Journal of Pediatric Perspectives
Year:2018 | Volume:6 | Issue:5 (53)|Papers Count:16

Splenosis is a rare condition defined as a heterotopic auto-transplantation of splenic tissue, typically after blunt abdominal trauma. It can occur anywhere in the abdominal cavity, or even the chest. Splenosis found in clinical practice is relatively rare because most patients are asymptomatic. We report a rare case of abdominal splenosis in a 7-year-old boy, 3 years after an abdominal blunt trauma.

Background: The present systematic review and meta-analysis is designed in order to assess the association between passive and active smoking and lipid profile of children and adolescents.Materials and Methods: An extensive search was done in databases of Medline, EMBASE, Web of Science, Scopus and CINAHL until October 2017. Two independent researchers screened articles and in the next step, full texts of probably relevant articles were read and summarized. At the end, results of mentioned studies were pooled and a standardized mean difference (SMD) with 95% confidence interval (95% CI) was reported.Results: Data from 17 studies (containing 41619 children and adolescents; age group between 4 and 18 years old; 51.72% boys) were entered. Comparing serum level of high density lipoprotein (HDL) in two groups of exposed and non-exposed to cigarette smoking showed that active exposure (SMD=-0.40, 95% CI: -0.59 to -0.21) and passive exposure to cigarette smoke (SMD=-0.18, 95% CI: -0.30 to -0.06) decreases the serum level of mentioned lipoprotein. Additionally, active exposure to cigarette smoke (SMD=0.16, 95% CI: 0.06 to 0.27) causes a modest increase in serum level of triglyceride. However, cigarette smoke exposure does not have any effect on the level of total cholesterol and low density lipoprotein (LDL).Conclusion: The present meta-analysis showed that exposure to cigarette smoke leads to a significant decrease in the level of HDL and triglyceride but, it does not have any effect of the level of total cholesterol and LDL in children and adolescents.

Background Few results have shown that renal parenchymal echogenicity increases in pediatric patients with no concurrent renal diseases. This study aimed to investigate the relation between non-renal diseases and renal cortical echogenicity in children with acute abdominal pain.Materials and Methods This cross- sectional study was conducted among 100 children referred to Amirkola Children’s Hospital (Babol city, Iran) with complain of acute abdominal pain during July 2015-July 2016. Patients with a known history of renal disease or urinary tract infections were excluded. All patients were examined with sonography. The parenchymal echogenicity of kidney was evaluated by comparison with that of liver and was divided into three categories: group 1, renal cortex echogenicity less than liver parenchyma echogenicity; group 2, renal cortex echogenicity similar to that of liver parenchyma; and group 3, renal cortex echogenicity greater than that of liver parenchyma.Results: Of 93 children finally assessed, 52 (55.9%) were boy; the mean age of patients was 6.45 years old. The diagnosed causes of abdominal pain included acute appendicitis (n=43, 46.2%), mesenteric adenitis (n=8, 8.6%), gastroenteritis (n=4, 4.3%), and invagination (n=2, 2.2%). Eighteen cases (19.4%) had abnormal renal echogenicity (equal to or more than that of liver). A significant relationship was found between non-renal diseases and renal cortical hyperechogenicity (p=0.03). After follow-up of 12 patients with renal hyperechogenicity for 1-2 weeks, all of them had normal findings in re-evaluation.Conclusion The results showed that renal hyperechogenicity is a non-specific and transient finding in children with acute abdominal pain and in favor of disorders other than renal diseases.

Background Meningitis is a common neurological emergency and a leading cause of death and neurological disability worldwide. MRI is extremely useful for detecting and monitoring the complications of meningitis. The purpose of this study was to describe the brain MRI findings in children with complicated meningitis.Materials and Methods This cross-sectional study was conducted in Radiology Department at the Central Pediatric Teaching Hospital, Baghdad, Iraq between the period of October 2015 and August 2017. A total of 40 children who were known cases of meningitis that not respond to the conventional treatment and examined with MRI were included in this study. MRI protocols were achieved with Variable Echo Multiplanar sequences and all the images were interpreted by two qualified radiologists for any intracranial findings.Results The mean age of patients was 3.3±3.2 years; 35% of them were infant age group. Females were more than males with a female to male ratio as 1.2: 1. About half of children were diagnosed by MRI with necrosis, 30% of them with hydrocephalus, 15% of them with abscess and 7.5% of them with subdural effusion. The hydrocephalus was found among children with lower mean age and abscess was found among children with higher mean age children.Conclusion The main MRI findings of children with complicated meningitis were necrosis, hydrocephalus, abscess and subdural effusion.

Background: One of the symptoms of mucositis caused by chemotherapy is pain. Mucositis management is initiated by assessment of oral hygiene and management of pain. Many uses have been mentioned for Satureja hortensis in traditional medicine. The study was carried out with the aim of determining the effect of Satureja hortensis extract mucoadhesive gel of 1% on severity of mucositis-induced pain in children under chemotherapy.Materials and Methods This randomized parallel double-blind clinical trial was carried out on 60 children who were affected by mucositis following chemotherapy in 2016. The samples were randomly assigned into two groups of intervention and control. The intervention group applied Satureja hortensis extract gel of 1% and the control group applied the placebo gel twice daily for 5 days after the onset of mucositis along with routine treatment. Oral mucosa was evaluated daily. Also, the Oucher pain tools and a demographic checklist were used. The data was analyzed using SPSS version 13.0 software.Results: The obtained data showed that the two groups had statistical difference in terms of the severity of the pain relief during the time, and pain severity reduced from 3.5±2.1 to 0.0 ± 0.0 in intervention group and 3.1 ± 1.8 to 0.4 ± 1.0 in control group in fifth day (p<0.001).Conclusion The study showed that the extract 1% of Satureja hortensis is effective in healing mucositis induced pain and can be used as a new treatment method in relieving reducing mucositis pain.

Background Cryptorchidism is defined the failure of one testis or both testes to permanently descend. It is considered as the most common congenital abnormalities. The risk of testicular cancer in men with a history of cryptorchidism increased from three fold to four fold, compared to those without history of cryptorchidism. We aimed to investigate prevalence and pathological features of cryptorchidism among Iranian Children in Central Iran.Materials and Methods In this analytical descriptive study, 61 boys with a diagnosis of cryptorchidism who referred to training hospitals of Yazd city, Yazd province (Central Iran) from January 2016 to January 2017, were enrolled. Information including demographic data was extracted from medical records. Data includingtesticular properties and localization of undescended testes were evaluated by surgeon. Data analysis was done using SPSS software version 19.0.Results Prevalence of disease in full term infants and premature were 3.27% and 29.5%, respectively. The most number of boys with cryptorchidism (22 cases) refereed to hospitals were in range of 12-24 months; 17 patients (27.86%) had history of family, andpalpable testicles and non-palpable testicles were observed in 53 patients (84.1%), and 10 (15.87%), respectively (P<0.05). Furthermore, 30, 21 and 10 cases had right testicle, left and bilateral testicle, respectively.Conclusion The prevalence of cryptorchidism was relatively high in our province. It seems that geographical, environmental, and genetic variations play a main role in the birth prevalence of these anomalies. In addition, the epididymal anomalies were observed in less than half of patients.

Background Regarding abnormalities in thalassemia major (TM) patients and the effects of leptin and ferritin on heart, aimed to investigate the possible relationship between leptin, ferritin and cardiac involvement in TM patients compared to controls.Materials and Methods In total 141 individuals entered to the present case-control study that consisted of 66 TM patients matched in age and sex with 75 healthy controls. The case group selected from those patients attending to the clinic of Ali Asghar Hospital, Zahedan-Iran. From participants, 5ml blood takes by a nurse and was isolated from serum samples in order to analyze ferritin and leptin levels. Major proceedings in patients were checking medical history, physical examination, chest X-ray and Electrocardiogram (ECG) that performed before echocardiography by unique cardiologist. The participants subjected to conventional examination for both right and left heart functions.Results Leptin level (p=0.026), height, weight and body mass index (BMI) were lower in patients (p<0.001). Ferritin levels were 4, 625.515±3, 782.618 and 49.387±25.386ng/ml in patients and controls, respectively (p<0.001). Serum Leptin and ferritin levels were similar in different age groups of patients (p>0.05). In left heart, LAd was higher in case (2.44 ± 0.42) significantly (p<0.001). QT (p<0.001), QTc (p<0.001), S in V1 (p=0.030), and Heart rate (P<0.001) were higher in TM patient. In patients, QTc (p=0.009), and QTcd (p=0.002) correlated with leptin, and IVSS (p=0.013), PWD (p=0.048), and in right heart, peak E (p=0.002), and peak A (p=0.034) were correlated with ferritin.Conclusion From the present study concluded that PWD and IVSS in left heart and Peak A and Peak E in right heart correlated with ferritin. QTc and QTcd correlated with leptin.

Dear Editor-in-Chief, Perinatal testicular torsion (PTT) is a rare entity, occurring in 1: 7500 newborns (1). It accounts for about 12% of all cases of torsion throughout childhood and is considered almost always extravaginal in origin (2). Although PTT is widely accepted to be an antenatal event, the exact timing and duration of torsion are not known (3). Perinatal testicular torsion usually presents as a bluish-black discolouration of the scrotum associated with a scrotal swelling, which is non-transilluminable. However, due to an important variation in clinical presentation, this condition remains unrecognized in many patients and may be missed or confused with other conditions (4). The management of PTT is controversial, due to the low viability of the testis and the possibility of bilateral torsion (5-7). This is a review of our experience with six cases of PTT, highlighting diagnostic and therapeutic difficulties of this condition. From January 2010 to June 2017, we treated five newborns with PTT (right side [n=2], left side [n=2], bilateral [n=1]). Their mean birth weight was 3.2 kg (range, 2.8-3.8 kg). Their age at presentation ranged from 2 hours to 6 days (mean, 38 hours). Doppler ultrasonography was performed in four patients, and was inconclusive in all cases. All patients underwent emergency exploration and found to have extravaginal torsion of testes. The patient with bilateral PTT had black, hemorrhagic and necrotic testes (Figure.1).Bilateral orchiopexy was performed after detorsion. At 3-month-old, both testes were viable and were in the normal position in the scrotum. In one patient with unilateral PTT, the torsed testis was ischemic but not frankly necrotic, so it was preserved, but on follow-up, it was found atrophic. In the remaining three patients, the testes were frankly necrotic; they were treated with orchiectomy and contralateral orchiopexy. On histology, the removed testes were totally necrotic without any viable testicular tissue. Perinatal testicular torsion is often difficult to diagnose mostly due to an important variation in clinical presentation. A high degree of suspicion is required for early diagnosis and management of this condition. Immediate emergency surgery is increasingly advocated for PTT in the hope of saving the testis (1, 7). Therefore, it is a reasonable option to leave in place even necrotic testis, whenever possible, as some testicular function may still be possible (4).

Background Neonatal mortality rate is one of the main indicators of health care systems in each country. The first step in improving the level of these indicators is to identify the causes of neonatal dead and its related factors. In this study, the causes of neonatal mortality and its related factors in neonatal intensive care unit at Imam Reza hospital were investigated.Materials and Methods A descriptive cross sectional study was carried out from 2014 to 2016, on all neonates who died in neonatal intensive care unit of Imam Reza Hospital in Kermanshah city, Iran. Information about the infant, mother and the causes of mortality of the infant were collected from hospital records of neonatal care unit and families and physician of infants. Then data was recorded in the data collection form and analyzed using SPSS version18.0 software.Results In this study, 566 newborns (19.2%) died of 2, 946 hospitalized infants. The most common causes of death was respiratory distress syndrome 190 (33.6%), and sepsis 128 (22.6%); 95.5% of neonatal deaths occurred at gestational age below 37 weeks, and 81.6% in birth weight less than 2, 500gr. Also, 452 cases (79.9%) had deaths during the first week after birth, and the highest deaths 274 (48.8%) were in the night shift (P<0.001).Conclusion According to the results of this study, the most common causes of neonatal death were prematurity (gestational age below 37 weeks), respiratory distress syndrome and sepsis. Most dead neonates have a weight below 2, 500 grams. The highest death rate occurred in the first week of birth and in the night shift.

Dear Editor-in-Chief, Adenovirus are double stranded DNA viruses, known to be capable of causing various kind of illnesses from mild respiratory infections in young children (known as thecommon cold) to life-threatening multi-organ disease in people with a weakened immune system (1). In humans, there are 57 accepted human adenovirus types (HAdV-1 to 57) in seven species (Human adenovirus A to G) (1). Adenovirus is currently recognized as one of the viral causes of diarrhea/gastroenteritis among children (2), with types 40 and 41 predominating as common causes of gastroenteritis, especially in children under the age of two year-old (2). This letter reports the preliminary investigation on the prevalence of Adenovirus among children (under-5 years old) presenting with diarrhea/gastroenteritis at the pediatric outpatients of Central Hospital, Warri, a tertiary health care facility in Delta State, South-South, Nigeria. Ethical approval was provided by the Delta Hospitals Management board in the letter CHW/VOL 1/17/14. This study included a total of 100 subjects, 75 children with clinical diarrhea/gastroenteritis, and 25 age and sex matched healthy children as controls. Adenovirus was detected in fecal specimens of subjects using a rapid lateral flow immunochromatographic assay kit (Gastro Vir-Strip, Coris Bioconcept, Belgium).Data on demographics and social characteristics where obtained with the aid of a self-administered questionnaire. The prevalence of Adenovirus was 14.7% (11/75 patients); Adenovirus was not detected among the control subjects. The prevalence of Adenovirus was more in Males than females, but this were not significantly different (odds ratio [OR]: 0.9592, 95% confidence interval [CI]: 0.2576, 3.5712). Adenovirus prevalence was also independent of age (P=0.9045). The prevalence of Adenovirus in this locality is quite close to the prevalence of 18%, and 19.3% in neighboring states of Ondo and Edo, Nigeria (3, 4), but less than 23% among children in Northwestern, Nigeria (5). In conclusion, the prevalence of Adenovirus was high; and was independent of age and gender. There is need for routine screening of Adenovirus among children with gastroenteritis/diarrhea in our locality irrespective of age or gender. Further studies are needed to provide information on prevalent Adenovirus subtypes and genotypes in this study location.

Background In order to enhance social adaptability and communication skills of exceptional children, researchers are trying to find a more effective and reliable approach. The present study aimed to compare the effectiveness of Game Therapy and Emotional Intelligence Education on the social compatibility and communicative skills of hyperactive and deaf children.Materials and Methods The population of this study included all the deaf and hyperactive students of the exceptional elementary school in Sari, Iran, in the school months of June to January 2017. The sample included 50 participants selected through cluster random sampling and divided into 2 experimental and control groups of deaf children each with 10 members and 2 experimental and control groups of hyperactive children each with 15 members. Inactive controls were placed. The instrumentation was Rutter Children's (Teacher's Form) Behavioral Questionnaire, Social Skills Rating by Teachers Scale, Game Therapy Intervention method for 12 sessions, and Emotional Intelligence Training for 8 sessions each lasting 1 hour on all male and female members of both groups. In order to compare the effectiveness, covariance analysis and t-test were administered and analyzed by SPSS version 23.0 software.Results: The findings of this study indicated that 12 sessions of game therapy and 8 sessions of emotional intelligence training significantly affect social compatibility and communicative skills of hyperactive and deaf students (P<0.05).Conclusion According to the results, the effectiveness of Game Therapy and Emotional Intelligence Training was higher on social compatibility and communicative skills of hyperactive children than the deaf children.

Background Dysentery is described as a diarrhea with visible blood in the feces. In some regions of world, resistance to antibiotic was reported. Therefore, it is very important to use a safer treatment for this disease. We aimed to survey the efficacy of Golden Immunstim drug on improvement of abdominal cramp, diarrhea, vomiting, and fever in dysenteric patients.Materials and Methods This study is a randomized clinical trial, conducted on 100 children with dysentery who visited the outpatient Pediatric Clinic of Amirkabir Hospital in Arak, Iran. Patients were randomly divided into two equal intervention and control groups (n=50). The intervention group received antibiotics (ceftriaxone with a dose of 50mg/kg twice per day [BID] until the symptoms of the patient improve and continue with oral Cefixime until the completion of the 5-day treatment period), and Golden Immunstim (two capsules per day for three days), and the control group only received routine antibiotics. The researchers assessed participants on days 3, 7 and 14. Data were analyzed using SPSS 23.0 software.Results On days 3, 7, and 14 abdominal cramp was in 12%, 2%, 0% in intervention group, respectively and was 16%, 0%, 0% in control group (p>0.05); Diarrhea 8%, 2%, 0 % in intervention group, and 8%, 0%, 0% in control group (p>0.05). Vomiting was in 2%, 0%, 0% of intervention group and 0%, 0%, 0% of control group (p>0.05); Fever was in 2%, 0%, 0% of intervention group and 6%, 0%, 0% of control group (p>0.05).Conclusion According to the results of this study, it can be concluded that Golden Immunstim has no effect on dysentery symptoms.

Background Skin cancer is the most common type of cancer, and its prevalence continues to increase. The aim of this study was to determine prevalence and psychological determinants of sunscreen use in order to prevent skin cancer among Iranian students based on the health belief model (HBM).Materials and Methods A cross-sectional study was conducted among 550 high school students in Abadan city, Southern Iran, during2017, which were randomly selected to participate voluntarily, in the Southern of Iran. Data collection was carried out using self-made questionnaire and the collected data were analyzed using SPSS version 16.0 software.Results The mean age of participants was 16.40+0.93 years, ranging from 15 to 19 years. Prevalence of using daily sunscreen was almost 15.5%. There was a significant relationship between using daily sunscreen with sex (female) and higher economic status (P<0.05). The Health Belief Model (HBM) variables predictor accounted for 27% of the variation in the outcome measure of use the sunscreen. Perceived barrier (Beta=-0.290 and P<0.001), Perceived benefits (Beta=0.242 and P<0.001) and cues to action (Beta=0.155 and P=0.006) were the more influential predictor on sunscreen use.Conclusion We found that girl students compare than boy students were more daily use of sunscreen. Furthermore, comprehensive sunscreen use promotion programs focus on psychological determinants such as perceived barrier, perceived benefits and cues to action may be usefulness of the results in order to promotion of sunscreen.

Background Infants of diabetic mothers (IDMs) have significantly greater risk for spontaneous abortion, stillbirth, congenital malformations and perinatal mortality and morbidity but whether maternal DM affects the neonatal innate immune system is unknown. We aimed to assess the immune response of infants of diabetic mothers (IDMs) with non-gestational DM for Hepatitis B vaccine and to compare them with those of healthy mothers.Materials and Methods At a prospective case control study in Minia University Hospital for Children, 150 neonates were included in this study; divided into 2 groups, Group I included 75 infants of diabetic mothers (IDMs) and Group II: Included 75 apparently healthy infants of apparently healthy mothers. These neonates received Hepatitis B virus vaccine during the first 24 hours of age and at 1 and 6 months of age, Hepatitis B virus surface antibodies, Hepatitis B virus envelope antibody (HBe Abs), and Hepatitis B core antibody (HBc Abs) were measured at 9 and 12 months of age.Results Results showed that at 9 months of age, Hepatitis B surface antibodies (HBs Abs) titers were significantly higher in healthy neonates compared to IDMs group (p<0.001); while at 12 months of age they were comparable (p=0.118). Negative correlation between HBs antibodies levels at 9 months and Aspartate Aminotransferase (AST), Alanine Transferase (ALT), Glycated Hemoglobin (HbA1c) and the duration of maternal diabetes (p<0.001).Conclusion According to the results, delayed immune response for hepatitis B vaccine was present in infants of non-gestational diabetic mothers compared to healthy neonates reflecting the effect of diabetes on the immune response of IDMs. They became immune at 12 months of age while normal healthy neonates became immune at earlier age.

Background: The enjoyment of different walks of life of health care is one of the top priorities. To this end, access is a precondition for the establishment of justice in human societies. Given that keeping the health of some groups in societies is of special importance due to their special age-physical conditions, the present study aimed to investigate the access of children and adolescents under 19 years old to hospitals and emergency centers in Kermanshah, Iran.Materials and Methods: In this descriptive-analytic and cross-sectional study, the statistical population comprised the children and adolescents under 19 residing in Kermanshah, Iran. Moreover, all public and private hospitals and emergency centers located in Kermanshah were studied. To evaluate the spatial deployment pattern of hospitals and emergency centers as well as correct and true access to them, all data and information were evaluated using the Network Analyst and Arc-GIS Software.Results: The results of the present study demonstrated that about 37% of the children and adolescents under 19 had appropriate access to hospitals and emergency centers. In terms of the status of access during 5, 10, and 15 minutes of driving, 42.90%, 80.27% and 89.28% had proper access to hospitals, respectively. Moreover, in terms of access through walking and driving, the 15-19 age group had the most access, as opposed to the 0-4 age group without access.Conclusion: In Kermanshah, the access of children and adolescents under 19 to hospitals and emergency centers using vehicles was in a desirable condition, an indication of the success of implementing some post-revolutionary health plans and reducing deprivation and eliminating inequalities across various regions. However, it should be noted that there were problems in terms of access to hospitals and emergency centers through walking, which requires taking actions by authorities in Kermanshah.

Background Adolescents, pay particular attention to their body image. Dissatisfaction with body image in people can lead to stress. Accordingly, this study aimed to investigate the effectiveness of group counselling on body image and coping strategies among adolescent girls.Materials and Methods This clinical trial study was conducted on 60 adolescent girls in Karaj City, Iran. The samples were selected using a multi stage sampling technique. For the intervention group, four counseling sessions were held weekly and each session lasted 60 to 90 minutes. The control group received an educational body image package at the end. The Multidimensional Body-Self Relations questionnaire and Body Image Coping Strategy Inventory were completed by participants in both groups before and two weeks after the intervention. The collected data were analyzed using the SPSS-19.0 software.Results The mean score of the positive rational acceptance before the intervention in intervention and control groups were 43.541±2.798 and 41.875±13.146, respectively. These values after the intervention were 62.708±2.484 and 46.972±16.545 in the intervention and control groups, respectively. There was a significant difference between the intervention and control groups in the mean score of body image and the positive rational acceptance two weeks after the completion of the intervention (P=0.0001).Conclusion The overall results of this study indicated the effectiveness of intervention (Group Counseling) in improving the body image score and increasing the positive strategic skills.