mehrnaz olfat

The symptoms and laboratory findings of Kawasaki disease (KD) and systemic-onset juvenile idiopathic arthritis (SoJIA) may overlap in the early phases. Coronary artery lesions are common complications seen in KD.

Cases Presentation: 

In this article, we report three cases of SoJIA (two males and one female) with prolonged relapsing fever and coronary artery involvement. Initially, all three cases were presumed to have KD and were treated with IVIG. All three cases had arthritis and lymphadenopathy, and one of them had a skin rash. After 3-8 weeks, fever and main clinical symptoms returned. In the second evaluation, they met the criteria for SoJIA and were treated with methylprednisolone, ibuprofen, and methotrexate. High ferritin levels were observed in all three cases (mean=6024 ng/ml).

Coronary artery involvement may rarely be seen in the early phases of SoJIA. Continuing or relapsing fever, late-onset arthritis, and increased serum ferritin levels may help distinguish SoJIA from KD.

The patient was an 11-year-old boy who was referred to our emergency department with a chief complaint of dry cough and shortness of breath. He was diagnosed with asthma when he was three years old and was treated with inhalers as needed. On physical examination, he had respiratory distress and biphasic wheezing. The patient was initially managed as an asthma attack; however, he did not respond to the treatment completely. After a pulmonology consult, he underwent a spirometry test, which was compatible with an obstructive pattern. He was a candidate for fiberoptic bronchoscopy, which revealed findings in favor of vocal cord dysfunction (VCD) and adult-onset laryngomalacia. As part of the management of VCD, we referred him to a psychiatric clinic, evaluating for psychological problems as aggravating factors. We found that he suffered from psychological disorders, including somatic symptoms disorders and mild to moderate depression. The patient was treated for his psychiatric problems. He responded to the treatment well, and the cough and dyspnea attacks resolved gradually after a few months.

 Mechanical ventilation (MV) is among the most common therapeutic modalities in pediatric intensive care units (PICU), which works based on a defined ventilation mode. Nowadays, conventional and alternative modes including adaptive pressure control (APC) and non-APC modes are frequently employed. Although MV can be helpful in many cases, it may cause some complications resulting in significant morbidity and mortality.

 This study aimed to investigate the demographic features and complications of mechanically ventilated children in a PICU in Iran, as well as to compare different ventilation modes.

 A retrospective case-control study was conducted in PICUs of children’s medical center hospital - a tertiary referral pediatric hospital.

 Of 66 patients included in this study, 33 patients were treated with APC modes, whereas 33 patients were treated with non-APC modes. The most common indications for intubation were respiratory failure (53%) and loss of consciousness (13.6%). The mean duration for intubation in patients with and without underlying disorder were 11.7 and 5.2 days, respectively (P-value < 0.01). The means of time for intubation in the APC and non-APC groups were 10 and 11.9 days, respectively (P-value = 0.145). A total of 23 (34.8%) patients had complications, including death, misplacement of the endotracheal tube, atelectasis, unplanned extubation, etc. There was no significant difference between groups regarding the rates of complications, except for atelectasis. Thirteen (19.7%) patients had atelectasis (2 patients in APC group (6%) and 11 patients in non-APC group (33.3%)) (P-value = 0.022). The mortality rate was the same for the both groups (P-value = 1).

 In sum, the most common indication for intubation was respiratory failure. No significant difference was observed among patients treated with the APC, and non-APC modes in terms of the complications occurred, except for atelectasis which occurred more frequently in the non-APC group. Therefore, it was concluded that there was no difference between conventional and alternative modes of mechanical ventilation in terms of morbidity and mortality.

Cystic fibrosis (CF) is an inherited disease which involves multiple organs including respiratory tract. It results in chronic respiratory signs and symptoms which exacerbate with frequent lung infections. The majority of exacerbations require hospitalization and intravenous antibiotic therapy as part of the management. The aim of this survey was to study the effectiveness of outpatient management of pulmonary exacerbations on pulmonary function tests. This randomized clinical trial included all CF patients older than 6 years old who presented with a pulmonary exacerbation and were able to perform Spirometric tests. All eligible CF patients first referred to pulmonary function tests center to determine forced expiratory volume in the first second (FEV1), residual volume (RV), total lung capacity (TLC) and airway specific resistance (SRaw). Then, they were treated outpatiently for 2 to 4 weeks and after that, they underwent all the tests again; and the participants’ improvements in pulmonary function tests after outpatient treatment were investigated. In this study, 32 patients were enrolled including 13 women (40.6%) and 19 men (59.4%). Mean and standard deviation (SD) of pulmonary variable, before and after the treatment were investigated. All of them were statistically significant. Sub-analysis of data based on gender was also performed showing that outpatient treatment led to significant improvements in all of the variables except for the percentage of RV in females (p value = 0.08). The findings revealed that outpatient management of CF exacerbations effectively improved values of FEV1, SRaw and TLC along with reducing RV values and air trapping. Thus, applying this method on appropriately selected CF patients, may prevent unnecessary hospitalization and subsequent disadvantages.

 Staphylococcus aureus is a gram-positive coccus bacterium responsible for a wide spectrum of human infections. The main colonization site for S. aureus in humans is the anterior nares. Health care workers (HCW) are commonly colonized with resistant microorganisms; however, it is not clear whether close contact with HCW is a risk factor for colonization with resistant microorganisms.

 The aim of the study was the determination of the risk of methicillin-resistant Staphylococcus aureus transmission from colonized parents to their children via daily contact.

 This was a cross-sectional study conducted in Hamadan city, the west of Iran, between October 2016 and March 2017. We defined two groups for our investigation. The first group included 1 - 6 years old children who their mother, father, or both were health care workers (HCW) in university-affiliated hospitals of Hamadan University of Medical Sciences, and the second group consisted of children whose parents were not health care workers. Both groups attended day care centers. One hundred and thirty-four children were enrolled in this study, from which 67 had HCW parents, and 67 had non-HCW parents.

 S. aureus colonization rate among children of HCWs was 17.9 % (12/67), and in children of non-HCWS was 32.8% (22/67). The colonization rate was not significantly different between these 2 groups (P = 0.052). Of all the S. aureus isolates, one methicillin-resistant isolate and one clindamycin-resistant isolate were observed. The D-test was positive in 12.1% of clindamycin sensitive isolates

 We recommend the use of anti-staphylococcal penicillin or first-generation cephalosporins in cases of non-life-threatening staphylococcal infections and clindamycin for MRSA infections. Regarding to our results, there is no difference in the choice of antibiotic between children of health care workers and other children. We also recommend avoiding switching therapy from erythromycin to clindamycin.

Subclavian artery thrombosis is an uncommon cause of limb ischemia in females without a history of vasculopathy. This condition usually occurs secondary to atherosclerotic changes and hypercoagulable states, which are generally asymptomatic. However, it can manifest with such symptoms as coldness, pain, and pulselessness in the upper extremity. Herein, we presented a 40-year-old female admitted to our hospital with three days history of right-side hemiparesis and complaints of imbalance and vertigo. The patient had a history of 2-month consumption of high-dose oral contraceptive (OCP) agents for birth control purposes. Cervical magnetic resonance angiography showed a significant occlusion in the proximal part of the left subclavian artery, leading to the diagnosis of subclavian artery thrombosis secondary to the use of long-term high-dose OCP. Our diagnosis was confirmed with the Doppler color sonography. This case demonstrated the importance of a full assessment regardless of the patient’s chief complaints. This kind of assessment allows for a faster and more effective management, thereby reducing the associated costs. Therefore, any suggestive signs or symptoms of arterial thrombosis should be followed up even in low-risk patients. Accordingly, in case the achievement of confirmatory findings regarding the diagnosis of arterial thrombosis, the patient should be immediately subjected to proper medical and surgical interventions.

As a new supplementary therapeutic option, cardiac rehabilitation (CR) is getting more attention every day. Several studies have proved its positive impact on qualitative criteria; but few studies have been done on quantitative criteria. The purpose of the present study is to evaluate the impact of CR on non-invasive measurement of maximum cardiac output by Pulse Pressure index (PPI) at the peak of exercise.
This is a non-randomized prospective cohort study conducted in Hamadan, Iran in 2015. One hundred eligible patients who had undergone coronary artery bypass surgery participated in our study, after obtaining cardiologist permission and informed consent. The PPI was measured at the peak of exercise before and after standard CR program.
Mean PPI was not significantly different before and after CR. PPI was significantly increased in patients younger than 60 years old (P = 0.022). In contrast to hypertensive patients, PPI increased significantly after CR in non-hypertensive patients (P = 0.002). PPI was significantly increased in non-diabetic patients after CR (P = 0.046), but not in diabetic individuals. Other variables did not show any statistically significant effect on PPI in response to CR.
Findings from our study revealed that PPI is associated with vascular atherosclerosis, as well as cardiac output; Positive effects of CR diminish in older, diabetic and hypertensive patients with more progressive atherosclerosis.

Kawasaki disease (KD) is an acute febrile illness of childhood that can lead to significant coronary artery abnormalities, particularly in untreated patients. Diagnosis of KD is made in the presence of its standard criteria, including bilateral conjunctivitis. Some patients do not fulfill the diagnostic criteria and are known as atypical KD..
In this report, we describe a 12-year-old boy presenting with prolonged fever, unilateral conjunctivitis, ipsilateral preauricular lymphadenopathy, skin rashes, and finger scaling. The initial evaluation for KD was negative, so he received gentamycin as a case of oculoglandular syndrome. The fever subsided, but he developed bilateral conjunctivitis later in course of the disease. A second echocardiograph revealed coronary artery dilation. He immediately received intravenous immunoglobulin (IVIG) and aspirin and was discharged from hospital with a recommendation of close follow-up..
To our knowledge, KD presenting with unilateral conjunctivitis and oculoglandular syndrome is not reported to date. G iven that delay in diagnosis and treatment of KD can cause serious cardiac complications, the diagnosis of Kawasaki disease should be considered in such cases..

Tracheal bronchus or pig bronchus is a rare congenital lung anomaly .In this condition, an ectopic bronchus arises from the lateral wall of the trachea, more commonly from right side. Although pig bronchus is usually asymptomatic, however in some patients it is presented with recurrent pneumonia and segmental atelectasis..
The patient was a five-month-old female referred to the clinic because of pneumonia with inappropriate response to antibacterial treatment and previous history of recurrent pneumonia. On chest X-ray, she had reduced volume right lung with mediastinal shift to the right side. Thorax computed tomography scan (CT scan) revealed pneumonitis. On bronchoscopy, there was no foreign body, but purulent exudates and fibrin were observed in her right lung and possibility of tracheal bronchus was not proposed. Although axial views of CT scan did not determine any anatomic anomaly, the coronal view reconstruction of her first CT scan revealed tracheal bronchus above the carina on the right side. The images of axial cuts of CT scan re-inspect one more time; it was interesting that it had some evidence of tracheal bronchus..
Recurrent pneumonia in right upper lobe sensitized physicians about the possibility of congenital anomalies particularly tracheal bronchus and coronal view reconstruction of CT scan should be requested..

Nowadays, parasitic infections are a major health problem throughout the world, particularly in the developing countries.. Considering the high susceptibility of children against parasitic infections, the current study aimed to determine the prevalence and associated risk factors of intestinal parasitic infections among children less than 10 years old in urban and rural areas of Hamadan district..Patients and The current study was conducted on 395 children (214 males and 181 females), referred to urban and rural health centers in Hamadan district in 2013. Stool samples were examined by formalin-ether concentration technique, and trichrome and modified Ziehl-Neelsen staining methods. The results were analyzed by chi-square test.. Of the 395 studied children, 112 (28.4%) were infected with intestinal parasites. Blastocystis hominis was the most frequently detected parasite with the prevalence of 18.5%, followed by Giardia lamblia (10.9%), Entamoeba coli (2.8%), Dientamoeba fragilis (0.8%), Iodamoeba buetschlii (0.8%), Chilomastix mesnili (0.5%), Cryptosporidium spp. (0.5%), Endolimax nana (0.3%) and Entamoeba hartmanni (0.3%). No cases of infection with helminth parasites were found.. The results of the study showed a high prevalence of Giardia lamblia and Blastocystis hominis in rural areas compared to urban regions. Therefore it is necessary to promote the public health awareness in the rural population, in order to reduce the frequency of parasitic infections..

Kawasaki Disease (KD) is an acute febrile vasculitis of early childhood and the leading cause of acquired heart disease in children. The most important complication of KD is coronary artery aneurysm that may lead to thrombosis and myocardial infarction, occurring in 25% of untreated cases. Fortunately, timely treatment decreases it to 2 - 4%. There is no specific test for the diagnosis of KD, which is entirely based on clinical and laboratory criteria.. Since KD is very common in Iran and other Asian countries, it is necessary to get a clear picture on the frequency of KD related anomalies in the clinical and laboratory findings as well as the frequency of coronary aneurysms in our region..Patients and We retrospectively studied the medical records of all children discharged from the Besat Hospital, Hamedan, Iran, with a final diagnosis of KD, from 2004 to 2013. Outpatient documents were also studied. Demographic data, clinical features, laboratory and echocardiographic findings were also recorded onto the forms.. Seventy four patients, 43 (58.1%) males and 31 (41.9%) females, were discharged with a final diagnosis of KD, 77% of which were less than 5 years old. No seasonal variability was noticed in the study population. Among all cases, 44 (59.5%) were diagnosed as complete and 30 (40.5%) as incomplete KD. Conjunctivitis, considered as the most common clinical finding, occurred in 79% of patients, whereas peripheral erythema was the least common, corresponding to 23% of cases. Finger desquamation and leukocytosis occurred in 54% and 49.3% of cases, respectively. Amongst the timely-treated patients, 11 (14,8%) developed coronary artery aneurysm.. Sex, age, and seasonal patterns of KD in Hamedan Province, IR Iran, are similar to other regions. However, finger desquamation is less prevalent, diminishing its value as a measure for patients’ follow up. The most common supplementary laboratory criteria were leukocytosis, thrombocytosis and anemia, which were determined by a complete blood count. Coronary artery aneurysm in timely-treated patients was far more common compared to other studies, which may indicate the need for revising the golden time for initiating the treatment..