The effect of baby walker on child development: a systematic review

Abstract:Baby walkers are used all around the world as a fun equipment without any dangers. In contrast with public beliefs, some researchers have claimed they can cause developmental delay. We aimed to investigate their effect on child development through a systematic review. We searched Pubmed, Google Scholar, Embase, and Scopus for related articles in English and included all study designs. Of 315 articles found in Pubmed, 1630 citations in Google Scholar, 18 articles in Embase, and 38 papers in Scopus, only 9 articles fulfilled the inclusion criteria. Among them, only a cohort and a cross-sectional study reported developmental delay caused by baby walker use. Based on the current data, evidence against baby walker is not enough regarding its negative effect on child development. This subject needs to be addressed more, considering the large number of baby walker users worldwide

Comparison of the efficacy of amitriptyline and topiramate in prophylaxis of cyclic vomiting syndrome

Objectives: Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder with no certain treatment. We aimed to compare the efficacy of amitriptyline and topiramate on prophylactic therapy of CVS.Materials and Methods: This is a randomized clinical trial conducted during 2016 in Isfahan, Iran. The inclusion criteria were CVS patients (based on Rome III) aging 3-15 years with normal physical examination, no metabolic disorder, and no gastrointestinal obstruction or renal impairment. Recruited patients were divided into two groups of amitriptyline (1 mg/kg/daily) and topiramate (1-2mg/kg/daily) and were followed 3-months. The outcome was evaluated by comparing severity of attacks (monthly frequency and duration of attacks) before and after intervention.Results: Thirty-six children entered each group and two patients left the amitriptyline group. Patients and disease characteristics were similar between groups before intervention (P-value>0.05). The frequency of attacks (standard deviation) after intervention in amitriptyline and topiramate group were 0.91 (0.40) and 1.07 (0.55), respectively (P-value=0.368) and the duration of attacks (SD) after intervention were 3.43 (2.46) and 4.90 (3.03), respectively (P-value=0.017). Twenty-three patients (68%) in amitriptyline group and 14 patients (39%) in topiramate group stopped having attacks after intervention (P-value=0.016).Conclusion: Amitriptyline can be considered as the better choice for CVS therapy compared to topiramate considering the high response rate of patients to this drug

Short-term side effects of low dose valproate monotherapy in epileptic children: a prospective study

Objectives: Considering the common use of valproate among children, we investigated short-term side-effects of low dose valproate monotherapy in epileptic children.Materials and Methods: In this prospective study, 209 epileptic children (48.3% male, mean age: 7.02 ± 3.13 years) on low therapeutic dose of valproate monotherapy (20-30 mg/Kg/daily) were enrolled and side-effects were evaluated through frequent clinical visits and laboratory tests during 6 months.Results: Weight gain was reported in 53.1% of patients. Decreased appetite was seen in 11% of patients, more frequent in younger cases (P=0.006). Abdominal pain, nausea/vomiting, diarrhea, and constipation were reported in 16.3%, 2.4%, 1.4%, and 1% of patients, respectively. Headache, tremor, dizziness, abnormal color vision, myoclonus, and bruxism were seen in 5.7%, 1.4%, 1%, 1%, 1%, and 0.5% of patients, respectively. Enuresis, hair loss, and skin rash were reported in 8.1%, 6.7%, and 0.5% of patients, respectively. Thrombocytopenia, impaired liver function tests, and leukopenia occurred in 1%, 1%, and 0.5% of patients, respectively.Conclusions: low dose valproate monotherapy may cause numerous side-effects, mostly not life-threatening and requiring no action. Besides more reported complications, we observed decreased appetite (among younger patients), enuresis, and abnormal color vision which have been briefly discussed in the literature and need to be addressed more

Post-treatment Guillain-Barre Syndrome in a Patient with Brucellosis; A Case Report

Introduction: Guillain-Barre Syndrome is an uncommon complication during acute brucellosis. Case presentation: In this study, we present a case of Guillain-Barre Syndrome in a 22-year old male patient with complaints of weakness in his lower limbs. He had a history of acute Brucella infection for four months and received antimicrobial medication. Conclusion: the patients can be affected by GBS after antimicrobial treatment

Predictors for surgical outcome in patients with Tumor-Associated epilepsy

This study aimed to evaluate possible predictors for postoperative outcome in patients with tumorassociated epilepsy. Methods: In this study, patients with tumor-associated epilepsy who were candidates for epilepsy surgery were included. After required presurgical evaluations, they underwent surgical resection of the tumor. Patients were followed 24-57 months after the surgery and were divided to two groups of seizure-free and not-seizure-free. Demographic data, medical history, seizure characteristics and tumor features were compared between the two groups to find possible predictors. Findings: Thirty-five patients (17 men and 18 women) with the mean age of 22.8 years (8 to 45 years) were enrolled this study. Most of the patients had temporal lobe tumors (68.0%) followed by frontal and parietal lobe tumors. Ganglioglioma was seen in 62.9% of the patients, followed by astrocytoma and dysembryoplastic neuroepithelial tumour (DNET). We found a non-significant positive correlation between better surgical outcome and being male, younger age at epilepsy onset, longer duration of epilepsy, more seizure frequency, tumors in right hemisphere, tumor type of ganglioglioma, and seizures with secondary generalization. Furthermore, we found that history of head trauma, infection of centeral nervous system (CNS), febrile convulsion, natural vaginal delivery, familial history of epilepsy, tumors in temporal lobe, having auras, developing more seizure types and ipsilateral temporal spikes on preoperative electroencephalogram (EEG) were associated with worst surgical outcome (P > 0.05 for all). Conclusion: In this study, we found no statistically significant predicting factor for surgical outcome; however, we found that being male, smaller ages at seizure onset, longer duration of epilepsy, higher seizure frequency before surgery, involvement of right hemisphere, ganglioglioma, and secondary generalization are more seen in patients with better surgical outcome while history of head trauma, CNS infection, family history of epilepsy, temporal lobe tumors, presence of aura, having multiple types of seizures, and epileptic discharges from temporal lobe in preoperative EEG were seen more in patients with poor outcome. Studies with larger sample sizes are suggested to confirm these findings

An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation.

Background. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. Case Presentation. We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. Conclusion. In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms

An Evaluation on Iran International Public Health Summer School in Relation to its Efficacy Based on Participants' Experience and Opinions

Background: A serious challenge to educate health staff for public health is to appear encouraging enough to persuade them for learning issues on this field and implementing new educational methods and innovative ways. Iran International Public Health Summer School (IPHS) made an effort to provide medical sciences students with a fortune to get familiar with and involved in public health. This study intended to evaluate the efficacy of this event. Materials and Methods: This cross-sectional study was performed in March–April 2015 by the help of an electronic self-administered questionnaire filled out by 49 Iranian participants 6 months after IPHS2014. The questionnaire assessed the main goals in seven main domains: Interest, activities, and general knowledge in the field of public health, general skills, educational methods, educational and executive schedules, and general satisfaction. Results: Average scores of all domains were >3 (the mean), and all were statistically significant. The highest average score belonged to educational methods (3.92) and the lowest was calculated for the item regarding participants' activities on public health (3.5). No significant difference was found between positive answers of individuals who were interested or active in public health prior to the event and those who had no background. Conclusions: We believe IPHS was a unique instance in Public Health Education in Iran. Considering the level of success of this program to reach its goals for both students' with or without any previous background on public health, it is recommended as a general model to be simulated in other developing countries

Association Between Sunlight Exposure and Vitamin D Intake and Multiple Sclerosis Disability and Progression

Background: Some studies on Multiple Sclerosis (MS) have suggested that adequate vitamin D intake can modulate the course of MS and decreases its incidence. However, there are limited studies with conflicting findings on the relation between MS severity, its course, and vitamin D intake.  Objectives: The current study aimed to compare vitamin D intake and sunlight exposure between MS phenotypes and evaluate their association with disability and fatigue in each phenotype. Materials & Methods: A total of 197 patients with MS were recruited from patients referring to MS clinic in Kashani Hospital in Isfahan, Iran. Subjects were assessed for sunlight exposure, vitamin D intake, physical activity, and fatigue. SPSS was used for statistical analysis. P<0.05 were set as significant. Results: According to the obtained results, expanded disability status scale and fatigue scale scores in Primary-Progressive MS (PPMS) and Secondary-Progressive MS (SPMS) groups were higher than RRMS group. In addition, patients in RRMS group had higher scores of sun exposure and physical activity, compared to SPMS and PPMS groups. We found a negative correlation between the scores of fatigue scale and sunlight exposure scale in RRMS patients. Conclusion: We found higher sunlight exposure in RRMS group and lower sunlight exposure in the PPMS group, while dietary vitamin D intake was not different between the groups. Further studies with larger sample sizes and stronger methodologies are required to evaluate our findings

Quantifying Induced Nystagmus Using a Smartphone Eye Tracking Application (EyePhone).

BACKGROUND: There are ≈5 million annual dizziness visits to US emergency departments, of which vestibular strokes account for over 250 000. The head impulse, nystagmus, and test of skew eye examination can accurately distinguish vestibular strokes from peripheral dizziness. However, the eye-movement signs are subtle, and lack of familiarity and difficulty with recognition of abnormal eye movements are significant barriers to widespread emergency department use. To break this barrier, we sought to assess the accuracy of EyePhone, our smartphone eye-tracking application, for quantifying nystagmus. METHODS AND RESULTS: We prospectively enrolled healthy volunteers and recorded the velocity of induced nystagmus using a smartphone eye-tracking application (EyePhone) and then compared the results with video oculography (VOG). Following a calibration protocol, the participants viewed optokinetic stimuli with incremental velocities (2-12 degrees/s) in 4 directions. We extracted slow phase velocities from EyePhone data in each direction and compared them with the corresponding slow phase velocities obtained by the VOG. Furthermore, we calculated the area under the receiver operating characteristic curve for nystagmus detection by EyePhone. We enrolled 10 volunteers (90% men) with an average age of 30.2±6 years. EyePhone-recorded slow phase velocities highly correlated with the VOG recordings (r=0.98 for horizontal and r=0.94 for vertical). The calibration significantly increased the slope of linear regression for horizontal and vertical slow phase velocities. Evaluating the EyePhones performance using VOG data with a 2 degrees/s threshold showed an area under the receiver operating characteristic curve of 0.87 for horizontal and vertical nystagmus detection. CONCLUSIONS: We demonstrated that EyePhone could accurately detect and quantify optokinetic nystagmus, similar to the VOG goggles