Growth factors in cystic fibrosis

Introduction: Cystic fibrosis is one of the most common autosomal recessive diseases that affects sweat glands and mucosa. CF is a hereditary disease with annual incidence of about 2500 new cases in United Kingdom. Insulin-like growth factor-1 [IGF-1] and insulin-like growth factor binding protein-3 levels decrease in CF. The aim of this study was to assess the role of growth peptides in patients with CF

Method: We searched PubMed, Google scholar, IranMedex, and Scientific Information Database [SID] in September 2012 to April 2014. We included clinical studies with available abstracts and full texts that were in English or Persian languages. Manual searching was conducted within the reference lists of articles. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data

Result: The earliest study was published in 1997 and the most recent one was in 2014. Study participants were adults in 3 studies [20%] and 12 studies [80%] were conducted in children. Patients with CF have lower levels of IGF-1 and there is a significant correlation between IGF-1 levels and growth index in patients with CF

Conclusions: IGF-1 decreases in children with CF and might be the cause of poor growth and low body mass index in these children

Medical treatment for hepatopulmonary syndrome:a systematic review

Introduction: Hepatopulmonary syndrome [HPS] is known as a chronicliver disease associated with severe pulmonary deoxygenation due tointrapulmonary vascular vasodilation. Although liver transplantationis accepted as a main treatment of HPS, identifying effective drugs forrecovery of HPS can be effective in postponing the transplantation anddecreasing the mortality rate of patients before the transplantation. In thisstudy we briefly reviewed the pathogenesis of HPS and also systematicallyreviewed the current pharmacological treatment of HPS

Method: Pubmed, Scopus, and Google scholar were searched for therelevant English language clinical and experimental articles about themedications used in the treatment of HPS

Results: A total of 38 articles were included in this study which mostlyresulted in decreasing NOS expression, NO production, endothelin-1activation, intrapulmonary angiogenesis and increasing oxygenation

Conclusion: Various drugs have been proposed in treatment of HPS butmore large controlled trial studies, is necessary to determine the exactefficacy of each drugs for HPS recovery

Synbiotic for prevention of antibiotic-associated diarrhea in children: a randomized clinical trial

Antibiotic- associated diarrhea is a common problem in pediatric population. There is growing interest in probiotics, probiotics and synbiotics for prevention of this complication because of their worldwide availability as dietary supplements. The aim of this study was to assess the efficacy of a synbiotic mixture in prevention of antibiotic- associated diarrhea. In this randomized controlled trial, 218 patients [111 in the synbiotic and 107 in the placebo group] aged 6 months to 14 years with respiratory tract infection and/ or otitis media who needed antibiotic treatment in outpatient setting, were enrolled. They received 1 billion Colony Forming Unit of seven probiotics species plus Fructooligosaccharide in form of powder or placebo [matched for size, shape, and volume] for 7 days. Amoxicillin, Amoxicillin-clavalanic acid, cefixim and Azithromicin were the most common drugs used by physcicians Mothers recorded stool frequency and consistency daily for 7 days. We found no significant difference [P>0.05] in occurrence of diarrhea between synbiotic and placebo groups. This synbiotic mixture did not appear to reduce antibiotic- associated diarrhea in children. Further studies are needed to investigate the potential benefits of Synbiotics in prevention of this disease

Utility of modeling end-stage liver disease in children with chronic liver disease

Chronic liver diseases consist of wide spectrum disorders that may be complicated by cirrhosis and therefore need to transplantation. The pediatric end-stage liver disease [PELD] score and model of endstage liver disease [MELD] score has been used as predictors of mortality chronic liver diseases listed for liver transplantation. The aim of this study is evaluation of relation between PELD MELD score and evidence of cirrhosis in children with choronic liver disease. This cross-sectional study conducted on 106 patients of chronic liver disease referred to Ghaem haspital, Mashhad university of medical science, Iran during 24 months period [2010-2013]. PELD and MELD score were calculated for all patients. Clincal and patholoogical findings of cirrhosis were recorded. Mean age of patients was 68/3 +/- 41.8 months. Mean PELD MELD score was -1/59 +/- 9/64. There was significant correlation between PELD MELD score and clinical icter, spelenomegaly, evidence of hepatopulminary syndrome, esophageal varices, evidence of cirrhosis in tissue specimences. PELD MELD score appear to be benefit for detection of cirrhotic children among paients with choronic liver disease

Viewpoints of traditional Iranian medicine [TIM] about etiology of pediatric constipation

Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. The diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Laboratory investigations such as barium enema, colonoscopy, anorectal manometry and colonic transit studies are rarely indicated except in those who do not respond to standard management. Treatment of childhood constipation involves several facets including education and demystification, toilet training, rational use of laxatives for disimpaction and maintenance and regular follow-up. Surgical options should be considered only when medical therapy fails in long standing constipation. Complementary and alternative medical therapies and practices are widely employed in the treatment of the children Constipation. This article aims to be a practical guide for paediatricians and primary care physicians, to outline the current etiology an TIM for the medical management of constipation in children

Evaluation of parental attitudes toward lumbar puncture in their children

Sometimes physicians need to assess some markers on selected children's cerebrospinal fluid according to lumbar puncture [LP]. Although immediate diagnosis and treatment especially for meningitis in necessary, But just at this moment, due to some incorrect believe in society, some parents may not allow physician to LP. The reality is that most of these people, if they have enough information about this issue, will not interfere. This study aimed to assess the knowledge and attitudes of parents toward this subject. Through a cross - sectional study we evaluated 91 parents of children, who must been undergone LP as physician's decision, selected during 18 months using purposive sampling. The data collection tool was a questionnaire that consisted of two sections of the child and the parents' knowledge and attitudes. Scientific validity of the questionnaire was confirmed by content validity. To achieve the objectives, SPSS 15 and descriptive statistics and chi-square test were used. 61 parents [67%] mentioned fear of some side effects as the main reason of their children 's LP discontent .The most important cause of fear was low back pain according to 50 [54.9%] parents 's view. 70 parents [76.9%] had some satisfaction after performing LP .There was statistically significant difference between proportion of satisfied parents and non-satisfied ones [p<0.001]. Average score parental satisfaction for LP was [7.2 +/- 3.2 87]. It seems that improvement of parents 's information about LP process and it's benefits by health care group, may influence on their belief and cooperation during diagnostic tests

Assessment the relationship between parents' literacy level with children growth in Mashhad: An analytic descriptive study

Present children are the investments of community in the future. Preparing children health which leads to the stability of community health, provided to accurate implementation of educational and health programs in the community and especially in mothers. So it is necessary to determine the relationship between parents' literacy with growth rate in children. This cross-sectional descriptive-analytic study was conducted on 300 mothers referring to 10 selected Mashhad health-care centers for monitoring their 6-24-month year old infants. They completed questionnaire. Participants were selected by cluster and simple random sampling. Data were analyzed by descriptive- analytic statistics and using SPSS 16. Present findings showed a significant relationship between literacy level of parents with child growth status, breast feeding rate, junk food consumption, referring to health care center for growth monitoring, the age of initiating supplementary nutrition, the use of oil and butter in baby food and rate of attending in educational classes. So that higher literacy level of parents was associated with using more formula, less junk food, oil and butter in baby's food and more referring times to health care center for monitoring child growth, desirable growth, and also initiating supplementary food more at the assigned time [P<0.05]. Parents' literacy level influence on children growth status. However, with increasing parents' literacy level, using formula for infants has been increased, but breast milk feeding is also high in this group

Complementary and alternative medicine [CAM] use in pediatric diseases: a short review

CAM therapies have become increasingly popular in pediatric populations. phytotherapy are the most common CAM used in children. Yet, little is known about children's preferences for CAM. But It is expected to become more widely integrated into the modern medical system, including the medical curriculum.The aim of this study is to introduce the prevalence and characteristics of CAM use in Pediatrics disease. Further research is warranted to examine the safety and effectiveness of this popular non-allopathic approach to children's health

Hyperbilirubinemia and neonatal infection

Hyperbilirubinemia is a relatively common disorder among infants in Iran. Bacterial infection and jaundice may be associated with higher morbidity. Previous studies have reported that jaundice may be one of the signs of infection. The aim of this study was to determine the incidence rate, presentation time, severity of jaundice, signs and complications of infection within neonatal hyperbilirubinemia. This cross sectional study was conducted between 2003 and 2011, at Ghaem Hospital, Mashhad- Iran. We prospectively evaluated 1763 jaundiced newborns. We finally found 434 neonates who were categorized into two groups.131 neonates as case group [Blood or/and Urine culture positive or sign of pneumonia] and 303 neonates with idiopathic jaundice as control group. Demographic data including prenatal, intrapartum, postnatal events and risk factors were collected by questionnaire. Biochemical markers including bilirubin level, urine and blood cultures were determined at the request of the clinicians. Jaundice presentation time, age on admission, serum bilirubin value and hospitalization period were reported significantly higher among case group in comparison with control group [p<0.0001]. Urinary tract infection [UTI], sepsis and pneumonia were detected in 102 [8%], 22 [1.7%] and 7 [0.03%] cases, respectively. We concluded that bacterial infection was a significant cause of unexplained Hyperbilirubinemia among jaundice newborns [10%]. Therefore, we advise performing screening test for UTI as part of the evaluation in asymptomatic jaundice infants presenting after five days of life and sepsis workup should be request in symptomatic infant especially in the first week of life

Iron and multivitamin supplements in children and its association with growth rate

Vitamin deficiency and iron deficiency anemia are common nutritional problems, at least in children under 5. These materials shortage, especially in the first two years of life, impair physical and brain growth, reduces the child's learning ability, reduces body resistance against infections, behavioral changes, apathy and finally social and economic adverse consequences would be followed. This study aimed to determine the supplements used in children under two years and its Association with Growth rate in Mashhad City. In this cross-sectional descriptive study, 300 children 6 to 24 months were recruited in health centers in Mashhad, Data was collected from mother and children' records and valid and reliable questionnaire was used to collect data. The data was analyzed by statistical tests and SPSS 11.5 and P<0.05 was considered significant. Results showed that 13.7 percent of families were with low income, 82.7 percent middle income and 3.7 percent well income. In growth chart, 86.7 percent of children showed appropriate growth, 10.3 percent had delayed growth and 3 percent had horizontal growth curve .In 80.7 percent of families, maternal multivitamin and iron drops have been used to their children regularly, 1.7 percent did not believe in these supplements and 17.7 percent of mothers sometimes used these supplements for their children. Results also showed statistical correlation significant variables of parental education, family income, mothers referred to health centers for monitoring the growth and get face to face training of personnel center drops of multivitamin with iron and growth status of children variable is available, so children who regularly have used supplements and income level and above are literate parents have grown more favorable than the other kids [P<0.05]. Regarding the importance of iron and multivitamin use in children under two years, necessary training must be provided to mothers in this field by health centers personnel. Meanwhile, it is recommended that the authorities must distribute periodical and enough drops to health centers

Kawasaki disease presenting as acute clinical hepatitis

Kawasaki disease is a systemic vasculitis of children. Among gastrointestinal symptoms of this disease jaundice occurs uncommonly. We present a 23 month boy with icter and clinical hepatitis and final diagnosis of kawasaki disease

case of lipoid congenital adrenal hyperplasia presenting with cholestasis

Lipoid congenital adrenal hyperplasia, is the rarest and usually the most severe form of adrenal steroidogenic defect,which may presents as infantile cholestasis. Here we present a 45 days old infant who came to our attention with cholestasis and severe intractable vomiting and electrolyte disturbances. Evaluation resulted in diagnosis of congenital adrenal hyperplasia. Hydrocortisone and flodrocortisone improved the symptoms including jaundice and vomiting. Hyponatremia and hyperkalemia also resolved with above mentioned treatment. Congenital adrenal hyperplasia as one of the causes of neonatal cholestasis should be kept in mind, whenever there are also electrolytes abnormalities