ABSTRACT
Statement of the Problem: Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported
Purpose: This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children
Materials and Method: A sensitive search of electronic databases of PubMed [since 1966], SCOPUS [containing EMBASE, since 1980], Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings [MeSH] keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included
Results: Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 [28.12] months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval [CI] 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk [RR]: 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep [RR: 5.1, CI 95%: 1.44-18.04] significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model
Conclusion: Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce [Level of evidence: C]
ABSTRACT
Since a new epidemic [third wave] of retinopathy of prematurity [ROP] sensed throughout the world in recent years, we aimed to assess newer risk factors for advanced ROP which needs treatment in Iranian neonates as a new target output of various neonatal care for this serious disease of newborn infants especially those born prematurely. In an analytic cross-sectional study all neonates <1500 g birth weight and/or <32 weeks gestational age admitted to our NICU as a tertiary level intensive care unit in Milad Hospital, Tehran, Iran during June 2006-June 2007 were included. All data were extracted from medical records and compared in two groups with or without treatment. Seventy one neonate infants entered our study. Twelve neonates [16.9%] progressed to advanced ROP. Final multivariate analysis model revealed that mean leukocyte counts during first 14 days of life [P=0.04], transfusions number [P=0.01] and hypocapnic episodes during first 14 days of life [P=0.02] were significantly different between the two groups of infants independently, even after simultaneous adjustment. Based on our findings, more amenable risk factors should be approached regarding more careful modulation of such overlooked risk factors which may lessen the burden of prematurity
ABSTRACT
There are disparate data regarding whether bilirubin is protective or toxic during free radical related illness among neonates. Seventy one infants with gestational age [GA] of<32 weeks and/or birth weight [BW] of<1500 g, who survived beyond 4 weeks and completed physical examinations were enrolled in this study. The infants were divided into two groups based on the presence or absence of advanced retinopathy of prematurity [ROP], grade III intraventricular hemorrhage [IVH], grade III necrotizing enterocolitis [NEC], respiratory distress syndrome [RDS], bronchopulmonary dysplasia [BPD], sepsis or severe fungal infection [SFI]. The mean of total serum bilirubin [TSB] of the first 14 days of life were measured and compared between these two groups. A significant lower TSB were found in severe form of ROP [P<0.001], grade III NEC [P=0.008], grade III IVH [P=0.021], SFI [P=0.003] and sepsis [P=0.007] in comparison to mild or disease free status. Moreover, the cut-off point of 5.1 mg/dl for the mean of TSB had the sensitivity of 88.1% and specificity of 84.6% to detect severe grades of ROP. Also the cut-off point of 3.25 mg/dl had 97.2% sensitivity and 100% specificity in order to distinguish SFI. It is concluded that bilirubin may play an antioxidant role in vivo as in vitro; and protect preterm infant against these free radical related disorders. Our findings suggest that not only the upper limits of serum bilirubin, but also the lower limits must be taking into account in order to both preventing from neurotoxic effects and free radical based illnesses, respectively