Evaluation of cytomegalovirus infection after six months of liver transplantation in children in Shiraz, Southern Iran

Liver transplantation [LT] is a life-saving treatment for end-stage liver diseases [ESLD]. Cytomegalovirus [CMV] infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset [after 6 months of LT] CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients [6%] developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children

Prevalence of zinc deficiency in 3-18 years old children in Shiraz-Iran

Zinc is an essential trace element with a prominent role in human nutrition. Zinc deficiency has been linked to growth retardation, hypogonadism in males, and lack of sexual development in females. It ranges from 50% in sub-Saharan Africa to 5% in high income countries. The aim of this study is to evaluate the prevalence of zinc deficiency in healthy children in Shiraz, Southern Iran. In this study, 902 children aged 3-18 years old were randomly sampled for serum zinc level. Age, sex, weight, height, BMI, stunting and wasting indices were also recorded. With atomic absorption spectrophotometry method, the serum level of zinc less than 70 micro g/dL was considered as deficient. Mean serum level of zinc was 122.3 +/- 55 micro g/dL. The prevalence of zinc deficiency was 7.9%. There was no relationship among serum zinc level and age, sex, height, weight or BMI, but mild wasting [weight for age] and mild stunting [height for age] were significantly more prevalent among zinc deficient children compared to children with normal or high level of zinc. Zinc deficiency in Shiraz is not as prevalent as other areas of Iran. It was significantly more frequent among stunted and wasted [malnourished] children. Difference in soil zinc level, recent wide prescription of zinc supplements by pediatricians and especial pattern of nutrition, considered as possible factors responsible for lower prevalence of zinc deficiency in Shiraz, deserve more investigations

Evaluation of candida infection after six months of transplantation in pediatric liver recipients in Iran

Liver transplantation [LT] is the standard treatment of end-stage liver diseases [ESLD]. Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. To determine the incidence of late-onset [after 6 months of LT] Candida infection in recipients. A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. One recipient [2%] developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder [PTLD]. The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications

Migraine headache and acid peptic diseases in children

Although there are some studies on correlation between migraine headache and GI symptoms, they did not significantly support the correlation between migraine headache and acid peptic diseases. This case control study aimed to find such a correlation. There were 70 patients [5-15 years old] who had endoscopic documented acid peptic diseases. The frequency of migraine headache in this group and also in a group consisting of a sample of normal population [300 individuals] without any GI problem in the past year was determined by a questionnaire. The frequency of migraine headache was determined in each kind of acid peptic disease in the patients, being 92.9%, 68.6%, 24.3%, 4.3%, and 4.3% among patients with gastritis, esophagitis, doudenitis, gastric ulcer, and duodenal ulcer, respectively. The frequencies of migraine headache among the normal population and acid peptic disease group were 11.3% and 22.9%, respectively. The difference was found to be statistically significant. Our findings showed a significant correlation between migraine headache and acid peptic diseases, especially esophagitis and gastritis. This result accords with that in some of the previous studies

Peri-operative high-dose V post-operative low dose steroid therapy in the management of biliary atresia: a preliminary report

The use of high-dose steroid therapy peri portoenterostomy may have a positive impact on the frequency of cholangitis and survival rate. A prospective study was conducted on two groups of patients [less than three months of age] suffering from biliary atresia from 1999 to 2005. The patients in group I [G I] were managed peri-operatively by high-dose methylprednisolone while the other group [G II] received low dose methylprednisolone only post-operatively [2mg/k/day for 1 month]. Infants in GI [n = 30] received methylprednisolone for 3 successive days before operation [10-8-6mg/kg/day], and 10 mg/k at the day of operation respectively. Thereafter the dose was tapered in the next successive 6 days by 8, 6, 5, 4, 3, and 2 mg/kg/day and continued for one month. Seventy two infants with biliary atresia were operated [39 girls and 33 boys]. Twenty-six of the 30 patients [86%] in G I became jaundice-free within 90 days after portoenterostomy while only seven [15%] of the 42 patients in G II had normal bilirubin [P < 0.0001]. Episodes of postoperative cholangitis in G I were 20% [6 of 30], and 53% [24 of 42] in G II [P < 0.005]. The difference in 3-year survival rate between the two groups is also remarkable: Eighty seven percent [26 of 30] in GI versus 29% [13 of 45] in G II [P < 0.005]. Death related to biliary atresia occurred in 1 [3.3%] patient in GI compared with 12 [29%] patients in G II [p < 0.005]. These results provide strong evidence that peri-operative high dose steroid therapy is not only safe in this patients population, but because of its anti-inflammatory and cholerrhetic effects has a positive impact on preventing recurrent cholangitis, and ultimately survival

Evaluation of medical clerkship training in pediatric department of Shiraz University of medical Sciences based on students' logbooks

Using logbooks in different sections of medical education has been helpful in investigating the educational status of medical students. In order to identify the educational status of clerkship students in pediatric ward, this study was designed to determine the condition of education as well as practical works of clerkship students based on their logbooks in Shiraz University of Medical Sciences. In this descriptive cross-sectional study, medical students' logbooks of a three month pediatric clerkship filled by 45 students in 2005, were studied and statistically analyzed. Clerkship students in pediatric ward received a handbook containing a list of diseases and procedures, and reported them based on their exposure as observation in morning classes or having a role in the treatment of the disease. The Mean of the frequency of observations in each part was analyzed by SPSS software. In pediatric ambulatory clinic, neonates emergency, pediatric emergency and pediatric general ward, 60.73% of the diseases mentioned in the list, were observed by students. In subspecialty wards, 18.16% of diseases were observed by students. Almost 59% of all procedures had been performed by each student. logbooks are suitable means for evaluation of educational status and are able to determine the acquired experiences in educational courses and reveal the deficiencies in learning process. In this study there was a major difference between students' familiarity with educational subheadings in specialty and subspecialty wards which is necessary to consider. Applying this method in evaluation of medical students' educational status is recommended

Living-related liver trasplantation in children: the Shiraz experience

The liver transplantation program was established at Shiraz Nemazee Hospital in 1993. Shortage of cadaver organ supply due to various social and legal issues urged us to develop a living-related liver transplantation [LRLT] program. So far 7 [6 males, 1 female] living-related liver transplantations have been performed at this center. The mean age of patients was 8.21 years [ +/- 4.16], with a range of 4.5 to 14 years. Live donors [3 mothers, 2 fathers, and 1 brother] with a mean age of 30.83 years [ +/- 4.11] underwent procurement of the left lateral segment without mortality or any serious morbidity. The native liver disease was idiopathic cirrhosis [1 case], biliary atresia [3 cases], Budd-Chiari syndrome [1 case], neonatal cirrhosis [1 case], and cryptogenic cirrhosis [1 case]. Allografts were implanted using piggy-back surgical technique. Baseline immunosuppression consisted of a triple drug regimen including cyclosporine, mycophenolate mofetil and steroids. Acute graft rejection was treated with intra-venous bolus of methyl-prednisolone. Early death occurred in 2 patients due to vascular thrombosis. Biliary complication was observed in 1 patient. Five patients are alive with a normal functioning liver. In conclusion, LRLT program is promising in Iran. It can help to overcome the shortage of organs and minimize the mortality of patients in the waiting list

Henoch-Schonlein purpura in children: Our experience with 165 cases from southern Iran

During a 6 year period from September 1992 to September 1998, 165 children with a final diagnosis of Henoch-Schonlein purpura [HSP] were managed and followed in our center. There were 87 [52%] boys and 78 [48%] girls, with age ranges of 1-16 years and mean age of 7.8 years. Forty-one% of the patients had evidence of preceding upper respiratory tract infection [URl]. The main clinical features were: skin eruption in 100%, GI symptoms in 79.5%, joint problems in 59.5% and renal involvement in 26.5% of cases. Thrombocytosis in 31% and increased ESR in 55% of cases were the main significant laboratory findings. Abdominal sonography was done in 58 cases with GI symptoms, and was abnormal in 28 cases [48%]: free peritoneal fluid in 26%, thickened bowel wall in 14%, ileus in 5% and intussusception in 3%. Sixty% of the patients received prednisolone for GI problems or renal involvement. Nine% of the cases had relapse and there was no death. It was concluded that: a] There is no significant sex difference in children with HSP in this area. b] The age of children with HSP in this area is the same as those in eastern countries, but relatively higher than that reported in western countries. c] Abdominal sonography can be a helpful means of diagnosis in patients with GI manifestations of HSP before skin eruption. d] The morbidity and mortality of HSP is very low if the disease is diagnosed in its early stages and managed properly

Treatment of helicobacter pylori [h. pylori] infection in children: a prospective study comparing two different therapeutic regimens

During a period of 10 months from May to February 1995, 120 children [72 girls, 48 boys] with an age range of 4-16 years [mean age 10.87, S.D +/- 2.7] with chronic abdominal pain who had an abnormal endoscopy [gastroduodenal mucosal defect] and positive urease test were treated for H. pylori. Patients were treated randomly with either metronidazole and amoxicillin [double therapy, group A] or metronidazole, amoxicillin and bismuth subsalicylate [triple therapy, group B], each for two weeks. 6-8 weeks after completion of treatment, patients were reevaluated by endoscopy and urease test. Endoscopy was normal in 75 cases [63%]. Of the 45 cases with abnormal endoscopy, 37 patients [82%] were in group A and 8 patients [18%] in group B [p<0.001]. The urease test was positive in 44 cases [70%] of group A and 12 cases [20%] of group B [p<0.001]. It is concluded that double therapy is relatively ineffective in eradication of H. pylori and triple therapy is less effective in this area compared with reports from industrialized countries. This difference is most probably due to greater drug resistance in this part of the world

Caustic ingestion in children: a prospective study in 64 cases

In a 2 year period, 64 children with caustic ingestion were prospectively studied. The ingested agents were: bleach in 41 patients, caustic soda in 13, strong acids in 8 and Savlon in 2. The injury was assessed within 48 hours of ingestion by fiberoptic endoscopy of the whole esophagus, stomach and duodenum in all patients. Grade 0 [normal] was seen in 43 patients, grade 1 in one, grade 2a in 11, grade 2b in 5 and grade 3 in 4 patients. No significant burn was found after ingestion of bleach. Signs and symptoms were unreliable in predicting the severity of injury. Those with grade 2 or 3 burn received corticosteroid, antibiotic and antacid. Only 3 cases [16.6%] developed esophageal stricture; one improved with esophageal dilation, the other two needed colonic interposition. It is concluded that: a] Endoscopy is safe and indicated after caustic ingestion but could be withheld in asymptomatic patients after ingestion of bleach. b] Corticosteroids when used with antibiotics are safe and may have a role in prevention of stricture formation. c] Early prophylactic esophageal replacement is not indicated even in severe burn without perforated viscus, since most cases recover without sequelae

Acute upper gastrointestinal hemorrhage in children: the role of endoscopy in diagnosis and treatment

Between March 1992 and September 1994, 85 children [41 male, 44 female; mean age 8.7 years, age range 6 days to 14 years] with clinical manifestation of acute upper gastrointestinal hemorrhage were admitted and managed in our ward. Hematemesis [88%] and melena [50%] were the most common presenting symptoms. History of concomitant disease, mainly upper respiratory tract infection [URI] was present in 57.5% of cases. History of ingestion of one or more drugs mainly salicylic acid [ASA] within one to two days before bleeding was obtained in 42% of cases. Upper endoscopy was performed in all cases within 48 hours after admission with no complication. The site of bleeding was detected in 88% of the patients. Findings included gastritis with erosion in 50%, duodenitis with erosion in 30%, peptic ulcer in 28%, esophageal varices in 9% and esophagitis in 3.5% of cases. Seventy five patients [82%] were managed with medical therapy alone. Seven cases [9%] with esophageal varices were successfully treated with injection sclerotherapy using 96% alcohol. Eight cases [9%] underwent surgical management to stop bleeding. The overall mortality rate was 3.5% [2 infants with septicemia and one child with renal failure]. We conclude that erosive gastroduodenitis and peptic ulcer are the major causes of acute upper GI bleeding in children and are most frequently associated with systemic diseases or drugs. Upper endoscopy is safe and valuable for detecting the site of bleeding and injection sclerotherapy is effective for control of variceal bleeding

Helicobacter pylori infection in children with chronic abdominal pain

During a six-month period [September 1992 to March 1993],the prevalence of Helicobacter pylori [H. pylori] was assessed in 100 children [age range 3-18 years] with chronic abdominal pain [abdominal pain for longer than 3 months]. Upper endoscopy was abnormal in 33% and gastric antral mucosal histopathology showed gastritis in 62%. Culture, urease test and Gram's stain for H. pylori were positive in 33%, 44% and 44% respectively. Four patients under 5 years of age had gastric mucosal colonization by H. pylori. H. pylori associated with gastric disorder occurred mainly in children older than 5 years. A significant correlation was found between H. pylori gastric colonization and histopathological signs of gastritis. This study suggests a pathogenic role for H. pylori in the development of gastroduodenal diseases and chronic abdominal pain in children in southern