Risk factors of bruxism in children and adolescents: A case-control study.

Objectives: This study aimed to investigate the risk factors of bruxism in children and adolescents under 15 years old in Iran. Materials & Methods: This case-control study was conducted in day clinics of Shahid Beheshti Hospital in 2020. Fifty children with bruxism in the case group and 50 without in the control group were compared to five risk factors, including intestinal parasites, sucking the fingers, biting objects, a family history of bruxism, and secondhand smoking (SHS). The statistical tests of smoking, odds ratio, and logistic regression were used for data analysis. Results: The mean age of the subjects was 10.6±3.2 and 10.8±2.9 years in the case and control groups, respectively. The bruxism showed significant relation with sucking the fingers, the family history of bruxism, and intestinal parasites. The SHS and biting objects showed no significant relation with bruxism. The logistic regression indicated that the study variables could explain the 22.6 to 30.1% of risk factors in bruxism. Conclusion: Bruxism is a common disorder in children and adolescents. The intestinal parasites might be associated with bruxism. These infestations should be diagnosed and treated in children with bruxism.

Correlation of sensitization to food allergens in Iranian patients with migraine and tension headaches.

OBJECTIVES: Headache is one of the most common neurological disorders around the world. Previous studies have proposed associations of food allergies with headaches. Therefore, this study evaluated the frequency of sensitization to food allergens in patients with migraine and tension headaches and their correlations with these disorders. METHODS: The study subjects consisted of 20 patients with migraine headache and 20 subjects with tension headache. Headache disorders were confirmed by a specialist. Food allergen sensitization was diagnosed by skin prick test (SPT) or radioallergosorbent test (RAST), clinical history, and physical examination. RESULTS: There was no significant difference in age and gender between patients with migraine and tension headaches. Other results showed sensitization to food allergens, such as egg, wheat, fish, banana, orange, and soybean, in patients with migraine headache was similar to those in subjects with tension headache. However, patients with migraine headache significantly differed from individuals with tension headache in allergic responses to tree nut (P=0.047), peanut (P=0.028), and cow's milk (P=0.044). CONCLUSION: The results of this study showed that sensitization to food allergens may relate to migraine headache which their diagnosis can help to better control and manage the disease.

Investigating the Relationship between Serum Levels of Interleukin-22 and Interleukin-1 Beta with Febrile Seizure.

A febrile seizure is the most common type of seizure in young kids, which is not fully known. Inflammatory mediators can affect the pathogenesis of the disease. Considering the controversy about the impacts of interleukin 1 beta (IL-1ß) and the lack of a study on interleukin 22 (IL-22), the purpose of the present study was to investigate the relationship between IL-22 and IL-1ß serum levels with febrile seizure in young kids. Our case-control study has been conducted on 120 young kids aged 6-60 months with the sign of the fever. Rectal temperature was measured for allcases. Patients with febrile seizure (n=60) and patients with fever and without a seizure (n=60) were investigated as case and control groups, respectively. Serum levels of IL-22 and IL-1ß were measured in all participants through the ELISA method. The serum level of IL-1ß was significantly higher in the case group compared to the control group (p˂0.001), while there were no significant differences between the two groups in terms of IL-22 (p=0.92). Unlike IL-1ß (p≤0.021), IL-22 showed no difference between two groups according to some demographic and clinical features like gender, age group, family history of febrile seizure, family history of epilepsy, and evolutionary status (p>0.22). Logistic multiple regression analysis showed that, unlike IL-1ß (p˂0.001), IL-22 does not change the chance of febrile seizure in the study groups (p=0.737). The findings of this study indicated that, unlike IL-1ß, IL-22 has not any changes/effects in the febrile seizure.

Perineal trauma: incidence and its risk factors.

Perineal trauma can lead to short- and long-term complications for the mother. The purpose of this study was to determine the incidence of perineal trauma and its related factors. In this cross-sectional study, the maternal, neonatal, obstetric and childbirth information for all women who delivered in Kashan city hospitals was studied. Data were analysed using the Chi-square test, the t-test and logistic regression. The incidence of perineal trauma was 84.3%. Ninety-five percent of the primiparous women and 43.9% of the multiparous women had an episiotomy ([p value<.001], AOR = 24.4). The chance of birth trauma in the cases of younger maternal age, increasing gestational age, induction of labour, fundal pressure, Iranian nationality and nulliparity are increased. The incidence of perineal trauma in this study was high and should be minimised with a limited use of an episiotomy. It is recommended that midwives and obstetricians pay more attention to the women at risk. Impact Statement What is already known on this subject? Perineal trauma is common in vaginal delivery. Scientific literature shows several predictors of perineal trauma such as maternal age, parity, induction of labour, gestational age and birth weight, etc.; although in other studies some of these variables were not associated with perineal trauma. Considering that the findings about the factors associated with birth injuries are controversial, we decided to assess the incidence of perineal trauma and its risk factors during childbirth. What the results of this study add? This study indicated a high incidence of perineal trauma and agrees with the existing literature that maternal age, parity, the induction of labour, gestational age, fundal pressure and nationality are associated with perineal trauma; however, other factors were not found as predictors in our study. What the implications are of these findings for clinical practice and/or further research? Our results agreed with the existing literature regarding some predictors of perineal trauma but not for birth weight, foetal distress, second stage duration, hospital type, etc. This data could be used to implement protocols for reducing the rate of a routine episiotomy, considering too the high risk women for the prevention of perineal trauma.

Prophylactic effect of riboflavin on pediatric migraine: a randomized, double-blind, placebo-controlled trial.

BACKGROUND AND AIM: Riboflavin may have an acceptable effect on migraine among children. This study was carried out to determine the prophylactic effect of riboflavin on migraine in children. METHODS: This randomized clinical trial study was performed at Shahid Beheshti Hospital in Kashan, Iran from December 2012 to February 2015. Ninety children with migraine were allocated randomly into 3 groups (placebo, low-dose and high-dose riboflavin). The outcomes (frequency, intensity and duration of headaches) were measured at baseline and 12 weeks of medication in each group, and the decrease of them were compared. SPSS software version 16 was used for analysis of the data. Descriptive statistics, Chi-square, Fisher's exact and t-test were used for statistical analyses. RESULTS: There was a significant decrease of migraine frequency (p=0.000) and mean duration (p=0.000) in the high-dose group compared with the placebo group. No significant reduction of frequency and mean duration of attacks were reported in the low-dose group compared to the placebo group (p=0.49 and p=0.69 respectively). There was no significant reduction of migraine intensity in the low-dose and high-dose groups compared to the placebo group (p=0.71 and p=0.74 respectively). CONCLUSION: High-dose riboflavin is a safe, well tolerated, cost-effective method of prophylaxis for children with migraine. TRIAL REGISTRATION: The trial was registered at the Iranian Clinical Trial Registry with number IRCT2013020412361N1. FUNDING: The study was supported by the Deputy of Research, Kashan University of Medical Sciences (grant number 91073).

Bilateral Ptosis as the First Presentation of Guillain-Barre Syndrome.

Objective Guillain-Barre syndrome (GBS) is the most common cause of acute weakness in children. It has multiple variant forms with different presentations. A rare initial sign is ptosis. In this study, we present a 10-year-old girl with bilateral ptosis without opthalmoplegia followed by a weakness in extremities with a favourable response to intravenous immunoglobulin. Due to the patient's initial eyelid levators, myasthenia gravis was ruled out by a Tensilon test and electrophysiological studies. Our report highlights the possibility of GBS as a cause of isolated ptosis, especially in cases without ophthalmoplegia.

Incidence and Risk Factors of Neural Tube Defects in Kashan, Central Iran.

OBJECTIVE: Neural tube defects (NTDs) are the most common congenital defects of central nervous system due to neural tube closure deficit during the third and fourth weeks of gestational age. Our study was performed to detect the incidence and risk factors of NTDs in Kashan, center of Iran. MATERIAL & METHODS: This case-control study was done on all pregnancies with NTD affected neonates (n=91) and 209 pregnancies with normal neonates from February 2007 to December 2012 in three hospitals in Kashan, center of Iran. Annual and the mean incidence of NTDs were calculated. Risk factors including neonatal gender, maternal age, gravidity, maternal abortion history, maternal gestational diabetes (GDM), folic acid use, familial marriage, maternal body mass index (BMI), birth season and family history of NTDs were evaluated by interview with mothers. Univariate and multivariate logistic regression were used to analyze the risk factors. RESULTS: The mean incidence of NTDs was 2.33 per 1000 births. The multivariate analysis indicated that maternal history of abortion (OR: 4.9, CI: 1.9-12.8), and maternal obesity (OR: 5.4, CI: 1.3-21.8) were significantly associated with NTDs. CONCLUSION: Maternal history of abortion and BMI were the major risk factors of NTDs.

The Etiology and Clinical Evaluations of Neonatal Seizures in Kashan, IRAN.

OBJECTIVE: Detection of seizure, its etiology, and clinical types is important for guiding therapy. This study was designed to evaluate the etiology and clinical evaluations of neonatal seizures in Kashan, Iran. MATERIALS AND METHODS: The data of 100 hospitalized neonates with a complaint of seizures in Kashan City, from January 2006 to January 2011 were evaluated. The pediatric neurologist made the final diagnosis. The gestational age, neonate admission age, type of delivery, and laboratory and radiological investigations were reviewed from the medical records. The relation of seizure etiology and other variables were compared using the Chi-square test. All the statistical analyses were performed using SPSS (ver 11.5). RESULTS: A total of 100 neonates were hospitalized with a diagnosis of seizures. The overall incidence rate of seizures was 2.6 per 1,000 live births. A total of 59% of seizures happened in the first three days of life. The etiologies of seizures were hypoxicischemic encephalopathy (HIE) (36%), hyponatremia (12%), hypoglycemia (11%), intracranial hemorrhage (11%), infections (10%), hypocalcemia (8%), metabolic disorders (7%), the structural anomalies (5%), and hypomagnesaemia (4%). In 23% of neonates, no specific etiology was found and 23% had multiple etiologies. In 45% of neonates, the EEG was not recorded. The type of the seizures were focal-clonic (26%), tonic (25%), multifocal clonic (34%), subtle (11%), and myoclonic (4%). The types of the seizure were unrelated to the paraclinical findings. CONCLUSION: Neonatal seizures are common and HIE was the main cause of seizures in this study. The clinical evaluation of neonatal seizures needs improvement.

Incidence of Neonatal Birth Injuries and Related Factors in Kashan, Iran.

BACKGROUND: Birth injuries are defined as the impairment of neonatal body function due to adverse events that occur at birth and can be avoidable or inevitable. Despite exact prenatal care, birth trauma usually occurs, particularly in long and difficult labor or fetal malpresentations. OBJECTIVES: This study aimed to investigate the incidence of birth injuries and their related factors in Kashan, Iran, during 2012-2013. PATIENTS AND METHODS: In this cross-sectional study, all live-born neonates in the hospitals of Kashan City were assessed prospectively by a checklist included demographic variables (maternal age, weight, and nationality), reproductive and labor variables (prenatal care, parity, gestational age, premature rupture of membrane (PROM), fetal heart rate (FHR) pattern, duration of PROM, induction of labor, fundal pressure, shoulder dystocia, fetal presentation, duration of second stage, type of delivery, and delivery attendance), and neonatal variables (sex, birth weight, height, head circumference, Apgar score, and neonatal trauma). Birth trauma was diagnosed based on pediatrician or resident examination and in some cases confirmed by paraclinic methods. Statistical analyses were performed by chi-square, student's t-test, and multiple logistic regression analyses using SPSS version 17. P ≤ 0.05 was considered statistically significant. RESULTS: In this study, the incidence of birth trauma was 2.2%. Incidence of trauma was 3.6% in vaginal deliveries and 1.2% in cesarean sections (P < 0.0001). The most common trauma was cephalohematoma (57.2%) and then asphyxia (16.8%). In multiple logistic regression analyses, decreased fetal heart rate (FHR), fundal pressure, shoulder dystocia, vaginal delivery, male sex, neonatal weight, delivery by resident, induction of labor, and delivery in a teaching hospital were predictors of birth trauma. CONCLUSIONS: Overall, incidence of birth trauma in Kashan City was lower in comparison with most studies. Considering existing risk factors, further monitoring on labor, and delivery management in teaching hospitals are recommended to prevent birth injuries. In addition, careful supervision on students and residents' training should be applied in teaching hospitals.

Causes and Associated Factors of Headaches among 5 to 15-year-old Children Referred to a Neurology Clinic in Kashan, Iran.

OBJECTIVE: Headaches are common neurologic problems for children and adolescents. They are divided into two types: primary and secondary. Primary headaches include migraines and tension-type as well as comprise the majority of headaches. We detect the causes of headaches and their associations with demographic variables among children and adolescents. MATERIALS & METHODS: This cross-sectional study was performed on 5-15 year-old children with headaches from March 2010 to April 2012 who presented at a pediatric neurology clinic in Kashan, Iran. Diagnosis of headaches was done in accordance with the International Classification of Headache Disorders. Data regarding the type of headache, age, gender, pain severity, aura, family history, and sleep disorder were collected. RESULTS: One hundred fourteen children (44 male and 70 female) with headaches were enrolled in the study. The types of headaches were comprised as follows: 67 cases of migraines, 38 cases of tension-type headaches, 2 cases of cluster headaches, and 7 cases of secondary headaches. Pulsating headaches, family history of headaches, insomnia, and pain severity had higher prevalence in migrainous patients. CONCLUSION: Physicians should extend their information gathering about primary and secondary headaches. Sleep disturbances and a family history of headaches were the most important factors associated with migraine headaches.

Vincristine-induced cranial neuropathy.

Vincristine (VCR) is a vinca alkaloid that is used for treatment of many malignancies. The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. Described here is the case of a 2.5-year-old boy, a known case of Wilms' tumor, treated by vincristine (0.067 mg/kg/day) and dactinomycin (0.045 mg/kg/day) after surgery. Three weeks after treatment, he presented with bilateral ptosis. Neurological examination revealed bilateral ptosis with normal pupillary reflex and eye movement. He received 3.015 mg cumulative dose of vincristine before development of ptosis. Treatment with pyridoxine (150 mg/m2 p.o. BID) and pyridostigmine (3 mg/kg p.o. BID) was started as neuroprotective agents, and after 7 days the problem disappeared. The treatment continued for 6 weeks and there were no signs of ptosis or a recurrence in follow up 2 months later.

A study on causes and types of abnormal increase in infants' head circumference in kashan/iran.

OBJECTIVE: Head circumference is a valuable index of brain growth and its disturbances can indicate different disorders of nervous system. Abnormal increased head circumference (macrocephaly) is common and observed in about 2% of infants. In this study, the causes and clinical types of abnormal increase in infants' head circumference were investigated in Kashan, Iran. MATERIALS AND METHODS: This cross-sectional study was performed on 90 infants less than 2 years of age with abnormal increase in head circumference in Kashan, during 2009- 2011. The data were collected by history taking, physical examination, growth chart, and imaging. RESULTS: 65 (72%) cases out of 90 infants were male and 25 ( 28%) cases were female. Fifty-three (58.8%) cases had familial megalencephaly, 30 (33.4%) had hydrocephalus, and other causes were observed in 7 (7.8%) cases. Eighty-three percent of Infants with familial megalencephaly and 50% with hydrocephalus had normal fontanels. In 90.6% of cases with familial megalencephaly, family history for large head was positive. Motor development was normal in 100% of cases with familial megalencephaly and 76.7% of hydrocephalic infants. CONCLUSION: Familial megalencephaly was the most common cause of macrocephaly in the studied infants, and most of them had normal physical examination and development, so, parental head circumferences should be considered in the interpretation of infant's head circumference and in cases of abnormal physical examination or development, other diagnostic modalities, including brain imaging should be done.

Cerebral sinovenous thrombosis (CSVT) in a neonate with different manifestations.

Cerebral sinovenous thrombosis (CSVT) is increasingly diagnosed in neonates. Despite many studies which have addressed diagnosis and management of pediatric CSVT, diagnosis of CVSD in neonates is difficult. A female neonate born by natural vaginal delivery was diagnosed with CSVT after initiation of seizure. The seizure was stabilized and after performing diagnostic tests, the diagnosis of CSVT was made. This report describes diagnosis of this rare condition in a newborn baby in order to make awareness about this serious condition in neonates.