فهرست مطالب

Comprehensive Pediatrics - Volume:7 Issue: 4, Nov 2016

Journal of Comprehensive Pediatrics
Volume:7 Issue: 4, Nov 2016

  • تاریخ انتشار: 1395/10/10
  • تعداد عناوین: 8
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  • Zahra Shahraki, Zohre Sadat Hashemi Bonjar, Forough Forghani *, Rezvane Nakhai Page 1
    Background
    Pregnancy-related nausea and vomiting or morning sickness with an overall prevalence rate of 80% is commonly appeared at the eighth week and frequently disappeared in most pregnant females at the 16th week of gestation. The severe form of the condition named hyperemesis occurs in one per 200 to 300 pregnancies; it is accompanied by dehydration, electrolyte instability and nutritional deficits and needs medical interventions. Limited data are available on harmful effects of common antiemetic medications used within pregnancy on human neonates..
    Objectives
    The current study aimed to compare the effects of ondansetron and vitamin B6 on neonatal outcome in pregnant females with pregnancy-related nausea and vomiting. Neonatal outcome included the probable difference in neonates’ gestational age, weight, height, head circumference and frequency of apparent congenital anomalies..
    Methods
    This randomized double-blinded clinical trial was conducted on 188 primipara singleton pregnant females with pregnancy-related nausea and vomiting who referred to state healthcare centers of Zabol, Iran, in 2014. The pregnant females were randomly assigned to receive drug packages including ondansetron tablets (4 mg) or vitamin B6 tablets (40 mg) and patients were instructed to take one tablet twice daily. Females were followed up until delivery and neonatal outcomes including any congenital anomaly, weight, height and head circumference at birth were assessed..
    Results
    There was no difference between the groups in the mean age of mother and the mean age of gestation. No differences were found between the groups regarding birth weight (3006.93 ± 441.86 versus 2949.65 ± 457.36 g, P= 0.67), height at birth (49.50 ± 1.45 versus 48.97 ± 1.47 cm, P= 0.75) and head circumference at birth (34.23 ± 1.22 versus 33.88 ± 1.26 cm, P = 0.56). No neonatal anomaly was observed in the two groups..
    Conclusions
    No significant differences were observed between the groups based on the neonatal outcome including neonatal anthropometric parameters and lack of congenital anomaly..
    Keywords: Ondansetron, Pregnancy, Vitamin B6, Morning Sickness, Hyperemesis Gravidarum
  • Parsa Yousefichaijan, Fatemeh Dorreh, Elahe Ziaei, Abdolghader Pakniyat* Page 2
    Background
    Gastroenteritis is one of the major causes of morbidity and mortality among children, and it accounts for 18% of childhood death. Conducting laboratory tests is challenging for these patients, and the validity of the laboratory studies in treatment and prognosis is in question..
    Objectives
    This study aimed to investigate the necessity of performing laboratory tests, and intended to reduce hospitalization costs..
    Methods
    Patients with moderate to severe dehydration due to gastroenteritis, who referred to the emergency ward of Amir Kabir hospital from April to August 2008, were enrolled in this cross- sectional descriptive study. The routine lab tests, including complete blood cell, urine analysis, stool exam and electrolytes were performed, and statistical analysis was done by SPSS software..
    Results
    Of the 610 patients, 0.3% had severe, 99.7% had moderate dehydration, and 42.78% were female. The lab results of the patients revealed the following information: Blood sugar: 97.3%; sodium: 95.5%; potassium: 93.5%; blood creatinine: 95.4%; blood urea nitro: 87.9%; urine analysis: 90.7%; urine culture: 96.8%; stool exam: 83.3%; white blood cell count: 87.7%. However, hemoglobin was found to be 77.4%, which was normal..
    Conclusions
    It is reasonable to evaluate blood urea nitrogen, potassium, and hemoglobin of children with gastroenteritis. Moreover, conducting white blood cell, stool exam, and urine analysis is recommended for those with febrile gastroenteritis, especially in girls younger than two years of age. Overall, conducting all the mentioned tests for these patients is not necessary as a routine, and decision should be made based on the clinical condition of the patients and their doctors’ opinion..
    Keywords: Gastroenteritis, Dehydration, Pediatric
  • Zahra Pirzadeh, Mehri Jamshidi *, Mohsen Mollamohammadi Page 3
    Background
    Acute poisoning in children (APC) is a preventable cause of pediatric emergency visits. Patterns of acute poisoning in children are different in various regions and times..
    Objectives
    The aim of this study was to assess the epidemiology of acute poisoning in children, who were referred to the emergency department of Qods teaching hospital in Qazvin, Iran..
    Methods
    In this descriptive, cross-sectional study, all children younger than 13 years old, admitted to the Qods teaching hospital in Qazvin (Iran), were assessed during September 2009 to September 2012. Demographic and clinical symptoms and signs of poisoned cases, poisonous agents and outcome of patients were studied..
    Results
    Four hundreds and thirty-four (2.59% of total hospital admission) patients with APC were admitted to the emergency department during the study period; 63.36% were male. Overall, 345 (79.5%) cases were under 6 years old. Drugs (265 cases) were common agents for APC. The ingestion route was responsible in 391 of APC. Methadone, benzodiazepines and kerosene were the most frequent poisonous agents. Neurologic symptoms and signs (256 cases) were the most common presentation of APC. Forty-five patients (10.36%) were admitted to the PICU. Three deaths (%0.06) occurred with monoxide carbon and methadone poisoning. Monoxide carbon poisoning was the deadliest agent..
    Conclusions
    Acute poisoning in children is a serious preventable cause of hospital admissions. It is one of the differential diagnoses in patients with sudden onset of neurological, alimentary, respiratory symptoms and signs, who are visited at the emergency department. Parental awareness and education about keeping potential poisoning agents safely is essential to reduce APC in children..
    Keywords: Acute Poisoning, Methadone, Kerosene, Emergencies
  • Parsa Yousefichaijan, Aziz Eghbali, Mohammad Rafiei, Hasan Taherahmadi, Abdolghader Pakniyat* Page 4
    Background
    Acute kidney injury (AKI) due to hypovolemia and gastroenteritis is still a common disease, especially among children in developing countries. The risk, injury, failure, loss, and end-stage renal disease (RIFLE) classification is used as the estimated indicator of outcomes and incidence of AKI. Leukocytosis may be seen with systemic infectious, inflammatory diseases, and pyelonephritis. However, the cell blood count is unspecific. Some studies have shown the role of complete blood count in AKI as a useful predictive factor for mortality. We aimed at investigating cell blood count indexes and HCO3 in the prognosis of children with RIFLE criteria of AKI..
    Methods
    In this prospective study, 206 patients with AKI, who were admitted to Amir-Kabir emergency department, were investigated. The complete blood count, erythrocyte sedimentation rate, serum HCO3, and electrolytes of the patients were measured and compared. All patients were followed monthly for 4 months for renal function test and clinical manifestation. Data analysis was performed by SPSS Version 18 (IBM Corp., NY, US.). Mean, standard deviation, standard error, and frequency were used for descriptive analysis; and t-test, Chi-square, Mann-Whitney and Friedman tests were used for data analysis..
    Results
    There were no significant differences between the 4 groups in white blood cell count, hemoglobin, hematocrit, and ESR at baseline (P > 0.05). The number of platelet units was remarkably higher, but the number of MPV and HCO3 was considerably lower in patients with loss/ failure criteria..
    Conclusions
    MPV is higher in the case of platelets destruction, and this is commonly observed in inflammatory diseases. Metabolic acidosis is related to AKI and may lead to disorders such as hypotension, cardiac dysfunction, and mortality. HCO3, and MPV are likely to act as a predictor of the development of AKI. Conducting a multicenter study with a larger sample size and longer follow-up is suggested to examine the predictive factor of AKI..
    Keywords: Acute Kidney Injury, Weight Blood Cell, Pediatric, Prognosis
  • Viatcheslav V. Berezhnoi, Marianne Heger, Walter Lehmacher, Georg Seifert* Page 5
    Background
    Acute tonsillopharyngitis is amongst the most common reasons for children, adolescents and young adults to consult with a physician. Despite extensive prescription, antibiotic therapy is indicated in less than one-fifth of these cases. New treatment strategies for patients with non-group-A-streptococcal acute tonsillopharyngitis are therefore required..
    Objectives
    EPs 7630 is an extract from the roots of Pelargonium sidoides DC. After positive clinical study results in children with acute bronchitis, the present study was conducted to demonstrate the efficacy of EPs 7630 in the treatment of acute tonsillopharyngitis in children..
    Methods
    In this double-blind placebo-controlled clinical trial with a group sequential design, the efficacy and tolerability of EPs 7630 were investigated in 6- to 10-year-old patients with acute tonsillopharyngitis, who showed no evidence of group A β-hemolytic streptococcus. Treatment duration was 6 days. Primary efficacy variable was change in the sum score of the tonsillitis severity score (TSS) on day 4 compared to baseline..
    Results
    Overall, data on the change of the TSS measured for the EPs 7630 and placebo group were available for 60 and 64 children, respectively. After 4 days of treatment, the TSS had decreased from 9.6 ± 1.2 to 2.8 ± 2.6 points in the active medication group and from 9.5 ± 1.3 to 6.1 ± 4.1 points in the placebo group (P
    Conclusions
    EPs 7630 was found to be efficacious in the treatment of acute tonsillopharyngitis in children and was very well tolerated..
    Keywords: EPs 7630, Pelargonium sidoides, Placebo, Tonsillopharyngitis
  • Nastaran Khosravi, Farhad Abolhasan Choobdar, Nasrin Khalesi, Arash Bordbar, Bagher Larijani, Zahra Arab, Mitra Nourbakhsh* Page 6
    Background
    Ghrelin is a pleiotropic hormone that regulates feeding and energy balance and stimulates growth hormone release. Ghrelin also exerts developmental and organizational effects during prenatal life..
    Objectives
    The aim of this study was to determine ghrelin levels in cord blood of small for gestational age (SGA) infants and its association with GH (growth hormone) and IGF-1 levels (insulin-like growth factor-1)..
    Methods
    Cord blood sample was obtained from 31 SGA and 25 appropriate for gestational age (AGA) infants. Acylated ghrelin, GH, and IGF-1 levels were measured by enzyme-linked immunosorbent assay..
    Results
    No significant differences were observed in ghrelin and GH concentrations between SGA and AGA infants. However, IGF-1 levels were significantly lower in SGA infants. Cord blood ghrelin was negatively correlated with the infants’ birth weight (r = -0.33, P = 0.013); on the other hand, IGF-1 level was positively correlated with birth weight (r = 0.43, P = 0.002)..
    Conclusions
    IGF-1 has the most significant effect on intrauterine growth. Acylated ghrelin is detectable in cord blood and correlated with birth weight, suggesting a role in intrauterine development, but its level is not affected by intrauterine growth retardation..
    Keywords: Ghrelin, Growth Hormone (GH), IGF, 1, Small for Gestational Age (SGA), Appropriate for Gestational Age (AGA), Intrauterine Growth
  • Jun Aoyagi, Takahiro Kanai *, Takane Ito, Jun Odaka, Takashi Saito, Hiroyuki Betsui, Takanori Yamagata Page 7
    Background
    We evaluated the effect of glucocorticoids (GCs) on bone strength via bone mineral density (BMD) scores and serum alkaline phosphatase (S-ALP) levels in children with idiopathic steroid-sensitive nephrotic syndrome (ISSNS) or IgA nephropathy (IgAN)..
    Methods
    Sixteen children with ISSNS and 13 with IgAN were eligible for this study. The BMD and S-ALP levels were measured before the initiation of steroid treatment (STx), one month after initiation of STx and one month after terminating STx (Phases 0, 1 and 2). For IgAN, scores and levels were measured before the initiation of STx (Phase 0) and 1, 3, 6, and 12 months after the initiation of STx (Phases 1, 2, 3, and 4)..
    Results
    In ISSNS, the BMD and S-ALP levels were significantly lower in Phase 1 than in Phase 0; however, scores and levels returned to baseline in Phase 2. In IgAN, BMD was significantly lower in Phase 2 than in Phase 0 while S-ALP levels were significantly lower in Phases 1, 2, and 3 compared to Phase 0. No significant difference was observed between Phase 0 and Phase 4..
    Conclusions
    In ISSNS, bone strength recovered one month after terminating STx. In IgAN, bone strength recovered 10 months after tapering of STx..
    Keywords: ALP, BMD, Glucocorticoids, IgA Nephropathy, ISSNS
  • Mojtaba Vahid Golpayegani, Hossein Behnia, Mahvareh Akhgar Araghi, Ghassem Ansari * Page 8
    Introduction
    Factor XIII deficiency is a relatively rare hereditary bleeding disorder, which is usually found during infancy or early childhood. This condition may involve both genders within different races in an equal manner. Its incidence is estimated at approximately 1 in 106 live births. Patients with factor XIII deficiency are presented with a pattern of neonatal hemorrhage and lifelong bleeding diathesis..
    Case Presentation
    A five-year-old female is presented here, who was diagnosed as a definite case of factor XIII deficiency, based on the clinical and laboratory findings at a medical specialist clinic. Typical clinical features of the disorder were the chief complaint of the patient, which was severe bleeding when she was brought into a specialized dental office following an earlier dental procedure..
    Conclusions
    The case was fully investigated and diagnosed as a case with factor XIII deficiency causing such uncontrolled bleeding after extraction of a tooth..
    Keywords: Factor XIII Deficiency, Coagulation Disorders, Bleeding Disorders, Clotting Problem