Tehran University Medical Journal

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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.

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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.

 

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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.

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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.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 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.

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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.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 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.

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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.

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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.

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