M. Asgarshirazi, M. Shariat, Raheleh Moradi, Z. Farahani, Farzaneh Ziaei
Background: Dysphagia is a frequent complication defined as difficulty in any stage of swallowing. Infants with a history of mechanical ventilation might show difficulty in coordinating pharyngeal muscles resulting in dysphagia. Objectives: The present study aimed to show the prevalence of swallowing disorders and associated symptoms among high-risk infants with a history of prolonged mechanical ventilation. Methods: A quasi-experimental study was conducted at the Breastfeeding Research Center, Tehran, Iran. All the neonates with a history of prolonged mechanical ventilation entered the study. Parents were asked to respond to a provided questionnaire regarding their infants’ swallowing disorders. Accordingly, the infants with any symptoms were considered candidates for intervention. The parents also received simple training to perform oral sensorimotor stimulation protocol for their children. Through a follow-up visit, the questionnaire was filled up for every infant. Finally, all the data related to the responses before and after interventions were compared to show the possible effects of the interventions. Results: A total of 25 infants entered the study. The mean mechanical ventilation period was 15.95 ± 6.644 days. Concerning the frequency of swallowing complications, 24 infants (96%) had different degrees of dysphagia. After 3 - 6 months of interventions, the number of cases with symptoms of coughing (P = 0.016), spitting food out by mouth (P = 0.0001), choking (P = 0.016), humid breath (P = 0.031), poor weight gain (P = 0.002), and the need to cut food into small pieces (P = 0.004) was significantly lower than the number of cases suffering from such complications before the intervention. The results also showed that after 3 - 6 months of interventions, dysphagia symptoms in 10 out of 24 infants (41.66%) entirely and in others (38.44%) partially improved. Conclusions: The results of the present study delineated that infants with a history of prolonged mechanical ventilation were at greater risk of swallowing complications. The early diagnosis and implementation of oral sensorimotor interventions could improve different symptoms of dysphagia.
{"title":"Evaluation of Swallowing Coordination in Infants with a History of Mechanical Ventilation Longer Than 7 Days in the Neonatal Period and Assessment of Response to Oral Stimulation Maneuver","authors":"M. Asgarshirazi, M. Shariat, Raheleh Moradi, Z. Farahani, Farzaneh Ziaei","doi":"10.5812/ijp-135552","DOIUrl":"https://doi.org/10.5812/ijp-135552","url":null,"abstract":"Background: Dysphagia is a frequent complication defined as difficulty in any stage of swallowing. Infants with a history of mechanical ventilation might show difficulty in coordinating pharyngeal muscles resulting in dysphagia. Objectives: The present study aimed to show the prevalence of swallowing disorders and associated symptoms among high-risk infants with a history of prolonged mechanical ventilation. Methods: A quasi-experimental study was conducted at the Breastfeeding Research Center, Tehran, Iran. All the neonates with a history of prolonged mechanical ventilation entered the study. Parents were asked to respond to a provided questionnaire regarding their infants’ swallowing disorders. Accordingly, the infants with any symptoms were considered candidates for intervention. The parents also received simple training to perform oral sensorimotor stimulation protocol for their children. Through a follow-up visit, the questionnaire was filled up for every infant. Finally, all the data related to the responses before and after interventions were compared to show the possible effects of the interventions. Results: A total of 25 infants entered the study. The mean mechanical ventilation period was 15.95 ± 6.644 days. Concerning the frequency of swallowing complications, 24 infants (96%) had different degrees of dysphagia. After 3 - 6 months of interventions, the number of cases with symptoms of coughing (P = 0.016), spitting food out by mouth (P = 0.0001), choking (P = 0.016), humid breath (P = 0.031), poor weight gain (P = 0.002), and the need to cut food into small pieces (P = 0.004) was significantly lower than the number of cases suffering from such complications before the intervention. The results also showed that after 3 - 6 months of interventions, dysphagia symptoms in 10 out of 24 infants (41.66%) entirely and in others (38.44%) partially improved. Conclusions: The results of the present study delineated that infants with a history of prolonged mechanical ventilation were at greater risk of swallowing complications. The early diagnosis and implementation of oral sensorimotor interventions could improve different symptoms of dysphagia.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"119 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77942913","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. Sarafi, L. Mohajerzadeh, M. Ebrahimian, Mahdokht Siavashi, Gholamreza Ebrahimi, N. Farahbakhsh, M. Hajipour, N. Mahdavi, Behnaz Niroomand
Background: Intrapleural instillation of fibrinolytic agents is novel in treating empyema. Although the efficacy of this method for treating empyema remains a topic of debate among experts, several studies have shown that the results of this technique are almost equivalent to surgical operations in the lower stages of the disease. However, in more advanced stages of empyema, surgery may be required. Despite the worldwide use of fibrinolytic agents instead of surgical procedures, the benefits of using these agents postoperatively still need to be defined. Objectives: In this prospective study, we aimed to compare the effects of streptokinase and alteplase in managing empyema in patients who underwent any surgical operations. Methods: We prospectively compared the outcomes of using alteplase and streptokinase in children who underwent surgical operations for empyema between 2015 and 2022. Following the surgery, fibrinolytic agents were instilled through thoracostomy tubes according to a specific protocol. The length of stay, frequency of complications, need for another surgery, and mortality were measured in each group. Results: Among 53 patients who met the inclusion criteria, 31 (58.5%) patients received streptokinase postoperatively, while the others were treated using alteplase. The length of stay after the surgery, wound infection, and mortality rate did not differ significantly between the groups (P-value = 0.394, 0.080, 0.767, respectively). However, the need for another surgery due to unexpanded lungs was significantly lower in the alteplase group (0% vs. 19.4%, P = 0.028). Conclusions: Alteplase as an intrapleural fibrinolytic is more effective than streptokinase in patients who underwent surgical operations due to empyema. The need for another surgery following the instillation of alteplase through chest tubes postoperatively may be decreased.
背景:胸腔内灌注溶纤剂是治疗脓胸的新方法。尽管这种方法治疗脓胸的疗效在专家中仍有争议，但一些研究表明，在疾病的较低阶段，这种技术的结果几乎相当于外科手术。然而，在更晚期的脓胸，可能需要手术。尽管在世界范围内使用纤溶药物代替外科手术，但术后使用这些药物的益处仍然需要明确。目的:在这项前瞻性研究中，我们旨在比较链激酶和阿替普酶在治疗任何外科手术患者的脓胸中的作用。方法:我们前瞻性地比较了2015年至2022年期间，阿替普酶和链激酶在接受外科手术治疗脓胸的儿童中的效果。手术后，根据特定的方案，通过开胸管灌注纤溶剂。测量每组患者的住院时间、并发症发生频率、再次手术的必要性和死亡率。结果:53例符合纳入标准的患者中，31例(58.5%)患者术后接受了链激酶治疗，其余患者采用阿替普酶治疗。两组患者术后住院时间、伤口感染、死亡率差异无统计学意义(p值分别为0.394、0.080、0.767)。然而，阿替普酶组因肺部未扩张而需要再次手术的患者明显较低(0% vs. 19.4%， P = 0.028)。结论:阿替普酶作为胸膜内纤溶剂治疗因胸肿而行外科手术的患者比链激酶更有效。术后经胸管滴注阿替普酶后再次手术的需要可能会减少。
{"title":"The Efficacy of Intrapleural Fibrinolytic Agents Following Surgical Intervention for Empyema Thoracis: A Prospective Cross-Sectional Study in a Pediatric Population","authors":"M. Sarafi, L. Mohajerzadeh, M. Ebrahimian, Mahdokht Siavashi, Gholamreza Ebrahimi, N. Farahbakhsh, M. Hajipour, N. Mahdavi, Behnaz Niroomand","doi":"10.5812/ijp-136509","DOIUrl":"https://doi.org/10.5812/ijp-136509","url":null,"abstract":"Background: Intrapleural instillation of fibrinolytic agents is novel in treating empyema. Although the efficacy of this method for treating empyema remains a topic of debate among experts, several studies have shown that the results of this technique are almost equivalent to surgical operations in the lower stages of the disease. However, in more advanced stages of empyema, surgery may be required. Despite the worldwide use of fibrinolytic agents instead of surgical procedures, the benefits of using these agents postoperatively still need to be defined. Objectives: In this prospective study, we aimed to compare the effects of streptokinase and alteplase in managing empyema in patients who underwent any surgical operations. Methods: We prospectively compared the outcomes of using alteplase and streptokinase in children who underwent surgical operations for empyema between 2015 and 2022. Following the surgery, fibrinolytic agents were instilled through thoracostomy tubes according to a specific protocol. The length of stay, frequency of complications, need for another surgery, and mortality were measured in each group. Results: Among 53 patients who met the inclusion criteria, 31 (58.5%) patients received streptokinase postoperatively, while the others were treated using alteplase. The length of stay after the surgery, wound infection, and mortality rate did not differ significantly between the groups (P-value = 0.394, 0.080, 0.767, respectively). However, the need for another surgery due to unexpanded lungs was significantly lower in the alteplase group (0% vs. 19.4%, P = 0.028). Conclusions: Alteplase as an intrapleural fibrinolytic is more effective than streptokinase in patients who underwent surgical operations due to empyema. The need for another surgery following the instillation of alteplase through chest tubes postoperatively may be decreased.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"59 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77220883","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}
F. Abbasi, Saideh Abdolahpour, Reihaneh Mohsenipour, A. Rabbani, Ali Talea, A. Mohebbi, M. Khazdouz
Background: Inborn errors of metabolism (IEMs) comprise over 1,000 disorders. Wide geographical and racial variations in the global birth prevalence and their inheritance patterns have been reported by epidemiological studies. Methods: Iran's Metabolic Registry was launched in March 2017. All patients diagnosed with IEM registered in the Iran Metabolic Registry from 2017 to July 2022 were included in this study. Results: During the five years, 1,233 patients were recorded in the database. Due to missing data, 320 patients were excluded from the study. Of the 913 registered patients, 402 were female, and 511 were male. The median age of registered patients was 10.3 years (one week to 48.3 years). The most prevalent group of IEMs was amino acid disorders, with 596 (66.6%) patients. The mortality rate of the patients was 36.5%. Conclusions: This study represents the first report from the IEM registry. A comprehensive registry of IEMs for collecting patient data will help clinicians with more accurate diagnoses of the disorders, monitoring, and follow-up. Furthermore, by estimating the burden of IEMs, the healthcare system and government could accurately assess the medication and equipment needed.
{"title":"Inborn Errors of Metabolism in Iran: First Report from Iran Metabolic Registry","authors":"F. Abbasi, Saideh Abdolahpour, Reihaneh Mohsenipour, A. Rabbani, Ali Talea, A. Mohebbi, M. Khazdouz","doi":"10.5812/ijp-130939","DOIUrl":"https://doi.org/10.5812/ijp-130939","url":null,"abstract":"Background: Inborn errors of metabolism (IEMs) comprise over 1,000 disorders. Wide geographical and racial variations in the global birth prevalence and their inheritance patterns have been reported by epidemiological studies. Methods: Iran's Metabolic Registry was launched in March 2017. All patients diagnosed with IEM registered in the Iran Metabolic Registry from 2017 to July 2022 were included in this study. Results: During the five years, 1,233 patients were recorded in the database. Due to missing data, 320 patients were excluded from the study. Of the 913 registered patients, 402 were female, and 511 were male. The median age of registered patients was 10.3 years (one week to 48.3 years). The most prevalent group of IEMs was amino acid disorders, with 596 (66.6%) patients. The mortality rate of the patients was 36.5%. Conclusions: This study represents the first report from the IEM registry. A comprehensive registry of IEMs for collecting patient data will help clinicians with more accurate diagnoses of the disorders, monitoring, and follow-up. Furthermore, by estimating the burden of IEMs, the healthcare system and government could accurately assess the medication and equipment needed.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79746459","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}
Mahmoud Mohammadi, R. S. Badv, G. Zamani, M. Ashrafi, Morteza Heidari, Zahra Rezaei, Mehran Beiraghi Toosi, Mahmoud Reza Zitatzadeh, Homa Ghabeli, R. Haghighi, E. Pourbakhtyaran
Background: During the COVID-19 pandemic, educational programs have increasingly relied on virtual methods. Objectives: In this study, we compared the effects of in-person and virtual electroencephalography (EEG) training on the knowledge of pediatric and adult neurology residents. Methods: The study participants consisted of 30 pediatric and adult neurology residents who were recruited nationwide via a virtual network. They were randomly divided into two groups for in-person and virtual education, respectively. Prior to the first workshop session, participants completed a pre-test comprising 19 knowledge-related questions. Two interactive training sessions focusing on benign variants in EEG were conducted, including two in-person workshops for eight residents and two online workshops for 22 residents. Each session lasted one hour, with one held every two weeks. After the second session, participants were asked to complete a post-test consisting of 24 questions (identical to the pre-test) and five workshop satisfaction-related questions. Results: Overall, the mean exam score after both the in-person and virtual workshops was significantly higher than the pretest score across all educational levels. The mean score differences in knowledge between the in-person and virtual groups after the workshop were similar, with no statistically significant difference. Approximately 90% of the participants believed that the workshop would be beneficial for their daily practice. Conclusions: Given the absence of a significant difference between in-person and virtual training methods in improving participants' knowledge and satisfaction with both approaches, we recommend integrating virtual EEG training into the educational protocol for pediatric and adult neurology residents. Nonetheless, larger sample size studies are required to further validate these findings.
{"title":"Virtual and In-person Electroencephalography (EEG) Training among Pediatric and Adult Neurology Residents during the COVID-19 Pandemic","authors":"Mahmoud Mohammadi, R. S. Badv, G. Zamani, M. Ashrafi, Morteza Heidari, Zahra Rezaei, Mehran Beiraghi Toosi, Mahmoud Reza Zitatzadeh, Homa Ghabeli, R. Haghighi, E. Pourbakhtyaran","doi":"10.5812/ijp-128717","DOIUrl":"https://doi.org/10.5812/ijp-128717","url":null,"abstract":"Background: During the COVID-19 pandemic, educational programs have increasingly relied on virtual methods. Objectives: In this study, we compared the effects of in-person and virtual electroencephalography (EEG) training on the knowledge of pediatric and adult neurology residents. Methods: The study participants consisted of 30 pediatric and adult neurology residents who were recruited nationwide via a virtual network. They were randomly divided into two groups for in-person and virtual education, respectively. Prior to the first workshop session, participants completed a pre-test comprising 19 knowledge-related questions. Two interactive training sessions focusing on benign variants in EEG were conducted, including two in-person workshops for eight residents and two online workshops for 22 residents. Each session lasted one hour, with one held every two weeks. After the second session, participants were asked to complete a post-test consisting of 24 questions (identical to the pre-test) and five workshop satisfaction-related questions. Results: Overall, the mean exam score after both the in-person and virtual workshops was significantly higher than the pretest score across all educational levels. The mean score differences in knowledge between the in-person and virtual groups after the workshop were similar, with no statistically significant difference. Approximately 90% of the participants believed that the workshop would be beneficial for their daily practice. Conclusions: Given the absence of a significant difference between in-person and virtual training methods in improving participants' knowledge and satisfaction with both approaches, we recommend integrating virtual EEG training into the educational protocol for pediatric and adult neurology residents. Nonetheless, larger sample size studies are required to further validate these findings.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"18 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81510788","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}
A. Yousefi, Nasim Behnoud, A. Ghobadi, F. Amini Behbahani, E. Norouzi
Background: Functional constipation (FC) is a common major problem in children. This study compared Jujube paste and polyethylene glycol (PEG) as laxative drugs in children with FC. Ziziphus Jujuba Mill (Jujube) was selected according to traditional Iranian medicine because it is native to Iran and a large extent of Asia, is safe and easy to access, with acceptable taste to children. Methods: This randomized controlled clinical trial was performed on 128 children aged 2 to 12 with FC according to Rome IV criteria. Patients were randomly divided into two groups of Jujube paste and PEG and underwent four weeks of treatment. The efficacy, safety, and tolerability of the Jujube oral product were compared with PEG. Results: Following four weeks of therapy, all clinical symptoms of constipation according to Rome IV criteria were improved significantly in both groups (P < 0.05). In all the seven criteria of Rome IV, Jujube paste was as effective as PEG and even stronger in reducing stool stiffness (P < 0.0001). No hazardous side effect was reported in the two groups. Moreover, the medication acceptance rate was higher in the group receiving Jujube paste than in the group receiving PEG. Conclusions: Jujube paste is as effective as PEG in pediatric FC. This product has high nutritional value and antioxidant properties, so it can be a safe substitute for PEG in pediatric FC.
{"title":"Jujube Versus Polyethylene Glycol for Maintenance Treatment of Pediatric Functional Constipation: A Randomized Clinical Trial","authors":"A. Yousefi, Nasim Behnoud, A. Ghobadi, F. Amini Behbahani, E. Norouzi","doi":"10.5812/ijp-131550","DOIUrl":"https://doi.org/10.5812/ijp-131550","url":null,"abstract":"Background: Functional constipation (FC) is a common major problem in children. This study compared Jujube paste and polyethylene glycol (PEG) as laxative drugs in children with FC. Ziziphus Jujuba Mill (Jujube) was selected according to traditional Iranian medicine because it is native to Iran and a large extent of Asia, is safe and easy to access, with acceptable taste to children. Methods: This randomized controlled clinical trial was performed on 128 children aged 2 to 12 with FC according to Rome IV criteria. Patients were randomly divided into two groups of Jujube paste and PEG and underwent four weeks of treatment. The efficacy, safety, and tolerability of the Jujube oral product were compared with PEG. Results: Following four weeks of therapy, all clinical symptoms of constipation according to Rome IV criteria were improved significantly in both groups (P < 0.05). In all the seven criteria of Rome IV, Jujube paste was as effective as PEG and even stronger in reducing stool stiffness (P < 0.0001). No hazardous side effect was reported in the two groups. Moreover, the medication acceptance rate was higher in the group receiving Jujube paste than in the group receiving PEG. Conclusions: Jujube paste is as effective as PEG in pediatric FC. This product has high nutritional value and antioxidant properties, so it can be a safe substitute for PEG in pediatric FC.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"137 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80519286","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}
Niloufar Ghanbari, Faezeh Badkoubeh, R. Shirzadi, M. Modaresi, B. Sadeghi, Zahra Hosseinpour Dahka, S. H. Mirlohi
Background: The coronavirus disease 2019 (COVID-19) dramatically impacts healthcare delivery. Pulmonary diagnostic procedures have had frequent disruptions during this pandemic. Objectives: This study aimed to discover how the COVID-19 pandemic affected pediatric flexible fiberoptic bronchoscopy. Methods: This retrospective cross-sectional study was carried out on pediatric patients who underwent fiberoptic bronchoscopy at a tertiary pediatric hospital affiliated to Tehran University of Medical Sciences. Procedural analysis was done from 20 March 2019 to 20 February 2020 (the pre-pandemic period) and 20 March 2020 to 20 February 2021 (during the pandemic period). The two groups were compared with regard to bronchoscopic indications and findings. Results: Our results from the data registry showed that within (group 1), 290 patients vs. 241 patients from 20 March 2020 till 20 February 2021 (group 2) were admitted to the operation room at least once for bronchoscopy procedures. Although the findings of foreign body aspiration in bronchoscopy were more frequent in group 2, this difference was not significant in the two groups (P = 0.055). The number of cases without abnormality in group 2 was significantly less than in group 1 (P = 0.006). The prevalence of Laryngomalacia was also significantly higher in group 2 (P = 0.000). Conclusions: Our results confirmed the reduction of bronchoscopy in children after the COVID-19 epidemic. However, there was no change in the immediate indications for bronchoscopy, and this pandemic had the most significant impact on elective bronchoscopy.
{"title":"Compare Indications and Findings of Fiberoptic Bronchoscopy in Children Before and During the COVID-19 Outbreak","authors":"Niloufar Ghanbari, Faezeh Badkoubeh, R. Shirzadi, M. Modaresi, B. Sadeghi, Zahra Hosseinpour Dahka, S. H. Mirlohi","doi":"10.5812/ijp-129708","DOIUrl":"https://doi.org/10.5812/ijp-129708","url":null,"abstract":"Background: The coronavirus disease 2019 (COVID-19) dramatically impacts healthcare delivery. Pulmonary diagnostic procedures have had frequent disruptions during this pandemic. Objectives: This study aimed to discover how the COVID-19 pandemic affected pediatric flexible fiberoptic bronchoscopy. Methods: This retrospective cross-sectional study was carried out on pediatric patients who underwent fiberoptic bronchoscopy at a tertiary pediatric hospital affiliated to Tehran University of Medical Sciences. Procedural analysis was done from 20 March 2019 to 20 February 2020 (the pre-pandemic period) and 20 March 2020 to 20 February 2021 (during the pandemic period). The two groups were compared with regard to bronchoscopic indications and findings. Results: Our results from the data registry showed that within (group 1), 290 patients vs. 241 patients from 20 March 2020 till 20 February 2021 (group 2) were admitted to the operation room at least once for bronchoscopy procedures. Although the findings of foreign body aspiration in bronchoscopy were more frequent in group 2, this difference was not significant in the two groups (P = 0.055). The number of cases without abnormality in group 2 was significantly less than in group 1 (P = 0.006). The prevalence of Laryngomalacia was also significantly higher in group 2 (P = 0.000). Conclusions: Our results confirmed the reduction of bronchoscopy in children after the COVID-19 epidemic. However, there was no change in the immediate indications for bronchoscopy, and this pandemic had the most significant impact on elective bronchoscopy.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"72 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73427560","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}
Cangcang Fu, Bing Han Wang, Lin Li, Jihua Zhu, Wei Li
Background: The global spread of coronavirus disease 2019 (COVID-19) has reached pandemic proportions. Attempts to control its spread have included a range of early screening and triage measures developed in several nations and areas. Objectives: This study aimed to determine how to prioritize pediatric fever patients to limit the time they had to wait for a consultation and, therefore, the potential of worsening and crises under the burden of COVID-19. Methods: The triage and emergency care process of children in the Fever Clinic of Children’s Hospital of Zhejiang University School of Medicine, Zhejiang, China, within 2019 - 2020 included flow charts, guidance signs, publicity materials, noon and night articulation, and emergency calls. To enhance the management of pre-consultation and triage, the incidence of adverse event injuries was tallied, and satisfaction surveys were conducted. The prevalence of infectious diseases was characterized by demographic and seasonal factors, and the chi-square test was employed to test for differences between groups. Results: From January 2019 to December 2020, four peak periods were observed in each year, namely February, July, September, and December in 2019 and March, June, September, and December in 2020. The peak of common respiratory virus infection was seasonal; however, a significant increase (χ2 = 52.17; P < 0.001) in the case of patients who needed emergency care was observed secondary to fever. The patients within the age range of 1 - 3 years were more in need of emergency care than any other age group (54.70%; 99/181). The most common disease requiring emergency care was febrile convulsions (55.2%). No infectious diseases were missed or underreported during the study period, and no medical personnel was infected. Conclusions: An effective pre-consultation assessment and triage management system and streamlined workflow are of great importance in safeguarding acute patients while preventing infectious diseases.
{"title":"Application of a Pre-examination and Triage of Children in Fever Clinics to Prevent and Control the Epidemic of Infectious Diseases","authors":"Cangcang Fu, Bing Han Wang, Lin Li, Jihua Zhu, Wei Li","doi":"10.5812/ijp-134112","DOIUrl":"https://doi.org/10.5812/ijp-134112","url":null,"abstract":"Background: The global spread of coronavirus disease 2019 (COVID-19) has reached pandemic proportions. Attempts to control its spread have included a range of early screening and triage measures developed in several nations and areas. Objectives: This study aimed to determine how to prioritize pediatric fever patients to limit the time they had to wait for a consultation and, therefore, the potential of worsening and crises under the burden of COVID-19. Methods: The triage and emergency care process of children in the Fever Clinic of Children’s Hospital of Zhejiang University School of Medicine, Zhejiang, China, within 2019 - 2020 included flow charts, guidance signs, publicity materials, noon and night articulation, and emergency calls. To enhance the management of pre-consultation and triage, the incidence of adverse event injuries was tallied, and satisfaction surveys were conducted. The prevalence of infectious diseases was characterized by demographic and seasonal factors, and the chi-square test was employed to test for differences between groups. Results: From January 2019 to December 2020, four peak periods were observed in each year, namely February, July, September, and December in 2019 and March, June, September, and December in 2020. The peak of common respiratory virus infection was seasonal; however, a significant increase (χ2 = 52.17; P < 0.001) in the case of patients who needed emergency care was observed secondary to fever. The patients within the age range of 1 - 3 years were more in need of emergency care than any other age group (54.70%; 99/181). The most common disease requiring emergency care was febrile convulsions (55.2%). No infectious diseases were missed or underreported during the study period, and no medical personnel was infected. Conclusions: An effective pre-consultation assessment and triage management system and streamlined workflow are of great importance in safeguarding acute patients while preventing infectious diseases.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136012323","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: Leptin is thought to play an important role in Crohn's disease (CD) pathogenesis and progression. Independent studies have revealed a strong upregulation of leptin expression in the mesenteric fat of CD patients. Objectives: This study assessed the relationship between leptin gene polymorphisms and CD susceptibility in a Chinese pediatric population. Methods: A total of 86 patients with CD and 142 healthy controls were recruited for this case-control study. The genotypes of 4 single-nucleotide polymorphisms (SNPs; rs2071045, rs41457646, rs11761556, and rs2167270) in the leptin gene were determined by multiplex polymerase chain reaction (PCR) combined with next-generation sequencing. Results: We found that leptin rs2167270 had a significantly different distribution of alleles and genotypes between CD patients and healthy controls (G is a risk allele: 83.7% of cases vs 72.5% of controls; odds ratio [OR] 1.947; 95% CI, 1.203-3.151; P = 0.006; GG is a risk genotype: 72.1% of cases vs 53.5% of controls; P = 0.021). Patients with the CC genotype (rs2071045) had a significantly increased risk of early onset of CD (58.3% in A1a vs 31.1% in A1b; P = 0.003). Similarly, patients carrying the G allele (100% in A1a vs 84.1% in A1b; P = 0.015) and GG genotype (100% in A1a vs 71.0% in A1b; P = 0.048) of rs41457646, A allele (93.3% in A1a vs 71.8% in A1b; P = 0.013) and AA genotype (93.3% in A1a vs 47.9% in A1b; P = 0.003) in rs11761556 had a higher risk of early onset of CD. However, there was no significant difference in any of these 4 SNPs between patients with and without perianal lesions, as well as in low and normal body mass index (BMI) patients. Conclusions: The leptin rs2167270 polymorphism is associated with the susceptibility to CD in a Chinese pediatric population. Leptin rs2071045, rs41457646, and rs11761556 might lead to the early onset of pediatric CD.
{"title":"The Association of Leptin Gene Polymorphisms with Crohn's Disease in a Chinese Pediatric Population","authors":"Anna Sun, Wei Li, Jianrong Shi, Hongya Wang, X. Shu, Shiqiang Shang","doi":"10.5812/ijp-135345","DOIUrl":"https://doi.org/10.5812/ijp-135345","url":null,"abstract":"Background: Leptin is thought to play an important role in Crohn's disease (CD) pathogenesis and progression. Independent studies have revealed a strong upregulation of leptin expression in the mesenteric fat of CD patients. Objectives: This study assessed the relationship between leptin gene polymorphisms and CD susceptibility in a Chinese pediatric population. Methods: A total of 86 patients with CD and 142 healthy controls were recruited for this case-control study. The genotypes of 4 single-nucleotide polymorphisms (SNPs; rs2071045, rs41457646, rs11761556, and rs2167270) in the leptin gene were determined by multiplex polymerase chain reaction (PCR) combined with next-generation sequencing. Results: We found that leptin rs2167270 had a significantly different distribution of alleles and genotypes between CD patients and healthy controls (G is a risk allele: 83.7% of cases vs 72.5% of controls; odds ratio [OR] 1.947; 95% CI, 1.203-3.151; P = 0.006; GG is a risk genotype: 72.1% of cases vs 53.5% of controls; P = 0.021). Patients with the CC genotype (rs2071045) had a significantly increased risk of early onset of CD (58.3% in A1a vs 31.1% in A1b; P = 0.003). Similarly, patients carrying the G allele (100% in A1a vs 84.1% in A1b; P = 0.015) and GG genotype (100% in A1a vs 71.0% in A1b; P = 0.048) of rs41457646, A allele (93.3% in A1a vs 71.8% in A1b; P = 0.013) and AA genotype (93.3% in A1a vs 47.9% in A1b; P = 0.003) in rs11761556 had a higher risk of early onset of CD. However, there was no significant difference in any of these 4 SNPs between patients with and without perianal lesions, as well as in low and normal body mass index (BMI) patients. Conclusions: The leptin rs2167270 polymorphism is associated with the susceptibility to CD in a Chinese pediatric population. Leptin rs2071045, rs41457646, and rs11761556 might lead to the early onset of pediatric CD.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"7 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85992736","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}
F. Mahjoub, F. Motamed, Nakisa Niknejad, F. Farahmand, F. Hadipour, Pooria Asili
Introduction: Bile acid synthesis disorder is a very rare autosomal recessive disorder, which is mainly diagnosed by detecting mutations in the genes encoding enzymes that are involved in bile metabolism, including Δ4-3-oxosteroid-5β-reductase and 3β-Δ5-hydroxy-C27-steroid oxidoreductase. The enzymatic impairments can result in the accumulation of atypical and hepatotoxic bile acid intermediates, which clinically lead to cholestasis and progress to cirrhosis and hepatic failure. Herein, we describe a case of bile acid synthesis disorder diagnosed using molecular genetic assessment. Case Presentation: A 7-year-old girl is presented with failure to thrive since early in life. She had a history of urinary tract infection at four years of age. The sonography was performed at that time and revealed renal microcalculi. She also had a history of abdominal pain, nausea, and vomiting. She underwent upper endoscopies three times to rule out celiac disease; nevertheless, duodenal biopsies were all reported as normal. Muscle weakness was detected at five years of age and electromyography and muscle biopsy findings were non-specific. She underwent a whole-genome study and was diagnosed with bile acid synthesis disorder (BASD). After six months, she was treated with ursodeoxycholic acid, 250 mg, which led to growth compensation and liver enzyme reduction. No adverse effect was reported during the treatment. Conclusions: Bile acid synthesis disorder is a rare disorder with non-specific features and several organ involvements. It may take several years to achieve the correct diagnosis. To our knowledge, this is the first genetically confirmed case of bile acid synthesis disorder reported in Iran.
{"title":"Bile Acid Synthesis Disorder, the First Reported Case from Iran, (Proven by Genetic Study), How the Unavailability of Drug Affected the Course of Treatment","authors":"F. Mahjoub, F. Motamed, Nakisa Niknejad, F. Farahmand, F. Hadipour, Pooria Asili","doi":"10.5812/ijp-133741","DOIUrl":"https://doi.org/10.5812/ijp-133741","url":null,"abstract":"Introduction: Bile acid synthesis disorder is a very rare autosomal recessive disorder, which is mainly diagnosed by detecting mutations in the genes encoding enzymes that are involved in bile metabolism, including Δ4-3-oxosteroid-5β-reductase and 3β-Δ5-hydroxy-C27-steroid oxidoreductase. The enzymatic impairments can result in the accumulation of atypical and hepatotoxic bile acid intermediates, which clinically lead to cholestasis and progress to cirrhosis and hepatic failure. Herein, we describe a case of bile acid synthesis disorder diagnosed using molecular genetic assessment. Case Presentation: A 7-year-old girl is presented with failure to thrive since early in life. She had a history of urinary tract infection at four years of age. The sonography was performed at that time and revealed renal microcalculi. She also had a history of abdominal pain, nausea, and vomiting. She underwent upper endoscopies three times to rule out celiac disease; nevertheless, duodenal biopsies were all reported as normal. Muscle weakness was detected at five years of age and electromyography and muscle biopsy findings were non-specific. She underwent a whole-genome study and was diagnosed with bile acid synthesis disorder (BASD). After six months, she was treated with ursodeoxycholic acid, 250 mg, which led to growth compensation and liver enzyme reduction. No adverse effect was reported during the treatment. Conclusions: Bile acid synthesis disorder is a rare disorder with non-specific features and several organ involvements. It may take several years to achieve the correct diagnosis. To our knowledge, this is the first genetically confirmed case of bile acid synthesis disorder reported in Iran.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72996570","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: Ventriculoperitoneal (V-P) shunt is a common surgery for pediatric patients with hydrocephalus. Migration of the shunt to the scrotum is rare. Its clinical presentation may be silent if the shunt keeps patent. We describe such a case following the implantation of a V-P shunt with scrotal migration, with the tip still kept in the peritoneal cavity with patent function. We will discuss this rare complication and review the literature. Case Presentation: A 28-week-old boy presented preterm-related spontaneous intraventricular hemorrhage and hydrocephalus. The patient underwent surgery via V-P shunt implantation. One month after the operation, V-P shunt migration with the right hydrocele was diagnosed while the tip was still in the peritoneal cavity with a patent function. We adopted a watch-and-wait approach in which outpatient follow-up would be continued until the patient was 1.5 years old, when we would decide whether to perform hydrocele repair and correct the drainage tube malposition or continue follow-up. The patient was alert with good activity and close follow-up. Conclusions: Ventriculoperitoneal shunt migration with hydrocele in young children is a rare complication after the surgery. Regular follow-up up to 1.5 years old is recommended for patients with the tip in the peritoneal cavity and patent shunt function. Surgical intervention is suggested for cases with tip in the scrotum, shunt kinking, remarkable hydrocele, or hydrocephalus progression. Although V-P shunt migration is uncommon, we should take care of it to find out and solve the problem.
{"title":"Dose Hydrocele in Children Caused by Ventriculoperitoneal Shunt Migration Always Need Surgical Intervention? Watch and Wait - A Rare Cause of Hydrocele","authors":"Shih-Wei Tzeng, Ming-Cheng Tsai","doi":"10.5812/ijp-122323","DOIUrl":"https://doi.org/10.5812/ijp-122323","url":null,"abstract":"Introduction: Ventriculoperitoneal (V-P) shunt is a common surgery for pediatric patients with hydrocephalus. Migration of the shunt to the scrotum is rare. Its clinical presentation may be silent if the shunt keeps patent. We describe such a case following the implantation of a V-P shunt with scrotal migration, with the tip still kept in the peritoneal cavity with patent function. We will discuss this rare complication and review the literature. Case Presentation: A 28-week-old boy presented preterm-related spontaneous intraventricular hemorrhage and hydrocephalus. The patient underwent surgery via V-P shunt implantation. One month after the operation, V-P shunt migration with the right hydrocele was diagnosed while the tip was still in the peritoneal cavity with a patent function. We adopted a watch-and-wait approach in which outpatient follow-up would be continued until the patient was 1.5 years old, when we would decide whether to perform hydrocele repair and correct the drainage tube malposition or continue follow-up. The patient was alert with good activity and close follow-up. Conclusions: Ventriculoperitoneal shunt migration with hydrocele in young children is a rare complication after the surgery. Regular follow-up up to 1.5 years old is recommended for patients with the tip in the peritoneal cavity and patent shunt function. Surgical intervention is suggested for cases with tip in the scrotum, shunt kinking, remarkable hydrocele, or hydrocephalus progression. Although V-P shunt migration is uncommon, we should take care of it to find out and solve the problem.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"15 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82474824","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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