فهرست مطالب elham pourbakhtyaran

 COVID-19 infection and its neurological manifestations were seen in children although less common than adults. The aim of this study was to determine the frequency of different types of neurologic findings of hospitalized children with COVID-19. ]

 This retrospective study was performed on hospitalized pediatric patients aged≤18 years with confirmed SARS-CoV-2 at Children’s Medical Center Hospital. Neurological manifestations were defined as the presence of any of the following symptoms: seizure, altered mental status, behavioral/personality change, ataxia, stroke, muscle weakness, smell and taste dysfunctions, and focal neurological disorders.

 Fifty-four children with COVID-19 were admitted and their mean age was 6.94±4.06 years. Thirty-four of them (63%) were male. The most frequent neurological manifestation was seizure (19 [45%]) followed by muscle weakness (11 [26%]), loss of consciousness (10 [23%]), and focal neurological disorders (10 [23%]). Other neurological manifestations consisted of headache (n=7), movement disorders (n=6), behavioral/personality change (n=5), ataxia (n=3), and stroke (n=3). Twenty-nine percent of our patients had leukocytosis. A neutrophil count above 70% was seen in 31% of participants. Among our patients, 81% had a positive reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2.

 During the current pandemic outbreak, hospitalized children with COVID-19 should be evaluated for neurological signs because it is common among them and should not be under-estimated.

Introduction. Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis. Methods. In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed. Results. Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones. Conclusion. Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required.

Spinal cord tumors are a rare diagnosis in children, mostly presented with unspecific symptoms which may pose a problem due to their possible malignancy and further complications. Yet there is little data regarding spinal cord lesions in our country. The aim of this study is to present a series of 37 cases of primary spinal tumors treated at the same institution and briefly review their pathology, symptoms and site of occurrence.

 37 cases of spinal cord tumors and masses were selected from March 2007 to 2017, excluding spinal dysraphism. Data regarding age, sex, clinical presentation, location of the mass, and pathology were retrospectively collected.

Mean age at diagnosis was 5 years and 8 months (standard deviation: 4.1 years). 21 were male and 16 were female (male-to-female ratio: 1.31). Pathological findings were 9 Neuroepitheliomas (6 Neuroblastoma, 2 Ganglioneuroma, 1 Ganglioneuroblastoma/Ganglioneuroma), 4 Ependymomas, 3 Primitive Neuroectodermal Tumors, 3 Glial tumors, 4 Neurodevelopmental tumors, 3 Lymphomas, 1 Hemangiopericytoma and 1 Neurofibroma. 26 patients had Motor symptoms (74.2%), 14 had pain (40%), 6 showed sensory symptoms (16.6%) and 4 had urinary symptoms (11.4%). The most common location of occurrence was the lumbosacral region.

While differing in pathological composition and location of tumors in comparison to other papers, our study presents possible presentations and/or expected pathologies in pediatric spinal cord tumors.

Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus.

This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital.

This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the IranianMinistry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records.

On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI.

The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.

Succinate dehydrogenase (SDH) deficiency is a rare autosomal recessive neurometabolic disorder that causes brain insult, neurodevelopmental delay, exercise intolerance, and cardiomyopathy. A 25-month-old boy was referred to our neurometabolic center due to developmental regression after injecting the influenza vaccine when he was 10 months old. Magnetic resonance imaging (MRI) showed high signal changes in the brain white matter, and magnetic resonance spectroscopy (MRS) detected a high succinate peak at 2.4 parts per million (ppm). The evaluation of urine organic acids showed a significant elevated succinic acid and whole exome sequencing, confirming SDH. Treatment with a mitochondrial cocktail was initiated, and remarkable improvement was observed. SDH deficiency as a treatable neurometabolic disorder should be considered in any patients with developmental disorders, accompanied by hyperintensity in white matter (as similar to leukodystrophia). Further evaluation is recommended since outcomes depend on early diagnosis and treatment.

Acute Spinal Subdural Hematoma (ASSH) is a rarely recognized condition that may result in severe irreversible neurologic complication. We presented a 7-year old girl was transferred to our hospital with limping and pain in lower extremities and acute paraplegia without history of direct trauma. The patient's lower limbs weakened. She was unable to bear weight. Deep Tendon Reflexes(DTR) in lower extremities had increased. Her MRI showed spinal subdural hematoma we reextended from T2 to T6. We performed laminectomy from T2 to T5 and about 70 cc of subdural hematoma was evacuated. After a month after the operation, the patient's neurological deficit resolved completely. The case illustrates the need of attention to clinical manifestation of acute spinal subdural hematoma and early diagnosis to prevent irreversible neurologic complication.

Renal diseases can be asymptomatic even in progressive disorders; therefore, detecting urine and ultrasound abnormalities may help facilitate early diagnosis and prevention of renal diseases. This study was conducted to investigate random urine parameters and urinary system ultrasonography findings in 7-11 year-old students. Healthy students from Tehran and Qom, Iran were enrolled in a prospective descriptive study and their sex, age, weight, height, and BMI were measured. Then, a fresh clean urine sample was collected and ultrasonography of the urinary tract was done. The urine specimen was tested for urine Ca/Cr, urine oxalate/Cr, and urine citrate/Cr. Of 932 students, 47.9% were female and 52.1% were male. The age range of the students was 7-11 years with a mean age of9.08 years. A history of renal disease and UTI was positive in 1.1% and 9.9% of the students, respectively. Ultrasound was normal in78% and abnormal in 22% of the students. Abnormal findings included hydronephrosis in 1.1%, fullness of the urinary tract in 0.1%, urinary system duplication in 3%, urolithiases in 0.7%, decreased kidney size in 0.4%, increased bladder thickness in 8.9%, and other abnormal findings in 7.8% of the subjects. Abnormal urine findings included hypercalciuria, in 10.9%, urine hyperuricosuria in 5.4%, urine hyperoxaluria in 12.8%, and hypocitraturia in 96.9% of the students. According to the results, nephrolithiasis may be due to hyperoxaluria, hypercalciuria, and hyperuricosuria in a normal population. Genetics and nutrition are more important risk factors. Therefore, some nutritional interventions for decreasing urine oxalate, calcium, and uric acid may be beneficial. Keywords: Urinalysis; Ultrasonography; Hypercalciuria; Hyperuricosuria; Hyperoxaluria; Child.

Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation (ROHHAD) is a rare disease. To date, there have been only few reported cases of ROHHAD syndrome.
We report a 5-year-old- Iranian girl who had normal growth and development until her 4th year of life. At that time, the patient developed weight gain, constipation, coldness in the extremities, and hyperhidrosis. She first presented to our children’s hospital with a suspected mediastinal mass on chest radiography. After surgery and resection of the mass (a ganglioneuroblastoma), extubation was unsuccessful, with tachycardia and hypertension occurring after each attempt. After 48 days in the ICU, we were still unable to wean her from mechanical ventilation. Finally, based on the rapid weight gain, hypoventilation, hypothalamic dysfunction, and signs of autonomic dysregulation, the patient was diagnosed with ROHHAD syndrome.
Only a few case reports have described ROHHAD syndrome, and it is therefore difficult to manage. In children with rapid and early-onset obesity associated with hypothalamic-pituitary endocrine dysfunction, ROHHAD syndrome should be considered in the differential diagnosis.

Congenital pulmonary lesions may be diagnosed through ultrasonographic screenings or be revealed as causes of respiratory distress in the neonatal period and infancy. Less commonly, they are detected as incidental features..
Our study represents the diversity of congenital pulmonary lesions and their characteristics during an 11-year period in a referral teaching children’s hospital in Tehran, the capital city of Iran..
Data from an 11-year period of patients with the final diagnosis of congenital pulmonary lesions in Mofid Children’s hospital were reviewed. The data included the prenatal ultrasonographic, postnatal radiographic, and pathologic diagnoses, along with the patient’s age, way of presentation, length of hospitalization, and accompanying features and morbidities..
Of 37 cases of congenital pulmonary lesions, 28 cases (75%) were boys. Thirty-six cases (97.2%) presented with pure pulmonary signs and symptoms. Of these cases, 16 (43.2%) were neonates, 17 (46%) were infants, and 4 (10.8%) were children. Twenty-seven (73%) patients missed the opportunity for early diagnosis. In order of frequency, cases were diagnosed as congenital lobar emphysema (43.5%), congenital cystic adenomatoid malformation (32.5%), pulmonary sequestration (19%), hybrid lesion (2.5%), or bronchogenic cyst (2.5%)..
In an analysis of retrospective data of 37 congenital pulmonary lesions, male predominance was obvious, as has been found in previous studies..

Addiction imposes a large medical, social and economic burden on societies. Currently, there is no effective treatment for addiction. Our struggle to decipher the different mechanisms involved in addiction requires a proper understanding of the brain regions which promote this devastating behavior. Previous studies have shown a pivotal role for insula in cigarette smoking. In this study we investigated the change in opium consumption after CVA. This study took place in three referral academic hospitals affiliated to Tehran University of Medical Sciences. Patients who suffered a CVA and were addicted to opium were recruited during their hospitalization or visit to the neurology clinic in this study. Age, sex and the route and mean amount of opium use of each patient before CVA and 1, 3 and 6 months post-CVA was asked using a questionnaire. The patients were divided into three groups based on the location of brain ischemia (insula, basal ganglia and non-insula non-basal ganglia group). Seventy five percent of the patients with ischemia of the insula changed the route or amount of opium use after CVA and 37.5% of them stopped opium use after CVA. These values were significantly higher than patients with non-insula non-basal ganglia ischemia (p values 0.005 and 0.03 for change in route or amount and stopping opium use, respectively). This was not true in patients with ischemia of the basal ganglia. Younger patients were more likely to change the route or amount of opium use and stop opium use after CVA (p values 0.002 and 0.026, respectively). The results of the present study indicate a possible role for the insula in opium addiction, especially in younger individuals.

Traditional haemostatic techniques in total thyroidectomy may cause some damages to surrounding tissues. It is believed that these damages can be reduced using ultrasonic dissector devices like Harmonic Scalpel (HS).. In this study, we investigated the efficacy of ultrasonic dissectors (HS) versus conventional techniques (Clamp and Tie)..Patients and A single blinded randomized clinical trial was performed at a referral educational center. Sixty eight eligible participants were enrolled and assigned to conventional group (operated with Clamp and Tie technique) and HS group (operated with Harmonic Scalpel). The following items were recorded in both groups: haemostatic technique, operative blood loss, duration of surgery, length of hospital stay, pathology, thyroid weight, postoperative recurrent laryngeal nerve injury, change in calcemia, pain, drainage volume and hematoma formation.. The results demonstrated that application of HS in thyroidectomy significantly reduces operating time (P < 0.0001) and Intra operative bleeding (P < 0.0001). Postoperative drainage (P < 0.0001), pain (P < 0.0001), hypocalcemia (P < 0.0001), and length of hospitalization (P < 0.0001) were significantly lower in HS group. Voice score was significantly lower in HS group (P < 0.0001).. HS in total thyroidectomy, reduces operating time, blood loss, postoperative pain, drainage volume, voice changes, and postoperative hypocalcemia, compared to conventional techniques..

Introduction. Assessment of the hemodialysis adequacy is one of the key factors in evaluating health service system. This would provide a good background for effective future planning by healthcare authorities. In this study, we aimed to evaluate the hemodialysis adequacy in Iran.Materials and Methods. One hundred and twenty-seven hemodialysis centers affiliated to 30 medical universities in Iran participated in this cross-sectional multicenter national study. All demographic data as well as hemodialysis prescription data, including blood flow rate, length of the hemodialysis session, hemodialysis membrane type, and composition of the dialysis solution were recorded for each patient. In addition, urea reduction ratio and Kt/V were calculated to determine the hemodialysis adequacy.Results. A total of 4004 patients were included in this study, 2345 men (58.6%) and 1659 women (41.4%). Bicarbonate-based solutions and low-flux membranes were prescribed for 77.0% and 97.6% of the patients, respectively. The mean blood flow rate was 242.9 ± 39.2 mL/min. The mean length of hemodialysis session was 229.2 ± 22.2 minutes. The mean urea reduction ratio and Kt/V were calculated to be 61.0 ± 11.8% and 1.2 ± 0.4, respectively. A Kt/V less than 1.2 and a urea reduction ratio less than 65% were found in 56.7%, and 65.2% of the hemodialysis patients, respectively.Conclusions. This study showed a substantial inadequate hemodialysis in Iran as compared with the Kidney Disease Outcomes Quality Initiative guidelines. Considering the impact of dialysis adequacy on quality of life and survival rates, as well as healthcare costs, rigorous attempts to achieve the desired goals are necessary.