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Background & Objective: Unnecessary pre-operative ordering of red blood cells (RBCs) in elective surgeries increases costs and waste of blood inventory. Maximum surgical blood order schedule (MSBOS) is a helpful strategy in the estimation of blood units needed for surgery and the prevention of overconsumption. In this study, an MSBOS for pediatric cardiac surgeries is designed. Methods: In this cross-sectional study, we included all pediatric patients who underwent elective cardiac surgery in Children's Medical Center in Tehran, Iran, from March 21, 2019, to September 22, 2019. Data consisted of the type of surgery and the number of blood units transfused and units cross-matched, based on which cross-match to transfusion ratio (CTR), the transfusion index (TI), and transfusion probability (T%) were calculated. Results: Overall 205 pediatric patients were included in the study. Four hundred and ten RBCs units were cross-matched, and 262 were transfused. The overall results of the CTR, T%, and TI for all the eight types of cardiac surgery were 1.56 (410/262), 76% (157/205), and 1.28 (262/205), respectively. The raw MSBOS for cardiac surgeries included ventricular septal defect, tetralogy of fallot, dextro-transposition of the great arteries, atrial septal defect, aortic coarctation, patent ductus arteriosus, pulmonary stenosis, and pacemaker insertion, which were 1.58, 1.03, 1.54, 1.66, 0.77, 0, 1.25, and 0 unit, respectively, and the figures were rounded up. Conclusion: Accurate MSBOS protocols reduce cross-match workload in laboratories, lead to the appropriate use of blood stocks with less wastage, save human and economic resources, and eventually, promote patient safety. [ABSTRACT FROM AUTHOR]

Background: Sick euthyroid syndrome (SES) is the most common endocrine disorder in critically ill patients. It has been shown that the decrease in T4 levels correlates with disease severity and prognosis. Whether SES is a compensatory response to the disease course or needs to be treated is not known yet. Objectives: To our knowledge, there are only a few studiesoncritically ill infants and children investigating the correlation between thyroid function and disease severity as well as its outcome. Therefore, this study aimed to investigate thyroid hormone levels in critically ill patients. Methods: In this study, thyroid function tests including thyroid stimulating hormone (TSH), total T3 (TT3), free T3 (FT3), total T4 (TT4), free T4 (FT4), and reverse T3 (rT3) were measured in 35 critically ill children admitted to intensive care unit (ICU) on days 1 and 3 of admission. Disease severity was evaluated using pediatric logistic organ dysfunction score (PELOD). Then the patients were divided into groups of survivors and non-survivors and the results were compared between these two groups accordingly. Results: Thirty-five patients, including 19 (54.3%) female and 16 (45.7%) male, with the mean age of 2 years (SD:_3.8 years, range: 4 months- 15 years) had entered the study basedonthe inclusion criteria. 25 (71.6%) patients were transferred from PICUto other wards and 10 (28.4%) patients died. Age and sex were not statistically different in survivors and non-survivors (P > 0.05). It was revealed that there was a significant reduction in mean TT3 levels in non-survivors compared to survivors on the first day of admission (P = 0.007). On the third day of admission, however, a significant reduction in TT4 levels were seen in non-survivors (P = 0.03). Conclusions: Thyroid function assessment, especially TT3 on the first day and TT4 on the third day of admission, along with PELOD score, might be helpful in predicting disease outcome and patient's survival. [ABSTRACT FROM AUTHOR]

Background: Shigellosis is a diarrheal disease caused by Shigella spp. The majority of cases and deaths occur among children less than 5 years old. In severe cases, antibiotic therapy is recommended to lessen the risk of serious complications and death. Prevalence of different Shigella species and their antibiotic resistance patterns are changing over the time. Objectives: The current study aimed at assessing the changes in the prevalence of Shigella species and their antibiotic susceptibility among 0- to 14-year-old children referred to Children’s Medical Center, Tehran, Iran, from 2009 to 2014. Methods: The results of stool cultures were retrospectively analyzed to determine the prevalence of different Shigella species, their antibiotic susceptibility patterns and their changes in the largest university affiliated pediatrics center in Tehran. Results: Among 40 700 stool cultures, 507 cases were positive for Shigella spp. Most cases occurred among children under 5 years old. Shigellosis was more prevalent among males. The most common species were Shigella sonnei and Shigella flexneri. In general, they were most sensitive to cefotaxime and most resistant to cotrimoxazole. Resistance to cefotaxime and nalidixic acid increased annually. Resistance to ampicillin had a descending trend. Resistance to cotrimoxazole remained almost constant. Conclusions: The most common species of Shigella changed from Shigella flexneri to Shigella sonnei over the years. In comparison with the previous studies, resistance to nalidixic acid increased and resistance to ampicillin decreased. The prevalence and antibiotic resistance patterns of Shigella species, at different times and regions are changing. To make appropriate decisions on treatment, it is necessary to monitor the changes. [ABSTRACT FROM AUTHOR]

Objective: Exposure to environmental tobacco smoke (ETS) is one of the major factors of predisposing children to develop several hazardous health problems. We decided to investigate the association between nicotinine, one of the nicotine metabolites and esophagitis in children with gastroesophageal reflux disease (GERD). Methods: In a case control study 46 children suffering from esophagitis referred to endoscopy ward were recruited. The control group consisted of 45 healthy children. Urine samples were collected and urinary cotinine level (UCL) measured. Findings: The mean age of esophagitis and control groups were 5.11±2.93 and 6.72±2.8 respectively. Sixty children were passive smokers; 31 of them had non-smoker parents. In control group, 32 (71.1%) children and in esophagitis group 29 (63%) children had non-smoker parents. The mean value of UCL in patients suffering from esophagitis was significantly higher than those in normal group (P=0.04, 24.98±6.4 ng/ml vs. 15.16 ± 3.9 ng/ml). Considering 50ng/ml as a cutoff point for UCL, it was significantly higher in passive smoker group than in non smoker group (P=0.02). The mean cotinine level differed significantly in esophagitis and control group. Conclusion: Our results indicate the increased risk of developing esophagitis in children with ETS exposure. [ABSTRACT FROM AUTHOR]