integrons as well as extended spectrum b-lactamases (ESBLs) among enteropathogenic E. coli isolates.Objectives: The main aim of this study was to investigate the prevalence of integrons as well as ESBLs among enteropathogenic E. coli isolates obtained from children with diarrhea in Tehran, Iran.Patients and Methods: In total, 42 enteropathogenic E. coli strains were isolated from children with diarrhea and examined for the presence of class 1 and 2 integrons. The combined disk method was also performed to detect ESBL production. Statistical analysis was used for the comparison of the categorical data.Results: Class 1 integron was identified in 24 (57.1%) isolates, while only 2 (4.8%) isolates harbored class 2 integron. Integrons were significantly associated with resistance to certain antibiotics, including; co-trimoxazole (P=0.016) and tetracycline (P=0.006). Of the 42 enteropathogenic E. coli isolates, 9 (21.4%) isolates were ESBL producers. However, no significant association was observed between the existence of integrons and ESBL production (P=0.26).Conclusions: Class 1 integrons are prevalent among enteropathogenic E. coli isolates, regardless of whether or not they produce ESBLs. This study emphasizes the alarming role of integrons in antibiotic resistance within diarrheagenic E. coli strains.

Background: Vancomycin-resistant Enterococcus (VRE) has been established as a significant health-care associated problem, and caused significant morbidity and mortality.Objectives: This study was aimed to determine prevalence of VRE colonization in severely ill patients admitted to Pediatric Intensive Care Unit (PICU), and identify potential risk factors for colonization, and in vitro susceptibility of VRE to linezolid.Patients and Methods: Rectal swabs were taken from 71 children 18 years old or younger who were admitted with serious systemic illness, including malignancy, chronic kidney, lung or liver diseases, treatment with chemotherapeutic agents, immunodeficiency, treatment with high-dose corticosteroids, malnutrition, previous treatment with 2nd or 3rd generation cephalosporin, aminoglycoside, and broad-spectrum β-lactam antibiotics within the past 3 months. Demographics and known risk factors were retrieved and assessed by statistical methods.Results: A total of 71 patients with a mean age of 29.1±38.5 months were enrolled in this study. The prevalence of VRE rectal colonization was 66.2%. None of the potential risk factors including age, gender, comorbidities, previous admission into ICU, length of stay in ICU, presence of invasive devices were significantly associated with VRE colonization. Linezolid-susceptible isolated strains accounted 97.9% Conclusions: The prevalence of VRE was higher compared to previous reports from local and international studies. In order to control the spread of VRE, appropriate use of antibiotics, adherence to infection control measures, and shortening the duration of ICU stay is highly recommended.

Background: Hospital acquired infections lead to significant morbidity and mortality in hospitalized patients. Proper implementation of hand hygiene by health care personnel (HCP), prevents nosocomial infections.Objectives: To monitor hand hygiene compliance by the medical and nursing staff in different wards of a children's hospital.Patients and Methods: Four wards were selected for surveillance. A trained pediatric resident observed four patient-beds and the hand hygiene behavior of health care professionals, physicians (house staff) and nurses, before and after touching the patients, during time slots of 20 minutes. The contacts were classified as ' high-risk' if the person came in contact with open wounds or other secretions/excretions; or ' low-risk' if there was no contact with body fluids. Findings were documented on a predesigned Hand Hygiene Observation Tool.Results: Overall, 510 patient contacts were observed and 1020 hand hygiene opportunities before and after patient contact were recorded. In total, 302 contacts (59.2%) were low risk and 208 (40.7%) were high risk. No hand washing or the use of alcohol hand rubs before contact was recorded by the observer stationed by the patients’ bed-side; however the HCP used disposable and surgical gloves before 87, (41.82%) high risk and 27, (8.94%), low risk contacts. Four individuals used hand hygiene after removal of gloves following high risk contact.Conclusions: Serious lack of adherence to standard protocols for hand hygiene by the HCP together with inappropriate glove use, calls for an urgent strategic planning to educate, train and motivate the health care personnel in all aspects of hand hygiene practices.

Background: Acute respiratory viral infection (ARVI) is a common cause of morbidity and mortality especially in pediatric patients. Among important respiratory pathogens, adenovirus is a most prevalent cause of upper and lower respiratory tract infection.Objectives: The aim of the present study was to determine the prevalence of adenovirus infection in pediatric patients with respiratory symptoms.Patients and Methods: This cross-sectional study was conducted from November 2010 to February 2012. An in-house nested-PCR was used to detect adenovirus in nasopharyngeal swabs from 328 children with 19 years of age or younger with acute upper respiratory tract symptoms referred to the hospitals affiliated with Shiraz University of Medical Sciences.Results: In this study, 150 (45.73%) and 178 (54.26%) patients were male and female, respectively. Among the patients, 243 (74.08%) patients were hospitalized in Shiraz teaching hospitals with ARVI related symptoms. The most common detected symptoms were fever, cough, and muscular pain. Most infected patients were children older than 5-year-old. According to the statistical analysis by using SPSS software, we did not find significant association between adenovirus infection and the risk factors such as age and sex, except an association with the seasonal time.Conclusions: The results of this study showed that the acute respiratory infection due to adenovirus in Shiraz mostly occurred during November 2011 to February 2012. In contrast to other studies, human adenovirus infection was more prevalent in children aged older than five-year-old. In addition, the infection rate in females was higher than in males.

Introduction: Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity.Case Presentation: We present a case of disseminated cryptococcosis, in a non-HIV patient with steroid resistant nephrotic syndrome (focal segmental glomerulosclerosis), who was given various immunosuppressive agents.Discussion: BACTEC blood culture, cerebrospinal fluid analysis, and chest x-rays, were consistent with a Cryptococcus neoformans infection. Treatment with liposomal amphotericin B, combined with flucytosine, followed by fluconazole, was successful.

Background: Group B Streptococcus (GBS) (Streptococcus agalactiae) is the leading cause of morbidity and mortality of newborn infants considered as a leading factor causing septicemia after birth. The standard method for the diagnosis of GBS colonization is culture in a selective broth medium. Today, it is accepted that PCR has a high sensitivity and specifically in diagnosis.Objectives: The goal of this study was to estimate the colonization of GBS in rectum of neonates of high-risk mother by culture and PCR method.Patients and Methods: Samples were taken from rectal mucus of 154neonatesof high-risk mothers for GBS by swab. Samples were tested by standard culture using Todd Hewitt broth and blood agar and also by PCR using primers specific for cfb gene.Results: Of 154neonates, Culture identified 17 (11%) neonates as colonized by GBS; and the PCR assay could identify 27 (17%) neonates with positive results for GBS. Mothers age range was 17-40 years (mean=26.1±5.1). Maternal age was significantly lower in PCR positive group (P=0.038) and in culture positive group (P=0.015). Using culture as the gold standard, sensitivity, NPV, specificity, and PPV of PCR were 100%, 100%, 92%, and 62%, respectively. The time required for PCR assay and culture were 2hours and 36hours, respectively.Conclusions: This study showed that incidence of GBS in Iranian high-risk neonates is high, so we strongly recommend screening of high-risk neonates for detection of GBS.

Context: High levels of interleukin-1 have been implicated in uncontrolled inflammation and fever in inflammatory diseases, including; familial Mediterranean fever, cryopyrin associated periodic syndrome, Behcet's disease and systemic onset juvenile idiopathic arthritis. The underlying specific genetic causes for these diseases have not yet been elucidated due to inferring factors, such as high levels of interleukin-1 beta (IL-1b) in the blood and etiology, as well as the disease manifestations.Conclusions: This review discusses the role of interleukin-1 beta and interleukin-18 production pathways in the development of systemic onset juvenile idiopathic arthritis and familial Mediterranean fever disease.

Background: Staphylococcus aureus (S. aureus) especially those with methicillin resistance are human pathogens capable of causing a wide variety of diseases, ranging from mild skin lesions to systemic and fatal infections.Objectives: The aim of this study was to detect the accessory gene regulator (agr) specificity groups among methicillin resistant and susceptible S. aureus isolated from children.Materials and Methods: During July 2012 to January 2013, 22 S. aureusc linical isolates were collected from children aged between 2 to 11, in Loghman Hospital of Tehran. Antibiogram test was performed using disc diffusion method. Polymerase chain reaction (PCR) was conducted to detect mecA gene and agr specificity groups.Results: Among 22 S. aureus clinical isolates collected from children, five isolates (22.7 %) were resistant to methicillin. fourteen isolates (63.6%) were resistant to amoxicillin and all were susceptible to vancomycin and linezolid. Agr specificity group I was detected in 12 (54.5%) isolates (in 2 MRSA and 10 MSSA isolates), agr group II in four (18%, in 3 MSSA and 1 MRSA), group III in 3 (9%, 2 in MSSA and one in MRSA), while agr specificity group IV was found in three (13.6%, 2 MSSA and 1 MRSA) isolates.Conclusions: The agr specific group I had the highest rate of detection among pathogens isolated from hospitalized children in Tehran.