Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia.

OBJECTIVE: Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. METHODS: This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-Ali Sina Hospital in Sari, Iran between January 2010 and January 2011. A non-probability quota sampling technique was used. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium Scale. The factors linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software 16 and independent sample t-test, χ(2) and binary logistic regression. P-values less than 0.05 were considered as significant. FINDINGS: One hundred thirty-four (17.9%) children had emergence agitation. The most frequent surgical procedures were ENT surgical procedures 315 (42.2%), abdominal surgery 177 (23.7%), orthopedic surgery 137 (18.3%), urology 97 (13%) and ophthalmic surgery 24 (3.2%). Otorhinolaryngological surgical procedures (P=0.001), pain (P<0.05) and induction behavior of children (P<0.005) were associated with higher rates of post anesthetic emergence agitation (P=0.001). CONCLUSION: This study identified the multiple independent risk factors which are associated with emergence agitation in children. To minimize the incidence of postanesthetic emergence agitation, these risk factors should be considered in the routine care by care providers in postanesthetic care unit.

Erythema at BCG Inoculation Site in Kawasaki Disease Patients.

INTRODUCTION: Kawasaki disease is an acute, self-limiting childhood systemic vasculitis with unknown etiology. Because there is no diagnostic test for Kawasaki disease, the diagnosis is based on clinical criteria. An important clinical sign that is not included in the classical clinical criteria for Kawasaki disease is a reaction at the Bacille Calmette-Guérin inoculation site that are present in about 30-50% of Kawasaki disease patients. THE AIM: of this review was to highlight the usefulness of the inflammation at the Bacille Calmette-Guérin inoculation site for early diagnosis of Kawasaki disease, we conducted a literature review on Medline in PubMed area, Google scholar, Magiran and Scientific Information Database using the search terms "Kawasaki disease, Erythema, BCG, inoculation site, children, cardiac complications, coronary artery lesion, aneurysm, incomplete Kawasaki in 2013. RESULTS AND DISCUSSION: A total of 15 articles had been found. Erythema at the Bacille Calmette-Guérin inoculation site was found in 49.87% of Kawasaki disease patients. Coronary artery abnormalities were found in 10.3% of cases. According to this review, BCGitis is more prevalent than cervical lymphadenopathy and rash and it can be a useful criterion in the diagnosis of incomplete Kawasaki disease in cases not fulfills the classic criteria of at least four of the five findings.

Depression and Anxiety Disorders among Patients with Psoriasis: A Hospital-Based Case-Control Study.

Background. Psoriasis is a common, genetically determined inflammatory and proliferative disease of the skin. Psychological stress can exacerbate the disease. This study sought to investigate the depression and anxiety disorders among patients with psoriasis and control group. Method. In this hospital-based case-control study, One hundred patients with psoriasis (case) referred to the dermatology department and 100 patients with otolaryngology problems and dermatological healthy volunteers (control) who referred to the Otolaryngology Department of Bouali Sina Hospital in Sari, Iran, in 2007 were studied. Demographic characteristics were recorded. Beck Depression Inventory and Spielberger State-Trait Anxiety Scale I-II were administered to the patients in both groups. Data were analyzed using SPSS statistical software and descriptive statistical tests. Results. From One-hundred patients in each group, 44 (45%) were men. Depression score was 67% and 12% in psoriatic patients and control, respectively. The Beck depression scores of patients with psoriasis were significantly higher than scores of the control group (P < 0.05). Based on Spielberger State-Trait Anxiety Scale, anxiety was found in 45% of patients in case group and 18% of controls. Conclusion. The results revealed that psoriatic patients reported significantly higher degrees of depression and anxiety than controls. In addition, psoriatic women were more depressed than psoriatic men.

Comparison of topical triamcinolone and oral atorvastatin in treatment of paederus dermatitis Northern Iran.

Dermatitis caused by stimulation of beetle paederus, is a common health problem in Northern and some southern parts of Iran. Since by now, traditional medicine and some corticosteroid agents have been used for treatment of dermatitis caused by beetle paederus. Because, there are few researches about classical treatment of the disease at academic level, this study planned to compare the effectiveness of triamcinolone ointment and atorvastatin tablet with placebo in treatment ofpaederus dermatitis in Northern Iran. A randomized double-blind clinical trial was carried out on 30 patients referred to the hospital and clinics at Sari and Neka countries in Northern Iran during 6 months. Patients were randomly divided into two therapeutic equal groups. The first group was triamcinolone ointment twice a day and a placebo atorvastatin tablet daily. The second group was oral atorvastatin one tablet (20 mg) daily and a placebo triamcinolone ointment twice a day. In Seventh day of visits, therapeutic response of the patients in triamcinolone and atorvastatin group were 93.33 and 80%, respectively. No significant differences were found in therapeutic outcome between the two groups (p > 0.05). The results showed both oftriamcinolone ointment and oral atorvastatin had similar effect on paederus dermatitis. Because the paederus dermatitis is a self-limited disease use of topical therapy for treatment of the disease is recommend.

Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients.

INTRODUCTION: We aimed determine the impact of an 8-week intradialytic exercise program, consisting of 15 minutes of cumulative duration low-intensity exercise during the first 2 hours of dialysis on serum electrolytes levels and hemoglobin. MATERIALS AND METHODS: In a randomized controlled trial of in an outpatient hemodialysis unit, clinically stable hemodialysis patients (n = 47) were included and assigned into the aerobic exercise group (n = 25) and the control group (n = 23). Aerobic exercises were done in groups, 15 min/d, 3 times a week, for 2 months. The main outcome measures were biochemical variables including serum levels of calcium, phosphate, and potassium levels and hemoglobin level. RESULTS: After an 8-week intervention, significant improvements were seen in serum phosphate levels (decreased by 1.84 mg/dL) and serum potassium levels (decreased by 0.69 mg/dL). No side-effects were observed. Serum calcium and hemoglobin levels did not change significantly in the exercise group. CONCLUSIONS: A simplified aerobic exercise program is a complementary, safe, and effective clinical treatment modality in patients with end-stage renal disease on dialysis.

Doppler ultrasonography as a predictive tool for permanent kidney damage following acute pyelonephritis: comparison with dimercaptosuccinic acid scintigraphy.

INTRODUCTION: The aim of this study was to investigate power Doppler ultrasonography for diagnosis and prediction of scarring compared with technetium Tc 99m dimercaptosuccinic acid scintigraphy in acute pyelonephritis. MATERIALS AND METHODS: Sixty-six children, aged 2 months to 6 years old, admitted with clinical and biological signs of their first febrile urinary tract infection were studied. All of the children underwent PDU and technetium Tc 99m dimercaptosuccinic acid scintigraphy within 7 days after diagnosis and repeat scintigraphy at least 6 months later, if results of the first study were abnormal. Scintigraphic and Doppler studies were interpreted and compared. RESULTS: Dimercaptosuccinic acid scintigraphy demonstrated scar in 7.6% of renal units, 3.1% of patients without reflux and 66.7% of those with high-grade reflux. Kidneys with permanent kidney damage had a mean resistive index (RI) of 0.71 ± 0.06, while the RI value for nonscarred kidneys was 0.66 ± 0.06 (P = .02). The best cutoff point of RI value was 0.715, with a sensitivity of 70%, a specificity of 87.7%, and positive and negative predictive values of 32% and 97%, respectively. These values significantly increased when grey-scale ultrasonography findings were brought into account. Reflux was observed in 19.7% of renal units, which were associated with significantly higher RI values (P = .05). CONCLUSIONS: Power Doppler ultrasonography with a cutoff value of 0.715 has a reasonable sensitivity and specificity for prediction of renal scarring in young children with febrile urinary tract infection.

The Effect of Performing Preoperative Preparation Program on School Age Children's Anxiety.

OBJECTIVE: The purpose of this study was to examine effects of performing preoperative preparation program on children's anxiety. METHODS: This study was performed in Amirkola Pediatrics Hospital, Mazandaran. A randomized controlled trail was performed on 122 children (7-12 years of age) admitted for elective surgery during 15 months. The researcher randomly assigned eligible participants in to the experimental and control groups, after pre-test baseline measurement had been taken. Analyzing was performed through independent t-test and χ(2) test. P<0.005 was considered statistically significant. The experimental group received therapeutic play and the control group received routine preoperative information preparation. FINDINGS: The mean and standard deviation of the state anxiety scores of children in experimental and control groups before intervention were 35.52±6.99 and 34.98±6.78, after intervention 31.44±5.87 and 38.31±7.44 respectively. The state anxiety score was lower significantly in the experimental group prior to preoperative surgery than in the control group (P=0.000). CONCLUSION: Performing preoperative program with using therapeutic play intervention is effective for preparing children before surgery and decreases their anxiety.

Hyaline vascular-type Castleman's disease in the hilum of liver: a case report.

BACKGROUND: Castleman's disease or angiofollicular lymphoid hyperplasia is a rare benign lymph node hyperplasia usually presenting as an asymptomatic mediastinal mass in children. The disease can present at any extra thoracic site with lymphoid tissue such as retroperitoneal, mesentery, axilla, and pelvis. Hepatic localization castleman disease is very rare in children. Herein, we reported a case of Castleman's disease arising from the lymph node in hilum of liver. CASE PRESENTATION: A 5 -year-old girl with chief complaint of abdominal pain for two months which exaggerated in last three days was referred to the hospital. On routine physical examination, only a generalized abdominal pain was noticed. Routine laboratory investigations and Chest X-Ray were normal. Abdominal Sonography revealed a 3.7 x 3.1 cm solid mass in the hilum of the liver. On the MRI images, a lobulated mass in the portal hepatic associated with mass effect on the portal vein was visible. Histological examination revealed expansion of mantle zone in lymphatic nodules accompanied by burnt out germinal centers. This pattern was matched with the diagnosis of the hyaline-vascular type of Castleman disease. The patient underwent a laparotomy. The patient had an uneventful postoperative course. CONCLUSION: This pattern was matched with the diagnosis of the hyaline-vascular type of Castleman disease.