Iranian Journal of Pediatrics
Year:2006 | Volume:16 | Issue:1|Papers Count:20

Background: Vesicoureteral reflux (VUR) affects approximately 1% of children. It is a risk factor for acute pyelonephritis. Reflux has been identified in 30-50% of children following urinary tract infection. Reflux nephropathy is one of the causes of hypertension and end stage renal disease in children. The primary diagnostic procedure for evaluation of VUR in children is fluoroscopic voiding cystography (VCUG) and radionuclide cystography (RNC). Many investigators have used voiding urosonography (VUS) for the diagnosis of reflux in an effort to eliminate the radiation exposure especially during follow-up period. Methods: We analyzed 25 children with suspected VUR who underwent RNC and VUS concurrently in Labbafi Nejad Hospital in Tehran. Reflux was diagnosed in 8 patients by RNC and in 9 patients by VUS. One case with reflux in RNC was not detected by VUS, and 2 cases with reflux in VUS were not detected by RNC. Findings: The diagnosis of reflux by these two procedures (RNC and VUS) was comparable (p=0.000, r=0.728). In addition, grades of reflux reported by these procedures were also comparable (p=0.000, r=0.724). We considered RNC as the method of choice for reflux diagnosis.  The specifity of VUS was 88% and its sensitivity 87%. Accuracy of this imaging was 88% (PPV=77%, NPV=94%). Conclusions: These results showed that VUS is a valuable procedure in follow-up and screening of patients with vesicoureteral reflux.  

Background: The aim of this study was to determine the minimal inhibitory concentration (MIC) of microorganisms causing nosocomial infections in the pediatric intensive care unit (PICU) of the Children's Medical Center in Tehran. Methods: All patients with nosocomial infections in the  PICU were enrolled in the study. Causative microoraganisms were coagulase  positive, and coagulase negative Staphylococci and Pseudomonas  aeruginosa. MIC of many antibiotics was determined by microbroth dilution according to NCCLS. Findings: Within a period of 18 months, thirty patients developed nosocomial infection including 17 cases with P.aeruginosa and 9 individuals  with Staph aureus infection. The remaining 4 patients were involved  with  coagulase negative Staphylococci. The most common sources were respiratory tract, blood stream, wound and soft tissue. Multi-antimicrobial resistance (resistance to Amikacin, Ceftazidim, Imipenem and Ciprofloxacin) was common among P. aeruginosa species All strains of Staph aureus were resistant to Methicillin (MRSA). These microorganisms were also resistant to clindamycin and ciprofloxacin in 88% of cases. Conclusion: Resistance to antimicrobial agents was high in our study, therefore routine MIC examination is necessary in PICU.    

Background: Hyperbilirubinemia is one of the most common problems in term newborns and the phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. The purpose of this study is to compare the effectiveness of conventional phototherapy, double phototherapy and intensive phototherapy in decreasing serum bilirubin. Methods: This interventional study was done on 60 neonates divided randomly in three groups. Infants in group 1 received conventional phototherapy, in group 2 double phototherapy and in group 3 intensive phototherapy. The criteria for inclusion in the study were a weight >2500 gr and serum bilirubin level ³18 mg/dl. Serum bilirubin level, rectal temperature and specific gravity of urine were evaluated 6 and 12 hours after phototherapy. The data were analyzed with SPSS and Anova soft wares. Findings: The mean total bilirubin level of single, double and intensive phototherapy groups at the beginning of therapy were 19.7±1.6, 20.3±2.4 and 21.1±2.0 mg/dl respectively, there was no significant difference between the values. After 12 hours of therapy the mean total bilirubin levels of single, double and intensive phototherapy group were 18.0±2.2, 15.7±2.3 and 16.8±2.5 mg/dl respectively. Serum bilirubin concentration decreased during phototherapy (p=0.000) and there were significant differences between three groups (p<0.014). Body temperature increased in double phototherapy group (p=0.001), but it was stable in other groups. There was no significant difference between the groups (p=0.6). And no significant difference of the mean value of urine specific gravity in the three groups was observed after 12 hours of phototherapy. Conclusion: Our study showed that intensive phototherapy is more effective than single and safer than double phototherapy in reduction of bilirubin in jaundiced newborns.

Background: In children and adolescents physical and psychological integrity threatening occur after disasters, whereby post traumatic stress disorder (PTSD) may be the first reaction. Psychological debriefing is a way for prevention and reducing PTSD symptoms. Many studies have shown the efficacy of behavioral therapy in treatment of post-traumatic stress disorder. Few evidence is available for using these techniques in combination for prevention and treatment of PTSD symptoms. This study compared the efficacy of psychological debriefing and cognitive behavioral group therapy combination on Bam earthquake related PTSD symptoms in children with a control group. Methods: In a control trial, we evaluated the efficacy of one session psychological debriefing and three sessions of group behavioral therapy in Bam earthquake adolescent survivors with PTSD symptoms and compared it with a control group. The mean age of participants was 9.07 (SD=1.7) years and no one had sever PTSD or other psychiatric disorder that needed pharmacological interventions. Before and after interventions we evaluated PTSD symptoms by use of K-SADS questionnaire and compared them with the control group. Results: The study included 100 persons, of whom 20 persons were excluded during intervention because of migration. The mean values of total PTSD symptoms and the symptoms of re-experience and avoidance were reduced after interventions. This reduction was statistically significant only for symptoms of re-experience. In control group the mean values of PTSD symptoms increased during study which was statistically significant. The two groups showed statistically significant differences of symptom reduction in total PTSD symptoms, re-experience and avoidance. No difference was detected for hyper arousal. Conclusion: Psychological debriefing and group behavioral therapy may have preventive effect on PTSD symptoms and may reduce symptoms of re-experience.  

Background: The neonates who are products of multifetal gestations have higher mortality rate than the singltons, besides they are prone to complications such as: asphyxia, prematurity, low birth weight, birth trauma, septicemia and respiratory distress syndrome (RDS). We studied the incidence of multifetal pregnancies, neonatal complications and mortality rate in this group of neonates in a prospective study in the hospitals affiliated to the Shiraz University of Medical Sciences. Methods: We evaluated these neonates and their mothers during hospital admissions for the maternal risk factors such as maternal age, history of infertility, pregnancy related complications and drug histories, hazardous factors related to delivery such as the method of delivery and its complications and neonatal problems in neonates who were the product of multifetal pregnancy, the rate and cause of mortality, and other complications such as birth asphyxia, RDS and congenital anomalies. Finally all of the data were statistically analyzed by software package social science (SPSS). Results: The incidence of twins was 232:10000, triplets 7: 10000. Mean gestational age in twin pregnancies was 35±3.5 weeks and mean birth weight 2184.9±606 gr; in triplets mean gestational age was 31±4 weeks and mean birth weight 1598.3±687 gr. The most common neonatal complication consisted of RDS (46.4%) which was also the leading (69%) cause of death in these neonates. There was inverse relation between the neonatal complications and birth weight, especially in asphyxic patients (p<0.001). Congenital anomalies were observed in 3% of neonates. Postnatal mortality rate was higher in normal vaginal deliveries compared to caesarean sections (p=0.04). There was no seasonal difference in the incidence of multifetal pregnancies. Conclusion: In this study the incidence of multiple pregnancies was higher than in other studies. The mortality rate was higher in the neonates born by vaginal delivery.

Background: The aims of this study were to evaluate the trend and clinical utility of the autopsy in Bahrami Children's Hospital in Tehran, Iran. Methods: In this retrospective descriptive-analytic survey during a six years course from 1998 to 2003, autopsies in the hospital were studied. The clinical and autopsy diagnoses were compared and categorized as follows: 1. Change (Clinical and Autopsy diagnoses discordant), 2. Add (Significant unexpected findings noted on the autopsy, although the clinical diagnosis was not altered), 3. Confirm (Clinical and Autopsy diagnoses concordant), 4. Autopsy inconclusive Findings: Eighty four autopsies were studied. Out of 350 neonatal deaths, autopsy was performed in 74 neonates (21%) and of 249 under 5 year deaths (except neonates) autopsy was performed in only 10 cases (4%). The autopsy rate declined during these years. In 61 cases (73%) the autopsy diagnoses confirmed the clinical diagnosis, in 10 cases (12%) it changed the clinical diagnoses, in 11 cases (13%) it significantly added to the clinical diagnoses and in 2  cases (2%) it was inconclusive. Conclusions: This study reveals a decline in neonatal and infant autopsy during a six year period. This study also demonstrates that neonatal and infant autopsy continues to provide clinically useful data in 25% of cases and remains a valuable tool in pediatric medicine.  

Background: The objective of this study was to provide estimates of the prevalence of obesity among Iranian school children and to determine the association between obesity and blood pressure. Methods: During one school year (2003-2004), all children (n=2766) of the 5th stage of primary school studying in area 9 of Tehran school areas (divided by the Ministry of Education for management purposes) were  screened for weight, height, and blood pressure. Findings: Of 2766 pupils, 1159 (41.9) were male and 1607 (58.1%) female. Mean weight of girls (37.1±8.3 kg) was significantly higher than that of boys (35.8±8.3 kg) (p<0.001). Girls were also significantly taller (144.1±7.6 cm) than boys (142.8±6.9 cm) (p<0.001). A significant difference was observed among mean systolic blood pressure in obese children (110.3±14.9 mmHg), overweight children (105.6±11.7 mmHg) and non-obese children (98.2±13.1 mmHg) (p<0.001). Multiple comparisons on Scheffer posthoc test showed that the differences between these three groups were all significant (p=0.001). Conclusions: In both sexes (especially females), inactivity and high-fat school snacks in school-aged children contribute to the increasing prevalence of obesity. To reduce the prevalence of adult obesity and its related diseases, like hypertension, in the future, conducting research in the prevention and/or treatment of childhood obesity is necessary.  

Background:Cardiac catheterization like other invasive procedures is afflicted with complications, one of the most important complications is vessel obstruction and arterial thrombosis that need urgent medical treatment. By means of operation or use of thrombolytic agents morbidity has been decreased. Because of scarcity of studies on the use of thrombolytic agents for vessel obstruction, especially in Iran, we studied the effectiveness of thrombolytic agents in vessel obstruction due to cardiac catheterization in children. Methods: This semi experimental study was performed from March 2001 to November 2004. We investigated 33 patients with vascular obstruction from 400 patients who underwent cardiac catheterization. Patients' age ranged from 2.5 to 72 months. Vessel obstruction was detected by physical examination of the distal extremities (pale, pulseless, cold foot) and pulse oximetry. Children with signs and symptoms of vessel obstruction without response to supportive care after 4 hours received streptokinase (Biotec Heber), they received 2000 u/kg as loading dose during 20-30 minutes and 1000 u/kg/h as continuous infusion. Streptokinase infusion decreased during 2-3 hours and discontinued after detection of pulse in foot (by means of pulse oximetry and physical examination). Some patients received corticosteroid and H2 blocker (ranitidine or cimetidine). Data are analyzed by SPSS software. Findings: In this study mean age of the patients was 19.1± 18.89 months, mean weight 7.9±4.1 kg and mean infusion time of streptokinase 17±12.4 hours. There was significant relation between weight and infusion time (p=0.049), and also there was significant relation between age and infusion time (p=0.039). There was significant relation between infusion time and type of cardiac defect (p=0.049). There was no significant relation between infusion time and sex of the patient (p>0.05). Results showed that the most common side effects were local blood oozing (27.5%) and hematoma (24.5%). Conclusion: Results showed that streptokinase can be effective in removing of vessel obstruction almost always after cardiac catheterization; it can also be a suitable replacement for Fougarty catheter to remove blood clots in cardiac catheterization especially in infants.    

Background: Bardet-Biedl syndrome (BBS) is an autosomal recessive disorder characterized by obesity, polydactyly of the hands and feet, retinitis pigmentosa, hypogenitalism and various degrees of intellectual impairment and renal anomalies. Other clinical features include: speech disorder, brachydactyly, developmental delay, polyuria/polydipsia, ataxia, poor coordination/clumsiness, diabetes mellitus, left ventricular hypertrophy, hepatic fibrosis. Spasticity and mental retardation fulfill the criteria for Laurence-Moon-Bardet-Biedl syndrome (LMBBS). Methods: From March 1998 to April 2003, five patients (4 females) with LMBBS were transplanted with kidneys taken from living unrelated donors (LURD). All 5 patients had Retinitis pigmentosa and obesity with a body mass index (BMI) up to 39.33. Findings: The cause of end stage renal failure (ESRF) was reflux nephropathy in one, neuropathic bladder in one and renal hypoplasia/dysplasia in three patients. Mean age at transplantation was 11 years (Range 6 to 17 years). Immunosuppressives were prednisolone, cyclosporine (Neoral) and mycophenolate mofetile (Cellcept). All of them suffered at least one episode of acute rejection shortly after transplantation but reversed with Methyl prednisolone pulses and in the last follow-up the mean creatinine was 1.2 (range 0.6 to 2mg/dl). Mean glomerular filtration rate (GFR) before transplantation was 10ml/min/1.73m2 and in the last follow-up 79 (range 38 to 137) based on Schwartz formula. Conclusions: Renal transplantation is safe and successful and renal replacement (RR) therapy of choice in patients with LMBBS and ESRF but special attention should be paid to BMI and steroid free immunosuppression should be considered if other suitable drugs such as Rapamycin are affordable.

Background: Most of molecular biology studies depend on making gene constructs. Although commercial plasmids are widely used for this purpose, sometimes due to the nature of the restriction sites or need of multiple subcloning, usual restriction sites available in original multiple cloning sites (MCS) of the plasmids could not be easily used, if not impossible at all. Here, we report an easy and fast method to construct suitable plasmid with a new MCS for constructing a 16kb gene targeting plasmid. Methods: Firstly, the suitable MCS was designed by studying the sequence of desired gene fragments in Gene runner software. Two partial complementary 74 base long oligonucleotides were designed and constructed to make this MCS. The original pUC19 MCS was replaced with the new one by enzymatic digestion of the plasmid and removal of the MCS, followed by adding the two complementary oligonucleotides and ligating the construct and transforming it into Ecoli TOP10 F'. The new plasmid was then purified and sequenced by M13 forward and reverse primers. Findings: Synthesis of two 74 base polynuclotides was successful, and these polynucleotides formed a double stranded fragment which was successfully inserted between HindIII-EcoRI sites of pUC19. Analysis of intermediate step results showed successful progress of cloning reaction. Final analysis of the plasmid by restriction analysis and sequencing the MCS confirmed authenticity of the new plasmid. Conclusions: The method described here is a fast and easy way to make suitable plasmid out of commercially available plasmids. This process can considerably decrease the time and cost of plasmid construction. Availability of suitable restriction sites in proper order makes it possible to directionally clone the desired gene fragments which is more efficient and excludes screening steps for the right direction of the fragments. The plasmid reported herein is specifically tailored to insert different fragments of a beta-globin gene targeting construct.  

Background: Inborn errors of metabolism is a general term applied to numerous genetic disorders pathology of which is usually attributed to excessive tissue storage or abnormally high circulating concentrations of a specific not degraded metabolic substance.  Early diagnosis can prevent irreversible complications of some of these disorders. Errors in carbohydrate metabolism belong to this category of disturbances. Sugars of clinical interest are all reducing sugars. The aim of this study was determination of the incidence rate and causes of positive Benedict’s test in hospitalized or outpatient children under 14 years of age. In addition, identification of interfering substances that could cause false positive results and the necessity of Benedict’s test prior to chromatography were other purposes of the study. Methods: 1473 urine samples in a case series and prospective study were examined. Benedict’s test was done for detection of reducing substances and paper chromatography for identification of the specific reducing sugar and amino acids present in the urine. Findings: 59% of the samples were positive for reducing substances. Significant decrease in positive results was occurred with restricted diet (free of fruits, vitamin C, honey, drugs).   Paper chromatography for sugars and amino acids were performed on positive samples.  Lactose was the most frequently found (32%) sugar followed by galactose (24%). In 54% there were no reducing sugars detected. The results also showed 36% cystein and 19% other amino acids in positive samples. No significant differences were observed in rate and degree of positive results with respect to sex and age of the patients. Conclusion: The results obtained in this study indicate that important reducing sugars or amino acids may be detected even in weakly positive results of Benedict’s test, thus justifying follow-up studies of positive test for reducing substances in urine.

Background: Febrile seizure is the most common convulsive disorder which occurs in 2% to 4% of children. Although the exact etiology of febrile seizure is unknown, some risk factors such as anemia have been reported. Due to high occurrence of febrile seizure in this area and because of the controversial result regarding the relationship between anemia and febrile seizure in pervious researches, this study was carried out to determine this relationship. Methods: This case-control study was done on 60 children with febrile seizure (case) and 60 febrile children without seizure (control) referred to Kashan Shahid Beheshti hospital during 2003. Two groups were matched for age and sex, type of feeding and use of supplemental iron. In all children hemoglobin level, hematocrit and red blood cell indexes were determined and data analyzed statistically by chi square and Fisher exact tests. Findings: This study revealed that 12% of patients in case group and 20% of children in control group had anemia (p=0.327). In children above 6 months and male subjects anemia was more common. Febrile seizures occurred most commonly at the age of 6 to 24 months. Conclusion: The risk of febrile seizure occurrence in anemic children seems to be less common than in children who do not suffer from anemia.    

Objective: Parry-Romberg syndrome is a rare disorder associated with unilateral facial atrophy involving skin, subcutaneous tissue, skeletal muscles and bone. Occasionally, there is central nervous system involvement with epilepsy being the most common manifestation. Case report: In this article­­­­, we report a 12 year-old boy with Parry-Romberg syndrome. He had seizures since he was 5 years old,  since 1 year ago the seizure attacks were refractory in spite of taking several antiepileptic drugs. Significant improvement was obtained after administration of intravenous immune-globulin (IVIG). Conclusion: IVIG may be of benefit when seizures in Parry-Romberg syndrome are intractable and resistant to antiepileptic drugs.  

Objective: Septo-optic dysplasia consists of optic nerve and septum pellucidum dysgenesis. This syndrome is divided into two subgroups (with or without schizencephaly) based on embryological and neuropathologic findings. In about 2/3 of the patients pituitary and hypothalamic dysfunction leads to diabetes insipidus, hypothyroidism and isolated GH deficiency. The association of this syndrome with cortical dysplasia is named septo-optic dysplasia plus. Case report: We report on a 2 year-old girl with visual loss, polyuria and Polydipsia. Her parents noticed visual problem as she was 2 months old. We found right hemiparesis, bilateral cupping and hypoplasia of the optic discs. CT scan, showed lobar holoporencephaly and ventriculomegaly. In MRI septo-optic dysplasia, and atrophy of the optic nerves and chiasma as well as absence of septum pllucidum were seen. In addition, we found central diabetes insipidus and partial GH deficiency in this case. Conclusion: This case illustrates the usefulness of MRI and other imaging procedures in diagnosing septo-optic and septum pellucidum dysplasia in children with developmental retardation.

Objective: Hydatid disease most commonly involves the liver and lungs; the abdominal cavity organs stand next in frequency, the parotid gland is a rare site of this disease. Hydatid disease is the most widespread, serious human cestode infection in the world. It is a zoonosis that is transmitted from domestic and wild members of the canine family. It is a serious problem in tropic areas and is seen in most areas of Iran. In children lungs are the most common site of infection whereas in adults liver is infected most frequently. It is rarely found in head and neck area and very few cases are reported in parotid gland. Case report: A 10-year old boy was presented with painless swelling of the right parotid gland. He was treated initially with antibiotics with no improvement. The microscopic examination of FNA aspirated material corresponded to an inflammatory process. The parotid tumor was surgically removed. Pathologic study of the cystic lesion revealed hydatid disease of the parotid gland.