Can STOP Trial Velocity Criteria Be Applied to Iranian Children with Sickle Cell Disease? / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Sickle cell disease (SCD) is strongly linked to stroke across all haplotypes in the pediatric population. Transcranial Doppler (TCD) ultrasound is known to identify the highest risk group in African-Americans who need to receive and stay on blood transfusions, but it is unclear if the same flow velocity cut-offs can be applied to the Iranian population. We aimed to evaluate baseline TCD findings in Iranian children with SCD and no prior strokes. METHODS: Children with genetically confirmed SCD (Arabian haplotype, homozygote) and without SCD (controls) were prospectively recruited from pediatric outpatient clinic over a period of 9 months. We performed TCD in both groups to determine flow velocities in the middle cerebral (MCA) and terminal internal carotid arteries (TICA). RESULTS: Of 74 screened children, 60 met the inclusion/exclusion criteria (62% female; mean age 10+/-4 years). Baseline characteristics did not differ between the cases and controls, except hemoglobin (Hb) which was significantly lower in the SCD group (P<0.001). The right MCA TAMM (Time Averaged Maximum Mean) was significantly higher than in controls (125+5.52 cm/s vs. 92.5+1.63 cm/s, P<0.001). Left MCA did not show differences. The TICA TAMM was also different between cases and controls (P<0.05). CONCLUSIONS: Among Iranian children with asymptomatic SCD and without receiving recent transfusion TCD velocities are higher as compared to healthy controls but appear much lower than those observed in STOP (Stroke Prevention Trial in Sickle Cell Anemia) studies. We hypothesize that some children at high risk may be present with velocities lower than 170-200 cm/s thresholds. A prospective validation of ethnicity-specific prognostic criteria is warranted.

Simple formulas for screening abnormal blood pressure in children and adolescents

Childhood hypertension has been extensively focused on in the past decades because of its increasing incidence, which is related to physicians' awareness and the increasing number of obese children. Age, gender, and body size are the main determinants of blood pressure in children. The revised childhood blood pressure tables of the National High Blood Pressure Education Program are a prerequisite for classification of childhood hypertension. Although these tables provide a reasonable basis, they are intricate and height percentile is needed for final diagnosis. Many attempts have been done to decrease such complexity. We present new formulas that are concise and memorable, and will help physicians to screen prehypertensive and hypertensive pediatric patients

effect of clofibrate on neonatal hyperbilirubinemia in uncomplicated jaundice

Clofibrate has been used for several years as a hypolipidemic drug. Our aim was to study the effect of Clofibrate on neonatal hyperbilirubinemia in uncomplicated jaundice. This clinical trial study has been conducted on 90 normal term neonates who were admitted for uncomplicated jaundice in 17th-Shahrivar Children's Hospital of Guilan University of Medical Sciences from September 2005 to January 2006. The data included: age, sex, total and direct serum bilirubin, weight and duration of hospitalization. All data were analyzed by using statistical methods. All 90 infants enrolled in our study had received phototherapy. The infants were divided into Clofibrate group [G1] consisting of 26 boys [57.8%] and 19 girls [42.2%] and Control group with 24 boys [53.3%] and 21 girls [46.7%] [G2]. There were no statistically overt differences between the two groups regarding sex distribution, age, weight and total serum bilirubin level at admission. Mean values for total bilirubin of serum in Clofibrate group 12, 24, 36, and 48 hours after admission were significantly lower than those for Control group [P<0.00l]. The mean time needed for phototherapy in Clofibrate group [38.8] [20-48h] was significantly shorter than that in control group [68.7] [36-96h] [P<0.00l]. Clofibrate is effective and probably a safe drug for neonatal hyperbilirubinemia that can decrease the time needed for phototherapy and hospitalization, although further studies with a more precise and longer follow up is needed for proving its safety to be used routinely in the treatment of neonatal hyperbilirubinemia

Multicystic dysplastic kidney in association with congenital ichthyosiform erythroderma

Multicystic dysplastic kidney is a noninherited congenital disease. Association of this disease with abnormalities of various organs is common. We, however, report a rare case of multicystic dysplastic kidney associated with congenital ichthyosiform erythroderma in an infant. Different developmental origins of the skin and the kidney can explain the scarcity of concurrent congenital skin and kidney abnormalities. Nonetheless, the development of both organs depends on mesenchyme-epithelial interactions for inductive signaling. It seems defects in the production of signaling molecules can explain such an association