A. Mandras, Maja Sujica, Vesna Stevanovic, Sladjana Miroljub Petrovic, Zoran Paunovic, Slavica Branko Ostojic
Introduction: Moyamoya disease (MMD) is an arteriopathy characterized by progressive stenosis of brain arteries. Neurological symptoms can range from headaches and dizziness to severe sensory and motor impairment. Revascularization surgery helps prevent repeated strokes and further brain damage. Two postoperative years, age up to six years, and certain comorbidities are recognized as risk factors for complications during the process of brain neovascularization. Anesthetic management of these patients is challenging since anesthesia can alter cerebral blood flow (CBF) and cause inadequate perfusion in affected areas. Case Presentation: We report the case of a six-year-old boy with MMD who underwent deep sedation with sevoflurane for a follow-up endocranial MRI. In addition to MMD, the boy had a genetic predisposition for thrombosis, an allergy to atropine, and was within the critical two-year postoperative period during which any alterations in CBF could lead to complications. We chose sevoflurane and oxygen for deep sedation because of its favorable profile on hemodynamics and its negative feedback effect on respiratory drive, which prevents anesthetic overdose, enables spontaneous breathing, and preserves normocarbia during the procedure. The procedure lasted two hours and was uneventful. The boy was discharged home two hours later. Conclusions: Although revascularization surgery in MMD has a high success rate, in 5% of patients, repeated strokes can occur, especially in high-risk groups such as our patient. Awareness of existing risk factors, along with careful pre-anesthesia preparation and a well-considered anesthetic plan, are mandatory to prevent alterations in blood flow and ischemic attacks.
{"title":"Sevoflurane Sedation for Postoperative Endocranial MRI in a Six-Year-Old Boy with Moyamoya Angiopathy: A Case Report","authors":"A. Mandras, Maja Sujica, Vesna Stevanovic, Sladjana Miroljub Petrovic, Zoran Paunovic, Slavica Branko Ostojic","doi":"10.5812/ijp-143646","DOIUrl":"https://doi.org/10.5812/ijp-143646","url":null,"abstract":"Introduction: Moyamoya disease (MMD) is an arteriopathy characterized by progressive stenosis of brain arteries. Neurological symptoms can range from headaches and dizziness to severe sensory and motor impairment. Revascularization surgery helps prevent repeated strokes and further brain damage. Two postoperative years, age up to six years, and certain comorbidities are recognized as risk factors for complications during the process of brain neovascularization. Anesthetic management of these patients is challenging since anesthesia can alter cerebral blood flow (CBF) and cause inadequate perfusion in affected areas. Case Presentation: We report the case of a six-year-old boy with MMD who underwent deep sedation with sevoflurane for a follow-up endocranial MRI. In addition to MMD, the boy had a genetic predisposition for thrombosis, an allergy to atropine, and was within the critical two-year postoperative period during which any alterations in CBF could lead to complications. We chose sevoflurane and oxygen for deep sedation because of its favorable profile on hemodynamics and its negative feedback effect on respiratory drive, which prevents anesthetic overdose, enables spontaneous breathing, and preserves normocarbia during the procedure. The procedure lasted two hours and was uneventful. The boy was discharged home two hours later. Conclusions: Although revascularization surgery in MMD has a high success rate, in 5% of patients, repeated strokes can occur, especially in high-risk groups such as our patient. Awareness of existing risk factors, along with careful pre-anesthesia preparation and a well-considered anesthetic plan, are mandatory to prevent alterations in blood flow and ischemic attacks.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141273363","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. Keivanfar, Mahnaz Kheiri, Sharareh Babaie, M. Reisi
Background: The rising prevalence of chronic respiratory failure in pediatric patients necessitates a detailed evaluation of home mechanical ventilation (HMV). Objectives: This study assesses the advantages of HMV devices, focusing on cases from Imam Hussein Children's Hospital. Methods: This research involved 20 children who required long-term ventilation and were admitted to both general and intensive care units at Imam Hussein Children's Hospital in Isfahan. Before discharge, a team of HMV experts trained the parents on the proper use of the ventilation devices. Post-discharge, the educational needs of the parents were assessed continuously, with regular home visits conducted by a nurse and a representative from the ventilator supplier. Results: Approximately 73% of the children demonstrated therapeutic effectiveness following HMV implementation. About 35% of parents observed no adverse effects in their children. The average cost savings from reduced ICU rehospitalizations was significant at 347.59%, and there was a 65.09% reduction in the costs associated with general ward hospitalizations. Conclusions: The adoption of HMV has led to improved health outcomes, substantial reductions in medical expenses, and shorter hospital stays. It is advisable to plan for broader implementation of HMV in children who require long-term ventilation.
{"title":"Home Mechanical Ventilation in Children: Complications and Benefits—A Two-Year Experience at a Referral Children's Hospital","authors":"M. Keivanfar, Mahnaz Kheiri, Sharareh Babaie, M. Reisi","doi":"10.5812/ijp-143798","DOIUrl":"https://doi.org/10.5812/ijp-143798","url":null,"abstract":"Background: The rising prevalence of chronic respiratory failure in pediatric patients necessitates a detailed evaluation of home mechanical ventilation (HMV). Objectives: This study assesses the advantages of HMV devices, focusing on cases from Imam Hussein Children's Hospital. Methods: This research involved 20 children who required long-term ventilation and were admitted to both general and intensive care units at Imam Hussein Children's Hospital in Isfahan. Before discharge, a team of HMV experts trained the parents on the proper use of the ventilation devices. Post-discharge, the educational needs of the parents were assessed continuously, with regular home visits conducted by a nurse and a representative from the ventilator supplier. Results: Approximately 73% of the children demonstrated therapeutic effectiveness following HMV implementation. About 35% of parents observed no adverse effects in their children. The average cost savings from reduced ICU rehospitalizations was significant at 347.59%, and there was a 65.09% reduction in the costs associated with general ward hospitalizations. Conclusions: The adoption of HMV has led to improved health outcomes, substantial reductions in medical expenses, and shorter hospital stays. It is advisable to plan for broader implementation of HMV in children who require long-term ventilation.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141273232","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: Due to differences in medical backgrounds, there have been few studies on medical clown care in Chinese hospitals. Objectives: This study aimed to explore the consolatory effect of the medical clown care model on children in a Chinese hospital. Methods: This study included 236 children aged 4 - 6 years and divided them into an intervention group (n = 116) and a control group (n = 120). The control group received routine nursing measures, while the intervention group experienced the medical clown care model. To assess the children’s pain levels and the anxiety levels of their parents, the Face Legs Activity Cry and Consolability (FLACC) Scale, Wong-Baker FACES Pain Rating Scale (W-B FPS-R), and Self-Rating Anxiety Scale (SAS) were used. Results: The baseline data for both groups were comparable at admission (P > 0.05). The FLACC score, W-B FPS-R score, and crying rate in the intervention group were significantly lower than those in the control group (4.81 vs 6.71, 4.69 vs 7.02, 44.83 % vs 79.16 %, P < 0.05). Parents in the intervention group also had lower preoperative anxiety scores compared to those in the control group (42.85 vs 52.69, P < 0.05). Furthermore, the postoperative pain incidence and drug use rates were significantly lower in the intervention group (18.97 % vs 30.83 %, 27.27 % vs 56.76 %, P < 0.05). Compliance and satisfaction were significantly higher in the intervention group than in the control group (P < 0.05). Conclusions: The application of the clown care model can effectively reduce children's pain, provide consolation, and relieve parental anxiety.
背景：由于医疗背景的差异，有关中国医院医疗小丑护理的研究很少。研究目的本研究旨在探讨医疗小丑护理模式对中国医院儿童的安慰效果。研究方法：本研究共纳入 236 名 4-6 岁儿童，将其分为干预组（116 人）和对照组（120 人）。对照组接受常规护理措施，干预组则体验医疗小丑护理模式。为了评估患儿的疼痛程度和家长的焦虑程度，采用了面腿活动哭泣和安慰量表（FLACC）、Wong-Baker FACES 疼痛评定量表（W-B FPS-R）和焦虑自评量表（SAS）。结果两组患者入院时的基线数据具有可比性（P > 0.05）。干预组的 FLACC 评分、W-B FPS-R 评分和哭闹率明显低于对照组（4.81 vs 6.71、4.69 vs 7.02、44.83 % vs 79.16 %，P <0.05）。干预组家长的术前焦虑评分也低于对照组（42.85 vs 52.69，P < 0.05）。此外，干预组的术后疼痛发生率和用药率明显低于对照组（18.97 % vs 30.83 %，27.27 % vs 56.76 %，P < 0.05）。干预组的依从性和满意度明显高于对照组（P < 0.05）。结论小丑护理模式的应用可有效减轻患儿的疼痛、提供安慰并缓解家长的焦虑。
{"title":"Consolation Effect of Medical Clown Care Model in Children with Inguinal Hernia During Perioperative Period: A Single-Center Study in China","authors":"Cui Liu, Tong Hou","doi":"10.5812/ijp-144106","DOIUrl":"https://doi.org/10.5812/ijp-144106","url":null,"abstract":"Background: Due to differences in medical backgrounds, there have been few studies on medical clown care in Chinese hospitals. Objectives: This study aimed to explore the consolatory effect of the medical clown care model on children in a Chinese hospital. Methods: This study included 236 children aged 4 - 6 years and divided them into an intervention group (n = 116) and a control group (n = 120). The control group received routine nursing measures, while the intervention group experienced the medical clown care model. To assess the children’s pain levels and the anxiety levels of their parents, the Face Legs Activity Cry and Consolability (FLACC) Scale, Wong-Baker FACES Pain Rating Scale (W-B FPS-R), and Self-Rating Anxiety Scale (SAS) were used. Results: The baseline data for both groups were comparable at admission (P > 0.05). The FLACC score, W-B FPS-R score, and crying rate in the intervention group were significantly lower than those in the control group (4.81 vs 6.71, 4.69 vs 7.02, 44.83 % vs 79.16 %, P < 0.05). Parents in the intervention group also had lower preoperative anxiety scores compared to those in the control group (42.85 vs 52.69, P < 0.05). Furthermore, the postoperative pain incidence and drug use rates were significantly lower in the intervention group (18.97 % vs 30.83 %, 27.27 % vs 56.76 %, P < 0.05). Compliance and satisfaction were significantly higher in the intervention group than in the control group (P < 0.05). Conclusions: The application of the clown care model can effectively reduce children's pain, provide consolation, and relieve parental anxiety.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124474","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}
K. Yakut, Isa Ozyilmaz, N. Yakut, Esma Bekece, Berna Ceylan, Muhammet Hamza Halil Toprak, G. Şahin, Ibrahim Cansaran Tanidir, Erkut Öztürk
Background: Cardiac involvement, stemming from the novel multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease-2019 (COVID-19), leads to common and severe complications. Objectives: The aim of this study is to compare and evaluate repetitive electrocardiogram (ECG) results and laboratory indicators in children diagnosed with MIS-C upon their initial hospital admission. Methods: This prospective, single-center study, conducted between December 2020 and October 2022, included repeated electrocardiographic and laboratory tests. Changes in the ECG over the course of the disease were regularly recorded for three months. Results: This study included 72 patients, 25 of whom were female. Mitral regurgitation and left ventricular systolic dysfunction were observed in 25% of the patients. Statistically significant differences (P < 0.05) were detected among the serial measurements of absolute neutrophil-lymphocyte count, CRP, procalcitonin, ESR, D-dimer, troponin T, pro-BNP, ferritin, and interleukin-6. Significant differences were also observed in heart rate, PR interval, QRS duration, QT duration, Fredericia QTc, JT interval, presence of sinus tachycardia, presence of first-degree AV block, presence of wide QRS, abnormal QRS axis, abnormal T axis, long QTc, and ST-T changes (P < 0.05). Additionally, significant differences were noted in the absolute lymphocyte count, troponin levels, and ferritin levels between patients with prolonged abnormal ECG findings and those whose ECG findings were normal or had returned to normal. Furthermore, statistically significant differences were observed in absolute lymphocyte count, ferritin, and fibrinogen levels among the other four groups (P < 0.05). Conclusions: Electrocardiogram findings in patients measured serially appear to improve over time. Since patients with MIS-C may experience ECG abnormalities that could lead to arrhythmias, close monitoring and the establishment of standardized approaches are essential. Long-term ECG abnormalities were associated with a decrease in absolute lymphocyte count and elevated levels of troponin, ferritin, and fibrinogen.
{"title":"Assessment of Repeated Electrocardiogram Findings in Pediatric Multisystem Inflammatory Syndrome Associated with COVID-19","authors":"K. Yakut, Isa Ozyilmaz, N. Yakut, Esma Bekece, Berna Ceylan, Muhammet Hamza Halil Toprak, G. Şahin, Ibrahim Cansaran Tanidir, Erkut Öztürk","doi":"10.5812/ijp-140887","DOIUrl":"https://doi.org/10.5812/ijp-140887","url":null,"abstract":"Background: Cardiac involvement, stemming from the novel multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease-2019 (COVID-19), leads to common and severe complications. Objectives: The aim of this study is to compare and evaluate repetitive electrocardiogram (ECG) results and laboratory indicators in children diagnosed with MIS-C upon their initial hospital admission. Methods: This prospective, single-center study, conducted between December 2020 and October 2022, included repeated electrocardiographic and laboratory tests. Changes in the ECG over the course of the disease were regularly recorded for three months. Results: This study included 72 patients, 25 of whom were female. Mitral regurgitation and left ventricular systolic dysfunction were observed in 25% of the patients. Statistically significant differences (P < 0.05) were detected among the serial measurements of absolute neutrophil-lymphocyte count, CRP, procalcitonin, ESR, D-dimer, troponin T, pro-BNP, ferritin, and interleukin-6. Significant differences were also observed in heart rate, PR interval, QRS duration, QT duration, Fredericia QTc, JT interval, presence of sinus tachycardia, presence of first-degree AV block, presence of wide QRS, abnormal QRS axis, abnormal T axis, long QTc, and ST-T changes (P < 0.05). Additionally, significant differences were noted in the absolute lymphocyte count, troponin levels, and ferritin levels between patients with prolonged abnormal ECG findings and those whose ECG findings were normal or had returned to normal. Furthermore, statistically significant differences were observed in absolute lymphocyte count, ferritin, and fibrinogen levels among the other four groups (P < 0.05). Conclusions: Electrocardiogram findings in patients measured serially appear to improve over time. Since patients with MIS-C may experience ECG abnormalities that could lead to arrhythmias, close monitoring and the establishment of standardized approaches are essential. Long-term ECG abnormalities were associated with a decrease in absolute lymphocyte count and elevated levels of troponin, ferritin, and fibrinogen.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141128025","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}
Setila Dalili, Shohreh Maleknejad, Tara Asgharpour, Soodeh Salehi, Marjan Mahdavi-Roshan, Afagh Hassanzadeh Rad
Background: Malnutrition presents a significant global health challenge, necessitating the creation of innovative treatment strategies. Objectives: This study explored the therapeutic impact of pancreatic enzymes on improving growth indicators in children suffering from moderate to severe malnutrition. Methods: In this clinical trial, patients aged 2 to 14 years with growth disorders (Z-score weight below -2) attending a Gastroenterology Clinic were randomly assigned to two groups: Pancreatic enzyme replacement therapy (PERT) and control. The trial involved a pilot study with 30 subjects in each group. The PERT group underwent a 2-month treatment regimen of 1000 U/kg pancreatic enzymes taken with the main three meals, complemented by a nutritional plan. In contrast, the Control group received mineral supplements and followed a regular diet. Demographic data and anthropometric indices, including height, weight, body mass index (BMI), and Z scores, were recorded before and after the intervention. Results: In this study, a statistically significant difference was observed in the mean values of weight, height, BMI, and appetite among children with growth disorders in the PERT group before and after the intervention. However, no statistically significant difference was found between the mean values in the PERT group and the control group. Conclusions: The results of this study suggest that the therapeutic effect of pancreatic enzymes on improving growth parameters in malnourished children was not statistically significant. Future randomized trials on a larger scale with longer treatment durations are warranted.
{"title":"The Therapeutic Effect of Pancreatic Enzyme Replacement on Anthropometric Parameters in Children with Malnutrition: A Pilot Clinical Trial","authors":"Setila Dalili, Shohreh Maleknejad, Tara Asgharpour, Soodeh Salehi, Marjan Mahdavi-Roshan, Afagh Hassanzadeh Rad","doi":"10.5812/ijp-146634","DOIUrl":"https://doi.org/10.5812/ijp-146634","url":null,"abstract":"Background: Malnutrition presents a significant global health challenge, necessitating the creation of innovative treatment strategies. Objectives: This study explored the therapeutic impact of pancreatic enzymes on improving growth indicators in children suffering from moderate to severe malnutrition. Methods: In this clinical trial, patients aged 2 to 14 years with growth disorders (Z-score weight below -2) attending a Gastroenterology Clinic were randomly assigned to two groups: Pancreatic enzyme replacement therapy (PERT) and control. The trial involved a pilot study with 30 subjects in each group. The PERT group underwent a 2-month treatment regimen of 1000 U/kg pancreatic enzymes taken with the main three meals, complemented by a nutritional plan. In contrast, the Control group received mineral supplements and followed a regular diet. Demographic data and anthropometric indices, including height, weight, body mass index (BMI), and Z scores, were recorded before and after the intervention. Results: In this study, a statistically significant difference was observed in the mean values of weight, height, BMI, and appetite among children with growth disorders in the PERT group before and after the intervention. However, no statistically significant difference was found between the mean values in the PERT group and the control group. Conclusions: The results of this study suggest that the therapeutic effect of pancreatic enzymes on improving growth parameters in malnourished children was not statistically significant. Future randomized trials on a larger scale with longer treatment durations are warranted.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987573","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}
{"title":"Methylprednisolone Pulses as an Effective Treatment in Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 (MIS-C), and the Best Alternative for IVIG","authors":"R. Assari, Vahid Ziaee","doi":"10.5812/ijp-147357","DOIUrl":"https://doi.org/10.5812/ijp-147357","url":null,"abstract":"<jats:p />","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140669695","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}
Jialu Xu, Wei Li, Yilin Zhu, Jiajin Wang, Haifeng Li
Objectives: To compare the clinical presentations and neurobiological features in children with acute Coronavirus disease 2019 (COVID-19) encephalopathy and Seasonal influenza A virus (IAV)-associated encephalopathy. Methods: We conducted a retrospective cohort study on patients diagnosed with COVID-19 encephalopathy between December 15, 2022, and January 15, 2023, and children diagnosed with IAV-associated encephalopathy between November 2017 and March 2023, who were less than 18 years old at the Children’s Hospital, Zhejiang University School of Medicine. Results: A total of 34 patients with acute COVID-19 encephalopathy and 37 patients with IAV-associated encephalopathy were included in this study. Elevation of cerebrospinal fluid (CSF) pleocytosis and CSF glucose, as well as downregulation of monocyte and TNF-α, were observed in both the COVID-19 ICU group and the moderate & severe group. The median age was younger (P < 0.001) and the median time for the occurrence of neurological symptoms was shorter (P < 0.001) in the COVID-19 group compared with the IAV group. More patients in the IAV group had altered levels of consciousness (P < 0.001) and were admitted to the ICU (P < 0.001). Consequently, more severe cases were observed in the IAV group (P = 0.007). Brain imaging showed a predominance appearance of acute necrotizing encephalopathy in the IAV group (P = 0.038). Regarding blood parameters, leukomonocyte levels were lower in the IAV group (P = 0.003) with lower expression of CD4 (P = 0.047). Random blood glucose (P = 0.001), D dimer (P = 0.004), and cytokine IL-2 (P = 0.005) were lower in the COVID-19 group, while IFN-γ (P = 0.013) was significantly higher. Conclusions: Influenza A virus-associated encephalopathy presented more severe manifestations. However, IFN-γ may act as a protective cytokine in COVID-19 encephalopathy.
{"title":"Comparison of Acute COVID-19 Encephalopathy with Seasonal Influenza A-Associated Encephalopathy","authors":"Jialu Xu, Wei Li, Yilin Zhu, Jiajin Wang, Haifeng Li","doi":"10.5812/ijp-142946","DOIUrl":"https://doi.org/10.5812/ijp-142946","url":null,"abstract":"Objectives: To compare the clinical presentations and neurobiological features in children with acute Coronavirus disease 2019 (COVID-19) encephalopathy and Seasonal influenza A virus (IAV)-associated encephalopathy. Methods: We conducted a retrospective cohort study on patients diagnosed with COVID-19 encephalopathy between December 15, 2022, and January 15, 2023, and children diagnosed with IAV-associated encephalopathy between November 2017 and March 2023, who were less than 18 years old at the Children’s Hospital, Zhejiang University School of Medicine. Results: A total of 34 patients with acute COVID-19 encephalopathy and 37 patients with IAV-associated encephalopathy were included in this study. Elevation of cerebrospinal fluid (CSF) pleocytosis and CSF glucose, as well as downregulation of monocyte and TNF-α, were observed in both the COVID-19 ICU group and the moderate & severe group. The median age was younger (P < 0.001) and the median time for the occurrence of neurological symptoms was shorter (P < 0.001) in the COVID-19 group compared with the IAV group. More patients in the IAV group had altered levels of consciousness (P < 0.001) and were admitted to the ICU (P < 0.001). Consequently, more severe cases were observed in the IAV group (P = 0.007). Brain imaging showed a predominance appearance of acute necrotizing encephalopathy in the IAV group (P = 0.038). Regarding blood parameters, leukomonocyte levels were lower in the IAV group (P = 0.003) with lower expression of CD4 (P = 0.047). Random blood glucose (P = 0.001), D dimer (P = 0.004), and cytokine IL-2 (P = 0.005) were lower in the COVID-19 group, while IFN-γ (P = 0.013) was significantly higher. Conclusions: Influenza A virus-associated encephalopathy presented more severe manifestations. However, IFN-γ may act as a protective cytokine in COVID-19 encephalopathy.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676363","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}
Yongnan Teng, Qingwei Dong, Xiao Liu, N. Zuo, Yuanda Zhang
Background: Helicobacter pylori (H. pylori) infection affects over 50% of the world's population and is the primary cause of duodenal and gastric ulcers, as well as gastric cancer. Objectives: To investigate the risk factors for recurrence following successful eradication of H. pylori infection in children aged 4 - 16 years in the Baoding area. Methods: The study included 328 children diagnosed with H. pylori infection at our hospital from January 2021 to June 2022, who had successfully undergone eradication treatment. A questionnaire covering personal history, family history, health status, and family socioeconomic status was administered to the children, coupled with a 1-year follow-up. Recurrence within this period was monitored, along with an analysis of the risk factors for recurrence post-eradication. Results: Out of 328 children with H. pylori infection, 295 (89.9%) were successfully followed up. Among these, 55 (18.6%) tested positive on the 13C-urea breath test and were considered to have recurrent infection (recurrence group), while 240 (81.4%) tested negative and were considered to have no recurrence (non-recurrence group). Univariate chi-square analysis of the questionnaire results indicated that age (P < 0.05), number of eradication treatments (P < 0.05), mother's education level (P < 0.05), place of residence (P < 0.05), family income (P < 0.05), family history of H. pylori infection (P < 0.05), separate meals (P < 0.05), and lunch location (P < 0.05) significantly influenced H. pylori recurrence. Multivariate analysis, which included factors showing significant differences in univariate analysis, was performed using a logistic regression model. This analysis identified multiple treatments (> 2 eradication attempts), residing in rural areas, and low family income as combined risk factors for H. pylori recurrence in children. Conversely, being older than 10 years, eating separate meals, and higher maternal education level emerged as protective factors against recurrence. Conclusions: There is a relatively high rate of H. pylori recurrence among children aged 4 - 16 years in this region, which may be linked to age, number of eradication treatments, dietary and hygiene habits, educational levels of family members, and economic status.
{"title":"Analysis of Risk Factors for the Recurrence of Helicobacter Pylori Infection in Baoding Children Aged 4 - 16 Years","authors":"Yongnan Teng, Qingwei Dong, Xiao Liu, N. Zuo, Yuanda Zhang","doi":"10.5812/ijp-139752","DOIUrl":"https://doi.org/10.5812/ijp-139752","url":null,"abstract":"Background: Helicobacter pylori (H. pylori) infection affects over 50% of the world's population and is the primary cause of duodenal and gastric ulcers, as well as gastric cancer. Objectives: To investigate the risk factors for recurrence following successful eradication of H. pylori infection in children aged 4 - 16 years in the Baoding area. Methods: The study included 328 children diagnosed with H. pylori infection at our hospital from January 2021 to June 2022, who had successfully undergone eradication treatment. A questionnaire covering personal history, family history, health status, and family socioeconomic status was administered to the children, coupled with a 1-year follow-up. Recurrence within this period was monitored, along with an analysis of the risk factors for recurrence post-eradication. Results: Out of 328 children with H. pylori infection, 295 (89.9%) were successfully followed up. Among these, 55 (18.6%) tested positive on the 13C-urea breath test and were considered to have recurrent infection (recurrence group), while 240 (81.4%) tested negative and were considered to have no recurrence (non-recurrence group). Univariate chi-square analysis of the questionnaire results indicated that age (P < 0.05), number of eradication treatments (P < 0.05), mother's education level (P < 0.05), place of residence (P < 0.05), family income (P < 0.05), family history of H. pylori infection (P < 0.05), separate meals (P < 0.05), and lunch location (P < 0.05) significantly influenced H. pylori recurrence. Multivariate analysis, which included factors showing significant differences in univariate analysis, was performed using a logistic regression model. This analysis identified multiple treatments (> 2 eradication attempts), residing in rural areas, and low family income as combined risk factors for H. pylori recurrence in children. Conversely, being older than 10 years, eating separate meals, and higher maternal education level emerged as protective factors against recurrence. Conclusions: There is a relatively high rate of H. pylori recurrence among children aged 4 - 16 years in this region, which may be linked to age, number of eradication treatments, dietary and hygiene habits, educational levels of family members, and economic status.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680223","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}
Narjes Jafari, Golazin Shahbodagh, Amir Hossein Hassani, Mohammad Nikoohemmat
Background: Idiopathic intracranial hypertension (IIH) is characterized by elevated cerebrospinal fluid pressure without space-occupying lesions, infections, or alterations in brain parenchyma. Diagnosing IIH in children poses a significant challenge for pediatricians, given the often nonspecific nature of clinical signs and symptoms. Objectives: Our study aims to evaluate the clinical presentations and potential risk factors among pediatric individuals diagnosed with IIH, considering the limited research in this particular domain. Methods: Clinical data from pediatric patients diagnosed with IIH who sought care at Tehran's primary referral children's hospitals were collected from 2013 to 2021, spanning eight years. These patients were subsequently contacted to follow up on the presence of persistent headaches and visual problems. Detailed records of their initial signs and symptoms were documented. To identify prognostic factors associated with persistent headaches and visual problems in pediatric IIH patients, binary logistic regression analysis was conducted. Results: A total of 81 pediatric patients were included in the study, with a mean age of 13.56 ± 4.404 years at the time of their IIH diagnosis. The most frequently reported clinical symptom among these patients was headache, observed in 85.2% of cases, followed by diplopia (50.6%), visual impairment (46.9%), and nausea with/without vomiting (44.4%). Furthermore, a substantial proportion of the patients were underweight (weight percentiles < 3). Our analysis showed that male patients and those without strabismus experienced significantly more recurrent episodes of IIH (P = 0.013 and P = 0.013, respectively). Notably, recurrent episodes and higher weight percentiles emerged as predictive factors for future persistent visual problems within our study population (P = 0.032 and P = 0.045, respectively). Conclusions: Recurrence of IIH was significantly less in female patients and those with strabismus. Additionally, we found that both lower and higher weight percentiles, as well as the occurrence of recurrent episodes, served as predictive factors for the development of persistent visual problems. However, our model could not predict persistent headaches.
背景：特发性颅内高压（IIH）的特点是脑脊液压力升高，但无空间占位性病变、感染或脑实质改变。由于临床症状和体征通常不具有特异性，因此诊断儿童 IIH 对儿科医生来说是一项重大挑战。研究目的考虑到这一特定领域的研究有限，我们的研究旨在评估被诊断为 IIH 的儿科患者的临床表现和潜在风险因素。研究方法从 2013 年到 2021 年，我们收集了在德黑兰主要转诊儿童医院就诊的被诊断为 IIH 的儿科患者的临床数据，时间跨度长达八年。随后与这些患者取得联系，对其是否存在持续性头痛和视力问题进行随访。他们最初的体征和症状都有详细记录。为了确定与小儿IIH患者持续性头痛和视力问题相关的预后因素，我们进行了二元逻辑回归分析。结果：研究共纳入了 81 名儿童患者，他们被诊断为 IIH 时的平均年龄为（13.56 ± 4.404）岁。这些患者中最常见的临床症状是头痛，占 85.2%，其次是复视（50.6%）、视力障碍（46.9%）和恶心伴/不伴呕吐（44.4%）。此外，相当一部分患者体重不足（体重百分位数小于 3）。我们的分析表明，男性患者和无斜视患者的 IIH 复发率明显更高（分别为 P = 0.013 和 P = 0.013）。值得注意的是，在我们的研究人群中，反复发作和较高的体重百分位数成为未来持续性视觉问题的预测因素（分别为 P = 0.032 和 P = 0.045）。结论女性患者和斜视患者的 IIH 复发率明显较低。此外，我们还发现，较低和较高的体重百分位数以及反复发作的情况都是导致持续性视力问题的预测因素。但是，我们的模型无法预测持续性头痛。
{"title":"Pediatric Idiopathic Intracranial Hypertension: Clinical Presentations, Risk Factors, and Prognostic Indicator","authors":"Narjes Jafari, Golazin Shahbodagh, Amir Hossein Hassani, Mohammad Nikoohemmat","doi":"10.5812/ijp-143360","DOIUrl":"https://doi.org/10.5812/ijp-143360","url":null,"abstract":"Background: Idiopathic intracranial hypertension (IIH) is characterized by elevated cerebrospinal fluid pressure without space-occupying lesions, infections, or alterations in brain parenchyma. Diagnosing IIH in children poses a significant challenge for pediatricians, given the often nonspecific nature of clinical signs and symptoms. Objectives: Our study aims to evaluate the clinical presentations and potential risk factors among pediatric individuals diagnosed with IIH, considering the limited research in this particular domain. Methods: Clinical data from pediatric patients diagnosed with IIH who sought care at Tehran's primary referral children's hospitals were collected from 2013 to 2021, spanning eight years. These patients were subsequently contacted to follow up on the presence of persistent headaches and visual problems. Detailed records of their initial signs and symptoms were documented. To identify prognostic factors associated with persistent headaches and visual problems in pediatric IIH patients, binary logistic regression analysis was conducted. Results: A total of 81 pediatric patients were included in the study, with a mean age of 13.56 ± 4.404 years at the time of their IIH diagnosis. The most frequently reported clinical symptom among these patients was headache, observed in 85.2% of cases, followed by diplopia (50.6%), visual impairment (46.9%), and nausea with/without vomiting (44.4%). Furthermore, a substantial proportion of the patients were underweight (weight percentiles < 3). Our analysis showed that male patients and those without strabismus experienced significantly more recurrent episodes of IIH (P = 0.013 and P = 0.013, respectively). Notably, recurrent episodes and higher weight percentiles emerged as predictive factors for future persistent visual problems within our study population (P = 0.032 and P = 0.045, respectively). Conclusions: Recurrence of IIH was significantly less in female patients and those with strabismus. Additionally, we found that both lower and higher weight percentiles, as well as the occurrence of recurrent episodes, served as predictive factors for the development of persistent visual problems. However, our model could not predict persistent headaches.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140681896","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: Leptospirosis is a significant zoonotic infection caused by Leptospira spirochetes, which are distributed globally. Infection typically occurs through exposure to water or soil contaminated by the urine of mammals, including dogs, cattle, pigs, or rodents. Objectives: The objective of this study was to elucidate the epidemiological, clinical, and laboratory characteristics of leptospirosis cases in Turkey. Methods: In a retrospective review, we analyzed the clinical and laboratory data of all individuals under 18 years diagnosed with leptospirosis at a secondary care center in Southeast Turkey from the beginning of 2020 to the end of 2022. Results: Over the two-year period, 36 confirmed cases of leptospirosis in individuals under 18 were identified. All patients had been engaged in activities at wells in cornfields, assisting their families with irrigation or related to well operations. Of these patients, 3 (8%) resided in urban areas, while 33 (92%) lived in rural settings. None required intensive care, and there were no fatalities reported. The most common symptoms at presentation were fatigue (83%), fever (75%), and nausea/vomiting (75%). Laboratory tests revealed that all patients had positive C-reactive protein (CRP) levels, with a significant portion (61%) showing highly positive results (CRP > 100). Conclusions: In conclusion, leptospirosis should be considered by clinicians when evaluating patients, especially those with risk factors like occupational exposure. Prompt testing for the disease is advisable under these circumstances.
{"title":"Epidemiology, Clinical and Laboratory Findings of Pediatric Leptospirosis in Southeastern Turkey","authors":"Özhan Orhan, Hüseyin Elçi","doi":"10.5812/ijp-142968","DOIUrl":"https://doi.org/10.5812/ijp-142968","url":null,"abstract":"Background: Leptospirosis is a significant zoonotic infection caused by Leptospira spirochetes, which are distributed globally. Infection typically occurs through exposure to water or soil contaminated by the urine of mammals, including dogs, cattle, pigs, or rodents. Objectives: The objective of this study was to elucidate the epidemiological, clinical, and laboratory characteristics of leptospirosis cases in Turkey. Methods: In a retrospective review, we analyzed the clinical and laboratory data of all individuals under 18 years diagnosed with leptospirosis at a secondary care center in Southeast Turkey from the beginning of 2020 to the end of 2022. Results: Over the two-year period, 36 confirmed cases of leptospirosis in individuals under 18 were identified. All patients had been engaged in activities at wells in cornfields, assisting their families with irrigation or related to well operations. Of these patients, 3 (8%) resided in urban areas, while 33 (92%) lived in rural settings. None required intensive care, and there were no fatalities reported. The most common symptoms at presentation were fatigue (83%), fever (75%), and nausea/vomiting (75%). Laboratory tests revealed that all patients had positive C-reactive protein (CRP) levels, with a significant portion (61%) showing highly positive results (CRP > 100). Conclusions: In conclusion, leptospirosis should be considered by clinicians when evaluating patients, especially those with risk factors like occupational exposure. Prompt testing for the disease is advisable under these circumstances.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140696024","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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