case report of acute necrotizing encephalopathy of childhood

Acute Necrotizing Encephalopathy of Childhood [ANEC] is a rare disease with a higher prevalence in the East Asia which is characterized with symmetrical and multifocal involvement of areas including thalamus, brainstem, cerebellum and white matter and it is associated with death as well as long-term neurological disabilities [sequel] in the individuals who survive. In this report, we introduce a child with acute neurological symptoms resulted by a possible infection process and explain his CT-scan and brain MRI as well as paraclinical symptoms

Mortality risk prediction by application of pediatric risk of mortality scoring system in pediatric intensive care unit

The Pediatric Risk of Mortality [PRISM] score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit [PICIT]. Herein, we intend to evaluate the efficacy of PRISM score in prediction of mortality rate in PICU. In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank [Mantel-Cox], Logistic regression model using SPSS 15. Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased [P<0.001]. A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%.PRISM score is a good predictor for evaluation of mortality risk in PICU

Causes and types of precocious puberty in North-West Iran

Precocious puberty is of concern because of the underlying disorders, the short adult stature, and the psychosocial difficulties. This study was carried out in order to evaluate the characteristics of children referred to pediatric endocrinology clinic with diagnosis of precocious puberty. In a cross-sectional study between February 2007 and September 2009, all of the children referred to pediatric endocrinology clinic in North-West Iran with diagnosis of precocious puberty were recruited. Data of 106 girls [82.2%] and 23 boys [17.8%] were analyzed. Mean age of the patients at the time of referral was 6.6 +/- 2.8 years [ranging 0.3-14 yr], which was 7 +/- 3.9 [ranging 0.3-14 yr] for boys and 6.6 +/- 2.5 [ranging 0.8-12 yr] for girls [P=0.6]. Out of 129 subjects, 56[43.4%] had precocious puberty, 71.4% [35 cases] of them were due to central precocious puberty and 28.6% [16 cases] were pseudo-precocious puberty. 73 out of 129 subjects [56.6%] were due to normal variants of puberty, normal puberty, and no puberty. 87.5% of subjects with central precocious puberty were idiopathic. Most of children referred with diagnosis of precocious puberty have benign normal variants. Most of cases with precocious puberty are affected with central precocious puberty, especially with idiopathic form of it

Acute hydrocephaly following methadone intoxication in a child

Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication

Efficacy of continuous high dose midazolam infusion in childhood refractory generalized convulsive status epilepticus

Prolonged and uncontrolled refractory status epilepticus [SE] is a life-threatening medical emergency in children [1, 2, 3]. There is no consensus on the optimal therapy for refractory status epilepticus [1]. The aim of this study was to develop a new method for treating patients with refractory status epilepticus. Ten children with refractory status epilepticus in Mofid Hospital, who did not respond to 10 microg/kg per min of intravenous midazolam, had their dose of midazolam increased to 30 microg/kg per min. All children were monitored for the development of side effects. Ten children with no response to low-dose midazolam were given a higher dose of midazolam, and 5 [50%] children had a good response. These patients had significantly different response to high-dose midazolam. One patient in the high-dose midazolam group was intubated and required mechanical ventilation. The duration of stay in the hospital and PICU and on mechanical ventilation in patients with no response to low-dose midazolam following with other drugs was longer than in the high-dose midazolam group. No death occurred in high dose midazolam group. High-midazolam dose drip infusion is a safe and effective protocol for refractory status epilepticus in children