Prevalence of nocturnal enuresis in school aged children. The role of personal and parents related socio-economic and educational factors

Nocturnal enuresis is a common psychosocial concern for both parents and children. In the present study we have determined the prevalence of nocturnal enuresis in Urmia, Iran children and associated personal and familial factors with this problem. A cross sectional epidemiological study for detection of nocturnal enuresis prevalence rate and evaluation of associated familial and personal factors in elementary school children [7-11 years old] from Urmia were investigated. The subjects were selected by cluster sampling method. Chi square test and logistic regression were used in univariate and multivariate respectively. Of the 1600 questionnaires distributed, 918 [57%] were completed and included in the final analysis. The rest, which were not filled by parents and also those out of our study age range were excluded. Gender of the subjects was almost equally distributed [48.6% males and 51.4% females]. Prevalence of nocturnal enuresis was 18.7% [n=172] and prevalence of daytime incontinence was 5.5% [n=51]. There was no significant gender difference between these two groups. Enuretics had crowded families, positive family history, low educational level of parents, jobless father, working mother, single parent, poor school performance, positive history of urinary tract infection [UTI]. Our results with enuresis prevalence and associated factors were comparable to other epidemiological studies from various countries. We found that Iranian families do not pay sufficient attention to their enuretic children

Outcome of immediate use of the permanent peritoneal dialysis catheter in children with acute and chronic renal failure

Peritoneal dialysis remains the only available option for patients which need immediate dialysis and it could be a bridge between end-stage renal failure [ESRD] and transplantation. There is a paucity of published experience of children with immediate use of permanent Tenckhoff Catheter for peritoneal dialysis from developing countries. In this study we report our experience on immediate use of permanent peritoneal access and continued peritoneal dialysis for a prolonged time. Fifty six patients were studied including 30 males and 26 females within the age range of 1 month to 14 years with mean age of 6.5 years in Urmia, Northwest Iran. No operative morbidity was seen. During a total of 499.5 continuous ambulatory peritoneal dialysis months, 16 patients had 28 episodes of peritonitis, which means a overall result of one episode per 17.8 months. There were 3 patients [5.35%] with catheter site leakage, 12 [21.4%] catheter obstructions [which led to omentectomy], 4 [7.2%] exit site infections [2 patients in the early postoperative period and 2 patients in during follow up]. Death due to catheter related complications occurred in 1 per 56 patients and due to non-catheter related causes in 10 per 56 patients. Present results indicate that catheter-related complications were not higher than those previously reported and peritoneal dialysis could be initiated immediately after catheter implantation and could be a safe bridge between end-stage renal failure [ESRD] and transplantation

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

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

Normal values for random urinary calcium to creatinine ratio in Iranian children

Due to worldwide variations, reference values of urinary calcium to creatinine ratio in pediatric population are not yet well established. To determine normal values for urinary calcium to creatinine ratio and its relation to urinary sodium or potassium, a descriptive [correlation type] study was conducted in 7 to 12 years old healthy children in Urmia, Iran. Primary school children were divided into two sectors and 7 clusters [4 cluster school boys and 3 school girls]. The subjects were randomly selected. Random, non-fasting morning urine samples were obtained from 364 healthy children aged 7 to 12 years during fall 2005 and immediately sent to laboratory to determine urine calcium [Uca], creatinine [Cr], sodium [Na] and potassium [K]. For data analysis, mean and 95th percentile of UCa/Cr and UNa/K were used. Pearson test was used to determine any relationship between UCa/Cr and UNa/K values. For comparison of UCa/Cr and UNa/K values between males and females, Mann-Withny test was used. A total number of 364 children were enrolled in the study. There were 208 [57.1%] males and 156 [42.9%] females. The mean and 95th Percentile for UCa/Cr was 0.11 [0.10 and 0.24 respectively. The mean and 95th percentile for UNa/K were 2.30 [1.42 and 5.21 respectively. There was no significant difference in UCa/Cr and UNa/K between two sexes [P > 0.05]. We found a weak relationship between UCa/Cr and UNa/K [P < 0.01]. UCa/Cr value may differ according to geographic location. For screening purposes, reference values should be determined in each geographic location

Technetium Tc 99m dimercaptosuccinic acid renal scintigraphy in diagnosis of urinary tract infection in children with negative culture

The aim of this study was to evaluate the accuracy of Technetium Tc 99m dimercaptosuccinic acid [99mTc-DMSA] renal scintigraphy in the diagnosis of urinary tract infection [UTI] in children with suspected infection but with a negative urine culture. The records of all children with suspected or definite diagnosis of UTI presented during a 2-year period were reviewed in this study. Abnormal findings on renal scintigraphy, voiding cystourethrography [VCUG], and ultrasonography were evaluated and compared between the patients with the definite diagnosis of UTI and those with suspected UTI and negative urine cultures. Of 210 patients, 86 had a definite diagnosis of UTI [group 1] and 124 had suspected UTI without a positive culture [group 2]. Abnormal findings on DMSA scans were seen in 76 patients [88.4%] in group 1 and 84 [67.7%] in group 2. Vesicoureteral reflux was detected by VCUG in 50% and 32.3% of the patients in groups 1 and 2, respectively. In group 2, vesicoureteral reflux was seen in 40.5% of the patients with abnormal DMSA scan. Ultrasonography findings were abnormal in 51.3% and 39.8% of the patients with abnormal DMSA scan findings in groups 1 and 2, respectively. According to our findings, in children with a negative urine culture and abnormal urinalysis, 99mTc-DMSA renal scintigraphy is helpful in diagnosing UTI and vesicoureteral reflux; we recommend VCUG when DMSA scan supports UTI despite a negative urine culture and a normal ultrasongraphy