Predicting factors and prevalence of meningitis in patients with first seizure and fever aged 6 to 18 months.

OBJECTIVE: To evaluate predicting factors and prevalence of meningitis in patients with first seizure and fever aged 6-18 months old. METHODS: This cross-sectional study was performed on 800 patients aged 6-18 months old who had first attack of seizure with fever between March 2005 and March 2012 in the pediatric ward of Ghaem Hospital, Mashhad, Iran. RESULTS: Among 800 patients, lumbar puncture (LP) was performed in 453 (56.6%) patients, of whom 80 cases had meningitis (17.6% of LP patients). Postictal drowsiness (p=0.003), neurologic deficit (p=0.000), and body temperature >/=38.5˚C (p=0.035) were among the clinical signs, which were statistically significant predicting factors for meningitis. Laboratory tests including white blood count (WBC) >/=15000 mm3 (p=0.004), and hemoglobin (Hb) <10.5 gr/dl (p=0.020) also had statistical significance in predicting meningitis. CONCLUSION: Postictal drowsiness, neurological deficit, body temperature >/=38.5˚C, WBC >/=15000 mm3, and Hb <10.5 gr/dl were clinical and laboratory factors predictive of meningitis in cases with first attack of seizure and fever.

Serum level of vitamin A in febrile children with and without seizure: A comparative study.

Objective: The role of vitamins and antioxidants in the febrile seizure (FS) has recently become of interest. The role of Vitamin A in seizure is remained controversial. It may suppress or provoke the seizure. In present study, the serum vitamin A level in febrile patients was compared with febrile seizure children for the first time. Method: In a cross-sectional study, eighty children aged 6-60 months including 40 febrile children and 40 children with FS were included. Blood samples were obtained, and the serum level of vitamin A and other blood parameters were measured. Results: Patients were similar in demographic characteristics (p = 0.06 for age and p = 0.41 for sex). The serum vitamin A level was 0.19 (0.12, 0.25) and 0.22 (0.17, 0.29) milligram per liter (mg/L) in febrile and FS group respectively (p = 0.33). In children aged less than 24 months the serum vitamin A level in FS and febrile group was 0.22 ± 0.07 and 0.24 ± 0.12 mg/L respectively (p = 0.56). In children aged more than 24 months the serum vitamin A level in FS group was higher significantly in comparison with febrile group (0.25 ± 0.11 and 0.16 ± 0.07 mg/L respectively, p = 0.01). Conclusion: Serum vitamin A level was not different in febrile children with and without seizure. Surprisingly in children aged more than 24 months, the serum level of vitamin A was higher in FS group than in the febrile children. More studies are needed to confirm the present observation.

The role of anemia in first simple febrile seizure in children aged 6 months to 5 years old.

OBJECTIVE: To assess the relationship between anemia and first simple febrile convulsion in patients 6 months to 5 years old. METHODS: This cross-sectional study was performed on 240 patients aged 6 months to 5 years old from 10 October 2010 to 15 December 2011 at Ghaem Hospital, Imam Reza Hospital, and Dr. Sheikh Hospital, Mashhad, Iran. Patients were divided into 2 groups: the control group who had fever without seizure, and the case group who had first simple febrile seizure. The anemia levels in both groups were evaluated and compared. RESULTS: The mean age of patients was 20.7+/-14.8 months. It was 20.53+/-15.07 for the case group, and 20.9+/-14.6 for the control group (p=0.74). The mean hemoglobin in the case group was 11.05+/-1.37, and 11.14+/-1.19 in the control group (p=0.58). Anemia was detected in 37.5% of the case group, and 36.7% of controls (p=0.89). CONCLUSION: There was no relationship between anemia and first simple febrile seizure.

A Comparison Between Serum Selenium Level in Febrile Children with or Without Seizure.

The role of trace elements in febrile seizure (FS) was considered recently. The present study was performed evaluating the serum level of selenium in febrile children aged 6-60 months with and without seizure. A cross-sectional study was performed in Mashhad University of Medical Sciences, Mashhad, Iran. Sixty patients aged 6-60 months including 30 children with FS and 30 febrile children without seizure were included. Blood sample was taken, and the serum level of selenium was measured. Data was analyzed using SPSS software. Sixteen patients in FS group (53.3%) and 10 patients in febrile group (33.3%) were males with an average age of 25.21 ± 15.91 and 26.47 ± 17.61 months, respectively. There was no significant difference between groups in age and sex (p = 0.77 and p = 0.19, respectively). The serum level of selenium was 87.34 ± 8.23 and 89.63 ± 9.83 µg/L in FS and febrile groups, respectively. Difference was not significant (p = 0.33). In children aged less than 1 year, the serum level of selenium in FS and febrile group was 83.32 ± 6.2 µg/L and 82.55 ± 8.32 µg/L, respectively. Difference was not significant (p = 0.87). In children aged more than 1 year, the serum level of selenium in FS significantly was lower compared to febrile group (87.96 ± 8.42 µg/L and 93.17 ± 8.66 µg/L, respectively, p = 0.04). The serum level of selenium was lower in children aged more than 1 year with febrile seizure compared to febrile ones.

Zinc deficiency and febrile seizure: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Zinc has been reported to be low in children with febrile seizure compared to febrile cases without seizures, but results are inconsistent. A meta-analysis was performed to systematically evaluate the serum level of zinc in febrile children aged between 6-72 months with or without seizures. MATERIAL AND METHODS: A systematic search of databases was performed from January 2000 to January 2019. Studies comparing the serum level of zinc in febrile children with or without seizure were selected. RESULTS: The major outcome was serum level of zinc. Random effect model was used to calculate pooled standardized mean differences (SMD) with 95% confidence intervals (CIs). A total of 31 articles were included. Meta-analysis suggested that the serum level of zinc is lower in patients with febrile seizure versus febrile cases without seizure (SMD: -1.2, 95%CI= (-1.47, -0.93). In subgroup and sensitivity analysis no significant change was observed in pooled SMD. In meta-regression analysis sample size as a continuous variable had a significant influence on between-study variance (p= 0.02). According to cumulative analysis the difference of serum level of zinc in febrile children with or without seizure decreased with time. CONCLUSION: This meta-result indicated a significant association of zinc deficiency with seizure in febrile children. It is suspected that decreased level of zinc may be involved in seizure occurrences and it may play a role in the pathogenesis of febrile seizure.

Serum Level of Vitamin D and Febrile Seizure? A Clinical Study.

OBJECTIVE: To evaluate the serum level of vitamin D in children aged six to 60 months with febrile seizure and febrile children without the seizure. MATERIALS & METHODS: Febrile children aged six to 60 months with or without seizure were studied. Demographic characteristics, serum level of vitamin D, and other laboratory findings were recorded. RESULTS: Among the 104 children, 51 patients had fever without a seizure and 53 patients had a febrile seizure. The mean subjects' age was significantly more in the febrile seizure group compared to the without seizure group (16.26 ± 11.87 versus 26.36 ± 14.11 months, p = 0.001). The mean serum level of vitamin D in the with and without seizure groups was 41.92 ± 22.42 and 48.41 ± 15.25 microgram per deciliter, respectively (p = 0.08). There was no significant correlation between serum level of vitamin D and seizure occurrence (p = 0.07). The mean serum sodium and potassium levels, and platelet count were significantly lower in the febrile seizure group compared to the without seizure group (p < 0.05). There were no significant differences between the two groups regarding hemoglobin, blood sugar, creatinine, blood urea nitrogen, calcium, alkaline phosphatase levels, and white blood cell count (p > 0.05). CONCLUSION: The serum level of vitamin D in febrile children with or without seizure was normal. The serum level of vitamin D was lower in patients with the seizure but not statistically significant. More clinical studies are needed to evaluate the relationship between febrile seizure and the serum level of vitamin D.

Gastroenteritis Related Seizure with or without Fever: Comparison Clinical Features and Serum Sodium Level.

OBJECTIVE: This study investigated the clinical characteristics and serum sodium level in children with gastroenteritis related seizure with or without fever. MATERIALS & METHODS: This clinical study was performed in Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran from 2007 to 2014. Overall, 165 patients aged 6-60 months with gastroenteritis related seizure were studied. Demographic, seizure and gastroenteritis characteristics and laboratory findings were recorded. RESULTS: Among the 165 children 47.3% were female. Vomiting was 2.7±2.6 and 3.9±1.9 times in febrile and afebrile group. Duration of diarrhea was 1.8±1.8 days and 2.1±1.3 days in febrile and afebrile groups (p=0.014). 36% in febrile group and 6.4% in afebrile group experienced seizure within the first 24 h of gastroenteritis (P<0.001). Seizure in 99.1% in febrile and 93.6% in afebrile group was generalized (P>0.05). Seizure was more than 5 min in 51.4% in febrile and 57.4% in afebrile groups (P>0.05). Drowsiness after seizure was seen in 72.9% and 60% in febrile and afebrile group respectively (P>0.05). The serum level of sodium was 137.6±3.98 mEq/L and 138.5±3.78 mEq/L in febrile and afebrile groups (P>0.05). 26.3% in febrile group and 8.5% in afebrile group had hyponatremia (P=0.012). There was no difference in seizure duration between hyponatremic patients and others (P>0.05). CONCLUSION: Type, duration of seizure and drowsiness after seizure had not any difference in febrile and afebrile cases. Vomiting and duration of diarrhea before admission was lower in febrile group. Seizure within the first 24 h of gastroenteritis was higher in febrile group. Mild hyponatremia in febrile group was higher than afebrile group. No difference in duration of seizure was detected between hyponatremic patients and others.

Predictive factors of pediatric intractable seizures.

BACKGROUND: This study was performed in children aged <15 years, at the Pediatric Neurology Clinic of Imam Reza Hospital affiliated to Mashhad University of Medical Sciences. The objective of this study was to recognize the main predisposing factors that result in uncontrolled seizures in patients so that we can start the treatment accurately. METHODS: There were two groups of patients; group I, consisted of 51 patients, with minimum refractory seizures of one episode per month while taking at least two antieplieptic drugs, and group II, comprised of 80 well-controlled patients chosen at random, who had no fit within 6 months after starting the treatment. RESULTS: Factors affecting the occurrence of refractory seizures included age <1 year, multiple seizures before starting the treatment, male gender, myoclonic seizures, neurologic defects, neonatal and daily seizures, and first abnormal electroencephalogram and brain computerized tomography scan. CONCLUSION: There are several factors that can predict development of uncontrolled seizures. Knowledge of these factors helps us to discriminate our patients and pay more attention to those at risk of developing uncontrolled seizures.

Relationship between Changes in Serum Sodium Level and Seizures Occurrence in Children with Hypernatremic Dehydration.

OBJECTIVE: To assess any relationship between serum sodium changes and seizure occurrence in children aged 2 months to 5 years with hypernatremic dehydration. MATERIALS & METHODS: This cross-sectional study was performed on 63 patients aged 2 months to 5 years from 20 March 2006 to 15 March 2012 at Ghaem Hospital and Dr. Sheikh Hospital in Mashhad, Iran. Patients were divided into 2 groups: case group with hypernatremic dehydration and seizure occurrence, and control group with hypernatremic dehydration and no seizures. RESULTS: The mean age of patients was 10.38 (2-48) months. Thirteen patients had seizures, 11 out of them, before admission and 2 during hospital staying. Serum sodium level at admission in those 2 patients with seizure occurrence after hospitalization was 169 (158-180) mmol/L, and in 50 patients without seizure was 162.8 (148-207) mmol/l. Also, the rate of decrease of serum sodium levels in these 2 cases within the first 12 hours after admission was 1.12, and in those without seizure was 0.54 (mmol/L/hour), and it was 0.47 and 0.53 (mmol/l/ hour) after 24 hours of admission, respectively. Severe dehydration was seen in 38.5% of cases and 14% of controls. CONCLUSION: There was not any relationship between changes in serum sodium level and seizure occurrence in children with hypernatremic dehydration.

The role of zinc sulfate in acute bronchiolitis in patients aged 2 to 23 months.

OBJECTIVE: Evaluating the effect of zinc sulfate in improving the clinical manifestations of acute bronchiolitis in children younger than 2 years. METHODS: This was a double blind pilot trial on 50 patients aged 2 to 23 months at Ghaem and Dr. Sheikh Hospitals in Mashhad from January 2008 to March 2009. Patients were randomly divided into two groups: a case group received oral zinc sulfate and to the control group was given placebo. FINDINGS: Mean age of case group was 168.0±108.6 days and control group 169.2±90.4 days (P=0.98) with male predominance in both groups. At first there was no statistically significant difference between the two groups in reducing the symptoms. But 24 hours after treating, improvement of some important manifestations including tachypnea, subcostal and intercostal retraction, wheezing and cyanosis revealed statistically significant difference in control group in comparison with case group (P=0.04). CONCLUSION: Zinc sulfate has no benefit in improving clinical manifestations of acute bronchiolitis.

Severe neonatal hyperbilirubinemia; causes and contributing factors leading to exchange transfusion at Ghaem Hospital in Mashhad.

Hyperbilirubinemia is common in neonates; it can have a serious rising course. Due to its critical morbidity called "kernicterus", severe neonatal hyperbilirubinemia causes which lead to exchange transfusion, should be clarified. This descriptive cross sectional study performed with reviewing of files of 118 neonates weighting 2kg and more who had exchange transfusion in pediatrics ward at Ghaem training hospital in Mashhad from April 2004 to March 2007. Among 118 patients, 75 (63.6%) were male, and 43 patients (36.4%) were female. The most common cause of exchange transfusion was ABO incompatibility (38.1%). In order of frequency, unknown etiology (25.4%), Rh incompatibility (16.1%) with no immune hydrops, Sepsis(8.5%), urinary tract infection (5.1%) and others (3.4%) (Including Crigler-Najjar and cephalohematoma) were next ones. Vaginal delivery and exclusive breast feeding were detected as associated factors. Mean serum bilirubin levels was 28.7 mg/dl (SD. 9.2) ABO incompatibility. ABO incompatibility was the main cause of exchange transfusion. Male gender, vaginal delivery and exclusive breast feeding were seen more among patients who need to be exchanged. So in case of ABO incompatibility especially when delivery route is vaginal, newborns should be visited soon again after early discharge from hospital.

A comparison between traditional yogurt and probiotic yogurt in non-inflammatory acute gastroenteritis.

OBJECTIVE: To compare the traditional yogurt and probiotic yogurt in improving acute non-inflammatory gastroenteritis. METHODS: A double blinded case-control clinical trial, performed in 100 patients aged 6 months to 12 years of age from October 2008 to September 2009 in Ghaem and Dr. Sheikh Hospitals in Mashhad, Iran. The patients were assigned to the following groups: the case group received a probiotic yoghurt and the control group received the ordinary yogurt. RESULTS: There were statistically significant differences between the case and control groups in reducing frequency of diarrhea in the first (p=0.000), second (p=0.013), third (p=0.028), and fourth (p=0.022), therapy. Also, there was a significant difference (p=0.000) in discontinuation of diarrhea between the case and control groups. CONCLUSION: Acute non- inflammatory gastroenteritis improvement is accelerated by probiotic yogurt consumption.

Role of intravenous extra fluid therapy in icteric neonates receiving phototherapy.

OBJECTIVE: To evaluate the role of intravenous extra fluid therapy in accelerating the reduction of jaundice in newborns who received phototherapy. METHODS: This study was performed on 100 terms, jaundiced neonates who had a total bilirubin of 18 mg/dl or more in the Pediatrics Ward of Ghaem Hospital, Mashhad, Iran from October 2007 to April 2008. The patients were randomly divided into 2 equal groups; group I (case group) were given extra parenteral fluid besides breast feeding, and group II (control group) received only breast milk. The rate of bilirubin decrement, length of hospital stay, and rate of blood exchange were compared. RESULTS: The rate of serum bilirubin decrease per hour in the first 12 hours after admission in group I (0.41 mg/dl [95%CI 0.1] versus 0.38 mg/dl in group II [95% CI 0.3], [p=0.22]). It was 0.41 mg/dl for group I (95% CI 0.0001), and 0.21 mg/dl (95%CI 0.06) for group II in the second 12 hours (p=0.02). After 24 hours, it was 0.38 mg/dl in group I (95% CI 0.0001), and 0.29 mg/dl in group II (95% CI=0.09) (p=0.037). The mean hospital stay was 68.5 hours in group I, and 67.4 hours in group II (p=0.95). CONCLUSION: Additional parenteral fluid therapy in icteric newborns can accelerate reduction in serum bilirubin levels in the first 24 hours.

Association of the expression of IL-4 and IL-13 genes, IL-4 and IgE serum levels with allergic asthma.

Immune and inflammatory responses mediated by cytokines, play important roles in the pathophysiology of asthma. These responses are associated with overexpression of Th2 cytokines such as IL-4 and IL-13. These two cytokines use common receptors for signaling that lead to identical immunological effects and regulation of the Th1/Th2 balance. The aim of this study was to determine whether patients with allergic asthma display overexpression of IL-4 and IL-13 genes. Using RT-PCR, we examined the expression of IL-4 and IL-13 genes in twenty asthmatic cases and twenty normal individuals. Total levels of serum IgE and IL-4 were also determined by ELISA method. Expression of IL-13 gene in 70% of patients with allergic asthma was higher than controls (P=0.01). There was no correlation between the expression of IL-13 gene and total level of serum IgE (P=0.07). Expression of IL-4 gene was detected in 30% of the patients and none of the normal individuals as determined by RT-PCR (P=0.01). Mean of serum IgE levels in patients and controls were 84.9 IU/ml and 62.2 IU/ml, respectively. Level of serum IgE was more than 100 IU/ml in 30% of patients (P=0.03). Mean of serum IL-4 levels in patients and controls were 15.73 pg/ml and 13.07 pg/ml, respectively. There was a relation between levels of serum IgE and IL-4 in 73% of cases. The results showed that there was a correlation between the expression of IL-4 gene and the level of serum IL-4. Levels of serum IgE and IL-4 were considerably higher in asthmatics than non-asthmatic controls.