Comparison of Abdominal X-ray Findings and Results of Surgery in Neonates with Gastrointestinal Obstruction

Background Gastrointestinal (GI) obstruction is one of the most important surgical emergencies in neonates. Surgeons should select between conservative and invasive strategies. Imaging modalities are important in proper diagnosis. This study evaluates the sensitivity of abdominal radiographies (with or without contrast) in detection of neonatal GI obstruction. Materials and Methods A cross-sectional study was performed on 62 neonates admitted in NICU of 22 Bahman and Dr. Sheikh Hospitals (Mashhad, Iran) from June 2013 for two years. Radiographic findings were recorded in questionnaires and compared with surgical results in patients who underwent surgery. Statistical analysis was used for determining the sensitivity of radiologic investigations in diagnosis of neonatal gastrointestinal obstruction. Results From 62 neonates with GI obstruction, 46.8% of cases were female and the others were male. According to surgery results, the frequency of colon obstruction was 51.6% and small bowel obstruction, gastric outlet obstruction and esophageal obstruction were seen in 27.4%, 9.7% and 17.7% of cases, respectively. The sensitivity of radiographies (with or without contrast) in detection of upper GI obstruction was 100% and in lower GI obstruction was 95.2%. Conclusion Generally, sensitivity of radiologic studies (radiographies with and without contrast) in neonatal GI obstruction was 96.5%, so it is a valuable noninvasive diagnostic method in these diseases

Churg-Strauss Syndrome in a Seven-year-old Boy: A Case Report

Churg-Strauss syndrome (CSS) is a type of vasculitis of small-to-medium sized vessels. This syndrome is known by a history of bronchial asthma with systemic necrotizing vasculitis and peripheral blood hypereosinophilia. It is currently called eosinophilic granulomatosis with polyangiitis (EGPA). This disease affects both genders and all age groups, but it is very rare among children. CSS diagnosis is based on clinical findings such as asthma, eosinophilia, rhinosinusitis, and signs of vasculitis in major organs. In cases where steroids alone or in combination with other immunosuppressive agents are used as treatment, the outcome and long-term survival are usually satisfying. In comparison with other types of systemic vasculitis, the mortality rate of this syndrome is low. In this study, we present the case of a 7-year-old boy with poorly controlled bronchial asthma since three years of age. This case had developed purpuric skin lesions, sinusitis, arthritis, and weakness of the limbs with symptoms of mononeuritis multiplex at the age of seven. After being admitted to our hospital, a series of studies, including complete blood count-diff, chest X-ray, paranasal sinus radiography, brain magnetic resonance imaging, nerve conduction study, spirometry, and serological tests for autoantibodies, were performed and he was diagnosed with CSS. Thereafter, he received regular corticosteroid therapy in combination with methotrexate, and his symptoms were generally well-controlled with the beginning of the treatment. The clinical characteristics, diagnosis, and management of CSS in children are also reviewed in this study

Clinical and laboratory characteristics of Juvenile Idiopathic Arthritis in Northeast Iran

Background: Juvenile Idiopathic Arthritis (JIA) is a chronic rheumatic disorder commonly affecting children younger than 16. The incidence and prevalence of JIA can vary greatly depending on ethnicity, genetic background, and socioeconomic status within different populations. Epidemiological studies play an essential role in planning successful treatment for chronic diseases like JIA and providing appropriate care measures in specific geographic regions.Methods: In this cross-sectional study, 149 children were referred to the pediatric rheumatology department of Akbar Hospital in Mashhad from 2016 to 2019. Data was collected from all children within the first six months of disease onset, including the number of affected joints, demographic characteristics, systemic symptoms, extra-articular manifestations, and medication regimens.Results: The most prevalent subtype of JIA is Oligoarticular, followed by Systemic JIA at 25.5%. Among children with enthesitis-related arthritis, more girls than boys were affected. Additionally, the most frequently affected joints in children were those of the lower limb. 5.4% of the total, had involvement of lumbosacral and sacroiliac joints. Serositis was observed in 2% of the patients. Uveitis was detected in 4 out of 154 patients (2.6%); 3 of these cases were chronic anterior uveitis, while one was acute anterior uveitis. 3 children (2%) were reported to have Macrophage Activation Syndrome (MAS).Conclusion: Diagnosing juvenile idiopathic arthritis and other rheumatic diseases in children can often be delayed due to physicians’ lacking adequate clinical knowledge. To properly manage this chronic childhood illness, it is crucial to identify its symptoms and clinical course. This study represents the most comprehensive research conducted on children with JIA in the Northeast of Iran

Fibrodysplasia Ossificans Progressiva (FOP): A Case Report with Oral and Maxillofacial Manifestations and new radiographic feature

Fibrodysplasia ossificans progressiva (FOP) is a rare form of genetic disorder categorized by progressive heterotopic ossification and congenital deformity of the big toes. Heterotopic ossification follows gradual inflammation of the soft tissues (flare-up) and results in limited movements in joints such as the Temporomandibular joint (TMJ). No effective medical treatment has been recognized for the treatment of FOP. FOP is commonly misdiagnosed, especially in the maxillofacial region. Patients with FOP often experience temporomandibular joint ankylosis. Therefore, dental professionals should be careful in planning treatment, including avoiding anesthesia injections, especially in the mandible. This study presents a case of FOP with temporomandibular joint ankylosis. An eight-year-old boy with the chief complaint of reduced mouth opening and clinical and radiological features of FOP.  The patient was referred to Mashhad Dental School in January 2016. He had not previously been diagnosed with FOP

Clinical Findings of Sydenham Chorea in Pediatric Patients: A Single-Center Retrospective Study

Purpose Sydenham chorea is known for its rapid, irregular, and aimless involuntary movements and is considered a benign and self-limiting condition among the major manifestations of rheumatic fever. The current study reviewed the demographic, clinical, and paraclinical findings of pediatric patients with Sydenham chorea. Methods This cross-sectional study was conducted among 22 patients with Sydenham chorea who were admitted to the pediatric wards of Mashhad Imam Reza and Ghaem Hospitals between 2006 and 2016. Data from these patients’ medical records were extracted, organized using checklist forms, and analyzed. Results Eight patients were male and 14 were female. The average age was 10.09±3.53 years. In 31.8% of patients, chorea was the only sign of rheumatic fever. Chorea was unilateral in 21.1% of patients. The most common clinical findings were, in descending order, jerky movements, facial grimacing, gait disorders, mental disorders, speech disorders, muscle weakness, and milkmaid's grip. Cardiac auscultation was normal in 76.2% of patients, while a holosystolic murmur was heard in 23.8%. In laboratory exams, 50% of patients were erythrocyte sedimentation rate (ESR)-positive, 31.2% were C-reactive protein (CRP)-positive, and 53.3% were anti-streptolysin O (ASO)-positive. Echocardiography showed the prevalence of mitral regurgitation (63.6%), aortic regurgitation (45.5%), tricuspid regurgitation (22.7%), pulmonary regurgitation (4.5%), and pericardial effusion (4.5%). Conclusion This study showed that Sydenham chorea can be the only sign of rheumatic fever. This disease typically occurs in children between the ages of 7 and 12. ESR, CRP, and ASO can be the most effective laboratory tests for diagnosis

Evaluation of Bone Densitometry Parameters in Children with Inflammatory Bowel Disease

Background: The present study was performed to assess densitometry indices in pediatric patients affected by Inflammatory Bowel Disease (IBD) in Mashhad city, east of Iran.Methods: Seventy pediatric IBD patients (8-18 age range) in Akbar Hospital in Mashhad were evaluated in terms of clinical parameters (age, sex, weight, height, IBD type, IBD activity, duration of disease, affected organ, management methods, treatment duration, hospitalization time, nutritional status and puberty), laboratory parameters (serum levels of vitamin D, albumin (Alb), calcium (Ca), phosphorous (P), sodium (Na), magnesium (Mg), Urea, creatinine (Cr) along with important hepatic enzymes aspartate aminotransferase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP)). Also, Dual-energy X-ray Absorptiometry (DXA) was applied for whole body and lumbar spine Bone Mineral Density (BMD) measurement.Results and conclusion: IBD was mostly manifested as ulcerative colitis (UC) (62.9%) and the disease duration and treatment course were mostly reported to be "over 6 months", with 88.6% and 84.3%, respectively. Most patients had normal (n = 43; 61.4%) and decreased (n = 20; 28.6%) nutritional status, sorted in tanner stage 4 (n = 40; 57.1%), had no hospitalization (81.4%), and received prednisolone (n = 33; 47.1%). Moreover, left colitis (n = 39; 55.7%) and pan colitis (n = 24; 34.3%) were the most affected parts. No statistically significant correlation was reported regarding lumbar BMD values in terms of gender, disease duration, treatment time, and IBD type. Also, there was no statistical association between the treatment type and involved tissues with lumbar and femoral BMD values among 70 examined children in the present study. Still, more studies are recommended to truly evaluate the bone densitometry parameters in children with inflammatory bowel disease

Comparison of Clinical Symptoms and Cardiac Lesions in Children with Typical and Atypical Kawasaki Disease

The present study was performed to evaluate the clinical symptoms and cardiovascular complications in patients with typical and atypical Kawasaki disease (KD). This retrospective study was conducted on the medical records of 176 patients with KD for three years. The study population was divided into two groups of typical and atypical based on the KD clinical criteria. The two groups were compared in terms of demographic data, clinical symptoms, cardiac lesions, and laboratory markers. Based on the diagnostic criteria, 105 (60%) and 71 (40%) patients were diagnosed with typical and atypical KD, respectively. The mean age of the typical patients (38.16 months) was higher than that of the atypical group (24.03 months) at the time of diagnosis (p < 0.05). The results revealed no significant difference between the two groups regarding the seasonal distribution of KD onset (p = 0.422). However, the most common season for the diagnosis of the disease was spring, followed by winter. There was no significant difference between the two groups in terms of fever duration (p = 0.39). Furthermore, vomiting was more common in the atypical patients than in the typical group (p = 0.017). In terms of the cardiac lesions, ectasia (p = 0.005) and lack of tapering of the distal coronary vessels (p = 0.015) were more frequently detected in the atypical group than in the typical group. Considering the laboratory findings, thrombocytosis (p = 0.010) and anemia (p = 0.048) were more common in the atypical group, compared to those in the typical group. On the other hand, the typical group had a higher serum alanine aminotransferase level (adjusted for age) (p = 0.012) and Hyponatremia (serum sodium concentration ≤130 mmol/L) (p = 0.034). Based on the findings of the current study, the fever duration from onset to diagnosis was slightly more in atypical KD patients than in the typical group, but not statistically significant, possibly due to more timely diagnosis of atypical KD. There was no difference in coronary aneurysm between the two groups at the time of diagnosis. The atypical group had a higher frequency of coronary ectasia and lack of tapering, indicating cardiac involvement. Consequently, these conditions should be given more attention in the atypical patients. Furthermore, the higher frequency of anemia and thrombocytosis in the atypical patients can be useful for diagnosis of this kind of KD

Cervicofacial Emphysema and Pneumomediastinum Following Dental Extraction: Case Report

Background: Pneumomediastinum is commonly caused by iatrogenic injury such as surgery on the cervical planes and chest or by tracheostomy. It is also well known that emphysema may occur after dental treatments using an air turbine drill, but there have been few cases of emphysema which extended to the mediastinum. Case Presentation: A 16-year-old boy is presented with subcutaneous emphysema and pneumomediastinum which developed 24 hours after surgery for extraction of an inferior second molar. We first describe history, clinical presentation and radiologic appearance of our patient and then review the literature about oral surgery causing pneumomediastinum. Conclusion: Surgical procedures in oral cavity can lead to the development of emphysema and pneumomediastinum when air turbine dental drills are used. To avoid these complications, air turbine high speed drills should be used only in necessary cases

Ultrasound Evaluation of Spinal Cord in Newborns with Sacral Pit

Background: Sacral pit is a shallow or deep dimple in the lower sacral region, with a reported prevalence of 3-5% among newborns. The aim of the present study was to investigate spinal cord abnormalities in newborns with sacral pit via ultrasound examinations. Methods: In this descriptive study, 3071 infants born at 34-42 weeks of gestation were studied in hospitals affiliated to Islamic Azad University of Mashhad, Iran during 2014-2015. Information including age, sex, and birth weight was recorded in a questionnaire. Infants with a sacral pit underwent ultrasonography; spinal shape and mobility in these infants were compared with their healthy counterparts. For statistical analysis, data were entered to Microsoft Excel software. Chi-square and student’s t-test were performed, using SPSS version 20. Results: Based on the findings, 1.6% of the studied infants were born with a sacral pit. The weight and age were not significantly different between healthy neonates and those with a sacral pit. The prevalence of sacral pit was higher in female cases (54.2%), although there was no significant difference between the genders. Ultrasound examination of the spinal cord revealed its normal position and motility in all newborns with a sacral dimple. Conclusion: The present results showed the normal shape and motility of the spinal cord in newborns with a sacral pit. Therefore, there was no correlation between sacral pit as a cutaneous marker and neural tube defects