healing effect of Arnebia Euchroma in second degree burn wounds in rat as an animal model

Finding more efficient agents with fewer side effects for treatment of burns has always been a concern for researchers. Silver sulfadiazine [SSD], apparently due to its antimicrobial effect, is still one of the most common prescribed agents. Previous studies suggested that Arnebia euchroma [AE] has shown antimicrobial and anti-inflammatory activities. This study investigates the healing effect of AE extract in comparison with SSD in second degree burn wounds. Forty eight female Wistar rats [220 +/- 20 g] were divided into four groups. Standard second degree burn wounds were induced on the back of their necks. One group was treated with SSD; two groups were treated with AE cream at concentrations of 10% [AE10] and 20% [AE20] and the control group which received no treatment. The duration of treatment was 28 days. This study revealed that AE and SSD noticeably improved re-epithelization, fibroblasts proliferation, and collagen bundle synthesis and had a noticeable anti-inflammatory effect compared with the control group. Results of the present study revealed that Arnebia euchroma herbal extract was an effective treatment for second degree burn wounds when compared with SSD

Thioacetamide-Induced acute hepatic encephalopathy in rat: behavioral, biochemical and histological changes

As a serious neuropsychiatric disease, hepatic encephalopathy [HE] is a clinical condition with several types regarding chronicity and clinical diversity that can develop as a complication of both acute and chronic liver failure. This study evaluates changes in thioacetamide [TAA]-induced acute hepatic encephalopathy [AHE] in rat as an animal model. Both genders of C57BL6, BALB/C mice and Sprague Dawley rats; [10 animals in each group] were compared for induction of AHE to clarify which animal and gender were appropriate. The animals [10 male rats in each group] were categorized in 4 groups according to the dose of the TAA administered [200, 300 and 400 mg/kg of TAA at 24 h intervals for 4 days]. A control group was treated with solvent of TAA which was water [5 ml/kg/day]. The behavioral, biochemical markers of hepatic failure and histological aspects of thioacetamide [TAA] induced AHE and the correlation between the clinical severity and liver failure biomarkers were evaluated. Rat was shown to be an animal model of choice for AHE while the optimum dosage of TAA to induce AHE was 300 mg/kg/day at 24 h intervals for 4 days. The behavioral score was partially correlated with the rising of some biomarkers and pathological findings. Rat can be introduced as the animal of choice for AHE to study the pathophysiology, pharmacology and the survival rate of disease in liver transplant patients

Evaluation of cytomegalovirus infection after six months of liver transplantation in children in Shiraz, Southern Iran

Liver transplantation [LT] is a life-saving treatment for end-stage liver diseases [ESLD]. Cytomegalovirus [CMV] infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset [after 6 months of LT] CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients [6%] developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children

Epidemiologic features of retinoblastoma in Shiraz, southern Iran

Retinoblastoma [RB] is the most common primary intraocular cancer of childhood. There is no published report on this affliction at our center as a referral center in southern Iran. This study aimed to perform a 15 years epidemiological assessment of RB, in Fars Province, Southern Iran. We retrospectively analyzed medical records of all patients with RB diagnosed in Khalili Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, Southern Iran. All available pathologic slides were reviewed and staging of tumors were revised using the TNM classification of 2008. Sixty-seven patients were enrolled in this study [46.3% females and 53.7% males]. Among the cases, 71.6% had unilateral and 28.8% bilateral RB. The mean age of symptom presentation and diagnosis were 20.5 +/- 16.5 and 26.3 +/- 20.1 months, respectively, which were significantly lower in bilateral cases. Leukocoria was the most common presenting symptom [56.7%], followed by strabismus [10.4%]. The result of histopathological review showed that RB in 70% of patients was at T1, T2 and T3 stage, but 30% were at T4 stage. Demographic and clinical variables of RB under the present study are comparable with published reports but our patients were diagnosed at the later stage, leading to poorer prognosis. It is necessary to expand the existing organizations into a comprehensive population-based registry system to obtain a clearer picture of the epidemiology of RB in our region

Evaluation of candida infection after six months of transplantation in pediatric liver recipients in Iran

Liver transplantation [LT] is the standard treatment of end-stage liver diseases [ESLD]. Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. To determine the incidence of late-onset [after 6 months of LT] Candida infection in recipients. A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. One recipient [2%] developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder [PTLD]. The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications

Therapy of chronic functional constipation in children before and after dietary education

The prevalence of chronic constipation in children has been reported between 0.3 and 28%. This study was conducted in southern Iran to compare the effect of a balanced and high fiber diet in children with chronic functional constipation. During summer 2007, all children [60] who referred to the Pediatric Department of Mottahari Clinic affiliated to Shiraz University of Medical Sciences and were diagnosed with chronic functional constipation entered this study. A questionnaire on the child's routine dietary regime was filled in for each child through face to face interviews with the parents. The questionnaire included demographic information, food habits, physical exam, and the para-clinical results of each participant. 30 parents were trained to supply a high fiber diet for their children, and its effect on chronic functional constipation was followed after two months. The children of these parents were considered as the case group and the other 30 children were considered as the control group. Before the parents were educated, the amount of fiber intake from fruits and vegetables by the children was 7.6 +/- 2.1 gr. in the case group which increased to 24.25 +/- 2.3 gr. after 2 months of training. The amount of water intake was 280 ml before training which increased to 600 ml afterwards and that of milk and yoghurt intake was 280 and 240 ml which decreased to 60 and 200 ml after training, respectively. The amount of beverage and fruit juice intake was 280 and 220 ml while after training it decreased to 100 and 60 ml, respectively. In the case group, 10% of the children had 3 to 6 times defecation per week before the intervention while this increased significantly to 56.7% of the children after the training. The stool consistency significantly changed from very firm to normal and soft consistency after training and the times of stool defecation increased significantly, too. The children's nutrition status changed from a poor state to a good status after training. Drug treatment was more effective in children that consumed high-fiber diet. It was shown that some of these changes were significant. The difference between the two groups was not, of course, significant which might be due to the small sample size

Can stereological studies be helpful in differentiating biliary atresia from neonatal hepatitis?

Cholestatic jaundice is a potentially dangerous condition which is often misdiagnosed by paediatricians as physiological or breast milk jaundice. The two most common causes of neonatal cholestasis [NC] are biliary atresia [BA] and neonatal hepatitis [NH]. Early and accurate differentiation of these two entities is very important as early surgery in BA improves the biliary drainage but the delay leads to irreversible hepatocellular damage. There has been much discussion over the value of hepatobiliary radioisotopic scans, liver histopathological features, serum g-glutamyl transpeptidase [GGTP] levels, and other tests which are widely used for differentiation of BA from NH. Stereology provides practical techniques for extracting quantitative information about a threedimensional material from measurements made on two-dimensional planar sections of the tissues. We suggest that the stereological study of different components of liver tissue may be useful in determining the function of liver and differentiating some liver diseases such as biliary atresia and neonatal hepatitis

Migraine headache and acid peptic diseases in children

Although there are some studies on correlation between migraine headache and GI symptoms, they did not significantly support the correlation between migraine headache and acid peptic diseases. This case control study aimed to find such a correlation. There were 70 patients [5-15 years old] who had endoscopic documented acid peptic diseases. The frequency of migraine headache in this group and also in a group consisting of a sample of normal population [300 individuals] without any GI problem in the past year was determined by a questionnaire. The frequency of migraine headache was determined in each kind of acid peptic disease in the patients, being 92.9%, 68.6%, 24.3%, 4.3%, and 4.3% among patients with gastritis, esophagitis, doudenitis, gastric ulcer, and duodenal ulcer, respectively. The frequencies of migraine headache among the normal population and acid peptic disease group were 11.3% and 22.9%, respectively. The difference was found to be statistically significant. Our findings showed a significant correlation between migraine headache and acid peptic diseases, especially esophagitis and gastritis. This result accords with that in some of the previous studies

Peri-operative high-dose V post-operative low dose steroid therapy in the management of biliary atresia: a preliminary report

The use of high-dose steroid therapy peri portoenterostomy may have a positive impact on the frequency of cholangitis and survival rate. A prospective study was conducted on two groups of patients [less than three months of age] suffering from biliary atresia from 1999 to 2005. The patients in group I [G I] were managed peri-operatively by high-dose methylprednisolone while the other group [G II] received low dose methylprednisolone only post-operatively [2mg/k/day for 1 month]. Infants in GI [n = 30] received methylprednisolone for 3 successive days before operation [10-8-6mg/kg/day], and 10 mg/k at the day of operation respectively. Thereafter the dose was tapered in the next successive 6 days by 8, 6, 5, 4, 3, and 2 mg/kg/day and continued for one month. Seventy two infants with biliary atresia were operated [39 girls and 33 boys]. Twenty-six of the 30 patients [86%] in G I became jaundice-free within 90 days after portoenterostomy while only seven [15%] of the 42 patients in G II had normal bilirubin [P < 0.0001]. Episodes of postoperative cholangitis in G I were 20% [6 of 30], and 53% [24 of 42] in G II [P < 0.005]. The difference in 3-year survival rate between the two groups is also remarkable: Eighty seven percent [26 of 30] in GI versus 29% [13 of 45] in G II [P < 0.005]. Death related to biliary atresia occurred in 1 [3.3%] patient in GI compared with 12 [29%] patients in G II [p < 0.005]. These results provide strong evidence that peri-operative high dose steroid therapy is not only safe in this patients population, but because of its anti-inflammatory and cholerrhetic effects has a positive impact on preventing recurrent cholangitis, and ultimately survival

Bowel movement patterns in children with acute appendicitis

Acute appendicitis is currently one of the most important causes of acute abdominal peritonitis and emergency laparatomy. Despite its low mortality, it remains a cause of concern for surgeons due to the postoperative complications of wound infection, sepsis, intrabdominal abscess and even bowel obstruction resulting from adhesions. High incidence of acute appendicitis provides a strong impetus for further studies. This study was conducted to determine the bowel movement patterns and dietary fiber consumption in pediatric patients with appendicitis in Shiraz, southern Iran. The study included 202 pediatric patients under the age of 18 years at Nemazee Hospital affiliated to Shiraz University of Medical Sciences, who had undergone appendectomy with the preoperative diagnosis of acute appendicitis from March 2003 to March 2004. Using a written semi-standard questionnaire, the variables recorded were age, gender, stool consistency, number of bowel movements, type of bread consumed, habit of fruit and vegetable consumption, clinical presentation [signs and symptoms] and the time taken from the onset of symptoms to arrival in hospital, the date of patients admission to the emergency room to the time of surgery, and the duration of postoperative hospitalization. The pathology of appendicitis was clarified and recorded. The patients aged from 3-18 years [mean: 11.2 +/- 3.6 years], with a male to female ratio of 2:4. Anorexia was the most common symptom, affecting 78.7% of patients. Of 31 patients with constipation, 58% did not report daily regular intake of fruits while the others had regular fruit intake. Only 3 patients [9.7%] had regular daily consumption of vegetables, and 27 patients [87.1%] had pathology reports of fecalith, while in the nonconstipated patients, only 1.2% had such reports. The abdominal pain was periumbilical in many patients [42.6%], which shifted to McBurny point in most [96%] patients. 134 patients [66.3%] visited a health center within 24 hours after the first symptoms. Surgeries were performed on 132 patients [65.3%] within 6 hours, on 67 patients [33%] within 6-12 hours, and on 3 patients [2%] in more than 12 hours. Our findings suggest a high rate of constipation in patients with lower fiber intake, which is consistent with the hypothesis indicating the role of dietary fibers in lowering the incidence of appendicitis

Endoscopic findings in children on non-steroidal anti-inflammatory drugs [NSAIDs]

Non-steroidal anti-inflammatory drugs [NSAIDs] remain as the initial approach to the pharmacologic management in juvenile rheumatoid arthritis [JRA]. Gastrointestinal [GI] damage associated with NSAIDs is common in adults, but there are few studies available in children. This study was performed to determine the GI complications due to the use of NSAIDs in a cohort of JRA patients by endoscopy. Twenty-one patients with JRA who were using NSAIDs for at least 3 months were assessed clinically and by endoscopy at Pediatric Immunology Clinic of Nemazee Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, southern Iran from June 1999 to June 2003. The mean age of the patients was 9.8 years [11 females], and the mean duration under NSAIDs management was 16 months. The most common NSAIDs used was diclofenac. GI symptoms were found in 42.9% of patients including 33.4% abdominal pain and 9.5% vomiting. There was no significant difference between the patients and symptoms free subjects in regard to mean duration of treatment. Macroscopic endoscopic lesions were found in 85.7% and infection of Helicobacter pylori [Hp] in 14.3% of cases. There was no significant relationship between endoscopic findings and duration of treatment or clinical symptoms. Our data showed that patients using NSAIDs had frequent GI damage without any relationship to the duration of treatment. There were also a high number of children with GI damage and without any clinical complaint. Furthermore, we found no significant relationship between the duration of drug use and the GI complaints, and no relation between duration and GI complaints to upper GI tract endoscopic lesions. The possibility of GI derangements with NSAIDs in pediatric age group is high. Close monitoring of symptoms and prevention measures are suggested

Clinical and laboratory features of hypertrophic pyloric stenosis

Hypertrophic Pyloric stenosis [HPS] is the most common surgical condition of stomach and duodenum which presents with intractable vomiting during the first weeks of life and death is unavoidable if left without treatment. This study aimed at evaluating the clinical and paraclinical characteristics of the disease in order to emphasize the importance of this potentially life threatening disease. In this retrospective study, from 1358 to 1382 hospital records of all the infants admitted in Shiraz university hospitals with the diagnosis of HPS were studied. From the 231 infants studied, 202 [87%] were male and 29 [13%] were female [male to female ratio of 8 to 1]. Ten cases [4.3%] had positive family history of the disease. 35 [15%] of them were the first child of the family. The onset of symptoms was between 2[nd] and 5[th] weeks of life in majority of the cases [75%]. Olive mass was observed in 116 [51%] of the cases, while constipation, bloody vomiting and jaundice were documented in 36%, 2% and 9% of the cases, respectively. Upper gastrointestinal series was diagnostic in 86% of the cases. However, abdominal sonography was helpful in only 88% of the cases. With proper observation and early diagnosis [by means of abdominal sonography] of patients suffering from repeated episodes of vomiting, the mortality and morbidity of this disease can be reduced

Investigation of H pylori colonization in adenotonsillectomy specimens by means of rapid urease [CLO] test

This prospective clinical study was performed to investigate the colonization of H pylori in adenoid and tonsil tissues by using the Campylobacter-like organism [CLO] test. Included in the study were 56 patients aged 3 to 43 yrs who had undergone adenoidectomy, tonsillectomy or adenotonsillectomy procedures under general anesthesia. Two-mm diameter tissue pieces of adenoid and tonsil specimens were placed in urease solution. Color changes were noted after 30 min and 24 hrs. 27 [48.2%] of the patients were shown to be H pylori positive and 29 [51.8%] were negative, regardless of the type of specimen. There was a high rate of H pylori colonization in tonsil and adenoid tissues. The cause of recurrent H pylori infections of the gastric mucosa may be the result of colonization in the adenotonsillar tissues. Prevention of H pylori colonization may reduce the recurrences of the disease

CIDP and achalasia: two manifestations of a disease or coincidental association

Chronic inflammatory demyelinating polyneuroradiculopathy [CIDP] is an immune mediated disorder characterized by progressive developing or relapsing symmetrical motor or sensory symptoms in more than one limb over a period of two months. Achalasia, as a primary esophageal motility disorder, is also characterized by increasing the tone of lower esophageal sphincter, absence or incomplete sphincter relaxation in response to swallowing, loss of esophageal peristalsis and rising intra-esophageal pressure. Herein, a case of CIDP, dysmotility- like symptoms, and achalasia is presented

Prophylactic ranitidine in prevention of GI bleeding in neontatal intensive care units

Upper gastrointestinal [GI] bleeding remains a problem in critically ill-newborns. The use of H 2 blockers, by maintaining gastric pH >/= 4, reduces the risk of stress-ulceration and gastric hemorrhage. This study therefore, has evaluated the effects of short-term prophylactic ranitidine in controlling gastric pH and prevention of GI bleeding in neonates. This randomized controlled study was carried out on 80 neonates admitted to Neonatal Intensive Care Unit ward of Nemazee Hospital, Shiraz, Iran. They were randomly divided into case and control groups and their gastric pH, stool occult blood and macroscopic bleeding were determined. Intravenous ranitidine was administrated [5 mg/kg/day] for four days in case group. Their gastric pH was measured before, one hrs, and two or three days after injection and successful prophylactic treatment was considered if gastric pH was 4. Upper GI bleeding was observed in 41% of all patients. After ranitidine, there was a significant increase in gastric pH which accompanied with the reduction of the frequency of upper GI bleeding. Furthermore, no significant changes were noted in gastric pH of control group. Prophylaxis with ranitidine seems to reduce the frequency of upper GI bleeding by significantly increasing gastric pH

Comparison of prednisolone alone and in combination with azathioprine regimens in treatment of autoimmune hepatitis: a Prospective study

Side effects of steroid therapy of autoimmune hepatitis are seen more frequently with prednisolone only regimen. However, the question of efficacy restrains the broad use of prednisolone in combination with azathioprine. To compare biochemical responses to the two standard immunosuppressive drug regimens [prednisolone alone and prednisolone in combination with azathioprine] in children with autoimmune hepatitis. The study was performed on 42 children with autoimmune hepatitis. Patients were attributed to two groups, with group A receiving prednisolone alone and group B receiving prednisolone in combination with azathioprine, using simple random attribution unless there was a contraindication to azathioprine. The patients were evaluated for treatment response on three occasions: short term [one month after starting therapy], intermediate term [four to six month after starting therapy], and long term [one year after starting therapy]. Chemical response was defined as decrease in aminotransferases to a level below two times the normal values and gamma globulin to lower than 2.8 g/dL. Clinical response was defined as improvement in the initial clinical signs and symptoms [jaundice, hepatomegaly, splenomegaly, fever, and edema/ascites]. There were no differences in chemical and clinical response rates between the two groups. Both clinical and chemical response rates in intermediate term were significantly higher than short term. However, clinical and chemical response rates in long term did not significantly differ from intermediate term. The study shows that some patients need time to respond to therapy. Nonetheless, it seems that whenever there is no improvement after six months of therapy, it is prudent to change the treatment regimen rather than waiting for response. With the same efficacy and less side effects, the combination regimen must be preferred as the standard regimen, unless there is a contraindication to azathioprine