Caspian Journal of Pediatrics

Background: Functional Constipation (FC) is one of the important digestive disorders in pediatrics. Its prevalence varies in different communities. The purpose of this study was to determine the prevalence of FC in our area between the school children and the impact of school on it.

Methods: This study was done on 4 to 12 years old children of nine schools and kindergartens of Amirkola, (2007). After completing the constipation questionnaires by parents and children, all constipated children referred to gastroenterologist to confirm the diagnosis of functional constipation. All children were followed in summer when they didn’t go to school and in next year-the winter of 2009. Age, sex, the incidence of constipation in the school time and the summer holiday, health status of the toilets in school and the age of children were recorded when they learned to clean themselves.

Results: Of all 493 studied cases the prevalence of FC was 21.3% (105 cases). There was no significant difference between the genders (p=0.913). All 99 constipated cases were reevaluated for constipation in summer and only 25
(18 boys and 7girls) of them were constipate. In the next school year the number of constipated case reaches to 90 cases again that there was significant relation between constipation and school months (p<0.01).

Conclusions: The prevalence of FC in children was significantly high and school attendance had a great impact on it. We advise that the awareness of school officials and parents can reduce the prevalence of FC.

Background: Non-alcoholic fatty liver disease (NAFLD) is increasingly a common disease which is created by the accumulation of fat in the liver. About 20% of adults and 5% of children suffer from this disease. In some studies, half of obese children had fatty liver disease and approximately 90% of the patients with fatty liver were obese. The aim of this study was to evaluate fatty liver disease in obese children referred to the pediatric clinic in Kashan, Iran, in 2012.

Methods: This study was done on 200 children aged 5-15 years with Body Mass Index (BMI) more than 95% and other causes of obesity were ruled out. Liver ultrasonography for evaluation of fatty liver and blood sampling were performed for these children.

Results: Of 200 studied children, 122 (61%) and 78 (39%) were male and female, respectively with mean age of 9.07 years. The average of BMI was 27.9. According to liver sonography, 118 (59%) patients had fatty liver that 91.5% of them were grade I and 8.5% grade II. Liver enzyme levels, serum lipids and uric acid were significantly higher in obese children with fatty liver. Fatty liver had a significant relationship with insulin levels but no with Fasting Blood Sugar (FBS).

Conclusions: In this study, the prevalence of fatty liver and associated disorder in obese children was high (59%). Therefore, the lifestyle changes are necessary to prevent childhood obesity and some measures should be carried out for the treatment of fatty liver in children.

Background: The prevalence of obesity is increasing and many countries are struggling with its high rate and serious complications. As a result of distinct diet in obese children, they may be susceptible to nutritional deficiencies in particular, iron deficiency. This study aimed to examine the relationship between obesity and iron indices.

Methods: In this cross-sectional study, 206 elementary school students were selected by stratified random sampling. Anthropometric parameters (waist circumference and body mass index) were measured, and fasting venous blood was collected to test serum iron, ferritin, transferrin saturation and complete blood count. To recognize the association between obesity and anemia, data were entered to SPSS and Lisrel software and analyzed using appropriate related test.

Results: It was revealed that waist circumference was negatively associated with levels of serum iron and transferrin saturation (p<0.05). In contrast, the highest waist circumference was positively and significantly related to higher levels of TIBC (p<0.05) compared to normal-weight children. Generally, it was concluded that waist circumference was significantly related to total iron binding capacity and serum iron levels (p<0.05). Similar negative significant associations were observed among children with an increase in body mass index and transferring saturation. Central and general obese children were more likely to have iron deficiency with and without anemia.

Conclusion: This study suggests that the higher levels of total and central obesity should be taken into account when assessing the children’s body iron status and should be treated before providing dietary recommendations to correct anemia. 

Introduction: cerebral vein thrombosis is a rare complication of nephrotic syndrome (NS). We report a known case of NS with hemorrhagic thrombosis.

Case report: A boy with previous history of NS was admitted with headache and decrease of level of consciousness and his brain images were revealed hemorrhagic thrombosis

Conclusions: cerebral vein thrombosis must be considered in patients with history of NS (especially in new cases and during of relapses) and prevention of hemoconcentration is very important to decrease thrombosis risk.

Background: Urinary tract infection (UTI) is an important complication after kidney transplantation (KT). UTI may cause kidney damage and dysfunction especially in children. Therefore, the aim of this study was to evaluate the risk of UTI after KT in adult and children and compare of them.

Methods: This study was done in Shaheed Beheshti Hospital (Babol Medical University). All patients, after KT and during one month after their operation were followed and divided to two groups (according their ages): more than 18 years old (adults) and under 18 years old (Children).Then, their urine samples were sent for culture every 2-3 days during admition and every week after discharged and more than 100000 single colony count were defined positive culture. Data were analyzed using t-test and p<0.05 was considered important.

Results: There were 508 cases and 450 patients were adult and others were children. Among them, 109 (24%) adult and 8(13.8%) children had positive urine culture, respectivley (P > 0.05) .In adult groups, 62 (21.6%) male and 47(28.8%) female patients had positive culture. However, in children group, 2 (6.3%) boys and 6 (23.1%) girls had positive culture, respectively (P<0.05).

Conclusions: According to positive culture, there was no difference between adult and children, but females had higher risk of positive U/C than males .So, more attention was needed after KT in females.

Introduction: Foreign Body Aspiration (FBA) represents a life-threatening emergency .It occurs primarily in children below 3 years. Generally, the most common aspirated FB is organic material such as nuts or beans. Sharp Foreign Bodies (FBs) are of particular concern to the attending clinician, because of their potential to perforate the air passage and cause possible complications. Here in, we report a rare case of sharp metallic pin aspiration in a child.

Case report: A 15-month-old boy was referred to our Emergency Ward due to the sudden onset of chocking and dysphagia which were transient. His mother was a tailor. He had history of ingestion of the similar pin two months ago. Chest radiography identified the radiopaque pin in the left side of chest. Rigid bronchoscopy was done and a sharp metallic pin was removed.

Conclusions: Aspiration of a sharp, metallic FB is a serious injury. Pain X-ray can confirm the diagnosis .FB inhalation is preventable by creating public awareness and parenteral education to keep small objects out of children. 

Aspiration of a sharp, metallic FB is a serious injury. Pain X-ray can confirm the diagnosis. FB inhalation is preventable by creating public awareness and parenteral education to keep small objects out of children. 

Kidney stone disease has become more common in children, but it remains non diagnosed in a significant proportion of patients, due to a lack of notable signs and symptoms. All children with colicky abdominal pain or microscopic hematuria should be examined thoroughly for urolithiasis. Patients’ histories in terms of family, medical, and drug and a thorough physical examination are required to be considered during diagnostic evaluation. Thereafter, diagnostic imaging methods should be aimed to detect the size, shape and location of calculi and also urinary tract anomalies. Ultrasound should be used as the initial imaging method to evaluate children with suspected nephrolithiasis. The noncontrast computerized tomography reserved for those in whom ultrasound is unable to diagnose stone. Increased water and fluid intake and a reduction of salt consumption are the common recommen dation to those children with a history of kidney stones, though the rate of stone recurrence in children is unknown. Since metabolic  disorders are the most frequent causes of stone in children, diagnostic evaluation should also target the detection of metabolic disorders including hypercalciuria, hyperoxaluria, hyperuricosuria and so on that may cause recurrent nephrolithiasis. Kidney stone is not a disease itself, but it is only a symptom. Therefore, its early diagnosis is mandatory for every child with the first stone event. In this article, we have summarized literature and emphasize that a few studies with acceptable quality are available on children with urolithiasis in Iran and the world that warrant future studies on this topic. 

Background: Diabetic ketoacidosis (DKA) is the final consequence and life-threatening complication of severe insulin deficiency in type 1 diabetes with occurrence of 20-40%. The aim of this study was to investigate the incidence and predisposing factors of DKA and its consequences.

Methods: This retrospective study was performed on 128 diabetic patients in Amirkola Children’s Hospital in 2005-2013. Patients' data were recorded in a predetermined questionnaire. The data were analyzed using SPSS.18.

Results: Of all 128 hospitalized diabetic patients, 103 patients (80.5%) were referred for the first time and 25 (19.5%) patients were previously treated with insulin. Of total 128 patients, 71 (55.5%) had some degree of ketoacidosis that severe ketoacidosis was the most common form (in 36 cases; 50.7%). Among patients with the diagnosis of ketoacidosis (71 patients), 54 patients (76%) presented with DKA as the first symptom of diabetes. Generally, the predisposing factors of ketoacidosis were seen in 39 (54.9%) patients, which were due to infections and insulin therapy discontinuation in 27 (69.23%) and 12 (30.76%) of them, respectively. In patients with previous diagnosis of diabetes mellitus and history of admission with diabetic ketoacidosis, 70.58% had previous treatment cessation.

Conclusions: In the current study, the incidence of ketoacidosis was high (55.5%). This subject seems to be related to lack of information about diabetes mellitus among population who require the universal education. On the other hand, in respect to high incidence of DKA among patients with cessation of previous insulin treatment, rigorous and complete training of them is critical.

Tacrolimus is a main drug for induction and maintenance immunosuppression for patients with kidney transplants in many centers. One of important side effect of drug is post-transplant diabetes mellitus. Of course, diabetes ketoacidosis (DKA) is rare. In this report, a 12-year-old girl with DKA was presented after 45 days of kidney transplantation. 

Background: Acoustic noise is one of the universal pollutants of modern society. Although the high level of noise adverse effects on human hearing has been known for many years, non-auditory effects of noise such as effects on cognition, learning, memory and reading, especially on children, have been less considered. Factors which have negative impact on these features can also have a negative effect on learning and education development. In the present study, the effects of traffic noise were studied as pollutant on memory and auditory verbal learning of elementary school children.

Methods: The present cross-sectional study was conducted on 166 normal children aged 9-11 years. Eighty children were selected from noisy areas (Leq> 50 dBA) and compared with 86 children from low noise areas (Leq <50 dBA). Using Persian version of the Rey Auditory-Verbal Learning Test, various aspects of memory were studied in low noise and noisy environments.

Findings: A significant difference was observed between two groups in all steps of the Rey test (p=0.00). There was a significant difference between two genders in various steps of Rey test (p=0.00). The average score of recognition was higher in the low noise group than the noisy one (p=0.00).

Discussion and conclusion:  Traffic noise had an adverse effect on the auditory verbal learning and memory of the studied students. Its effect is more on boys than girls. Since learning is very important in the development of students’ education and social skills, therefore, it is necessary to reduce the noise exposure of students in schools.

Background: Extracardiac malformations can be seen in 20-45% of infants with congenital heart disease (CHD). Chromosomal abnormalities exist in 5-10% of patients with CHD. The aim of this study was to assess the frequency of overt extra cardiac malformations in children with CHD.

Methods: This descriptive epidemiologic study was conducted on 720 patients with CHD referred to the pediatric cardiac clinic of the most important south west referral center of Iran in 2014. Data were collected by studying patients' files during this time.

Results: Totally, 401(55.7%) and 319 (44.3%) of patients were male and female, respectively. Extracardiac malformations were diagnosed in 53 cases (7.36%) and multiple extracardiac malformations involving more than one anomaly were present in 10 cases (1.38%). The most frequent extracardiac malformations in the current study included skeletal and visceral abnormalities and then genitourinary was seen. Of all patients, 33 (4.58%) cases were affected by syndromic features of which Down syndrome was the most common.

Conclusions: Investigation for extra cardiac abnormalities in patients with CHD is very important, since proper diagnosis and early treatment of these abnormalities can improve the patients' outcomes. On the other hand all the patients with overt and syndromic abnormalities require investigation for a possible CHD.