The effects of asthma on the oxidative stress, inflammation, and endothelial dysfunction in children with pneumonia.

BACKGROUND: In community-acquired pneumonia (CAP), pulmonary vascular endothelial dysfunction, inflammation, and oxidative stress (OS) are prominent and interesting as the unfavorable clinical outcomes of it. Asthma as a common chronic respiratory disease may affect the clinical outcomes of pneumonia, but the exact mechanism of this effect remains unclear. The present study aimed to assess the effects of asthma on the OS, inflammation, and endothelial dysfunction biomarkers in the children pneumonia. METHODS: A cross-sectional study designed with a total of 75 children including both severe CAP and asthma (as group I), severe CAP alone (as group II), and healthy children (as group III) was conducted. Fasting blood samples were taken to the assay of serum malondialdehyde (MDA), total antioxidant capacity (TAC), tumor necrosis factor-alpha (TNF-α), soluble vascular cell adhesion molecule-1 (sVCAM-1), and plasminogen activator inhibitor-1 (PAI-1). The mean of anthropometric and biochemical parameters was compared by ANOVA and Tukey post-hoc test between groups. RESULTS: We observed TAC levels in groups I and II (0.997 ± 0.22 and 1.23 ± 0.21 mmol/l, respectively) were significantly lower compared with group III (1.46 ± 0.19 mmol/l, P value < 0.001). It was significantly higher in group II than in group I (P value < 0.001). Also, we observed MDA and TNF-α levels in groups I (6.94 ± 1.61 µmol/l, 7.34 ± 2.23 pg/ml, respectively) and II (2.57 ± 0.40 µmol/l, 5.54 ± 1.84 pg/ml, respectively) were significantly higher compared with group III (1.89 ± 0.27 µmol/l, 3.42 ± 1.32 pg/ml, P value < 0.001, P value < 0.001, respectively). VCAM-1 and PAI-1 levels as the endothelial dysfunction biomarkers were significantly higher in group I (1.5 ± 0.62 mmol/l, 10.52 ± 3.2 AU/ml, respectively) compared with groups II (1.06 ± 0.53 mmol/l and 8.23 ± 3.4 AU/ml; P value < 0.001, P value < 0.001, respectively) and III (0.6 ± 0.35 mmol/l and 2.39 ± 0.83 AU/ml; P value < 0.001, P value < 0.001, respectively). Also, VCAM-1 and PAI-1 levels were significantly higher in group II compared with groups III (P value < 0.001, P value < 0.001). CONCLUSIONS: Asthma can exacerbate the vascular dysfunction of pneumonia in children by increasing oxidative stress, inflammation, and endothelial dysfunction.

Frequency and Causes of Discharge against Medical. Advice in children

Introduction: Discharging with personal satisfaction is one of the main problems in hospitalization, when the patient leaves the hospital sooner than the doctor's advice. This will exacerbate the disease and increase the risk of hospital re-admittance. In this regard, more attention should be given to children because they are not able to understand the above meaning or participate in decision making. Materials and Methods: In this descriptive cross-sectional study, all children who were discharged due to personal satisfaction from the hospital were included. The 4-page checklist for the various causes of "leaving the hospital despite medical advice" was divided into three sections: Causes related to the patient's own issues, causes related to the hospital medical staff and the causes of the hospital situation, and a page of demographical variables included gender, age and history of hospitalization and ward of hospitalization. Results: A total of 310 cases (7.4%) were discharged with personal satisfaction of their parents. The most important factor linked to discharge with personal satisfaction was the poor economic condition of parents. In terms of factors related to the medical staff, the lack of proper handling of the nurse and then the doctor were the most important factors for discharge. Conclusion: It seems that economic issues are the most important factor in the discharge of children with parental consent of parents. On the other hand, factors such as unacceptable and unpopular behavior of nurses and doctors play crucial role in this phenomenon. Parents who are under intense psychological stress due to economic problems and child illness can be at risk of developing this phenomenon if they are not mentally supported by health staffs

Electrocardiographic Corrected QT (QTc) Dispersion Value as a Predictor for Estimation of Neonatal Mortality in Pre-Term Neonates.

INTRODUCTION: Electrocardiographic (ECG) corrected QT (QTc) interval and dispersion were used as prognostic variables in adult patients and limited studies showed the relationship between QTc prolongation and dispersion with some clinical situations in newborn babies. AIM: In the present study, we compared the electrocardiographic (ECG) variables such as QTc interval and dispersion of healthy full-term and pre-term neonates with those who suffered from non-cardiac illnesses. METHODS: This prospective cohort study involved 127 neonates including four study groups: normal full-term neonates, ill full-term neonates, normal pre-term neonates and ill pre-term neonates. Neonates with fever, apnea, poor feeding, tachypnea, muscle retraction, grunting, reduced neonatal reflexes, positive blood culture or antibiotic therapy > 3 days were considered as ill neonates. QTc interval and dispersion were calculated and compared among the four groups. RESULTS: QTc interval was significantly (p = 0.012) higher in ill pre-term neonates in comparison with normal pre-term ones (418.74± 54.29 ms vs. 386.66± 39.26 ms). QTc dispersion was calculated and showed significantly higher mean values in ill pre-term neonates when compared with normal full-term, ill full-term and normal pre-term ones. QT dispersion and QTc dispersion of dead neonates were significantly (p= 0.0001-0.01) higher than alive ill pre-term neonates at 3, 7 and 28 days after birth. CONCLUSION: QTc interval and dispersion seem to represent non-invasive, reliable predictors of mortality in pre-term ill neonates, but further investigation is needed to confirm cutoff values for the risk assessment.

Evaluation of hypercalciuria in patients receiving intravenous Cefotaxime.

INTRODUCTION: Cefotaxime is one of the third generation cephalosporins, which is used against many infections. This drug has a urinary excretion and potentially may have nephrotoxic effects. Hypercalciuria can cause important complications, including the formation of kidney stones. In the recent study, we decided to evaluate hypercalciuria in children receiving cefotaxime. MATERIALS AND METHODS: This case-control study was conducted in Amirkabir hospital (Arak, Iran), where 30 children received intravenous cefotaxime were placed in the case group and 30 children without intravenous administration of cefotaxime were included in the control group. The ratio of calcium to creatinine was measured in both groups. Data were analyzed by SPSS software version 23. RESULTS: This study showed that the ratios of male and female children in both the groups were 19 (63.3%) and 11 (36.7%) respectively, the mean age of children in the case group was 2.36 years with a standard deviation of 0.71 and the mean age of the children in the control group was 5.18 years with a standard deviation of 3.31. The ratios of urine calcium to creatinine in the case and control groups were 0.90 with a standard deviation of 1.79 and 0.37 with a standard deviation of 0.44 (P value = 0.003). CONCLUSION: According to the above results, it is concluded that receiving intravenous cefotaxime may increase calcium to creatinine ratio in children.