Caustic ingestion in children in south of Iran: a two-year single center study

Background: Caustic ingestion is one of the most important injuries during childhood, which leads to serious sequel. In this study, we evaluated the clinical manifestations, endoscopic appearance, complications, and treatment results in patients with caustic ingestion in our hospital

Methods: Hospital chart of patients with caustic ingestion who admitted to Nemazee Teaching Hospital affiliated to Shiraz University of Medical Sciences during a 2-year period [2015-2016] were reviewed retrospectively. The age, sex, nature of the caustic agent, clinical presentations, grade of injury in endoscopy, degree of parents' education, site of ingestion, accidental or intentional attempts, complications, and outcomes were reviewed

Results: In this study the charts of 41 patients [26 boys and 15 girls] with caustic ingestion over the 2-year period were reviewed. The mean age of the patients was 4.4 year. Of them, 95.1% had ingested the materials accidentally, and 2 [4.9%] patients had ingested unknown substances for suicidal attempt. Of all cases, 68.3% of caustic ingestion occurred in the kitchen. 19 [46.3%] agents were acidic substances and 17 [41.5%] were alkali agents. 5 [12.1%] patients ingested unknown substances. 24.3% of the patients were asymptomatic and the most common presentation was drooling [34.14%]. 26.8% of the patients had dysphagia, and 24.3% presented with oral ulcer. 7.3% had abdominal pain, 4.8% had fever, and 2.4% had hematemesis. 14 [34.1%] patients had normal feature, 6 [14.6%] had grade I injury, 12 [29.3%] had grade II injury, and 8 [19.5%] had grade III injury in endoscopic evaluation

Conclusion: Most of the caustic ingestion occurred in kitchen. Male was the dominant sex in the caustic injury

Endoscopic pyloroplasty for severe gastric outlet obstruction due to alkali ingestion in a child

A common belief is that alkali ingestion causes severe esophageal damage and limited gastric injury due to the buffering action of acid. Gastric injury has been observed in patients who ingested alkali. Gastric outlet obstruction [GOO] secondary to caustic ingestion occurs due to fibrosis after resolution of the acute injury and inflammation, most commonly 6 to 12 weeks after initial ingestion. The traditional treatment for GOO related to ingestion of corrosive agents is surgery. Experience with endoscopic balloon dilation of corrosive-induced GOO is limited in children. This is the first report of endoscopic pyloroplasty in a child with GOO due to caustic alkalis ingestion that was treated with balloon dilation [using TTS balloon ranging from 6-15 mm] in Iran. Four dilation sessions were required for symptomatic relief of dysphagia. After one year of follow up, weight gain was normal

Perforated meckel's diverticulum in a 3-day-old neonate; a case report

Perforation of Meckel's diverticulum is a rare complication in neonatal period. A 3-day-old term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel's diverticulum was detected. Pathological reportofthe tissue showed inflamed diverticulum withheterotopic gastric muco-sa. This is the first report of Meckel's diverticulum perforation inaneonate in our country

Clinical manifestations among children with chronic functional constipation

Constipation is one of the most frequent cause of patient visits to pediatric gastroenterology clinics. Early diagnosis and treatment is important. There are few studies about clinical manifestations of constipation in children. We aimed to find the relative frequency of gastrointestinal manifestations of constipation among constipated children. This cross-sectional study was carried out on children aged < 18 years old with chronic functional constipation referred to Imam Reza Clinic of Shiraz University of Medical Sciences. Children with organic causes of chronic constipation were excluded from study. Rome III criteria were used for defining constipation. The duration of study was 1 year starting from September 2010. Abdominal pain, fecal mass, rectal bleeding, anorexia, fecal soiling, retentive posture, withholding behavior, anal fissure, and pen-anal erythema were recorded for each case based on history and physical examination. Data were analyzed using SPSS software, version 13.0 [Chicago, IL, USA]. Of 222 children with functional constipation, 124[55.9%] were girls and 98 [44.1%] were boys with a mean +/- SD age of 5 +/- 3.12 years. The mean +/- SD duration of constipation was 2.2 +/- 1.9 years. Large and hard stool was present in 93.7% of the patients. Painful defecation and withholding behavior were seen in 92.3% and 91.9% of the patients, respectively. Fecal impaction was more frequent among boys compared with girls [p<0.01]. Fecal soiling was present in 40.8% of the boys and 28.2% of the girls [p=0.04]. Large and hard stool, painful defecation and withholding behavior were the most frequent signs or symptoms among children with chronic functional constipation. Fresh rectal bleeding and anal fissure were the least frequent signs and symptoms in this group

Complications of blind versus ultrasound-guided percutaneous liver biopsy in children

Background and study aims: Liver biopsy is a well-established procedure in the diagnosis and follow-up of liver diseases. Complications of liver biopsy are rare but potentially lethal. The aim of this study was to evaluate the complications of percutaneous liver biopsy and to compare the complications of blind and ultrasound-guided percutaneous liver biopsy in paediatric wards of Nemazee Hospital of Shiraz in the south of Iran

Patient and method: To complete the questionnaire, registered information of liver biopsies due to different causes in paediatric patients between 2008 and 2012 was retrospectively reviewed. All children aged between 0 and 18 years, who underwent liver biopsy [due to any indication], participated in this study

Results: Liver biopsies were obtained from 210 patients. Seven of 210 cases were excluded due to unreliable data. A total of 209 liver biopsies were done in the rest of the cases [n = 203]. Of all cases of liver biopsies, 22 [10.5%] experienced complications after biopsy. Pain [n = 7] was the most frequent complication in 22 cases of liver biopsy. Mortality rate was one [0.5%] due to rupture of subcapsular haematoma. In terms of complication [p = 0.592], there was no significant difference statistically between patients with blind liver biopsy [n = 16] and patients with ultrasound-guided liver biopsy [n = 6]

Conclusion: In terms of complications, there was no significant difference when the patients were evaluated with and without ultrasound-guided biopsy

Frequency of celiac disease in children with chronic functional constipation in Shiraz-Iran

Celiac disease is an autoimmune mediated small intestine inflammation which occurs due to hypersensitivity reaction to gluten and related proteins in diet in genetically predisposed individuals. Prevalence of celiac among the population is about 0.5 - 1 % in most countries. Frequency of celiac disease in children is the subject of a few research. In this study, we aim to determine the frequency of celiac disease in patients presenting with functional constipation. This cross-sectional study was conducted on children referring to Imam Reza Clinic, affiliated to Shiraz University of Medical Sciences during one year starting from 2011, March 20. One hundred and one children 2-18 years of age with constipation for more than 2 months according to ROME III criteria. The entire participants underwent serologic studies of Total IgA and IgA TTG. Serum IgG TTG was measured in cases with reported values of Total IgA below the lowest normal limits. Moreover, endoscopic biopsy of the small intestine was also performed for patients with positive serology. Of all the 101 studied participants, only four individuals [3.96 %] had positive test results for IgA TTG [potential celiac disease]. One of these patients refused to do endoscopy and endoscopic small intestine biopsy was performed for 3 patients. Two of them had normal pathology and one of them [0.99 %] was confirmed for celiac disease. The frequency of celiac disease in children with chronic constipation is slightly higher than general population but without significant difference 0.99% VS 0.6% ; p=0.64]. So the screening serologic test for celiac disease is not recommended in children with chronic constipation

Isolation and antibiotic susceptibility of Shigella species from stool samples among hospitalized children in Abadan, Iran

The aim of this study was to determine the incidence of Shigella species and their antimicrobial susceptibility patterns in hospitalized children with Shigellosis in Abadan, Iran. Shigellosis is caused by different species of Shigella and one of the most common causes of diarrhea in children. This disease is endemic in many developing countries including Iran. This prospective cross sectional study was conducted in a teaching hospital in Abadan, Iran during June 2011 to May 2013. Stool specimens were collected from pediatric age group. All isolates were confirmed as Shigella species by biochemical and serologic tests. Antibiotic sensitivity pattern of these isolates was studied by disk diffusion Method. Among all 705 stool samples, 36 [5.1%] yielded Shigella. Of cases, 392 [55.6%] were girl and 313 [44.4%] were boy. The most common Shigella isolates were S. flexneri [n=19, 52.7%] followed by S. sonnet [n=11, 30.5%], S. boydii [n=4, 11.1%] and S. dysenteriae 2[5.5%]. Of the Shigella isolates, 47.2% showed resistance to two or more antimicrobial agents. Resistance pattern against various antimicrobials were as follows: trimethoprim-sulphamethoxazole [80.5%], ampicillin [63.8%], tetracycline [58.3%], chloramphenicol [33.3%], nalidixic acid [27.7%], and cefixime [16.6%]. There was no resistance against ciprofloxacin and ceftriaxone. The most common isolates were S. flexneri followed by S. Sonnei. There was no antibiotic resistance against ciprofloxacin and ceftriaxone. TMP-SMZ showed highest resistance pattern

Pediatric burns in Khuzestan Province, Iran

Burn injuries are the most frequently occurring injuries among pediatric populations worldwide, and they are significant pediatric injuries in Iran. This study was conducted to analyze the pattern of pediatric burns in Khuzestan province in the south-west of Iran from April 2006 to March 2007. The location of the study was Taleghani Hospital, a sole center for burn patients in Khuzestan province. The number of patients with burns admitted to the center in 1 year [from April 2006 to March 2007] was 211. Data were obtained by reviewing the medical records of patients hospitalized at the center. Of the patients, 85 [40.3%] were female and 126 [59.7%] were male. Of the 85 female patients, 50 were from urban areas and 35 were from rural areas. Of the 126 male patients, 68 [54%] were from urban areas and 58 [46%] were from rural areas. The mean +/- SE age of the children ranging between 0 and 11 years was 3.20 +/- 0.188. Scalding was the predominant cause of burns and caused 86.7% of the burns. The age of the patients with scald injuries [2.95 +/- 2.56 years] was significantly lower than that of patients with flame injuries[4.28 +/- 3.3 years] [P =0.007]. Correlation analysis showed that younger children and urban residents are more vulnerable to scald injuries. The mean body surface area of burns was 20.5 +/- 10.26 cm in all patients. Scalding was the most common cause of burns. Age o 4 years and residency in urban areas were the major factors increasing the risk of burn accidents in children in Khuzestan. An appropriate burn prevention program, with focus on education, is needed to prevent this injury

Study of acetabular index before and after salter innominate osteotomy

To evaluate pre and post acetabular index in patients with Developmental Dysplasia of Hip whom underwent Salter innominate osteotomy. This cross sectional study was carried out on patients with CDH that underwent Salter innominate osteotomy. All cases with CDH admitted in Imam Khomeini and Razi Hospitals from November 2007 to August 2009 were included. Age, sex, number of involved limb, and affected side were recorded. Antero-posterior [AP] roentgenogram were done and acetabular index were calculated before and after surgery. Five months later after surgery, AP Roentgenogram were obtained from cases and acetabular index were calculated again. Before and after surgery acetabular index were compared for each cases. Dislocation of hip and avascular necrosis occurrence and grading were assessed for each case. Dislocation rate were assessed based on proposed criteria by author from 0 to 4. This criteria was based on percentage of head of femur, which was not covered by acetabulum. Our classification is as follows: Grade 0: No dislocation; grade I: 30% subluxation; grade II: 30-60% subluxation grade III: 60-90% subluxation; grade IV: Complete dislocation. During two year period of the study, fourteen CDH patients were operated. From these cases, four hips were excluded because the patients did not come for follow up. Pre operative acetabular index was 34.40 +/- 1.22 and post operative acetabular index was 19.20 +/- 1.22. There was significant difference among pre- and post- acetabular index. This study showed that there was significant difference among pre and post operative acetabular index. Our limitations in this study were low sample size and short duration of follow-up. Another prospective study with more sample and long duration is recommended

Helicobacter pylori infection; in cases with and with out subjective halitosis

In most individuals H. Pylori is acquired early in the life [before 5 years]. H. Pylori infection is more common in the third world countries, where about 90% of adults may be infected. Helicobacter pylori is one of the suspected causes of halitosis in children. To evaluate the relationship of helicobacter pylori and halitosis. 33 patients with chief complaint of halitosis included in our study. Halitosis was evaluated as a subjective symptom in this study. Careful history was obtained. All patients underwent physical examination in order to rule out sinusitis, otitis, and possible cause of halitosis. 67 patients without halitosis were selected as control group. All patients were aged 4-17 years old. Urea Breath Test was done for all patients. UBT has >95% sensitivity and specifity for diagnosis of H.pylori infection. Chi-square test and Yate's corrected x[2] was used to analyzes finding. Epi-info ver 6 were used. In the case groups 7 patients had H. pylori infection and 26 patients had not. In the control group 18 patients had H.pylori infection and 49 patients had not halitosis [P=0.53]. There is no significant differences between case and control group. In this study we did not find relationship between H.pylori infection and halitosis

External hemorrhoids in children

Hemorrhoids in children are not common. The most common cause of hemorrhoids in the young children is portal hypertension. A 3 year old boy with history of hematemsis and external hemorrhoids is being reported. Patient had associated varices for which he was put on proparnolol

Peutz-Jeghers syndrome in a girl with chronic abdominal pain

It is a report of a seven years old girl with Peutz-Jeghers syndrome. Mode of presentation, various investigations, pattern of family history and management aspect are reported

Clinicopathologic findings in 35 children with Wilson disease

Wilson disease is a rare autosomal recessive disorder of copper metabolism. Wilson disease is the most common metabolic cause of fulminant hepatic failure in children over the age years. The aim of this study was to find the major clinical and pathologic findings of Wilson disease in children in Tehran. This retrospective study was carried out in the Mofid children's hospital. Thirty five patients suffering from Wilson disease were studied. Ceruloplasmin level below 20 mg/dl and urinary copper excretion level above 100 micro g/24hr were considered as the inclusion criteria. Of the patients, 20 cases were males and 15 were females with average age of 9 years. The most patients were in 8-9 and 10-11 years age group with 37% and 20%, respectively. Hepatic invoIvement was confirmed in 100% of patients. Jaundice was seen in 20 patients [57%], abdominal enlargement together in 20 patients [57%], and encephalopathy in 9 patients [26%]. Serum copper was reduced in 100% and low-serum ceroluplasmin in 100%, increased urinary copper excretion in%97, increased AST and ALT in 100%, increased PT was in 94% patients, anemia was found in 100%, leucopenia in 14%, and thrombocytopenia was seen in 71% of patients. In this study, 37% of patients had neurological symptoms such as tremor, ataxia, difficulty in speech and delayed education. 32 patients had undergone ophthalmic examination and 62% showed KF ring in their ophtalmoscopy. According to this study, hepatic and neurologic involvement is the most consistent finding in the Wilson disease. Most patient were in the age's group of 8-9 and 10-11

Study of the risk factors related with helicobacter pylori infections in children with peptic ulcer disease

Helicobacter pylori is the cause of peptic ulcer and gastroduodenal disease in children and adults. The prevalence of H-pylori infection has increased during past decade. Most of evidence has shown the patients got infected child hood. This study was carried out for recognizing the risk factors of H-pylori in children with gastrointestinal problems who had undergon evaluation endoscopy in Mofid Children Hospital. In this case control study, the number of patients infection and control were 47 in each group. The patient and control groups were matched for age and sex. Demographic variable were registered in information forms. Positive urease test was considered as a patient and negative urease test was considered as control group. All of the risk factors for H-pylori infection were evaluated for both groups and CI in the samples was evaluated with 95% estimation. The number of family members were 4.1 +/- 1.2 in the control group and 5.7 +/- 1.2 in the patients group. Attitude were higher in the patients group toward low consumption of fruit, vegetables, liquid vegetables, seed oil, smoking in family, low level education of parents, blood group A and parents dyspepsia. In the all risk factors CI>1.0 and P<0.05. The consumption of fruit, vegetables, liquid vegetable, seed oil, and negative history of smoking are the reasons for decreasing H-pylori infection in the children and adults

Role of anorectal manometry to improve the results of biopsy in diagnosis of chronic constipation

Most pediatric constipation cases may be treated with an adequate diet and moderate use of laxatives and enemas. A significant proportion of patients, however, does not show improvement with these therapeutic measures. In these cases, it is necessary to establish the differential diagnosis between functional and structural constipation. The objective of this study was to compare the result of two methods of evaluation, manometry before biopsy and biopsy alone. This cross sectional study was carried out in the children with chronic constipation that were referred to Mofid Children Hospital and underwent rectal manometry from 2002-2006. Chi-square test was used for the analysis. From 347 patients who underwent anorectal manometry, 134 patients had evidence that indicated neurologic abnormality and hirschprung disease. From these patients, based on parental agreement, biopsy were obtained from 69 patients. Histopathologic study was performed on 69 samples, and 57[82.6%] specimens had evidence of neuroanatomic abnormality as a cause of the disease. From the 423 biopsy that were obtained from rectal wall without previous anortectal manometry, only 125[29.55%] patients had pathological evidence of structural abnormalities due to Hirschprung disease. From all the biopsy [480], only 57[11.87%] patients had anorectal manometry. Based on there results of anorectal manometry they underwent biopsy. Performing anorectal manometry as a first step to approach constipation could increase specifity of biopsy in contrast to performing biopsy without anorectal manometry. Due to some limitation, we did not obtain biopsy from patients whose manometry was normal