Iranian Journal of Pediatrics
Year:2004 | Volume:14 | Issue:2|Papers Count:19

Background: The prevalence of growth hormone deficiency (GHD) has been reported differently in previous studies.Methods: This case-series study includes 120 children with short stature aged between 4-15 years referred to Endocrine and Metabolism Center (1997-98) in Tehran.These children have been observed at least 6-12 months. Initial evaluation includes: complete blood count (CBC), erythrocyte sedimentation rate (ESR), calcium, phosphor, Alkaline Phosphates, urea, cratinine, triiodothyronine (T3), Thyroxin T4, thyrotropin-stimulating hormone (TSH), urinalysis, urine culture, stool exam, karyotyping (in girls) and bone age investigation. GH was measured by two standard stimulation tests. Peak levels of GH less than 10µg/lit in two provocative tests are compatible with GH deficiency.Results: Twenty children (17.4%) had GHD. Fourteen of them were boys. Bone age in 15 (60%) cases was delayed and the height was more than 3 SD below the mean for age. Two children had deficiency of other hypophysial hormones and one of them suffered from craniopharyngioma.Conclusion: In this study prevalence of GHD was more than in pervious investigation, because it has been performed in a referral center of endocrine diseases.

Background: Despite occurrences of several earthquakes in Iran, there aren't no document data from clinical and demographic findings of patients. The aim of this study was to analyze the demographic and clinical findings of pediatric trauma patients referred to Tehran University of Medical Sciences Hospitals after Bam earthquake in 2003.Methods: Medical records of all of pediatric trauma patients with age lower than 18 year old who were admitted in Imam Khomini, Shariati and Sina hospitals were reviewed retrospectively.Results: From 440 total number of patients, 25.4% (51 boys and 61 girls) were pediatrics. Eighty-two percent patients were transported to our hospitals within the first 3 days after earthquake. The limbs were the most common organs injured (61.6% alone and 14.3% together with other organs). Of these patients, 34.5% had operative surgery and there were no tetanus in our subjects. Thirty percent patients suffered from infectious disease and the most common infectious disease was urinary tract infection. Acute renal failure developed only in 5 patients.Conclusion: The good management of our patients caused low rate of acute renal failure and any clinical findings of tetanus. The high rate of limbs injuries need appropriate management in future.

Background: The acute appendicitis is the most common surgical intervention and urgency during the pediatric age group. The most important challenge is the problem of diagnosis. The aim of this study is survey of clinical presentation, laboratory data in acute appendicitis confirmed by pathology and comparing with those who had normal pathology.Methods: This is a cross-sectional description study on 140 children less than 16 years of age who had appendectomy at Shahid-Mobasher Kashani and Ekbatan Hospitals in Hamedan. All clinical and paraclinical data were collected by checklists and analyzed statistically by SPSS.Results: 105 patients (75%) had pathologic findings and 35 patients (25%) had normal appendices.There were statistically significant association (P<0.05) between the frequency of appendicitis with sex, vomiting, RLQ pain, leukocytosis and shifting to left in peripheral blood smear.Conclusion: Because of high rate of appendectomy with negative pathologic finding, in suspected cases, the proper history, frequent clinical examination, close observation, and other modalities as graded compression sonography, CT scan and laparoscopy should be considered.

Background: Breast-milk jaundice occurs in 13% of neonates between 2nd and 4th day of life.Method: A prospective study was performed between December 2002 and December 2003 in Children"s Medical Center, Tehran.Enrollment criteria included term neonates with no underlying organic illness causing poor feeding, hypernatremia (serum sodium level more than 150 mEq/L), weight loss greater than 5% and urinary specific gravity above 1012.Results: Out of 217 cases of neonatal jaundice, 37 were recognized as jaundice caused by breast-milk. Nipple anomalies were significantly more common. In 32.4% of mothers, data was analyzed with student t test, chi-square and Pearson correlation.The results showed significant statistical relation between educational situation and frequency of breast feeding (P= 0.000).Conclusion: The results of this study support the view that the level of knowledge of lactation was associated with frequency of breast feeding.

Background: Importance of breast feeding is well known to every body. Many factors can effect breast feeding. Nowadays, with development in obstetrics, several studies have been done on relation between cesarean section and other obstetric interventions with the duration of breast feeding.Methods: Subjects of this study were all of mothers who were referred to the obstetric clinics in Yasuj which include 80 cases with normal vaginal delivery and 80 cases with cesarean section.These mothers had 1-4 year-old children, without any diseases or consumption of drugs that could affect breast feeding. They were selected randomly by means of a questionnaire that included demographic information, information on the level of education and job of the mother, type of delivery, kind of anesthesia used for cesarean section, breast feeding, artificial feeding and the age at which the complement feeding was started.Results: We found a positive relation between the level of education and type of delivery, by increasing educational level, the rate of cesarean especially elective cesarean increased. There was also a relation between mother's job and type of delivery, the rate of cesarean section in working mothers was higher than that in house wives (64/7% vs. 42/2%).Working mothers had a shorter duration of breast feeding (26.7% of working mothers and 73.3% of house wives nursed their babies longer than 12 months).There was no relation between mode of delivery and duration of breast feeding. Cesarean section did not hinder a successful breast feeding.Conclusion: It seems that breast feeding in subjects of this study is culture-related and training of the mothers plays a major role in maintenance of this willingness. Therefore, the combination of knowledge, willingness and support of the mothers can lead to a successful breast feeding.

Background: Acute leukemia is a common malignancy in childhood that is now curable with chemotherapy. The use of chemotherapeutic agents has numerous complications. We studied the incidence of gastrointestinal complications and its relation to specific phases of treatment.Material and method: In a cross-sectional study we examined 75 patients with acute leukemia who were treated with chemotherapy (Oct 2003 - Aug 2004) in Sheikh Hospital in Mashad/Iran. These patients had at least one GI complication caused by chemotherapy. The data was collected using a questionnaire.Results: The most common complications were oral ulcers (56%) and odinophagia (25.3%). The mean age of patients with diarrhea (p=0.018) and abdominal distention (p=0.008) was considerably higher than of other patients and it was significantly lower in patients with odinophagia (p=0.001); perioral ulcers (p=0.017), diarrhea (p=0.045), nausea and vomiting (p=0.031) and oral aphthes (p=0/043) were notably more common during the first phase of modified BFM Protocol for ALL treatment.Conclusion: The age of the patient and the phase of treatment have significant statistical relation with GI complications.

Background: One of the prevalent causes of injury to the esophagus and stomach in children is caustic ingestion. Most of the cases of alkaline or acidic ingestion in children occur accidentally. Acute and chronic complications of caustic ingestion in children are severe and occasionally life-threatening. This study was conducted on children with caustic ingestion accepted as in-patients during 2002-2004 in Loghman Hakim Hospital.Methods: All children hospitalized for caustic ingestion, aged 16 years and younger, were evaluated from demographic viewpoint as well as clinical history, endoscopies findings, method of treatment and observed complications.Finding: Out of 72 children under study, 41 had consumed acidic and 31 alkaline materials. 74.7% of patients were accidentally afflicted with food poisoning. Relevant clinical symptoms consisted of vomiting, oropharyngeal lesions, restlessness, abdominal pain, and dysphagia, in order of occurrence.In endoscopy of esophagus, 68% of patients had G1 or normal endoscopy and 32% had a burning intensity of G2a or higher. 16.7% underwent surgery and the rest were under medical treatment. 20.8% were inflicted with esophageal stricture and stenosis, 2.8% with esophageal perforation and mediastinitis, and 1.4% lost their lives.Conclusions: The role of prevention as a comprehensive strategy promoted by medical councils, the media, and radio and TV is imperative. It is recommended that dangerous caustic pharmaceutical, sanitary and industrial materials be filled in containers with safe and tight lids or caps.

Background: Acute respiratory tract infections cause 4.5 million childhood deaths all over the world. Most of these deaths occur in the developing countries. Both bacterial and viral pathogens are responsible for these deaths. Adenovirus respiratory tract infections are spread over the entire world, but the fatal disease is rarely seen.Methods: This descriptive case-series study has been conducted from October 2003 to September 2004 on 96 children of up to 5 year old. The relative frequency of adenovirus respiratory tract infection was studied. For this purpose, the nasopharyngeal secretions were obtained to detect adenovirus by Immunofluorescent Antibody (IFA) method. Seasonal incidence, age distribution, and clinical signs and symptoms of this infection were studied.Findings: The relative frequency of Adenovirus respiratory infection was 10.4%. Most commonly it occurs in children aged less than 1 year and in autumn. In addition, cough and rhinorrhea are the most common signs (90%) and fever is the most common symptom (100%) in our patients. Similarly, pneumonia was the most common (40%) clinical manifestation in our patients.Conclusion: According to above data, the frequency of Adenoviurs infection and the common age for infection in this study are similar to other studies but pneumonia is the common illness which can be explained by the fact that this hospital is a referral center for these patients.

Background: Brucellosis is an infection of domestic and wild animals (classical zoonosis) that is transmittable to human through abraded skin and mucosa by contact with infected animals or ingestion of infected dairy products. It is endemic in our country. It can involve various human organs including urogenital system. There is a few report of brucellar epididimo-orchitis in children.Methods: This case-series study has been conducted from between October 1993-2003 on pediatric age group (3-16 y) with epididimo-orchitis. Findings in Brucellar group were compared with those in nonspecific group.Findings: In 8 cases brucellosis was diagnosed and in others (13 cases) non specific bacterial epididimo-orchitis. There were fever, leukocytosis and increased RBC sedimentation rate only in a few cases.Conclusion: In endemic areas all cases of epididimo-orchitis must be worked up for brucellosis. The distinction between brucellar and nonspecific epididimo-orchitis is essential since the treatment is entirely different.

Background: Syndrome of inappropriate secretion of ADH (antiduiretic hormone) is one of the important causes of hyponatremia. In this situation, despite the decrease of plasma osmolality, the secretion of ADH continues. It is a complication of infection of respiratory tract and tumors.Methods: We have studied prevalence and causes of SIADH in 600 admitted patients in Baharloo hospital.Results: There was 18.5% hyponatremia and 7% SIADH. It was more frequent in girls, and in 1-5 year old children. The most common predisposing diseases were pneumonia, asthma, gastroenteritis and meningitis. In SIADH patients we had 3 mortalities. We did not have hypouriceima.Conclusion: This syndrome was mild in our patients.

Malnutrition has many detrimental effects on functional capacities of brain.Micronutrients such as iodine, zinc and iron have significant roles in the metabolic activities of the human body.In malnourished children there is a constellation of deficiencies of different macro - and micronutrients. Therefore the adverse impacts on the central nervous system is obvious.In this article we have tried to demonstrate the incidence of deficiencies of different micronutrients in Iranian infants and children.Unfortunately, as can be seen, these figures are very concerning. Our study showed the following data:Mean value for zinc deficiency among infants 18.6% and among children 31%. Mean value for iron deficiency among infants 37.8% and among children 18.2%. short stature due to malnutrition 15.9%, FTT (decreased weight) 10.5% and stunting 5.6%.

Background: Congenital icthyosis associated with neurologic deficit, developmental delay and spasticity suggests Sjogren-Larson syndrome (SLS). The most important neuro-imaging findings in this syndrome is white matter impairment.Case: We report an 14-month old infant with SLS with congenital ichthyosis, psychomotor delay and lower limb spasticity. Brain MRI shows white matter changes as previous reports, with a nectoric lesion in left temporal lobe that has not been reported yet.

Background: Malaria is an acute and chronic illness characterized by paroxysms of fever, chills, sweating, fatigue, anemia, and splenomegaly. Most malarial deaths occur in infants and young children. Plasmodium falciparum causes the most severe form of malaria and is associated with more intense parasitemia.A manifestation of severe disease most common in young children includes cerebral malaria. Mortality rate of cerebral malaria is 20 to 40%. Malaria acquired in P. falciparum areas with known chloroquine resistance or where there is any malaria hotline should generally be treated with drugs other than chloroquine. In this paper we introduce a case of cerebral malaria from Zahedan/Iran.Case report: A 13-year old girl is presented with fever, jaundice, pallor and seizure. She was treated initially with chloroquine and premaquine. During treatment she developed convulsions with decreased level of consciousness. Suspecting chloroquine resistance this was substituted by quinine. After three days, she recovered completely and blood smear was free of parasites