Iranian Journal of Pediatrics
Year:2006 | Volume:16 | Issue:2|Papers Count:23

Background: The aim of this study was to evaluate clinical findings, microscopic examiniation and culture of vaginal secretions, and response to treatment in prepubertal girls with vulvovaginitis.Methods: We studied prospectively over a period of about 6 years in a clinic for pediatric kidney and urinary tract diseases, 171 girls aged 2.5-8 years with urogenital symptoms.Findings: Dysuria, erythema, itching, soreness, and vaginal discharge were frequently observed genital symptoms and signs. Pathogenic bacteria were isolated in 27% of cases, Streptococcus Pyogenes being a common agent. Nonpathogenic enteric flora was isolated in about 43%. There was no growth of bacteria in 30%. Poor hygiene was an associated factor in those with nonpathogenic positive culture (P=0.001). Purulent vaginal discharge occurred more in cases with vulvovaginal pathogenic infection than in those with negative culture, and this difference was statistically significant (P<0.001). Also there was significant difference in WBC count in vaginal smears of patients with pathogenic bacteria and of those who had no growth of pathogens (P<0.001). Candida and sexually transmitted agents were not found in any of the girls. Labial fusion was not an uncommon abnormality. Simple measures to improve hygiene and use of local estrogen were effective in the patients with nonpathogenic and nonspecific etiology. Conclusion: Physical examination of genital area should be done in all girls with genitourinary symptoms. Antibiotic should be prescribed based on bacteriologic culture of vaginal secretion.Appropriate hygienic practices and local estrogen application is the most effective therapy in children with noninfectious vulvovaginitis.

Background: Depressive, anxious, aggressive and regressive behaviors are the most common psychiatric symptoms following natural disasters in children. Art, play and behavioral techniques are used for reducing these traumatic symptoms. We studied the effect of 12 sessions of group play therapy in children 3 to 6 years old who had been exposed to the Bam earthquake directly.Methods: This study was carried out to evaluate the effect of 12 sessions of group play therapy with cognitive-behavioral approach for the preschool aged children who had been exposed to the Bam earthquake directly and had lost at least one of their first degree family members. Mental retarded children and those with psychiatric or severe medical problems that needed medications were excluded.Before and after interventions we evaluated post traumatic, emotional and anxiety symptoms by using Yule’s PTSD scale and behavioral symptoms by Rutter’s questionnaire. Then we compared before and after interventions scores.Findings: At first 19 children were included in the study, 13 of them completed at least two thirds of the interventional sessions. We excluded six children who participated in fewer sessions. The mean scores of Yule’s PTSD scale and Rutter's questions reduced during interventions which was statistically significant.Conclusions: Trauma/grief focused group play therapy may be effective in reducing post traumatic symptoms of natural disasters in preschool aged children.

Conclusion: Pd-Grastim may be preferred to Neupogen in Iran, because of the same effectiveness but lower cost. Methods: Absolute Neutrophil count (ANC), total WBC, platelet count (on the 15th day of chemotherapy), and event of fever and neutropenia in this period, were measured after 60 courses of chemotherapy and 4 days of G-CSF, in two separate but the same patients groups, Pd-Grastim (group 1) and Neupogen (group 2). Findings: Mean values of WBC count, ANC, and platelet count were similar (P.V.>0.05). No significant difference was observed for episodes of neutropenia (ANC<500), event of fever and neutropenia, and days of hospitalization between these groups. Effectiveness and also side effects of Pd-Grastim and Neupogen were similar. Lower cost of Pd-Grastim was the only significant difference between these two forms of G-CSF. Background: G-CSF is one of the new medications that may reduce duration and severity of neutropenia after chemotherapy. Two forms of G-CSF are now available in Iran: Neupogen (original from), and new production of Iran named Pd-Grastim. We decided to compare the efficacy and side effects of these two of the drug.

Background: Appropriate treatment of bacterial meningitis especially in children is a important problem due to multiple drug resistance. The determination MIC of conventional antibiotics for bacterial meningitis with quantitative E. test is exactly practical and essential. We studied MIC of conventional antibiotics in pediatric acute bacterial meningitis older than two months, center children hospital, 1382-1384.Methods: In this prospective and cross sectional process research we measured MIC of antibiotics in 30 positive bacterial culture in CSF or blood with quantitative E. test and compared with qualitative disk diffusion test.Findings: Antibiotic resistance of 10 Haemophilus influenzae type b patient was: ampicillin resistance in 90%, co-Amoxiclave R. in 10% chlorampheicol R. in 40%, third gerenation cephlosporins R. (ceftriaxone and cefotaxime) in 0% and cotrimoxazole R. in 100% and antibiotic resistance of 20 streptococcus pneumonia patient was: penicillin R. in 35%, chloramphenical R.in 10%, third generation cephalosporin's R in 5%, rifampin R. in 10% and cotrimoxazole R. in 60%.In comparison of two methods E-Test and Disk Diffusion we found insignificant difference.Conclusions: Antibiotic Resistance of our study is compatible with other studies. Therefore it seems that composition of ampicillin and chloramphenicol as empiric therapy for bacterial meningitis for many years ago, aren't appropriate today and third generation cephalosporin's alone or with vancomycin is a suitable therapy.

Background: Sedentary behavior in childhood is one of the strongest risk factors for many chronic diseases and somatic conditions in adulthood, including cardiovascular disease, hypertension, obesity and osteoporosis.This study was an investigation to design a surveillance system for non-communicable diseases.Methods: The present national survey was performed as a multi-centric cross-sectional study for the baseline survey of a project entitled: "Childhood & Adolescence Surveillance and Prevention of Adult Non-communicable Diseases": CASPIAN Study. The study was supported by the World Health Organization and performed by the Ministry of Health, the Ministry of Education, with collaboration of 23 universities of Medical Sciences. One of the items studied was the physical activity. Physical activity data is evaluated by metabolic equivalent (METs) accelerometers.Results: 21111 school pupils aged 6 to 18 years consisting of 10858 girls (51.4%) and 10235 boys (48.6%) have been studied. 5.2% of them were obese and 9.4% overweight. The mean times of moderate and vigorous physical activity were 4.7 and 0.8 hours everyday. Boys were more active than girls (P<0.05) and primary school students were more active than high school students (P<0.05). Watching television, using the computer, or playing video games were the most common sedentary activity in students. Conclusion: Physical activity in our subjects was in acceptable level. Boys tend to be more active than girls, and there is a decrease in activity over the adolescent years.

Background: Impetigo is a common infectious skin disease and most commonly occurs in children. Etiologic agents are Staphylococcus aureus or Beta-heamolytic Streptococcus group A or combination of these organisms. Adequacy of treatment is related on sensitivity of bacteria to common prescribed antibiotics.Methods: Study of the frequency of bacterial culture results from lesions and antibiograms for four systemic antibiotics cephalexin, erythromycin, cloxacillin and penicillin were assayed. Impetigo cases admitted to the dermatology clinic of Ghaem hospital in Mashhad for one year beginning from June 2001, were studied. These patients had no history of systemic of topical antimicrobial agents application. Results of antibiograms obtained from culture of skin lesions were analyzed with Chi-Square test.Findings: Twenty two (88%) patients were younger than 20 years. Twenty one cases (84%) had non bullous impetigo. In 17 (68%) cases lesions were localized on the face. Because of secondary contamination in 3 cases, statistical analysis was performed on 22 cases.The most common bacteria (95.5%) was Staphylococcus aureus. Antibiograms of S.aureus showed complete sensitivity to cephalxin in 85.3%, erythromycin in 63.6%, cloxacillin in 40.9%, and penicillin in 13.6% of cases. Conclusions: Staphylococcus aureus was the most common organism in 95.5% of cases and cephalexin was the first choice oral antibiotic followe0d by erythromycin.

Background: Dyslipidemia is frequently observed in patients with diabetes mellitus and has led to development of screening programs and intervention studies. Dyslipidemia has been identified as an important risk factor for coronary heart disease.Methods: 128 patients with type 1 diabetes attending a single pediatric endocrine clinic underwent anthropometric and biochemical assessment. Anthropometric measurements followed WHO criteria. Blood samples were analyzed for glycated hemoglobin (HbA1 C), cholesterol (chol), triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL), and blood pressure was recorded.Findings: Patients' mean age was 12.6± 4.1 years. Patients' mean age at the onset of diabetes was 7.1±2.8 years. Mean duration of diabetes was 6.9±3.2years. 48.5% of patients had some form of dyslipidemia. 21.4% had isolated hypertriglyceridemia, 11.6% isolated hypercholesterolemia and 15.5% mixed hyperlipidemia. Factors associated with dyslioidemia included longer duration of diabetes, higher mean age, higher mean HbA1C (p 0.001). Hypertriglyceridemia was more frequent in female patients and subjects with higher BMI (p<0.05). The mean value of TG 199.9±74.1 mg/dl, TC 178.5±29 mg/dl and LDL 141.2±37 were significantly higher in patients with poor metabolic control (mean value of HbA1C 9.3±1.8) than the diabetic patients with better control (mean value of HbA1C 7.1±0.77), TG 156.8±55.9mg/ dl; TC143.5±37.6 mg/dl and LDL 108±21.2.Conclusion: Our findings indicated that type I diabetic patients with poor metabolic control are at higher risk of developing dyslipidemia. However, given the well documented problems of lifestyle regulation and compliance in optimizing control especially in this age group, we need to develop alternative and simple interventional strategies to improve outcome. Monitoring of lipids should be extended and yearly screening of patients for dyslipidemia recommended.

Background: Ceftriaxone is almost widely used in the treatment of pediatric infection and this is accompanied by some complications.The aim of this study was to determine the incidence of abnormal ultrasonography finding of gallbladder (pseudolithiasis or sludge) during ceftriaxon therapy and its relation to fasting, sex and G6PD deficienty.Methods: This quasi-experimental survey was done in Amirkola Children's Hospital, Babol, Iran. First ultrasonography was done before initiation of ceftrixone therapy and it was repeated 24-48 hours after therapy and in the 5th ,7th, 10th and 14th day after the treatment. If abnormal finding was seen, ultrasonography was done weekly in the first two weeks until the side effect disappeared. Data was collected and analyzed by SPSS software. Findings: Of all 108 patients, who were between 3 months to 10 years old, 20 cases had abnormal finding in gallbladder (2 sludges and 18 pseudolithiases). Length of fasting before ceftriaxone therapy had a positive relation with possibility of stone formation (p<0.005), but age, sex, duration of therapy and G6PD deficiency were not related (p>0.05). In four cases pseudolithiasis was formed after only 1-2 dose of ceftriaxone. Shortest and longest periods of resolution of complications were 1 and17 days respectively after formation.Conclusion: Incidence of pseudolithiasis or sludge formation during ceftriaxone therapy was 18.5% and fasting had a great effect on these complications.

Background: Pain control is the main concern in improving the quality of medical care in children. Injection is one of the painful procedures done on the child in hospital. The goal of this research was to evaluate the problems nurses encounter in using methods to reduce injection pain in children.Methods: The present study is a descriptive-analytic done with cooperation of 30 nurses working in pediatric units of two hospitals of Tehran city with a job experience of at least three months. The instrument used in this study included two questionnaires: 1) Demographic information, 2) Nurses’ view about the existent obstacles in using methods of reducing injection pain in children.Findings: 100% of the study samples were female and held a BS degree in nursing. They aged between 22- 24 and more than 80% of them had more than one year of experience in pediatric department. The results obtained through the questionnaire on the nurse’ view about the existent obstacles in using methods of reducing injection pain in children, show that in personal –management dimension “the lack of time and unporportional number of nurses to number of patients”, in educational dimension “the unavailability of pain measurement instruments”, in environmental-equipment dimension “the lack of enough toys and entertainment to use the injection pain reducing methods to children” and finally in motivational dimension “the undue satisfaction of the nurses regarding the working hours and shifts”, have been named as number-one problems.Conclusions: the results of the present study show that in using methods to reduce the injection pain in children, nurses face different problems in different aspects. The analysis of data of the present study indicates that the most salient solutions to remove this problem is to from pain-control nurse committees in the hospital.

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency can cause hemolytic anemia and neonatal jaundice. Screening of newborns by examining the cord blood for enzyme activity has been proposed for prevention of its complications. The aim of the present study was to determine the incidence of G6PD deficiency in newborns in Vali-e-Asr hospital, Tehran. The relation between G6PD deficiency and the variables of sex, gestational age, jaundice, hemolysis, and anemia was also examined.Methods: 450 newborns during a 9-month period were examined for G6PD activity by Fluorescent Spot Test of specimens of cord blood and for other variables.Findings: 9 neonates (8 males and 1 female) were G6PS deficient. The incidence of G6PD deficiency was 2% (3.3% for boys and 0.5% for girls). Six (66.7%) cases of G6PD deficiency developed jaundice. None of the G6PD-deficient neonates developed anemia. Only one case had a high cord blood reticulocyte count. G6PD deficiency was correlated with sex and neonatal jaundice. There was no correlation between G6PD deficiency and gestational age, hematocrit and reticulocyte count of the cord blood. Conclusion: The incidence of G6PD deficiency in newborns in Vali-e-Asr hospital in Tehran was 2% Screening of the male newborns for enzyme deficiency by examining the cord blood is suggested.

Background: Recently, the prognosis of acute post- streptococcal glomerulonephritis (APSGN) has been reported as improved compared with the results of previous studies. In an attempt to clarify this in Iranian children, we analyzed the clinical course of patients with APSGN.Methods: In this retrospective study, a total of 53 children diagnosed as having APSGN according to the presence of hematuria and/or proteinuria, evidence of group A beta- hemolytic streptococcal infection, transient hypocomplementemia and absence of clinical or histological evidence of previous renal disease were studied in our department between March 1986 to September 2002.Finding: Fifty- three children, 19 females and 34 males, aged 3-13 years (mean 8.7 years) were enrolled in the study. All children had hematuria, proteinuria and decreased serum complement. There were no patients with renal dysfunction, but one case with nephritic syndrome. Forty-three (81%) had hypertension according to Second Task Force criteria. Blood pressure (BP) was normal in the remaining 10 (19%) patients. Eight children were lost for the follow up examination. Two patients received renal biopsy. Both biopsies were abnormal showing mild changed with corresponding immunologic findings. Forty-five children were reassessed after an average of 5 months (rage 1 month to 66 months). At the last follow-up all of these children were in good physical health. The BP, serum creatinine, and complement levels were within normal limits.Conclusion: These findings indicated that the prognosis of APSGN during childhood is excellent, when adequately recognized and received supportive measures in the treatment, including control of high blood pressure and chemical imbalance in acute phase of disease. Additionally, according to our results, we could predict a favorable prognosis and reassure the family

Background: ELA2 gene responsible for coding human neutrophil elastase, a powerful serine protease carried by blood neutrophils and capable of destroying most connective tissue proteins. The NE gene consist of 5 exons and 4 introns. Methods: Peripheral blood obtained from healthy individuals. Total RNA was isolated using RNA standard techniques from fresh separated cells by polymorphoprep. RNA was analyzed by employing PCR amplification of reveres transcribed using a total of ten specific primers. We amplified five exon of ELA2 gene separately and sequenced each exon. Mutational analysis was performed by directed capillary sequencing method.Findings: We have found new single nucleotide polymorphism (SNP) in exon II codon 44.It was a silent mutation G to A substitution but no changes in amino acid sequences were seen. The codon sequence was GCG that has changed to GCA.Conclusion: The purpose of SNP detection is mainly recognition of susceptible people to certain diseases and providing suitable drugs based on each person genetic information. SNP information in Iranian patients can be used for analysis of drug response to human diseases.

Background: Urinary tract infection is known as one of the most common bacterial infections in children. Early diagnosis and treatment along with recognition of risk factors and long-term follow – up of the patients are the most important factors in preventing scar formation in kidneys. This study was carried out to estimate the relation of the time from onset of symptoms to the start of treatment to scar formation in kidneys. Methods: This study was done by historical cohort method on 120 patients divided into 2 groups of 60. The treatment was started on time for the first group, for the second with delay. All of the patients suffered from urinary tract infection and were DMSA scanned after six months. The frequency of scar formation in kidneys in the two groups was compared and the results were analyzed by SPSS software.Finding: 75% of the girls and 25% of the boys suffered from urinary tract infection. No obvious relation between the scar formation and appearance, parents’ social level and children’s gender was found. A meaningful relation was found between treatment delay and scar formation in kidney due to urinary tract infection (RR=3, CI=14-6.5). The minimum and maximum delay time between onset of symptoms and start of treatment has been 4.8 days. Based on this research, a delay of more than 6 days in treatment may cause kidney scar formation twice as much (RR=2.15, CI=1.1-4.6).Conclusion: Scar formation risk increases with delay in antimicrobial therapy in urinary tract infection. It is strongly recommended to begin the proper treatment as soon as possible to prevent kidney damage.

Objective: Thrombocytopenia is the most common hemostatic disease of the newborn. Inherited giant platelet syndromes are a heterogeneous group of rare bleeding disorders. In this paper we describe here a female neonate with autosomal dominant hereditary macro thrombocytopenia. Case report: A female neonate was referred to our center due to mucosal hemorrhage (nasal and gastrointestinal bleeding). Her mother’s platelet count was normal. However her father, paternal uncle and two paternal aunts also had severe thrombocytopenia and all of them underwent splenectomy for idiopathic thrombocytopenic purpura (ITP). Considering all clinical and laboratory findings, autosomal dominant hereditary macro thrombocytopenia was the best diagnosis.Conclusion: It is important to differentiate between congenital and acquired thrombocytopenia to avoid unneeded and potentially harmful therapy. Treatment is not usually necessary, however some patients with hereditary thrombocytopenia may benefit from bone marrow transplantation.

Objective: Prolonged exogenous administration of ACTH or hydrocortisone or its analogs results in a clinical pattern identical to the spontaneous disorder and is frequently referred to as Cushingoid syndrome. This syndrome is generally reported as a result of oral or parenteral steroids administration. Case Report: Our report present a five-month old baby with typical Cushingoid changes following local steroid application due to diaper rash. Clobetasol was used for diaper rash, but had not used systemic corticosteroid. Serum Cortical and ACTH was very low and no detectable. After discontinuation of local steroid, Skin complication recovered gradually and after 5 months, completely.Conclusion: Local corticosteroids may be high absorption and cause systemic complication such as Adrenal insufficiency and Cushingoid syndrome.

Background: Henoch- Schoenlein purpura (HSP) is the most common vasculitis in children. It is characterized by purpura, arthritis, gasterointestinal involvement and glumerulonephritis. There is a male to female predominance. It is estimated that some infections such as BHGAS can predispose to HSP. Methods: In a retrospective study we evaluated clinical and laboratory findings in patients with HSP diagnosis admitted to Ghaem and Imam Reza hospitals in Mashad. Findings: It is known that skin, joint and gastrointestinal involvement is the most common presentation of disease. In our patients, kidney disorders were not detected. Hyperleukocytosis, positive CRP, elevated ESR and ASO titers were frequently observed laboratory signs in these patients.Conclusion: In this study HSP had a good prognosis and we didn’t any kidncy complication in our subjects.

Background: Even though phototherapy has been used for more than 30 years, reports of significant toxicity are rare. Phototherapy is highly effective method for preventing and treating hyperbilirubinemia. Methods: A prospective study was performed in 200 neonates with hyperbilirubinemia in Children's Medical Center, Tehran. Complications of phototherapy (weight loss, fever, loose stool, Hypocalcaemia, thrombocytopenia) were evaluated. Findings: There was a positive relation between efficacy and irradiance but complications were not different. Hypocalcaemia, thrombocytopenia and loose stool (P<0/05) were found.Conclusion: Intensive phototherapy and double phototherapy were more effective than single phototherapy. There was no relation between mode of phototherapy and complications.