فهرست مطالب abdolkarim hamedi

Urinary tract infection (UTI) in children is a serious condition that should be treated promptly and properly to prevent further complications. The most common causative agent of UTI is Escherichia coli (E.coli). This study aims to investigate the resistance profile of E.coli in pediatric cases of UTI.
In this cross-sectional study, the positive cultures for E.coli in patients admitted in Dr. Sheikh Children Hospital of Mashhad, Iran, in Feb 2020 to Feb 2021 were assessed. The demographic factors including age and sex were excluded. Urinalysis was conducted to assess the number of bacteria (categorized as mild, moderate, and many) and the WBC count (categorized as > 5/hpf, > 10/hpf, and > 15/hpf). Furthermore, the antibiogram was consulted to assess the sensitivity and resistance to different antibiotics. Data was analyzed using SPSS software.
In 160 children (20 males and 140 females) with the mean age of 24.00 ± 26.06 months, urinalysis showed that 22.5% were in the mild bacteriuria category, 21.3% in moderate bacteriuria, and 56.3% in the many bacteriuria category. For WBC count in urine, 12.5% had more than 5/hpf WBC, 11.9% had more than 10/hpf WBC, and 75.6% more than 15/hpf WBC. Regarding resistance, 4.5% of the patients were resistant to Amikacin, 6.5% to Nitrofurantoin, 20% to Ofloxacin, 35.1% to Ciprofloxacin, 50% to Gentamicin, 52.6% to Cefixime, 59.5% to Cefazolin, and 76.1% to Trimethoprim. The mean age and also the frequency of sex showed no significant difference between different severities of bacteriuria and WBC count in urine analysis (P > 0.05).
The highest E.coli resistance was to Trimethoprim, Cefazolin, Cefixime, Gentamicin, and Ciprofloxacin. The lowest resistance was to aAmikacin and Nitrofurantoin.

The most common cause of coronary artery aneurysms in children is Kawasaki disease (KD). One of the risk ratings used to predict coronary artery aneurysms is the Harada score. This study aims to assess the negative predictive value (NPV) of Harada scoring in children with KD. This cross-sectional study was conducted in Mashhad (Iran) from January 2014 to December 2017. The Harada score was generated for each patient using demographic, laboratory, and echocardiography data retrieved from their medical records.  The patients were divided into typical and atypical cases, and the sensitivity, specificity, positive predictive value (PPV), and NPV were calculated. The Chi square test, independent t test, Mann–Whitney U test, and Fisher exact test were used to analyze the data in SPSS software (version 23.0). P≤0.05 was considered statistically significant. The study involved 168 individuals with a mean age of 29.91±19.52 months, including 103 typical and 65 atypical cases. Regarding cardiac complications, the atypical group had a significantly greater rate of coronary artery tapering (P=0.030). Out of 101 patients with cardiac complications, the Harada score was positive in 57 cases, while it was falsely negative in the remaining 44 patients. The calculated sensitivity, specificity, PPV, and NPV were 56.44%, 53.73%, 64.77%, and 45%, respectively.  The findings revealed that the Harada scoring is ineffective in detecting coronary artery aneurysms or dilation in KD patients.

Human T cell lymphotropic virus type I (HTLV-1) infection is endemic in specific regions of the world, including northeastern Iran. Besides mother to fetus transmission, it can be transmitted through breast feeding, sexual contact, and blood transfusion. The aim of this study was to determine the frequency of HTLV-1 in children.

This cross-sectional study was conducted on children from 6 months to 14 years of age hospitalized in Imam Reza Hospital between January 2016 and January 2017. HTLV-1 antibody testing was done on all patients admitted within one year, and the positive results were further confirmed by Polymerase chain reaction (PCR). After determining the frequency, the types of feeding and possible transmission ways of the virus were investigated.

Out of the 1358 children admitted, 758 entered the study and were tested for HTLV-1 antibody. The result was positive in 58 patients (7.65%) who were further tested by PCR and 11 (1.45%) had positive antibody result. Out of the 58 positive children, 28 (48.3%) were male and 30 (51.7%) female. Most of the children were in the age range of 6 to 30 months and breastfed. In terms of location, most of them lived in Mashhad (58.62%).

Our results demonstrated that the frequency of HTLV-1 antibody among children of 6 months to 14 years was 7.65%. They were tested by PCR and 1.45% were positive. This region therefore still remains an endemic area for HTLV-1 infection.

Acetaminophen and ibuprofen are the most widely used drugs in pediatric medicine to control fever and pain. There are different opinions about the effectiveness, duration of effects, and side effects and duration of action in controlling pain and fever of these drugs. In this study, we decided to examine the antipyretic effects of two common drugs to provide solutions based on the results.

During six months in the second half of the year, 400 children referred to a pediatric clinic with fever were divided into two groups. One group was prescribed acetaminophen at a dose of 15 mg per kg every 4 to 6 hours to control fever, and the other group was prescribed ibuprofen at a dose of 10 mg per kg every 6 to 8 hours. Patients underwent telephone or in-person follow-up 24 hours after drug administration, and each group was evaluated for the time to stop fever after medication, the duration without the fever after each dose, and the interval between doses.

Four hundred children were examined and split into 185 children in the first group (acetaminophen) and 145 children in the second group (ibuprofen). In the first group, the average duration of stop the fever after taking the drug was 35 minutes, and in the second group, 55 minutes. Duration without fever after taking the drug was 2 hours in the first group and 4 hours in the second group. In the first group, drug dissatisfaction was much lower than in the second group.

The best antipyretic drug in children, especially in infections, is acetaminophen, which, of course, must be taken in sufficient and correct doses and avoid taking antipyretic drugs, which is also anti-inflammatory. Although ibuprofen and diclofenac are also antipyretics, they should not be used as antipyretics, especially in pediatric infections. Compared to acetaminophen, these drugs have both more side effects and a longer reduction in body temperature.

Background :

  Septic arthritis is an acute infection of the joint space and a pediatric emergency. Delay in proper diagnosis and treatment, while prolonging the course of treatment, can have serious complications. The present study aimed to assess the clinical and laboratory profile of septic arthritis among patients hospitalized in the pediatric ward of Imam Reza Hospital of Mashhad, Iran.  

This retro-prospective study was conducted on the medical files of children from 2 months to 16 years old hospitalized in Imam Reza Hospital, Mashhad, Iran, from March 2011 to March 2019 due to a diagnosis of septic arthritis. A checklist capturing the age, gender, clinical symptoms, laboratory symptoms, affected joint, and type of treatment was prepared and completed according to the medical files of the patients.  

Out of 173 studied patients, 91 (53%), and 82 (47%) of cases were boys and girls, respectively. The patient was two months to 16 years old. The hip joint was affected more in 78 patients (45%). Among the clinical symptoms, fever was the most common found in 134 cases (77%). Moreover, 11 cases had positive blood culture where staphylococcus aurous with five positive reported cases (45%) was a major observation. Furthermore, four cases were reported to have a positive joint culture. CRP was positive in 94.8% of patients. 

 Conclusion: 

  Septic arthritis is one of the pediatric emergencies that should be diagnosed rapidly, and immediate treatment should be started to prevent irreversible complications. The most common symptom of arthritis in infants is restlessness and immobility and limp in children.

Herpes zoster occurs due to reactivation of varicella zoster-virus (VZV) that is latent in dorsal root ganglion cells after primary varicella infection. It can occur in any age but is very rare during infancy. Acquisition of this virus in utero or early after birth may result in infantile herpes zoster.

Here, it is aimed to report an infant with herpes zoster whom his mother had developed varicella two years before pregnancy.

Despite the rarity of shingles in infants after birth, any infant who has a vesicular lesion in a particular neurological dermatome should be aware of the disease.

The COVID-19 infection, which has been a pandemic since early 2020, can occur in pregnant women and can be transmitted to the baby after birth. There are few reports of this transmission in newborns. Because there are several causes for respiratory symptoms in a neonate, it is difficult to diagnose COVID-19 infection in the newborn. Evaluation of antibody in the blood umbilical cord may be an option in the future. We studied the COVID-19 infection in newborns.

In this longitudinal follow-up study, pregnant mothers who had suspicious symptomsof coronavirus infection before or after childbirth were consulted by the medical team for neonatal infection. Newborns were evaluated for respiratory symptoms. PCR test for corona virus was performed on pharyngeal swab or tracheal tube sample of the newborns.

Twenty-five pregnant women with symptoms suspicious coronavirus infections were consulted by the team of specialists from March 15 to April 15, 2020. After delivery their babies were carefully examined and followed up. Four neonates had coronavirus confirmed by PCR test.

Our study showed that neonates can become infected with Covid-19 and it should be considered amongst various differential diagnosis of neonatal respiratory diseases.

Kawasaki Disease (KD) is a vasculitis with multi-organ involvementof unknown etiology; it is the most common cause of pediatric-heart diseases in developed countries. Treatment with Intravenous Immunoglobulin (IVIG) prevents coronary artery lesions; although there are some IVIG-resistant cases, combination therapy with corticosteroids and IVIG is one of the recommendations for treatment of these cases. The aim of this study was to compare these three options for treatment of Kawasaki Disease and to evaluate their ability to deal with coronary artery complication of Kawasaki Disease.
A prospective cross- sectional study of hospitalized cases of Kawasaki Disease, conducted in pediatric department of Imam Reza hospital, Mashhad-Iran, during 2013 to 2015 (18 months). Based on demographic and clinical data of these patients, children with high risk of unresponsiveness to IVIG therapy (based on Harada score), were determined and treated with IVIG and corticosteroids- combination initially. Follow-up patients for heart complications were 6 weeks.
Twenty five patients (89.2%) out of total 28 hospitalized patients in this period of time who fulfilled diagnostic criteria were considered as complete Kawasaki Disease. Coronary Artery Lesions (CALs) were shown in 4 patients during the follow-up period, with high risk in patients with incomplete presentation (33.3% versus 12%, P The current study showed that IVIG plus intravenous methylprednisolone (IVMP) combination therapy is a safe and effective treatment regimen in prevention of CALs.

Moyamoya disease is a rare vaso-occlusive illness with an unknown etiology characterized by stenosis of the internal carotid arteries with spontaneous development of a collateral vascular network.A 15-month-old girl was referred to the emergency ward of Imam Reza Hospital due to decreased level of consciousness, focal seizures and fever during the previous 24 hours with an impression of encephalitis. Physical examination revealed left side hemiparesis; however brain CT-Scan did not show any significant lesions. Initial therapy with vancomycin, ceftriaxone and acyclovir was administered. CSF analysis did not show any abnormality and the blood as well as CSF cultures results were negative. Brain MRI showed hyperintensity at right frontal and parietal regions, suggesting vascular lesion. Magnetic resonance angiography (MRA) showed bilaterally multiple torsions in vessels at the basal ganglia consistent with moyamoya vessels.In all children exhibiting encephalitis, vascular events such as moyamoya disease should be considered. Brain MRI is a critical tool for this purpose. Common causes of encephalitis such as herpes simplex should also be ruled out.

Nosocomial Infections (NI) are a frequent and relevant problem, in other hands; those are responsible of mortality especially in pediatric ICU(Intensive Care Unit) and NICUs (Neonatal Intensive Care Unit). Healthcare-associated infections are important in wide-ranging concern in the medical field. The most cause of nosocomial infection include: bloodstream infection, urinary tract infection, pneumonia, and wound infection. The purpose of this study was to determine the epidemiology of the three most common NI in the Pediatric department. We performed a prospective study in a single pediatric department during 12 months. Children were assessed for 3 NI: wound infections, pneumonia and Urinary Tract Infections (UTI), as the same method as Center of Disease Control criteria(CDC). All patients were followed up and individuals who had have NI and their treatment was entered in this study. In this study 811 patients were hospitalized that 60% of them were male and were older than 60 months. The main causes of hospitalization include: toxicity, seizure, respiratory infection and fever. Among them 15 cases had NI (1.87%). The most NI occurred in pediatric intensive care unit (PICU) and it was followed in aspect of intubation. The most cultured organism was pseudomonas that they suspected to ceftazidime and isolate from blood and endotracheal tube. NI presence was associated with increased mortality and length of stay in hospital. This study highlights the importance of NIs in children admitted to a pediatric department especially Pediatric Intensive Care Unit (PICU) in a developing country. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.

Using of natural and synthetic surfactant is a rescue treatment for respiratory distress syndrome. In Iran, Survanta and Curosurf are the most frequent used natural surfactant preparations. We compared the clinical response and safety of two surfactants poractant alpha (Curosurf) and beractant (Survanta) for treatment of respiratory distress syndrome (RDS) in preterm infants. This study was a clinical trial study that performed during a 2-year period in Ghaem Center''s neonatal care unit.Sample size was calculated with 95% confidence and power 80. 104 premature infants were treated with surfactant, 74 in survanta group and 30 in Curosurf group,. The differences between the two groups were assessed by ANOVA or the calculation of relative risks. There were no statistically significant differences between infants treated with S and C in mean gestational age (30.58 vs. 29.00 weeks) and birth weight (1388 vs.1330 g). Also there was no significant difference between groups, incidence at 28th day of Bronchopulmunary dysplasia (%40.5 vs. %40), Intra ventricular hemorrhage III/IV (%13/5 vs. % 13/3), pneumothorax (%20 vs. % 20), Patent ductus arteriosis (%28/3 vs. % 20), and death (%28 vs. % 26/6). This study concluded that Survanta and Curosurf are similar in treatment of neonatal respiratory distress syndrome.

Medication errors are considered as the most common medical errors. Some of these errors are related to the mistake in dosage prescription and number and duration of drug usage. The purpose of this study was to evaluate the efficacy of the educational intervention-pamphlets of common medication on the accuracy of medical intern students in prescription. In this interventional study، 94 interns from pediatrics، surgery، and internal sections entered to the study and were randomly divided in to two groups; without pamphlet (control group) and with pamphlet (case group). The test was obtained using the questionnaire before and after the intervention. The accuracy of prescription was determined by paired t test، before and after the test and by independent t test between the groups. Educational intervention as pamphlet had positive effects in all studied sections of internal، surgery and pediatrics. The final mean scores of interns after the intervention in groups of without and with pamphlets were 37. 64±15. 21 Vs 50. 52±15. 80 (P=0. 018)، 69. 37±9. 46 Vs 85±8. 66 (P<0. 001) and 34. 61±12. 15 Vs 35. 83±7. 63 (P=0. 76) in internal، pediatric and surgery sections، respectively. Use of the educational pamphlets have effective role in accuracy of interns prescription.

Group B Streptococcus (GBS) is one of the most important bacteria in the majority of maternal and neonatal infections, such as chorioamnionitis, endometritis, bacteremia, sepsis and meningitis. During pregnancy, GBS screening is one of the recommended strategies that are recommended by center of disease control (CDC). This study was aimed to determine the rectovaginal colonization prevalence among pregnant women, and also the rate of transmission to their offspring. Between June 2008 and April 2009, two hundred pregnant women admitted in department of Obstetrics and Gynecology (Ghaem Hospital, Mashhad, Iran) were enrolled in present study. Samples from maternal rectum and vagina as well as neonate ear and umbilical cord were taken for culture. The colonization rate for GBS in pregnant women and their neonates was around 6% and 5% respectively. All the carrier mothers were cases with premature rupture of membranes (at least 18 hours before delivery). In terms of colonization, there was a significant correlation between mothers and newborns, and more than 80% of neonates from GBS carrier mothers were colonized by GBS.

Acute bacterial meningitis which is a pediatric emergency with high mortality and morbidity must be diagnosed and treat promptly. Often diagnosis of bacterial meningitis from viral meningitis is difficult after some days. Determination of some inflammatory mediators’ example IL-6 and HS-CRP were useful in differential diagnosis of bacterial and viral meningitis.. This study attempted to Determining HS-CRP and IL6 in serum and CSF in children suspected meningitis and Comparing value HS-CRP and IL6 in bacterial/viral meningitis..Patients and Of children that hospitalized in pediatric emergency ward (Ghaem Hospital Mashhad university of medical science, in duration 01 Dec 2010-01 Dec 2011) and for they performed lumbar puncture, 1cc serum and CSF of they were taken to laboratory and have measured IL-6 with Elisa method and HS-CRP with immunoturbidometry method, patients were followed up and finally we compared levels of this two mediators.. Finally, this study performed on 81 children and infants. From 81 cases, 27 cases (33.3%) had bacterial meningitis 27 cases (33.3%) viral meningitis and 27 cases (33.3%) had normal CSF. IL-6 concentration in the CSF and serum were significantly raised in cases of bacterial meningitis (P = 0.001, P = 0.01) but HS-CRP concentration in the CSF and serum were not significantly raised in cases of bacterial meningitis (P = 0.46, P = 0.29). Mean IL-6 concentration in the CSF in bacterial meningitis was (180.74) and in viral meningitis was (39.08). Mean HS-CRP in CSF in bacterial meningitis was (2.22) and viral meningitis was (1.29). Mean HS-CRP in serum in bacterial meningitis was (8.23) and viral meningitis was (6.36).. The measurement of IL-6 in the CSF and serum in potentially a very useful diagnostic tool for differential diagnosis of bacterial and viral meningitis..

Newborn identification is a significant issue for parents and treatment systems. In Iran, used of footprint method for this that it may result hospital infection and misidentification. Our subject of this study was evaluation of health care worker's views (include gynecologists, pediatricians, newborn nurses and midwives) about footprint identification method. In this cross sectional study 203 health care workers participated and filled short questionnaire which had two parts (Attitude and Perceptions) with 14 questions and one open unstructured response. The questionnaire was distributed among health care workers. Data were analyzed by using of SPSS software version 18 and frequency and percentage of responses were identified. A total of 203 questionnaires of participants include 28 (13.7%) gynecologists, 84 (41.3%) pediatricians, 45 (22.1%) newborn nurses and 46 (22.5%) midwives were analyzed. 157 person of them (77%) know that footprint take from all newborn, 93 person (45.6%) did not know what way use for newborn identification in developed countries and 83 person (40.7%) did not know about risk of infection transmission, 68 person (33.3%) opposed with this way and 132 person (64.7%) prefer to use alternative method. Footprint identification method is not a health care workers priority and must be replaced with alternative method.

Adenovirus is the leading etiological agent among the causes of acute diarrhea in infants and young children and the second cause of diarrhea in children by age of 4 years. However, there isnt an accurate statistic for the frequency of adenovirus diarrhea in our area. So we decided to perform a study on the incidence of adenovirus in acute diarrhea.. In this study, the incidence of adenovirus infection was studied in 200 children less than six years of age who were suffering from acute gastroenteritis between March 2008 and July 2009 in Mashhad, Iran. Adenovirus antigen was detected by Latex Agglutination Test (Rotascreen) method.. Adenovirus was detected in 2% of the stool samples that were collected from children. The frequency of adenovirus infection was significantly higher among patients 12-24 months of age (75%) than children of more than 30 months (25%) old. The highest rate of adenovirus antigen detection was observed among 12-24 months of age group. The peak incidence was in winter and autumn.. Adenovirus is an important and common agent in causing gastroenteritis in children less than 6 years of age. Adenovirus is more dangerous than rotavirus; there is no need to use antibiotics for treating these children. We should recognize the agent in order to cure the patients with conservative actions.

Exogenous natural and synthetic surfactants is a rescue treatment for respiratory distress syndrome (RDS). The goals of the study were to compare the clinical response and side-effects of two frequently used surfactants, poractant alfa (Curosurf) and beractant (Survanta), for the treatment of respiratory distress syndrome in preterm infants.

This clinical trial study was performed during a two-year period in the Neonatal Intensive Care Unit of Ghaem Hospital in Mashhad, Iran. Sample size calculated by a 95% confidence and power of 80, included 104 premature neonates, 74 in survanta and 30 in curosurf groups. The level of statistical significance was considered to be < 0.05

There were no statistically significant differences between the infants treated by survanta or cursurf groups regarding their mean gestational age (30.58 Vs. 29.00 weeks) and birth weight (1388 Vs. 1330 g), (p=0.3) There were also no significant differences between the two groups regarding incidences of broncho- pulmonary dysplasia (BPD) (40.5% Vs. 40%), intraventricular hemorrhage (IVH) grades III/IV (13.5% Vs. 13.3%), pneumothorax (both 20%), patent ductus arteriosus (PDA) (28/3% Vs. 20%) or death (28% Vs. 26.6%) on the 28th day postpartum.

This study showed that survanta and curosurf had similar therapeutic effects in the treatment of neonatal respiratory distress syndrome.

Rotavirus is the most important pathogen responsible for acute diarrhea in infants and young children. The incidence of rotavirus infection was studied in 156 children less than six years of age who were suffering from acute gastroenteritis, between February 22, 2006 and February 21, 2007 in Mashhad. Rotavirus antigen was detected by latex agglutination test (Rotascreen) in 28.8% of the stool samples examined. The frequency of rotavirus infection was significantly higher among patients under 24 months of age (69%) than among children two years old or more (31%). The peak of incidence was in the winter. This study revealed that rotavirus is an important etiological agent of acute gastroenteritis among children in Mashhad.

Neonatal sepsis is an important cause of death and morbidity in newborns and is diagnosed by isolation of organism in blood culture. In several reports,reliablity of blood cultures were done from umbi lical catheters,have been demonstrated. The objective of the present study was to determine,wether an inde welling umbilical catheter, could be an alternative site for blood culture. In a prospective study over 6 months during 2006,141 paired blood cultures from 134 infant,were done simultaneously from peripheral site and umbilical catheter (mostly U. V. C),during the first four days of life. Majority of these infants were preterm and admitted to NICU for special care. these infants had indwelling umbilical line and had indication of sepsis workup. A total of 141 pairs of blood cultures were obtained from 134 infants. In 16 infants blood culture pairs were positive for one organism in both peripheral vein and umbilical site. 71. 6% of total cultures (n=11)pairs were negative in boths site. A total of 22 pairs were positive in one site only,with 5 positive from peripheral vein only and the other 17 from umblical site. Two pairs were positve in boths site with two different organism. In over all 16 infant (11%)of blood were considered to be contaminated. Contamination rate were 2. 4% and 9. 2% for peripheral and umbilical catheter site. Contamination rate increased after 48 hours of age in umbilical catheter. The result showed that after 2 days contamination rate for blood culture taken from catheter line increased and specifity decreased. We recommended that blood culture via umblical catheter in first 2 days in sick neonates with indwelling catheter can be a alternate site of blood culture sampelling.