Association Between Maternal and Neonatal Serum Vitamin D Levels and the Incidence of Early-Onset Sepsis

Background: Early-onset neonatal sepsis (EOS) is a systemic infection that occurs within the first week of life. Objectives: This study investigated the association of serum vitamin D levels in pregnant women and their neonates with the prevalence of EOS. Methods: This case-control study was performed among 50 term/late pre-term neonates admitted to our NICU due to EOS, alongside 50 healthy neonates matched for gestational age range and sex. Maternal and neonatal serum vitamin D levels were measured. The criteria for diagnosing EOS included any/combination of: respiratory, cardiovascular, hemodynamic, neurological, gastrointestinal, body temperature, or metabolic signs. For sepsis cases, CBC, CRP, blood type, blood culture, chest X ray, and in some cases, and CSF analysis and culture were tested. Mothers’ clinical history was collected. Results: Each group included 30 (60%) male and 20 (40%) female neonates. Birth weight averages were 2772 ± 667 and 3215 ± 349 grams in the case and control groups, respectively (P < 0.001). The mean serum vitamin D levels were 49.75 ± 25.53 and 56.41 ± 18.17 nmol/L in the case and control groups, respectively. The control group mothers had a significantly higher vitamin D level (68.24 nmol/L versus 55.01 in mothers of sepsis cases, p=0.005) and showed a correlation with the vitamin D levels of their neonates (R = 0.731, P < 0.001), while the data failed to show a correlation between vitamin D level in mothers and their neonates in the sepsis group (R = 0.241, P = 0.115). C-section delivery was more prevalent among the sepsis cases (P < 0.001). Conclusions: Early-onset neonatal sepsis is associated with vitamin D deficiency in neonates and their mothers, low birth weight, and being delivered by C-section.

Unusual Presentation of Pulmonary Interstitial Glycogenosis: A Case Report Study

Introduction: Pulmonary interstitial glycogenosis (PIG) is a kind of children’s interstitial lung disease (ChILD). This is exclusively limited to neonates and infants. Often, PIG is diagnosed in the lung biopsy in a short time after birth (usually < 6 months). Most cases of PIG in infants are symptomatic within the first days to weeks of life. PIG expresses itself with diverse clinical symptoms such as tachypnea and hypoxia and may lead to acute respiratory failure in neonates. Case Presentation: In this case report study, we presented a 1.5-year-old boy with the chief complaint of stage 4 clubbing in fingers and toes. Mild chest deformity was observed in his physical exam. No evidence of respiratory and cardiac complications was observed. Initial lab tests and further specific studies were normal. His parents did not mention the history of any diseases in this patient. His chest X-ray (CXR) showed hyperinflated lungs, diffuse bilateral interstitial infiltration, and hazy opacities. Ground glass opacities (GGO) and interlobular septal thickening and cystic changes with reversed halo sign in both lungs were observed in his chest computerized tomography (CT). Finally, pulmonary biopsy showed a high level of glycogen-laden mesenchymal cells in the interstitium of alveoli, and vimentin-positive interstitial infiltration in lung parenchyma confirmed the PIG diagnosis. Conclusions: The new manifestation of PIG, which has been reported in this case, can be beneficial for future diagnoses of PIG.

Analysis of Association Between the Effects of Methylphenidate and DRD4 Gene Polymorphisms in Patients with Attention Deficit Hyperactivity Disorder

Background: Drug treatment is one of the most important treatments for attention deficit hyperactivity disorder (ADHD). The DRD4 gene is a transporter and receptor coding gene of dopamine and is one of the most important genes under investigation in the disorder and etiology of ADHD. In this study, the association between rs3758653 C/T and VNTR exon 3 repetition polymorphisms of the DRD4 gene and the effects of methylphenidate were investigated in patients with ADHD disorder consuming methylphenidate. Methods: The descriptive-analytical study was performed on 122 patients (5 - 18 years old) with ADHD who were treated with methylphenidate. DNA was extracted using salting out method. Subsequently, the rs3758653 polymorphism in the 5'UTR region of DRD4 gene was genotyped by PCR-RFLP method, and the VNTR fragment in exon III of DRD4 gene was investigated by electrophoresis gel on acrylamide gel method. After eight weeks from the start of drug treatment with methylphenidate, the intensity of symptoms was evaluated using the Conners scale. Finally, all data from questionnaires and information that were resulted from laboratory findings were analyzed using ANOVA and repeated measure analysis. Results: Of the 122 patients under study, 15 patients (12.3%) were responded to the drug treatment, and 107 patients (87.7%) were not responded. The significant differences were not revealed in genotype, and allele frequencies of between rs3758653 (C/T) and exon III 3'VNTR repeats polymorphisms of the DRD4 gene and responder and non-responder of ADHD groups to the drug treatment. Conclusions: The results showed that the reduction of ADHD symptoms with drug treatment is not related to DRD4 sub-types in patients with ADHD.

Pruritus, as a Neglected Symptom, in Opioid Poisoning in Children

Background: Opioid poisoning is common and fatal childhood poisoning in Iran with nonspecific, hidden, vague, and misleading clinical manifestations in some cases. Objectives: The aim of this study was to investigate and emphasize pruritus, as a neglected and helpful symptom in this important poisoning. Methods: In this cross-sectional study, one hundred pediatrics patients (< 14 years) with opioid poisoning who were referred to Loghman Hakim Hospital, Tehran-Iran, from April 2018 to April 2019 were enrolled the study. Demographic data including age, sex, type of poisoning, clinical manifestations including pruritus, its onset, location, duration, and therapy, also laboratory findings including complete blood count (CBC) and Eosinophilia recorded in patient-specific information forms. The collected data were analyzed using SPSS 21 software. Results: The patients’ mean age was 43.4 ± 31.4 months. Fifty-seven (57%) of them were male. Fifty-two (52%) of them reported Pruritus that in 84% observed in face. In 31% of children, itching resulted in skin scratches. The most common clinical manifestations were CNS depression (93%), respiratory suppression (68%), vomiting (52%), pruritus (52%), and meiosis (51%). There was no significant relationship between pruritus and gender, age, laboratory findings, family history of addiction, and allergy. Pruritus had a significant difference with Respiratory suppression (apnea, bradypnea, cyanosis), meiosis, vomiting, and redness of the skin (P-value: 0.05, 0.003, 0.009, and 0.002, respectively). Pruritus was controlled by naloxone in all of our patients. Conclusions: According to the results of the present study, pruritus is a common and helpful clinical manifestation in children with opioid poisoning that helps the physician for correct diagnosis, especially in hidden clinical scenarios.

Predicting Successful Extubation Rate Using Modified Spontaneous Breathing Trial in PICUs

Background: Extubation readiness is assessed by spontaneous breathing trials (SBTs); however, there is a lack of universally agreed protocols for their accurate performance and reporting in pediatric intensive care units (PICUs). Objectives: We aimed to evaluate extubating bundles, including modified SBT, in predicting successful extubation in critically-ill children with planned extubation. Method: This prospective cross-sectional study was based on the collection of data from 150 critically-ill children admitted to the PICU at Minia University Hospital. From January 2019 to June 2020, those children admitted to the PCIU and subjected to mechanical ventilation (MV), and extubation were enrolled. When the clinical team decided a child was ready for extubation based on the extubating bundle, a modified SBT (10 min) was used. It was started with switching to the CPAP\PS mode, followed by PS zero, and maintaining the original PEEP for 3 min. Finally, PS was kept at 5 - 8 cm H2O, and the original PEEP was maintained for the remaining 7 min (total period of 10 min). Results: The extubation bundle with modified SBT could predict extubation success with 89% sensitivity and 89.9% positive predictive value (PPV). There were no significant differences in age, weight, gender, and length of intubation between children with failed SBT and those who were successfully extubated. In 41 cases, SBT failure occurred in 3 ‐ 5 min, while nine cases showed failure in 6 ‐ 10 min. Conclusions: Extubation bundle with modified SBT before elective extubation is indicated for children. Guidelines for extubation among critically-ill children are needed to reduce unnecessary exposure to mechanical ventilation's adverse effects. Further multicenter research is required to enhance outcomes and decline the burden of these patients.

Evaluating the Effect of Vitamin A on Persistent Wheezing in Infants With Bronchiolitis in Southern Iran in 2018

Background: Bronchiolitis is a viral infection that causes the airways (bronchioles) in the lungs to become narrow, which makes breathing difficult. Objectives: This study aimed to evaluate the effect of vitamin A on persistent wheezing in infants with bronchiolitis. Methods: This study was performed on 60 infants with bronchiolitis who were randomly divided into two equal groups (n = 30) of intervention (receiving 5000 units per kg of vitamin A injection) and control. The severity of wheezing and retraction and number of breaths in the patients were recorded. Chi-square, Mann-Whitney U test, and t-test were used to compare the data. Results: Our study showed that 6.7% of infants in the control group had severe wheezing during the discharge, while no wheezing was reported in the intervention group. Also, the rate of moderate wheezing in the control and intervention groups was 40% and 10%, respectively (P = 0.006). Two weeks after treatment, the moderate wheezing frequency in the control group was 30%, but no wheezing was recorded in the intervention group, which was statistically significant (P < 0.001). Conclusions: In this study, administration of vitamin A significantly reduced the severity of wheezing in patients with bronchiolitis. Accordingly, it is recommended that vitamin A along with other treatments, be prescribed for all infants with symptoms of bronchiolitis.

The Effect of the Yeast Probiotic Saccharomyces boulardii on Acute Diarrhea in Children

Objectives: This study aimed to evaluate the effect of yeast probiotic Saccharomyces boulardii on the frequency and duration of acute diarrhea in children. Methods: Sixty children were randomized to receive yeast probiotic S. boulardii in a daily dose of 250 mg (trial group-30 patients) or placebo (control group-30 patients) for five days. The clinical and demographic characteristics of two groups were recorded before the intervention. After intervention, the two groups were compared in terms of frequency of diarrhea, duration of diarrhea, and hospital stay. Results: The median (interquartile range) of frequency of diarrhea in the trial group was significantly lower than placebo group (4 [2] vs. 5 [2.5]) (P = 0.04). Also, the median (interquartile range) of duration of diarrhea in the trial group was significantly lower than placebo group (3 [2] vs. 4 [2.5]) (P = 0.03). There was no significant difference between groups for hospital stay (P = 0.8). Conclusions: The present study reveals that the use of yeast probiotic S. boulardii can reduce the frequency and duration of acute diarrhea. Therefore, we recommended S. boulardii administration to acute diarrhea in children.

Association Between Overweight and Obesity and Overactive Bladder in Children: A Cross-sectional Study

Background: Overactive bladder (OAB) is a common cause of voiding dysfunction in children and is classified as lower urinary tract dysfunction (LUTD). In recent studies, obesity and overweight are assumed as risk factors for voiding dysfunction and urinary incontinence in children. Objectives: This study was conducted to evaluate the correlation between overweight and obesity with OAB in children. Methods: This cross-sectional study measured BMI in 56 children aged between 3 and 16 years with OAB (case group) and 56 healthy matched children (control group). Overweight and obesity were compared between the two groups. The study also accessed lower urinary tract symptoms and their association with BMI in the OAB children. The data were analyzed using the SPSS software version 18.0 for windows (SPSS Inc., Chicago, IL). Results: The mean age of the OAB patients was 7.71 ± 2.65 years, and 38 (67.8%) of them were female. Frequency and holding maneuvers were the most prevalent complaints. A history of urinary tract infection was detected in 46 (82.1%) of the OAB patients. There were no significant differences in overweight and obesity between the two groups (P = 0.23). Conclusions: No correlation was observed between overweight and obesity with OAB. The reason may be different socioeconomic conditions or malnutrition in these children. Thus, it is recommended to perform a study with a larger sample size in our community to assess malnutrition in the general children population.

A Child with Multiple Inflammatory Syndrome in Children, Stroke and Cardiac Insufficiency

: Multiple inflammatory syndrome in children (MIS-C) is a multisystem inflammatory disease following COVID-19 in children. This disease occurs a few weeks after COVID-19. A child with this condition develops a cytokine release cascade that results in organ damage. The involved organs include the heart, lungs, brain, gastrointestinal tract, and central nervous system. Fever is present in all patients and Kawasaki-like symptoms are one of the common features in these children. In this article, we introduce a child with MIS-C who has skin, gastrointestinal, neurological, and renal symptoms and has been hospitalized in the PICU.

Effectiveness of Different Educational Methods on Oral Health in 7-13-year-old Visually Impaired Children in Tehran: A Randomized Trial

Background: Conventional oral health education is not suitable for visually impaired children. Objectives: Considering the importance of oral health, this study aimed to investigate the effectiveness of different educational methods on oral hygiene status. Methods: Following a clinical trial design, 88 visually impaired children, aged 7 to 13 years, living in Tehran were recruited and randomly allocated to four groups of verbal-tactile, verbal-braille, multisensory, and control. Initially, all children were well informed about the importance of oral hygiene; then, the baseline levels of plaque score and gingivitis were recorded by Silness & Loe plaque index and Loe & Silness gingival index, respectively. Experimental groups received oral health education through different methods. The instructions were repeated after one month, and plaque and gingival indices were reevaluated after two months. Data analysis was administered by analysis of variance (ANOVA) and posthoc tests using SPSS 20.0. Results: After receiving the intervention, all groups showed a decrease in plaque and gingival indices, with the most reduction in the multisensory group (with a statistically significant difference (P = 0.0001) between multisensory & control for both plaque & gingival indices). The least change was observed in the verbal-braille group compared to the control (for plaque index and gingival index after two months (P = 0.04) and (P = 0.17), respectively). Conclusions: This study demonstrated that the multisensory method (verbal-tactile-braille) is the best option to educate visually impaired children, with significantly more acceptable results.