Clinical manifestations, laboratory findings and outcomes of children with herpetic encephalitis in Amirkola children hospital, Northern Iran

Herpes simplex encephalitis [HSE] is a fatal infection of the central nervous system. The early diagnosis of HSE is crucial because the early introduction of antiviral therapy can significantly decrease mortality and morbidity associated with this disease. This study was carried out to determine the clinical manifestations, laboratory findings and the outcome of the children admitted due to a presumptive diagnosis of HSE to Amirkola Children Hospital; a referral hospital in the north of Iran, during 2006-2007. This cross-sectional study was performed on patients with diagnosis of HSE in Amirkola Hospital, affiliated to the Babol University of Medial Sciences in the north of Iran. All of the children with a diagnosis of encephalitis were enrolled in this study. After admission, a special investigation including CSF analysis, electroencephalogram [EEG], Computerized tomography [CT scan] and/or magnetic resonance imaging [MRI] were performed. PCR [Polymerase Chain Reaction] analysis for herpes virus DNA was done on CSF sample in all patients. All the patients with a clinical diagnosis of herpetic encephalitis were treated with acyclovir at the time of admission but every patient with a positive PCR was assumed as a definite diagnosis of HSE. Clinical manifestations, laboratory findings and outcome of patients were collected. At the end of the study, frequency of HSE was reported according to the PCR for HSV DNA among the children admitted due to encephalitis. The mean age of the patients was 5.58 +/- 3.46 years. The most common clinical manifestations were fever [70%], nausea, vomiting [54%] and headache [44%]. Seizure was more common among girls, and was significantly more prevalent in younger patients. Abnormal EEG was presents in 42%, abnormal CT-scan in 38% and abnormal MRI in 48% of subjects. PCR was positive in 34% of our patients. All patients were discharged from the hospital after treatment with acyclovir. Herpetic encephalitis should be considered in each patient admitted with sudden change in the level of consciousness in a previously healthy child with fever and antecedent viral infection

[Incidence of sepsis in neonates with indirect hyperbilirubinemia in Shohadaye Tajrish hospital]

Jaundice is one of the common problems in neonates and may lead to some irreversible complications. 60% of term and 80% of preterm neonates during first week of their life are icteric which mostly are due to indirect and physiologic hyperbilirubinemia. This problem could have some important pathologic causes, such as sepsis. Because of the high referral rate of neonates with jaundice and suspicion of bacteremia and sepsis, this research conducted to determine the rate of bacteremia and causative microorganisms in Shohadaye Tajrish hospital. This study was based on patient's records. All patients were fullterm [>37 weeks] newborn with age of <28 days and birth weight of >2500 g with chief complaint of indirect hyperbilirubinemia without any symptoms of sepsis that were admitted in Shohadaye Tajrish hospital during years 2002-2003. Neonates with symptoms of sepsis and direct hyperbilirubinemia were excluded. Positive blood cultures confirmed sepsis. During the period of this study, 394 neonates were admitted due to hyperbilirubinemia and 201 cases had the criteria of research. 153 cases had positive blood culture and 21 [13.7%] had bacteremia but in second blood culture of these neonates, 5 cases had positive blood culture and only in 2 cases the same bacteria were grown and in 3 other cases different bacteria were detected in sepsis work up, 2.8% had erythrocyte sedimentation rate more than 15, C-Reactive Protein [CRP] was 1+ in 3.6% of patients, 2+ in 1.2% of patients, 3+ in 0.6% of patients. In 94.5%, CRP was negative, the serum levels of bilirubin in 14.9% were less than 15, 54.7% between 15 and 20, and in 30/4% were more than 20. 97.4% had jaundice on the first week of life, 4% were Glucose-6-phosphate dehydrogenase deficient, 18.9% had ABO incompatibility, and 8.4% had Rh blood group incompatibility. Cause of jaundice in 67.8% was unknown. There was no positive urine culture in suprapubic specimen, but in 17% of patients' urine culture were positive in urine bag specimen. It seems that bacteremia and sepsis without any clinical symptom [other than direct hyperbilirubinemia] is unlikely to happen and sepsis work up can cause excessive sampling, and sometimes lead to misdiagnosis

Glucose-6-phosphate dehydrogenase G6PD deficiency

Glucose-6-phosphate dehydrogenase deficiency, the most worldwide common enzyme deficiency, causes a spectrum of diseases including neonatal hyperbilirubinemia, acute and chronic hemolysis. Persons with this condition also may be asymptomatic. This X-linked inherited disorder most commonly affects persons of African, Asian, Mediterranean, or middle-Eastern descent. Approximately 400 million people are affected in the world. Prevalence of G6PD deficiency in Tehran was 2.1% [3.6% boys- 0.6% girls] in Babol [12.5% boys, 4.1% girls] in Sari [14.3% boys, 3% girls]. This condition usually is diagnosed by fluorescent spot test. Different gene mutation different levels of enzyme deficiency, with classes assigned to various degrees of deficiency and disease manifestation. Acute hemolysis is usually caused by exposure to an oxidative stressor in the form of oxidative drug or fava beans and is self-limited, but in rare instances it can be severe enough to warrant a blood transfusion. Neonatal hyperbilirubinemia may require treatment with phototherapy or exchange transfusion to prevent kernicterus. Variant that causes chronic hemolysis is uncommon and is related to sporadic gene mutations. The prevalence of molecular mutation varied in north of Iran, Mazandaran [66.25% Mediterranean, 27% Cantham and 6.75% Cosensa]. Gilan [86.4% Mediterranean, 9.7% Cantham], Golestan [69% Mediterranean, 2.67% Cantham]. The most important way for prevention is screening of neonate for G6PD deficiency and avoidance of exposure to oxidant agent, Fava bean and also early treatment of neonatal jaundice

Congenital malformations at a referral hospital in Gorgan, Islamic Republic of Iran

This study recorded the rate of congenital malformations in 10000 births at a referral hospital in Gorgan, Islamic Republic of Iran in 1998-99. The overall incidence of congenital malformations was 1.01% [1.19% in males and 0.76% in females]. Anomalies of the musculoskeletal system had the highest incidence [0.38%], followed by central nervous system [0.28%] and genitourinary system [0.25%]. The incidence of congenital malformations in different ethnic groups was 0.85%, 1.45% and 1.70% in native Fars, Turkman and Sistani groups respectively. Sex and ethnic background are factors in the rate of congenital malformations in this area