Journal of Comprehensive Pediatrics
Volume:1 Issue: 2, Dec 2007

Kawasaki disease (KD) is a systemic vasculitis that occurs most commonly in children les than 5 years. We assessed 85 cases of the disease (KD) in Iranian society of pediatrics from March 2004 to March 2005. We retrospectively analyzed 85 medical records of children with KD; SPSS software Version 13.0 for windows was used for this statistical analysis. The distribution for clinical manifestations and laboratory findings were observed by using data collected from questionnaire forms enrolled all over Iran. In our report, 35 cases fulfilled all diagnostic criteria of KD whilst 36 cases had incomplete criteria (atypical form). 14 cases that enrolled were not fulfilled those criteria. Our criteria for case definition were according to Rowley's and Newburger’s studies. We think that the number of atypical cases appears to be increasing.

Home monitors designed to identify cardiorespiratory events are frequently used for premature infants who suffer from persistent apneic and/ or bradycardic events after they are otherwise ready for discharge home. We have hypothesized that using event recording monitor will characterize the events during home monitoring and identifies at what postconceptional age (PCA) the infants are event free. 12 hours bedside four channel pneumogram was performed on 452 preterm infants born at ≤34 weeks of gestational age before hospital discharge. 108 infants had at least one episode of apnea≥20 second and/ or one episode of bradycardia< 80 beats per minute (BPM) for ≥5 second and they were considered symptomatic and discharged on event recording monitor. The monitor documented transthoracic impedance, electrocardiogram and heart rate. The monitor was downloaded at least once a month. An event was considered to be significant when an apnea lasted ≥20 seconds or when the heart rate was <80 BPM for ≥5 seconds for PCA <44 weeks and <60 BPM for PCA ≥44 weeks. Each infant was monitored for at least one month after the last event. Infants who were monitored for <50% of available days or <8 hours per day were excluded from the study. Duration of post discharge monitoring ranged from 4-30 weeks (median 7 weeks). When the patients were events free PCA ranged from 34-55 weeks (Median 39 weeks). Compliance for the usage of monitor for available days was 50-100% (median 100%). For daily use the time range was 8-12 hours (median 19 hours). During 152,664 hours of home monitoring 1,240 events were recorded. Of these events only 184 were apnea more than 20 seconds 47% of infants did not have apnea ≥20 seconds after discharge. 80% of infants with apneic episode had ≤5 episodes during home monitoring. Bradycardia without apnea of at least 20 seconds represented 32% of the events. 75% of bradycardiac episode were associated with short apnea (10±4 seconds). Preterm infants discharged home on event recording monitor had low incidence of apnea ≥20 seconds. Using event record monitor will characterize the events during home monitoring and is helpful in determining the appropriate time of discontinue monitoring

Lung abscess is a rare and jeopardizing disease. It is still capable of causing substantial mortality in children.We performed a retrospective study on 22 children during a 15-year period in our center. A total of 22 children were identified including 13 boys and 9 girls. Five of them had primary lung abscess and seventeen had secondary type. Thirteen of the cases (60%) were diagnosed only by CT-scan without any other evaluation. Eighteen cases had been managed by antibiotic and the mean duration of antibiotic therapy was 12 days. Surgical procedure was done in 4 cases. Gram positive organisms i.e Streptococcus pneumonia and Staphylococcus aureus were the most prevalent organisms involved in our cases. No complications and mortality were seen in our study.

Urtica dioica is a plant that is used as an edible herb with capability of lowering blood glucose. The aim of this study was to determine the effects of extracted and purified blood glucose lowering substance (BGLS) of Urtica Dioica on mice and then in patients with type I diabetes mellitus. The effective substance of the extract was prepared and identified by thin layer chromatography method and then by gel filtration, Fourier transform infra red, mass spectrometry gas chromatography and paper chromatography after acid hydrolysis. Different case control studies were done by this substance on mice. Eight hours before and during the tests all of the mice were fasted. At the first stage 4 separate studies, each in 3 groups of normal mice were done, and blood glucose (BG), liver glycogen, serum insulin and muscle lactic acid were measured after intraperitoneal (ip) injection of BGLS in the first group, distilled water in second group and no injection in the third group. At second stage 20 mice became diabetic by administration of streptozotocin and then divided into two even case and control groups and blood glucose (BG) was measured before and after ip injection of BGLS. At the third stage, BG was measured before and after oral administration of BGLS to normal mice. At fourth stage LD50 of substance was identified in mice and at the 5th stage, in a short 2 day study on 8 patients, the effect of oral administration of one dose of BGLS at 00:07 h on the second day was evaluated. In the first stage, BG of the first group with the mean of 76 ± 5 mg/dL was significantly lower than the second and third groups (108±8 mg/d and 105±9 mg/dL, respectively; p<0.001). Serum insulin level was not significantly different among the 3 groups. Liver glycogen of the 1st group (10.74 ± 0.23 mg/g) was significantly more than the 2nd group (10.08 ± 0.21 mg/g, p = 0.03) and the 3rd group (9.95 ± 0.24, p = 0.016). Lactic acid level of muscles in the 1st group (1.4 ± 0.07 mg/dL) was higher than the 2nd & 3rd group (1.07 ± 0.07 mg/dL and 1.02 ± 0.06 mg/dL respectively) (P < 0.001). In the second stage, BG level was 158 ± 8 mg/dL after 4 hr of ip injection of BGLS in the case group vs 319 ± 14 mg/dL in control group (P < 0.001. In the third stage). BG decreased from 137 ± 7.1 to 77 ± 17 mg/dL in normal mice after oral administration of BGLS, that was significantly more than decrement in control group (from 146 ± 11 to 120 ± 19 mg/dL) (P < 0.01). In the fourth stage, The amount of LD50 of BGLS was 8.9 mg/ 30 gram mouse. Finally study on patients with type 1 DM resulted in decrement of blood glucose at 2200 h that was significantly lower than the previous day (P=0.001). There is a glucose lowering substance in Urtica dioica that does not increase insulin secretion and can be absorbed through intestinal lumen.

Human brucellosis, a multi-organ system disease which may mimic other conditions, has a low incidence in childhood and the diagnosis may be easily missed. Brucellosis has become a major medical problem in some provinces of Iran. This study aimed to examine the epidemiology, clinical, and laboratory features, and treatment outcome of Brucellosis. We retrieved and reviewed the records charts of all patients admitted to pediatric infectious diseases, Ghods Hospital from March 1995 to March 2004 with a clinical diagnosis of brucellosis whose brucella agglutination titer was 1:160 or greater in department. Information on age, gender, history of using unpasteurized milk or milk products, presenting symptoms and physical signs were extracted from the patients’ files. We also noted the result of routine laboratory tests, treatment given and outcome of treatment. Children under 12 years constituted the total brucellosis admissions. One hundred and seventy-five patients (107 males, 68 females with a M/F ratio of 1.6:1) had a diagnostic label of brucellosis and a brucella titer of 1:160. Eighty-seven patients (50%) were 1-6 years old, 86 (49%) were 7-12, while 2 patients were under 1. One hundred (57%) patients were from rural areas and 75 (43%) from cities. The admission for the disease was in summer in 76 patients (43%), followed by spring in 52(30%), winter in 24 (14%) and autumn (13%). One hundred and fourteen (65%) had history of using unpasteurized milk or milk products. The most frequent symptoms were arthralgia (79%) and fever (78%). The most common physical findings were fever (51%) and arthritis (26%). Of patients, 157 cases (89.5%) had acute and 17 (9%) had chronic disease. Normal white blood cell count was found in 123 cases (71%), anemia in 33 (19%), increased erythrocyte sedimentation rate (ESR) in 92 (53%), positive C-reactive protein (CRP) in 85 (48%) and positive radiological changes in 20 (11%). The most common antibiotics used were cotrimoxazole + gentamycin in 83 (47.5%) and cotrimoxazole + rifampin in 72 (41%) cases. Brucellosis presents in various ways and should be included in the differential diagnosis of arthritis in endemic countries. As symptoms, signs and first-line laboratory findings are not characteristic, agglutination tests, and if possible, blood culture should be performed in any child with prolonged fever. Treatment is effective, but prevention of the disease by educating high risk families is indicated.

The present study evaluated efficacy of a single injection of ceftriaxone 50mg/kg IM in comparison with a 10-day treatment course with oral amoxicillin 50mg/kg/d in 3 divided doses for acute otitis media in children. A randomized clinical trial was performed on 110 children between 5 months to 12yr who randomly were divided in to ceftriaxone group (n=54) and amoxicillin group (n=56) as case and control groups, respectively. Demographic data and clinical manifestations of patients were similar in both groups. Forty-eight (88.9%) and 51 (91%) patients were cured in case and control groups, respectively. There was no significant different in response to therapy between the two group (p<0.05). This study showed that the efficacy of single injection of ceftriaxone 50mg/kg IM was equal to a 10-day treatment course with oral amoxicillin 50mg/kg/d divided in 3 doses in non-complicated acute otitis media in children.

To describe the immunologic characteristics and outcomes of the patients with serious BCG complication in a 15- year survey. A descriptive and retrospective study was performed in 2 referral pediatric infectious wards of central Children Hospital, and Rasool Akram Hospital Tehran, Iran between 1989 and 2004. We studied 76 patients (72% male and 28% female) with serious BCG complications. mean age of 14.41± 1.43 months the results were follows:severe combined immunodeficiency 15.7 % of cases Leukopenia 1.4%; lymphopenia in 2.8%; cell mediated immunodeficiency in 26.3 %, chronic granulomatous disease in 11.2%, common variable immunodeficiency 6.5 %; NK cell deficiency in 5.2%; isolated CD4 deficiency in 5.1 %; hyper IgM syndrome in 1.4 %, mild abnormality in nitroblue tetrazolium (NBT) test 4.2 %;mild hypogammaglobulinemia in 4.2 % and idiopathic disseminated BCG infection in 15.7% of patients.Nineteen patients died due to progressive disseminated mycobacterial infections. N.k cell deficiency has yet reported as a risk factor for progression and complication of BCG infection. we suggest combination therapy with IFN- and chemotherapy in all cases of" idiopathic disseminated BCG infections.

To determine the prevalence rate of ophthalmia neonatorum and its bacterial and chlamydial causes among hospital-born babies in three medical centers in Tehran, during 2001–2002. This descriptive study was performed on 3140 hospital-born babies including 1699 male and 1441 female subjects. All newborns were examined and followed up to the age 30 days after discharge for the signs of conjunctivitis. In the cases of ophthalmia neonatorum, the bacterial etiology was verified by examination of smears and cultures of ophthalmic exudates and Chlamydia Tracomatis was verified by direct immunofluorescent (DIF) microscopy. There were 170 cases of ophthalmia neonatorum (5.4%). Exudate smears were positive for Gram positive cocci in 20.6%, Gram –ive bacilli in 8.8%, and Gram negative cocci in 1.8% and were negative in 68.8%. The most frequent microorganisms found based on cultures were: coagulaseive staphylococci (15.3%), Staphylococcus epidermidis (13.5%), E. coli (7.6%), and Staphylococcus aureus (5.9%), but there was no growth in 48.2% of the cultures. DIF samples were positive for Chlamydia trachomatis in 10 cases (5.9%). Most of the affected babies were male (62.4%) and more than 75% were born through normal vaginal delivery (NVD). Premature rupture of membranes (PROM) was the most common maternal precipitating factor (10%). The prevalence rate of ophthalmia neonatorum among hospital-born babies in Tehran is considerable and neonates born to mothers with PROM through NVD, especially the male newborns should be carefully observed for development of ophthalmia neonatorum.

Intestinal parasitic diseases are very common in Iran, especially among children, and the statistics show that these pathogens are more common among primary school students, in comparison with other age groups. To determine the rate of outbreaks of these pathogens in the city of Varamin, the primary school students in the academic year 1999-2000 were studied. The method of research was descriptive and the study was observational – interviewing. The simple sampling method was carried out over 293 primary school students in the city of Varamin. The samples were tested by direct laboratory methods and sedimentary concentration. For the purpose of finding cryptosporidum, Ziel-Neelsen modified method (88 samples out of total samples) was used for detection of cryptosporidium. Of 293 primary school students, 139 (47% were reported positive) for intestinal parasited of which, 116 students (83%) had one parasite, 21 students (15%) had two parasites and 2 students (2%) had 3 parasites. Giardia contamination was seen in 78 cases (49%) and was the most common contamination. Eighty-eight samples were reported negative for cryptosporidium. There was no significant difference among students of rural and urban areas for parasitism. There was not significant difference between males and females regarding the rate of contamination. There was a significant difference between mother's and father's occupation with the rate of contamination among students. However, the above-mentioned correlation was found to be weak based on Tchouprov test (14 and 15% respectively). There was a significant difference between parent's educational level and the rate of contamination. All students were drinking hygienic water (From pipeline) and 99% of these students were washing their hands with soap and water after using toilet. This study suggested that there was a significant relationship (although weak) between mother and fathers’ occupations and the rate of contamination among students and also a significant difference, existed between parentsُ educational level and the result of stool examination indicating the importance of general awareness and knowledge in preventing intestinal parasitic diseases.

HIV has infected 4.4 million children worldwide and has resulted in 3.2 million deaths. The progression of vertically acquired HIV infection appears to have a trimodal distribution. Approximately, 15% of children have rapidly progressive type of disease, while the remainders have either a chronic progressive course or an infectious pattern typical of that in adults. Mean survival is about 10 years. Children can be asymptomatic for many years, and the appearance of an opportunistic infection in a 10-year-old child in whom AIDS is subsequently diagnosed is not rare. Neurologic findings in an infected child are: Motor delay, hypotonia, hypertonia, and/or pyramidal tract signs which may indicate progressive HIV encephalopathy or opportunisic infection of the CNS. Our case was an 8-year old boy presented with fever, vomiting, and loss of consciousness.The patient was a known case of HIV infection due to mother’s infection in perinatal period and was on treatment from 3 years before his referral. He was presented to our hospital for the fever which had started one month earlier and refractory vomiting. The patient got in coma on the chest examination; tachypnea, crackles and heart murmur were auscultated. In neurologic examination, anisocoria, right-sided hemiparesis, increased deep tendon reflexes in the right side and extensor plantar reflex, Kernig and Brudzinski signs were detected. Eventually, the patient died after 46 days of hospitalization in pediatric intensive care unit because of full sepsis..