Antipyretic efficacy of acetaminophen and ibuprofen in children aged 6 months to 10 years

Fever and consequent convulsion are among major concerns for parents of febrile children. Many antipyretic drugs are applied excessively to decrease ever in children. Many antipyretic drugs are applied excessively to decrease fever in children. This research is designed to study the efficacy and stability effects of cetaminophen and Ibuprofen in febrile children aged 6 months to 10 years old. This single-blind clinical trial study was performed on 390 children [aged 6 months to 10 years] referring to pediatric emergency department. The cases were divided equally and randomly into two groups, allocated to receive either 15 mg/kg Acetaminophen or 10mg/kg Ibuprofen. Including criteria was oral temperature of 38-40 degrees centigrade or rectal temperature of 38.5-40.5 degrees centigrade. Temperatures were recorded at the time of admission, 2, 4 and 6 hours after receiving antipyretic drug. Data was analyzed by SPSS software. T-tests and chi-square test were used for statistical comparisons. Findings revealed that mean temperatures on admission were 39.01 +/- 0.7 degrees centigrade and 39.03 +/- 0.69 degrees centigrade in the Acetaminophen and Ibuprofen groups, respectively, showing no significant difference. Mean temperatures at 2 hours after initiation of treatment in Acetaminophen and Ibruprofen groups were 38.78 +/- 0.92 degrees centigrade and 37.25 +/- 0.78 degrees centigrade, respectively [P<0.0001]. After 6 hours, the temperatures were 37.36 +/- 0.92 degrees centigrade and 36.99 +/- 0.05 degrees centigrade [P<0.002]. Overall, stability of antipyretic effect of Ibuprofen was more than Acetaminophen. Results indicate that Ibruporfen is more effective than Acetaminophen in maximum decline in temperature and its stability in lowering temperature is better than Acetaminophen. It is suggested that Ibruprofen be used as an antipyretic in children older than 6 months when Acetaminophen cannot control fever or more stable antipyretic is expected

[Pheocoromocytoma; a case report]

Pheochromocytoma is a neoplosia of chromaffin cells that is very rare in children. Its signs and symptoms result from the release of catecholamine. It is usually a solitary, unilateral encapsulated tumor. The predominant clinical findings are crises of hypertension, palpitation, abdominal pain, paleness, vomiting, sweating, and weight loss. Its diagnosis requires a certain degree of suspicion. Case report: We report on a 3-year-old child with pheochromocytoma of difficult clinical management. Diagnosis was confirmed by anatomicophathological study. The patient recovered after surgical resection of the tumor. The patient was a rare case of pheochromocytoma, his problems being especially hypertension and was cured after surgical resection of the tumor. This demonstrates the beneficial effect of early diagnosis and treatment

Diagnostic validity of electrocardiography compared with echocardiography for diagnosing left ventricular hypertrophy in patients with beta-thalassemia major

Left ventricular hypertrophy [LVH] is an important risk factor in determining cardiovascular disease prognosis. Echocardiography [ECHO] is a sensitive and specific tool for detection of LVH but cost and operational consideration tend to limit its utility; in contrast, the Electrocardiography [ECG] is widely available, expensive and less operator dependent. Since the comparison of diagnostic validity between ECG and ECHO for evaluating of LVH has not been well studied, this survey was carried out on a number of major beta-thalassemia patients. This descriptive-analytical study was performed on 135 patients [including male and female] with major beta- thalassemia over 8 years old. Patients with heart failure, valvular or structural heart disease, renal and endocrine disease and Hb<10g/dl were excluded. ECG and ECHO were performed 48 h after blood transfusion. ECG criteria of LVH and myocardial performance index [MPI] in ECHO were measured. Sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of ECG indexes were calculated separately for both sexes and compared with ECHO findings. The patients included 64 [47/4%] males and 71 [52/6%] females. ECG indexes were found as follows: 70% sensitivity of the Sokolow-Lyon index, 14.3%; specificity, 90.3% PPV, 40% NPV and. Sensitivity of the Sokolow-Lyon-Rappaport, specificity, PPV, and NPV were 61.9%, 25/8%, 27/4%, 60%, respectively. Sensitivity of the Cornell index was66.6%. specificity 13.3%, PPV 86% and NPV 4.7%, Sensitivity of the White-Bock index was 0%, specificity 100%, PPV 0% and NPV was 68.9%. There was significant relationship between ECG indexes and some ECHO parameters. In this study there was a reverse and significant relationship between left acceleration time [AT] and the Sokolow-Lyon-Rappaport index statistically [r = 0.181, p = 0.035]. There was a significant direct relationship between left deceleration time [DT] and the Sokolow-Lyon-Rappaport index [r = 0.181, p = 0.036]. A reverse significant relationship between right AT and the Sokolow-Lyon index was seen [r = 0.173, p = 0.044]. A direct and significant relationship between diastolic inter ventricular septum diameter [IVSd] and the Sokolow-Lyon-Rappaport index was also observed [r = 0.186, p = 0.031]

[Comparison between echocardiography finding and cardiac catheterization data in diagnosis of pulmonary hypertension]

Pulmonary hypertension [PHT] is a common accompaniment of many congenital cardiac lesions. Cardiac catheterization is the gold standard method for confirming the diagnosis of PHT and for guiding management. Doppler ultrasound also can be used non-invasively to estimate the pulmonary artery pressure. We reviewed the clinical history, examination and echocardiogram of 84 patients [male=50, female=34] [mean age = 4.2 Y [3m-15y] who underwent cardiac catheterization for their congenital heart problem in our pediatric cardiology ward [Mar 2001-Apr 2002]. The patients were divided into pulmonary hypertension [PHT] group and normal pulmonary artery pressure [NPAP] group according to the results of catheterization. PHT was diagnosed in 40 patients [47%] by catheterization compared with 42 patients [50%] by echocardiography. Mean age of PHT groups was 3.38 years [3 months to 4 years] by 24 male [60%]; and 5.5y [8-15] by 26 male [59%] in NPAP group. The sensitivity and specificity of echocardiography in diagnosis of PHT was 100% and 95% respectively. The positive predictive value of echo cardiography was 95% and the negative predictive value was 100%. These results indicate similar diagnostic power by echocardiography and catheterization in identifying pulmonary hypertension

[Correlation between serum uric acid level in children with congenital heart disease and severe pulmonary hypertention]

This study evaluated correlation between serum uric acid level with pulmonary hypertension and progress of pulmonary vascular disease in children with Congenital Heart Disease [CHD] and Eisenmenger syndrome. This case-control study was performed on 75 patients with congenital heart disease, from Mar 2001 to Apr 2004 that had referred to pediatric cardiology ward in Ali-Asghar hospital, Zahedan and then cardiac catheterization performed at Khatam Hospital. Among 75 patients, 25 cases suffered from Eisenmenger syndrome [group 1], 25 cases had pulmonary hypertension [group 2] and 25 cases were in control with normal pulmonary artery pressure [group 3]. Then collected data were analyzed with SPSS and Chi-square, Mann-Whitney, Kruskal-Wallis and correlation tests and then results of three groups were compared to one another. Mean age in Eisenmenger syndrome [group 1] was 2.75 +/- 2.23 years, in pulmonary hypertension [group 2] 3.52 +/- 3.76 and in control [group 3] 4.01 +/- 2.34 [P>0.05]. There was no significant statistical difference between three groups regarding age and sex [P>0.05]. The mean pulmonary artery pressure was 71.65 +/- 9.26 in group 1, 39.22 +/- 10.09 in group 2 and 13.65 +/- 1.69 mmHg in group 3 [P<0.001]. The mean QP/QS ratio was 1.2 +/- 0.29 in group 1, 1.89 +/- 0.31 in group 2 and 1 +/- 0 in group 3 [P<0.001]. The mean RV pressure was 92.2 +/- 12.72 mmHg in group 1, 60.4 +/- 16.7 in group 2 and 25.44 +/- 3.29 in group 3 [P<0.001]. The mean pulmonary vascular resistance was 0.952 +/- 0.1 in group 1, 0.33 +/- 0.12 in group 2, and 0.13 +/- 0.01 in group 3 [P<0.001] there was a correlation between serum uric acid level and pulmonary vascular resistance in group 1 [r=0.425, P<0.034]. The mean serum uric acid level was 6.83 +/- 2.07 mg/dl, 4.01 +/- 1.14, 4.45 +/- 0.75 in the three groups respectively [P<0.05]. Also this study showed that there is no statistical significant relationship between mortality rate and serum uric acid in group 1. In this study, a significant correlation between increased serum uric acid level and increased pulmonary vascular resistance in patients -with Eisenmenger syndrome -was found and there was no a significant correlation between serum uric acid level and pulmonary vascular resistance in other groups. So serum uric acid could be used for prediction of severity and progress of Eisenmenger syndrome in children with congenital heart disease [CHD]

[Left ventricular mass index and diastolic function in children with thalassemia major]

Cardiac complications are the major cause of morbidity and mortality in patients with Beta Thalassemia Major [BTM]. Increased left ventricular mass index is due to ventricular hypertrophy after iron overload. The purpose of this study was to assess the relationship between left ventricular mass index [LVMI] and diastolic function and early diagnosis of cardiac involvement by echocardiography. This cross-sectional study was conducted on 44 patients with BMT and a healthy control group [matched based on age and sex] in Ali-Asghar hospital of Zahedan from September 2002 to December 2003. After physical examination, complete M-Mode, 2D and Doppler echocardiography studies were performed and left ventricular diastolic and left ventricular mass index were assessed and these data were compared with those of the control group. From 44 patients 24 were male. The mean age was 14.3+2.9 years. The mean weight, height and body surface area [BSA] were 34.5 +/- 7.4, 142.2 +/- 12.3, 1.16 +/- 0.17 respectively. Compared to the control group, the mean weight, height and BSA in cases were decreased, the mean heart rate increased and systolic and diastolic blood pressures decreased significantly. LVMI increased significantly [50% compared with that of the control group] too. Cardiac output stroke volume and also heart rate increased significantly due to increased left chamber size. Systolic function was in acceptable range in all subjects excluding 5 patients. Diastolic dysfunction was more common and isovolumic relaxation time [IVRT] was the most frequent abnormal diastolic index which increased significantly with increment of LVMI. The results of this study showed that prolonged IVRT and LVMI had a significant correlation. Therefore the assessment of LVMI and diastolic function is a must that leads to early diagnosis of cardiac dysfunction

[Evaluation of knowledge and behavior of parents about vaccination of their under 6 year-old children in Zahedan]

Immunization is the most efficacious and cost effective intervention available to improve the health and wellbeing of children and prevention of infectious disease.The goal of this research was the determination of knowledge and behavior of parents about vaccination of under 6 year-old children in Zahedan. This study was descriptive analytic. The sample size was 1066 persons [father or mother] and the data was collected with a questionnaire containing parents' specifications [gender, age and education level]. The collected data was analyzed with Chi-square test.rom 1066 persons 756 persons [70.9%] had moderate knowledge, and 159 persons [14.9%] had low knowledge about vaccination. 844 persons [79.2%] had performed complete and 222 persons [20.5%] incomplete vaccination for their children. In this study we found significant relation between knowledge and age, as well as educational level and information source of parents [p<0.001]. The relationship between parent's behavior about vaccination and her age [p=0.2], and her education level [p=0.1] was not significant, but relationship between parents behavior and information source was significant [p=0.007]. Parents' information source was Radio, TV, journals, books and newspapers, friends, physicians and health care workers.Parents' knowledge about vaccination is an important factor in prevention of infectious diseases, so it will be rewarding to work on increasing parents' knowledge about vaccination by any available means