Iranian Journal of Pediatrics
Year:2005 | Volume:15 | Issue:2|Papers Count:15

Background: We performed this study considering the fact that many chronic diseases have their origin in early life, their risk factors in childhood and adulthood are identical, and an early primary prevention is of great importance. 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 dietary habits in relating to non-communicable diseases (NCDs).Results: 21111 school pupils aged 6 to 18 years consisting of 10858 girls (51.4%) and 10253 boys (48.6%), as well as one of their parents have been studied. 84.6% of them lived in urban and 15.4% in rural areas, 90% visited public and 10% private schools. The most frequent type of fat used for food preparation in home was hydrogenated solid fat (73.8%), and most families consumed bread prepared with white flour (58.4%), only 19.7% of pupils never added salt to their table foods. The mean consumption frequency of fruits and vegetables, sweets, salty/fat snacks and deep fried foods was 16.5, 10,4.9 and 3.98 times/week respectively, without significant difference between different school levels.Conclusion: The unhealthy dietary habits of the children and adolescents of our community are a major threat for the health of this age group and make our community prone to an epidemic of NCDs in the next two decades, and emphasizes the role of the pediatricians and other related health professionals in the primary prevention of chronic diseases.

Background: Type 1 diabetes is the most common endocrine disorder of childhood. This disease is followed by a variety of bio-psycho-social consequences of which cardiovascular diseases are considered to be the most significant cause of mortality among them. This is due to atherosclerosis, and dyslipidemia plays an important role as a risk factor. The aim of the present study was to evaluate the need for early screening of patients for dyslipidemia. Methods: In a descriptive and cross-sectional study we assessed a sample of 51 randomly selected patients, with a mean age of 13.47±(2.6) years, ranged from 5 to 19 years, referred to Khorasan Center of Diabetes Research. We determined lipoproteins with biochemical methods and Hemoglobin A1C (HbA1C) with chromatography as well. Finally, the data was analyzed by SPSS. Results: The mean levels ± ISD of triglycerides (TG), total cholesterol (TC), low density lipoproteins (LDL), high density lipoproteins (HDL), and HbA1C were 97±55.4, 180.8 ±44.1, 113.3±32.6, 48.4±10 mg /dl and 8.1%±1.8 respectively. In poorly controlled patients (HbA1C>9), the mean level of TG, TC, LDL, HDL was 123.6±5.80, 199.40+61.78, 129.20±44.66 and 50.93+9.61, and in the second group (HbA1C≤9) was 85.94±40.64, 173.03±32.66, 106.64±23.71 and 47.28±11.23 mg/dl respectively.Conclusion: Mean lipid value of our patients in comparison with those assumed as treatment goals confirmed that only TC and LDL were higher. Poorly controlled group compared with the rest of patients had significantly higher TG, TC and LDL levels, in the case of HDL, the difference was not significant.

Background: Scleroderma is a multisystem autoimmune connective tissue disease characterized by thickening and hardening of the skin. Methods: Over 12 years we have observed 35 patients with scleroderma in the Pediatric Unit of Rheumatology. The diagnosis was established clinically and paraclinically in all patients.Results: There was female predominance (F:M=2/5:1) (71% females, 29% males). The age of onset was 6 months to 16 years, the mean age being 10 years. Fever, fatigue, malaise were presented in 30-60%. The frequency of symptoms and signs was: nonpitting edema in 16%, hard skin in 60%, sclerosis of distal limbs in 72%, facial sclerosis in 15%, atrophy and hyper- or hypopigmentation in 40%, telangiectasis in 15%, subcutaneous calcification in 10%. Raynaud's phenomenon in 60%, digital ulceration in 16%, muscle pain and weakness, and arthralgia in 30%. Rare manifestations included, dysphagia (16%), dyspnea (15%), cardiovascular disease, pericarditis, cardiomegaly, and CHF in 15%. Laboratory abnormalities included: anemia in 60%, positive F-ANA>1/160 (20%), ESR>50 (40%), CRP 3+ (40%). Skin biopsy documented increase in the collagen content of dermis in 75%.Conclusion: Scleroderma is not rare disease in Iranian children in compared with European children, but it is more rare in comparison with adult.

Background: One of the most common tests performed in the hematology laboratories is erythrocyte sedimentation rate (ESR) test at the first and second hours for monitoring the course of infections, inflammatory diseases and some types of cancers. The recommended method by the international council for standardization in hematology (ICSH) and national committee for clinical laboratory standards (NCCLS) for ESR measurement is based on the traditional Westergren method, using EDTA anticoagulated sample without dilution. But selected method for routine works in laboratories is using sodium citrate while EDTA is used in most other hematological tests. Now if the same blood samples containing EDTA could be used for ESR measurement, it would lead to decrease in laboratory working load as well as the amount of required blood. Methods: Three hundred cases (125 males, 75 females, 79 of the total cases anemic) were included in this study. 150 cases were less than 14 years and 150 cases more than 14 years old. Two blood samples were taken from each patient with EDTA or sodium citrate anticoagulant. We used samples of CBC test as EDTA containing samples. The first and second hour ESR were measured simultaneously for both samples using Westergren method under completely identical conditions and the results were recorded, the ESR results obtained using sodium citrate in the first and second hour were compared with the ESR test results of the same patients with EDTA containing samples by paired t-test. Results: It was observed that there was significant difference between the results of ESR test by using two anticoagulants in adults and anemic cases. But in children, statistical difference between first hour ESR test results using EDTA and sodium citrate was not significant.Conclusion: It can be concluded that if only first hour ESR in children is required, samples containing EDTA can be used which will decrease the amount of required blood to a half. It would also cause a decrease in working load of laboratories.

Background: Using herbal drugs is the common way for treatment of diseases in traditional and alternative medicine. These drugs have important role and strong cultural background among people in treatment of hyper-billirubinemia. It is necessary to evaluate the effect of herbal drugs by scientific methods. The goal of this study is to investigate the in vitro effect of common herbal drugs used traditionally in management of neonatal hyperbillirubinemia. Methods: in this study 0.5 cc of 5 common herbal drugs (Cichorium intybus, Fumaria parviflora, Zizyphus jujuba, Alhagi pseudoalhagi and Purgative manna) which are obtained by hydrochloric instillation were added to 1 ml of serum of jaundiced neonates and then the level of billirubin determined by Diazo blank method. Findings: This study revealed that only Cichorium intybus extract decreases the level of bilirubin significantly (p<0.05). Conclusion: Other herbal drugs may decrease billirubin level with other mechanisms, for example by cathartic effect or activating of liver enzymes, but this study revealed that Cichorium intybus is the only drug that has direct decreasing effect on billirubin. For further investigation, we recommend to separate the effective substance of Cichorium intybus and determine its effectiveness in vivo.

Background: Cardiac involvement that persists after Kawasaki disease is a major problem in the coarse of disease and it is the leading cause of death. The aim of this study is to investigate the relationship between inflammatory markers (CRP, ESR, PLT) that are potential mediators for atherogenesis at the onset of disease and coronary involvement as a sequelae and also the incidence of clinical manifestation in Kawasaki disease. Methods: A case-series study was performed to test the hypothesis that late coronary involvement is associated with elevated level of CRP, ESR & PLT at the onset of Kawasaki disease. A total of 36 patients (26 male and 10 female) were studied. All of them were treated with IVIG, and coronary involvement was studied with Echocardiography. Results: Levels of CRP, ESR and PLI were measured in all patients. Among 14 patients (38%) that had coronary involvement ESR level was above 90 in 71% patients, CRP levels were elevated in 92.9% and PLT count was elevated in 73% of patients. The results were analyzed by ANOVA, chi-square and Independent t-test and demonstrated that there is no valuable association between the level of ESR (p= 0.38), CRP (p=0.16), PLT count (p=0.11), and cardiac involvement. Among 36 patients the clinical manifestations were as follow: fever (100%). Oropharyngeal mucosal inflammation (88%). (lymphadenopathy (75%), skin rash (55%) and edema of the extremities (50%). Conclusion: The results demonstrate that there is no statistical association between the level of ESR, CRP and PLT with late cardiac involvement. It seems that further investigations in longer period of time are needed to confirm the relation between cardiac involvement and these laboratory tests.

Background: Febrile seizures are the most common convulsive events in childhood, occurring in 2-5% of children. About one third of these children will have a recurrence during a subsequent febrile infection. Methods: This is a randomized clinical trial in 85 healthy children, aged 6 months to 5 years, who were not treated before. These children received randomly either oral diazepam (0.33 mg/kg/tds for two days during febrile illness) or continuous oral Phenobarbital (3-5mg/kg /24 h). Results: Ultimately 64 patients completed the study and were followed up for an average of 13 months (12-18 months). The rate of recurrence of febrile seizure was 18.2% in diazepam group and 32.3% in phenobarbital group; the difference is not statistically significant (p=0.16). Conclusion: There was no significant difference between intermittent oral diazepam or continuous oral phenobarbital.

Background: The aim of this study was to determine measles antibody titer in children who received two doses of vaccine and were reimmunized at 7 years of age. Methods: The school children were randomly choosen from various areas of Tehran who had received two doses of measles vaccine at 9 and 15 months of age and reimmunized at 7 years of age. Measles antibody was measured in children aged 7 years and 4-6 weeks after reimmunization by Enzyme-linked immunosorbent assay (ELISA). Findings: A total of 339 children were evaluated. Antibody titers in 132 (38.9%) children were more than 10 IU/ml (mean 68.3 IU/ml) and 207 (61.1%) less than 10 IU/ml. Antibody titers in 32 of 42 children who had been reimmunized were less than 10 IU/ml. In two (6.3%) of 32 children antibody titers did not rise after reimmunization and the mean antibody titer in remainder (30) of the children was 71.3 IU/ml. Antibody titers in 10 (23.8%) of 42 children before and after reimmunization were 58 and 168.5 IU/ml respectively. After reimmunization, the mean antibody titer in children with high titer before reimmunization was higher than those with low antibody titer. Conclusion: This study indicates that children with two dose measles immunization before and after the first year of age are still immunologically resistant against measles at 7 years of age. Immunization is the most efficacious and cost effective intervention available to improve the health and wellbeing of children and prevention of the infectious disease.

Background: Major Thalassemia is a chronic hemolytic anemia. It is the most common hemoglobinophathy disorder in Khuzestan province. Hypoparathyroidism is one of its endocrinologic complications due to Iron deposition especially in the second decade of life. Early diagnosis of this complication could prevent other sever disorders such as seizures, osteopenia, and osteoporosis.Methods: In a cross sectional study, 96 patients with major thalassemia at the age above ten years referred to Shafa Thalassemia Center, Ahwaz, in addition information about age, sex, weight, height, duration and route of desferral injection, duration of transfusion therapy, vitamin D and calcium consumption, social and educational level of parents, history of splenectomy, any history of seizures, tingling, chvostek, trousseau, carpopedal signs, plasma level of calcium, phosphorus, alkaline phpsphatase, PTH, BUN, Cr, ferritin, and total protein were obtained using questionnaires.Findings: In ninety-six patients with major thalassemia the prevalence of hypoparathyroidism was %27/1 in 11-39 year- olds (average 19.3 years). All patients had low serum calcium, PTH, high serum phosphorus and low to normal alkaline phosphatase. In 26 patients with hypoparathyraidism, 46% had tingling, 38.4% positive chvostek, 30.7% positive trousseau and 11.5% carpopedal spasm. 69.2% of the patients had only sign, whereas 30.8% showed clinically no signs. The average level of serum ferritin in thalassemia patients without hypoparathyroidism was 2770 ng/ml, in hypoparathyroid patients 5020 ng/ml. From 10 patients with irregular desferral consumption 7 patients had overt hypoparthyroidism. Significant correlation was seen between irregular desferral consumption, high ferritin level and hypoparathyroidism. Conclusions: Screening for hypoparathyroidism is recommended in children with major thalassemia aged above 15 years once every 6 months or yearly with measurement of plasma level of PTH, Ca and alkaline phosphatase.

Background: Urinary tract infection is a common bacterial disease in children which may cause chronic renal failure and hypertention. Many reports suggest that the rate of antibiotic resistance to infectious organisms is increasing. Therefore periodic surveillance of resistance rates is needed to ensure that appropriate recommendations can be made for better management & preventing of late sequelae.Methods In this cross sectional descriptive study we investigate the results of urinalysis, urine culture and antibiotic sensitivity of the isolated organisms in the urine of 1556 children aged under 10 years in Mashhad city between April 2001 and June 2002. Described parameters are age, sex, incidence of significant bacteriuria, leucocyturia, causative bacterial agents, and antibiotic sensitivity pattern.Findings: The most common age group in both sexes was infantile period. Median age was 20.3 months in boys and 47.5 months in girls. E.coli, klebsiella and proteus were the causative organisms in 87.3%. They were sensitive to cefotaxime, cefixime, cephalotin, amikacin, ciprofloxacin, nitrofurantoin and gentamicin in more than 96% while resistant to trimetoprim-sultamethoxazol in about 75%.Conclusion: We recommend, with regard to continuous changing in causative microorganisms isolated from patients with urinary tract infection and antibiotic sensitivity pattern, as a guideline for physicians, to determine bacterial sensitivity in populations yearly.

Background: Intestinal obstruction is a common cause of abdominal surgery in pediatric age group. A delay in diagnosis and treatment of this disease can lead to serious complications. This study has been conducted to evaluate different causes of intestinal obstruction. Methods: 231 children were operated on intestinal obstruction. Prior to surgery all patients underwent a labarotory examination consisting of CBC, abdominal X-ray and, if necessary, gastrointestinal (GI) study with contrast media or CT-Scan and sonography. Final diagnosis was reached by surgical findings. Results: 231 children were operated due to intestinal obstruction. Among these, 128 cases, (55.4%) were male and 103 cases (44.6%) were female. The causes of intestinal obstruction were: Incarcerated hernia in 41 cases (17.7%), GI atresia in 38 cases (16.4%), malrotation in 32 cases (13.8%), anorectal malformation in 29 cases (12.5%) and benign or malignant masses inside or outside GI tract in 28 cases (12.1%). Conclusion: The most common causes of intestinal obstruction were: incarcerated hernia, GI atresia and malrotation.