Diagnostic accuracy of laboratory markers for diagnosis of acute appendicitis in children.

BACKGROUND: Acute appendicitis (AA), the most common abdominal emergency disease, is one of the most important causes of hospitalization of children. Studies have shown that white blood cell (WBC) count, mean platelet volume (MPV), C­reactive protein (CRP), and erythrocyte sedimentation rate (ESR) can play an important role in the diagnostic prediction of appendicitis. Therefore, the aim of this study was to evaluate the diagnostic value of WBC count, polymorphonuclear leukocytes (PMNs) percentage, MPV, CRP, and ESR for the diagnosis of AA. METHODS: In this study, 100 medical records were reviewed for children referred to the hospital complaining of abdominal pain and who underwent operation with a provisional diagnosis of acute appendicitis based on clinical and laboratory findings. Patients were divided into two groups according to the pathology gold standard method: AA and the other group with acute abdominal pain without appendicitis (AAP). The diagnostic accuracy of WBC, PMNs%, MPV, ESR, and CRP were compared for patients with AA and AAP. RESULTS: A total of 100 patients (50 with AA and 50 with AAP) were identified. The sensitivity and specificity of WBC and PMNs% were 78 and 66%, and 76 and 54%, respectively; ESR was 80 and 48%, respectively; and CRP was 82 and 62% (30-89%), respectively. A low specificity (8%) and 70% sensitivity was calculated using the cutoff point of 8.1 fl for MPV. CONCLUSION: Our data suggest that children with AA often present with significantly higher WBC count, ESR level, CRP level, PMNs%, and lower MPV level. The results of the study showed that WBC, CRP, and ESR, along with other diagnostic methods, can be useful in diagnosing AA in children. MPV is not effective in the diagnosis of AA due to its specificity; however, a significantly lower level was found in children with AA.

Pediatric Intussusception in Northern Iran: Comparison of Recurrent With Non-Recurrent Cases.

BACKGROUND: Intussusception represents as the invagination of a part of the intestine into itself and is the most common cause of intestinal obstruction in infants and children between 6 months to 3-years-old. OBJECTIVES: The objective of this study was to determine the recurrence rate and predisposing factors of recurrent intussusception. PATIENTS AND METHODS: The medical records of children aged less than 13-years-old with confirmed intussusception who underwent reduction at a tertiary academic care in northern Iran (Mazandran), from 2001 to 2013 were reviewed. Data were extracted and recurrence rate was determined. The two groups were compared by chi square, Fisher, Mann-Whitney and t-test. Diagnosed cases of intussusception consisted of 237 children. RESULTS: Average age of the patients was 19.57 ± 19.43 months with a peak of 3 to 30 months. Male to female ratio was 1.65 and this increased by aging. Recurrence rate was 16% (38 cases). 87 (36.7%) underwent surgery. These were mainly children under one year old. In 71% (40) of episodes recurrence occurred 1 to 7 times within 6 months. The recurrence occurred in 29 (23.5%) children in whom a first reduction was achieved with barium enema (BE) and 5 (5.7%) children who had an operative reduction (P < 0.001) in the first episode. Pathological leading points (PLPs) were observed in 5 cases; 2.6% in recurrence group versus 2% in non-recurrence group (P = 0.91). Three patients had intestinal polyp, 2 patient's lymphoma and Mackle's diverticulum. Age (P = 0.77) and sex (P = 0.38) showed no difference between the two groups. PLPs were observed in 1.4% of children aged 3 months to 5 years. This was 13.3%, in older children (P = 0.02). CONCLUSIONS: The recurrence of intussusception was related to the method of treatment in the first episode and it was 5-fold higher in children with BE than in operative reduction. Recurrent intussusceptions were not associated with PLPs, they were more idiopathic.

Starved human fibroblasts secrete acidic proteins inducing post re-feeding proliferation and in vitro cell migration: a potential tool for wound healing.

BACKGROUND INFORMATION: There are several reports indicating that starved fibroblasts show higher proliferation rates when re-fed with foetal bovine serum. We have evidence demonstrating that this phenomenon is related to secretory proteins which may be beneficial to wound healing. RESULTS: After re-feeding, 16 and 72 h serum-starved fibroblasts showed the highest and lowest proliferation rates, 1.59 and 0.51-fold difference compared to the non-starved control, respectively (P < 0.05). However, the latest value could be normalised by incubating cells with 16 h-starved fibroblast cell culture supernatant (16-SFS), prior to re-feeding. A strong correlation was found between total protein level in starved fibroblast culture supernatants and post re-feeding proliferation rates (r(2) = 0.90, P < 0.001). Two-dimensional gel electrophoresis analysis of 16-SFS confirmed the presence of proteins with relative molecular weights of 10-120 kDa and pI ranging from 4 to 6. A significant difference in calcium influx course was found between 16-SFS and the negative control (Dulbecco's Modified Eagle Medium) (P < 0.05). There was no significant difference in Ca(2+) concentrations after 1 h between non-starved controls and 16-SFS-treated fibroblasts. The scratch test demonstrated that the 16-SFS is able to induce fibroblast migration. CONCLUSIONS: We concluded that human starved fibroblasts secrete proteins that are able to induce post re-feeding cell proliferation and fibroblasts migration, probably through the induction of a sustained calcium influx. This is worth being considered as a potential tool for wound healing.

Early surgical intervention for diaphragmatic paralysis in a neonate; report of a case and literature review.

BACKGROUND: Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure. CASE PRESENTATION: We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days. CONCLUSION: Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis.