Toilet training in Iranian children: a cross-sectional study

There is still controversy about the methods and the age of toilet training that are varied in different cultures. This is a survey of Iranian parents' views about the appropriate age, the true age, the methods used for toilet training, and the association with voiding problems. Questionnaires were filled-out containing items on demographic data, the parents' view, the method applied, and the age at which toilet training was accomplished in children aged 2 months to 5 years. In addition, pediatric lower urinary tract scoring system questionnaires were distributed among 217 children aged 5-15 years with lower urinary tract symptoms between 2008 and 2010 in outpatient clinics. P<0.05 was considered significant. 566 children [335 girls and 231 boys] were assigned to the study. In asymptomatic group, the majority of parents believed that the appropriate age to start toilet training was 1-2 years. The method used by the parents was intensive in 52% and child-oriented in 44%. There was strong reverse correlation between the level of education of father with applying punishment for training and direct correlation between toilet refusal and the later age of completing toilet training [LR: 6.3, P<0.05]. The mean age of completing toilet training was about 23 months in asymptomatic and 23.7 months in symptomatic children [P>0.05]. There was no correlation between wetting episodes at day or night and the age of toilet training. Intensive approach was more popular and the age of toilet training had no influence on the lower urinary tract symptoms

[Clinical correlation between findings of renal scintigraphy and clinical/laboratory findings in children with febrile UTI]

Urinary tract infection [UTI] is one of the most common bacterial infections in children. Non-specific symptomatology in infants and young children makes the clinical differentiation between lower UTI and acute pyelonephritis [APN] difficult. The aim of this study was to assess the correlation between APN findings of renal cortical scintigraphy and selected clinical/laboratory findings of febrile UTI in infants and children admitted at our center. A prospective study was conducted in 83 infants and young children aged I month -8 years hospitalized with febrile UTI in nephrology ward of Abuzar children's hospital. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography [US], voiding cystoureterography [VCUG], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], hemoglobin [Hb], white blood cell count [WBC] and urine analyses were performed. Mean age was 24.3 months with 82% [68] girls. DMSA scintigraphy showed APN findings in 45/83[54.2%] patients, with a mean age of 30.2 months, including 9 males [20%] and 36 [80%] females. There were statistically significant correlations between the APN findings of DMSA scintigraphy and the fever duration, body temperature, lucocytosis, anemia, proteinurea, CRP levels and ESR [p<0.05]. Vesicoureteral reflux was found in 20.5% of patients with no statistically significant correlations to the APN findings of DMSA scintigraphy. Although initial DMSA renal scintigraphy is useful for determination and localization of kidney involvement during febrile UTI, some clinical and paraclinical findings can predict the scintigraphycal findings of kidney involvement that need further evaluations for portable complications in the future

How to reach rapid diagnosis in sickle cell disease?

Sickle cell disease [SCD] is a common hereditary disease in Iran. In developed countries, newborn screening programs have been established to ensure early diagnosis, but in most developing countries, screening is not performed and the diagnosis is often delayed. The aim of the present work was to investigate the clinical presentation of SCO in Iran and comparison of its hematologic indices with normal children. The study included 44 pediatric patients [26 boys and 18 girls] with sickle cell anemia [SS], 27 sickle / beta °-thalassemia [S beta °], and 21 sickle /beta [+]-thalassemia [S beta[+]]. Fifty seven healthy individuals matched with the patients were randomly selected as controls. Mean age at diagnosis in SS group was 4.3 years. At the time of diagnosis all patients were anemic, 89% complained of painful crises. Hemoglobin[Hb] concentration, red blood cell [RBC] count and HbxRBC product in SS group was significantly lower than in control group [P<0.001], mean corpuscular volume [MCV] and mean corpuscular hemoglobin [MCH] showed no significant differences. HbxRBC product below 45 and MCH/RBC above 7 have the best sensitivity and specificity for differenting SS group and the control normal group [91 and 98% for HbxRBC arid 89 and 100% for MCH/RBC respectively]. Mean age at diagnosis in S beta [+] group was higher than in SS and Sp° groups [7.45 year vs 4.26 and 4.25 year] [P<0.001]. In addition, S beta ° and S beta[+] groups had significantly lower MCV, MCH, and HbxRBC indices compared with control group. We suggest that in an anemic patient with history of pain crises, normochrome normocytic anemia, HbxRBC <45 and MCH/RBC >/= 7, SCD should be considered and the patient evaluated accordingly to confirm the diagnosis

Survival at 1, 3, and 5 years in diabetic and nondiabetic patients on hemodialysis

We analyzed survival of 185 adult patients on maintenance hemodialysis [9 h/wk to 12 h/wk] at Emam Khomini Hospital in Ahvaz, Iran. Patient survival at 1, 3, and 5 years was 89.2%, 69.2%, and 46.8%, respectively. There was no significant difference between diabetic and nondiabetic patients in 1-year survival [87.1% versus 89.7%, P = .66]. But, 3- and 5-year survival rates of diabetic patients were significantly lower than those of nondiabetic patients [52.2% versus 73.8%, P = .04; zero versus 56.9%, P < .001; respectively]. Based on our findings, the survival of diabetic patients undergoing hemodialysis was much worse than survival of nondiabetic patients. Thus, prevention of diabetic nephropathy should be more emphasized; and if end-stage renal disease is present, other renal replacement therapies such as kidney transplantation must be considered as soon as possible

Chronic kidney disease in southwestern Iranian children

The aim of the study was to determine the etiology of Chronic Kidney Disease [CKD] among children attending the pediatric nephrology service at Abuzar children's hospital in Ahvaz city, the referral center in Southwest of Iran. We reviewed the records of 139 children, diagnosed to have CKD over a 10-year period. CKD was defined a glomerular filtration rate [GFR] below 60 ml/1.73 m2/min persisting for more than 3 months. Among 139 children 81 [58%] were males. The mean age at diagnosis of CKD in the patients was 4.2 [ +/- 3.6] years. Mean level of serum creatinine at presentation was 1.9 [ +/- 1.4] mg/dl. The mean GFR at presentation was 33.5 [ +/- 15.4] ml/1.73m2/min while 22% of the patients were already at end stage renal failure indicating that these children were referred too late. Congenital urologic malformation was the commonest cause of CKD present in 70 [50.4%] children [reflux nephropathy [23.1%], hypo/dysplastic kidney [15.8%], obstructive uropathy [10.8%], and prune belly syndrome [0.7%]]. Other causes included hereditary nephropathies [17.2%], chronic glomerulo-nephritis [6.5%], multisystemic diseases [4.3%], miscellaneous and unknown [each one 10.8%]. The mean duration of follow-up was 26 [ +/- 24.67] months. Peritoneal or hemodialysis was performed in 10 patients. Six patients underwent [4 live-related and 2 non-related] renal transplantation. The rest have died or received standard conservative management for CKD. The commonest causes of CKD were reflux nephropathy, hypo/dysplastic kidney, hereditary nephropathy and obstructive uropathy. Patients presented late, had severe CKD and were malnourished and stunted