A case report: An atypical Kawasaki syndrome following aseptic meningitis in a 9-month old infant

چکیده: مقدمه: بیماری کاوازاکی، التهاب عروق (Vasculitis) حاد و وسیع در اعضای مختلف بدن می باشد. سن شیوع بیماری کاوازاکی بین 1 تا 5 سالگی است و زمانی که خارج از این محدوده باشد، تشخیص آن دشوار و شانس عوارض بیماری بخصوص عوارض قلبی افزایش می یابد. معرفی بیمار: شیرخوار 9 ماهه ای بود که با علایم مننژیت در بخش اطفال بیمارستان هاجر شهرکرد بستری و پس از دریافت درمان دارویی و بهبود علایم، مجدداً در روز هشتم بستری دچار تب بالا، فارنژیت و اسهال و بی قراری گردید. در معاینه بیمار کنژنکتیویت غیر چرکی دو طرفه، ترک خوردگی لب ها، لنفادنوپاتی و دیگر علایم تیپیک کاوازاکی را نداشته ولی قلب تاکی کارد و سرعت سدیمانتاسیون اریتروسپتی (ESR) بیمار نیز افزایش یافت. کودک با تشخیص بیماری کاوازاکی آتیپیک تحت درمان ایمونوگلوبولین وریدی قرار گرفت، پس از 24 ساعت تب بیمار کاهش و علایم بالینی وی بهبود یافت. ESR بیمار ده روز پس از ترخیص mm/hr10 گزارش گردید. نتیجه گیری: بر اساس این گزارش بالینی در زمان ابتلا به مننژیت باکتریال اگر مجدداً بیمار دچار تب بالا و افزایش ESR گردید باید بیماری کاوازاکی، علاوه بر دیگرعوارض مننژیت مد نظر باشد

Case Presentation of a 23-Month-old Herpes Simplex Virus-infected Girl with Brain and Oesophageal Involvement.

Herpes simplex virus (HSV) is the most common identifiable cause of serious or life threatening sporadic, endemic encephalitis. Typical HSV encephalitis in patients outside neonatal age is caused by HSV-1. A 23-month-old girl was referred to our hospital with a three-day history of fever, listlessness, slurred speech, and suspicious oesophageal foreign body impaction. Laboratory evaluations showed white blood cell count of 10900 /mm3 with 65% neutrophils. Upper endoscopy revealed diffuse severe ulceration in middle to distal third of oesophagus and no foreign body was found in oesophagus or stomach. Parenteral acyclovir was prescribed for herpes encephalitis in addition to antibiotics for central nervous system infection. Chest X-ray and brain MRI was unremarkable. Lumbar puncture revealed normal protein and glucose with 10 white cell count. She developed a raising liver enzyme tests. Total and direct bilirubin was 1.2 mg/dc and 0.2 mg/dc respectively. Because of neurological symptoms, acyclovir was adopted for our patient from the beginning. The girl did not respond to medication and died after 28 days. Progression of her disease prior to referral appears to contribute to the administered treatment inefficacy. Severe rapid progression of disease prior to referral and potential resistance to acyclovir could cause treatment failure

Correlation of transcutaneous and serum bilirubin levels in infants with neonatal jaundice hospitalized in Hajar Hospital in Shahrekord

Background and Aim: Bilirubin level measurement through BiliCheck device can be a useful method in diagnosing neonatal jaundice due to no need for frequent blood-taking. Thus, the present study aimed to compare serum and transcutaneous bilirubin levels in infants with neonatal jaundice hospitalized in Hajar Hospital in Shahrekord. Materials and Methods: In this descriptive-correlation study, 417 infants with neonatal jaundice were examined. A questionnaire including demographic information (age and weight of infant at the time of reception, weight at the time of birth, age of pregnancy, and infant sex) was completed. As the infants were hospitalized, the blood-taking were done to control serum bilirubin based on the routine stages of the unit and transcutaneous Bilirubin level was controlled by BiliCheck device and the data were recorded. Pearson coefficient and independent t-test statistical analysis were used through SPSS software. Results: From the total of 417 infants under this study, 322 infants were term and 95 infants were preterm. 51.3% were male and 48.7% were female. Weight average of term infants was 3081467.88 and in the preterm infants, it was 2335572.44 gram. The results indicated the linear coefficient was direct and meaningful between the serum and transcutaneous bilirubin levels in term and preterm infants. ‍Conclusion: The findings suggested that mean difference of bilirubin levels on these two methods of measurement in term infants in different days were meaningful while there is no significant mean difference in preterm infants indicating the efficacy of this device in measuring bilirubin levels in preterm infants

Hybrid Model for It Investment Analysis: Application to Rfid Adoption in the Retail Sector

One of the major obstacles in Information Technology (IT) adoption is its return on investment analysis. IT benefits in organizations are hard to measure and are usually realized over time. System dynamics approach has been used in IT literature to identify the impact of IT on business processes. Given benefits of any IT system in organizations, however, there is a high degree of uncertainty in achieving such benefits. Managerial flexibility in decision making process of implementing a new IT helps managers to overcome this uncertainty over time. Traditional cost benefit analysis such as NPV that is typically used to value any technology is unable to value managerial flexibilities while real options theory offers a model that can value a new investment as uncertainties about the system decreases over time. In this dissertation, we are proposing a new hybrid model for IT return on investment (ROI) that combines system dynamics and real options as two major techniques in economics of IT. This robust hybrid model takes advantages of both techniques while overcoming their weaknesses. We propose a systems dynamic solution to simulate the way an IT influences and improves an organization to be able to estimate the parameters used in the real options model. The hybrid model is used to find the best time for investing in item-level RFID in the retail sector.The results of return on investment analysis on item-level investment show that the variable cost of investment that is the tag prices dominates the return on investment. Other factors such as product unit price and consequently type of retail stores are important as well. The system dynamics simulation provided some major parameters of the real options model such as the expected payoffs and volatility of the expected payoffs that were hard to find in the literature.Business Administration (MBA

The prevalence of serotypes of Haemophilus influenzae in healthy children 1 to 5 years referred to Imam Ali clinic of Shahrekord in 2012

زمینه و هدف: هموفیلوس آنفلوآنزا یکی از عوامل بیماری زای مهم در سیستم تنفسی بوده که می‌تواند باعث عوارض متعدد به ویژه در کودکان شود. این مطالعه با هدف تعیین شیوع سروتیپ های هموفیلوس آنفلوآنزا در مخاط حلق کودکان سالم مراجعه کننده به کلینیک امام علی (ع) شهرکرد انجام شده است. روش بررسی: در این مطالعه توصیفی- تحلیلی، 378 نمونه حلقی به صورت تصادفی از کودکان 1 تا 5 سال مراجعه کننده به کلینیک امام علی شهرکرد در سال 1391 گرفته و با دو روش کشت و PCR بررسی گردید. سروتیپ کل نمونه های مثبت با روش PCR بررسی گردید. یافته ها: در این مطالعه 42 مورد (1/11 درصد) حامل هموفیلوس آنفلوآنزا بودند (فاصله اطمینان 95 درصد) که در بین آن ها 34 مورد بدون طبقه بندی و 8 مورد کپسول دار بود. در میان انواع کپسول دار 4 مورد سروتیپ f، 2 مورد سروتیپ b و 2 مورد سروتیپ d داشتند. بین شیوع هموفیلوس آنفلوآنزا با وجود برادر یا خواهر زیر 5 سال (044/0=P) و تحصیلات پدر (041/0=P) ارتباط معنی دار آماری دیده شد. نتیجه گیری: نتایج این مطالعه نشان داد که سروتیپ غالب نوع بدون طبقه بندی (بدون کپسول) می باشد. علی رغم شیوع بیشتر سروتیپ نوع f، وفور سروتیپ b به عنوان یک از مهمترین عوامل تهاجمی در کودکان حامل باکتری در این مطالعه، لزوم توجه بیشتر مسئولین بهداشتی- درمانی نسبت به این عامل بیماری زا را خاطر نشان می نماید

Frequency of celiac disease in children with type 1 diabetes

Background and aims: Occurrence of celiac and diabetes is accompanied by numerous complications in children and if diagnoses do not occur promptly, celiac disease complications including gastrointestinal disorders, loss of appetite and damage caused by hypoproteinemia, and most importantly, growth disorder occurs in diabetic children. This study was aimed to compare the frequency of celiac disease in children with diabetes aged under 15 years and the controls of the same age referring to the clinics affiliated with Shahrekord University of Medical Sciences. Methods: In this case-control study, using convenience sampling, 42 patients with diabetes and 43 patients without diabetes admitted for gastrointestinal diseases were assigned as cases and controls, respectively. The description of all patients was provided, and physical examinations and serologic tests were conducted on them. If the serologic tests tTGA-IgA and tTGA-IgG were positive, the intestinal biopsy was taken. The data were analyzed by descriptive statistics and t-test, chi-square, and Mann–Whitney test in SPSS. Results: The mean serum levels of tTGA-IgA and tTGA-IgG were significantly higher in the case group than the control group (P<0.05). There were significant differences in weight gain between the cases and the controls (P=0.017). The frequency of celiac disease was 15% (n: 6) in children with diabetes with a significant difference from the controls (P=0.02). Conclusion: In this study, the frequency of celiac disease was higher in children with diabetes than children without. Therefore, in the study area, routine screening for celiac disease is helpful in reducing possible disorders and complications in diabetic children

First Detection of Leishmania major DNA in Sergentomyia (Spelaeomyia) darlingi from Cutaneous Leishmaniasis Foci in Mali

Leishmania major complex is the main causative agent of zoonotic cutaneous leishmaniasis (ZCL) in the Old World. Phlebotomus papatasi and Phlebotomus duboscqi are recognized vectors of L. major complex in Northern and Southern Sahara, respectively. In Mali, ZCL due to L. major is an emerging public health problem, with several cases reported from different parts of the country. The main objective of the present study was to identify the vectors of Leishmania major in the Bandiagara area, in Mali. Methodology/Principal Findings: An entomological survey was carried out in the ZCL foci of Bandiagara area. Sandflies were collected using CDC miniature light traps and sticky papers. In the field, live female Phlebotomine sandflies were identified and examined for the presence of promastigotes. The remaining sandflies were identified morphologically and tested for Leishmania by PCR in the ITS2 gene. The source of blood meal of the engorged females was determined using the cyt-b sequence. Out of the 3,259 collected sandflies, 1,324 were identified morphologically, and consisted of 20 species, of which four belonged to the genus Phlebotomus and 16 to the genus Sergentomyia. Leishmania major DNA was detected by PCR in 7 of the 446 females (1.6%), specifically 2 out of 115 Phlebotomus duboscqi specimens, and 5 from 198 Sergentomyia darlingi specimens. Human DNA was detected in one blood-fed female S. darlingi positive for L. major DNA. Conclusion: Our data suggest the possible involvement of P. duboscqi and potentially S. darlingi in the transmission of ZCL in Mali

Comparison of amoxicillin and metronidazole effect on three-drug regimen for the treatment of Helicobacter pylori infection in children

Helicobacter pylori is an important risk factor for chronic gastritis, peptic ulcer, and gastric cancer. Three-drug regimen is the first-line treatment for this infection, but the response rate to treatment varies in different geographical regions. This study was conducted to comparatively determine the effect of amoxicillin and metronidazole on three-drug regimen to treat H. pylori infection in 1-15-year-old children. This clinical trial was conducted on 82 patients aged 1-15 years with convenience sampling referring to the Endoscopy Unit of Hajar Hospital, Shahrekord. Group 1 was administered with clarithromycin, amoxicillin, and omeprazole (CAO), and Group 2 with, clarithromycin, metronidazole, and omeprazole (CMO). One month after completion of the treatment, stool antigen test was used to study the eradication of H. pylori. Data were analyzed using SPSS software by Chi-square test. Three of the 82 patients were excluded from the study because of side effects caused by drugs. Nearly 87.2% of the patients in CAO-Treated group and 92.5% in CMO-Treated group had response to treatment. There was no significant difference in eradication rate between the two regimens (P = 0.43). The two regimens displayed no superiority over each other for eradicating H. pylori infection and response rate to treatment in children aged 1-15 years