Iranian Journal of Pediatrics
Year:2003 | Volume:13 | Issue:1|Papers Count:21

Recombinant DNA technology made it possible to produce biological drugs and pharmaceutical companies produced recombinant human drugs. There have been reports on the formation of antibodies against residual host cell protein. For this reason, it is important to check the patients sera for antibodies which could possibly be induced by recombinant drug it self and/or by contaminating proteins of the host cell. The present report refers to the obtainment of polyspecific antisera directed against Escherichia coli host strain used to produce recombinant human growth hormone. The antisera were obtained by the cascade immunization method. The animals (n=3 rabbits) were initially immunized with E. coli strain. The analysis of the antisera by dot blotting method showed a progressive recognition of the cascade method. These antisera were also used by ELISA methods. Results showed antibodies rising against E. coli polypeptide antigen.

Voiding dysfunction is a spectrum of abnormal learning of voiding behavior seen in 10-15% of children. Clinical symptoms are frequency, dysuria, urge incontinence or infrequent voiding. In some cases constipation is also seen. The complication is recurrent urinary tract infection with or without vesicoureteral reflux and probable renal insufficiency. For evaluation, urine analysis and urine culture, renal ultrasound and evaluation of urinary residue as well as voiding cystoureterography, renal DMSA scan and urodynamic study may be necessary.

Urinary tract infection is one of the most prevalent pediatric diseases which, if diagnosed and treated promptly, can lead to potential severe sequelae. Positive urinary nitrite is a sensitive test to determine urinary tract infection. In this study we evaluate the effect of delayed urinalysis on the result of urinary nitrite. We studied mid-stream clean catch urine of 30 children in Imam Sajjad Hospital of Yasouj University of Medical Sciences. Specimens stored at room temperature and urinary nitrite measured at 0, 0.5, 1 3 and 6 hours after collection. All specimens revealed negative urinary nitrite on beginning. 10% of specimens (3 cases) became nitrite positive between 30 minutes until 6 hours after collection. These false positive results of urinary nitrite were shown to have no relationship with urine culture and therefore no relativity to urinary tract infection. 3 reported positive cultures were not the same specimens with positive urinary nitrite and were related to non-nitrite positive organisms.We conclude that with passage of time after urine collection urinary nitrite may become falsely positive and lead to over-diagnosis of urinary tract infection. Therefore, all collected specimens must be transferred to laboratory as soon as possible to avoid false positive values.

Urinary tract infection (UTI) in children is usually treated with orally administered antibiotics for 7–10 days. Because of the unreliability of the patient compliance with the prescribed medications and because single-dose aminoglycoside therapy has been shown to be effective in adults with lower UTI, we conducted this retrospective study to asses efficacy of a single dose of gentamicin in patients with anatomically normal urinary tract, who had recurrent UTI.In this study 79 episodes of UTI in 43 patients treated with gentamicin (41 with single-dose and 38 with conventional method of 7-10 days). All patients, except 7 (2 in conventional therapy and 5 in single-dose group), received both methods of therapy in different episodes of infection.Isolated organisms from patients in single-dose group consisted of E. coli (90.4%), Klebsiella (7.3%), and miscellaneous bacteria (2.3%). In conventional therapy group E. coli (87%), Klebsiella (5.2%), and miscellaneous bacteria (7.8%) were isolated. E. coli was the most frequently isolated microorganism in both groups and sensitive to given antibiotics with no exception. 90.26 % of urine cultures were negative in single-dose group and 94.3 % in conventional therapy group 48-72 hours after treatment, the difference was statistically not significant (p=0.36).Cumulative recurrence rate was 56 % in single-dose and 48.6% in conventional therapy group 6 weeks after treatment with no significant difference (p=64%). Relapse rate (recurrence of the same organism and the same sensitivity as for the therapy begin) 6 weeks after treatment) was 57.3 % in single-dose and 33.5 % in conventional therapy group. This difference was also statistically not significant (p=26%).No side effects could be detected in patients who had been treated with single-dose.The results of the study allow the conclusion that in the absence of urinary tract malformations a single-dose treatment of UTI in children will be effective enough.

Air pollution is a major problem in Tehran. Most important agents responsible for the high pollution include carbon monoxide, sulfur dioxide, nitrogen dioxide, hydrocarbons and suspended particles. Determination of quality and quantity of polluting agents is of great importance for sustaining the inhabitants health level. We studied carbon monoxide, one of the most hazardous air-polluting agents, in 22 urban districts of Tehran. The results showed that in average 4.39% of the air in Tehran has a CO concentration of 15-30 ppm. The 12th district with 17.99% and 11th district with 16.43% had the highest pollution of carbon monoxide. 6th and 7th districts had 11.22% and 9.5% respectively. The lowest level of pollution was found in 21st district (0%) and 1st district (0.11%). Variance analysis of districts of Tehran showed that there is a significant relation between mean air pollution of 11th and 12th districts and other districts.

Mercury vapor poisoning is a serious and potentially fatal problem. The mercury vapor may cause pneumonitis and death due to respiratory failure. Manifestations of mercury poisoning are respiratory, gastrointestinal, and neurological problems. All kinds of mercury can cause tissue damages, probably by destroying ribosomes and impairing protein synthesis.In this article, we present a case of mercury poisoning with respiratory distress in an eight-month old male infant. Mercury was brought home by an individual who was not aware of the risk involved. The health hazards of heavy metals need to be reinforced to medical profession and the general public.

Cystinosis is a hereditary autosomal recessive metabolic disorder in which increased cellular absorption of cystine causes its accumulation in lysozymes. Cystine is accumulated in reticuloendothelial cells of kidneys, cornea, and sclera as well as fibroblasts and leukocytes. This leads to development of the typical clinical symptoms. The incidence rate of the disease is 1/26000 to 1/200000.We report on an 8-month-old boy presenting with poor weight gain, anorexia, polydypsia, polyuria, restlessness, calmness in low-light environment, frequent vomiting and disturbance in bowel movements. A sibling of the child and an uncle of his expired of the same disease.Cystine crystals were observed in bone marrow smears and in corneae cystine precipitations were seen with slit lamp.It is recommended to think to metabolic disorders, especially cystinosis, in children presenting with polydipsia and polyuria.

Cystinosis is a relatively rare recessive autosomal inherited metabolic disease. In this metabolic anomaly free cystin is accumulated in the cell lysozymes of the different body tissues. The nephritic form of the disease begins in infancy and leads to Fanconi syndrome with polyuria, polydisia, metabolic acidosis, phosphaturia and Vitamin D-resistent rickets. If not treated, it can end in chronic kidney insufficiency. In the beginning of the disease phosphocysteamine can prevent the accumulation of cystin in the lysozymes and can hinder the progress of the disease.In our study we treated 15 cystinosis patients (7 girls, 8 boys) with phosphocystamine. The mean age at beginning of the symptoms was 8.4 months. Unfortunately, the disease was diagnosed and treatment started at a mean age of 3.58 years. Therefore, all patients had their kidney complications at the time the treatment with phosphocysteamind began. Anyhow, creatinine clearance increased after treatment in 12 patients. There was a significant relation between the time of beginning of the treatment and patients condition after treatment, i.e. the earlier the treatment began, the better was the function of the kidneys after treatment with phosphocysteamin.

Favorable physical growth is a reliable measure for the evaluation of health situation in children especially in the first two years of life. To evaluate the normal growth of the children international tables and diagrams are consulted. But with regard to the geographical, racial and local differences, these lose on accuracy and sensitivity. This study was conducted to evaluate the relation between the physical growth of 0-2 year-old children and the socioeconomic as well as the grade of education of their parents. These children were seen in the health centers of Karadj/Iran.The study cohort consisted of 300 children and the information was extracted from their health files of 24-month-old children. The interrelation of weight, height and head circumference was studied using the Logistic Regression Model for each of these factors.The data were collected using a questionnaire containing 37 questions based on the special goals of the study. The results are registered in 3 tables. In order to study the units to be investigated, we used description and deduction statistics.The results show that there are significant statistical interrelation between the weight and gender of the child (P=0.034) as well as the grade of education of the mother and father s occupation (P=0.000). Between the weight of the child with nutrition (chicken, fish, mutton) there is also a significant interrelation.The results show additionally that proper nutrition is one of the most important factors affecting the process of growth and weight gain in children. The degree of mother s education and economical situation of the family (father's employment) affects the weight gain of the child.

We studied 415 newborns in the city of Bushehr in order to identify infants with G6PD deficiency and eliminate the induction of acute hemolytic crisis by informing the families about the extrinsic factors that the G6PD-deficient patients should avoid.The method used in the study was the fluorescent spot test. Abnormal fluorescence due to G6DP deficiency (severe and partial) was found in 8.4% of the samples (6.5% severe and 1.9% partial), i.e. 1 in 51 females and 1 in 7 males.This study suggests the necessity for the establishment of a screening test as a routine for all newborns, especially in the coastal cities in order to make an opportune detection and an appropriate counseling available.

Lower gastrointestinal bleeding (LGIB) occurs below ligament of Treitz. Its incidence is 1/5 of upper gastrointestinal bleeding (UGIB), but due to extension of the area (all sites of small and large bowel), evaluation of its etiology is more difficult. We conducted this study on children over one month of age who were referred to Namazi Hospital (Shiraz) in order to find the causes of the bleeding and the relationship between age, nutrition, concomitant signs and symptoms, and severity of bleeding with regard to the etiology of bleeding. From 100 patients (61 boys and 39 girls) with an average age of 4.5 years (40 days to 16 years), 38 had colonic polyps, 17 lymphoid nodular hyperplasia, 8 ulcerative colitis, 4 Meckel's diverticulum, 2 solitary rectal ulcer (with rectal prolapse and constipation), one rectal varicosis (with portal hypertension) and one malacoplakia. In 29 cases the etiology of the bleeding remained unknown.

Iron deficiency and iron deficiency anemia is one of the most important nutritional problems in the world. On the basis of WHO statement, more than two million people of the world are anemic. In Iran 20-30% of the population is anemic.We interviewed 67 health workers for awareness of preventive measures on iron deficiency anemia. This investigation showed that only 50% of health' workers had knowledge of this anemia and 47% of them knew how to prevent it.In order to raise the health level of society and to prevent Socio-economic complications of iron deficiency anemia, we recommend To conduct similar studies in other cities, To make some changes in health workers programs, To employ the media to improve knowledge of families.

In both developed and developing countries, low birth weight (LBW) has a tremendous impact on both health care system and affected families. This warrants the continuous search for risk factors for LBW that are amenable to prevention.We evaluated 2642 newborns in the maternity hospitals in Guilan. 2560 mothers visited at least once health centers during pregnancy and 82 mothers (3.1%) did not consult any health center at all.The mean birth weight of live born neonates was 3270 grams, 5.2% weighed less than 2500 grams.Regarding the 95% coverage of mothers with prenatal maternal care in provinz Guilan, the results show that the frequency of LBW in newborns whose mothers have not received this care during pregnancy, is 2.5 times higher and it is recommended to generalize and intensify the prenatal maternal care to reach to the regarded limit for year 2005 (under 5%).

Henoch Schoenlein Purpura (HSP) is a vasculitis of small vessels (post capillaries, arteriols and venols) with unknown etiology. We studied the disease in 134 children, who were admitted to the Children's Medical Center in Tehran from March 1986 to February 2001.The mean age of patients was 7.259 (SD - 2.982).The male to female ratio was 67%. Maximal seasonal occurrence was in autumn and spring.A history of infectious disease prior to HSP, mostly URI, was positive in 52% of cases.Most frequently encountered signs and symptoms were: Skin manifestation in 94%, arthralgia and arthritis in 79.85%, gasterointestinal involvement in 72.38%, renal involvement in 38.8%.Laboratory findings: Anemia in 52%, increased ESR and positive CRP in 64%, serum 19A was abnormal in 12.19% of patients.Culture of pharynx was positive in 19.4% of samples and ASOT>625 in 13.4%. There was a positive history of drug administration prior to admission in 40.30%. BUN and serum creatinine was increased in 14.2%.Complications occurred in 30.59% of cases, 14.63% had renal problems.We found hematuria in 36.11%, proteinuria in 33% of cases and severe gastrointestinal pain and hemorrhage in one case.About 35.8% of our patients were managed conservatively, and 16.4% were treated with NSAIDs, 53.7% with corticosteroids, 14.2% with cytotoxic drugs, and 7.5% received methylprednisolone and cyclophosphamide pulse.This study being conducted in hospitalized patients, did not contain mild and moderate cases of HSP, who are normally managed as outpatients.In order to get more precise results, we suggest to study cases who are visited in outpatient clinics.

Turner syndrome is a complex of clinical manifestations due to loss of on X chromosome. Classic genotype is 45XOwhich is seen in 50-75 % of the cases; others show a mosaic pattern of karyotype. There is a range of mild clinical forms to full classic presentation.This study is based on observations in 71 out of 100 Turner syndrome cases seen in two centers for genetics during 20 years (1980-2000).76.1% of the patients had classic karyotypes, 24.1% mosaic pattern.The patients complained mostly at the age of 11-15 years of amenorrhea and short stature. There was no significant relationship between parents' age and occurrence of Turner's syndrome in their offspring.Observing lymphedema of extremities in neonates and young infants, which is seen in a high percentage of cases, can lead to an early diagnosis and hormonal substitution as well as investigating and management of other anomalies of the syndrome. This was in our cases seldom done and the diagnosis was established in adolescence because of amenorrhea, delayed puberty and short stature.

Patients with medically uncontrolled seizures present a major challenge to physicians, health care system and society. To increase the likelihood of a positive outcome, physicians must systematically approach patients with apparently intractable epilepsy.It is important to distinguish between modifiable causes of uncontrolled seizures and non-modifiable ones.Some patients may have unsatisfactory seizure control because of non-compliance, or ignoring precipitating or triggering factors.Other seizures may be intractable due to non-epileptic causes. Finally seizures persist because of inappropriate treatment, i.e. the wrong drug has been prescribed for a particular seizure type, or a correctly selected agent was prescribed in insufficient dosage.The best examples of endogenous predictors of intractability are structural brain disease which can not be repaired surgically, progressive metabolic or degenerative encephalopathy, and Lennox- Gastaut syndrome.Successful treatment of intractable epilepsy may be achieved through rational combination of antiepileptic drug therapy, use of adjunctive agents, dietary and hormonal manipulation and even surgery.Considering socio-economic, cultural, and environmental related problems etc, in this article rational approach to intractable seizures is being presented to achieve more success in the management of refractory epilepsy.