Renal function in children with cyanotic congenital heart disease: pre- and post-cardiac surgery evaluation

Cyanotic congenital heart diseases [CCHDs] are a series of cardiac anomalies that have long been recognized as a potential cause of nephropathy. There have been few reports on renal impairment in patients with CCHD before and after corrective cardiac surgery. The aim of this study was to evaluate the prevalence of renal dysfunction before and after cardiac surgery and the impact of some risk factors on final renal outcome. Thirty children with CCHD who had done corrective cardiac surgery in the previous 6 months were enrolled in this study. All data prior to surgery were collected from the charts. Post-operation data including blood and spot urine samples were taken simultaneously for CBC, Cr, and uric acid and 24 hour urine was collected for microalbumin and Cr during the follow up visits. Pre- and post-operation parameters were compared to study the impact of cardiac surgery on renal function. Pre- and post-operative GFRs were not significantly different. Final GFR was significantly and inversely associated with pre- and post-operation age [P=0.008 r=-0.48, P=0.03 r=-0.38]. Three [10%] patients had microalbuminuria. The prevalence of microalbuminuria in children older than 10 years was 30%. There was no link between microalbuminuria and age, GFR, and hematocrit [P=0.1, P=0.3, P=0.3, respectively]. Patients with preoperation hematocrit >45 had a significantly lower final GFR compared to children with HCT <45 [83.7 +/- 6.5 vs 111.10.2, P=0.001]. The mean uric acid fraction [FEua] excretion was 8.21 +/- 4.75. Pre-operative HCT was inversely associated to FEua [P=0.01, r=-0.44]. There was no relationship between FEua and age, serum uric acid, and GFR [P=0.7, P=0.4, P=0.2]. Children with CCHD are at increased risk of renal injury which is related more to the duration of cyanosis and higher degree of hematocrit level. To lower the risk, corrective cardiac surgery is recommended to be done as soon as possible to improve renal function and stop more renal impairment

Epidemiology of Helicobacter pylori infection among Iranian children

Background and study aims: Infection with Helicobacter pylori [HP] either in children or in adults is a risk factor for gastric cancer. The Golestan province located in northeast Iran has been known to be a high-risk area for oesophageal and gastric cancers. This study was conducted to assess the epidemiology of this infection in the children of Golestan

Patients and methods: This study was carried out in 2009 on healthy children [1-15 years] of the Golestan province. Serum immunoglobulin G [Ig G] antibody against HP was tested in these children and positive samples were tested for anti-cytotoxin-associated antigen A [anti-CagA] antibody. To assess the relationship between HP infection and the risk of gastric cancer, the Golestan province was divided into high- and low-risk areas based on the incidence rate of gastric cancer. The chi-squared test was used to assess the relationship between variables

Results: Totally, 194 subjects were recruited. The prevalence of HP infection in our area was 50.5%. The prevalence of HP infection was significantly higher in the high-risk than in the low-risk area for stomach cancer [p = 0.004]. The seropositivities of HP [p = 0.03] and CagA [p = 0.04] were significantly lower in children <5 years than in others

Conclusion: Our results showed a high prevalence of HP infection in children of the Golestan province of Iran. We also found a significant positive relationship between childhood HP infection and the risk of gastric cancer. Hence, childhood HP infection may be considered a possible determinant of gastric cancer in this high-risk area. Implementation of preventive programmes may help to reduce the burden of childhood HP infection and, consequently, gastric cancer in this area

[ experience of couple-family relationship in female psychiatric inpatients: a qualitative study]

The goal of the present study was to describe the experience of female psychiatric inpatients, of couple-family relationships. The method of phenomenology was used in this qualitative study. The subjects comprised female patients hospitalized in Noor Psychiatric Hospital in Isfahan. Fourteen subjects were selected using purpose-oriented sampling, up to reaching data saturation. Data were collected using an unstructured interview and Colaizzi's seven stage process was used for data analysis. The findings were classified in 847 conceptual codes. Subsequent to the fourth level coding, the data were divided into two main groups: [1] causes of the illness and their aggravating factors [behavior of spouse, behavior of spouse's family, behavior of subject, miscellaneous factors and childhood and adolescence period], and [2] subjects' reactions [to the behavior of spouse, toward continuing to live and to sexual relation with spouse]. Women experience many negative events in their marital life, with undesired effects on mental health. Taking these issues into consideration and providing families and couples with related education could have significant effects in improving mental health among women

[Errors in medication orders and the nursing staffs reports in medical notes of children]

Medication errors are the most common type of medical error and an avoidable cause of iatrogenic injury in pediatric patients. These errors can occur at any point in the process of ordering, transcribing, dispensing, administering, or monitoring medications. This study was conducted to verify medication errors by analyzing medication orders and the nursing staffs reports in medical notes of children admitted in Madany Pediatric Hospital, Khoramabad, Iran, in the first 6 months of 2004. This is a descriptive cross-sectional and hospital information based study. Samples included 898 medical charts of children selected by random sampling. The data collection instruments were a demographic questionnaire for patients, physicians and nurses, a scale for analyzing medication orders and a scale for analyzing the nursing staff's reports. Data are analyzed by SPSS Ver. 11.5 software. Analysis of the medication orders indicated that in 74.1%, drug administration precautions were not written down, in 47.8%, exact time or intervals of drug administration were not recorded, in 45.5%, drug unit was not stated or it was incomplete or ambiguous, and in 20.5%, orders had at least one drug interaction. Analysis of nursing staffs reports indicated that in 77.5%, drug administration precautions were not indicated, in 14.9%, drug interactions were not noted, in 14.8%, time or intervals of drug administration were not according to orders, and in 6.3%, medication was not administered by nurses. In the busy and complex environment of pediatric units, medication errors can occur frequently. However, most of these errors are trivial and do not harm patients. The types of errors indicate the need for continuous education and the implementation of management tools that allow the promotion of the practice and monitoring results as medication errors are indicators of the quality of the Healthcare provided. Therefore, their detection and systematic analysis of their causes can contribute to their systematic prevention, thus improving the healthcare