Journal of Pediatrics Review
Volume:8 Issue: 1, Jan 2020

 Physical environment contamination and in particular, air pollution might cause long-term adverse effects in child growth and a higher risk of catching non-communicable diseases later in life.

This study aimed to overview the human studies on the association of exposure to ambient Particulate Matter (PM) with childhood obesity.
Data Sources: We systematically searched human studies published until March 2018 in PubMed, Scopus, Ovid, ISI Web of Science, Cochrane library, and Google Scholar databases.
Study Selection: All studies that explored the association between PM exposure and childhood obesity were assessed in the present study, and finally, 5 studies were used in the meta-analysis.
Data Extraction: Two independent researchers performed the data extraction procedure and quality assessment of the studies. The papers were qualitatively assessed by STROBE (Strengthening the Reporting of Observational studies in Epidemiology) statement checklist.

The pooled analysis of PM exposure was significantly associated with increased Body Mass Index (BMI) (Fisher’s z-distribution=0.028; 95% CI=0.017, 0.038) using the fixed effects model. We also used a random-effect model because we found a significant high heterogeneity of the included studies concerning the PM (I2=94.4%; P<0.001). PM exposure was associated with increased BMI (Fisher’s z-distribution=0.022; 95% CI=-0.057, 0.102). However, the overall effect size was not significant, and heterogeneity of the included studies was similar to the fixed effect model. 

Our findings on the significant association between PM10 exposure and the increased BMI (r=0.034; 95%CI=0.007, 0.061) without heterogeneity (I2=16.6%, P=0.274) (in the studies with PM10) suggest that the PM type might account for the heterogeneity among the studies. 

The findings indicate that exposure to ambient PM10 might have significant effects on childhood obesity.

Nocturnal Enuresis (NE) refers to intermittent involuntary voiding during sleep in a child aged five years or more without any other urinary tract symptoms. Although pharmacological interventions are useful, the NE of most children relapses after the medication is discontinued. Persian Medicine (PM), as an complementary and alternative medicine, offers some useful herbal remedies to manage this disorder. This study aimed to introduce the most common medicinal plants used in Iranian Traditional Medicine (ITM) for the treatment of NE in children. 

 In this study, we collected and classified the information about nocturnal enuresis in the old reliable Persian medical texts. Then the achieved information was compared with contemporary medical findings in credible published articles.

NE is a well-known disorder mentioned in PM. Lifestyle modification, in addition to herbal, animal, and mineral medicines, have been used to treat NE; however, most remedies have focused on medicinal herbs. In our investigation, 29 plants were used in ITM as the most frequently used herbs for the treatment of NE in children. These therapeutic herbs were used alone or in combination with other compounds in various forms. Most of them control NE with their anticholinergic and antispasmodic effects. Through literature review, it was found that few studies have investigated the utilization of these plants in children with enuresis.

Despite the vast use of these herbs in PM, evidence of their effectiveness in children with enuresis is not strong, so clinical trials and pharmacological tests are required to evaluate safety and efficacy of these herbal remedies.

Marcus Gunn Jaw-Winking (MGJW) synkinesis is characterized by drooping eyelid and retraction with jaw movement. MGJW is usually seen alone, although familial cases have been documented. One of the problems that may occur with MGJW is Monocular Elevation Deficiency (MED). The concomitant MGJW, congenital ptosis, and MED represent a congenital misdirection syndrome that involves oculomotor nerve. 

In this report, we present a 13-year-old girl with MGJW with severe ptosis and concomitant MED in her left eye. A brief review was performed about this case too.

MED and MGJW maybe two extremes of one disease, because there is of a high probability of the same inheritance in the two conditions (both are due to a gene defect). Also, in our case with more severe ptosis, MED appeared, while in her aunt with less ptosis and milder MGJW, MED was absent.

ABO/Rh incompatibilities are common causes of hemolytic disease of newborn. Alloimmunization due to minor RBC antigens may also cause severe hemolysis and hyperbilirubinemia necessitating exchange transfusion in the early neonatal period.

Here we report a rare case (first such report to our knowledge in Iran) of severe hemolytic disease of the newborn due to anti-Rh17 antibody (an antibody to the RhCc/Ee antigen protein) in a newborn with maternal blood group BRhd

Presenting this case would improve the insight and knowledge about managing severe hemolytic anemia due to minor group alloantibodies postnatally, and highlight the importance of prenatal surveillance and diagnosis for the optimal management of alloimmune hemolytic disease.

Laing early-onset distal myopathy is a disorder with autosomal dominant inheritance pattern caused by a mutation in the MYH7 gene that encodes the human β-myosin heavy chain. Most previous studies reported this disorder with mild symptoms involving foot and hand fingers extensors as its early-onset and neck flexors as late-onset symptoms. In this study, the previously reported cases suffered from the same mutation are reviewed, too. 

Our study describes pathological, clinical, imaging, and genetic findings in the first Iranian patient suffering from Laing distal myopathy. The subject is an 8-year-old boy with a moderate phenotype and upper and lower limbs involvement. He also showed a weakness in neck flexors, previously reported in similar cases at early ages. A genetic study was done using the whole exome sequencing method. Next generation sequencing findings revealed a c.4850-4852AGA deletion (p.k1617del) mutation in MYH7, which previously reported as the cause of Laing distal myopathy. This case is the first indication of Laing distal myopathy from Iran.

Presenting the first Iranian patient with an already known MYH7 mutation associated with Laing distal myopathy will prove the previously reported heterogeneity of this disorder’s phenotype severity, morphological variation, and age of symptoms onset.

Adipocytic tumors and its variants are common neoplasms of adults; however, they are rarely seen in paediatric age group, too.  Lipoblastoma typically occurs in children and are diagnosed by the presence of a multivacuolated lipoblast. However, things get complicated when one has to search for these lipoblasts in a background of classical lipoma. As a result, such cases are misdiagnosed and managed inappropriately. We report the first case of a congenital lipoma like lipoblastoma with an unusual presentation.

A 10-day-old male was admitted to the Paediatric Surgery Outpatient Department with a mass in his perianal region since birth. On examination, the mass was non-tender, pedunculated, and located at the margin of the anal opening. A provisional clinical diagnosis of anal tag was made, and swelling was excised. Grossly, we received a skin covered soft tissue mass measuring 1.2cm in diameter. The cut section was yellow and had a soft to firm consistency. Histopathological examination showed a well-delineated moderately cellular lesion comprising of lobules of adipocytes in varying stages of maturation; large number of mature adipocytes and few interspersed multivacuolated lipoblasts. A final diagnosis of lipoma-like lipoblastoma was made. 

Lipoma-like lipoblastoma can be seen as a congenital mass and at unusual sites like the perianal region. An accurate diagnosis of this entity is essential for appropriate management. Histopathology is the gold standard for diagnosis and calls for increased awareness.

Neuromuscular blocking agents relax skeletal muscles relaxation operation or mechanical ventilation. Accidental injection of these agents is a medical error which can lead to a minor sequel or devastating complications. We report an inadvertent subcutaneous injection of atracurium in circumcision operation and also briefly review the international databases related to the reported case.

A two month-old infant was scheduled for circumcision under local anesthesia. Five minutes after subcutaneous injection of atracurium instead of lidocaine for local anesthesia, the patient developed respiratory apnea, cyanosis, muscle relaxation, and bradycardia. Then the patient was intubated and transferred to the Neonatal Intensive Care Unit (NICU) to receive supportive care and kept under follow up. After taking supportive and therapeutic cares, there was no complication. The patient, after complete recovery, was discharged without any problems.

Despite all efforts to prevent medical errors, they can happen. Reporting these cases highlights the importance of early diagnosis of errors, correcting therapeutic interventions, and delivering accurate management of conditions for control and elimination of symptoms and complications.

The Methicillin-resistant Staphylococcus aureus (MRSA) strains cause wide spectrum infections in hospitals and are responsible for the majority of the community-acquired infections. The emergence of community-acquired MRSA in patients without risk factors represents a high risk for public health. 

In this study, we aimed to molecular typing the nasal carriage MRSA strains harbored mecA gene isolated from healthy children living in the North of Iran and also to determine the pattern of vancomycin susceptibility in these isolates.  

The MRSA strains were identified using standard microbiological and molecular procedures. The antibiotic susceptibility test was performed according to the clinical and laboratory standards institute. The MRSA strains were characterized by spa typing. 

In total, 14 different patterns of spa genes were obtained from MRSA isolates in this study, which included t790 (23.07%), t2962 (15.38%), t267 (15.38%), t159 (7.69%) and t701, t094, t1816, t11332, t937, t2135, t180, t160 [1 (3.84%) isolate per each type]. The rate of resistant isolates to cefoxitin, , cefalotin, clindamycin, cefazolin, co-amoxiclav, co-trimoxazole, and cephalexin antibiotics were 69.23%, 100%, 46.15%, 96.15%, 100%, 3.48%, and 100%, respectively. In total, six (23.07%) revealed vancomycin-intermediate resistant phenotype and five (19.23%) isolates revealed vancomycin-resistant S. aureus phenotype.

This study showed the different variants of MRSA strains based on molecular typing, among healthy children. Continuous surveillance studies to monitor MRSA should be encouraged to gain a better understanding of the circulating MRSA strains and prevent community spread of this pathogen.