Search

Background: Guillain-Barre syndrome (GBS) is a post-infectious immune-mediated peripheral neuropathy, progressing bilaterally and often symmetrically and affecting sensory and motor function. Most cases completely recover, but around 20% of cases may lead to complications, incomplete recovery, or even death. Objectives: This study aims to assess the prognosis of GBS in pediatric patients and possible associated conditions regarding recovery or prognosis. Methods: We investigated 71 cases of GBS admitted to Mofid Pediatric Hospital from March 2014 to March 2017. Demographic, clinical, and laboratory data were retrospectively recorded and analyzed. Two follow-up visits were performed after 1 to 3 and 5 to 8 years from onset, according to the GBS Disability Scale, and recovery of motor function was assessed during patients' visits to the clinic. Results: We found 35 male and 36 female subjects with an average age of 6.17 ± 3.82 (range 0.9 up to 15 years old); cases were mostly presented with myalgia and weakness (78.9%) followed by headache, found in 5 patients (7%). Around 84.5% of patients had an upper respiratory infection as their antecedent infection. Fifteen cases of autonomic dysfunction were observed, and 15 patients had cranial nerve involvement. Most cases had the acute inflammatory demyelinating polyradiculoneuropathy (AIDP) form of GBS on electrophysiologic tests. Analysis showed onlyaxonal involvement was significantly correlated with poor prognosis (P-value<0.05), and other variables were not significantly correlated. Conclusions: Compared to the current literature, we found fewer autonomic dysfunctions, cranial neuropathies, and a smaller percentage of AIDPs in our data. Altogether, the axonal form of GBS is reported as a predictor of an unfavorable prognosis in GBS patients. [ABSTRACT FROM AUTHOR]

Background: Morquio A, an autosomal recessive lysosomal storage disease, is caused by a defect in the enzyme N-acetyl-galactosamine-6-sulfatase. This leads to the accumulation of the glycosaminoglycans chondroitin-6-sulfate (C6S) and keratan sulfate (KS), resulting in various skeletal manifestations, multisystemic impairments, and significant morbidities. Objectives: This study aimed to evaluate the impact of the addition of elosulfase alfa to the hospital protocol on treating Iranian pediatricians with Morquio A syndrome. Methods: A before and after study was conducted on ten patients with Morquio A syndrome diagnosis from 2019 to 2020. Elosulfase alfa was prescribed with the standard dose of 2 mg/kg/weekly IV infusion for 54 weeks. Then, growth indices, quality of life, and cardiopulmonary data were collected by research assistants using a pre-designed check. Data were entered in SPSS version 23. Quantitative variables were compared between the two periods using the Student's t-test, and qualitative variables were compared using the χ² test or Fisher's exact test. Results: Ten pediatricians with MPS IV were included, seven of whom were female, with the mean age of 5.8±2.3 years. The mean-time for walking 6m(P = 0.005), standing (P = 0.005), the stair climb test (P = 0.007), and quality of life (P = 0.015) had significant statistical difference before and after treatment by elosulfase alfa. Conclusions: The addition of elosulfase alfa in patients with Morquio A syndrome was associated with a significant improvement outcome in the 'after' treatment period. [ABSTRACT FROM AUTHOR]

Background: During the first wave of COVID‐19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID‐19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID‐19 and the previous year. For poisoning admissions during COVID‐19, we also evaluated the cause by age and clinical outcomes. Methods: This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol‐poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre‐COVID‐19 reference period (same dates in 2019). Results: Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID‐19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15‐ to 18‐year‐olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15‐ to 18‐year‐olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001). Conclusion: The Iranian methanol poisoning outbreak during the first wave of COVID‐19 was associated with significantly increased hospitalization rates among children and adolescents—including at least six pediatric in‐hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers. [ABSTRACT FROM AUTHOR]

Introduction: New Coronavirus disease 2019 (COVID-19) has caused serious health problems worldwide. The disease first started in Wuhan, China, and then resulted in thousands of deaths throughout the world. Case Presentation: According to data from involved patients, children and neonates include a small proportion of patients with COVID-19. However, in some cases, hospitalization and even death still may occur. In this case report, we described mortality associated with COVID-19 in two pediatrics from Qom city, Iran. One of them presented with severe symptoms that needed high-flow ventilation and admission to the ICU. Conclusions: The findings of this report confirm that COVID-19 may cause death in pediatrics, like in adults. Timely diagnosis, precise evaluation of clinical symptoms, and effective treatment of COVID-19-infected children can play an important role in reducing mortality rates. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify gastrointestinal (GI) and liver injury presentations in children admitted with COVID-19 infection. Methods: In this retrospective study, we studied all children with suspected symptoms of COVID-19, referred to Amirkola Children's Hospital. Clinical manifestations of the digestive and respiratory systems and liver function tests were evaluated for all cases. Results: Eighteen children were studied. The most common clinical symptoms were fever, anorexia, weakness, nausea and vomiting, cough, diarrhea, and abdominal pain, respectively. Also, 5/18 (27.8%) and 7/18 (38.9%) of cases had abnormally high alanine aminotransferase (ALT), aspartate aminotransferase (AST), respectively. Additionally, in icteric cases, direct bilirubin was raised. There was no significant relationship between pulmonary lesions and abnormal excess in ALT (P = 0.59) and AST (P = 0.62). Conclusion: The findings showed that there were no severe clinical GI symptoms in children with COVID-19 infection. Besides, children with increased liver enzymes did not have more respiratory involvement than those without a rise in liver enzymes. [ABSTRACT FROM AUTHOR]

Background and Aim: Hearing loss can have disabling effects on all aspects of children's life and demographic factors of families can have significant effects on children's auditory development. The main aim of the study was determining the effects of socioeconomic and education level on auditory behaviors of hearingimpaired children. Methods: The study was cross sectional descriptive- analytic study and was conducted on 207 parents of children under age of four years with native Persian speaking parents with literacy skill. Their hearing impairment was identified before the first month of age. Early occurrence of hearing loss was considered to exclude any effects of early exposure to normal auditory stimuli on the outcome measurements. The children had at least 3-month experience with the cochlear implant (CI) after best fitting and adaptation to their device at the time of the study. Samples were selected by convenience sampling method from available subjects. For determining socioeconomic level, Ghodratnama socioeconomic status (SES) questionnaire was used. Infants and Toddlers Meaningful Auditory Integration Scale (IT-MAIS) was selected for the auditory behaviors study. Results: Socioeconomic and educational level of the family showed no significant effects on auditory behaviors. The age of receiving auditory assistive device had weak but statistically significant effect on the outcome. Conclusion: It seems that socioeconomic status and educational level of the family did not contribute to the auditory behaviors of children with cochlear implant. The generalizations of these results need further studies. [ABSTRACT FROM AUTHOR]

BACKGROUND Hepatic dysfunction has been associated with poor prognosis in critically ill patients. We aimed to investigate the incidence of early liver dysfunction and its association with probable predictive variables in a group of Iranian patients. METHODS The study was conducted on 149 pediatric patients referred to the pediatric intensive care unit (PICU), Shiraz University of Medical Sciences, Shiraz, Iran between April and October 2016. Serum levels of liver aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, and international normalized ratio (INR) were recorded in 24, 48, and 96 hours after admission. RESULTS On the first day of admission, direct bilirubin was the least (9.1%) and abnormal alkaline phosphatase level was the most (66.9%) common abnormalities. Abnormal levels of all tests except alkaline phosphatase were predictive of increased rate of mortality. In univariable logistic regression, abnormal aminotransferases (ALT and AST), INR, total bilirubin, and direct bilirubin had significant relationship with patients' mortality after 24, 48, and 96 hours. In multivariable logistic regression only ALT and INR in the first 24 hours had significant relationship with mortality in final model. Although univariate logistic regression revealed a significant relationship between AST and ALT levels with PICU length of stay, no significant relationship was observed between these variables and PICU length of stay (except AST in the first 24 hours) in multivariable analysis. CONCLUSION Increase in liver enzymes may predict mortality and increased PICU length of stay in critically ill children. [ABSTRACT FROM AUTHOR]

Aim: The Emergency Department is one of the most challenging wards of the hospital for studying patient safety and the prevention of treatment errors is the basic rule in the quality of health care. The present study was conducted to evaluate the selected risk processes of Pediatric Emergency of Qaem Educational Hospital in Mashhad by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. Materials and Methods: A mixed method was used to analyze failure modes and their effects with HFMEA. Five high-risk processes of the Pediatric Emergency were identified and analyzed. To classify failure modes, nursing errors in clinical management model; for classifying factors affecting error, the approved model by the United Kingdom National Health System; and for determining solutions for improvement, Theory of Inventive Problem Solving was used. Results: In 5 selected processes, 28 steps, 80 sub-processes and 254 potential failure modes were identified with HFMEA. Thirty-seven (14.5%) failure modes as high-risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors as 62.3%, and knowledge and skill as 8.1% respectively. Also, 23.6% of preventive measures were in the category of human resource management strategy. Conclusion: Using the proactive method of HFMEA for identifying the possible failure of treatment procedures, determining the effective cause on each failure mode and proposing the improvement strategies, has high efficiency and effectiveness. [ABSTRACT FROM AUTHOR]

Background: Reduced survival and impaired quality of life of the children affected by cancers is one of the most important health problems. In this study, 5-year survival of children affected with Central nervous system (CNS) tumors and its related factors were evaluated. Materials and Methods: Participants in this historical cohort study consisted of 161children with mean age of diagnosis 72 ± 51 months (median:60 months, range from 1 month to 17 years) who were diagnosed with CNS tumors from 1999 to 2005. All patients had referred to Oncology hospitals of Shiraz University of Medical Sciences, Shiraz, Iran. Data were extracted by checklist from their medical records. Result: Five-year overall survival (OS) and disease free survival (DFS) of the patients were 59% (standard error: 5%) and 51.7% (standard error: 5%). Moreover, 10-year OS was calculated as 47% (standard error: 7%). Based on tumor histology, OS was 70% for low grade tumors and 52% for high grade tumors (P=0.202). Based on the results, gender (girls had longer survival than boys), recurrence, neurologic deficit and age of diagnosis (60-119 months had longer survival), were determined as the influencing factors on OS rate (HR (95% CI) =0.48 (0.24-0.98), P=0.044, 0.48(0.25-0.93) P=0.031, 0.42 (0.18-0.95), P=0.039, and 0.32 (0.11-0.88), P=0.029, respectively). Moreover, tumor location in diencephalon was determined as poor prognostic factors ((HR (95% CI) =10 (1.9-57), P=0.007). Conclusion: Aforementioned prognostic factors should be taken into account by oncologists to make better decisions in the management of the patients with CNS tumors. It seems that survival is a multifactorial event and besides these prognostic factors, it might be also related to different clinical settings, ethnicity and type of treatment. Further studies with more focus on different treatment modalities are suggested. [ABSTRACT FROM AUTHOR]

Background: Abdominal tumors are still a diagnostic problem in children. This study was conducted to assess the presentation and types of childhood intra abdominal tumors in children in Shiraz. Materials and Methods: Participants of this historical cohort study consisted of 298 children aged between 1.5 months to 15 years old who were diagnosed with abdominal mass between March 2003 and March 2013. All patients referred to pediatric surgery wards of Namazi hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Data extracted by checklist included patient's demographic data, type of malignancy, signs and symptoms at the time of presentation and duration of signs and symptoms. Results: The majority of tumors were retroperitoneal followed by intra-peritoneal and pelvic masses. Wilms tumor was the most common tumor constituting 34% of all cases followed by neuroblastoma (24.7%), and non-Hodgkin lymphoma (12.7%). The most common signs and symptoms were abdominal pain (39.5%), abdominal distention (34.2%), palpable mass (27.5%), weight loss (19.4%), fever (16.7%), and vomiting (10.7%). Conclusion: Better understanding of signs and symptoms of abdominal masses can facilitate early diagnosis and proper treatment of malignant abdominal tumors in children. [ABSTRACT FROM AUTHOR]

Background This study aim to determine the association between height and cancer in the children aged 14 years at the time of diagnosis in Rasht, Iran. Materials and Methods In this cross-sectional study, height of patients with a malignancy (≤14) at the time of diagnosis measured in the standard charts of United States National Center for the Health Statistics (NCHS). Data were reported by descriptive statistics and analyzed by Regression tests in SPSS version 19. Results Overall, 78 male (38.6%) and 124 female (61.4%) patients with various kinds of malignancies were evaluated for their heights. Leukemia was the most common type of cancer. The median height of the patients was more than 20th percentile and under 50th percentile of the NCHS. No significant association was found between height and leukemia. Conclusion Previously, the median height of Iranian girls and boys (≤15) reported under 20th percentile of the NCHS. In this study, the median height of the patients at the time of diagnosis was more than 20th percentile of the NCHS. There was a correlation between height and cancer among our patients, although, this correlation can be assessed by further cohort study. [ABSTRACT FROM AUTHOR]