Journal of Pediatrics Review
Volume:1 Issue: 2, Apr 2013

Corticosteroid resistant and dependent nephrotic syndrome in children is a challenge and there are some difficulties in treating such patients. We reviewed the current studies that evaluated therapeutic role of a relatively new immunosuppressive drug “rituximab” in reducing proteinuria and reduction of relapse rate in less than 16 year old patients with non-responsive or steroid dependent nephrotic syndrome. We searched Medline, Embase, web of science and Cochrane library with appropriate keywords and conducted the complete remission, relapse rate and the mean number of relapses 12 months after therapy on Meta-analysis. We put the data on two different subgroups; steroid resistant nephrotic syndrome and steroid dependent or frequent relapser nephrotic syndrome. In Steroid Resistant Nephrotic syndrome children, the complete remission was 0.27 (0.2- 0.34). In Steroid Dependent Nephrotic syndrome patients, the overall standard mean differences of mean number of relapses 12 months after treatment in pooled four studies (56 cases) was 2.63 (2.03, 3.24). In these dependent patients, the data on relapse rate after treatment pooled on 6 studies (162 cases) and yield to the rate of 0.42 (0.15, 0.69) with the range of 0.09 to 0.83. In conclusion, Rituximab is a reasonable therapy for Steroid Dependent and Steroid Resistant Nephrotic syndrome children. In view of paucity of randomized data, we suggest to perform newer controlled multicenter studies.

Febrile seizure is the most common convulsive disorder in children and different studies reported controversial results about the association between this disorder and iron deficiency, in some studies, iron level in children with febrile seizures is higher than control and in some reports is less than the control group. So, we systematically reviewed all the studies in this field and analyzed their findings using meta-analysis methods. This review and meta-analysis was conducted by iron and fever keywords on articles published in the databases Pubmed, Googlescholar and Federated search of medical digital library includes a variety of international databases. All articles by the end of March 2012 were studied. Case-control studies were selected and quality assessment of studies were surveyed by STROB criteria and information requirements, including the status of iron deficiency anemia, iron levels and ferritin level of eligible studies were extracted and analyzed by Comprehensive Meta Analysis Version 2.0 software and The Forest and Funnel chart was drawn. Finally 11 studies included 1357 children with febrile seizure and 1347 children in the control group were evaluated. The odds ratio of iron deficiency anemia in children with febrile seizure in comparison to the control group was 1.27 (OR = 1.27, CI95%: 1.03 -1.56). Ferritin level was not significant between the two groups (p=0.022), but iron levels in the two groups was significant (p=0.000). Iron deficiency considered as a risk factor in the incidence of febrile seizure and interventional studies can be helpful to confirm this hypothesis.

Allergic rhinitis is a very common disorder that affects children. To determine the national prevalence of allergic rhinitis symptoms in Iranian children, we conducted a systematic review and meta-analysis. We conducted a literature search by using the Google Scholar from 1992 until 2012. The search terms were included: Allergic rhinitis, ISAAC and Iran. All the selected studies on children were performed by the International Study of Asthma and Allergies in Childhood protocol. By following the criteria, we gathered 436 articles. The required information from each study includes the authors, date, city, number of children in age groups 6-7 and 13-14. The information was recorded on particularly designed sheets. The data were analyzed by STATA 11.In this study, we analyzed 13 studies. 20668 children were in 6-7 years age group and 22920 were in 13-14 years age group. The pooled prevalence of allergic rhinitis in children 6-7 years of age was 11.9% and in children aged 13-14 was 21.2%.The result shows that the prevalence of allergic rhinitis in Iranian children is high. This information can be used to help allergic rhinitis control.

Device-associated nosocomial infection is a significant part of nosocomial infection and can cause the majority of its mortality, morbidity, extra lengths of hospital stay and cost. In a 13-year review, the online database was searched for full articles to find research on epidemiology of device-associated nosocomial infection in pediatric and neonatal wards. Twenty two papers were included; five articles report data both in pediatric and neonatal intensive care units. The maximum reported value per 1000 device day was in pediatric intensive care unit (36.5). The largest count of involved patients was 391527 in a Chinese trial and 4 were done multinational. Most papers were accomplished in the developing countries and showed that the rates of device-associated nosocomial infection was decreased in before/after study by applying hygienic or educational interventions on safer care. Device-associated nosocomial infections frequently occur in pediatric and neonatal intensive care units. This condition is preventable by the use of proper hygienic education and we need more attention on the prevention and diagnosis to reduce the rate of its complication, mortality and economic impact.

Fever accompanied by rash is a common finding in pediatric patients. Although, in most cases, the disease is trivial, in some cases it may be the first and/or the sole manifestation of a serious and life threatening condition in patients. The spectrum of differential diagnosis is broad and many different infectious and some noninfectious agents cause this syndrome. To establish a timely diagnosis, providing appropriate therapy and considering proper preventive measures if necessary, a systematic approach relying on a clear history, careful clinical examination along with particular attention to epidemiological features are the most important factors to pursue this syndrome. In this paper, the aim is to give an overview of how to deal with these patients clinically to establish a timely probable diagnosis of patients, providing proper early medical intervention without applying specific laboratory tests.

Chronic urticaria is defined as a skin disease with central induration (wheal) and erythema formation around it (flare) that appears at least twice a week and remains at least for 6 weeks continually. The incidence of urticaria in children is about 0.1-3%. Most cases of chronic urticaria occur in children between 6-11 years. Autoimmune and allergy immaturity is one of the reasons of lower incidence of chronic urticaria in younger children. Quality of life impairment in children with urticaria has been known to be similar to diseases with severe atopic dermatitis, epilepsy, diabetes mellitus and asthma. There are several causes for chronic urticaria in children in different reports. In most of cases the known etiologic agents are varies from 21 to 83%. Overall, infectious causes of chronic urticaria in children are more common and obvious than other in adults. In most cases, the cause of chronic urticaria are idiopathic or autoimmune. Urticaria severity divided to mild, moderate and severe was based on the number of wheals and severity of pruritus. Diagnosis of chronic urticaria is based on a good history and physical examination. The treatment of chronic urticaria is a patient education that is to remove the triggering and aggravating agents, resolving and treating of the known disease and the use of various medicines based on the history and clinical findings. The first medical therapeutics lines in children are anti-histamines, beta-blocker H1 and new generation of non-sedating agents.

Emergence Agitation that has been first described by Eckenhoff et al. in 1960’s is a dissociated state of consciousness in which the child is inconsolable, irritable, uncooperative, typically thrashing, crying, moaning or incoherent. It is also a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This literature review focused on presence of Emergence Agitation and contributing factors in children under general anaesthesia. It was conducted on Medline in PubMed area, Alta Vista Data bases, CINHAL and Google scholar in January 2013 for publications written in English with the following keywords: “Emergence Agitation, Etiology, Treatment, Pediatric Anaesthesia, Postanesthetic Care Unit, Children, inhaled anesthetics, intravenous anesthetics and Post Anesthetic Emergence Delirium”. In this paper, we intend to review the factors contributing postanesthetic emergence agitation in children to improve our vision in this area.

Chédiak-Higashi syndrome is a rare autosomal recessive congenital immunodeficiency mainly characterized by a condition called oculo-cutaneous albinism. The affected subjects have light-colored hair, vision problems, blood clotting (coagulation) abnormalities and in adulthood varying neurologic disorders. Recurrent infections, particularly viral infection with other disorders in childhood are usually life threatening. It has demonstrated mutations throughout the CHS1/LYST gene. The nature of the mutation can be a predictor of the severity of the disease. The current therapeutic options are: Antibiotics, chemotherapy and bone marrow transplantation. This review will discuss the clinical and molecular aspects of this syndrome for better understanding of the factors that may cause abnormalities.

Acute disseminated encephalomyelitis (ADEM) is a rare immune mediated and demyelinating disease of the central nervous system that usually affects children. It as a monophasic disorder related with multifocal neurologic symptoms. Here in this paper we report seven cases of ADEM in pediatrics and besides a review of literatures are presented.