Alvarado vs. Pediatric Appendicitis Score (PAS) in Acute Appendicitis of Children

Introduction: Acute appendicitis in children is associated with morbidity and mortality due to late diagnosis. Several scoring systems, such as Alvarado and PAS have been developed to help diagnose acute appendicitis in children to make the most accurate and prompt decision. The purpose of this study was to compare the efficacy and diagnostic value of these scoring systems. Materials and Methods: In this cross-sectional study, 130 children aged 5-14 with suspected acute appendicitis were included. After the collection of demographic data, all patients were scored by Alvarado and PAS systems. The decision for surgery was made by a surgeon, independently of these scores. The diagnosis of acute appendicitis was affirmed by surgical and pathologic findings. Results: Male: Female ratio was 1.32:1, and the average age of the patients were 9.2±2.7 years. The mean Alvarado and PAS scores were higher in patients with positive pathologic findings. Neutrophilia >75% and RLQ tenderness had the highest relationship with the diagnosis of the disease. The diagnostic value of Alvarado was higher than PAS concerning the area under the ROC curve. The cutoff point of 7 was associated with a sensitivity of 74.5% and specificity of 66.7% for the Alvarado score, and a sensitivity of 58.5% and specificity of 79.2% for the PAS score. Conclusions: The results showed the high sensitivity of Alvarado and the high specificity of PAS. However, the sensitivity, specificity, PPV, and NPV of these criteria were not satisfactory for the confirmation of the diagnosis

A Case of Giant Gastric Trichobezoar

Trichobezoar is an unusual form of bezoar found in the digestive tract, mostly in the stomach. The patient is often a female in her adolescence who pulls out and swallows her hair. This habit could stem from anxiety and the trichotillomania disorder. These hairs accumulate in the stomach and cause gastrointestinal symptoms. Our patient is a 14-year-old girl who came to us complaining of abdominal pain. Upon further evaluation by ultrasonography and endoscopy, trichobezoar was diagnosed. Laparotomy and gastrotomy were performed,and a large bezoar was removed. Although the occurrence of trichobezoar is rare, surgeons should always consider the situation in patients with vague gastrointestinal symptoms and psychological problems, especially in young female individuals

The relationship between attention-deficit/ hyperactivity disorder and trauma in adolescents

Objective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity and trauma severity. Methods: In this descriptive correlational study, the study population included traumatic adolescents aged 12-18 years referred to Shohada hospital in Tabriz, Iran in 2016. Among this population, 91 subjects were selected. In order to exclude subjects with other psychiatric disorders, a psychiatrist performed clinical interviews with them. In this regard, the short form of Conner’s Comprehensive Behavior Rating Scales Revised Edition (CBRS-R) and Pediatric Trauma Scale were used. For data analysis, Pearson correlation coefficient and independent t test were applied. Data were analyzed using SPSS software version 22. Results: There was a significant positive relationship between trauma severity and ADHD score, hyperactivity, and oppositional/Impulsivity (P < 0.01). Conversely, no statistical significance was observed between attention deficiency and trauma severity. The severity of trauma was higher among ADHD group than normal individuals. There were also correlations between socioeconomic status (SES) and oppositional/impulsive patients. In this regard, higher scores of oppositional/impulsivity were observed among patients with lower SES. Conclusion: Traumas have significant effects on economic and humanistic aspects of life in modern era. Our findings showed that there was a statistically significant relationship between hyperactivity-inattention and trauma intensity in adolescents. Therefore, to prevent traumatic events, ADHD screening at schools is suggested. By the same token, informing parents through mass media can help reduce the consequences of inattention/ hyperactivity disorder in the society

Does Severity of Attention Deficit /Hyperactivity Disorder impact Trauma in Children?

Introduction: Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with high heritability. It is the most common childhood mental disorder. The key aspects of ADHD may put the affected children at risk for different traumatic experiences. Therefore, this study was conducted to investigate the relationship between the severity of trauma and ADHD symptoms in children. Methods: In this descriptive-correlational study, the target population included 90 children aged 6-12 years old, visiting Imam Reza, Children, Sina, and Shohada Hospitals in Tabriz, Iran. The severity of trauma was assessed, using placebo transdermal system (PTS), and the ADHD symptoms were evaluated, using Conners' Parent Rating Scale. To rule out other psychiatric disorders, the Child Symptoms Inventory-4 (CSI-4) was employed. Results: Results showed a significant positive correlation between the severity of trauma and ADHD, hyperactivity, oppositional/impulsivity, and attention-deficit scores (P < 0.01). In addition, results from the independent t-test suggested a significance difference between the ADHD and non-ADHD children in terms of the severity of trauma. Conclusion: There was a significant relationship between the symptoms of ADHD and the severity of trauma in children, in a way that the scores of the aforementioned variables improved with increasing the severity of trauma. Regarding the profound effects of trauma on human and financial resources, required measures should be taken for making house and school settings safe for such children