Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center's Experience.

Background: Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP. Methods: This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the t test, Fisher's exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant. Results: The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by Escherichia coli (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures. Conclusion: Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region's bacterial resistance features.

A Comparison of the Effect of Kegel Exercises and Conventional Therapy versus Conventional Therapy Alone in the Treatment of Functional Constipation in Children: A Randomized Clinical Trial.

Background: There have been few studies on the effect of Kegel exercises on the treatment of functional constipation in children. Hence, the present study investigated the add-on role of Kegel exercises in children with functional constipation. Methods: This clinical trial was conducted on children with functional constipation, according to Rome IV, who were referred to the pediatric department of Imam Reza Clinic (Shiraz, Iran) in 2022. The sample consisted of 64 children who were randomly assigned to either the intervention or the control groups. In the control group, a pediatrician administered conventional therapy, including diet training, defecation training, and polyethylene glycol (PEG) syrup (0.7 g/Kg daily). In the treatment group, in addition to conventional therapy, a pediatrician taught Kegel exercises to the child both verbally and in writing in the presence of their parents. To investigate the effectiveness of the intervention, frequency of defecation, defecation time, assistance used for defecation, incomplete emptying, unsuccessful defecation, abdominal pain, and painful defecation were selected as the outcomes. Independent sample t test was used for continuous variables. Categorical variables were reported as frequency and percentages. To examine the difference in categorical outcome variables, Wilcoxon (pre and post), Chi square, and Fisher exact tests were used. Data were analyzed using SPSS software version 21. P<0.05 were considered statistically significant. Results: Twenty-seven (88.4%) patients in the Kegel exercise group reported a defecation time of less than 5 min, while only 12 (37.5%) patients in the control group reached this time, and this difference was statistically significant (P=0.001). Moreover, patients in the treatment group showed significant improvements in terms of incomplete emptying of stool, unsuccessful defecation, abdominal pain, and painless defecation (P=0.001, P=0.001, P=0.001, P=0.037, respectively). After intervention, the use of laxatives, digits, or enemas to assist defecation was not significantly different between the groups (P=0.659). Conclusion: Kegel exercise was an effective adjunctive treatment for pediatric functional constipation.Trial Registration Number: IRCT20230424057984N1.

Operation of a giant occipital encephalocele in an infant: A surgical case report.

INTRODUCTION AND IMPORTANCE: Encephalocele is a rare medical condition where certain parts of the central nervous system protrude through a skull defect, resulting in a deformity where the head size is smaller than the protrusion. This condition is relatively uncommon, and only a few cases have been reported worldwide. CASE PRESENTATION: We present a case of a 13-day-old neonate with a giant occipital encephalocele who underwent a successful surgical intervention in a resource-limited setting. CLINICAL DISCUSSION: The diagnosis of encephaloceles is frequently by clinical examination, although sonography could be helpful before birth. It is crucial that this patient receives immediate surgical intervention. In cases where hydrocephalus and ventriculomegaly are absent, we predict a better prognosis. The prone position is preferred in these operations, and Anesthesia is a real challenge. CONCLUSIONS: Congenital giant occipital encephaloceles can be identified clinically shortly after birth. They cause a substantial surgical challenge due to their massive size. Surgical repair must be performed as early as possible.

Stone removal in a 5-year-old child with extrahepatic biliary obstruction using ERCP: A case report and a mini-review.

Key Clinical Message: ERCP is a safe and effective method for managing biliary obstruction in children. A case report illustrates successful removal of a bile duct stone in a 5-year-old child using ERCP. Pediatric ERCP is a viable option for treating biliary diseases in well-equipped centers, alongside other approaches. Abstract: We describe a 5-year-old child with extrahepatic biliary stone who successfully underwent endoscopic retrograde cholangiopancreatography for stone removal. He suffered from persistent colicky abdominal pain accompanied by fever that confirmed biliary stone. ERCP along with other methods, can be considered a safe procedure for managing BD in children.

Terminal ileitis and cytotoxic lesion of corpus callosum as the presenting features of Multisystem inflammatory syndrome in children (MIS-C): a case report.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a post-viral inflammatory vasculopathy characterized by persistent fever, multiorgan dysfunction, significant laboratory markers of inflammation, lack of an alternative diagnosis, and prior SARS-CoV-2 infection or exposure in children and adolescents. The most common early symptoms include a prolonged fever, as well as dermatologic, mucocutaneous, and gastrointestinal symptoms such abdominal pain, vomiting, and diarrhea. CASE PRESENTATION: We present a pediatric patient with multisystem inflammatory syndrome with the development of abdominal pain and seizure who was found to have a circumferential wall thickening of the terminal ileum and ileocecal junction in abdominal CT scan. The brain MRI of the patient showed cytotoxic lesions of the corpus callosum (CLOCC) which had hypersignal intensity with a few diffusion restrictions in the splenium of the corpus callosum. CONCLUSION: This case is being reported to raise awareness of MIS-C presenting characteristics. Given the rising number of MIS-C patients and a lack of understanding regarding early diagnostic clinical characteristics and therapy, further research into clinical presentations, treatment, and outcomes is urgently needed.

Epidemiological characteristics and outcomes of COVID-19 in asymptomatic versus symptomatic patients.

Background: The clinical manifestations of COVID-19 are different, which can be attributed to asymptomatic carriers, acute respiratory disease and pneumonia with different severities. The aim of this study was to compare the epidemiological characteristics and outcomes of COVID-19 in patients with clinical symptoms versus asymptomatic patients. Methods: In this retrospective cohort study, the epidemiological characteristics of two groups of patients, with clinical symptoms (n = 38,630) and without clinical symptoms who were definitive cases of COVID-19 (n = 2,327) were investigated in the southwestern of Iran. Chi-square test was used to evaluate the differences between qualitative variables in the two study groups. Results: Of 40,957 patients with COVID-19, 2,327 (5.68%) were asymptomatic, of whom 1391 (59.77%) were males, 1841 patients (79.11%) had a history of contact with definite or suspected cases of COVID-19. Asymptomatic patients were older than symptomatic cases. Patients with clinical symptoms had higher mortality rate than asymptomatic patients (2.68% in symptomatic patients vs 0% in asymptomatic patients). Conclusion: According to the results of our study, the detected viral load in asymptomatic individuals was similar to that of symptomatic patients, indicating that asymptomatic infections can potentially transmit the disease. Therefore, screening and detection of asymptomatic cases is an important and key measure in prevention and early control of COVID-19 worldwide.

Beneficial effects of Japanese sake yeast supplement on biochemical, antioxidant, and anti-inflammatory factors in streptozotocin-induced diabetic rats.

BACKGROUND: Using chemical agents in the treatment of diabetes mellitus type 2 may have some limitations due to frequent side effects. Some novel and natural agents may be promising alternatives in this case. This study was designed to evaluate the effects of oral Japanese sake yeast supplement, as a novel agent, on biochemical antioxidant and anti-inflammatory parameters in experimentally induced diabetic rats. MATERIALS AND METHODS: After inducing diabetes (55 mg/kg intraperitoneal injection of streptozotocin), 120 male adult Wistar rats were randomly divided into 5 groups and each group received 0 (control), 15, 30, or 45 mg/kg of sake yeast or was considered a nondiabetic control. Then, the serum levels of tumor necrosis factor-α, IL-6, C-reactive protein, malondialdehyde, glutathione, total antioxidant status, glucose, cholesterol, triglycerides, and insulin were evaluated and compared to baseline measures. RESULTS: The results showed that oral administration of sake yeast at different concentrations reduced levels of malondialdehyde, glucose, cholesterol, and triglycerides and increased levels of insulin, glutathione, and total antioxidants (P<0.05). The best responses were observed in the nondiabetic control group. CONCLUSION: Sake yeast supplement may be useful as a novel agent in the treatment of diabetes.