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Volume 57, Issue 3 (6-1999)
Meckels Diverticulum is the most common congenital anomaly of GI tract. Complications develop in about 4% of cases as an acute abdomen. During the last 12 years, 58 patients with Meckel's diverticulum were treated in Amir-Kabir children's hospital. The majority of our cases (84%, 49 from 58) were under 6 years of age, with boys outnumbering girls (4:1). Intestinal obstruction was the most common form of presentation, included 60% of symptomatic patients and lower GI bleeding was the second one and included 25% of symptomatic cases. 31% (18 cases) were found in laparotomy for other reasons (Asymptomatic). There were heterotopic gastric mucosa in all of 10 patients with lower GI bleeding out in 4 of 18 incidentally discovered cases. In conclusion the Meckel's diverticulum must be one of the primary concern, in the differential diagnosis of the pediatric patients with painless, moderate to massive rectal bleeding with or without clots, intestinal obstruction or abdominal pain of uncertain cause. Heterotopic tissue in Meckel's diverticulum has important role in occurrence of complications.
Volume 58, Issue 3 (6-2000)
Abdominal mass is one of the commonest clinical findings in children. The purpose of this study was to evaluate abdominal masses in different age groups in a referral children surgical center. We retrospectively reviewed records of 325 patients (57% boys, mean age 37.7 months) admitted to Amir Kabir hospital in period of 12 years for abdominal mass surgery. The 4 most common abdominal masses was Wilm's tumor (22.4%), abdominal lymphoma (13.5%), neuroblastoma (12.5%) and hydronephrosis (12.3%). These masses composed 60% of abdominal masses and the remaining were: Hydatid cyst of liver, ovarian masses, liver masses, choledochal cyst, mesentery and omental cyst, etc. This results were found to be similar with little differents to results of other centers.
Volume 59, Issue 1 (4-2001)
Abdominal masses in neonatal period is one of the main causes of patients bed ridden in infantal surgery wards. The rapid encounterance with these patients has caused a decrease in mortality and morbidity. This study is a kind of historical research which has been conducted on data base management systems of two above mentioned hospitals between years 1361-1378. The final outcome was only 25 cases. From these neonatus, 68 percent were male and 32 percent were female. Most of the patients were in their first neonatal week. The etiologies related to urinary system (56 percent), were found to be in the first place. Tumors of different origins (20 percent), ovarian masses (12 percent) and gastrointestinal tract (12 percent) had their own places respectively. Majority of cases have had surgical operations (92 percents). The case fatality rate among these patients was 24 percent which most of it was because of benign causes. The rate of mortality in male was much larger than female neonatus. We concluded that the inspection of embryo's urinary system with ultrasound and primary examination of neonatus, is vital and in most of the cases, an urgent surgery is indicated. Also laboratory assessment and radiological examination in suitable therapeutic procedures in first 48-72 hours in recommended.
Volume 65, Issue 12 (3-2008)
Background: Acute lymphoblastic leukemia (ALL) is the most common cancer in the pediatric population. With modern treatments, the chance of the complete recovery is nearly 100%. The most important prognostic factors are appropriate treatment protocol and determination of patient risk factors based on clinical, morphological, immunological and cytological characteristics. In this study we reviewed frequency of these factors, like as age, gender, the primary white blood cell number, sub- group on the base of FAB classification, immunophenotype and the clinical progress.
Methods: In this retrospective study, we reviewed 877 pediatric patients with the diagnosis of ALL between the years of 1994 and 2004. In these patients the age, gender, primary WBC count, sub-group based on the FAB classification, immunophenotype and the clinical progress in 177 patient with acute lymphoblastic leukemia at Imam Khomeini Hospital between the years of 1994 to 2004 were determined.
Results: Of these patients, 1.6% was younger than one year, 24.8% more than ten years old and 73.6% were between the ages of one and ten years 63.8% were male. WBC counts were above 50,000/ul in 28.8% of the patients. FAB classifications included L1 in 80.2%, L2 in 17.5% and L3 in 2.3% of the patients. Immunophenotypes included pre-B cell in 63.8%, early pre-B cell in 23.1%, T cell in 12.3% and mature B cell in 0.8% of the patients. Marker CD10+ was detected in 88.1% of the B cell cases. In this study group, 74% of the patients recovered, 16.3% died and 16.5% relapsed.
Conclusions: The prevalence of FAB-L1 and pre-B cell cases in this study is greater than a previous study, while the prevalence of FAB-L2 and early pre-B cell cases is less than that of the previous study.
Volume 67, Issue 9 (12-2009)
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Background: Asthma prevalence has
increased in developed and developing countries in several last decades. Although
cigarette smoking is an identified risk factor for many diseases such as coronary
Heart disease and chronic obstructive lung disease, its effect on asthma is
controversial. The aim of this study was to determine the odds ratio and its confidence
interval for asthma morbidity among children referred to the Immunology and
Allergy department of children medical center according to their parents'
smoking and daily cigarette consumption.
Methods: A case-control study was conducted during two years period on the asthmatic
patients who referred to Immunology and Allergy department of children medical center.
Demographic information and parents' smoking and daily cigarette consumption
assessed by a questionnaire. Healthy children with same age and sex were entered
to the study as the control group. Statistical analysis was performed to
calculate odds ratio.
Results: Among 215 patients who entered the study 63 patients were exposed the cigarette smoke. Odds ratio for asthma morbidity
among children whose parents smoke more than five cigarettes per day in
comparison with whose smoke less than five or do not smoke was 2.38 (p<0.01).
Conclusion: Parent's cigarette smoking is
a risk factor for childhood asthma and could increase the risk of asthma to 2.38 folds in children whose
parents smoke more than five cigarettes. Increasing in parents' knowledge level
that probably relate to their education results in cigarette consumption
decline.
Volume 68, Issue 9 (12-2010)
Background: Recently, many cases diagnosed as pediatric autoimmune neuropsy-chiatric disorders associated with group A beta hemolytic streptococcus infection (PANDAS) due to production of autoimmune antibodies. Object of this study was comparison the titer of antibodies against group A beta hemolytic streptococcus (ASOT, Anti-DNase B, and Anti streptokinase) between children with movement disorders (tic and tourett's disorders pediatric autoimmune psychiatric disorders) and healthy control.
Methods: A cross sectional/ cases control study in pediatric neuropsychology ward and clinics in two referral hospitals (Rasoul & Aliasghar) affiliated by IUMS had done in Tehran, Iran (2008-2010). We selected 53 children with tic disorder and 76 healthy controls (age matched children). The antibody titers (IU/ml) in their area were compared and analyzed statistically. The area under ROC, sensitivity, specificity and positive predictive value of tests calculated.
Results: Age of cases was between 4-16 years. All antibody titers had significant difference between two groups (p<0.0001 p=0.05 p=0.002 for ASOT, Anti-DNase and Antihyaloronidase respectively). ASOT (cut off level> 200IU/ml) had 75% sensitivity 84% specificity and 80% PPV Anti- streptokinase (cut off level> 332IU/ml) had 34% sensitivity 85% specificity, and 90% PPV Anti-DNase (cut off level> 140IU/ml) had 70% sensitivity 99% specificity and PPV 90%.
Conclusion: Patients with tic disorder had a significant high antibody titer against streptococcal infection in comparison with healthy children. It presents possible role for streptococcal infection in tic disorders. Treatment of streptococcal infection is achievable by using of long acting Penicillin in our country. Use of aggressive treatment like plasmaphresis etc needs future RCT studies.
Volume 69, Issue 10 (1-2012)
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Background: Recent
evidence suggest that group A ß-hemolytic streptococcal (GABHS)
infection may increase the risk of
pediatric autoimmune neuropsychiatric disorders (PANDAS) composed of the clinical signs of obsessive-compulsive and
attention deficit hyperactivity disorders. The objective of this study was to compare
the titer of antibodies against GABHS between children with PANDS and the controls.
Methods : This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran
during 2008-2010. We compared serum antibodies
streptolysin O, deoxyribonuclease B, and streptokinase against GABHS
quantitatively in 79 cases with PANDAS and 39 age-matched controls. The
area under ROC curve, sensitivity, specificity and positive predictive value (PPV) of tests were calculated.
Results : Most cases were studied in summer (57%) and spring (23%). The three aforesaid antibodies were higher in the cases (P=0.001). Antisterptolysin O (cut-off point 195) had a 90% sensitivity, 82% specificity and a 92% PPV, (CI=95%, 0.99-0.91). Anti streptokinase (cut-off
point 223)
had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.934-0.735). Anti-DNase (cut-off point 140) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.99-0.91).
Conclusion: The
study demonstrated a possible role for streptococcal infection in PANDAS.
We found a significantly higher antibody titer against GABHS in
OCD and ADHD cases in comparison with
healthy children. Treatment of streptococcal infection is achievable by the use
of long-acting penicillin. Use of aggressive treatment schedules like
plasmaphresis, IVIG, etc needs further RCT
studies.
Volume 71, Issue 7 (10-2013)
Background: Damages caused by scald burns are common and can cause severe complications and death. The purpose of this study was to define risk groups and then methods of prevention and treatment is designed to fit.
Methods: Data for this retrospective study of hospitalized patients in Shahid Motahari Hospital in Tehran from 2007-2011 were compiled. Data including age, sex, cause of burn, and degree of burn and ultimate fate of the victims were collected from scald burns. Burns caused by boiling water and hot food (Scald) , in two age groups : 12 and under 12 years ( children) and more than 12 years ( adults) were compared in terms of statistics .
Results: A total of 1150 patients consisting of males (57.9%) and females (42.1%) were studied. The most common age was 1 year old and 50% of patients were under 3 years of age. 87.9% burned with boiling water and 12.1% had experienced burns with hot food. Incentive to burn was 0.3% cross burning and 99.7% incident. A maximum number of burns in children 12 years and younger males (42.1%) and a minimum number in men over 12 years (15.7%) were observed. Mean percentage of burns was 11% in over 12 years group and 30.9% in 12 and under 12 years group. The average hospital stay was 11.4 days and the mortality rate was 4.8%. The final status of the patients was as fallows: full recovery 904 cases (78.6%), partial recovery 134 (11.7%), clearance with personal consent 41 (3.6%), death 55 (4.8%) and 16 cases (3.1%) were among other reasons.
Conclusion: In general it can be said, scald burns incidence in individuals aged 12 and younger were more than the older ones and the mean of burns was lower in individuals with over 12 years old. There was a sexual preference for males under 12 years. Mortality rate in the two groups has not any statistically significant difference. There was no statistically significant association between sex and mortality rate. Some of our findings are depending on cultural, social and economic conditions, so generalized this findings to other geographical areas should be done with caution.
Volume 73, Issue 1 (4-2015)
Background: Orthopedic trauma is a common type of injury in children and may cause deep and permanent psychological and physical damage both for the patient and the parents. This study aimed to analyze the epidemiology age, gender distribution and the mechanism of injury in patients presenting to a level I trauma center in urban population of Tehran. Methods: In this prospective descriptive study, the patients under 19 years old with orthopedic trauma who were hospitalized in Tehran Shafa University Hospital were entered. This hospital is the main orthopedic referral center in Iran. The patients were prospectively evaluated from April 2013 to March 2014. The data were collected and analyzed. Results: The study included 1081 patients under 19 years old. There was a male predominance (76.8% n= 830). The boys had a higher mean age 11.04±5.06 year, versus girls with mean age 8.67±4.63 year (P< 0.05). The peak age of boys was 18 and the girls had two peaks at three and nine. The fractures occurred in upper limb in 70.8% (n= 621) and 29.2% (n= 256) in lower limb of patients. There were 27 cases with joint dislocation, 5 cases with knee ligamentous injuries, 128 cases with soft tissue injuries and 44 cases with spine injuries. The most frequent mechanism in both gender were falls from standing position (48.5%). The most common fractures were foreman both bone fractures (n: 146 16.7%), elbow supracondylar fractures (n: 134, 15.3%) and distal radius fractures (n: 84, 9.6%). The most fractures occurred in summer (30.1%) and the least in winter (18.1%). Conclusion: Evaluation of epidemiologic factors can lead to the best prediction and treatment planning of trauma. Early recognition of injury, even minor, and expected care using specialized teams will help to improve outcomes for these patients. This study determines the most at risk children for trauma and fractures and may help the parents to prevent damage.
Volume 80, Issue 9 (12-2022)
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Methods: This was a cross-sectional study. In this study, in a period of three years from (March 2016 to March 2019), all patients admitted to the PICU of Tehran Bahrami Children's Hospital were examined. The sample size was calculated 380. Demographic information, diagnosis during hospitalization, underlying disease, and initial tests during the first 24 hours of hospitalization were recorded in the checklist. To evaluate the demographic findings between patients with and without UGIB, chi-square and Fisher tests were used. A p-value of less than 0.05 was considered significant.
Results: 462 patients were studied, of which about (58%) were male. The mean age of the samples was 48 months and the average length of hospital stay in PICU was ten days. In general, (21.21%) of patients had gastrointestinal bleeding on the first day and (12.12%) on the second day of hospitalization. Gastrointestinal bleeding occurred in 50 patients (10.82%). Use of ventilator, pulmonary diseases, coagulation and blood diseases were significantly more common in patients with gastrointestinal bleeding than in children without gastrointestinal bleeding. Cardiac, neurological, hepatic, and renal disease were not significantly different in patients with gastrointestinal bleeding compared to children without gastrointestinal bleeding. Conclusion: The occurrence of gastrointestinal bleeding in critically ill patients admitted to the PICU is a serious risk. The most important risk factor for upper gastrointestinal bleeding is mechanical ventilation. Other risk factors of gastrointestinal bleeding are lung disease, coagulation diseases, hematologic and oncologic disease. |
Volume 81, Issue 4 (7-2023)
Methods: This 3-year descriptive cross-sectional study was performed on all male and female patients with any vasculitis referred to the outpatient clinic and rheumatology department of Akbar Children's Hospital from the beginning of September 2017 to the end of September 2020. Has been. This study was based on information obtained from the checklist (information from the inpatient and outpatient records and information in the HIS). Checklist information included age, gender, drug history, history of surgery, clinical symptoms in different systems, season of disease onset, etc.
Results: Out of 263 children, 135 (51.33%) had Henoch-Schonlein and 100 (38/02%) of them had Kawasaki. The numbers of Behcet, Takayasu and Churg-Strauss patients were 20, three and two, respectively. In most subgroups, female patients were more common than male patients. Kawasaki and Takayasu had the lowest and highest age of onset, respectively. The most common seasons of appearance for Henoch-Schonlein and Kawasaki were autumn and summer respectively. In most subgroups, skin rashes are the most common clinical symptom, with, the most common types being petechiae and purpura.
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Conclusion: In the present study, the most common type of vasculitis diagnosed in children in eastern Iran was reported by Henoch-Schonlein and Kawasaki respectively, which was completely different from the most common types of vasculitis in adulthood and indicated the importance of age in diagnosing the type of vasculitis. The necessity of clinical suspicion of these two diseases in children with skin rashes, along with matching with other clinical findings, is undeniable.
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Volume 81, Issue 7 (10-2023)
Methods: This study investigated the incidence of complications caused by vaccination in infants and children under seven years old in Shahrood city in a 5-year period from April 2016 to March 2020. We collected demographic and clinical information, by referring to the health centers and complications recorded after routine vaccinations such as fever, rash, diarrhea, swelling and other complications of vaccination were collected.
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Results: Findings Among the 429 registered complications between 2016 and 2020, most complications were related to pentavalent and trivalent vaccines. Among the registered complications, high fever is the most common complication in both term and pre-term groups. (202 cases, 47.1%) other complications included maculopapular rash (59 cases), mild local complications (55 cases), vomiting (41 cases), and continuous screaming (36 cases), respectively. Among these, 123 cases were resolved without treatment, 297 cases were resolved with drug treatment on an outpatient basis, and only eight cases required hospitalization.
Conclusion: In general, the vaccination program is highly effective despite having limited side effects. Knowing this information, can increase vaccination in the country. |
Volume 82, Issue 1 (4-2024)
Methods: This pilot quasi-experimental study was conducted on 60 children admitted to the Children's Medical Center hospital from March 2020 to June 2021. For the control group, routine care (standard physiotherapy) was started on the second day of intubation and continued until discharge from the intensive care unit. In this study, we used an early mobilization protocol including active and passive exercises. The intervention was implemented by Pediatric intensive care unit nurses under supervision of a pediatric critical care fellowship physician. In the intervention group, passive exercises were started on the second day of intubation. At each shift, the nurses check the level of sedation and presence of delirium in the patients using the Richmond Agitation-Sedation Scale and the Cornell Assessment of Pediatric Delirium questionnaire. If the results showed that the sedation was not deep and delirium was not present, then active exercises were initiated. If the child did not achieve an adequate score indicating the absence of deep sedation and delirium, the patient remained in the passive exercise phase. The length of stay was recorded based on the patients' records. Descriptive and inferential statistics were used for data analysis using SPSS version 23.
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Results: The results showed that there was no significant difference in the length of stay in the pediatric intensive care unit (PICU) between the control (23.20±6.34 days) and intervention (22.60±6.18 days) groups (P=0.77).
Conclusion: The implementation of early mobilization did not significantly reduce the length of PICU stay for pediatric. The researchers are advised to identify and evaluate evidence-based guidelines for implementing early mobilization in children with different diagnoses. |
Volume 82, Issue 6 (9-2024)
Methods: This cross-sectional descriptive-analytical study was conducted over a 3-month period (February, May, and June) in 2021 at the Pediatric Hospital of Jundishapur University of Medical Sciences, Ahvaz. All patients hospitalized in the intensive care unit and infectious disease ward with vancomycin prescription were included in the study. Patients who were hospitalized for less than three days or had no desire to enter the study were excluded from the study. Vancomycin prescription by clinical pharmacist was reviewed based on the latest version of Lexicomp from Wolters Kluwer and the National Health Service (NHS) guidelines.
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Results: Of the 91 hospitalized patients, 70.3% (64 cases) were prescribed vancomycin without performing an antibiogram culture based on experience and 29.7% (27 cases) were based on an antibiogram culture. In 96.7% (88 cases) , the duration of intravenous vancomycin infusion did not comply with the protocol. Red Man Syndrome was observed in 8.8% (8 cases). In 91.2 % (83 cases), no adverse effects were reported. In 65.9% (60 cases), the drug dose was determined based on the correct renal function Glomerular filtration rate (GFR) and in 34.1%, the drug dose was determined regardless of the renal function of the patients. Vancomycin doses were lower and higher than the guidelines in 6 and 25 patients, respectively. Out of all patients, eighty four cases recovered and seven cases died.
Conclusion: In almost half of the patients, Vancomycin were prescribed based on experience and without performing an antibiogram test. Use of guidelines, Serum level monitoring programs and continuous medical education for doctors can be effective in rational use of antibiotics. |
Volume 82, Issue 7 (10-2024)
Methods: This retrospective study was conducted from 2017 to 2021 in Akbar and Sheikh children's hospitals. The study population included 50 children under the age of 14 who were diagnosed with rectal prolapse and visited the hospitals. Data were collected using pre-prepared checklists and analyzed using SPSS version 24. Inclusion criteria were children under 14 years diagnosed with rectal prolapse, while exclusion criteria included incomplete data or other severe unrelated health conditions.
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Results: The results showed that 67.4% of the sample were boys, and the most affected age group was children under 2 years (38.8%). A total of 57.1% of the children had daily bowel movements, and 68.2% reported consistently hard stools. Additionally, 48% of the children experienced pain or burning during defecation.
Conclusion: The findings of this study indicate that children with rectal prolapse often face challenges related to stool consistency and defecation pain, despite having frequent bowel movements. These results emphasize the need for targeted interventions to improve stool consistency and manage pain to effectively prevent and treat rectal prolapse. |
Volume 82, Issue 10 (1-2025)
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Background: Controlling pain and anxiety in children is important and at the same time more difficult compared to adults. In the present study, an attempt has been made to reduce the overall dose and, as a result, the complications caused by ketamine by adding local anesthesia with lidocaine after analgesia and intravenous sedation with ketamine.
Methods: A double-blind, randomized clinical trial was carried out at the emergency ward of Khatam Al-Anbia Hospital, Zahedan, between June 2018 and March 2019. A total of 60 children with finger injuries with the age range of 1 to 5 years were divided into two groups of 30 people by random block method. The control group was injected with only intravenous ketamine at a dose of 1.5 mg/kg, and the intervention group was injected with local anesthesia with lidocaine after the injection of intravenous ketamine. Data analysis was performed using SPSS software (version 21) with descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (Student’s t-test, chi-square test, and Mann-Whitney U test) at a significance level of P<0.05. Results: The recovery time in the intervention group (29.27±9.48 minutes) was significantly less than the control group (35.90±10.59 minutes) (P=0.01). No significant cardiopulmonary complications occurred in the two groups. The incidence of vomiting (P=0.08) and the drop in blood oxygen saturation percentage (P=0.3) were higher in the control group than in the intervention group, but it was not statistically significant. Adding local anesthesia to intravenous injection of ketamine significantly delays the duration of the second repetition of ketamine injection (P=0.01), But it did not affect the time of the first and third repetition of ketamine dose. Conclusion: The findings of this study indicate that the intervention group required significantly fewer ketamine doses than the control group. Notably, adjunctive lidocaine local anesthesia was associated with shorter recovery times and prolonged intervals before second-dose ketamine administration, while no such effects were observed for the first or third doses. These results imply that lidocaine supplementation could optimize intravenous ketamine therapy by accelerating recovery and reducing subsequent dose requirements, though additional research is needed to validate these observations. |
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