Evaluation of Lipid Profile Changes in Pediatric Patients with Acute Mononucleosis

BACKGROUND: Acute Epstein-Barr virus (EBV) infection could lead to atherogenic lipid profile changes in adults; while there is no evidence about the children with Infectious mononucleosis (IM). The aim of this study was to evaluate the lipid profile of the children in acute phase of mononucleosis and two months after the recovery. MATERIALS AND METHODS: From 2010 through 2012, 36 children with IM aged 1-10 years were enrolled in a prospective cross-sectional study. Fasting serum total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and triglyceride level were measured during acute phase of the disease and after 2 months of the recovery. RESULTS: From 36 patients enrolled, 25 (69.4%) cases were male and the mean age of the patients was 4.1 ± 2.0 years. The mean of the total cholesterol level in the acute phase and 2 months after the recovery were149.5 ± 35.3 mg/dL and 145.7±30.6, respectively (P = 0.38). However, the serum level of HDL cholesterol in patients after 2 months of recovery was significantly increased (37.9 ± 9.3 mg/dL vs. 28.5 ± 10.6 mg/dL, P <0.001). The mean value of serum LDL cholesterol was significantly reduced, two months after recovery (81.4 ± 19.5 mg/dL, vs. 92.6 ± 28.8 mg/dL, P = 0.009). Furthermore, the serum triglyceride level was significantly reduced after the recovery (108.7 ± 36.9 mg/dL) compared with the acute phase (163.8 ± 114.3 mg/dL) (P = 0.004). CONCLUSION: EBV infection in children could change lipid profile which is partially restored 2 months after the recovery.

prospective study to assess vancomycin serum concentrations in pediatric patients with current dosing guidelines

Concerns about increasing bacterial resistance to vancomycin, have caused the adult treatment guidelines to recommend higher trough concentrations based on the type and location of infectious disease. Although these recommendations are not specific to children, the values can be extrapolated. This prospective study was designed to evaluate efficacy of current vancomycin dosing recommendations to achieve therapeutic trough serum concentration in pediatric patients. Laboratory data, vancomycin dosing and subsequent serum concentrations of children in a community teaching pediatrics hospital were collected and analyzed. Trough serum levels were determined at steady state and compared with Infectious Disease Society of America [IDSA] 2011 guidelines for the treatment of Methicillin-Resistant Staphylococcus Aureus [MRSA] infections. In a prospective observational, cross-sectional study in a university medical center in Tehran, Iran, 50 patients, who received vancomycin for more than 4 doses, were recruited and their trough vancomycin level was determined. The mean age and creatinine clearance of patients were 5.47 +/- 4.24 and 87.5 +/- 31.25, respectively. Eleven [22%] patients received vancomycin at 40 mg/kg/day [low dose] and 39 [78%] at 60 mg/kg/day [high dose]. Considering trough goals of 10-14 and 15-20mg/L in low and high dose groups, serum levels in 91% [73% sub-therapeutics] and 85% [69% sub-therapeutics] of patients were not in recommended therapeutic range, respectively. This study has shown that current recommended vancomycin dosing regimens in pediatric patients [40-60 mg/kg/day], resulted in sub-therapeutic serum concentrations in our study population

Association of systemic Anaplastic large cell Lymphoma and active Toxoplasmosis in a child

Introduction: Anaplastic large cell lymphoma is a subset of non-Hodgkin lymphoma and an unusual disease in children

Case Presentation: Herein we have reported a 7- year- old girl with a large necrotic skin ulcer on the chest caused by systemic form of anaplastic large-cell lymphoma and simultaneous active toxoplasmosis diagnosed by PCR on lymph node specimen. There were few reports showing a role for toxoplasma infection to cause some malignancies such as lymphoma in adults

Conclusions: Based to our knowledge, this has been the first report of simultaneous systemic anaplastic large cell lymphoma and active toxoplasmosis, documented by positive PCR on tissue biopsy in a child. This case report has suggested more attention to the accompanying Toxoplasma gondii infection as a probable cause of some types of lymphomas

Multidrug-resistant Acinetobacter baumannii infection in intensive care unit patients in a hospital with building construction: is there an association? / 대한마취과학회지

BACKGROUND: Acinetobacter baumannii (A. baumannii) has emerged globally as a significant pathogen in hospitals. It is also present in soil and water. In a previous study, we discovered that the A. baumannii class 2 integron occurred most frequently. Here, we determined whether the A. baumannii class 2 integron is in the soil around our hospital, and if the soil is the cause for increasing numbers of A. baumannii infections in our intensive care unit (ICU) patients. METHODS: This cross-sectional prospective study was conducted in two ICUs at Loghman-Hakim Hospital, Tehran, Iran, from November 2012 to March 2013. Patient, soil, and hospital environment samples were collected. All isolates were identified using standard bacteriologic and biochemical methods. The phenotypes and genotypes were characterized. The standard disc diffusion method was utilized to test antimicrobial susceptibility. Integron identification was performed by multiplex polymerase chain reaction. RESULTS: A total of 42 A. baumannii clinical strains were isolated, all from patient samples; 65% of the isolated species were classified as class 2 integrons. The strains were 100% resistant to piperacillin, piperacillin-tazobactam, ceftazidime, ceftriaxone, cotrimoxazole, cefepime, ceropenem, and cefotaxime. However, all of the strains were sensitive to polymyxin B. A. baumannii was detected around the lip of one patient. CONCLUSIONS: Further research is necessary to establish a relationship between A. baumannii and soil, (especially in regards to its bioremediation), as well as to determine its importance in nosocomial infections and outbreaks in the ICU.

Comparison of tuberculin skin test result and interferon gamma response to human PPD in BCG scar positive and negative children

The aim of this study is to compare Tuberculin Skin Test [TST] result and interferon gamma response to human PPD [purified protein derivative], in scar positive and scar negative BCG-vaccinated children. Between August 2007 and May 2008 a total of 236 children aged 1-168 months [mean 21 months] admitted to Mofid Children's Hospital, Tehran, Iran, were enrolled in a cross-sectional study. Each patient was examined for BCG vaccine scar and tested with TST and human PPD-based Interferon Gamma Release Assay [IGRA]. Two hundred and twenty one cases out of 236 [44% female, 1-168 months, mean age 21 months] were scar positive of whom 95% TST result was negative. Human PPD-based IGRA was positive in 110 [49.8%], negative in 85 [38.4%] and indeterminate in 26 [11.8%] of scar positive patients. Fifteen children [40% female, 1-156 months; mean age 42 months] were scar negative. All the scar negative cases were TST negative. Human PPD-based IGRA was positive in 10 [66.7%], negative in 4 [26.7%] and indeterminate in 1 [6.7%] of scar negative patients. Immune responsiveness to human PPD antigens in scar positive and negative children may not correspond with results of the Tuberculin Skin Test

Comparison of neutrophil apoptosis by the pseudomonas aeruginosa exotoxins between healthy individuals and term infants

Pseudomonas aeruginosa may be colonized in different human tissues and result in some infections potentially. Thus, considering that these bacteria are resistance to most of the current antibiotics, an examination on pathogenesis mechanisms of such bacteria can be effective in controlling the infections developed by it. In this project, among 40 blood samples [20 healthy persons, 20 infants], an amount of 5 ml [2 ml in the infants] heparinized blood was collected from each and then neutrophils were isolated by a standard method and were counted by neubauer lam. After culturing Pseudomonas bacteria in broth medium, some tubes with densities of 1, 2, 3 and 4 McFarland were prepared and the bacteria were isolated by centrifuge method with 3000rpm for 10 minutes and then its exotoxin were exposed to neutrophils of the groups under study. The effect of time and the bacteria count on the amount of the secreted toxin and in adjacency to neutrophils was measured. There were 11 men and 9 women in the health group and the infants group consisted of 12 boys and 8 girls. Death cell percentage of neutrophils was 100% in the health group and 8.90% in the infants group. Percentage of bacterial growth in the medium 1 and 2 McFarland was zero; in the medium 3 McFarland, it was 12.5% in the healthy group and 1% in the infants group [p<0.10]. The average rate of cell death in the minute 15th was different in two groups [68.5% in health group vs. 92.5% in the infants] [p<0.0005]. This study showed the effect of Pseudomonas bacteria on the development of early cell death in the infants very well. As it was shown, this effect is time-dependent and this cell death [apoptosis] is occurred in the infants earlier than health people

Skeletal involvement of Brucella melitensis in children: a systematic review

Brucellosis is a protean disease and should be excluded in any febrile child with a constellation of symptoms such as fever, malaise, sweating, arthralgia, and joint swelling in endemic areas. Skeletal system involvement is the most common source of complaints in brucellosis. The frequency of skeletal involvement in children is 6.4% to 73.5%. There are some controversies regarding the most common sites of involvement: sacroiliac versus peripheral joints. In the vast majority of cases, peripheral joint involvement in pediatric brucellosis has a monoarticular pattern, although there is no agreement about the most commonly involved peripheral joint. In this systematic review, published articles that describe the bone involvement of Brucella melitensis, as the most prevalent kind of the microorganism in the region, in children are evaluated

Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella [MMR] vaccination in children

In Iran, the measles, mumps and rubella vaccine [MMR] is administered in a two-dose protocol where the first dose is scheduled at 12 months of age. This study aims to determine the efficacy of the MMR vaccine by testing IgM and IgG antibody levels 4 - 7 weeks after primary vaccination. A single group cohort study was performed on healthy children, 12 - 15 months of age, who were vaccinated at health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, from January to April 2009. Children with negative vaccination and/or clinical history for measles, mumps or rubella were administered the first dose of the MMR live attenuated vaccine. IgG and IgM antibodies were checked by enzyme linked immunoassay [ELISA] in serum samples 4 - 7 weeks after vaccination. A child was considered seropositive if antibody levels were higher than the assay cut-off level set by the ELISA kit. Samples from 240 children were checked for antibodies against measles and rubella. Measles serum IgM level was positive in 71.7% of samples and IgG in 75.8%. The rubella serum IgM level was positive in 71.7% of children and IgG in 73.8%. From 190 blood samples that were checked for mumps antibodies, serum IgM was positive in 68.9% and IgG in 95.3%. No significant relationship was found between seropositivity and age or gender. IgG and IgM antibody levels were below the assay cut-off levels against measles and rubella in approximately one-fourth of the children following primary MMR vaccination. A second dose was necessary to raise the level of protection against measles and rubella

child with intestinal basidiobolomycosis

Fungal infections of the gastrointestinal tract are not common in children, especially in immunocompetent ones. In this case report we describe a child who was presented with abdominal pain and mass, bloody diarrhea and fever. He was treated for amebiasis, but due to treatment failure and deterioration of his condition, he underwent a laparatomy. Histologic examination of the excised bowel in the second look revealed Basidiobolomycosis, a fungus belonging to the order Entomophthorales. The signs, symptoms, treatment and diagnosis of the present case indicate that fungal infections must be considered not only in immunocompromised patients with abdominal pain and mass, but also in apparently immunocompetent ones

ELISA cut-off point for the diagnosis of human brucellosis; a comparison with serum agglutination test

Brucellosis is a world-wide disease, which has a diverse clinical manifestation, and its diagnosis has to be proven by laboratory data. Serum agglutination test [SAT] is the most-widely used test for diagnosing brucellosis. The enzyme linked immunosorbent assay [ELISA] can also determine specific antibody classes against brucella. It is a sensitive, simple and rapid test, which could be an acceptable alternative to SAT with fewer limitations, however, like any other new test it should be further evaluated and standardized for various populations. This study was planned to determine an optimal cut-off point, for ELISA which would offer maximum sensitivity and specificity for the test when compared to SAT. Four hundred and seven patients with fever and other compatible symptoms of brucellosis were enrolled in the study. Serum agglutination test, 2-Mercaptoethanol test, and ELISA were performed on their sera. The cut-off point of 53 IU/ml of ELISA-IgG yielded the maximal sensitivity and specificity comparing to the other levels of ELISA-IgG, and was considered the best cut offpoint of ELISA-IgG to diagnose acute brucellosis. At this cutoff, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 84.09%, 85.38%, 62.20, 94.90, 5.75, 0.18, respectively. The best cut-off point of ELISA-IgG is 53 IU/ml, which yields the maximal sensitivity and specificity to diagnose acute brucellosis

use of polymerase chain reaction assay versus cell culture in detecting neonatal chlamydial conjunctivitis

One of the most common bacterial infections that causes ophthalmia neonatorum is Chlamydia trachomatis, [C. trachomatis]. Very few studies have been performed in Iran using both cell culture and polymerase chain reaction [PCR] methods to determine the prevalence of C. trachomatis as an etiological agent of ophthalmia neonatorum. This study aimed to evaluate the prevalence of neonatal chlamydial conjunctivitis [NCC] as diagnosed by both methods in two hospitals in Tehran, Iran. From March 2008 to May 2009, out of 2253 neonates, 241 [10.7%] with clinical findings of conjunctivitis were included in this study. A total of241 conjunctival swabs were tested by cell culture [as the gold standard test], PCR, and Giemsa staining. Cell cultures were positive for C. trachomatis in 31 [12.9%] neonates, C. trachomatis was positive in 40 [16.6%] neonates by PCR and 18 [7.5%] by Giemsa staining. The sensitivity of PCR was 100%, whereas Giemsa staining sensitivity was 58.1%. High sensitivity [100%] and specificity [95.7%] of PCR as compared to culture makes it a proper diagnostic method for the detection of C. trachomatis

Serologic evidence of pertussis infection in vaccinated Iranian children

It seems that the incidence of pertussis-like illnesses is considerably increasing despite the wide coverage of immunization with the whole cell pertussis vaccine. We aimed to investigate the occurrence of pertussis in vaccinated children by measuring anti-pertussis antibodies. In this cross-sectional study, blood samples were taken from vaccinated children aged 2, 4, 6, 12, 18, and 72 months. Anti-pertussis IgG and IgA were measured by ELISA. P < 0.05 was considered significant. 725 children were enrolled in the study. Geometric mean titers for IgG that showed a slight decease after 2 months of age and increased distinctly in children aged 72 months. The frequency of the individuals whose IgG was above the determined cut-off [derived from mean+2SD] was observed in 1% of the 2, 4, and 6-month-old infants, 6% of the 12 and 18-month-olds and 12% of the 6-year -old children. Positive IgA titers were detected in 5, 9, 6, 23, 11, and 8% of children aged 2, 4, 6, 12, 18, and 72 months, respectively. Since a considerable percentage of children had high levels of anti-pertussis IgG antibodies [>/=2 SD], positive anti-pertussis IgA, and most importantly an increased level of anti-pertussis IgG geometric mean titer at 6 years of age, further investigations regarding the protection provided by the presently used pertussis vaccine seems necessary

Surveillance of ventilator-associated pneumonia in a neonatal intensive care unit: characteristics, risk factors, and outcome

This study determined the incidence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia [VAP] in newborns hospitalized in a Neonatal Intensive Care Unit [NICU] in Tehran, Iran. A prospective cohort study was carried out in the NICU of Mandieh Hospital over a period of one year, from December 2008 to November 2009, on all neonates mechanically ventilated for more than 48 hours. VAP was diagnosed in accordance with the CDC definition of nosocomial pneumonias for patients younger than 12 months. Risk factors relevant to the development of VAP were studied. Multiple logistic and Cox regression analysis were performed to determine independent predictors for VAP and survival rate, respectively. There were 81 neonates enrolled. VAP occurred in 14[17.3%], at rate of 11.6/1000 days on the ventilator. Gram negative bacteria were the predominant etiologic agents. The most common bacterial isolates from the endotracheal aspirate were E.coli [21.4%]. KIebsiella [21.4%], and Pseudomonas [14.1%]. The only VAP predictor was sputum [odds ratio [OR]=5.11, P=0.02]. Mortality rate for VAP was 2/14[14.3%]. Duration of mechanical ventilation [hazard ratio [HR] 0.96, P0.01], birth weight [HR=0.81, P < 0.001], and purulent tracheal aspirate [HR=0.25, P < 0.006] were independent predictors of overall survival. VAP occurs at a significant rate in mechanically ventilated newborns. Additional studies are needed to accurately determine the incidence and risk factors in order to develop effective preventive and therapeutic protocols

Immunohistochemical detection of p53 protein expression as a prognostic factor in wilms tumor

Histological typing, especially the evidence of anaplasia and stage of the tumor are two major prognostic indicators in Wilms tumor, but some genetic factors have recently been noted. Mutations in TP53, which is a tumor suppressor gene, have been demonstrated to be associated with poor prognosis in some malignancies. There are also few studies which have confirmed the correlation between p53 protein overexpression and advanced course in Wilms tumor. This study was conducted to determine the correlation p53 immunoexpression and prognosis and outcome of Wilms tumor. The overexpression of p53 in 44 specimens of children [26 boys and 18 girls] with Wilms tumor [median age, 36 months; range, 4 to 96 months] was assessed in Mofid Children's Hospital, Tehran, Iran. The overexpression of p53 was determined by immunohistochemistry with antihuman p53 antibody. A positive immunostaining for p53 was detected in 24 of the 44 cases [54.7%]. The grade of the tumor and anaplasia were associated with p53 positivity, but there was no association of p53 with the tumor stage. In comparison to p53 negatives, week-moderate and high p53-expressing tumors had significantly decreased the overall survival [hazard ratio, 3.75 and 8.61; P=.05 and P=.01, respectively]. Overexpression of p53 protein in Wilms tumor is an indicator of poor pro gnosis, because it is correlated with unfavorable histology tumors and a shorter survival period

Management of child with loss of consciousness [with infections etiology considerations]

True approach and appropriate behavior to the child with loss of consciousness whom referred to emergency room is one of the important skills of every physician. If there is defined diagnostic and therapeutic algorithm in the emergency room for managing these children, it helps physicians not to be confused and save golden time for survival of the patients. After describing the history taking, physical and neurologic exams' skills in children with loss of consciousness, this article explain the etiological factors which are classified into traumatic and nontraumatic agents. Infectious encephalopathies and applied classification of them are more evaluated and emphasized in our paper

Blood pressure screening in school-aged children in Tehran

Hypertension is one of the most common diseases in the world and a major risk factor for cardiovascular, renal, and neurologic diseases. It seems that hypertension and overweight in children are a growing epidemic. The aim of this study was to investigate the prevalence of hypertension in school-aged children in Tehran. In a cross-sectional study, blood pressure and anthropometric measurements were performed on school-aged children in Tehran from 2008 to 2009. Children aged 7 to 11 years from 5 public schools in Tehran were included. Blood pressure, weight, and height measurement were performed at the school. At each screening, 3 seated blood pressure, weight, and height measurements were made and at least after 3 minutes of rest and choosing proper cuff, blood pressure was measured by a pediatric nephrologist and a pediatric assistant. A total of 425 school-aged children were included. Twenty-four percent of the primary school children had hypertension and 12% were shown to be overweight. Hypertension was more common in students of the north of Tehran in comparison to other geographic parts of Tehran. There was a significant difference in the prevalence of hypertension between girl students of north of Tehran and girls of the other parts of Tehran. We concluded that hypertension is a common problem in school-aged children. Our study re-emphasized the need for prevention and control of high blood pressure in children to manage the global diseases burden due to hypertension

relationship between osteogenesis imperfecta and spinal muscular atrophy

A 4-month-old female with osteogenesis imperfecta [OI] type II was admitted in PICU of our center due to severe respiratory distress and fever with a diagnosis of severe pneumonia, and mechanical ventilation was initiated. Due to severe hypotonia, NCV and EMG were performed, and spinal muscular atrophy [SMA] type I was diagnosed

Association of serum soluble triggering receptor expressed on myeloid cells levels in malignant febrile neutropenic patients with bacteremia and fungemia

Infections are the major cause of morbidity and mortality in febrile neutropenic patients with malignancy. Rapid diagnostic tests are needed for prompt diagnosis and early treatment which is crucial for optimal management. We assessed the utility of soluble triggering receptor expressed on myeloid cells [sTREM-1] in the diagnosis of bacteremia and fungemia in febrile neutropenic patients. Sixty-five febrile neutropenic children with malignancy hospitalized in Mofid Children's Hospital during a period of one year from January 2007 were recruited for this cross sectional study [mean age 66.2 +/- 37 months; 35 females and 30 males]. Thirty patients [46.2%] had acute lymphoblastic leukemia, 2 [3.1%] acute myeloid leukemia, one [1.5%] lymphoma and 32 [49.2%] were under treatment for solid tumors. Simultaneous blood samples were collected for measurement of serum sTREM-1 levels and for blood cultures which were grown in BACTEC media. Gold standard for the presence of infection was a positive BACTEC culture as a more sensitive method compared to current blood culture techniques. Blood cultures with BACTEC system were positive in 13[20%] patients [12 bacterial and one fungal culture]. The mean serum sTREM-1 level in BACTEC positive patients was 948.2 +/- 592.9 pg/ml but in BACTEC negative cases it was 76.3 +/- 118.8 pg/ml [P<0.001]. The optimal cut-off point of sTREM-1 for detecting patients with positive result of BACTEC was 525 pg/ml with sensitivity and specificity of 84.6% and 100%, respectively. Our study revealed a significant association between serum sTREM-1 level and bacteremia and fungemia in febrile neutropenic patients suffering malignancy with acceptable sensitivity and specificity

Comparison of community and healthcare-associated MRSA in Iran

To characterize and compare the epidemiological and microbiological aspects of community and healthcare-associated MRSA [CA-MRSA, and HA-MRSA] cases in Iran, this prospective cohort study was conducted from January to December 2008 in seven hospitals. Staphylococci were isolated from 109 hospitalized patients. MRSA isolates were classified into HA-MRSA and CA-MRSA based on clinical features. Antibacterial susceptibility patterns of the isolates to eight antibiotics routinely used to treat infected patients were determined according to standard agar dilution methods. Staphylococcal Cassette Chromosome mec [SCCmec] type of isolates and their correlation with antimicrobial susceptibility patterns in CA and HC isolates were determined. Of 109 isolates, 15[13.7%] were community-associated and 94 [86.3%] were healthcare-associated MRSA. The most frequent SCCmec types in the studied hospitals were SCC mec type I [56.9%] and type II [22%]. Relatively sulfamethoxazole, clindamycin, rifampin, erythromycin, tetracycline and doxycycline were noticed. To our knowledge, this is the first time that the analysis of SCCmec type is carried out in Iran according to the clinical criteria. Difference in the prevalence of HC-MRSA and CA-MRSA based on the clinical and epidemiological features may indicate the need for revisiting the classification of MRSA. The high prevalence of multi-drug resistant MRSA could be as a result of the excessive use of antibiotics in the hospitals. Therefore, periodical assessment of antibacterial susceptibility patterns of the MRSA strains is warranted

[Chronic cough and its approach in children]

In childhood the most common reason for referring to clinics is coughing. As a protective mechanism the normal child has some cough during the day especially in polluted urban areas [expected cough]; therefore previous history of cough, time of severity and its quality is important in diagnosis of pathologic cough. Chronic cough in children is a 3 weeks duration one, it is divided to specific and non specific cough. After ruling out possible exposure to allergens we take chest x-ray as the first step and then if x-ray or history and physical exam were abnormal we evaluate it as a specific cough. If we didn't find any specific etiology for chronic cough, follow up and observation is recommended, and it should be told to parents there is no harm for their child and usage of drugs is not necessary. Usage of symptomatic anti cough drugs has the same effects as placebo. Paying attention to this symptom and appropriate approach for diagnosis and treatment of each type of chronic cough will help physician to do their best in the management of this symptom