External Otitis: An Unusual Presentation in Neonates.

Acute otitis externa (AOE) is an infection of the external auditory canal, the auricle, and the outer surface of the tympanic membrane. Although AOE is one of the most common otologic conditions encountered in pediatric population, it is known to primarily affect children older than 2 years. We report a case of AOE caused by Staphylococcus aureus in a 23-day-old neonate. A 23-day-old female infant presented to our neonatology clinic with irritability and discharge from the right ear. There were yellow otorrhea, mild erythema, and edema of right external ear canal. There was no sign of otitis media on otoscopy. The results of laboratory tests were insignificant. The discharge culture grew colonies of methicillin-sensitive Staphylococcus aureus. After 48 hours of treatment with intravenous cloxacillin, significant improvement was observed. The present case highlights an unusual presentation of staphylococcal infection in a neonate. This is the first case of methicillin-sensitive Staphylococcus aureus otitis externa in an immunocompetent newborn.

Comparison of propranolol and pregabalin for prophylaxis of childhood migraine: a randomised controlled trial.

Migraine involves 5-10% of children and adolescents. Thirty percent of children with severe migraine attacks have school absence and reduced quality of life that need preventive therapy. The purpose of this randomised control trial study is to compare the effectiveness, safety and the tolerability of pregabalin toward Propranolol in migraine prophylaxis of children. From May 2011 to October 2012, 99 children 3-15 years referred to the neurology clinic of Mofid Children's Hospital with a diagnosis of migraine enrolled the study. Patients randomly divided into two groups (A&B). We treated children of group A with capsule of pregabalin as children of group B with tablet of propranolol for at least 8 weeks. In this study, 99 patients were examined that 91 children reached the last stage. The group A consistsed of 46 patients, 12(26.1%) girls, 34 (73.9%) boys and the group B consisted of 45 patients, 14(31.1%) girls, 31 (68.9%) boys. Basis of age, gender, headache onset, headache frequency, migraine type, triggering and relieving factors there was no significant difference among these groups (P>0.05). After 4 and 8 weeks of Pregabalin usage monthly headache frequency decreased to 2.2±4.5 and 1.76±6.2 respectively. Propranolol reduced monthly headache frequency up to 3.73±6.11 and 3.34±5.95 later 4 and 8 weeks respectively. There was a significant difference between these two groups according to headache frequency reduction (P=0.04). Pregabalin efficacy in reducing the frequency and duration of pediatric migraine headache is considerable in comparison with propranolol.

Leukocyte count and erythrocyte sedimentation rate as diagnostic factors in febrile convulsion.

Febrile convulsion (FC) is the most common seizure disorder in childhood. white blood cell (WBC) and erythrocyte sedimentation rate (ESR) are commonly measured in FC. Trauma, vomiting and bleeding can also lead to WBC and ESR so the blood tests must carefully be interpreted by the clinician. In this cross sectional study 410 children(163 with FC), aged 6 months to 5 years, admitted to Bahrami Children hospital in the first 48 hours of their febrile disease, either with or without seizure, were evaluated over an 18 months period. Age, sex, temperature; history of vomiting, bleeding or trauma; WBC, ESR and hemoglobin were recorded in all children. There was a significant increase of WBC (P<0.001) in children with FC so we can deduct that leukocytosis encountered in children with FC can be due to convulsion in itself. There was no significant difference regarding ESR (P=0.113) between the two groups. In fact, elevated ESR is a result of underlying pathology. In stable patients who don't have any indication of lumbar puncture, there's no need to assess WBC and ESR as an indicator of underlying infection. If the patient is transferred to pediatric ward and still there's no reason to suspect a bacterial infection, there is no need for WBC test.

Quantitative assessment of right atrial function by strain and strain rate imaging in patients with heart failure.

OBJECTIVES: We sought to evaluate the regional longitudinal strain/strain rate profiles in the right atrial wall to quantify right atrial function in systolic heart failure patients. BACKGROUND: According to previous studies on the deformational properties of the left atrium, the systolic strain and strain rates represent the atrial reservoir function and the early and late diastolic strain rates show the conduit and booster functions, respectively. METHODS: Thirty patients with a diagnosis of heart failure (left ventricular ejection fraction < or = 35%) scheduled for right heart catheterization were enrolled. Echocardiography was performed to obtain right atrial deformation indices just before the procedure. The control group consisted of 32 healthy adults matched for age and sex. The deformity indices obtained consisted of the right atrial peak systolic strain (RAS), right atrial peak systolic strain rate (RASSR), right atrial early diastolic strain rate (RAEDSR), and right atrial late diastolic strain rate (RALDSR). RESULTS: The right atrial deformation indices were significantly compromised in the heart failure patients versus the normal subjects (RAS: 68.5 +/- 53.9 vs 189.3 +/- 61.2, P = 0.000; RASSR: 2.9 +/- 1.9 vs. 5.3 +/- 1.5, P = 0.000).There was a significant correlation between the RAS and RASSR and cardiac output (RAS: r = 0.5, P = 0.005; RASSR: r = 0.5, P = 0.003), and cardiac index (RAS: r = 0.6, P = 0.001; RASSR: r = 0.6, P = 0.001). CONCLUSION: In light of our findings, we conclude that a diminished RA function, as assessed by strain imaging, plays a critical role in the pathophysiological process of heart failure patients.