Journal of Pediatric Perspectives
Year:2018 | Volume:6 | Issue:6 (54)|Papers Count:15

Dear Editor-in-Chief, Pulmonary hydatid cysts in children are a significant public health problem in Tunisia. Its impact is huge on economy with monetary loss estimate of $763, 980, 979 in the USA (1). While hepatic cysts are the most common in adult pathology, the lung is the number one location for hydatid cysts in children which causes a serious problem due to lack of standardized therapeutic strategy (2). We reported our experience in diagnosis and management of pulmonary hydatid cysts in a pediatric department in southern Tunisia. This study retrospectively evaluated patients who had been diagnosed with pulmonary hydatid cysts in the department of pediatric emergency and reanimation in Hedi Chaker hospital in Sfax, Tunisia, between 2006 and 2017.Over 11-year period, we diagnosed and managed 14 children with lung hydatid cyst. The mean age was 8 years 2 months (3 years 8 months to 13 years); 4 were females and 10 were males and 92.3% were from rural areas. Chief complaints were cough pain in the thorax and dyspnea. Conventional X-ray made for all children revealed a unique cyst in 13 cases and multiple unilateral cysts in one. The right lung was mostly affected. Ultrasonography was performed for all patients in order to detect another location revealed hepatic cysts in 5 cases and one splenic hydatid cyst. Thirteen children underwent a surgical treatment by thoracotomy approach. Postoperative course was uneventful. Recurrence after operation was seen in one case. Albendazole was prescribed in 8 patents. One patient developed aspergilloma with good response for medical treatment. The follow-up mean was 4 years. Hydatid cyst is caused by Taenia Echinococcus and is prevalent in sheep raising areas such as Tunisia (3). It remains a serious public health problem due to its complications that occur both in pre and postoperative course (4). The chest radiography is the first diagnostic method for lung cyst that allows to suspect and sometimes to confirm the pulmonary cyst (1, 3). In all our patients chest radiography allowed to suspect the diagnosis and CT-scan was the key to confirm it and to provide a better description of the density and the localization. Surgery is the main treatment of pulmonary hydatid cysts of children (4). Medical therapy was not applied routinely, but only for cases with multiple lung plus liver hydatid cysts, to prevent the possibility of a relapse (5). In conclusion pulmonary hydatid cyst is a serious public health problem with serious financial burden in endemic areas. Diagnosis is radiologic and treatment is surgical with a moderate place to medical treatment.

Thromboembolism is a rare complication of primary nephortic syndrome. Both venous and arterial thrombosis might occur in steroid responsive and steroid resistant nephrotic syndrome. This is the report of an infant with nephrotic syndrome and renovascular hypertension, complicated with asymptomatic intracardiac thrombus and managed appropriately with medical treatment.

Background: According to evidence, the main treatment plans for children with gastroenteritis include the use of an oral solution or intravenous infusion for hydration, continued nutrition; zinc supplementation. The aim of this study was to investigate the effectiveness of Gastro-Fix (registered nutritional supplement) versus placebo on length of hospitalization and duration of diarrhea in children with acute gastroenteritis.Materials and Methods: We conducted a double blind randomized placebo-controlled trial in children with acute gastroenteritis (age between 6 and 120 months). Three hundred eligible patients randomly allocated to one of two parallel groups, Intervention received Gastro-Fix, whereas the placebo group received baby food (cereal based on skimmed milk and wheat without mineral) for a total of 6 days. Gastro-Fix and baby food was administered as a same sachet that could be opened and mixed in water. The primary outcome was length of hospitalization and duration of diarrhea.Results: The Mean length of hospitalization in Gastro-Fix and placebo was 3.43+0.57 and 4.70+0.59 day respectively (P<0.001). Median duration of diarrhea was 3 days (range: 3-5, IQR: 3–4 days) in the Gastro-Fix group and 5 days (range 3-6, interquartile range [IQR]: 4–5 days) in the placebo group which was statistically significant (P<0.001). The highest efficacy (diarrhea-free percentage of children) of the Gastro-Fix was observed at day 4 (relative risk [RR]: 0.28; 95% confidence interval [CI]: 0.23-0.35), and at day 5 (RR 0.08; 95% CI: 0.03-0.17) after the intervention.Conclusion: Finding of this study showed that Gastro-Fix can be effective in reducing duration of diarrhea and length of hospitalization in children with diarrhea. This product is suggested to be used in children with acute gastroenteritis.

Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi are the parasites that infect humans. Plasmodium falciparum and Plasmodium vivax cause most of the malarial infections worldwide. Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi are susceptible to chloroquine. Chloroquine was the world's most widely used antimalarial drug, but the most common and virulent parasite Plasmodium falciparum is now increasing resistance. Chloroquine-sensitive Plasmodium falciparum concentrates chloroquine to higher levels than did chloroquine-resistant parasite. Chloroquine concentrates in the highly acidic digestive vacuoles of susceptible Plasmodium parasites, where it binds to heme and disrupts its sequestration. Failure to inactivate or even enhanced toxicity of drug-heme complexes kill parasites via oxidative damage to membranes and digestive proteases.The loading dose of chloroquine in children is 10 mg/kg administered intravenously or by mouth and then three 5 mg/kg doses of chloroquine every 24 hours starting 6 hours after the loading dose should be given. Chloroquine is well absorbed, widely distributed in body tissues, slowly metabolized by the liver and very slowly cleared from the body. Residents in malaria endemic areas develop considerably immunity over time, but pregnancy makes women more vulnerable and infection during pregnancy increases the risk of anemia, miscarriage, stillbirth, and prematurity. The children are more vulnerable than adults to malaria infection. The aim of this study is to review the published data on the clinical pharmacology of chloroquine in children and their mothers.

Obesity is a major risk factor for many diseases in children. Considering the widespread pandemic of pediatric obesity, developing more strategies for life style management of this disorder is essential. Therefore it was decided to conduct a more comprehensive study for prevention and treatment children obesity based on Traditional Persian Medicine (TPM). In this review we searched the most important TPM textbooks (such as Al-Havi, Al-qanun fit-tib, Kamel al Sanaeh), Classical Medicine (CM) text book (Krause's Food and the Nutrition Care Process), and scientific databases such as Data sources included (Medline, Scopus, Embase, Google Scholar) the period from 2000 to 2017 in terms of obesity management. The keywords Saman Mofrat, Setteh-e-Zarurieah, lifestyle, pediatric, children and obesity have been used in this search.Based on TPM the six essential principles (Setteh-e-Zarurieah) must be observed in management of pediatric obesity that these essential factors are as follows: air, food and drink, sleep and wakefulness, evacuation and retention, body movement, mental movement and repose. Unhealthy lifestyle for example irregular sleep, constipation, overeating and wrong nutritional habits, insufficient physical activity, and emotional excitement, such as sadness and anxiety are plays an important role in obesity that confirmed by classical medicine. Moreover, TPM has a particular attention to the type of nutrients and their temperament and the children’s digestion ability. So, further clinical trials should be performed to confirm the long-term efficacy of healthy lifestyle in pediatric obesity management.

Background Respiratory Distress (RD) is a life-threatening respiratory failure. This study aimed to evaluate the diagnostic value of N-terminal prohormone of brain natriuretic peptide (NT-pro-BNP) in distinguishing respiratory and heart diseases in neonates.Materials and Methods Hundred fifty neonates aged 2-3 days randomly collected from those who hospitalized in the related ward of the Ali Ebne Abitaleb Hospital, Zahedan, Iran. After sampling 2ml blood from venipuncture by trained nurse in the related ward separated serums performed in a laboratory. Then, 250 ml of the patients’ serum was isolated to assess NT- pro-BNP level using ELISA kit (USA). Data were analyzed using SPSS software version 20.0 with considering of P<0.05.Results Mean of NT-pro-BNP in respiratory, Acyanotic, cyanotic and controls were 386.22±208.82, 384.83±183.74, 372.23±143.04, and 161.70- ± 121.2, respectively. Weight, height and head circumference had different mean ranks for respiratory, Acyanotic, cyanotic and healthy groups, respectively (P<0.05).Conclusion According to the results, despite of some reports, NT-proBNP is good biomarker to determine differentiate between cardiac and respiratory during neonate.

Background: Postpartum depression (PPD) is a type of disorder could have serious effects on the mother, the baby, and other family members, given the contradictory results of the previous studies about the effect of education programs, aim of the present study was to evaluate the effect of educational programs on postpartum depression in Iranian women.Materials and Methods: English electronic information databases such as Medline (via PubMed), Scopus, ISI Web of Science, EMBASE, and Cochrane Library were searched until February 2018. In addition, Iran doc, Barakatskns, Magiran, Medlib, SID, and google scholar were searched using equivalent keywords in Persian until February 2018. Cochrane Q test (p<0.05 as statistically significant), and I2 index were used to evaluate heterogeneity. Funnel plot and Egger’s regression were conducted to detect publication bias.Results: The finding of the Meta –analysis indicate that education interventions was found to be more effective and could significantly improve postpartum depression (Standard Mean division (SMD) =1.44; P<0.001; Confidence Interval [CI] =0.595 to 2.40; Heterogeneity p<0.001; I2=87%). The funnel plot appears asymmetric with an outlier study. However, this finding was not confirmed by Egger's test that was nonsignificant (p=0.262), and show no asymmetry. The level of depression was lower in women receiving problem-solving skills in compared to who received no intervention (SMD=1.83; P<0.001); the level of depression showed a significant boredeline decline in women receiving Mindfulness-based Cognitive Therapy compared to those who did not receive intervention (SMD=1.20; P=0.089).Conclusion: Based on the finding of the current meta-analysis, it can be said that educational programs that teaches Mindfulness-based cognitive and problem-solving skills can improve of postpartum depression.

Background Recognition of risk factors for childhood pneumonia as the main cause of mortality and morbidity is essential. We aimed to determine the relationship of pneumonia with parental smoking in hospitalized children under 10 years old in Qom city, Iran.Materials and Methods This case-control study was performed among 240 children under 10 years old in Ayatollah Golpayegani hospital in Qom city, Iran. Patients were recruited by convenience sampling; 120 patients with pneumonia as the case group, and 120 patients without pneumonia as the control group were enrolled. Parents were asked about duration of exposure to cigarette smoking, the number of cigarettes smoked per day by parents, the frequency of the smokers in family of children, parental education, age of exposure to cigarette smoking, location of smoking, frequency of hospitalization, and duration of hospitalization. The parental smoking was assessed and compared across two groups. The data were analyzed using SPSS software (version 13.0).Results The mean age in case group was 29.1±30.3 months and in control group was 32.9±31.1 months. In this study it was seen that lower age of smoking exposure was related to pneumonia. In fact significant difference was found between the groups for age of exposure to cigarette smoking (p=0.001), and location of smoking (p=0.048), but the other variables such as duration of hospitalization (day), hemoglobin level, frequency of the smokers in family of children and parental education had no association (P>0.05).Conclusion Based on the results of this study and comparing with similar studies conducted in this field, it can be concluded that pneumonia is related to parental smoking especially in younger ages.

Background: Lophomonas blattarum is protozoan generally parasitizes in the intestinal tracts of some arthropods. It can infect adults and children with unspecific respiratory symptoms. We aimed to investigate the frequency of Lophomonas blattarum in children with respiratory symptoms in North East of Iran.Materials and Methods: One hundred fifty-six children with respiratory symptoms were investigated in a descriptive-analytical study using Bronchoalveolar lavage (BAL) according to enumeration method in March 2016 to March 2017. Data was collected via a check list, prospectively. All had Bronchoscopy and chest X-ray. The data were analyzed using SPSS program.Results: Of the 156 studied children, 40.4% (n=63) of patients with the average age of 5.11±2.9 years were positive for L. blattarum infection. In positive cases, 42.9% (n=27) were male. There was a significant relationship between gender and Lophomonas infection (p=0.0006). The most common respiratory symptoms were cough, fever, wheeze and tachypnea. Radiography of infected patients showed pulmonary infiltration (16.7%), unilateral lung hyperinflation (23.1%), consolidation (19.9%), and lung collapse (14.7%). Underlying diseases were detected in 4 infected patients. Bronchoscopy showed abnormal results in 22 patients (14.1%). Most common abnormalities were in order: mucus plaque (22.7%), left bronchomalacia (18.2%), left bronchial stenosis (18.2%) and foreign body aspiration (13.6%).Conclusion: Generally, 40.4% of children with respiratory symptoms were positive for L. blattarum infection. It is suggested to consider L. blattarum as a cause of pulmonary infections in patients with pulmonary symptoms.

Background: Head lice infestation constitutes a serious health problem in marginalized areas where schoolchildren and their families are mostly affected. This study aimed to compare 3 lice control protocols approved by Ministry of Health and Medical Education, based on 1% permethrin shampoo, 4% dimethicone lotion and (1: 1) vinegar wet combing for the treatment of outpatients of Imam Reza Hospital of Mashhad city (Iran).Materials and Methods: The quasi-experimental before-and-after design was applied to evaluate the effectiveness of protocols, using SPSS software version 16.0. The study involved 154 infested individuals from both sexes during 2015 and 2016. The patients were clustered into 4-age categories;<5 to>13-year-old and their demographics were recorded. The results were recorded on weekly basis by a hospital-based dermatologist and an entomologist. Application times of permethrin, dimethicone and vinegar were 8-10 min, 8 h and 20-30 min respectively.Results: Age, gender, familly size and hair length were the most significant demographic variants involved in treatments outcomes at P ≤ 0.05. The protocols showed different efficacies a week after intervention keeping the same trend to the end. The dimethicone treated group indicated the highest control levels (86% and 74%). The recovery rates at first endpoint were 86, 64.2 and 60.8%, and at the second endpoint were 74, 45.3 and 45.1% for dimethicone, permethrin and vinegar respectively. Dimethicone was 4.3 times more potent than either of vinegar or permethrin (P<0.05).Conclusion: Pediculosis infected school age children of both sexes. Permethrin was as effective as vinegar wet combing, but significantly weaker than dimethicone. Given its efficay on both adult and nit stages, dimethicone can be the drug of choice for pediculosis control.

Background: Worldwide Intra-Uterine Growth Restriction carries out high rate of fetal and neonatal morbidity and mortality. Perinatal mortality rates are 4-8 times higher for growth-retarded infants. Intra-Uterine Growth Restriction (IUGR) is subdivided into symmetrical and asymmetrical subtypes. We aimed to focus on the actual incidence of each subtype of IUGR and disparities.Materials and Methods: Across-sectional descriptive study applied on 52 singleton newborns admitted to the NICU at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from January to December2015.We assessed them for some demographic characteristics, anthropometric measures, investigation and a thorough physical examination with an estimation of the Ponderal Index (PI) values; these data were analyzed using SPSS software version 18.0.Results: We found equal gender distribution for each sex. The 63.46% of IUGR babies were of asymmetrical type, while 36.53% were symmetrical. Incidence rate was higher among multiparous mothers than primiparous as 51.9%. The asymmetrical subtype mostly delivered by Normal Vaginal Delivery (63.6%), while the symmetrical subtype mostly delivered by Cesarean section (68.4%). Respiratory distress syndrome was the commonest early complication, the higher percentage was among symmetrical than asymmetrical subtypes 57.9%, 27.3%, respectively. Among all deaths, 33.35% had asymmetrical subtype. The mean birth weight for a symmetrical subtype was 1.410 gr, while for the symmetrical subtype it was 1.760 grams.Conclusion: The asymmetrical IUGR newborns were more than symmetrical type. More than two thirds of symmetrical IUGR were delivered with Cesarean section, while more than two thirds of asymmetrical IUGR were delivered normally and more than half of symmetrical IUGR were with RDS. Sex had no effect on IUGR distribution.

Background Children are more likely to be burned than other age. The aim of this study was to determine the burn-related factors in children in Kermanshah province, Iran.Materials and Methods In the present hospital based case-control study, 198 under 15 years age children who were burned (from beginning of spring 2016 until the end of spring 2017), enrolled into the study as cases and 198 children referred to the hospital for non-burning reasons selected as controls. The cases and controls were frequency matched for age and gender variables. Principal Component Analysis test was used to construct the socioeconomic variable and univariate, moreover multivariate logistic regression tests were used to determine the burn-related factors. All analyses were carried out using SPSS software version 21.0.Results: The mean age of children with burns was 4.3 ± 3.5 years. The most common factor of burns was hot liquids with 48.5%. Body mass index (Odds Ratio (OR)=1.252, P=0.004), number of household members more than 5 body (OR=8.472, P<0.001), absence of more than one watchful (OR=2.481, P=0.026), hours without watchful (OR=8.649, P<0.001), illiterate mother (OR=9.778, P=0.002), petroleum storage at home (OR=1.815, P=0.046), and the lowest quartile of socioeconomic level (OR=7.220, P<0.001) increased the chance of burning in children. Increase of mother age (OR=0.938, P=0.005) and the worker father (OR=0.233, P=0.002) reduced this chance.Conclusion: Based on results of current study, burning in children is a multifactorial outcome including individual, social and environmental factors such as Body mass index, household size, mother age, father job, less watchful, hours without watchful, illiterate mother, petroleum storage at home, and socioeconomic status.

Background: Recently, the prevalence of influenza threatening the society health; preventative strategies are effective method in reducing risk prevalence of influenza. The aim of this study was to determine the cognitive determinants of influenza preventive behaviors among high school students based on the Health Belief Model (HBM).Materials and Methods: This cross-sectional study, conducted among 300 high school students (170 girls and 130 boys) in Southern of Iran. Students were randomly selected to participate voluntarily in the study. Participants filled out a standard self-administered questionnaire. Questionnaire included three sections including influenza preventive behaviors, demographics variables and HBM variables which comprised of 46 items. Data were analyzed by SPSS software (version 16.0).Results: The mean score of influenza preventive behaviors was 14.66 [mean female: 15.42+ 4.93) and mean boy: 13.61+ 4.71)], ranged from 0 to 28.The HBM variables accounted for 23% of the variation in influenza preventive behaviors (Adjusted R squared=0.23, F=15.288 and P<0.001). The best predictor was self-efficacy (ß=0.358, P<0.001). Female student, and high level of parents education was a significant association with doing influenza preventive behaviors (P<0.05).Conclusion: Based on our results, it seems that implementation of interventional programs to increase self-efficacy about influenza preventive behaviors may be usefulness of the results in order to promotion of influenza preventive behaviors.

Background: Central venous catheter (CVC) is used for measuring hemodynamic variables, transfusion of blood, fluids and medications when peripheral vascular lack sufficiency. Unfortunately CVC is associated with many complications ranging from anxiety and discomfort for the patient to severe mechanical side effects such as arterial lacerations, pleural and pericardial injury as well as infection and thrombosis. This study aimed to survey of a practical approach to central venous catheterization in pediatric patients.Materials and Methods: In this retrospective and descriptive study, rate of success and complications of central venous catheterization by the anesthesia team for the hospitalized children 0-15 years from 2009 to 2016 years at Mofid Children Hospital, Tehran-Iran, were investigated. Advancement of catheters tips in pleural space; peritoneal cavity and pericardium were recognized by rat tail blood flow as a practical approach which was proved by chest X- ray. Successful rate and complications of inserting CVC were collected by researchers using medical records of the patients.Results: There were 2, 385 (53%) female and 2, 115 (47%) male patients. Patient’s age ranged from 1 month to 10 years, mean 12.25±6.45 months. About 4, 500 patients who underwent central venous catheterization were investigated that 815 patients (18%) had improper catheterization in the internal jugular and 374 patients (8%) had accidental arterial injury and 160 patients (3%) had accidental pleural injury. Accidental pleural injury were recognized by rat tail blood flow in the liquid column connected to the catheter to the patient's bedside and all of them was proven by taking control image.Conclusion: Using rat tail blood flow as a practical approach to central venous catheterization in pediatric patients can be associated with prevention of the plural injury and subsequent pneumothorax and hemothorax.

Background: The birth of a child with mental retardation can put a lot of mentally pressure on people around her, especially on mother. Therefore, the purpose of this study was to investigate the effectiveness of group counseling based on the reality therapy on the resilience and psychological well-being of mothers with an intellectual disabled child.Materials and Methods: The research was quasi-experimental with pretest-posttest design and control group. Forty mothers with an intellectual disabled child who their children were studying at the exceptional schools of Kermanshah city in 2017; selected by simple random sampling and assigned into two intervention (n=20), and control groups (n=20). The intervention group received group training in 10 sessions of 60 minutes (one session every week). The research tools include Conner and Davidson Resilience (2003), and Reef Psychological Well-Being (1980). Data were analyzed by SPSS software (version 21), and multivariate analysis of covariance.Results: The mean of mothers’ resilience in the intervention group was 74.41±8.33 in post-test; in the control group, 45.41±16.84 in post-test. The mean of the psychological well-being of mothers in the intervention group was 72.5±83.3 in post-test; in the control group, these values were 34.12±7.47 in post-test, respectively. The results of the independent t-test showed that there is a significant difference between two groups in terms of resilience and psychological well-being (p<0.001).Conclusion: According to the results, the mothers under the group training based on the reality therapy had a significant improvement in increasing the level of resilience and psychological well-being compared to the control group.