فهرست مطالب azar dastranji

Kawasaki disease is an acute and rare febrile disease that affects children and is characterized by conjunctivitis, redness of the lips and mouth, diffuse skin lesions, edema and redness of the hands and feet, and cervical lymphadenopathy. Since the start of the COVID-19 pandemic, Kawasaki disease has become much more prevalent and has more diverse manifestations.

This retrospective cohort study included patients diagnosed with Kawasaki symptoms between January and October 2021 at the Tabriz Children's Education and Therapeutic Center. The diagnosis was made using the guidelines of the American Heart Association (2017) and the American College of Rheumatology.

All referred patients had fever, and additional symptoms may include skin involvement (93%), mucosal involvement (87%), end changes in the peripheral exterimities in the form of erythema and scaling (75%), gastrointestinal manifestations (51%), cardiac manifestations (42%), followed by respiratory (27%), and finally cervical lymphadenopathy (18%).

Manifestations of Kawasaki disease during the COVID-19 pandemic can be much more diverse and severe. Knowing the variety of clinical symptoms and uncommon findings of Kawasaki disease in these patients can help to early distinguishing between Kawasaki and Kawasaki like disease and prevent the progression of the disease.

Foreign body aspiration (FBA) is a life-threating event in pediatric especially under 3 years of age. Chest radiography and computed tomography are the most available imaging modalities and rigid bronchoscopy is the treatment of choice. Sometimes incidental findings may be detected in the course of FBA management. In this study we report a case of 4-year-old girl who was admitted due to sudden onset of cough and cyanosis. Based on history and examination, diagnosis of foreign body aspiration was made but chest radiograph showed a round mass in the right upper hemithorax. The Foreign body was removed with Rigid bronchoscopy then the mediastinal mass was surgically removed completely. Pathological study reported a neuroblastic tumor.

Influenza causes various seasonal respiratory diseases, resulting in significant morbidity and mortality in children. Influenza is a highly contagious disease causing global pandemics. This study aimed to investigate the frequency and outcome of influenza in children admitted to the Tabriz Children's Hospital.

This cross-sectional study included suspected influenza patients admitted to the Tabriz Children's Medical Center between 2014 and 2019 diagnosed with positive influenza through RT-PCR of pharyngeal secretions samples.

We evaluated 114 cases of influenza with a median age of 48 months (range: 2-156 months) and 53.5% were boys. A total of 87 cases (77%) were infected with subtype A/H3N2, which was the most frequent, followed by 2 cases (1.8%) of subtype A/H1N1, 23 cases (20.4%) of subtype B 23, and one case (0.8%) of uncategorized A subtype. The disease was common in winter with 63 cases (56.3%).

The frequency of influenza in children during five years was 8.95%, which is higher in males. Also, the highest frequency of influenza in the present study was observed in the age group of 1 to 5 years. The mortality rate of influenza in children during the last five years was equal to 7.9%.

Children under 5 years of age are more susceptible to influenza (especially type A subtype H3N2) and higher hospitalization rate and mortality, which can be prevented with a vaccine.

Adenoidal hypertrophy (AH) is a common disorder in pediatric population with severe complications due to nasal air way obstruction. Adenoidectomy is a choice treatment for children with severe symptoms due to AH, however; it is accompanied with several side effects such as complication of surgery and emotional distress. We evaluated the efficacy of intranasal corticosteroid (Fluticasone) therapy on size and symptoms of Adenoid Hypertrophy.

In this clinical trial 45children with AH (2-14 years old) were enrolled. All of them underwent 8 weeks course of intranasal Fluticasone therapy and their symptoms before and after treatment were scored and also compared by questionnaires. They were divided into Atopic and non- Atopic groups and these two groups were compared with each other after treatment according to their response to therapy.

After 8 weeks treatment with intra nasal fluticasone, improvement in all symptoms score of AH including (Snoring , Sleep Apnea ,Mouth breathing and Nasal congestion)  was statistically significant(p=0.000). Significant improvement after treatment was observed in atopic patients and 92% of them (36 of 39) showed decrease clinical symptom of AH however this number in non-atopic patients was 50% (p value =0.024).

Our study demonstrates that an 8 weeks treatment with intranasal corticosteroid (Fluticasone) is associated with decrease in size of AH and all symptoms of obstruction. So intranasal corticosteroid therapy can prevent of adenoidectomy especially in atopic patients.

Cough variant asthma (CVA) is known by airway Hyper responsiveness and nonproductive chronic cough without wheezing for a minimum duration of 8 weeks. It is less common form of asthma. This study was conducted aiming to diagnose the role of serum Immunoglobulin E (IgE) in diagnosis of cough variant form of the disease. In this cross sectional study, 80 patients with an age range of 5-14 years were included with clinical criteria for CVA who referred to pulmonology clinic of Tabriz Children Hospital, Tabriz, Iran. Serum IgE level was measured and severity of CVA based on Global Initiative for Asthma (GINA) classification was determined, finally the relationship between serum IgE level and severity of CVA was evaluated. In patients with CVA without history of allergic disease, mean serum titer of IgE was 138.2 ± 17.5. Significant difference of serum IgE level in different severities of CVA was detected (P = 0.001). Serum IgE level in patients with CVA is a reliable marker for diagnosis and evaluation of the severity of disease.

About 40 to 60% of all patients admitted to pediatric intensive care unitsundergo mechanical ventilation and 10 to 20% will fail to be extubated. We aimed to determine the role of the rapid shallow breathing index (RSBI) in predicting successful weaning of pediatric patients with respiratory failure. This cross-sectional study, was performed on 72 mechanically ventilated children (36 in the lung failure group and 36 in the pump failure group) who were admitted in Tabriz children’s hospital in pediatric intensive care unit (PICU), Tabriz city, Iran. In order to spontaneous breathing trial (SBT) criteria, the patients who had FiO2 less than 40%, PEEP less than or equal to 5 cmH2O and PaO2 higher than 60 mmHg, was placed on spontaneous ventilation mode (PSV+CPAP) to maintain a PEEP of less than or equal to 5 cmH2O, PS of less than or equal to 8 cmH2O and FiO2 of less than or equal to 40%. After 2 hours, measured tidal volume and respiratory rate to calculate the RSBI then the patient was extubated. From 72 patients were enrolled in this study, 26 patients failed in extubation. The total RSBI threshold was 6.7 breath/min/ml/kg (AUC = 0.739, 95%CI = 0.618 – 0.861; p = 0.001)) with a sensitivity of 73.1% and a specificity of 80.4% for success of extubation. Patients successfully extubated had significantly lower RSBI 4.65 ± 3.03 breath/min/ml/kg compared to extubation failuregroup. Based on the result of this study, the rapid shallow breathing index with a threshold of 6.7 breath/min/ml/kg was considered to be an acceptable and practical criterion for predicting the outcome of weaning in children

Diagnostic criteria for acute lung injury (ALI) and Acute RespiratoryDistress syndrome (ARDS) includes acute onset of disease, chest radiographdemonstrating bilateral pulmonary infiltrates, lack of significant left ventriculardysfunction and Pao2/Fio2 (PF) ratio ≤300 for ALI or ≤200 for ARDS. Recent criteriarequire invasive arterial sampling. The pulse oximetric saturation Spo2/Fio2 (SF) ratiomay be a reliable non-invasive alternative to the PF ratio. In this cross-sectional study, we enrolled 70 patients with ALI or ARDSwho were admitted in Tabriz children’s hospital pediatrics intensive care unit (PICU).Spo2, Fio2, Pao2, charted within 5 minutes of each other and calculated SF and PFwere recorded to determine the relationship between SF and PF ratio. SF values wereexamined as a substitute of PF ratio for diagnosis ARDS and ALI. The relationship between SF and PF ratio was described by the followingregression equation: SF=57+0.61 PF (P<0.001). SF ratios of 181 and 235 correspondedof PF ratio 300 and 200. The SF cutoff of 235 had 57% sensitivity and 100% specificityfor diagnosis of ALI. The SF cutoff of 181 had 71% sensitivity and 82% specificity fordiagnosis of ARDS. SF ratio is a reliable noninvasive surrogate for PF ratio to identify childrenwith ALI or ARDS with the advantage of replacing invasive arterial blood sampling bynon-invasive pulse oximetry.

One ofdiagnostic criteria for Acute Lung Injury and Acute Respiratory Distress Syndrome is pao2/fio2 (PF) ratio 300 for ALI or 200 for ARDS. This criteria requires invasive arterial sampling. Measurement of Spo2/Fio2 (SF) ratio by pulseoximetry may be a reliable non invasive alternative to the PF ratio. Methods and Materials: In a cross sectional study we enrolled 105 sample of patients with ALI or ARDS, to determine the Spo2/Fio2 (SF). Pao2 wasmeasured through arterial blood sampling and Spo2 measured with pulse oximetry and documented within 5 minutes of each other. The relationship between SF and PF ratio was described by the following equation: SF=57+0/61PF (P<0/001). Spo2/Fio2 (SF) ratios of 181 and 235 can be substituted pao2/fio2 (PF) ratio of 200 and 300 in ARDS and ALI respectively. The ALI SF cutoff of 235 had 57% sensitivity and 100% specificity, and ARDS, SF cutoff of 181 had 71% sensitivity and 82% specificity. Spo2/Fio2 (SF) ratio is a reliable noninvasive marker to determine children with ALI or ARDS and can be used instead of it.

Diagnostic criteria for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) requires acute onset of disease، chest radiograph demonstrating bilateral pulmonary infiltrates، lack of significant left ventricular dysfunction and Pao2/Fio2 (PF) ratio 300 for ALI or 200 for ARDS. And the latter one requires invasive arterial sampling. Measurement spo2 by pulse oxi metry and calculation spo2/Fio2 (SF) ratio may be a reliable non invasive alternative to the PF ratio.

In this cross sectional study، 70 patient diagnosed for ALI or ARDS admitted in Tabriz children’s hospital PICU were enrolled. Then spo2، Fio2، Pao2 charted within 5 minutes were measured and the ratio of SF and PF were calculated and compared. SF threshold the values were determined to replacement PF ratio for diagnose ARDS and ALI.

The relationship between SF and PF ratio was described by the following regression equation SF=57+0/61PF (P<0/001). SF ratios of 181 and 235 corresponded of PF ratio 300 and 200. The ALI SF cutoff of 235 had 57% sensitivity and 100% specificity، and ARDS، SF cutoff of 181 had 71% sensitivity and 82% specificity.

SF ratio is a reliable noninvasive marker for PF ratio to identify children with ALI or ARDS. A nd can be replaced pulse oximetry by arterial blood sampling.