Background: Considering the lack of studies to investigate the effect of atropine administration on delirium incidence in a post-anesthesia care unit (PACU) in children, this study was conducted with the aim of investigating the effect of atropine administration on delirium incidence and other complications in children undergoing surgery. Methods: The present double-blind, randomized clinical trial was conducted on 70 children aged 1 - 6 years that were candidates for lower abdominal surgery. The patients were assigned to two groups, each consisting of 35 patients. Before induction of anesthesia, 0.02 mg/kg of atropine and 0.02 mg/kg of normal saline were administered intravenously in the first (atropine) and second (control) groups, respectively. Patients’ mean arterial blood pressure (MAP), heart rate (HR), and incidence of complications after surgery were recorded. Results: The results of the present study revealed that the two groups had no significant difference in terms of the mean MAP in any of the studied times (P-value > 0.05). However, the mean HR during surgery was significantly higher in the atropine group compared with the control group (P-value < 0.05). In addition, although the incidence and severity of delirium in the atropine group were insignificantly higher than that of the control group, respiratory complications such as decreased saturation and laryngospasm were lower in the atropine group compared with the control group (P-value > 0.05). The volume of suctioned secretions in the atropine group, with a mean of 6.26 ± 2.47 cc was significantly lower than its volume in the control group, with a mean of 14.57 ± 4.27 cc (P-value < 0.001). Conclusions: According to the findings of the present study, although the administration of atropine slightly increased delirium incidence, it could reduce the incidence of respiratory complications and secretions after surgery. However, more studies are required to make a more definitive conclusion in this respect.
{"title":"Effect of Atropine Administration Before Induction of Anesthesia on the Incidence of Delirium and Other Complications in a Post-anesthesia Care Unit (PACU) Among Children Undergoing Surgery: A Randomized, Placebo-Controlled Clinical Trial","authors":"F. Rajabi, A. Shafa, Mahtab Shirani","doi":"10.5812/ijp-126575","DOIUrl":"https://doi.org/10.5812/ijp-126575","url":null,"abstract":"Background: Considering the lack of studies to investigate the effect of atropine administration on delirium incidence in a post-anesthesia care unit (PACU) in children, this study was conducted with the aim of investigating the effect of atropine administration on delirium incidence and other complications in children undergoing surgery. Methods: The present double-blind, randomized clinical trial was conducted on 70 children aged 1 - 6 years that were candidates for lower abdominal surgery. The patients were assigned to two groups, each consisting of 35 patients. Before induction of anesthesia, 0.02 mg/kg of atropine and 0.02 mg/kg of normal saline were administered intravenously in the first (atropine) and second (control) groups, respectively. Patients’ mean arterial blood pressure (MAP), heart rate (HR), and incidence of complications after surgery were recorded. Results: The results of the present study revealed that the two groups had no significant difference in terms of the mean MAP in any of the studied times (P-value > 0.05). However, the mean HR during surgery was significantly higher in the atropine group compared with the control group (P-value < 0.05). In addition, although the incidence and severity of delirium in the atropine group were insignificantly higher than that of the control group, respiratory complications such as decreased saturation and laryngospasm were lower in the atropine group compared with the control group (P-value > 0.05). The volume of suctioned secretions in the atropine group, with a mean of 6.26 ± 2.47 cc was significantly lower than its volume in the control group, with a mean of 14.57 ± 4.27 cc (P-value < 0.001). Conclusions: According to the findings of the present study, although the administration of atropine slightly increased delirium incidence, it could reduce the incidence of respiratory complications and secretions after surgery. However, more studies are required to make a more definitive conclusion in this respect.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72516875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mehrjerdian, L. Barati, Farshid Kompani, M. Vakili, F. Teymouri
Background: Enuresis is bedwetting that occurs during sleep in children over five years old. If left untreated, it can lead to social and psychological problems for children and their parents. The role of copeptin in patients with primary monosymptomatic nocturnal enuresis (PMNE) has been reported in several studies. Due to the favorable structural properties of copeptin and the reflection of arginine vasopressin (AVP) concentration, it can be used as an alternative marker for AVP secretion. Objectives: This study aims to compare the levels of copeptin in healthy and enuresis children aged 5 - 15 years. Methods: This case-control study was performed on 42 children with primary monosymptomatic enuresis and 42 children without enuresis who were referred to the clinic of Taleghani hospital in Gorgan in 2020. Copeptin levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. Results: Out of 84 patients, an equal proportion of girls (21 patients) and boys (21 patients) participated in both the case and control groups. The age of the children was 8.05 ± 2.46 years, and there was no statistically significant difference between the two groups (P = 0.16). The mean level of copeptin in the case and control groups were 6.7 ± 4.27 and 6.87 ± 8.52 pg/mL, respectively, significantly lower in the case group (P = 0.03). There was a statistically significant difference in the level of copeptin between the boys in the two groups (P = 0.03). Although the mean level of copeptin in the girls in the patient group was lower than that in the control group, this difference was not statistically significant (P = 0.35). Conclusions: In this study, the mean level of copeptin in PMNE was significantly lower than that in the control group, which suggests it may be considered as a probable biomarker for the prediction of response to treatment with desmopressin, but further study is required to confirm this hypothesis.
{"title":"The Relationship Between Copeptin Level and Enuresis in Children Aged 5 - 15 Years","authors":"M. Mehrjerdian, L. Barati, Farshid Kompani, M. Vakili, F. Teymouri","doi":"10.5812/ijp-130774","DOIUrl":"https://doi.org/10.5812/ijp-130774","url":null,"abstract":"Background: Enuresis is bedwetting that occurs during sleep in children over five years old. If left untreated, it can lead to social and psychological problems for children and their parents. The role of copeptin in patients with primary monosymptomatic nocturnal enuresis (PMNE) has been reported in several studies. Due to the favorable structural properties of copeptin and the reflection of arginine vasopressin (AVP) concentration, it can be used as an alternative marker for AVP secretion. Objectives: This study aims to compare the levels of copeptin in healthy and enuresis children aged 5 - 15 years. Methods: This case-control study was performed on 42 children with primary monosymptomatic enuresis and 42 children without enuresis who were referred to the clinic of Taleghani hospital in Gorgan in 2020. Copeptin levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. Results: Out of 84 patients, an equal proportion of girls (21 patients) and boys (21 patients) participated in both the case and control groups. The age of the children was 8.05 ± 2.46 years, and there was no statistically significant difference between the two groups (P = 0.16). The mean level of copeptin in the case and control groups were 6.7 ± 4.27 and 6.87 ± 8.52 pg/mL, respectively, significantly lower in the case group (P = 0.03). There was a statistically significant difference in the level of copeptin between the boys in the two groups (P = 0.03). Although the mean level of copeptin in the girls in the patient group was lower than that in the control group, this difference was not statistically significant (P = 0.35). Conclusions: In this study, the mean level of copeptin in PMNE was significantly lower than that in the control group, which suggests it may be considered as a probable biomarker for the prediction of response to treatment with desmopressin, but further study is required to confirm this hypothesis.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88692149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elmira Hajiesmaeil Memar, A. Zeinaloo, M. Mirzaaghayan, Mojtaba Gorji, A. Ghamari, Mahya Ghahremanloo, Ehsan Aghaei-Moghadam
Introduction: The people worldwide have been affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection since its appearance in December, 2019. Kawasaki disease-like hyperinflammatory shock associated with SARS-CoV-2 infection in previously healthy children has been reported in the literature, which is now referred to as a multisystem inflammatory syndrome in children (MIS-C). Some aspects of MIS-C are similar to those of Kawasaki disease, toxic shock syndrome, secondary hemophagocytic syndrome, and macrophage activation syndrome. Case Presentation: This study reported an 11-year-old boy with MIS-C presented with periorbital and peripheral edema, abdominal pain, elevated liver enzymes, severe right pleural effusion, moderate ascites, and severe failure of right and left ventricles. Conclusions: Due to the increasing number of reported cases of critically ill patients afflicted with MIS-C and its life-threatening complications, it was recommended that further studies should be carried out in order to provide screening tests for myocardial dysfunction. Adopting a multidisciplinary approach was found inevitable.
{"title":"Report of the Association Between Multisystem Inflammatory Syndrome and Severe Myocarditis","authors":"Elmira Hajiesmaeil Memar, A. Zeinaloo, M. Mirzaaghayan, Mojtaba Gorji, A. Ghamari, Mahya Ghahremanloo, Ehsan Aghaei-Moghadam","doi":"10.5812/ijp-122272","DOIUrl":"https://doi.org/10.5812/ijp-122272","url":null,"abstract":"Introduction: The people worldwide have been affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection since its appearance in December, 2019. Kawasaki disease-like hyperinflammatory shock associated with SARS-CoV-2 infection in previously healthy children has been reported in the literature, which is now referred to as a multisystem inflammatory syndrome in children (MIS-C). Some aspects of MIS-C are similar to those of Kawasaki disease, toxic shock syndrome, secondary hemophagocytic syndrome, and macrophage activation syndrome. Case Presentation: This study reported an 11-year-old boy with MIS-C presented with periorbital and peripheral edema, abdominal pain, elevated liver enzymes, severe right pleural effusion, moderate ascites, and severe failure of right and left ventricles. Conclusions: Due to the increasing number of reported cases of critically ill patients afflicted with MIS-C and its life-threatening complications, it was recommended that further studies should be carried out in order to provide screening tests for myocardial dysfunction. Adopting a multidisciplinary approach was found inevitable.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85802550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The relationship between vitamin D and primary monosymptomatic nocturnal enuresis (PMNE) is still controversial. Objectives: This study aimed to investigate the relationship between different vitamin D levels with the development and severity of PMNE. Methods: A case-control study of 534 children (267 children with PMNE as the case group and 267 healthy children without enuresis as the control group), aged 6 - 15 years old, was conducted in two tertiary primary care hospitals, Tehran, Iran, from 2015 to 2021. The participants' demographic characteristics and vitamin D status were evaluated in both groups. The relationship between vitamin D levels with enuresis and its severity was studied as the main outcome measures. Multiple logistic regression models were utilized for statistical analyses to assay the odds ratio at a confidence interval of 95%. In this study, P < 0.05 were set as the significance level. Results: Vitamin D levels significantly differed between the two groups (18.58 ± 9.83 ng/mL and 30.23 ± 10.62 ng/mL, respectively; P < 0.001). After adjusting for confounders, vitamin D was significantly associated with enuresis (< 20 ng/mL, OR 3.07, 95% CI 1.9 - 4.95, P = 0.0001; 20 - 30 ng/mL, OR 2.72, 95% CI 1.47 - 3.67, P = 0.0001). Adjusted OR with 95% CI concerning the history of parental enuresis was 15.03 (95% CI 1.88 - 19.6, P = 0.01). The prevalence of vitamin D deficiency and insufficiency in the PMNE subjects were 107 cases (40.1%) and 109 cases (40.8%), respectively, and the prevalence values in the control group were 57 cases (21.3%) and 71 cases (26.6%), respectively (P < 0.05). Furthermore, the participants with higher frequencies of bedwetting represented lower vitamin D levels (severe, 10.6 ± 1.23 ng/ mL; moderate, 19.46 ± 1.21 ng/mL; mild, 26.8 ± 2.61 ng/mL, P = 0.0001). Conclusions: According to the finding of this study, parental history, and the participants’ vitamin D status were significant risk factors for the PMNE development. Vitamin D levels were significantly lower in the PMNE children. The prevalence of vitamin D deficiency and insufficiency was significantly higher in the enuretic subjects. Children with higher frequencies of bedwetting represented lower vitamin D levels.
背景:维生素D与原发性单症状性夜间遗尿(PMNE)的关系仍有争议。目的:探讨不同维生素D水平与PMNE发生及严重程度的关系。方法:2015 - 2021年在伊朗德黑兰两所三级基层医院对534名6 - 15岁儿童进行病例对照研究，其中经PMNE患儿267例为病例组，无遗尿症健康患儿267例为对照组。对两组参与者的人口统计学特征和维生素D状况进行评估。研究了维生素D水平与遗尿症及其严重程度的关系。采用多元logistic回归模型进行统计分析，以95%的置信区间测定优势比。本研究以P < 0.05为显著性水平。结果:两组患者维生素D水平差异显著(分别为18.58±9.83 ng/mL和30.23±10.62 ng/mL);P < 0.001)。调整混杂因素后，维生素D与遗尿显著相关(< 20 ng/mL, OR 3.07, 95% CI 1.9 - 4.95, P = 0.0001;20 ~ 30 ng/mL, OR 2.72, 95% CI 1.47 ~ 3.67, P = 0.0001)。父母遗尿史的校正OR和95% CI为15.03 (95% CI 1.88 ~ 19.6, P = 0.01)。PMNE组维生素D缺乏和不足患病率分别为107例(40.1%)和109例(40.8%)，对照组患病率分别为57例(21.3%)和71例(26.6%)，差异有统计学意义(P < 0.05)。此外，尿床频率较高的参与者维生素D水平较低(严重，10.6±1.23 ng/ mL;中等，19.46±1.21 ng/mL;轻度，26.8±2.61 ng/mL, P = 0.0001)。结论:根据本研究的发现，父母史和参与者的维生素D状况是PMNE发展的重要危险因素。PMNE组儿童的维生素D水平明显较低。在尿毒症患者中，维生素D缺乏和不足的发生率明显更高。尿床频率较高的儿童体内维生素D含量较低。
{"title":"Are Vitamin D Levels Linked to Primary Monosymptomatic Nocturnal Enuresis in Children? Six Years of Experience about a Controversy in Medicine: A Case-control Study","authors":"S. Siroosbakht","doi":"10.5812/ijp-133755","DOIUrl":"https://doi.org/10.5812/ijp-133755","url":null,"abstract":"Background: The relationship between vitamin D and primary monosymptomatic nocturnal enuresis (PMNE) is still controversial. Objectives: This study aimed to investigate the relationship between different vitamin D levels with the development and severity of PMNE. Methods: A case-control study of 534 children (267 children with PMNE as the case group and 267 healthy children without enuresis as the control group), aged 6 - 15 years old, was conducted in two tertiary primary care hospitals, Tehran, Iran, from 2015 to 2021. The participants' demographic characteristics and vitamin D status were evaluated in both groups. The relationship between vitamin D levels with enuresis and its severity was studied as the main outcome measures. Multiple logistic regression models were utilized for statistical analyses to assay the odds ratio at a confidence interval of 95%. In this study, P < 0.05 were set as the significance level. Results: Vitamin D levels significantly differed between the two groups (18.58 ± 9.83 ng/mL and 30.23 ± 10.62 ng/mL, respectively; P < 0.001). After adjusting for confounders, vitamin D was significantly associated with enuresis (< 20 ng/mL, OR 3.07, 95% CI 1.9 - 4.95, P = 0.0001; 20 - 30 ng/mL, OR 2.72, 95% CI 1.47 - 3.67, P = 0.0001). Adjusted OR with 95% CI concerning the history of parental enuresis was 15.03 (95% CI 1.88 - 19.6, P = 0.01). The prevalence of vitamin D deficiency and insufficiency in the PMNE subjects were 107 cases (40.1%) and 109 cases (40.8%), respectively, and the prevalence values in the control group were 57 cases (21.3%) and 71 cases (26.6%), respectively (P < 0.05). Furthermore, the participants with higher frequencies of bedwetting represented lower vitamin D levels (severe, 10.6 ± 1.23 ng/ mL; moderate, 19.46 ± 1.21 ng/mL; mild, 26.8 ± 2.61 ng/mL, P = 0.0001). Conclusions: According to the finding of this study, parental history, and the participants’ vitamin D status were significant risk factors for the PMNE development. Vitamin D levels were significantly lower in the PMNE children. The prevalence of vitamin D deficiency and insufficiency was significantly higher in the enuretic subjects. Children with higher frequencies of bedwetting represented lower vitamin D levels.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87350788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Afarin Neishabouri, Parham Torabinavid, A. Kajbafzadeh
Introduction: Renovascular hypertension is among the significant causes of severe hypertension in pediatrics. Primary therapeutic approaches, including drug therapy or angioplasty, are not always feasible, and their effectiveness is variable. Meanwhile, several conditions leading to renal function impairment, including severe renal artery stenosis, may represent the respective kidney as an apparently non-functioning organ in various imaging modalities. We aim to demonstrate that the only organ in the body of a child with non-treated renovascular hypertension and severe renal artery stenosis is the ipsilateral non-functioning kidney. This kidney is alive and protected from hypertension by renal artery stenosis. Renal autotransplantation (RAT) can be superior to nephrectomy in such cases to protect from severe hypertension. This phenomenon can be confirmed by controlled hypertension and hypertrophy of transplanted kidney accompanied by shrinkage of contralateral compensatory hypertrophy. Case Presentation: We introduce a 14-year-old child with a history of diagnosed hypertension from seven years ago, presenting with resistance to four-drug therapy. Renal scintigraphy and intravenous pyelography found no activity pertaining to the relative kidney, and angiography exhibited severe stenosis of the renal artery with preserved blood circulation. Renal autotransplantation successfully restored the function of the respective kidney based on pre-and post-surgery intravenous pyelography and decreased the blood pressure to normal limits. Conclusions: Our experience shows we cannot mark a kidney as a "non-functioning" organ only on the basis of the preliminary findings from conventional imaging modalities, including intravenous pyelography, scintigraphy, and duplex ultrasound. Moreover, in cases that angioplasty is failed or is not feasible, renal auto-transplantation may be a safe alternative with promising outcomes in patients with renovascular hypertension, being able to restore the function of the kidney.
{"title":"Renovascular Hypertension and Seemingly Non-functioning Kidney Renewed Following Auto-transplantation: Pearls from Over Two Decades of Follow-up","authors":"Afarin Neishabouri, Parham Torabinavid, A. Kajbafzadeh","doi":"10.5812/ijp-127243","DOIUrl":"https://doi.org/10.5812/ijp-127243","url":null,"abstract":"Introduction: Renovascular hypertension is among the significant causes of severe hypertension in pediatrics. Primary therapeutic approaches, including drug therapy or angioplasty, are not always feasible, and their effectiveness is variable. Meanwhile, several conditions leading to renal function impairment, including severe renal artery stenosis, may represent the respective kidney as an apparently non-functioning organ in various imaging modalities. We aim to demonstrate that the only organ in the body of a child with non-treated renovascular hypertension and severe renal artery stenosis is the ipsilateral non-functioning kidney. This kidney is alive and protected from hypertension by renal artery stenosis. Renal autotransplantation (RAT) can be superior to nephrectomy in such cases to protect from severe hypertension. This phenomenon can be confirmed by controlled hypertension and hypertrophy of transplanted kidney accompanied by shrinkage of contralateral compensatory hypertrophy. Case Presentation: We introduce a 14-year-old child with a history of diagnosed hypertension from seven years ago, presenting with resistance to four-drug therapy. Renal scintigraphy and intravenous pyelography found no activity pertaining to the relative kidney, and angiography exhibited severe stenosis of the renal artery with preserved blood circulation. Renal autotransplantation successfully restored the function of the respective kidney based on pre-and post-surgery intravenous pyelography and decreased the blood pressure to normal limits. Conclusions: Our experience shows we cannot mark a kidney as a \"non-functioning\" organ only on the basis of the preliminary findings from conventional imaging modalities, including intravenous pyelography, scintigraphy, and duplex ultrasound. Moreover, in cases that angioplasty is failed or is not feasible, renal auto-transplantation may be a safe alternative with promising outcomes in patients with renovascular hypertension, being able to restore the function of the kidney.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82334380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahshid Naserifar, Sahar Arab Yousefiabadi, Nasser Vahdati-Mashhadian, Mahshid Ataei, Nilufar Hashempour, N. Jafari, S. Eslami, Z. Taherzadeh
Background: In pediatrics, many drugs are used without marketing authorization. Recommendations are often based on clinical experience. Therefore, the risk of inappropriate prescription (IP) is high. It is necessary to have a tool for pediatric IP detection. Objectives: This study was performed to develop and validate a Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions (POPI) screening tool to facilitate its use in pediatric practice in Iran. Methods: Using forward- and backward-translation procedures, an efficient and effective tool was provided in the current study and clinical settings. The two-round Delphi technique established content validity. The criteria were then piloted in a cross-sectional study in the pediatric patients of Khorasan Razavi and East Azerbaijan in Iran. Results: A total of 104 explicit criteria (79 IPs and 25 omissions) were obtained and submitted to an 18-member expert panel (including 8 pharmacists, 2 clinical pharmacists, and 8 pediatricians working in a hospital or the community). Then, 98 out of the 104 criteria submitted to the experts were selected after two Delphi rounds (75 IPs and 23 omissions). The content validity and reliability of the tool were obtained by expert assessment (Cronbach’s alpha for the entire criteria: 0.60). At least, the rate of one inappropriate prescribed medication was 69% in Mashhad, almost twice that of Tabriz (35%). Conclusions: The modified POPI criteria comprise the first screening tool to assess rational prescriptions for pediatric patients in hospital and outpatient settings. Clinical validation and reliability studies are needed and planned by the authors to evaluate the usability and reliability of this tool.
{"title":"Modified Omission of Prescriptions and Inappropriate Prescriptions (POPI) Criteria to Assess the Quality of Prescriptions to Pediatric Patients","authors":"Mahshid Naserifar, Sahar Arab Yousefiabadi, Nasser Vahdati-Mashhadian, Mahshid Ataei, Nilufar Hashempour, N. Jafari, S. Eslami, Z. Taherzadeh","doi":"10.5812/ijp-123229","DOIUrl":"https://doi.org/10.5812/ijp-123229","url":null,"abstract":"Background: In pediatrics, many drugs are used without marketing authorization. Recommendations are often based on clinical experience. Therefore, the risk of inappropriate prescription (IP) is high. It is necessary to have a tool for pediatric IP detection. Objectives: This study was performed to develop and validate a Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions (POPI) screening tool to facilitate its use in pediatric practice in Iran. Methods: Using forward- and backward-translation procedures, an efficient and effective tool was provided in the current study and clinical settings. The two-round Delphi technique established content validity. The criteria were then piloted in a cross-sectional study in the pediatric patients of Khorasan Razavi and East Azerbaijan in Iran. Results: A total of 104 explicit criteria (79 IPs and 25 omissions) were obtained and submitted to an 18-member expert panel (including 8 pharmacists, 2 clinical pharmacists, and 8 pediatricians working in a hospital or the community). Then, 98 out of the 104 criteria submitted to the experts were selected after two Delphi rounds (75 IPs and 23 omissions). The content validity and reliability of the tool were obtained by expert assessment (Cronbach’s alpha for the entire criteria: 0.60). At least, the rate of one inappropriate prescribed medication was 69% in Mashhad, almost twice that of Tabriz (35%). Conclusions: The modified POPI criteria comprise the first screening tool to assess rational prescriptions for pediatric patients in hospital and outpatient settings. Clinical validation and reliability studies are needed and planned by the authors to evaluate the usability and reliability of this tool.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73056429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Ahmadipour, Golnaz Mahmoudvand, Arshia Fakouri, Simin Farokhi, A. Karimi Rouzbahani
Introduction: Sodium leak channel, non-selective (NALCN) is an ion channel with an important function in neuronal excitability. The activity of NALCN is essential in the balance of rhythmic behaviors. Infantile hypotonia with psychomotor retardation and characteristic facies 1 (IHPRF1), which occurs due to biallelic NALCN variants, leads to dysmorphic characteristics and global developmental delay. We hereby report 2 non-related patients with IHPRF1 syndrome. Case Presentation: The first case was a 1 - year-old girl referred to our center because of constipation and poor weight gain, and the other was a 2 - year-old girl presenting with hypotonia, constipation, and poor weight gain. Whole exome sequencing led to the detection of homozygote NALCN variants. Interestingly, in both cases, a novel variant of c.1434 + 1G>A in NACLN was identified, which, to the best of our knowledge, has not been reported as a pathogenic variant so far. Conclusions: NALCN dysfunctions lead to rare yet clinically significant disorders. Due to the potential mortality, further studies are essential for a more comprehensive understanding of these rare disorders.
{"title":"A Novel NALCN Homozygote Variant in Non-related Infants with IHPRF1 Syndrome: A Report of 2 Cases","authors":"S. Ahmadipour, Golnaz Mahmoudvand, Arshia Fakouri, Simin Farokhi, A. Karimi Rouzbahani","doi":"10.5812/ijp-134610","DOIUrl":"https://doi.org/10.5812/ijp-134610","url":null,"abstract":"Introduction: Sodium leak channel, non-selective (NALCN) is an ion channel with an important function in neuronal excitability. The activity of NALCN is essential in the balance of rhythmic behaviors. Infantile hypotonia with psychomotor retardation and characteristic facies 1 (IHPRF1), which occurs due to biallelic NALCN variants, leads to dysmorphic characteristics and global developmental delay. We hereby report 2 non-related patients with IHPRF1 syndrome. Case Presentation: The first case was a 1 - year-old girl referred to our center because of constipation and poor weight gain, and the other was a 2 - year-old girl presenting with hypotonia, constipation, and poor weight gain. Whole exome sequencing led to the detection of homozygote NALCN variants. Interestingly, in both cases, a novel variant of c.1434 + 1G>A in NACLN was identified, which, to the best of our knowledge, has not been reported as a pathogenic variant so far. Conclusions: NALCN dysfunctions lead to rare yet clinically significant disorders. Due to the potential mortality, further studies are essential for a more comprehensive understanding of these rare disorders.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77363181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Yaşa, Ilker Gonen, E. Dincer, Aslan Babayiğit, Ozge Saglam, M. Çetinkaya
Background: Deferring the umbilical cord clamping produces more satisfactory neurological and hematological outcomes. Another alternative for the deferred umbilical cord clamping is the umbilical cord milking. Objectives: This study aimed to evaluate different placental transfusion techniques in terms of hematological parameters for term neonates. Methods: This observational study included 120 term infants assigned to groups of deferred cord clamping for 60 seconds (DCC), cut cord milking for four times with a speed of 10 cm/second (CCM), intact cord milking for four times (ICM), and a historical control group of immediate cord clamping (ICC). The primary outcome of this study was hematological parameters at birth and 24th hours. Hyperbilirubinemia, polycythemia, or respiratory distress were secondary outcomes. Results: The median gestational ages and birth weights of neonates were 39 (37 - 40) weeks and 3270 (2365 - 4850) grams, respectively. Umbilical cord hemoglobin (Hb) and hematocrit (Hct) levels were significantly higher in the ICM group (P < 0.01). Hemoglobin and Hct levels at 24th hours of life were similar in DCC, CCM, and ICM groups and significantly higher than those in the ICC group (P < 0.01). No significant difference was found among the groups in terms of hyperbilirubinemia, polycythemia, and respiratory distress. Conclusions: To the best of our knowledge, this study was one of the most comprehensive studies evaluating the effects of different placental transfusion strategies on hematological parameters in term infants and the first study exploring intact cord milking in term infants. Intact cord milking was suggested to be associated with higher hemoglobin levels at birth. All DCC, ICM, and CCM techniques were found to be more effective than ICC in terms of early hematological parameters.
{"title":"Different Placental Transfusion Strategies and Their Effects on Short - Term Hematological Parameters in Term Infants","authors":"B. Yaşa, Ilker Gonen, E. Dincer, Aslan Babayiğit, Ozge Saglam, M. Çetinkaya","doi":"10.5812/ijp-133597","DOIUrl":"https://doi.org/10.5812/ijp-133597","url":null,"abstract":"Background: Deferring the umbilical cord clamping produces more satisfactory neurological and hematological outcomes. Another alternative for the deferred umbilical cord clamping is the umbilical cord milking. Objectives: This study aimed to evaluate different placental transfusion techniques in terms of hematological parameters for term neonates. Methods: This observational study included 120 term infants assigned to groups of deferred cord clamping for 60 seconds (DCC), cut cord milking for four times with a speed of 10 cm/second (CCM), intact cord milking for four times (ICM), and a historical control group of immediate cord clamping (ICC). The primary outcome of this study was hematological parameters at birth and 24th hours. Hyperbilirubinemia, polycythemia, or respiratory distress were secondary outcomes. Results: The median gestational ages and birth weights of neonates were 39 (37 - 40) weeks and 3270 (2365 - 4850) grams, respectively. Umbilical cord hemoglobin (Hb) and hematocrit (Hct) levels were significantly higher in the ICM group (P < 0.01). Hemoglobin and Hct levels at 24th hours of life were similar in DCC, CCM, and ICM groups and significantly higher than those in the ICC group (P < 0.01). No significant difference was found among the groups in terms of hyperbilirubinemia, polycythemia, and respiratory distress. Conclusions: To the best of our knowledge, this study was one of the most comprehensive studies evaluating the effects of different placental transfusion strategies on hematological parameters in term infants and the first study exploring intact cord milking in term infants. Intact cord milking was suggested to be associated with higher hemoglobin levels at birth. All DCC, ICM, and CCM techniques were found to be more effective than ICC in terms of early hematological parameters.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73758551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Ichthyosis is an epidermal disruption that increases insensible water loss. Hypernatremic dehydration is a consequence of skin disruption. This study reviewed the treatment of hypernatremic dehydration in patients with ichthyosis comparing to patients with intact skin. Case Presentation: We studied five neonates with hypernatremia, including three ichthyosis cases and two normal-skin neonates. This case-series study showed that the sodium correction rate is slower in infants with ichthyosis than in infants with normal skin. The first and second neonates needed less sodium than fluid intake than normal skin infants, although fluid requirement was lower in the third ichthyosis infant than in others due to less skin disruption in this infant. Conclusions: Fluid therapy in hypernatremic dehydration in ichthyosis patients is different from neonates with intact skin because of excessive insensible water loss in these patients. It may be needed to give more fluid and less sodium depending on the degree of skin disruption, which may not be determined by physical examination.
{"title":"Management of Hypernatremia Dehydration in Three Neonates with Ichthyosis","authors":"Razieh Sangsari, M. Saeedi, K. Mirnia","doi":"10.5812/ijp-129542","DOIUrl":"https://doi.org/10.5812/ijp-129542","url":null,"abstract":"Introduction: Ichthyosis is an epidermal disruption that increases insensible water loss. Hypernatremic dehydration is a consequence of skin disruption. This study reviewed the treatment of hypernatremic dehydration in patients with ichthyosis comparing to patients with intact skin. Case Presentation: We studied five neonates with hypernatremia, including three ichthyosis cases and two normal-skin neonates. This case-series study showed that the sodium correction rate is slower in infants with ichthyosis than in infants with normal skin. The first and second neonates needed less sodium than fluid intake than normal skin infants, although fluid requirement was lower in the third ichthyosis infant than in others due to less skin disruption in this infant. Conclusions: Fluid therapy in hypernatremic dehydration in ichthyosis patients is different from neonates with intact skin because of excessive insensible water loss in these patients. It may be needed to give more fluid and less sodium depending on the degree of skin disruption, which may not be determined by physical examination.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81116976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: School timings could influence teens' sleeping patterns by interrupting their sleep or the timing of light can shift their biological clock. The COVID-19 pandemic has altered teens’ sleeping schedule making it important to analyze the effects of long-term social distancing on adolescents’ sleep and mood. Objectives: This study analyzes the effects of long-term social distancing, due to the COVID-19 pandemic, on their sleeping patterns and mood. Methods: In this cohort study, data from the 2018 – 2020 Korea Youth Risk Behavior Web-based Survey (KYRBS) were used to compare teens’ sleep patterns in 2020 with those in 2018 – 2019. The primary outcomes of this study were the sleep duration and sleep time of adolescents throughout the week, between 2018 and 2019, and in 2020. The secondary outcomes were the teens’ mood, health perception, and sleep satisfaction, including differences in total sleep time and sleep discrepancies between weekends and weekdays. Results: Around 58 – 63 thousand students were surveyed each year, and the participation rate was 94.9 – 95.6%. After exclusion, 132,839 teens participated in the survey. From 2018–2020, the height and body weight of the participants did not change. After adjusting for participants’ sex and school year, it was found that more teens felt happy, fewer teens experienced sadness and desperation, and fewer teens had suicidal thoughts in 2020, compared with the previous two years. They also slept 10 minutes later (9.743 (95% confidence interval 7.954 - 11.530)), with wake-up times of 3 – 5 minutes later on weekdays (4.684 (3.449 - 5.919)). On weekends during social distancing, they slept 16 minutes later (15.721 (14.077 - 17.366)), with wake-up times of 12 minutes later (12.309 (10.393 - 14.225)). Although they slept five minutes less on weekdays (-5.059 (-6.817 to -3.301)) and three minutes less on weekends (-3.413 (-5.419 to -1.407)), their overall sleep satisfaction increased, and differences in sleep duration between weekdays and weekends decreased in 2020. Conclusions: During social distancing, the mood and sleep efficiency of teens improved. In the future, once the COVID-19 pandemic subsides, online classes can be included in the curriculum of school systems to ensure healthy sleep patterns in teenagers.
{"title":"The Effects of Long-term Social Distancing on Sleep and Mood in Adolescents During the COVID-19 Pandemic","authors":"S. Rhie","doi":"10.5812/ijp-130598","DOIUrl":"https://doi.org/10.5812/ijp-130598","url":null,"abstract":"Background: School timings could influence teens' sleeping patterns by interrupting their sleep or the timing of light can shift their biological clock. The COVID-19 pandemic has altered teens’ sleeping schedule making it important to analyze the effects of long-term social distancing on adolescents’ sleep and mood. Objectives: This study analyzes the effects of long-term social distancing, due to the COVID-19 pandemic, on their sleeping patterns and mood. Methods: In this cohort study, data from the 2018 – 2020 Korea Youth Risk Behavior Web-based Survey (KYRBS) were used to compare teens’ sleep patterns in 2020 with those in 2018 – 2019. The primary outcomes of this study were the sleep duration and sleep time of adolescents throughout the week, between 2018 and 2019, and in 2020. The secondary outcomes were the teens’ mood, health perception, and sleep satisfaction, including differences in total sleep time and sleep discrepancies between weekends and weekdays. Results: Around 58 – 63 thousand students were surveyed each year, and the participation rate was 94.9 – 95.6%. After exclusion, 132,839 teens participated in the survey. From 2018–2020, the height and body weight of the participants did not change. After adjusting for participants’ sex and school year, it was found that more teens felt happy, fewer teens experienced sadness and desperation, and fewer teens had suicidal thoughts in 2020, compared with the previous two years. They also slept 10 minutes later (9.743 (95% confidence interval 7.954 - 11.530)), with wake-up times of 3 – 5 minutes later on weekdays (4.684 (3.449 - 5.919)). On weekends during social distancing, they slept 16 minutes later (15.721 (14.077 - 17.366)), with wake-up times of 12 minutes later (12.309 (10.393 - 14.225)). Although they slept five minutes less on weekdays (-5.059 (-6.817 to -3.301)) and three minutes less on weekends (-3.413 (-5.419 to -1.407)), their overall sleep satisfaction increased, and differences in sleep duration between weekdays and weekends decreased in 2020. Conclusions: During social distancing, the mood and sleep efficiency of teens improved. In the future, once the COVID-19 pandemic subsides, online classes can be included in the curriculum of school systems to ensure healthy sleep patterns in teenagers.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74756354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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