Treatment of internal rectal prolapse in children: A cross sectional study.

Objectives: Internal rectal prolapse in children is one of the causes of annoying and drug-resistant constipation. The disease causes a type of obstructive constipation due to the appearance of mucosal folds in the distal rectum. If the diagnosis is made in time according to the methods proposed by the author, the treatment can also be done with simple techniques. In this article, the treatment methods for this well-known disease are presented. Methods: This is a prospective cross-sectional study, Sixty children (36 girls and 24 boys) between the ages of 6 months and 15 years who have specific symptoms of this disease and different degrees after definitive diagnosis of anesthesia with Delshad-mash have been treated with the sclerosing solution under the rectal mucosa or excision prolapse. Results: Depending on the severity of the disease, treatment with a subcutaneous injection of sclerosing solution responds well. The condition resolves after years of suffering from high degrees of prolapsed mucosal excision. Conclusion: Diagnosis of internal rectal prolapse can be made based on specific symptoms and barium enema radiology before the anesthesia test for children and determine the patient's treatment path and prevent additional operations such as colostomy-pulmonary with misdiagnosis of Hirschsprung.

Understanding the use of oral rehydration therapy: A narrative review from clinical practice to main recommendations.

Background and Aims: Fluid loss due to diarrhea remains a significant cause of mortality among children under the age of 5. Methods: Oral rehydration therapy (ORT) is a first-line therapeutic measure to compensate the volume loss due to diarrhea and vomiting among gastroenteritis patients. Despite adequate knowledge, the practice of ORT is limited, particularly in developing countries. Results: Several recommendations are provided regarding the use of ORT to treat hypovolemia, however, the information regarding its adequate usage is restricted within the healthcare centers and professionals. Conclusion: This review highlights the importance of providing recommendations regarding the use of ORT. We also discuss the barriers and alternatives that might limit its use.

Epidemiological Study of Acute Unintentional Poisoning Among Children in Iran.

The occurrence of different types of poisoning and early diagnosis is important for therapeutic measures. In this study, we investigate the epidemiological causes of acute poisoning in children.In this retrospective descriptive study, children presented with acute poisoning during 2010-2019 to Shahid Madani Hospital were included. The Electronic Medical Record system of the hospital was accessed to obtain the data of the patients. The data included was demographic information, type of poisoning, clinical findings, complications, duration of hospitalization, parents' education status, and mortality status.Of 336 patients included in the study, the mean age of patients was 4.90±3.27 years (range: 1-12 years). There was a significant correlation between the age of the child and the type of poisoning, p=0.001. The most frequent age group was 5 years and less (69.6%). The most frequent sex group was male (58.6%). However, there was no significant correlation between the sex of the child and the type of poisoning. Parents' education and ICU admission were also associated significantly with the type of poisoning, p=0.001, respectively. The most common type of poisoning in children was medication (60.6%) which was mainly due to methadone. The mortality rate in the study was 1.2%.Our study showed that pharmacological drugs are the main cause of poisoning in our population. Age of the children is likely to be associated with the type of poisoning however, no gender difference was found in this regard was found in our study.

Relationship of citrulline and tissue transglutaminase antibody with duodenal histopathology among children with celiac disease.

Objectives: Non-invasive biomarkers, for the diagnosis of celiac disease, can reduce the need for biopsy, particularly in pediatric patients. The aim of this study was to investigate the levels tissue transglutaminase antibody (tTG) and plasma citrulline and its correlation with intestinal biopsy. Methods: In this cross-sectional descriptive study, Pediatric patients with celiac disease referred to (XXX)were included. The patients underwent tTG antibody test along with plasma citrulline measurements using HPLC ((high performance liquid chromatography). Biopsy was performed in all the patients and clinical and demographic findings were recorded in a patient form. The data were statistically analyzed using SPSSv22. Results: Of 118 patients with celiac disease, the mean level of citrulline in patients was 17.48 ± 6.92 and the mean tTG titer was 183.17 ± 41.25. The two variables were inversely correlated with each other, p < 0.01. With an increase in Marsh levels, a significant reduction in citrulline levels and an increase in plasma tTG levels were seen, p < 0.01, respectively. The mean citrulline and tTG titer was not associated with gender and the age of the patients. Conclusion: Our findings indicate that citrulline and tTG antibody titer are significant biomarkers for the diagnosis of celiac disease and the severity of intestinal atrophy among pediatric patients.

Factors associated with febrile seizures among children.

OBJECTIVE: Febrile seizures are usually benign and are not presented with neurological manifestation. However, complex febrile seizures are presented with recurrence and might require meticulous management. The aim of this study was to evaluate the demographic, clinical, and laboratory parameters of children with febrile seizures and the correlation between these factors. METHODS: In this retrospective study, children presented with febrile seizure in 2019 presented (XXX) were included. Data based on their history, physical examination, and laboratory tests and discharge recommendations were recorded in a checklist. Data were computerized and statistically analyzed using SPSSv25. RESULTS: Of 77 patients were studied, the mean age of the patients was 29.4 ± 17.6. The mean duration of seizures was 5.09 ± 3.78 min and the mean temperature during seizures was 38.41 ± 0.83 °C. In 44 (57.14%) patients no cause of the fever was recorded. 10 (12.99%) patients had multiple seizures within 24 h 70 (90.91%) seizures ended without medication, and 5 (6.49%) patients were treated with diazepam. The gender of the patients was only correlated with white blood cells, p = 0.014. Other laboratory parameters did not show significant correlation with the gender, p > 0.05. The discharge recommendation was significantly correlated with recurrence within 24 h and type of seizure, p < 0.001, respectively. Lab parameters were significantly associated with family history, p = 0.036 and post-seizure drug, p = 0.005. CONCLUSION: Our study showed that biochemical findings may not be suggestive of febrile seizures and recurrence of seizures and family history is associated with the course of treatment in terms of drugs and imaging.

Effects of aminophylline on the levels of neutrophil gelatinase-associated lipocalin (NGAL) in asphyxiated term neonates.

OBJECTIVE: Our study evaluates the effects of aminophylline in the reduction of NGAL levels in perinatal asphyxia. METHODS: Term neonates with hypoxic ischaemic encephalopathy who were divided into two groups, the treatment and placebo. Urine NGAL levels were measured on day one and four of the treatment using BIOPORTO kits in both the groups. RESULTS: Day 1 NGAL levels were not statistically different in either group irrespective of the age, gender and the mode of delivery. on 4th day, NGAL in treatment group significantly decreased as compared to day 1 levels and placebo day-4 levels. significant differences were seen between first and fourth day NGAL levels among children with normal and caesarean birth and among female and male neonates. CONCLUSIONS: Following the treatment with aminophylline, NGAL levels in asphyxiated neonates are likely to reduce. Further studies based on other kidney dysfunction parameters can lead to the better and accurate conclusions.

Determination of carnitine ester profile in the children with type 1 diabetes: a valuable step towards a better management.

Objective: This study is designed to investigate the levels of carnitine and acylcarnitines (ACs) in the children with diabetes type 1 compared to the healthy subjects.Methods: Forty-two type 1 diabetic children and healthy subjects were recruited in the study, respectively. In addition to FBS and Hb A1C, free carnitine and ACs in butyl-ester form in the fasting blood samples were assessed by isotope dilution mass spectrometry for all diabetics and controls using the tandem mass spectrometry system.Results: Diabetic patients had a higher level of C, C4, C6, C14, C18:2, and C18:2OH. Females had elevated C14:2 compared to the males. The C18:2 and C18:2OH levels were elevated as the Hb A1C level increased. The C18:2, C14OH were mostly increased in the prediabetic and diabetic patients, respectively.Conclusion: Increased ACs level indicates the increased acyl-CoA intermediates for the fatty acids and amino acids oxidation.

Frequency of Cardiac Arrhythmias in Children with Cardiological Consulting and Containing Electrocardiogram.

BACKGROUND: Heart diseases are the leading causes of mortality and Congenital Heart Disease (CHD) is the most common birth defect reported worldwide. OBJECTIVE: The aim of this study was to evaluate the incidence of arrhythmias and CHD and the association between the two, among infants and children reported to our center. METHODS: This cross-sectional study included infants and children who were referred to Shahid Madani Hospital, Khorramabad. Electrocardiogram (ECG) was performed in these children to determine the type of arrhythmia and records were used to obtain demographic data and the data regarding CHD. RESULTS: Of 200 children enrolled in the study, 10 children had arrhythmias, 12 had tachycardia, 5 had bradycardia, and 31 had congenital disease. Among children with arrhythmias, 1 had atrial fibrillation, 4 patients had paroxysmal supraventricular tachycardia, 1 person had right bundle branch block, 1 had ventricular tachycardia, 2 had premature ventricular contractions and 1 had junctional ectopic tachycardia. Of the 31 children with CHD, 9 patients were presented with small ventricular septal defect, 4 children had patent foramen ovale, 2 had pulmonary stenosis and 1 of the children had tetralogy of fallout, arterial and ventricular septal defects and transposition of greater arteries, respectively. CONCLUSION: We reported a positive correlation between the arrhythmias and CHD. A larger number of studies collecting focusing on different age groups are therefore required to verify our findings.

Prevalence of Congenital Heart Disease among Children in Khorramabad (West of Iran).

AIMS: Congenital heart disease is among the most common congenital anomalies in pediatrics. The aim of this study was to evaluate the prevalence of congenital heart disease in children in Khorramabad, Iran. METHODS: This is a descriptive-cross sectional study where all the children diagnosed with congenital heart disease by echocardiography were enrolled to the Shahid Madani Hospital. Patient information was collected by means of a questionnaire. Of 1600 children who underwent cardiac counseling, 9.75% presented congenital heart disease. These were most prevalent among the children of 0-28 days of the age (14.7%) and least in children aged 1 month-1 year. According to this study, atrial (20.3%) and ventricular septal defect (10.5%) were the most common heart defects, respectively. Among signs and symptoms of cardiac disease, 49.1% of children had cyanosis, 89.7% with increased CT (cardiothoracic)-ratio, and 82.7% of had heart murmur. Congenital heart disease was more prevalent in male infants (58%) and 6.6% patients had heart failure and 1.4% had other congenital conditions, such as Down syndrome. RESULTS: According to our findings, atrial and ventricular septal defects are the most common congenital heart anomalies, respectively, in pediatric patients in Khorramabad.

Noninvasive markers for esophageal varices in children with cirrhosis.

BACKGROUND: The diagnosis of esophageal varices (EV) is based on the findings of esophagogastroduodenoscopy (EGD), biopsy, and serum markers. Thus, noninvasive cost-effective tests through which high-risk EV children can be diagnosed are needed. PURPOSE: This cross-sectional study aimed to identify the noninvasive markers for EV in children with liver cirrhosis. METHODS: A total of 98 children with liver cirrhosis were evaluated in this study. The spleen size, platelet count, serum albumin, liver function test results, and risk scores were evaluated prior to endoscopy. The endoscopic investigations aimed to identify the presence of EV and red signs, and determine varices sizes. RESULTS: Endoscopy revealed varices in 43 subjects (43.9%). The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index (APRI), platelet count to spleen size ratio, and risk score differed significantly between patients with and without EV on univariate analysis; however, the logistic regression analysis showed no differences, indicating that none of these parameters were independently associated with the presence of EV. CONCLUSION: Platelet count, risk score, platelet count to spleen size, and APRI can be useful tools for the identification of highrisk patients with EV and might reduce the need for invasive methods like EGD.

Clinical Manifestations and Therapeutic Findings of the Children with Glucose-6-Phosphate Dehydrogenase Deficiency Presenting Favism.

AIM: Favism is characterized as acute anemia, due to Glucose-6-phosphate dehydrogenase (G6PD) deficiency as a result of fava beans intake. It is associated with paleness, jaundice, and hemoglobinuria. In this study, signs, symptoms and therapeutic findings of the patients with hemolysis due to G6PD deficiency were investigated in Shahid Madani Hospital of Khorramabad, Lorestan. METHODS: This is a single-center cross-sectional descriptive study that was conducted on all children with G6PD deficiency-induced hemolysis. RESULTS: 308 children (64.3% male and 35.7% female) were included in this study. The most common complaint was jaundice (82.5%) and the most common cause of hemolysis was the intake of fava bean (85.7%). 68% of the children were treated with hydration/fluid therapy. Blood transfusion was conducted in 36.36% of the cases and the mean of blood administered was 18.9 cc/kg. CONCLUSION: In this study, hydration therapy was performed in most of the children presenting favism. Also, the incorrect calculation of the amount of blood needed for transfusion increased the frequency of blood transfusions and prolonged hospitalization time.

Evaluating the Usefulness of Lab-Based Test for the Diagnosis of Pneumonia in Children.

OBJECTIVE: The aim of this study is to determine the distribution of the results of routine laboratory tests for the diagnosis of pneumonia in children in Khorramabad. METHODS: This is a cross-sectional study and was performed on 650 children with pneumonia who were referred to Shahid Madani Hospital. From patients' test results, the following data were recorded: whether the results were normal or not, age, sex, serotype, history of diabetes mellitus, and the presence of urinary and digestive tract symptoms. RESULTS: There was no difference in the prevalence of pneumonia, gender-wise, whereas 40% of the patients were under 2 years. In addition, 53.7% of the patients were presented with leukocytosis. From the blood test, blood urea nitrogen, creatinine, sodium, and potassium were normal in most of the patients. Stool examination, urine analysis, urine culture, erythrocyte sedimentation rate, C-reactive protein, and blood sugar were also normal in these patients. CONCLUSION: Children under the age of 2 years are more susceptible to lung infections. Findings from blood tests such as leukocytosis are useful for making initial diagnosis other than computed tomography scan. Other lab tests might not give any useful results. In addition, a closer examination of the urinary system and digestive tract involvement is recommended, prior to urine or stool analysis.

Evaluation of α-klotho level in insulin dependent diabetes mellitus (IDDM) children.

Objectives Reduced levels of α-Klotho is associated with the pathogenesis of various diseases including diabetes. In type I diabetes, decrease in Klotho leads to apoptosis of ß-cells of pancreases. The aim of this study was to evaluate the levels of α-Klotho in type I diabetic pediatric patients. Methods In this cross-sectional single centered study, 46 patients presenting type I diabetes mellitus (case group) and 78 control group under the age of 12, referred to our clinic were included in our study. Serum levels of soluble Klotho were measured by sandwich ELISA in case and control groups. Statistical analysis was conducted for the data recorded via questionnaire. Results Mean age of the patients in the case and control group was 7.65 ± 3.09 and 7 ± 2.37, respectively. Type I diabetes patients had a significant reduction in the levels of serum Klotho, as compared to controls (p<0.001). However, gender and age-based comparison between patient and control group was not significant. Conclusions This study reports a significant decrease in the serum levels of α-Klotho in type 1 diabetic patients. Low levels of Klotho can be associated with diabetic nephropathy and other comorbidities in these patients.

Initial Treatment of Respiratory Distress Syndrome with Nasal Intermittent Mandatory Ventilation versus Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial.

BACKGROUND: Neonatal respiratory distress syndrome (RDS) in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation (MV) nowadays researchers in interested minimizing MV. To determine, in very low birth weight (BW) preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation (early NIMV) compared with early nasal continuous positive airway pressure (early NCPAP) obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. METHODS: In this single-center randomized control trial study, infants (BW ≤ 1500 g and/or gestational age ≤ 34 weeks) with respiratory distress were considered eligible. Forty-four infants were randomly assigned to receive early-NIMV and 54 comparable infants to early-NCPAP. Surfactants were given, when FIO2 requirement was of >30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. RESULTS: 98 infants were enrolled (44 in the NIMV and 54 in the NCPAP group). The Preventive power of MV of NIMV usage (95.5%) was not lower than the NCPAP (98.1%) strength (hazard ratio: 0.21 (95% confidence interval: 0.02-2.66); P: 0.23). The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP (the median (range) was 24 (18.00-48.00) h versus 48.00 (22.00-120.00) h in NIMV versus NCPAP groups; P < 0.001). Similarly, the duration of dependency on oxygen was less, for NIMV (the median (range) was 96.00 (41.00-504.00) h versus144.00 (70.00-1130.00) h in NIMV versus NCPAP groups; P: 0.009). Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group. CONCLUSIONS: Initial treatment of RDS with NIMV was safe, and well tolerated. Furthermore, NIMV had excellent benefits such as reduction of the duration of treatment, oxygen dependency period and length of hospital stay. Therefore, the primary mode with NIMV could be a feasible method of noninvasive ventilation in very premature infants.