Intranasal midazolam compared with intravenous diazepam in patients suffering from acute seizure: a randomized clinical trial

Acute seizure attack is a stressful experience both for health care personnel and parents. These attacks might cause morbidity and mortality among patients, so reliable methods to control the seizure preferably at home should be developed. This study was performed to measure the time needed to control seizure attacks using intranasal midazolam compared to the common treatment [intravenous diazepam] and to evaluate its probable side effects. This study was conducted as a not blind randomized clinical trial among 60 patients coming to Imam Ali Hospital, Zahedan, Iran. The patients were 2 months to 15 years old children coming to our emergency department suffering from an acute seizure episode. Intranasal midazolam was administered 0.2 mg/kg equally dropped in both nostrils for case group and intravenous diazepam was administered 0.3mg/kg via IV line for control group. After both treatments the time needed to control the seizure was registered by the practitioner. Pulse rate and O[2] saturation were recorded at patients' entrance and in minutes 5 and 10 after drug administration. The time needed to control seizure using intranasal midazolam [3.16 +/- 1.24] was statistically shorter than intravenous diazepam [6.42 +/- 2.59] if the time needed to establish IV line in patients treated by intravenous diazepam is taken into account [P<0.001]. The readings for O[2] saturation or heart rate did not indicate a statistically significant difference between two groups of patients either at entrance or 5 and 10 minutes after drug administration. Considering the shorter time needed to control acute seizure episodes compared to intravenous diazepam and its safety record, intranasal midazolam seems to be a good candidate to replace diazepam, as the drug of choice, in controlling this condition

Evaluation of congenital hypothyroidism in Fars province, Iran

In Iran thyroid-stimulating hormone [TSH] based neonatal screening program is included in health care services from 2005 for detection of patients with primary congenital hypothyroidism [CH]. This study was performed for a critical evaluation of the screening program primary congenital hypothyroidism in Fars province, Iran. From November 2006 to September 2007, TSH serum concentrations of 63031 newborns, 3 to 5 days old born in Fars province, were measured by heel prick. The newborns with TSH >/= 5mIU/L were recalled for measurement of serumT4 and TSH in venous blood samples Of 127 recalled subjects, 43 were confirmed to be hypothyroid, showing a prevalence of 1:1465 with F:M ratio of 1.05:1. The most common clinical and radiological findings were prolonged jaundice [73%], large anterior fontanel [56%], wide posterior fontanel [55%], absence of distal femoral epiphysis [20%], and umbilical hernia [11%]. Scintigraphy of the thyroid with [99m]TC revealed eutopia [67.4%], hypoplasia [23.3%], agenesis [4.7%] and ectopia [2.3%]. It is concluded that a cut off value of TSH >/= 5mIU/L overestimates recalling the number of patients with CH. The most common cause of congenital hypothyroidism is not dysgenesis of the gland and perhaps dyshormonogenesis in Iran is more common than what is reported in other countries

Lowe syndrome: report of a case and brief literature review

The oculocerebrorenal syndrome of Lowe [OCRL] is a rare x-linked recessive disorder first described in 1952. This syndrome is characterized by ocular involvement, mental retardation and kidney disease. The causative gene is OCRL1. Survival rarely exceeds 40 years. A 13-year-old boy was referred because of short stature. In physical examination his height was 108.2 cm. He had poor growth, psychomotor retardation, severe hypotonia, congenital cataract which was operated on earlier in life, searching nystagmus, anti social behavior and used foul language. He had been on treatment for renal tubular acidosis [Fanconi syndrome] since 8 month of age. The possibility of OCRL should be considered in boys with cataracts and glumerolar disease. As the condition can be diagnosed in first months of life, early treatment can prevent patients from various complications

Ellis van creveld syndrome: report of a case and brief literature review

Ellis van Creveld syndrome [EvCS] is a rare autosomal recessive [AR] disorder first described in 1940. The syndrome manifests with several skeletal, oral mucosal and dental anomalies, congenital cardiac defects and nail dysplasia. EvCs should be differentiated from other chondrodystrophies such as achondroplasia and Morquio's syndrome. A nine-year old girl was referred with short stature. In physical examination her height was 105 cm. She had normal intelligence, small teeth, abnormal crown and adontia in mandibular incisors. Other findings included bilateral postaxial polydactyly in hands, narrow thorax, hypoplastic nails in hands and feet and genu valgum. Ellis van Creveld syndrome is a rare autosmal disorder with a high mortality in early life. As the condition is easily diagnosed at birth, early treatment can prevent patients from various complications and undue psychological trauma