[Etiological evaluation of mental retardation among children 3-14 years of age referred to pediatric Neurology clinic Imam Khomeini Hospital during 1996-2000]

Mental retardation [MR] is a common problem in the world especially in the developing countries. Nearly 2-3% of total population have IQ below 70 but only 0.3% of them have severe mental retardation. The purpose of this study is to evaluate the etiologic factors of mental retardation. In a retrospective study, we collected 160 cases referring to the pediatric neurologic out patient of Imam Khomeini Hospital with the chief complaint of mental retardation between 1996-2000, and documented their IQ with the help of Ravon test. The causes of MR were divided into pre/ peri / postnatal and unknown ones. The causes were prenatal in 24[15%], perinatal in 82[51.3%], postnatal in 31[19.4%] and unknown in 23[14.4%] of the cases. In the first group [prenatal causes] fragile X syndrome was the most frequent one 5 cases [3/1%]. But hypoxic- ischemic encephalopathy 31 cases [19.37%], neonatal infection 25 cases [15. 61%], hyperbilirubinemia 16cases [10%] and RDS 12 cases [7.5%] were the most frequent causes in the perinatal group, and epilepsy 16 cases [10%], C.N.S. infection 5 cases [3.1%], trauma 5 [3.1%] were the most frequent causes among the postnatal groups. As the result, we conclude that in the majority of our patients, the cause of MR were perinatal accidents. Secondly perinatal causes were the most important and common causes [51.2%]. Moreover, it appears that these factors were preventable and preventive medicine could be an effective measure in the reducing the incidence of MR

[Evaluation of Cow's milk allergy among infants with bloody stools]

Cow's milk allergy [CMA] is an immunologic phenomenon to the proteins present in Cow's milk. It frequently appears with gastrointestinal [GI] problems such as abdominal pain, diarrhea and bloody stool. Its frequency is about 1.9 - 7.5% and symptoms usually appear in early months of life. In this study, we assess CMA in infants with rectorrhagia. In this study infants [< 2years] with complaints of rectorrhagia reporting at the children's clinic at Imam Khomeini Hospital were included. Inclusion criteria comprised of parents' report of passage of bloody stools, absence of infeetion and local conditions such as anal fissure, acidic PH and lactase deficiency. Then formal consents were taken, skin prick test and open food challenge test were performed. Those who were refractory to diet without cow's milk protein were assessed by colonoscopic procedure. Among 198 infants with rectorrhagia, 51 patients were eligible for this study [41% bo1.s . 58.8% girl and with mean age of 5.3 month] . Besides rectorrhagia other manifestation was: diarrhea [80%], abdominal pain [56.9%]. Atopic dermatitis [21.6%] and recurrent vomiting [10%]. Skin prick test were done in 37 cases which was positive in 18 pts. 47 patients had positive challenge tests, in 4 patients with negative challenge test was colonsopy performed. Two cases had nodularity with eosinophilia infiltration, allergic colitis were reported in the others. All patients [including these 4 cases] reponded well to exclusion diet. It has been shown in this study that Cow's Milk Allergy [CMA] has a significant prevalence in infants [<2 years] with rectorrhagia . The definite diagnosis is made by challenge test and the treatment is exclusion diet. According to the results, it is recommended that CMA should be taken in to consideration in children exhibiting gastrointestinal symptoms