[Clinical evaluation of the effects of two types of oral combination of midazolam in sedating pediatric dental patients]

Conscious sedation is frequently employed for the management of precooperative or extremely anxious dental patients. Many medications have been used to sedate children in the dental office separately and in combination in an attempt to find an ideal sedation regimen. However, it seems that there is a need for finding a drug with more effectiveness and lower complications. This study was undertaken to compare the effectiveness of oral combinations of midazolam/ketamine and midazolam/hydroxyzine in sedating pediatric dental patients. In this prospective, double-blinded, crossover clinical study, 25 uncooperative children ages 37 to 56 months [mean age of 48.1 months], in need of at least 2 restorative visits were selected. The subjects were assigned randomly to receive either a combination of midazolam 0.5 mg/kg and ketamine 5mg/kg or midazolam 0.5 mg/kg or hydroxyzine 2 mg/kg prior to dental treatment at the first appointment. The alternative drug regimen was administered at the second appointment. All the subjects also received 50% nitrous oxide/oxygen during treatment. The child's behavior, in all 4 behavioral criteria including sleeping, crying, body movement and overall behaviors, during injection and procedure, was evaluated by an independent clinician who was unaware of the drug given to the child. The data was analyzed using Wilcoxon and McNemar tests. Midazolam/ketamine was found to be significantly more effective than midazolam/hydroxyzine during injection and procedure for sleeping [p=0.00, p=0.001, respectively], crying [p=0.00, p=.001] and body movement [p=0.001, p=0.001] and was more successful, according to the overall behavior evaluation criteria [p=0.008]. Midazolam/ketamine resulted in safe and effective sedation for the dental treatment of young children and in comparison to midazolam/hydroxyzine, it resulted in less sleeping, crying, movement and better overall behavior during the dental treatment

Modulation of blood pressure in hypertensive patients by vitamin C

Essential hypertension is characterized by endothelial dysfunction, arterial stiffness, and increased oxidative stress. We evaluated the effect of short-term treatment with the antioxidant vitamin C on blood pressure in essential hypertensive patients. A total of 50 participants with essential hypertension were evaluated before and after the study. They received 250 mg vitamin C twice daily for one month. Blood pressure, weight and height were measured before and after intervention. Body mass index was calculated and dietary pattern was assessed by using food frequency questionnaire and 24 dietary recalls. We observed a significant decline in both systolic blood pressure [138.1 +/- 12.7 vs 134.2 +/- 11.5 mmHg, p<0.005] and diastolic blood pressure [87.2 +/- 10.1 vs 85 +/- 8.8 mmHg, p<0.005] of the participants after one month of vitamin C intake. These effects were independent of patient's BMI. Our results indicates that daily intake of 500 mg supplementary vitamin C [250mg twice daily] may have beneficial effects on blood pressure and thus reducing the risk of complications

Myasthenia gravis in Iranian children

Considering the marked difference between the clinical course and management of juvenile myasthenia gravis, congenital/genetic myasthenia gravis and transient neonatal MG, the differential diagnosis is very important. This study was undertaken to evaluate the clinical spectrum of myasthenia gravis in children and determine the factors helping clinicians in their diagnosis and management of the disease. In a retrospective study from 1994 to 2002, all pediatric patients with myasthenia gravis [MG] admitted to Department of Pediatric Neurology in Mofid Children Hospital affiliated to Shahid Beheshti University were enrolled. Of 32 children, 7 and 25 suffered from congenital and juvenile types of MG, respectively. The initial symptoms in congenital MG were ptosis [7/7], limitation of eye movement [2/7] and mild generalized weakness [6/7]. Although 85% of cases with congenital MG, tested positive for Tensilon test, no myasthenia crisis or spontaneous remission was observed in any of the patients. The female to male ratio was 1.5/1 which was correlated to adult MG. In children with juvenile MG, the mean age was 5.7 +/- 4.2SD years. The most common symptoms were ptosis in 96% and generalized weakness in 76% of the cases. 32% of patients experienced one myasthenia crisis. EMG was diagnosed in 83% and tensilon test was positive in 84% of the cases. One patient had hyperthyroidism and another had hypothyroidism and both were epileptic. Eight patients underwent thymectomy microscopically. Thymic follicular hyperplasia was observed in five cases [62%], and the remaining three cases were normal. 12.5% of patients recovered completely after thymectomy and there was no need for medication during the follow up. 50% of cases showed relative improvement but it was negligible in 37% of patients. This study revealed that thymectomy lacks remarkable prognostic influence

Myasthenia gravis in iranian children

This study was undertaken to evaluate the clinical spectrum of myasthenia gravis in children and determine factors that help the clinician in his/her diagnosis and management. A retrospective review was performed on all pediatric patients suffering from myasthenia gravis [M.G] admitted in the department of pediatric neurology of the Mofid Hospital of the Shaheed Beheshti University, between 1994 and 2002. Of the thirty-two children with M.G. enrolled in our study, seven were suffering from the congenital type while the remaining [25 cases] had the juvenile M.G. Initial symptoms of congenital M.G were ptosis [7/7], limitation of eye movement [2/7] and mild generalized weakness [6/7]. Although the Tensilon test was positive in 85% of congenital M.G cases, no myasthenia crisis or spontaneous remission was observed in any of them. In children with juvenile M.G, the age of presentation was 1.2 to 12.5 years, mean age 5.7 +/- 4.2 years [15 girls and 10 boys]. The most common presenting symptoms in juvenile group were ptosis in 96% and generalized weakness in 76%. Eight of them [32%] had had at least one myasthenia crisis. EMG was diagnostic in 83% and the tensilon test was positive in 84%. One patient had hyperthyroidism and had already been diagnosed with hypothyroidism; two of them were epileptics. Eight patients underwent thymectomy microscopically; in specimens examined, five [62%] showed thymic follicular hyperplasia while in remaining three results were normal. One patient [12.5%] recovered completely after thymectomy with no need for medication during the follow up. Four patients [50%] showed relative improvement and in three cases [37%] improvement was negligible. The results showed a female to male ratio of 1.5/1 which was correlated to adult M.G. The most common presenting symptoms consisted of ophtalmoplegia, with bilateral ptosis being the most significant. Although this study revealed that thymectomy lacks any remarkable prognostic influence, all patients had thymectomy within two years of disease onset. Some reports have indicated positive results if surgery was performed within two years of onset of disease