Therapeutic effects of oral zinc supplementation on acute watery diarrhea with moderate dehydration: a double-blind randomized clinical trial

Background: To assess the therapeutic effects of oral zinc supplementation on acute watery diarrhea of children with moderate dehydration

Methods: All 9-month to 5-year-old children who were admitted with acute watery diarrhea and moderate dehydration to the Children Ward of Motahari Hospital, Urmia, Iran in 2008 were recruited. After the application of the inclusion and exclusion criteria, the patients were randomly allocated to two groups: one group to receive zinc plus oral rehydration solution [ORS] and the other one to receive ORS plus placebo. All the patients were rehydrated using ORS and then receiving ORS for ongoing loss [10 ml/kg after every defecation]. Additionally, the patients in the intervention group received zinc syrup [1 mg/kg/day] divided into two doses. A detailed questionnaire was filled daily for each patient by trained pediatrics residents; it contained required demographic characteristics, nutrition and hydration status, and disease progression. The primary outcome [frequency and consistency of diarrhea] and the secondary outcomes [duration of hospitalization and change in patients' weight] were compared between the two groups

Results: The mean diarrhea frequency [4.5 +/- 2.3 vs. 5.3 +/- 2.1; P=0.004] was lower in the group receiving zinc +ORS; however, the average weight was relatively similar between the two groups [10.5 +/- 3.1 vs. 10.1 +/- 2.3; P=0.14]. The qualitative assessment of stool consistency also confirmed earlier improvement in the treatment group in the first three days of hospitalization [P <0.05]. The mean duration of hospitalization was significantly lower in the patients receiving zinc supplements [2.5 +/- 0.7 vs. 3.3 +/- 0.8 days; P=0.001]

Conclusion: Our results imply the beneficial effects of therapeutic zinc supplementation on disease duration and severity in patients with acute diarrhea and moderate dehydration in Iran

Association between Celiac Disease and Intussusceptions in Children: Two Case Reports and Literature Review / 대한소아소화기영양학회지

Association between celiac disease and intussusception has been reported in adult. Although intussusception is common in children, it rarely has been reported in association with celiac disease. Two children, 5 and 7 years old, with celiac disease are reported here, whose initial presentation was intussusception prior to investigation for concomitant failure to thrive. They presented with acute and severe abdominal distention with vomiting, and donuts and pseudo-kidney appearance in abdominal ultrasonography. One patient's intussusception had reducted spontaneously, however the other had required surgery. In investigation for concomitant failure to thrive, tissue transglutaminase levels were very high and duodenal biopsies revealed celiac disease. Thus celiac testing is recommended in children with intussusception and growth failure.

Idiopathic hypercalciuria in children with vesico ureteral reflux and recurrent urinary tract infection

Our aim was to determine association of vesicoureteral reflux [VUR] and idiopathic hypercalciuria in children with recurrent and single episode of urinary tract infection [UTI]. The study group consisted of 45 children with VUR and recurrent UTI, and 2 control groups: 45 normal healthy children [control group 1] and 45 children with VUR and single episode of UTI [control group 2]. Idiopathic hypercalciuria was defined as urine calcium to creatinine ratio more than 0.8 [mg/mg] in infants younger than 1 year old, and more than 0.2 [mg/mg] in older children [without any detectable causes for hypercalciuria]. The study group consisted of 26 [57.8%] girls and 19 [42.2%] boys, with the mean age of 41.14 +/- 22.1 months. Nine [20%] subjects had hypercalciuria. The control group 1 composed of 22 [48.9%] girls and23 [51.1%] boys, with the mean age of 43.98 +/- 16.23 months. In this group, 6 subjects [13.3%] with hypercalciuria were detected. The control group 2 composed of 23 [51.1%] girls and 22 [48.9%] boys, with the mean age of 39.96 +/- 24.2 months. In group 2, 7 subjects [15.6%] with hypercalciuria were detected. Comparison between such results was not statistically significant. Despite reports of different studies about accompanying of hypercalciuria with recurrent UTI with or without anatomical abnormalities, according to the present study, idiopathic hypercalciuria is not a major contributing factor to recurrent UTI in children with VUR

Colocolic intussusception without lead point; a case report and literature review

Colocolic intussusception is rare in children and most cases in adolescents are produced by a lead-point.A review of the English-written literature revealed only three cases of colocolic intussusception without lead point. A seven year-old boy with chief complaint of colicky abdominal pain and vomiting for five days, dysentery for 4 days, and no response to antibiotic therapy, increasing pain and abdominal distension was referred to pediatric gastroenterologist. Abdominal x-ray revealed multiple air-fluid levels and gasless colon. Pseudo-kidney appearance was reported in abdominal ultrasound at splenic flexure. Colocolic intussusception diagnosis without any lead point was confirmed in laparotomy and reduced with milk-out procedure. In children with dysentery especially in presence of colicky abdominal pain, abdominal distention and no response to antibiotic therapy, abdominal ultrasound to rule out intussusception is recommended

Coagulase negative staphylococcus; the most common cause of neonatal septicemia in Urmia, Iran

A prospective study to determine the prevalent bacterial agents of neonatal sepsis and their antimicrobial susceptibility in Imam Khomeini teaching hospital, Urmia, from Oct 2002 to Nov 2006. Newborns with clinical signs of septicemia and positive blood culture during fifty months were prospectively studied. Samples for blood cultures, complete blood count, erythrocyte sedimentation rate, C-reactive protein, sugar, electrolytes, cerebrospinal fluid and urine analysis/culture were obtained; ampicillin and gentamycin were started empirically. Results were analyzed by SPSSis package and cross tabulation was done. Two thousand three hundred twenty five newborns from 4827 neonatal admissions were screened for septicemia. Two hundred twenty seven episodes of sepsis occurred in 209 newborns. The boys/girls ratio was 1.67: 1 and 63.9% of patients were premature. There were 164 [72.2%] cases of EONS and 63 [27.7%] cases of LONS. Coagulase negative Staphylococcus [CONS] was the most common [54%] cause of both early and late onset neonatal sepsis and showed high degree of resistance to commonly used antibiotics; ampicillin [100%], ceftriaxon [65%], cefotaxim [67%] and gentamicin [51%], but comparatively low resistance to vancomycine [10%], imipenem [19%], and ciprofloxacine [23%]. Neonatal sepsis in our ward is mainly caused by gram-positive organisms, which are developing resistance to commonly used antibiotics. The initial empirical choice of ampicillin and gentamycin appears to be unreasonable for our environment

Delayed presentation of right - sided diaphragmatic hernia after mechanical ventilation in a newborn with hyaline membrane disease: a case report

Delayed presentation of right-sided diaphragmatic hernia occurred after the improvement of hyaline membrane disease in a male newborn. He presented with respiratory distress during the first few hours of life and had hyaline membrane disease confirmed by chest roentgenogram. After initial improvement with antibiotic therapy and ventilatory support for 2 weeks, sudden deterioration of respiration occurred and subsequent chest roentgenogram revealed herniated viscera in the right hemi-thorax. Two days ago his chest roentgenogram was normal. He did not have any other causes for diaphragmatic hernia such as group B streptococcal infection or necrotizing enterocolitis. To our knowledge, this association has not been previously reported in newborns