فهرست مطالب

Pediatrics - Volume:27 Issue: 4, Aug 2017

Iranian Journal of Pediatrics
Volume:27 Issue: 4, Aug 2017

  • تاریخ انتشار: 1396/08/08
  • تعداد عناوین: 20
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  • Swagoto Mukhopadhyay, Kristin Ojomo, Karolina Nyberger, John G. Meara* Page 1
    Nearly a third of the global burden of disease require availability of surgical and anesthetic services. However, five billion people currently lack access to safe, affordable surgical and anesthesia care. Each year, appendicitis, hernia, open fracture and other common, treatable surgical diseases result in millions of disabilities and deaths. This is in part due to lack of political will, financial resource allocation, and relevant policy measures. To address these glaring needs, the lancet commission on global surgery (LCoGS) was formed to identify the barriers to access of surgical and anesthesia care, and the current state of these services worldwide. Additionally, its purpose was to identify opportunities for improvement and development to provide safe surgery in low-income and middle-income settings. To address the needs of surgical and anesthesia services LCoGS created 5 key messages, a set of 6 core surgical system indicators, and a health system strengthening framework for national surgical care planning. These key outputs of the commission highlighted that a widespread expansion of surgical care improves overall health and welfare of populations and improved economic returns. The findings were published as a report in the spring of 2015 to facilitate increased surgical care access that was safe, affordable, and cost-effective particularly for low-income and middle-income countries. In this review article, we summarize this seminal report and ldquo; global surgery 2030: evidence and solutions for achieving health, welfare, and economic development and rdquo; published in the Lancet 2015.
    Keywords: Global Surgery, Lancet Commission on Global Surgery
  • Selcen Yaroglu Kazanci *, Neslihan Ozkul Saglam, Rahma Houssein Omar Page 2
    Background
    Vitamin B12 plays a role in hematopoiesis, neuronal functions, the synthesis of myelin and epithelium, and the mucosal functions of the gastrointestinal system, so patients with vitamin B12 deficiency may complain of a variety of symptoms.
    Objectives
    This study aimed to investigate the association between vitamin B12 levels and clinical symptoms in children and adolescents.
    Methods
    Patients visiting the pediatric outpatient clinic for any reason between April 1 and September 30, 2014 were enrolled in the study. Patients with active infectious diseases, with chronic diseases, or who had any disease or were taking any medications causing vitamin B12 deficiency were excluded from the study. The patient’s complaints were recorded. Each patient’s serum vitamin B12, 25-OH vitamin D, folic acid, and complete blood count were measured in addition to routine tests.
    Results
    A total of 524 patients who were 8.3 ± 4.2 years old (2.6 months - 15.3 years), which consisted of 272 females (51.9%) and 252 (48.1%) males, met the inclusion criteria. The vitamin B12 level was less than 200 pg/mL in 166 (31.7%) of these patients and was less than 300 pg/dL in 302 (57.6%) of these patients. Vitamin B12 level was not associated with any complete blood count parameters except MCV. The patients with vitamin B12 deficiency were also 25-OH vitamin D deficient (P
    Conclusions
    With vitamin B12 deficiency defined as a vitamin B12 level
    Keywords: Adolescent, Pediatrics, Abdominal Pain, Paresthesia, Musculoskeletal Pain
  • Fatemeh Famouri, Nazanin Zibanejad, Payam Kabiri, Roya Kelishadi * Page 3
    Background
    Gastroesophageal reflux disease (GERD) is defined as “troublesome symptoms or complications of GER”, and is a multifactorial disorder. This study aimed to compare the treatment outcomes of hypoallergenic diet vs. ranitidine on symptoms of gastroesophageal reflux disease (GERD) in infants.
    Methods
    In this randomized clinical trial, 50 patients aged less than 1 year, who were suspected to have GERD on the basis of I-GERQ-R, were enrolled. They were randomly allocated to two groups of equal number, one group received ranitidine and the other hypoallergenic diet for 2 weeks. The frequency of GERD symptoms, including irritability, vomiting, anorexia, respiratory symptoms and arching, were compared between the two groups before and after the trial.
    Results
    After a two-week trial, the frequency of vomiting and respiratory symptoms decreased significantly in both groups (P
    Conclusions
    The current findings suggest that the hypoallergenic diet might have significant effect on GERD symptoms; these effects are comparable with those of ranitidine. Considering the possibility of cow’s milk protein allergy in this group of patients, we recommend that the treatment of GERD in pediatric population be initiated with hypoallergenic diet and in case of not achieving significant effect, pharmacological treatment be added and applied as a combination therapy.
    Keywords: Gastroesophageal Reflux Disease, Anitidine, Food Allergy
  • Fatemeh Nayeri, Bita Ebrahim, Mamak Shariat, Hosein Dalili, Majid Kalani, Niloofar Karbasian, Mahdi Sheikh * Page 4
    Background
    The Finnegan scoring system which is used to initiate and guide neonatal abstinence syndrome (NAS) therapy has several limitations that make it difficult to be used by many healthcare providers. Therefore in practice many experienced clinicians use their clinical judgements for initiating and continuation of NAS treatment.
    Objectives
    Assessing the degree of association between clinical judgments of experienced neonatologists and the Finnegan scoring system to initiate NAS treatment, and identifying the most prevalent items of the Finnegan scoring system which are independently associated with the need for NAS treatment.
    Methods
    This multi-centric prospective cohort study evaluated 60 admitted neonates who were born to illicit drugs dependent mothers and exhibited signs and symptoms of NAS. Neonates were evaluated based on the Finnegan scoring system once at birth and every four hours. Three consecutive Finnegan scores of ≥ 8 or two consecutive Finnegan scores of ≥ 12 were considered as the requirement for treatment with morphine. Five expert neonatologists with > 15 years of experience, who were blinded to the Finnegan score results visited the patients and their clinical judgments for initiating the medical treatment for NAS were recorded.
    Results
    Based on the Finnegan scoring system 26.7%, and based on the clinical judgment 30% of neonates required medical treatment. There was an excellent correlation between Finnegan scoring system and clinical judgment of experienced neonatologists (r = 0.75, P
    Conclusions
    In special circumstances when using Finnegan scoring system in regular basis is not applicable, initiating NAS treatment based on the clinical judgments of expert neonatologists can be acceptable. Tremor, convulsion, increased muscle tonicity, tachypnea, projectile vomiting, and poor feeding can be used for screening neonates after birth for early identification of opioid-exposed infants who might require medical treatment.
    Keywords: Addiction, Drug Dependency, Withdrawal
  • Hosein Shabaninejad, Asra Asgharzadeh, Nima Rezaei, Aziz Rezapour Page 5
    Background
    Immunoglobulin (Ig) replacement therapy is used for treating a variety of primary immunodeficiency diseases (PIDs). Ig replacement therapy is the most important therapy for these diseases, since it protects the body against infections and reduces autoimmune disease symptoms. The purpose of this research was to estimate the cost of subcutaneous and intravenous Ig therapy in Iran.
    Methods
    This study is carried out from the perspective of Iran’s healthcare system and all the medical costs are calculated. Cost variables include personnel, equipment, and supplies. The data required for cost estimation are obtained from the records of children’s Medical center of Tehran for 2015. Personnel and medical treatment costs are calculated based on relative value units. For SCIg, cost items are extracted from the literature.
    Results
    The total cost of IVIg and SCIg for the health system in the first year of treatment is $1370 and $121 respectively. The results indicate that SCIg reduces costs and is the preferred treatment for PID patients.
    Conclusions
    SCIg therapy significantly reduces the costs of the healthcare system compared to IVIg therapy, and this is enough economic justification for introduction of this treatment in the Iranian healthcare system. SCIg is also critical in reducing the direct costs of patients.
    Keywords: Cost Analysis, Primary Immunodeficiency, Immunoglobulin Replacement, Healthcare System
  • Jinmiao Lu, Jing Li, Qin Li, Zhiping Li * Page 6
    Background
    Patent ductus arteriosus (PDA) is a common congenital heart defect in premature infants. Intravenous injection of ibuprofen is used for PDA treatment, but its optimum dose, efficacy, and safety are unclear.
    Objectives
    This meta-analysis aimed to access randomized controlled trials that compared high- or low-dose ibuprofen with a standard dose of ibuprofen for closure of PDA in preterm infants.
    Methods
    The standard search methods of the Cochrane neonatal review group were used to screen ibuprofen versus indomethacin trials. All groups that used ibuprofen in those trials were filtered out. The high-dose group was defined as those using an average dose of ibuprofen greater than or equal to 10 mg/kg in the first three days.
    Results
    We identified 14 studies of good methodological quality comparing ibuprofen to indomethacin trials among neonates. Results showed that high-dose ibuprofen could remarkably raise the closure rate (relative risk = 0.90, 95% CI = [0.81, 1.00], P = 0.04). No significant differences were found in adverse effects, bleeding disorders, or oliguria. The closure rate in neonates with PDA increased with the ibuprofen dosage (R2 = 0.9990). The loading dose produced a significant closure rate compared with the low-dose group (relative risk = 1.91, 95% CI = [1.25, 2.92], P = 0.003), with no increase in toxic side effects.
    Conclusions
    Loading dose is a necessary strategy for infants with PDA. A high dose of ibuprofen for PDA closure was more effective than a normal dose of ibuprofen. The side effects in both treatment groups were not significantly different. Given the small sample size and risk of bias in all trials, the tolerability and safety of the dose regimen should be assessed in a large population before considering the use of these doses for PDA.
    Keywords: Ibuprofen, Indomethacin, Patent Ductus Arteriosus, Premature Infant
  • Nazafarin Ghasemzadeh *, Seyed-Mahdi Salehi, Fatemeh Faramarzi-Razini Page 7
    Background
    Humans have made various efforts to overcome infertility since ancient times. One of the modern assisted reproductive techniques is surrogacy which in this way; a woman agrees to become pregnant and carry a baby for another couple and give them the resulting offspring after birth so that they take paternal and maternal responsibility. The content of the contracts between the owner of the uterus and the applying couples is delivery of the baby to the intended couples that is usually determined by indicating the time “immediately after birth” or “as soon as birth” or “upon birth” when the nutritional status of the child by breastfeeding is not determined and even in other articles it has not even been considered. In Iran, according to the articles of the written surrogacy contract, surrogate has to deliver the baby to the intended couples immediately after birth, too. Therefore breastfeeding of newborn infant has been missed in surrogacy agreement.
    Objectives
    In this study, we have attempted to defend the right to be breast-fed for the child of surrogacy and the right of the breast-feeding for the surrogate mother as rights that make others obligation in Iran. In addition, we propose an altruistic way and the acceptance of two motherly perspectives in surrogacy for the realization of this right.
    Methods
    This study is a theoretical, review, library and content analysis study. First, a combination of key words such as Surrogacy Act, Ethics, Surrogacy Arrangement, and Breastfeeding was searched in the valid databases. Due to lack of the theme of breastfeeding in surrogacy contracts, in the second part of the study, the importance of breast milk was investigated from the medical and Islamic perspectives by searching keywords in medical database, verses of Quran and valid juridical sources and the related extracted information were categorized and their content was analyzed. Then, the right to breastfeed the baby in surrogacy was examined from the rights perspective and how to exercise this right.
    Results
    Consideration of the importance of breastfeeding from the medical, Islamic points of view and legal perspective, breastfeeding is recognized as a right of newborn and mother’s right or obligation. Surrogacy develops a mother-child relationship and is therefore liable to mother and child benefits. On the other hand, the breastfeeding right is not mentioned explicitly in surrogacy contract and this right has been missed.
    Conclusions
    It is suggested that in surrogacy both the intended parents and the owner of the womb be provided with the necessary information about the advantages of the breast milk for the child and for the mother at the time of consulting before signing the contract. In addition, the breastfeeding right should be given to the surrogate mother and it should be stated that this right is not considered as the custody right.
    Keywords: Breastfeeding, Surrogacy Contract, Islamic Perspective
  • Ortega-Molina Jm, Solans-Perez De Larraya A., Salgado-Miranda A., Jerez-Calero A., Uberos-Fernandez J., Gonzalez Ramirez A. R., Garc, Iacute, A-Serrano Jl* Page 8
    Objectives
    To assess risk factors of retinopathy of prematurity leading to delayed retinal vascularization in the first stage of ROP.
    Methods
    A retrospective study (2000 - 2016) was performed in 275 infants who were born at a gestational age of ≤ 32 weeks. Delayed vascular development was calculated as the difference in avascular area measured in terms of disc diameters between patients with risk factor and those with no risk factor.
    Results
    Intrauterine fetal demise of one twin, apnea, exchange tranfusion and intubation days (≥ 10 days) lead to delayed retinal vascularization of 1.74, 1.58, 1.17, and 1.11 disc diameters and of 3.35, 3.04, 2.25 and 2.13 weeks respectively. Delayed retinal vascular development was less than 1 disc diameter in other factors such as HS-PDA, sepsis, degree of hyaline membrane ≥ III, cerebral hemorrhage, birth weight (every 100 g less), gestational age (every week less), postnatal weight gain (every 1 g less/day) and cerebral hemorrhage. However, since these factors are quantitative (birth weight, gestational age and postnatal weight gain), the greater the adverse effect, the greater the delay will be.
    Conclusions
    Intrauterine fetal demise of one twin, apnea, exchange tranfusion and intubation days (≥ 10 days) lead to delayed retinal vascular development more than 1 disc diameter at 4 - 6 weeks of postnatal life.
    Keywords: Retinopathy of Prematurity, Angiogenesis Modulating Agents, Risk Factors
  • Jameela Abdulaziz Kari *, Catherine Quinlan, John Deanfield, Rukshana Shroff, Kjell Tullus Page 9
    Background
    Steroid-resistant nephrotic syndrome (SRNS) is associated with early atherosclerosis because of comorbidities including persistent hyperlipidemia and hypertension. The aim of this study was to determine the incidence of abnormal carotid intima-media thickening (cIMT) as an early sign of atherosclerosis in a small group of children with SRNS.
    Methods
    A total of 8 children with SRNS (mean age, 10.8 ± 4.2 years at recruitment and mean disease duration, 40.9 ± 20.7 months) were studied; all children were normotensive. B-mode ultrasound was used to measure cIMT, and the results were compared with healthy controls.
    Results
    Children with SRNS had significantly thicker CIMT (0.44 ± 0.04 mm), compared to the controls (0.37 ± 0.59 mm) (P
    Conclusions
    Children with SRNS had an abnormal vascular phenotype with a thicker CIMT, compared to the controls and showed evidence of hypercholesterolemia.
    Keywords: Steroid, Resistant Nephrotic Syndrome, SRNS, cIMT, Children
  • Ying Zhang, Shao-Yong Yuan, Li-Ping Zou *, Ying-Xue Ding, Bing He Page 10
    Background
    Infantile spasm (IS) is a catastrophic epileptic syndrome of childhood and is usually insensitive to conventional antiepileptic drugs. Studies revealed that prenatal stress (PS) exposure and Melanocortin-2 Receptor (MC2R) may be involved in the pathogenesis of IS. However, the exact mechanism still remains unknown.
    Methods
    In this study, PS was initially given to Wistar rats and ACTH injection was performed in offsprings. Seizure was then induced and evaluated, followed by MC2R immunohistochemistry and expression detection.
    Results
    Significant differences in seizure number, MC2R and CRH expressions were observed among different subgroups.
    Conclusions
    Our study suggested that PS exposure may be an important factor in the pathogenesis of IS. ACTH together with low expression of MC2R, may inhibit IS seizures.
    Keywords: ACTH, Infantile Spasm, MC2R, Prenatal Stress Exposure
  • Talieh Zarifian, Yahya Modarresi, Laya Gholami Tehrani, Mehdi Dastjerdi Kazemi, Mahyar Salavati, Amir Sadeghi, Soheila Shahshahani * Page 11
    Objectives
    The present study aimed to adapt articulation assessment, a subtest of the diagnostic evaluation of articulation and phonology, and to determine its reliability and validity for Persian speaking children.
    Methods
    The Persian version of articulation assessment (PAA) was administered to 387 children aged between 36 - 72 months, M (SD):53.7 (± 10.1) by month, after the adaptation process. A methodological study including test–retest reproducibility, score-rescore consistency and evaluating validity (through content, convergent and discriminative validity) was then carried out in order to determine the psychometric properties of the instrument.
    Results
    Content validity ratio for Persian item’s content coverage, agreement image and syllable structure were 0.86 - 1, 0.92 and 0.94, respectively. Minimum content validity index of 0.93 exceeded in terms of relevancy, simplicity and clarity of instructions. The percentage agreement for the test-retest was 91.35-100% and the score-rescore analysis was 92.95-100%. The convergent validity was reasonable. The Persian Articulation Assessment’s mean scores for individuals with articulation disorders being significantly lower than those by normal children, showed discriminative validity (t = 7.245, df = 34, P
    Conclusions
    The Persian version of Articulation Assessment is suggestive of a reliable and valid instrument for evaluating the articulation skills in Persian speaking children.
    Keywords: Articulation Assessment, Validity, Reliability, Persian, Children
  • Fatemeh Sayarifard, Molood Safarirad, Ali Rabbani, Azadeh Sayarifard *, Vahid Ziaee, Aria Setoodeh, Parastoo Rostami Page 12
    Background
    Type 1 Diabetes mellitus (DM) causes changes in bone mineral density (BMD).
    Objectives
    The aim of this study was to evaluate BMD in children with type 1 DM and predictive factors of BMD loss in these patients.
    Methods
    This cross-sectional study was conducted on 112 children with type 1 DM referrtd to children’s medical center in Tehran, Iran during 2015 and 2016. Serum levels of hemoglobin A1c (HbA1c), Insulin-like growth factor 1 (IGF-1), 25-hydroxy vitamin D (25(OH) D), calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphates (ALP), Fasting blood sugar (FBS) was recorded. Lumbar spinal BMD (L1-L4) was measured in all patients by dual energy X-ray absorptiometry (DEXA). A BMD Z-score of ≥ -1 was accepted as normal; between -1 and -2, in the low range of normality; and ≤ -2 , low BMD. Bone mineral content (BMC) was calculated by DEXA and recorded.
    Results
    Median age was 12.5 (4 - 14) years. Low BMD and BMD in the low range of normality were diagnosed in 17 (15.2%) and 25 (22.3%) of patients, respectively. There was a significant correlation between BMD and patient age (P
    Conclusions
    Glycemic control in children with type I diabetes is mainly predictor of changes in BMD and the changes in BMD were observed mainly in older ages and is independent of gender.
    Keywords: Type 1 Diabetes mellitus_Bone Mineral Density_Children
  • Maria Elisabetta Baldassarre, Antonio Di Mauro, Annarita Cintoli, Giuseppina Mincarone, Silvio Tafuri, Nicola Laforgia Page 13
    Background
    Non-communicable chronic diseases (NCDs) are still the major cause of mortality and morbidity in young adults.
    Objectives
    The aim of the study was to evaluate the influence of neonatal characteristics on NCD development.
    Methods
    A questionnaire was assessed to evaluate the influence of cesarean section (CS), breastfeeding and prematurity on development of some NCDs. The questionnaire was distributed through an online form.
    Results
    We received 6,379 responses. According to data, CS was not associated with the development of asthma and allergies, celiac disease, type I and II diabetes or obesity and a tendency to be overweight. The study revealed an inverse association between breastfeeding and risk of asthma and allergies, type II diabetes, obesity and a tendency to be overweight. No association was found in relation to type I diabetes or celiac disease. Preterm birth was not associated with development of asthma and allergy, celiac disease or type I and II diabetes, but seems to have a protective role in the development of obesity.
    Conclusions
    Many neonatal characteristics could influence the development of NCDs during life. These characteristics could have a direct or indirect influence on neonatal gut establishment with subsequent health implications later in life. Further longitudinal studies are needed to confirm our conclusions.
    Keywords: Prematurity, Breastfeeding, Cesarean section, Non, communicable Chronic Diseases
  • Li Jiang, Shan Gao, Lingzhi Qiu, Lianghua Zhu, Yue Li, Rui Jin * Page 14
    Background
    Orosomucoid 1-like protein 3 (ORMDL3) and STAT6 have roles in the pathogenesis of asthma.
    Objectives
    To explore the expression of STAT6 and ORMDL3 in a murine model of bronchial asthma and determine potential correlations between ORMDL3 and STAT6, interleukin (IL)-4, and IL-13. The effects of dexamethasone on the expression of STAT6 and ORMDL3 were also investigated.
    Methods
    Female BALB/c mice were randomly separated into three groups: control group, asthma group and dexamethasone group. The asthma and dexamethasone groups were sensitized with ovalbumin (OVA) by intraperitoneal injection in the presence of aluminum hydroxide followed by several inhalation challenges with OVA. The dexamethasone group was intraperitoneally injected with dexamethasone before challenge. The levels of IL-4 and IL-13 in serum were detected by enzyme-linked immunosorbent assay. The expression of STAT6 and ORMDL3 in lungs was measured by real-time PCR, western blot and immunohistochemistry.
    Results
    The concentrations of IL-4 and IL-13 and the expression of STAT6 and ORMDL3 were significantly up-regulated in the asthma group compared with the control group and were markedly suppressed by dexamethasone treatment.
    Conclusions
    The expression of ORMDL3 in asthmatic mice was closely related to STAT6, IL-4, and IL-13. Dexamethasone inhibited the expression of ORMDL3 and alleviated airway hyperresponsiveness.
    Keywords: Asthma, Murine model, Dexamethasone, Orosomucoid 1, Like Protein 3, STAT6 Interleukin
  • Aysegul Ertugrul *, Benan Baykaci, Ilker Ertugrul, Selman Kesici, Ebru Gunes Yalcin Page 15
    Objectives
    With the advancements in neonatal and pediatric intensive care services and technology, the number of children requiring long term mechanical ventilation support is increasing. Home mechanical ventilators enable discharge of patients with chronic respiratory failure from hospital and allows children to grow in natural environment. The objective of this study was to define clinical characteristics and follow up results of pediatric patients who are dependent on invasive home mechanical ventilation support.
    Methods
    This retrospective study included a total of 61 patients discharged from pediatric intensive care unit while on mechanical ventilation (HMV).
    Results
    The median age of patients was 8.5 (2 - 196) months with 60% of them being younger than 12 months. The decision for HMV was made after median 38 ± 37.2 days of mechanical ventilation in hospital. The most common reason of dependency on invasive HMV was found as central nervous system and neuromuscular diseases by 94%. The median duration of follow up was 11 months (4 days-7.5 years). HMV was no longer necessary in 12% of patients ventilated for neurological reasons and 50% for chronic pulmonary diseases. Anthropometric measures were observed to be improved in 69% of the patients. Mortality rate attributed to complications of tracheostomy was 15% and overall mortality was found as 46.7%.
    Conclusions
    HMV enables ventilator dependent patients to be discharged and allows patients to develop and grow in their natural environment which helps them to catch up their growth potentials. The survival and quality of life (QoL) of these patients can be improved by family education and with the support by nutrition and care rehabilitation programs.
    Keywords: Home Mechanical Ventilation, Children, Mortality, Outcome
  • Aytekin Kaymakci, Sirin Guven, Seher Erdogan, Ilhan Ciftci *, Recai Gokcan Page 16
    Objectives
    This study is an evaluation of the accuracy of ultrasonography (USG), computed tomography (CT), and Alvarado score (AS) in the diagnosis and management of acute appendicitis in children.
    Methods
    Records of pediatric patients admitted to the pediatric emergency department (ED) between 2008 and 2012 were evaluated retrospectively. Patient data from the national electronic health information system was screened and those with complete clinical and imaging findings (AS, preoperative USG and/or CT images) and postoperative pathological diagnosis were included in the study.
    Results
    Study group consisted of 449 children with diagnosis of suspected acute appendicitis aged between 3 and 15 years (mean age: 9.20 ± 2.73 years). Of the total, 428 (95.3%) patients underwent appendectomy and 21 (4.7%) cases were treated conservatively. Mean duration of symptoms was 4.94 ± 1.84 hours. Pathological evaluation results were negative (i.e., removal of normal appendix) in 36 (8.4%) patients; histopathological diagnosis was acute appendicitis in 392 (91.6%) patients. Perforated appendix was found in 38 (8.5%) patients. In patients with histopathologically confirmed appendicitis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT in diagnosis of acute appendicitis were 96.3%, 55.6%, 92.8%, and 71.4%, respectively. Sensitivity, specificity, PPV, and NPV of USG were 73.5%, 22.2%, 91.1%, and 69.2%, respectively. Negative appendectomy rate was 6.4% (n = 8) in patients who had preoperative CT scan, and 6.5% (n = 28) in patients who had USG examination.
    Conclusions
    CT has higher sensitivity than USG in diagnosis of acute appendicitis. USG, on the other hand, is widely accessible method and does not use ionizing radiation. Therefore, it may be used as initial radiological imaging method in acute appendicitis. Thin-filter, contrast-unenhanced CT scans may be preferred in cases where clinical signs and USG findings are unclear or controversial.
    Keywords: Alvarado score, Appendicitis, Computed tomography, Ultrasonography, Children
  • Meral Bayat *, Nevin Uslu, Emine Erdem, Yagmur Sezer Efe, Nurten Variyenli, Filiz Arican, Selim Kurtoglu Page 17
    Background
    This is a cross-sectional study performed to assess the use of complementary and alternative medicine (CAM) in children with T1DM.
    Methods
    200 mothers of children with T1DM under observation in Pediatric Endocrinology Polyclinic of a university hospital between September 2014 - September 2015 were interviewed regarding CAM use in their children.
    Results
    40.0% of mothers of children with T1DM used CAM to control blood glucose and to support treatment. CAM users often used herbs, mixtures and praying. Those who preferred herbal used black cumin, cinnamon and olive leaves, while those who preferred mixtures used a yoghurt-lemon mixture and mengisu. There was no difference between HbA1c values of children who used CAM and those who did not (P > 0.05). Patient’s sex, family income level, and educational level of mother and father did not affect CAM use (P > 0.05).
    Conclusions
    Children with T1DM often received herbs, mixtures and praying. Nurses should provide diabetic children and their parents with training and counseling about the advantages and hazards of CAM.
    Keywords: Child, Complementary Therapies, Diabetes, Alternative Medicine, Nurse
  • Maryam Hassanzad, Shahram Kharabian Masouleh *, Sabereh Tashayoie Nejad, Saba Karimzadeh, Ali Akbar Velayati Page 18
    Background
    Respiratory failure secondary to recurrent respiratory infections is the most common cause of death in Cystic fibrosis (CF).
    Objectives
    To assess the efficacy of noninvasive positive pressure ventilation (NIPPV) on respiratory function, use of accessory respiratory muscles, ease of physiotherapy for respiratory clearance, quality of sleep and nutritional status in CF patients with respiratory failure.
    Methods
    All CF patients admitted to the pediatric department of Masih Daneshvari hospital, Tehran from March 2015 to January 2016 were studied. The inclusion criteria were clinical evidence of respiratory distress and signs of respiratory acidosis. The exclusion criteria were nausea and vomiting, not tolerating NIPPV, need for intubation, pneumothorax, presence of giant bullous emphysema or decreased level of consciousness. Baseline spirometry and venous blood gas (VBG) was obtained before and after NIPPV. A simple questionnaire was filled out for the nutritional status, sleep quality, ease of physiotherapy for airway clearance and the volume of secretions after NIPPV compared to baseline. Paired samples t-test and Wilcoxon Signed Rank test in SPSS version 16 were used for the before and after comparison of numerical and ordinal variables, respectively.
    Results
    Out of a total of 53 CF hospitalized patients 17 met the inclusion criteria. There were 10 (58.8%) males and 7 (41.1%) females with a mean age of 11 ± 4.57 (10 - 25) years, mean weight of 31.85 ± 10.11 (13 - 48) kg and mean BMI of 14.16 ± 2.71 (5.9 - 18). The mean Saturation of peripheral oxygen (SPO2), respiratory rate (RR) and mean partial pressure of CO2 (PCO2) of patients before the intervention were 75 ± 13.25% (52 - 90%), 32 ± 11.17 (22 - 55) mmHg and 55.20 ± 17.62 (30.3 - 108), mmHg respectively. A significant difference was noted after the intervention in SPO2, venous PCO2 and RR compared to baseline (P
    Conclusions
    NIPPV in CF patients with respiratory failure can improve the respiratory function, sleep quality and nutritional status of patients. Also, NIPPV enhances airway clearance during respiratory physiotherapy.
    Keywords: Cystic Fibrosis, Noninvasive Positive Pressure Ventilation
  • Mahmoud Shekari Khaniani, Fatemeh Amini Yeganeh, Shahrokh Amiri, Sima Mansouri Derakhshan* Page 19
    Background
    Mutations in gene are the most common single genetic cause of autism-spectrum disorders, therefore we investigated the possibility that the intermediate alleles may also contribute to the origin of Autistic disorder.
    Methods
    We screened 96 males, recruited from North West of Iran, who were diagnosed with autistic disease for CGG repeat size. The frequencies of either intermediate or premutation alleles were matched with 168 male controls. All patients and normal controls were of Azeri Turkish ethnicity.
    Results
    Three mutated, five intermediate and four premutation carriers were identified among Autistic patients, compared with one premutation carrier in normal controls, representing a significant excess in small size FMR1 allele carriers (= 0.006). There was also a significant excess of the intermediate carriers compared with normal controls (= 0.006).
    Conclusions
    Both of these alleles may show roles in the etiology of autism, possibly as a result of the rise of mRNA. Considering that there are individuals in the general population are carriers of intermediate and premutation alleles, further screening of larger samples of Autism patients is recommended, in order to estimate the role of small size of CGG repeat alleles in the aetiology of autism.
    Keywords: Autistic Disorder_Fragile X Syndrome_Gene_Intermediate Alleles_Premutation Alleles