Iranian Journal of Pediatrics
Year:2005 | Volume:15 | Issue:1|Papers Count:16

Background: Current study aimed to assess the possibility of prediction of continuous performance test in primary school children with attention deficit hyperactivity disorder, with parents and teacher reports of inattention, hyperactivity and oppositional behavior. Methods: Fifteen school aged children with Attention Deficit Hyperactivity Disorder without co-morbid psychiatric disorders were selected from Roozbeh child and adolescent psychiatry clinic. Teachers and parent Conners questionnaires, Continuous Performance Test and 4 class dictation scores were registered from each subject.Results: Commission errors were correlated with hyperactivity scale in the parent report (r=-0.50, p<0.05), and with ADHD score (r=-0.49, p<0.05). Omission error was correlated with inattention (r=0.66, p<0.05) and ADHD score (r=0.51, p<0.05) on teachers report. Reaction time was correlated with oppositional (r=0.51, p<0.05) subscale in parents Conners questionnaire. Dictation scores were correlated with inattention on parents report (r=-0.52, p<0.05) and omission on Continuous Performance Test (r=-0.79, p<0.05).Conclusion: Current study reported a significant correlation between neuropsychological tests and questionnaires, in ADHD.

Background: Favism is an acute hemolytic anemia which occurs in G6PD deficient individuals by ingestion of fava beans or inhalation of fava plant's pollens. Awareness of clinical features and laboratory findings of this life threatening condition is first step in proper management and prevention of its complications. Methods: This retrospective descriptive study presents five years' data on hospitalized cases of favism in Tehran. Data were collected from Mofid University Hospital for Children. We reviewed all in-patient charts for cases of favism who presented with acute hemolytic crisis due to fava beans ingestion from March 1995 to March 2001. Data on demographic and clinical features (e.g. pallor, dark urine and jaundice) and laboratory findings (e.g. serum concentrations of hemoglobin, creatinine, total and direct bilirubin, liver transaminases, reticulocyte count, direct Coombs test, qualitative G6PD measurement, and presence of hemoglobin, bilirubin, and urobilinogen in urine), positive family history of favism and history about blood transfusion were evaluated. Findings: A total of 523 cases were recorded of whom 75.7% were male. The mean age of our patients was 27.7 months ± 46.4. Dark urine, pallor and jaundice were common manifestations of favism (96.6%, 75.3%, and 70% respectively). Male gender was significantly associated with pallor and hemoglobin ≤7 gr/dL. (p = 0.04 and p = 0.001). Conclusions: Our findings about clinical features and laboratory findings in favism were compatible with those in literature. Our study suggests that parents are not reliable sources for differentiating of some clinical features of favism (e.g. paleness and jaundice).

Background: The incidence of primary vesicoureteral reflux (VUR) is less than 1% in the general normal population, but it is high in siblings of children with VUR, with a reported incidence of 4.7-51%. VUR represents one of the most significant risk factors for acute pyelonephritis in children and caries long-term renal parenchymal damage. The purpose of this study was to detect the age-related incidence, and severity of reflux, in siblings of children with reflux. Methods: Out of 80 index patients with VUR, 95 siblings were evaluated with direct voiding cystography from 1994 to 2004. All siblings underwent renal ultrasonography (US) for size, shape, parenchymal echogenicity, corticomedullary differentiation, irregularity of the kidney outlining, and parenchymal reduction. Findings: Out of 95 siblings, 34 had VUR, representing an incidence of 35.8%. The mean age at study entry of the 37 boys and 58 girls was 65 months (range 3 months to 13 years). Reflux was unilateral in 22 siblings and bilateral in 12. Of the 34 refluxing siblings (46 refluxing ureters), 12 (35.3%) had history of symptomatic urinary tract infection (UTI). Of the 46 refluxing units 22 were mild, 13 moderate, and 11 were severe. Conclusion: Reflux is low in the majority of siblings. This study confirms a significant overall incidence of VUR (35.8%) in the siblings of patients with known reflux. Additionally, our review suggests that all siblings over 6 years should undergo a screening for VUR because of the high likelihood of identifying reflux in this population, even in the absence of urinary tract infection.

Background: Immunization is the most efficacious and cost effective intervention available to improve the health and wellbeing of children and prevention of infectious disease. Methods: The goal of this research was the determination of knowledge and behavior of parents about vaccination of under 6 year-old children in Zahedan. This study was descriptive analytic. The sample size was 1066 persons (father or mother) and the data was collected with a questionnaire containing parents' specifications (gender, age and education level). The collected data was analyzed with Chi-square test. Results: rom 1066 persons 756 persons (70.9%) had moderate knowledge, and 159 persons (14.9%) had low knowledge about vaccination. 844 persons (79.2%) had performed complete and 222 persons (20.5%) incomplete vaccination for their children. In this study we found significant relation between knowledge and age, as well as educational level and information source of parents (p<0.001). The relationship between parent's behavior about vaccination and her age (p=0.2), and her education level (p=0.1) was not significant, but relationship between parents behavior and information source was significant (p=0.007). Parents' information source was Radio, TV, journals, books and newspapers, friends, physicians and health care workers.Conclusion: Parents knowledge about vaccination is an important factor in prevention of infectious diseases, so it will be rewarding to work on increasing parents' knowledge about vaccination by any available means.

Background: Brain abscess is one of the most important diseases among the neurosurgical infectious diseases which is accompanied by considerable mortality and morbidity. The aim of this research is contemplation of brain abscess in children (5-12 years) to ascertain the incidence, effectual underlying factors, clinical and laboratory findings and mortality and morbidity rates in Ghaem hospital in Mashad since 10 years ago. Methods: This is a descriptive and analytic study in children with brain abscess in Ghaem hospital achieved retrospectively. We considered age, sex, underlying factors, clinical and laboratory findings, location of abscess, methods of treatment (medical or surgical), the duration of staying in hospital, and mortality and morbidity of the disease. Statistical analysis was achieved with Odds Ratio and Chi2 test.Findings: The age of children with brain abscess was 5-7 years. Male to female ratio was 1.6 to 1.The most common underlying factors for brain abscesses were acute and chronic diseases of ear, mastoiditis, and chronic cyanotic heart disease (CCHD). The patients had fever (55.5 %), headache (46.6%), focal neurological findings (64.6%) and altered consciousness in 46.7%. The most common sites of involvement were: temporo-parietal (20%) and parietal lobe (18.2%). Pus culturing was positive in 34% of cases. In 73.3% of cases one organism and in 26.6% several organisms were found in the culture. We achieved aspirated type operation in 93.3 % of cases. The incidence of mortality and morbidity was 17.7% totally. The mortality and morbidity rates in patients with CCHD and otogenic brain abscess were 11.1% and 22.2% respectively. There was no meaningful correlation between mortality and morbidity with the number of abscesses or patients age.Conclusion: Attention to hygiene of mouth and teeth in pediatric patients with cyanotic heart disease is very important in prevention of infectious brain diseases. We must also consider attention to ear-nose-throat diseases of children. It is very important that the patients are examined again after treatment because of finding and treatment of unknown otitis and chronic sinusitis.

Background: Neonatal cholestasis syndrome includes a wide spectrum of clinical conditions ranging from congenital malformations of the hepatobiliary tree, infections, and inborn errors of metabolism to some clinical conditions with or without genetic predilection. The aim of this study is the survey of epidemiological and clinical findings of cholestasis in our center for a better approach and management of cholestatic newborns. Methods: We undertook a retrospective analysis of the medical notes of all infants treated for cholestosis at our center between 1999-2004. Results: Male to female ratio of 61 analyzed cases of neonatal cholestasis syndrome was 2/1. Intrahepatic causes were responsible for 73.3 % of cholestasis cases consisting of neonatal hepatitis 2, inspissated bile syndrome 1, and histiocytosis 1 cases. Extrahepatic cholestasis was diagnosed in 20/3 % of cases as choledocal cyst in 2, and billiary atresia in 14 cases.Conclusion: Intrahepatic cholestasis is commonest form of neonatal cholestasis in our center. Early diagnosis and management of neonatal cholestasis is of great importance for good results of treatment. This can be achieved by instructing the parents and health personnel to refer the suspected newborns to neonatology center as soon as possible.

Background: Shunt infection, a common problem in shunt-inserted patients, is an important concern in neurosurgery. It increases mortality rate and causes developmental and cognitive delay in children. Use of antibiotics and selection of them in preventing shunt infection is controversial. In this randomized clinical trial, we compare the effect of ceftriaxone and co-trimoxazole in this concern. Methods: We studied 85 hydrocephalous children hospitalized in Children's Medical Center (2003-2004). Patients, aged 1 month to12 years, were divided into two similar groups (according to age, sex, and etiology of hydrocephaly), received one of both antibiotics pre-op and followed up for possible infection for one year. Results: Shunt infection occurred in 10 patients aged 2-36 months <6 months after surgery (80%). We did not find any significant difference between the two antibiotics regarding infection prevention. The most effective factors in increasing shunt infection were low age of the patients and CSF leakage.Conclusion: According to the ineffectiveness of antibiotics in preventing shunt infection, it seems that the risk can be reduced by controlling other factors like better sanitation and less traffic in operating rooms, faster surgery and decreasing chance of CSF leakage.

Background: In the study, we evaluated efficacy and complications of T-tube application in treatment of intestinal atresia in newborns. Methods: In this randomized clinical trial study, 40 neonates with intestinal atresia were studied. The patients were divided into two comparable groups. After preparation of general conditions for operation, the surgery was applied under general anesthesia. In the first group, primary end-to-end anastomosis with T-tube application and in the second group only primary end-to-end anastomosis was done. Baseline variables (age, sex and birth weight), signs of disease, interval between surgery and beginning of oral nutrition, duration of hospitalization, post operation complications and mortality were compared between the two groups.Results: Age, sex, birth weight, age in operation time, frequency of abdominal distention, bilious vomiting, failure of meconium pass and congenital anomalies were not different significantly. Also interval between surgery and beginning of oral nutrition was not different. In 2 of 20 neonates (10%) in T-tube group post operation complications occurred, but in the other group, 9 neonates of 14 neonates (64.3%) complications were seen after operation (p=0.002). Two neonates (10%) in T-tube group and 8 neonates (40%) in the other group died during post operation follow up (p=0.03). Conclusion: It seems that primary end-to-end anastomosis with T-tube application in neonates with intestinal obstruction decreased complications and mortality rate. More similar studies with larger samples are recommended.

Background: Early diagnosis and treatment of neonatal disease, particulary the surgical disease has great importance. Methods: We had studied the neonatal diseases needed to surgical treatment, associated anomalies, medical treatment, short-term complications and mortality in a period of October 2002 to October 2004 in NICU of Ekbatan hospital. Findings: We studied 126 surgeried neonate in a prospective descriptive study, 63.5% were male. The diseases were: Hirshprung 19.0%, imperforated anus 16.7%, esophageal atresia 18.7%, inguinal hernia 9.5%, clef lip 6.3%, omphlocele 4.0%, meconium ileus 3.96%, jugenal atresia, necrotizing enterocolitis and meningomyelocele 1.58% , pneumothorax, chylothorax, sacrocoxygeal teratoma, hepatoblastom, ovarian cyst, mechel's diverticulum, gastrochesia, thyroglosal duct cyst, cystic hygroma, posterior urethral valve has 0.79% frequency in our study. We didn't find any associated anomaly in 58.73% of our cases. Electrolyte abnormality was the most post-operative complication, majority of them needed to medical treatment. In this study, mortality rate was 10.3%. Conclusion: Our study revealed that NICU, appropriate surgical techniques, appropriate pre & post operative medical treatment has dramatic effect in improving their outcome and diminishing surgical complications.

Background: Autosomal recessive polycystic kidney disease is characterized by renal collecting duct cysts, congenital hepatic fibrosis (biliary dysgenesis) and autosomal recessive pattern of inheritance.The disease usually manifests in infancy, and has a high mortality rate in the first year of life. Kidney involvement is always present and manifests as variable degrees of non-obstructive collecting duct ectasia, usually in bilateral and symmetrical fashion and interstitial fibrosis. Patients almost always have also hepatic involvement as congenital hepatic fibrosis (periportal fibrosis with anomaly and dilatation in intrahepatic biliary ducts) that can cause portal hypertension with esophageal varices, bleeding and hypersplenism. The relative degrees of kidney and liver involvement tend to be inverse: Children with severe renal disease usually have milder hepatic disease and vice versa. Case report: This paper presents a 23-month old female with progressive renal failure and hepatic involvement (portal hypertension, esophageal varices bleeding and hypersplenism), which has been reported rarely.