Risk Factors of Seizure in Childhood Shigellosis.

Objectives: Shigellosis is one of the common causes of bacterial diarrhea in children. Seizures are common in shigellosis. It is essential to identify the risk factors of seizure in this disease. Materials & Methods: This study was conducted on 224 children with shigellosis. The patients were divided into: With (case groups = 63 cases) and without seizures (control group = 161 cases). Groups were compared regarding different variables such as age, gender, clinical symptoms, and laboratory findings. Data analysis was done using statistical tests and SPSS software. Logistic regression analysis was used to determine the risk factors of seizures. Results: Out of 224 cases of children with shigellosis, 107 (47.8%) were male and 117 (52.2%) female. Significant differences were observed between the two groups in terms of age, history of febrile convulsions, frequency of bloody diarrhea, frequency of fever, duration of diarrhea before hospitalization, abdominal pain, increase in BUN, hyponatremia, hypocalcemia, and red blood cell count in stool (P<0.05). Logistic regression analysis showed that a history of febrile seizure, fever, and hyponatremia are the risk factors for seizures in shigellosis. Conclusion: This study concluded that a history of febrile seizure, fever, and hyponatremia are risk factors for seizure in childhood shigellosis, thus rapid diagnosis and treatment of childhood shigellosis with risk factors is very important.

Evaluating the Ability of PRISM4 and PIM3 to Predict Mortality in Patients Admitted to Pediatric Intensive Care Unit; a Diagnostic Accuracy Study.

Introduction: Limited resources and the large number of children in need of services in the pediatric intensive care unit (PICU) emphasize the need for effective allocation of resources for improving the outcome of at-risk patients. This study aimed to evaluate and compare the accuracy of PRISM4 and PIM3 systems in prediction of in-hospital mortality of patients admitted to PICU. Methods: The present retrospective cross-sectional study was a diagnostic accuracy study performed on patients admitted to PICU of Qods Hospital, Qazvin, Iran, during one year. Scores of PRISM4 and PIM3 scales were calculated for each patient using the available calculators, and the outcome of patients regarding in-hospital mortality was recorded. Finally, screening performance characteristics of the mentioned scales in prediction of patients' mortality were calculated and reported. Results: 218 patients with the mean age of 40.68 ± 37.92 (2-160) months were studied (57.8% female). There was a significant direct correlation between PIM3 score and duration of stay in PICU (p < 0.0001; r = 0.259), need for inotropic drug administration (p = 0.001), and mortality rate (p = 0.001). In addition, area under the receiver operating characteristic (ROC) curve of PIM3 and PRISM4 in prediction of mortality among patients admitted to the PICU was 0.939 (95%CI: 0.880 - 0.998) and 0.660 (95%CI: 0.371 - 0.950), respectively (p = 0.001). Based on the findings, the best cut-off point for PIM3 scale in prediction of mortality was the score of 4 and it was estimated to be the core of 8 for PRISM4 scale. Sensitivity and specificity of PIM3 scale in prediction of mortality in the cut-off of 4 points were 100.00 (95% CI: 56.09- 100.00) and 81.51 (95% CI: 75.47- 86.38), respectively. These measures were 42.85 (95%CI: 11.80- 79.76) and 98.10 (95%CI: 94.89- 99.39) for PRISM4 model, which indicates the higher sensitivity of PIM3 system in this regard. Conclusion: based on the results of the present study, the accuracy of PIM3 is significantly higher than PRISM4 in prediction of in-hospital mortality among patients admitted to the PICU. It seems that considering the 100% sensitivity of PIM3 in prediction of outcome, this model is a better tool for screening patients who are at risk for in-hospital mortality in order to pay more attention and allocate more resources to improve their outcome.

Clinical and Laboratory Findings of Viral Influenza among Children Hospitalized in Qazvin Pediatric Hospital in Iran (2015-2020).

BACKGROUND: Children are one of the most important groups at risk of catching an influenza infection. The consequences of influenza in some children, especially children with chronic and underlying diseases, can be very severe and lead to hospitalization. OBJECTIVE: The purpose of this research was to determine children with influenza and their clinical and laboratory findings in Qazvin Children's Hospital between 2015 to 2020 years. METHODS: In this descriptive cross-sectional study, epidemiological and clinical findings of children hospitalized due to confirmed influenza were considered. A total of 1468 children with a suspected diagnosis of influenza were included in this study. Then, based on the Real-time Polymerase Chain Reaction (PCR), a total of 229 were confirmed positive for influenza. Statistical analysis was done using software SPSS 23.0, Analysis Of Variance (ANOVA), and t-test (p≤0.05). RESULTS: The results showed that most of the patients (53.7 %) were infected with influenza H1N1 type. Most comorbidities were observed with Central Nervous System (CNS) disease and febrile seizure (each one 3.10 %). The highest clinical feature was fever (83.4 %). Significant relationship was observed between the season (p=0.001), soreness in throat (p=0.001), febrile seizure (p=0.051), muscle and joint pain (p=0.059), rhinorrhea (p=0.006) and shiver (p=0.051), and occurrence of influenza. Also, 4 children had died from influenza during hospitalization. CONCLUSION: Children with influenza were examined in this study. Influenza has some side effects on children's health. Due to the irreversible and dangerous effects of influenza, early diagnosis and appropriate treatment in children is important.

The Effect of Adding Honey to Zinc in the Treatment of Diarrhea in Children.

BACKGROUND: Honey has been used in medicine since ancient times. Limited reports are available to indicate its antibacterial, antiviral, and antidiarrheal properties. This study aimed to determine the effect of honey on acute diarrhea in children. METHODS: This randomized clinical trial included 80 children with acute diarrhea. Forty children received honey and zinc gluconate (trial group) and 40 received only zinc gluconate (control group). After treatment, vomiting/diarrhea duration, the recovery time, and the duration of hospitalization were compared between the groups. RESULTS: Among the 40 children in the trial group, 19 were male and 21 were female. In the control group, 25 children were male and 15 female (P=0.26). After initiating treatment, the duration of diarrhea, recovery time, and the duration of hospitalization was significantly shorter in the trial group than in the control group (P<0.05). CONCLUSION: This study showed that honey with zinc gluconate reduces the duration of diarrhea, accelerates the recovery time, and shortens the duration of hospitalization.

The Relation between Urinary Tract Infection and Febrile Seizure.

OBJECTIVES: Febrile seizure is the most common type of seizure among children. Identification of factors involved in febrile seizure is highly critical. The present study was conducted to determine the association between children's urinary tract infection and febrile seizure. MATERIALS & METHODS: In this case-control study, 165 children with simple febrile seizure (case group) were compared with 165 children with fever and without seizure (control group) in terms of urinary tract infection (UTI) in Qazvin, central Iran in 2015-2016. The age of children was between 6 months to 5 yr. RESULTS: Among 165 children with febrile seizure, 25 (15.2%) had urinary tract infection. In the control group, only 2 patients (1.2%) had UTI. There was significant difference between two groups regarding urinary tract infection (P=0.001). Among 25 children with UTI in the case group, 17 children (68%) had acute pyelonephritis, and the remaining 8 children (32%) had cystitis. The two patients with UTI in control group had cystitis (P=0.055). CONCLUSION: Urinary tract infection could be a risk factor for febrile seizure. Therefore, all patients with febrile seizure are examined in terms of urinary tract infection.

Vitamin D receptor gene (FokI, TaqI, BsmI, and ApaI) polymorphisms in children with urinary tract infection.

BACKGROUND: Little is known about the genetic background of urinary tract infection (UTI) in children. METHODS: In this study, vitamin D receptor (VDR) gene polymorphisms were compared between 60 children with UTI (case group) and 60 healthy children (control group). DNA extraction, polymerase chain reaction, and the restriction fragment length polymorphism methods were used to perform the genetic analysis. RESULTS: There was a significant difference between the case and control groups for VDR gene, ApaI and Bsml, polymorphisms (P < 0.05). The frequency of VDR Bb, bb, Aa, and aa genotypes, and the b and a alleles in the case group was significantly higher than that in the control group (P < 0.05). A significant difference was also found between lower UTI and acute pyelonephritis groups for the VDR Apal and Bsml genotypes (P < 0.05). There was no significant difference between children with first UTI and those with more than one UTI for VDR gene polymorphisms (P > 0.05). CONCLUSION: This study showed that there is a significant relationship between VDR gene, Apal and Bsml, polymorphisms and UTI in children. The results indicate that these polymorphisms may play a role in pathogenesis of UTI.

Correlation between serum vitamin D level and neonatal indirect hyperbilirubinemia.

BACKGROUND: Considering the significant prevalence of Neonatal Indirect Hyperbilirubinemia (NIH) and its irreversible neurological complications, identifying the factors involved in the prevalence of neonatal jaundice is essential. The present study was conducted to determine the relationship between serum vitamin D levels and the prevalence of NIH in infants admitted to Qods Hospital of Qazvin in Iran in 2015-16. METHODS: In this case-control study, 30 term infants with NIH (the case group) were compared with 30 healthy, non- icteric, term infants (the control group) in terms of serum levels of 25-hydroxyvitamin D. The results were analyzed and compared between the two groups using t-test and the Chi-square test. RESULTS: The mean and standard deviation of serum 25-hydroxyvitamin D levels were 10.76 ± 8.6 ng/dl in the case group and 14.88 ± 11.38 ng/dl in the control group. There were no significant differences between the two groups (P = 0.11). CONCLUSION: The results suggest the lack of a relationship between vitamin D levels and NIH. However, further prospective studies are needed to conclude that vitamin D has no role in the pathogenesis of NIH.

Association between vitamin D and urinary tract infection in children.

PURPOSE: The present study aimed to determine the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and Urinary tract infections (UTIs) in children. METHODS: In this case-control study, 70 children with UTI (case group) were compared with 70 healthy children (control group) in terms of serum 25(OH)D levels. The children were between 1 month and 12 years of age. Serum 25(OH)D levels were measured using enzyme-linked immunosorbent assay (ELISA). The results were analyzed and compared between both groups. RESULTS: Among 70 children with UTI (case group), 5 children (7.2%) were male and 65 (92.8%) were female. Among the healthy children (control group), 9 (12.8%) and 61 children (87.2%) were male and female, respectively (P=0.39). The mean±standard deviation of age in the case and control groups were 53.2±35.6 and 36.1±60.2 months, respectively (P=0.24). The mean level of serum 25(OH)D in the case group was significantly higher than that of the control group (20.4±8.6 ng/mL vs. 16.9±7.4 ng/mL, P=0.01). CONCLUSION: This study showed that there was a relationship between serum 25(OH)D levels and UTI in children. It seems that 25(OH)D plays a role in the pathogenesis of UTI.

Feasible Relation between Glutathione Peroxidase and Febrile Seizure.

OBJECTIVE: We aimed to determine the relationship between serum glutathione peroxidase and febrile seizure. MATERIALS & METHODS: In this case-control study, 43 children with simple febrile seizure (case group) were compared with 43 febrile children without seizure (control group) in terms of serum glutathione peroxidase level, measured by ELISA method. This study was conducted in Qazvin Children Hospital, Qazvin University of Medical Sciences in Qazvin, Iran in 2012-2013. The results were analyzed and compared in two groups. RESULTS: From 43 children 24 (53%) were male and 19 (47%) were female in children with simple febrile seizure, and 26 (60%) were male and 17 (40%) were female in febrile children without seizure (control group) (P=0.827). Serum glutathione peroxidase level was 166 U/ml (SD=107) in the case group and 141 U/ml (SD=90.5) in the control group of no significant difference. CONCLUSION: There was no significant relationship between serum glutathione peroxidase and simple febrile seizure. Thus, it seems that glutathione peroxidase, an essential component of antioxidant system, does not play any role in the pathogenesis of simple febrile seizure.

Comparison of the Effect of Two Kinds of Iranian Honey and Diphenhydramine on Nocturnal Cough and the Sleep Quality in Coughing Children and Their Parents.

Coughing in a child induced by upper respiratory tract infections (URTIs) can be a problem, both for the child and its parents. Current studies show a lack of proven efficacy for over-the counter (OTC) medications, but promising data support the use of honey for children. The aim of this study was to compare the effects of two kinds of Iranian honey with diphenhydramine (DPH) on nocturnal pediatric coughs and the sleep quality of children and their parents. This was a clinical trial (registered in IRCT; No.: 28.20.7932, 15 October 2013). The study consisted of 87 patients. All the parents completed a standard previously validated questionnaire. The children were randomly assigned to one of three treatment groups: Group 1, Honey type 1 (Kimia Company, Iran) (n = 42), Group 2, Honey type 2 (Shahde-Golha, Iran) (n = 25), and Group 3, DPH (n = 20). Each group received double doses of the respective treatments on two successive nights. A second survey was then administered via a telephone interview in which the parents were asked the same questions. The mean scores for all aspects of coughs were significantly decreased in each group before and after the treatment. All three treatments improved the cough and sleep scores. Honey type 1 was superior to DPH in improving all aspects of coughs, except the frequency, and Honey type 2 was more effective than DPH in improving all aspects of coughs, except the sleep quality of the child. There was no significant difference between Honey type 1 and 2 in any aspects of cough relief in the present study. The results suggest that honey may provide better cough relief than DPH in children and improve the sleep quality of children and their parents.

The association of hypercalciuria and hyperuricosuria with vesicoureteral reflux in children.

OBJECTIVES: One of the important complications of vesicoureteral reflux (VUR) is the development of urolithiasis. Identifying factors involved in development of urolithiasis in children with VUR is immensely important. This study was conducted to determine the association between hypercalciuria and hyperuricosuria with VUR in children. METHODS: One-hundred children with VUR (case group) were compared to 100 healthy children (control group) in terms of hypercalciuria and hyperuricosuria. To measure these markers, random morning fasting urine samples were used. Data were analyzed using statistical tests. RESULTS: Hypercalciuria and hyperuricosuria frequencies, and also urine calcium/creatinine (Ca/Cr) and urine uric acid/creatinine (UA/Cr) ratios were significantly higher in the case group compared to the control group (P < 0.05). A significant difference was found between hypercalciuria and hyperuricosuria in severity of VUR (P < 0.05). A positive correlation was observed between hypercalciuria and hyperuricosuria and severity of VUR (P < 0.05). CONCLUSIONS: The present study showed that there is association between hypercalciuria, hyperuricosuria and VUR in children. It is recommended to adopt measures to prevent the development of urolithiasis in VUR patients.

Zinc sulphate for acute bronchiolitis: A double-blind placebo-controlled trial.

The use of adjunctive therapies to achieve rapid recovery from clinical symptoms of acute bronchiolitis would appear necessary. This study was performed to determine the effect of zinc sulphate on treating acute bronchiolitis. In this study, 100 children affected with acute bronchiolitis were investigated. Fifty patients received oral zinc sulphate and 50 patients placebo. Signs and symptoms of the disease were compared between two groups at the time of admission and then 24, 48, 72, 96 and 120 hours after the beginning of treatment. The trend of recovery of clinical signs and symptoms was more favourable in the case group than in the control group in 24, 48, 72, 96 and 120 hours after beginning of the treatment. The significant differences were observed between the two groups in terms of improvements in coughing and wheezing 48 and 72 hours after the beginning of the treatment (P<0.05). Full recovery was observed in 49 (98%) patients receiving zinc sulphate within 72 hours of the beginning of treatment (P=0.0001). The present study showed that administration of zinc sulphate accelerates improvement from clinical signs and symptoms of acute bronchiolitis. Thus we recommend the use of zinc sulphate for the treatment of acute bronchiolitis.

Neurological Manifestations of Renal Diseases in Children in Qazvin/ Iran.

OBJECTIVE: Renal diseases are one of the most common causes of referrals and admissions of children, hence it is important to know their neurological presentations. This study aimed to determine neurological presentations of renal diseases in children. MATERIAL & METHODS: A total of 634 children with renal diseases, admitted to Qazvin Pediatric Hospital, Qazvin, central Iran from 2011 to 2013 were studied. Neurological presentations of patients were established and the results were analyzed using statistical tests. RESULTS: Neurological presentations were found in 18 (2.8%) out of 634 patients, of whom 15 had febrile seizures, two thromboembolism, and one encephalopathy. Among patients with urinary tract infection (UTI), 2.6% had febrile seizures, 11.1% of those with glomerulonephritis had encephalopathy, and 3.7% of those with nephrotic syndrome had cerebral thromboembolism. CONCLUSION: Results showed neurological presentations in 2.8% of children with renal diseases, and febrile seizure as the most common presentation.

The role of overweight and obesity in urinary tract infection in children.

This study was conducted to determine the relationship between overweight/obesity and UTI in children. A comparison was made, in terms of overweight and obesity, between 135 children with UTI (case group) and 135 healthy children (control group). UTI was diagnosed through urine culture. Dimercaptosuccinic acid renal scanning (DMSA) was also used to distinguish between lower UTI and acute pyelonephritis. Overweight and obesity were determined based on standard body mass index (BMI) curves. There were 12 (8.8%) overweight and 26 (19.2%) obese children in the case group. Four (3.0%) overweight and five (3.7%) obese children were found in the control group. There was a significant difference between the two groups regarding overweight and obesity frequencies. However, no such difference existed between children with cystitis and acute pyelonephritis. This study showed a significant relationship between overweight/obesity and UTI. Therefore, overweight and obesity may play a role in the pathogenesis of UTI in children.

Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection.

Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children's hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size. Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited.

Serum Zinc Concentrations in Children with Acute Bloody and Watery Diarrhoea.

OBJECTIVES: The role of zinc in the pathogenesis of diarrhoea is controversial. This study was conducted to compare serum zinc levels in children with acute diarrhoea to those found in healthy children. METHODS: This case-control study was carried out at the Qazvin Children's Hospital in Qazvin, Iran, between July 2012 and January 2013. A total of 60 children with acute diarrhoea (12 children with bloody diarrhoea and 48 children with watery diarrhoea) and 60 healthy children were included. Zinc levels for all subjects were measured using a flame atomic absorption spectrophotometer and data were analysed and compared between groups. RESULTS: Mean serum zinc levels in the patients with acute bloody diarrhoea, acute watery diarrhoea and the control group were 74.1 ± 23.7 µg/dL, 169.4 ± 62.7 µg/dL and 190.1 ± 18.0 µg/dL, respectively (P = 0.01). Hypozincaemia was observed in 50.0% of children with acute bloody diarrhoea and 12.5% of those with acute watery diarrhoea. None of the patients in the control group had hypozincaemia (P = 0.01). CONCLUSION: Children with acute bloody diarrhoea had significantly reduced serum zinc levels in comparison to healthy children. However, a study with a larger sample size is needed to examine the significance of this trend.

Serum interleukin -8 is not a reliable marker for prediction of vesicoureteral reflux in children with febrile urinary tract infection

Objective: In view of the side effects of voiding cystourethrography (VCUG), identification of noninvasive markers predicting the presence of vesicoureteral reflux (VUR) is important. This study was conducted to determine the predictive value of serum interleukin-8 (IL-8) in diagnosis of VUR in children with first febrile urinary tract infection (UTI). Materials and Methods: Eighty children with first febrile UTI were divided into two groups, with and without VUR, based on the results of VCUG. The sensitivity, specificity, positive and negative predictive value positive and negative likelihood ratio, and accuracy of IL-8 for prediction of VUR were investigated. Results: Of the 80 children with febrile UTI, 30 (37.5%) had VUR. There was no significant difference between the children with and without VUR and also between low and high-grade VUR groups in terms of serum concentration of IL-8 (P>0.05). Based on ROC curve, the sensitivity, specificity, likelihood ratio positive, and accuracy of serum IL-8 was lower than those of erythrocyte sedimentation rate and C-reactive protein. Multivariate logistic regression analysis showed significant positive correlation only between erythrocyte sedimentation rate and VUR. Conclusions: This study showed no significant difference between the children with and without VUR in terms of the serum concentration of IL-8. Therefore, it seems that serum IL-8 is not a reliable marker for prediction of VUR.

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome: Report of a Rare Case in Newborn.

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare and the most severe form of functional intestinal obstruction in the newborn. The characteristic features of this congenital and fatal disease are abdominal distension, absent or decreased bowel peristalsis. Abdominal distension is a consequence of the distended, unobstructed urinary bladder with or without hydronephrosis. We present a case of female newborn with antenatal ultrasound revealing a large cystic mass in pelvic with urinary tract origin, abdominal distension, a peristalsis of the intestine and micro colon.

Tick-borne Relapsing Fever in Children in the North-west of Iran, Qazvin.

Relapsing fever is caused by the Borrelia species of spirochetes. Louse-borne epidemics of the disease may happen but the endemic disease is generally transmitted to humans by the bite of an infected tick (Ornithodorus). Clinical and laboratory findings of tick-borne relapsing fever in children in the north-west of Iran, Qazvin, were evaluated. This study was conducted from September 1992 to September 2012. Records from 53 cases of tick-borne relapsing fever (TBRF) were reviewed. In positive cases, febrile illness, and spirochetes were recognized in peripheral blood preparations. Of the 53 children younger than 12 years, fifty two percent were male and about one third (34%) of the patients were in the age range of 7-12 years. The disease is recorded through the whole year but its peak occurs during summer (52.8%) and autumn (32.1%). Sixty eight percent of patients were living in urban areas but had frequent travel to rural area. Thirty two percent of the cases were living in rural areas where their dwellings were close to animal shelters. All (100%) of the 53 subjects were febrile. Travellers to the rural areas with high prevalence of the disease should be attentive of the risk of tick-borne relapsing fever and use suitable control measures. Consequently relapsing fever should be considered when patients who live in or have vacationed in north-west of Iran show a recurring febrile illness.

The role of zinc in acute pyelonephritis.

This study was conducted to determine the serum concentration of zinc in children with acute pyelonephritis. Serum zinc levels of 60 children with acute pyelonephritis and 60 healthy children were compared. Acute pyelonephritis was diagnosed using Tc-99m dimercaptosuccinic acid (DMSA) renal scan. Serum zinc levels were measured by the atomic absorption flame spectrophotometry. The levels in question in the case and control groups were 70.73 ± 14.15 and 87.61 ± 12.68 mcg/dL, respectively (P=0.001). There was no correlation between serum zinc level with inflammatory markers, severity of acute pyelonephritis and duration of the disease. This study showed that there is a correlation between serum zinc level and acute pyelonephritis. Zinc would therefore appear to play a certain role in the pathogenesis of acute pyelonephritis.