[Evaluation of response to treatment with polycitra-K in urolithiasis of children]

Development of stone depends on certain physicochemical factors. Several treatment methods including increased fluid intake and dietary modification, medical therapies such as potassium citrate and use of extracorporeal shock wave lithotripsy [ESWL] and finally surgery methods are used for treatment of urolithiasis. The aim of this study was to evaluate the level of response to medical therapy with polycitra-K in children with urolithiasis. The study population comprised all patients less than 14 years old with urolithiasis visited at Mofid and Labafi Nejad hospitals within the last five years. All patients with an initial ultrasonography showing stone in urinary tract. At the end of study, the complete resolution or passage or a decrease in the size of stone in later sonography was defined as response to treatment. From 109 patients, 91 cases continued medical therapy with polycitra-k and 51 patients [56%] responded to treatment. Hypercalciuria and hyperuricosuria were found to be the etiological factors in 25% and 19% of patients, respectively. The stone analysis revealed that 50% were composed of ca-oxalate. Stone disease was more common between the ages 1-3 years and the most common complaint was hematuria [20%]. Calcium Oxalate stones were the most frequent stones which responded to polycitra. The response rate in girls and boys was similar and in different age groups it was almost equal. Based on the response rate of medical therapy with polycitra-k is recommended for treatment of urolithiasis in children

Aseptic meningitis in pediatrics: Epidemiologic evaluation and cerebrospinal fluid changes

This study aimed at investigating seasonal variation, clinical symptoms, and cerebrospinal fluid [CSF] changes in patients with aseptic meningitis admitted in Mofid hospital between 1995 and 1996. A total of 63 children with aseptic meningitis were enrolled in the study. Their age, gender, season of the disease, etiology, clinical symptoms, CSF changes, and treatment were evaluated and documented. Data were analyzed using SPSS 11.5. The male to female ratio of the patients was 2.5 to 1, mean age being 6.5 years. The disease occurrence was most common in spring and summer, and the most common symptoms observed were fever [92.6%], followed by nausea and vomiting [88.88% and 68.25%], neck stiffness, neck stiffness [54%], seizure [19%], kernig sign [14.28%], Brudzinski's sign [11.11%], and 1.58% of the patients had history of head injury. Mean white blood cell count for CSF was 165/mm3 [range, 6 to 850/mm3], the common cells being mononuclear cells; mean red blood cell count was 538 [range, 0 to 8100/mm3]; protein and glucose levels were within the normal ranges. Blood and CSF culture and CSF smear were negative. Prognosis was excellent and mean duration of recovery was 5 days [range, 2 to 18 days]. Although the clinical symptoms of aseptic meningitis are similar to those of bacterial meningitis, its prognosis is excellent. The CSF features can be used to diagnose the disease

[Spontaneous resolution of vesicoureteral reflux [VUR] in Iranian children, a single center experience in 533 cases]

Experience with vesicoureteral reflux [VUR] differs in different centers and there are lots of controversies surrounding this issue. The aim of this study was to evaluate Spontaneous resolution and prognosis of the disease among Iranian children. In this case series study, 1278 children with urinary tract infection and visited at pediatric nephrology clinic in Tehran, Iran during 1999-2007 were studied. Primary VUR was found in 533 Patients. Following the diagnosis, the patients received prophylactic antibiotic and were annually followed with radionucleo cystography [RNC]. Patients underwent surgery in case the medical treatment failed [breakthrough infection] or new renal scar formation. 533 patients with VUR were studied. Patients' mean age with VUR was 3.7 +/- 2.4 years [range: 2 days to 18 years old]. During an average follow-up duration of 3.3 +/- 2.2 years, spontaneous resolution was observed in 40% of 279 patients who had follow-up RNCs. The mean interval between VUR diagnosis and spontaneous resolution was 1.5 +/- 1 years [range: 2 months to 6 years]. The resolution rate was decreased with increment of reflux grade so that for grades I to V, VUR was resolved in 63%, 57%, 27%, 22% and 10% of the cases, respectively. Anti reflux surgery was performed in 27[10%] of patients during follow-up. Based on the excellent results obtained from clinical therapy using low dose antibiotics, it is recommended that VUR grades 1 to 4 be managed medically with low-dose oral antibiotic prophylaxis and close follow-ups

Comparison between diazepam and phenobarbital in prevention of febrile seizure: clinical trial

Febrile convulsions [FC] are the most common convulsive events in childhood, occurring in 2-5% of children. About one third of these children will have a recurrence during a subsequent febrile infection. This sudden neurologic problem is extremely frightening and emotionally traumatic for parents so some physicians try to prevent recurrence of FC by prescribing different drugs. This is a randomized clinical trial in 85 healthy children, aged 6 months to 5 years, who were not treated before. These children received randomly either oral diazepam [0.33 mg/kg/TDS for two days during febrile illness] or continuous oral Phenobarbital [3-5mg/kg /24 h]. Ultimately 64 patients completed the study and were followed up for an average of 13 months [12-18 months]. The rate of recurrence of febrile seizure was 18.2% in diazepam group and 32.3% in Phenobarbital group; the difference is not statistically significant [p=0.16]. There was no significant difference between intermittent oral diazepam and continuous oral Phenobarbital for FC prevention

Urinary interleukin 6 and 8 concentrations in children with acute pyelonephritis, before and after treatment

Urinary tract infections [UTI] are common cause of morbidity and mortality especially in young children around the world. Pyelonephritis can lead to scar formation, and subsequent hypertension and renal failure. Interleukins play a major role in renal scar formation following febrile pyelonephritis. The aim of this study was to investigate the level of urinary interleukin-6 [UIL-6] and UIL-8 concentrations during the acute phase of pyelonephritis and after two kinds of treatment. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with acute pyelonephritis who were treated with Ceftriaxone plus steroids [case group] and in 20 patients treated with antibiotic alone [control group]. Cases and controls were age and sex matched. Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 hours after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated. The differences between the cytokine/creatinine ratios in the initial urine samples and the follow-up samples were significant in the case group [p < 0.001], but not for the controls. In addition, combined antibiotic and steroids significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone [p < 0.05]. We conclude that steroids combined with antibiothics significantly decrease UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This result can suggest that the clinical use of corticosteroids may prevent scar formation following pyelonephritis

[Renal transplantation in children with cystinosis]

Cystinosis is an inherited metabolic disease in which transfer of cystine out of lysosome is impaired. This phenomenon leads to accumulation of cystine in different organs and causes organ dysfunction. Growth retardation is seen in these patients and later they go on to develop renal failure needing dialysis or renal transplantation. The aim of this study was to evaluate the outcome and complications of renal transplantation in patients with cystinosis. In this case series study in years 1996-2006 all patients with renal failure due to cystinosis who received renal transplantation, were followed for 43 +/- 1/1 months, Before operation, all patients were examined to determine if they are appropriate candidate for renal transplantation and after operation DPTA scan was performed to evaluate graft function and in later follow up necessary lab tests were done. All patients received triple immunosuppressive therapy including cyclosporine, prednisolone and Mycophenolate Mofetil. In the presence of rejection symptoms such as fever and a rise in creatinine, graft rejection was confirmed by DPTA scan and sonography of transplanted kidney. Patient survival was 100% and 4 years graft survival was 86.7%. Mean creatinine level before operation was 5.44 +/- 2.58 and post operation was 0.86 +/- 1.03 and at the last follow-up was 1.51 +/- 1.45 mg/dl, mean GFR at the last follow-up was 54.1 +/- 31.2 ml/min/1.73m2. Six [40%] patients were on dialysis before operation, 5 [33%] had acute rejection and 5 [33%] suffered from UTI after the operation. Growth retardation was seen in all of patients. Thirteen patients [86%] were affected by CMV infection and 6 [40%] by CMV disease; that were treated successfully by Ganciclovir for 2 weeks. One patient was affected by vessel thrombosis in post operation period and one patient had graft loss due to kink of vessel after operation. Renal transplantation in patients with cystinosis has favorable outcome. It is the treatment of choice for patients with cystinosis and End Stage Renal Failure [ESRF]

[ study of patients admitted with serum sickness in Mofid Children Hospital from [April 2005 to September 2007]]

Serum sickness is a type III hypersensitivity reaction mediated by immune complex deposition with subsequent complement activation, small vessel vasculitis, and tissue inflammation. Disease is caused by exposure to foreign proteins, equine diphtheria antitoxin. However, sporadic cases of serum sickness from non-protein antibiotics such as penicillins continue to occur. A retrospective chart review was conducted in 28 children who were admitted because of serum sickness in Mofid Children Hospital since April 2005 to September 2007. Of 28 cases included in our study, 17 were male and 11 female. 24 of the 28 cases [86%] aged less than five years old. In 25 of the 28 patients [89%], the onset of symptoms occurred 1-3 weeks after administration of the inciting antigen, in two patients less than one week, and in one patient more than three weeks. Associated symptoms included arthritis 36%, subjective fever 75%, arthralgia 85%, skin rash and angioedema 100% were observed during admission. Furazolidone was the most common cause of disease in this study. The incidence of serum sickness is decreasing as a result of public health vaccination programs that have decreased the need for specific antitoxins. However, currently, non-protein drugs such as furazolidone are the most common causes of serum sickness-like reactions