Journal of Comprehensive Pediatrics
Volume:5 Issue: 1, Feb 2014

Progressive destruction of the lungs leads to increased morbidity and mortality rates in patients with CF. In various studies, it has been shown that quantitative evaluation of parenchymal changes in lung high-resolution computed tomography (HRCT) in CF patients measured by the 2006 revised Brody scoring is compatible with the clinical status. CF patients are mostly children who cannot perform complicated pulmonary tests. Unfortunately, screening tests are not performed in many countries, such as Iran, resulting in late diagnosis in older ages, with consequently more diffuse parenchymal involvement and more hospitalization. The quantitative measurement of parenchymal changes in HRCT seems to be useful for early and accurate evaluation of the clinical status.. The aim of this study was to determine the severity and prevalence of pulmonary changes in late diagnosed CF patients by means of the HRCT Brody scoring system..Patients and Pulmonary HRCT results of 23 CF patients with the mean age of 13.5 years (5 - 18 years) were scored with the Brody scoring system. The system provided sub-scores for evaluating the presence and severity of five variables in central and peripheral regions of six lung lobes.. All studied patients had bronchiectasis and peribronchial wall thickening (PBWT) which were caused by the disease chronicity. However, parenchymal changes in the form of ground glass opacity (GG) and consolidation (CON) were significantly less prevalent, compared to other parameters. The highest score among all lobes was related to bronchiectasis and the lowest to the parenchymal changes (CON, GG). The scoring parameters of bronchiectasis, PBWT, GG, CON, and air trapping showed no significant difference in lobar, central or peripheral involvement, while only mucous plugging was more prominent in the peripheral zones. The contribution of lobar involvement appeared in the following order: right upper lobe (RUL) > left lower lobe (LLL) > right lower lobe (RLL) > left upper lobe (LUL) > Lingula, right middle lobe (RML).. It seems that in advanced cases of CF, at older ages and with lack of appropriate medical care, severity, prevalence, and appearance of lung lesions do not follow a definite specific pattern. Therefore, a similar study is suggested in older patients with a larger sample size for comparison of results..

Sleep habits and total sleep duration are essential factors for healthy growth and development of children. There is evidence showing that eating time and quantity as well as proportion of foods macronutrients affect the sleep quality.. The aim of this study was to investigate the sleep habits of preschool children in Qazvin and the role of calorie, macronutrients and caffeine intake in a mixed normal meal on sleep induction.. A total number of 210 children of 3 - 6 years old (108 boys and 102 girls) were randomly selected from a pediatric clinic in the city of Qazvin. Participants’ heights and their weights were recorded using standard techniques. Sleep habits questionnaires were filled out and three 24-hour diet-recalls for one weekend and two weekdays were assigned by a trained health worker.. The total night sleep duration, bedtime and wake-up time in the morning were 10.30 ± 1.30 hours, 23.30 ± 1.30 pm and 9.0 ± 1.30 am, respectively. Among all children, 21.9% had sleep onset latency and the bedtime of 56% was 10 pm or later. The results of this study showed no significant relationship between calorie, macronutrients, and caffeine intakes of the children, and the total sleep duration, bedtime, wake-up time, and sleep latency (P > 0.05).. Based on the results of this study, no significant relationship was observed between the dietary intake and sleep habits. This might be due to the small sample size or other factors, suggested to be investigated in the future..

Congenital lung malformation (CLM) is a rare condition with high incidence of mortality and morbidity. CLM is often discovered incidentally on routine prenatal ultrasound or other postnatal imaging tests. Depending on the size of lesion and degree of functional impairment, prognosis is different. Today, fetal lung abnormalities are increasingly detected prenatally by ultrasound imaging.. This study aimed to evaluate the CLM cases in pediatric pulmonary ward of Masih Daneshvari Hospital during an 8-year period from 2002 to 2010.. In a retrospective study, 21 patients (12 females, nine males), diagnosed with CLM, were enrolled. The mean age of participants was 7.3 years (ranging from 1 month to 16 years). All patients were histopathologically diagnosed with CLM and their demographic data including age, sex, and clinical signs and symptoms were recorded. To confirm the diagnoses and rule out the differentials, patients underwent bronchoscopy, angiography and other proper diagnostic procedures. Afterwards, they were divided into several subgroups based on the malformation and type of involvement, including agenesia, hypoplasia, aplasia, bronchogenic cyst, and sequestration.. We reported two agenesis, five hypoplasia, six aplasia, two bronchogenic cyst, and six sequestration cases. All patients were symptomatic at the time of diagnostic workup. The most common clinical signs and symptoms were respiratory distress and recurrent pulmonary infections.. Considering the wide range of clinical manifestations from no clinical symptom to severe respiratory distress at birth, imaging including chest X-ray, CT scan with contrast and MRI are of great values for early diagnosis of CLM. Early diagnosis could provide a more appropriate timing of evaluation and treatment options, lower mortality and morbidity, and better prognosis..

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..

Substance abuse during pregnancy leads to considerable adverse effects in mothers and their infants.. The purpose of this study was to evaluate perinatal complications in opium-addicted mothers and their newborns, exposed to opium in utero..Patients and During a one-year period (2008 - 2009), 45 opium-addicted mothers and their newborns were enrolled in a case-control study in Niknafs maternity hospital, Iran. Maternal drug usage was determined via self-reporting during structured interviews. Neonates with in-utero opium exposure were assessed and treated for neonatal abstinence syndrome (NAS). Demographic characteristics and perinatal complications for case and control subjects were obtained from medical records.. All cases were addicted to inhaled opium and none received methadone therapy. None of the cases was a heavy cigarette smoker, consumed alcohol, or had positive serology result for sexually-transmitted diseases. The mean ages were similar in both case and control groups. There was a higher prevalence of opium addiction among spouses of the case group subjects compared with the control group (P = 0.001). The case group had significantly lower education level (P = 0.01) and socioeconomic status (P = 0.001) compared to the control group. Low birth weight (LBW) was more frequent in the opium-exposed neonates compared with the control group neonates (P = 0.001). In the opium-exposed infants, signs of NAS were found in 32 (71%), requiring pharmacotherapy in 25 (55%) cases.. Opium addiction among Iranian pregnant women is associated with an increased frequency of LBW in newborns. Furthermore, approximately half of the newborns exposed to opium in utero require pharmacotherapy for NAS. These findings support the need for comprehensive multidisciplinary evidence-based interventions in at-risk population..

Alanine aminotransferase (ALT) level is the most common diagnostic test used for detection of liver damage; however in the past few years some studies have questioned the normal aminotransferase range in adults and have suggested its revision.. In this study, we assessed the upper limit of ALT and aspartate transaminase (AST) in a healthy population of Iranian children..Patients and A total of 500 apparently healthy children, aged 1 - 15 years, were enrolled in the study. Each patient''s serum AST, ALT, triglyceride, cholesterol, and fasting blood sugar were checked. Participants with low or high body mass indexes as well as abnormal lipid profiles and fasting blood sugars were excluded from the study.. A total of 340 subjects with a mean age of 9.2 ± 3.5 years were included in the study. According to our study we reported the 95th percentile of ALT values, corresponding to the upper limit of normal in healthy individuals, as 21 U/L for children. Furthermore, the 95th percentile of AST values, corresponding to the upper limit of normal range in healthy children, was 29 U/L.. A clearly lower cutoff of normality for liver enzyme values in children of our population was demonstrated in this study. However, age and gender were not found to be determining factors for upper limit of normal range for ALT in children..

Kawasaki disease (KD) is a vasculitis affecting multi-organ systems including liver and kidneys. KD is diagnosed by some clinical criteria including sterile pyuria, microscopic hematuria, proteinuria due to renal involvement, liver abnormalities manifesting as abnormal liver function tests, gallbladder hydrops, and hypoalbuminemia.. The aim of the study was to determine the frequency of liver and renal abnormalities in patients with KD, hospitalized in Ali-Ebne-Abitaleb Hospital of Zahedan during 2006 - 2013.. Paraclinical findings including serum and urine tests as well as gallbladder ultrasonography of 47 patients with KD hospitalized in Ali-Ebne-Abitaleb Hospital of Zahedan during 2006 - 2013 were reviewed retrospectively.. Liver abnormalities were found in 22 (46.8%) cases and impaired liver function tests were more common than other liver abnormalities in this cross-sectional study. The incidence of abnormal liver function tests in this study was about 42%. Gallbladder hydrops were found in 6 (12.7%) patients and 18 (38.3%) had renal involvement. Sterile pyuria was the most common urine abnormality with incidence of 36.2%. Microscopic hematuria and proteinuria were rarely found; in addition, serum urea nitrogen and creatinine had normal levels in all patients.. The possibility of KD should be considered in any infants or children with abnormal results in liver or renal function tests. Paraclinical findings of liver and renal involvements of all patients were partly similar to the previous studies..

Rotavirus infection is one of the most common causes of severe dehydrating diarrhea in children with a significant health burden on them, in Middle Eastern countries, including Iran.. We aimed to investigate P serotype of group A rotavirus variability among children hospitalized with acute gastroenteritis (AGE), track the changes in the genotypes of circulating viruses, and elucidate the efficacy of introducing the commonly accepted rotavirus vaccines to the national vaccination program..Patients and All children 14 years or younger, admitted in the Infectious Disease Ward of Bahrami Children’s Hospital due to acute nonbloody gastroenteritis between January 2009 and January 2010, were included in this study. Stool samples were collected and specific rotavirus genotype primers were defined by Virology Lab of the Pasteur Institute. The specimens were assessed for rotavirus using RNA-PAGE and semi-nested multiplex molecular virology techniques.. Twenty nine rotavirus strains were retrieved from 150 samples collected from hospitalized children with gastroenteritis (14 males and 15 females; mean age 20.9 ± 18.19 months) were included in the study. The most frequent P serotype was P8 (86.2%), followed by P6 (6.9%) and P4 (6.9%). In addition, the majority of strains (89.65%) exhibited a long electrophore-type pattern on the PAGE system. Rotavirus was mostly isolated from children aged less than 2 years (86.2%), and during winter (44.7%). No significant relationships were observed between the rotavirus infection and; age, sex, season, or initial signs and symptoms such as fever, estimated dehydration on admission, nausea, and vomiting.. Results of the current study supported the potential efficacy of introducing RotaTeq and Rotarix vaccines to the Iranian children vaccination program. We also propose prospective studies on confirmed rotavirus diarrheal illness in various parts of Iran, to determine the distribution of various genotypes across the country..

Chronic physical conditions in children significantly affect the quality of life in parents, especially mother. Many people with chronic pulmonary conditions as well as their family members need psychiatric assistance.. The goal of the current study was to evaluate the mental status as well as substance abuse behavior of mothers of asthmatic children..Patients and This was an observational cross-sectional study performed through completion of a questionnaire by participants. All mothers of asthmatic children at Masih Daneshvari Hospital from February 2011 to March 2013, consisted of 182 individuals, were included in the study after obtaining informed consents. The SCL-90 (symptom check list) questionnaire was completed by patients. History of substance abuse or cigarette smoking was asked from the sample group. Correlations between variables were analyzed using student t-test and chi-square test by SPSS-16 software (the statistical package for social science).. The mean age of participants was 33 ± 5 years and the average number of their children was 2 ± 1. The percentages of participants with scores in the abnormal range (≥ 2.5) were 17% for anxiety, 2% for obsessive compulsion, 15% for aggression, and 15% for the reference idea. Smoking had significant correlation with the presence of physical complaints (P < 0.007). Smoking history correlated with obsessive-compulsive behavior (P < 0.007) and substance abuse correlated with physical complaints (P = 0.001). Presence of physical complaints correlated with allergy in the children (P = 0.035). The total questionnaires'' score and scores for each section also correlated (P = 0.000).. This study showed that mothers of asthmatic children are prone to psychiatric symptoms. These symptoms included high scores on anxiety, aggression, reference idea and obsessive-compulsive thoughts. Scores on the physical complaint section were significantly higher in mothers whose children had allergic symptoms. Therefore, it is recommended that they get evaluated for psychiatric symptoms, and psychiatric treatment is recommended alongside treating asthma in their children..

Sedation is defined as the attenuation of CNS reflexes following usage of some medications; this can be used to provide patient comfort with no undesirable loss of consciousness.. This study focused on the efficacy of oral diphenhydramine-midazolam versus oral diphenhydramine for pediatric sedation in the emergency department..Patients and One hundred children up to 13 years, referred to the emergency department for suturing their wounds, were randomized into two groups. Group I received 1.25 mg/kg diphenhydramine and group II received 1.25 mg/kg diphenhydramine plus 0.5 mg/kg midazolam, orally. Later, the drug compliance and anxiety were categorized. Child behavior patterns such as crying, consciousness and movement were recorded. Two weeks after discharge, subjects were followed-up for any experience of complication.. The maximum time to achieve the optimal sedation was 16.13 ± 4.78 minutes in group I and 7.1 ± 2.49 minutes in group II (P < 0.0001). Behavior study of the children was obtained by phone calls to their parents 2 weeks after discharge; restlessness and insomnia were less frequently seen in group II in comparison with group I (P < 0.0001). Combination of diphenhydramine-midazolam in comparison with only diphenhydramine, provides a higher quality of sedation, with fewer complications before diagnostic and therapeutic procedures in children..