Background: One of the most challenging operations in children for anesthesiologists and surgeons is foreign body aspiration. Bronchospasm and desaturation may lead to bradycardia and even death. Objectives: The study aimed to evaluate the effect of preoperative dexamethasone and β2 agonist (salbutamol) administration on children who had foreign body aspiration during the rigid bronchoscopy on these undesired complications. Methods: Children were divided into two groups via random numbers table, independent of their clinical conditions. β2 agonist (salbutamol) (2.5 mg < 20 kg, 5 mg > 20 kg) and dexamethasone (0.5 mg/kg) were administrated to group 1, 30 minutes before the operation. The same agents were administrated to group 2 during anesthesia induction. The occurrence of bronchospasm, desaturation, and bradycardia was evaluated. Results: There were 27 children in each group. There was no statistically significant difference between the two groups’ time periods between the onset of the symptoms and procedure (P > 0.05). The two groups were similar in clinical aspects. Clinically, periods of spasm and desaturation were shorter, and patients recovered faster in group 1, but the bronchospasm numbers, desaturation, and bradycardia periods were similar in both groups. Conclusions: The results seem statistically similar. Since the periods of spasm and desaturation were shorter, and patients recovered faster in patients with preoperative administration of β2 agonists (salbutamol) and dexamethasone, we may suggest that a larger data set in future studies may lead to more significant results and a better conclusion.
{"title":"Preoperative Dexamethasone and β2 Agonist Administration to Children with Airway Foreign Bodies: Effects on Intraoperative Respiratory Complications","authors":"Ufuk Ates, Ergun Ergun, Kutay Bahadir, Ozlem Selvi Can, Anar Gurbanov, Coskun Ozbicer, Murat Cakmak, Meltem Bingol-Kologlu, Gulnur Gollu","doi":"10.5812/ijp-130800","DOIUrl":"https://doi.org/10.5812/ijp-130800","url":null,"abstract":"Background: One of the most challenging operations in children for anesthesiologists and surgeons is foreign body aspiration. Bronchospasm and desaturation may lead to bradycardia and even death. Objectives: The study aimed to evaluate the effect of preoperative dexamethasone and β2 agonist (salbutamol) administration on children who had foreign body aspiration during the rigid bronchoscopy on these undesired complications. Methods: Children were divided into two groups via random numbers table, independent of their clinical conditions. β2 agonist (salbutamol) (2.5 mg < 20 kg, 5 mg > 20 kg) and dexamethasone (0.5 mg/kg) were administrated to group 1, 30 minutes before the operation. The same agents were administrated to group 2 during anesthesia induction. The occurrence of bronchospasm, desaturation, and bradycardia was evaluated. Results: There were 27 children in each group. There was no statistically significant difference between the two groups’ time periods between the onset of the symptoms and procedure (P > 0.05). The two groups were similar in clinical aspects. Clinically, periods of spasm and desaturation were shorter, and patients recovered faster in group 1, but the bronchospasm numbers, desaturation, and bradycardia periods were similar in both groups. Conclusions: The results seem statistically similar. Since the periods of spasm and desaturation were shorter, and patients recovered faster in patients with preoperative administration of β2 agonists (salbutamol) and dexamethasone, we may suggest that a larger data set in future studies may lead to more significant results and a better conclusion.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"14 5-6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136273314","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: This study aimed to systematically evaluate the effectiveness of a clinical nurse specialists training program in Zhejiang Province, China, from participants’ perspectives. Methods: This cross-sectional study was conducted with 209 PICU nurse specialists who participated in the training program from 2016 to 2021. All participants completed an online questionnaire two years after graduation. We collected their demographic characteristics and their development status after the training (e.g., continuous improvement of core competence, research skills, and promotion). Chi-squared test was applied to assess the differences in effectiveness across subgroups. Results: In total, 209 (87.8%) out of 238 nurses responded to the survey among whom 73.7% launched new projects in their hospital after training and 75% published research articles in peer-reviewed journals. Also, 32.4% received promotions, and 67% participated in ICU-related continuing education programs. Based on multivariate regression analysis, the execution of new projects was closely related to the nurse’s position and the level of their working hospitals. The job title and position were associated with publication, research performance, promotion, and continuing education. Conclusions: The nurse specialists of the PICU carried out a set of new projects implanting new skills that they had learned from the training program. Their core competence was improved, including theoretical knowledge and operation skills, teaching capacities, and scientific research abilities. Many trainees published papers, applied for research grants, got promotions, and had further opportunities for continuing education.
{"title":"Evaluation of the Clinical Nurse Specialists Training Program in Pediatric Intensive Care Units in China: Quantitative Results from Participants’ Perspectives","authors":"Cangcang Fu, Jihua Zhu, Nannan Lin","doi":"10.5812/ijp-135556","DOIUrl":"https://doi.org/10.5812/ijp-135556","url":null,"abstract":"Background: This study aimed to systematically evaluate the effectiveness of a clinical nurse specialists training program in Zhejiang Province, China, from participants’ perspectives. Methods: This cross-sectional study was conducted with 209 PICU nurse specialists who participated in the training program from 2016 to 2021. All participants completed an online questionnaire two years after graduation. We collected their demographic characteristics and their development status after the training (e.g., continuous improvement of core competence, research skills, and promotion). Chi-squared test was applied to assess the differences in effectiveness across subgroups. Results: In total, 209 (87.8%) out of 238 nurses responded to the survey among whom 73.7% launched new projects in their hospital after training and 75% published research articles in peer-reviewed journals. Also, 32.4% received promotions, and 67% participated in ICU-related continuing education programs. Based on multivariate regression analysis, the execution of new projects was closely related to the nurse’s position and the level of their working hospitals. The job title and position were associated with publication, research performance, promotion, and continuing education. Conclusions: The nurse specialists of the PICU carried out a set of new projects implanting new skills that they had learned from the training program. Their core competence was improved, including theoretical knowledge and operation skills, teaching capacities, and scientific research abilities. Many trainees published papers, applied for research grants, got promotions, and had further opportunities for continuing education.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"34 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80048147","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}
Mahsa Soti Khiabani, Hosein Alimadadi, M. Abdolsalehi, M. Sotoudeh Anvari
: Reports of acute hepatitis with unknown origin in children have been published worldwide since April 2022. Due to the unfamiliar nature of the disease and the alarming trend of increasing reports worldwide, health workers must become aware of its diagnosis and treatment. Accordingly, the committee for developing guidelines for the Department of Pediatrics, Tehran University of Medical Sciences, prepared a clinical guideline for more efficient management of these patients. Due to the limited information about this disease, it has been tried to categorize and specify the required diagnostic and treatment measures based on the latest published data. Herein we express this algorithmic approach and diagnostic and therapeutic guidelines for acute hepatitis with unknown origin in children.
{"title":"Clinical Guideline and Diagnostic Algorithm of Acute Hepatitis with Unknown Origin in Children: Tehran Children’s Medical Center Protocol","authors":"Mahsa Soti Khiabani, Hosein Alimadadi, M. Abdolsalehi, M. Sotoudeh Anvari","doi":"10.5812/ijp-134101","DOIUrl":"https://doi.org/10.5812/ijp-134101","url":null,"abstract":": Reports of acute hepatitis with unknown origin in children have been published worldwide since April 2022. Due to the unfamiliar nature of the disease and the alarming trend of increasing reports worldwide, health workers must become aware of its diagnosis and treatment. Accordingly, the committee for developing guidelines for the Department of Pediatrics, Tehran University of Medical Sciences, prepared a clinical guideline for more efficient management of these patients. Due to the limited information about this disease, it has been tried to categorize and specify the required diagnostic and treatment measures based on the latest published data. Herein we express this algorithmic approach and diagnostic and therapeutic guidelines for acute hepatitis with unknown origin in children.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"55 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73015111","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: 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":"31 1","pages":""},"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":"24 19 1","pages":""},"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":"153 1","pages":""},"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":"1 1","pages":""},"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":"96 1","pages":""},"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":"23 1","pages":""},"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":"8 1","pages":""},"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}
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