Clinical and Paraclinical Findings in Shigelosis

Objective:Shigella infections are one of the major causes of diarrhea worldwide and especially in developing countries. This study was conducted to investigate clinical symptoms, predisposing factors and effective antibiotic regimens in children hospitalized for clinical dysentery. Material & Methods: Children older than 6 months admitted for gastroentritis in Bahrami hospital in Tehran from September 1998 to September 2001 with a positive fecal culture for Shigella were included in this study. The data was gathered from patients' records. Findings: From 173 patients, 46.2% were females mostly aged 2-5 years. More than 50% of patients were admitted in summer. The frequency of anemia was 31.8% and 34.7% were under the median growth curve. Except diarrhea, the most frequent clinical manifestations of shigellosis were fever (98.2%), dehydration (87.2%) and convulsion (68.2%). 135 (78%) patients received Nalidixic acid and the rest was treated with ceftriaxone as the first choice because of their poor condition on admission. Nine (5.2%) patients died with Ekiri syndrome and sepsis manifestation despite antimicrobial treatment. Conclusion:The mortality rate in this study was higher than in other studies. Fifty-six percent of mortality cases was due to Ekiri syndrome and the remainder was due to sepsis in children less than 1 year old. We found no specific clinical symptom or sign for shiglosis

Leukocyte Count and Erythrocyte Sedimentation Rate as Diagnostic Factors in Febrile Convulsion

"nFebrile convulsion (FC) is the most common seizure disorder in childhood. white blood cell (WBC) and erythrocyte sedimentation rate (ESR) are commonly measured in FC. Trauma, vomiting and bleeding can also lead to WBC and ESR so the blood tests must carefully be interpreted by the clinician. In this cross sectional study 410 children(163 with FC), aged 6 months to 5 years, admitted to Bahrami Children hospital in the first 48 hours of their febrile disease, either with or without seizure, were evaluated over an 18 months period. Age, sex, temperature; history of vomiting, bleeding or trauma; WBC, ESR and hemoglobin were recorded in all children. There was a significant increase of WBC (P<0.001) in children with FC so we can deduct that leukocytosis encountered in children with FC can be due to convulsion in itself. There was no significant difference regarding ESR (P=0.113) between the two groups. In fact, elevated ESR is a result of underlying pathology. In stable patients who don't have any indication of lumbar puncture, there's no need to assess WBC and ESR as an indicator of underlying infection. If the patient is transferred to pediatric ward and still there's no reason to suspect a bacterial infection, there is no need for WBC test

Effectiveness of motivational interviewing in promoting hand hygiene of nursing personnel

Background: Motivational interviewing (M.I.) is an option for modifying an individual′s behavior. It is used as an educational method in recent years. The aim of our study was to indicate whether or not education, using lecture alone and lecture with M.I., would affect the performance of nursing personnel regarding their hand hygiene. If so, which of these two methods were most effective for this purpose? Methods: This was an interventional study conducted in Bahrami Pediatric Hospital in Tehran. The study population consisted of all nursing personnel in the hospital. Considering the responsibilities of different nurses and their educational status, we divided them into three classes. The participants of each class were randomly assigned to either the control or experiment groups training lecture alone or lecture with M.I., respectively. We used Independent-t, Paired-t, Mann-Whitney U and Wilcoxon signed ranks tests for analysis. Results: Education using lecture alone improved the hand hygiene performance of nursing personnel only in the first and third classes ( P = 0.002 and P = 0.001, respectively). Similarly, lecture combined with M.I. improved the hand hygiene performance of personnel in the first and third classes ( P < 0.001 and P = 0.004, respectively). The latter method was more effective compared to lecture alone in the first and third classes ( P < 0.001 and P = 0.013, respectively). Conclusions: Education based on lecturing improves hand hygiene performance among nursing personnel. It will be more effective if combined with M.I

Comparison of Propranolol and Pregabalin for Prophylaxis of Childhood Migraine: a Randomised Controlled Trial

Migraine involves 5-10% of children and adolescents. Thirty percent of children with severe migraine attacks have school absence and reduced quality of life that need preventive therapy. The purpose of this randomised control trial study is to compare the effectiveness, safety and the tolerability of pregabalin toward Propranolol in migraine prophylaxis of children. From May 2011 to October 2012, 99 children 3-15 years referred to the neurology clinic of Mofid Children's Hospital with a diagnosis of migraine enrolled the study. Patients randomly divided into two groups (A&B). We treated children of group A with capsule of pregabalin as children of group B with tablet of propranolol for at least 8 weeks. In this study, 99 patients were examined that 91 children reached the last stage. The group A consistsed of 46 patients, 12(26.1%) girls, 34 (73.9%) boys and the group B consisted of 45 patients, 14(31.1%) girls, 31 (68.9%) boys. Basis of age, gender, headache onset, headache frequency, migraine type, triggering and relieving factors there was no significant difference among these groups (P>0.05). After 4 and 8 weeks of Pregabalin usage monthly headache frequency decreased to 2.2±4.5 and 1.76±6.2 respectively. Propranolol reduced monthly headache frequency up to 3.73±6.11 and 3.34±5.95 later 4 and 8 weeks respectively. There was a significant difference between these two groups according to headache frequency reduction (P=0.04). Pregabalin efficacy in reducing the frequency and duration of pediatric migraine headache is considerable in comparison with propranolol

Final 3.indd

Abstract Background: Human rotavirus genotypes G1-G4, G9, P[4] and P Methods: A total of 700 stool specimens were collected from children and assessed for the presence of rotaviruses by the dsRNA-PAGE technique. G and P typing of the positive samples were performed by semi-nested multiplex RT-PCR. Results: Rotaviruses were isolated in 19% of samples. A total of 14 rotavirus dsRNA different electrophoretypes were detected. The predominant genotype was G1 (76.3%), followed by G4 (11.5%), G8 (0.8%), P[4] (9.2%) and P[8] (66.4%), respectively. In mixed type samples, the majority were of genotype G1P[8] (53.4%), followed by G1P[4] (9.2%) and G4P[8] (4.6%). Mixed types consisted of 3.1% of the total sample followed by G1G2/-P (1.5%), G1G4P[4] (0.8%) and G1G4P[8] (0.8%). Conclusion: In this study, a high prevalence of the G1P[8] genotype was determined to be the cause of childhood gastroenteritis in Tehran, Iran. The sequence of G and P genotypes showed high levels of similarity to strains from other Asian countries. Our data will be useful for future vaccine formulation in Iran

The Effects of Clinical Skills Learning Centers on Learning Promotion among Pediatrics Interns

Introduction: During the recent two decades, practical medical skills’ training has experienced dramatic changes, which has led to establishment of CSLCs (Clinical Skills Learning Centers). Thus, it is necessary to evaluate the effects of these centers on students' learning of the relevant procedures. The main objective in this study was comparing the output of skills training processes in two groups of medical interns trained in conventional settings (training only on bedside) and conventional settings plus the use of CSLCs. Methods: This is a quasi experimental study conducted on two groups of medical interns introduced to Bahrami Hospital (affiliated with Tehran University of Medical Sciences) for their pediatric course. Twenty five students were taught by the conventional method (control), and 19 students received training in Pediatrics CSLC (experiment). The sampling method was simple & non-randomized. The study used OSCE (Objective Structured Clinical Examination) for assessments of student’ learning, and SPSS15 software, Kolmogrov-Smirnov, paired and independent T – tests for analytical purposes. Results: There was a significant difference between the mean scores of the two groups of interns before and after training (P<0.001).Mean and SD of the scores in the experiment group after training were 120.69±14.84, while for the control group they were 102.87±11.20. Mean and SD of score changes (difference between before and after pediatrics ward rotation) for experiment and control groups were 29.6±12.32, and 16.45±7.97, respectively, which were significantly different(p<.001) Conclusion: Clinical skills training in Bahrami's CSLC was effective in promoting medical interns' pediatric practices. We suggest that training in CSLCs be included in traditional pediatric training courses

Effects of cannabinoid receptor type 2 in respiratory syncytial virus infection in human subjects and mice

An accumulating body of evidence suggests that the endocannabinoid system plays a significant role in pathophysiological processes and impacts disease severity. Here we investigate the possible role of a cannabinoid receptor type 2 (CB2) functional variant in determining disease severity and the potential pharmacological therapeutic effects of CB2 activation in viral respiratory infection. The common missense variant (CAA/CGG; Q63R) of the gene-encoding CB2 receptor (CNR2) was evaluated in 90 inpatient and 90 outpatient children with acute respiratory tract infection (ARTI). The frequency distribution of respiratory syncytial virus (RSV)-the main cause of severe cases of bronchiolitis and pneumonia in children-was studied in all collected samples. The mechanism through which CB2 affects clinical outcomes in case of RSV infection was studied in Balb/c mice model using AM630 as a CB2 antagonist. The potential therapeutic effect of CB2 activation during RSV infection was studied using a selective agonist, JWH133. The CB2 Q63R variation was associated with increased risk of hospitalization in children with ARTI. Children carrying the QQ genotype were more prone to developing severe ARTI (OR = 3.275, 95% CI: 1.221–8.705; p = 0.019). Of all the children enrolled in the study, 83 patients (46.1%) were found positive for RSV infection. The associated risk of developing severe ARTI following RSV infection increased more than two-fold in children carrying the Q allele (OR = 2.148, 95% CI: 1.092–4.224; p = 0.026). In mice, the blockade of CB2 by AM630 during RSV infection enhanced the influx of BAL cells and production of cytokines/ chemokines while exaggerating lung pathology. CB2 activation by JWH133 reduces the influx of BAL cells and production of cytokines/chemokines while alleviating lung pathology. Collectively, CB2 is associated with RSV severity during infancy and may serve as a therapeutic target in RSV infection through the alleviation of virus-associated immunopathology