Is Additional Fluid Therapy Effective in the Treatment of Children with Urinary Tract Infection?

Introduction: Urinary tract infection can result in many complications such as abscess, hypertension, renal failure, renal scar, reflux, etc. Since there is no general agreement on the administration of additional fluid (1.5 times maintenance) for the early treatment of UTI, this study was conducted to evaluate the effect of additional fluid therapy.Materials and Methods: In This clinical trial study, 206 children with UTI who were admitted at Amir Kabir Hospital (Arak, Iran) from March 2012 to March 2013 were divided into two groups of 103. One group received the usual amount of maintenance fluid while the other group received 1.5 times more than usual maintenance. The course of the resolution of dysuria, frequency, malodorous urine, abdominal pain, and fever was compared between the two groups. Urine culture was performed for all patients 2, 7-10, and 90 days after admission. The patients were age and sex matched. The data was analyzed using descriptive statistics and the X2 method based on independent sample t-test.Results: Additional fluid had a significant effect on malodorous urine dysuria. However, it had an inverse effect on the treatment of fever and urinary frequency as it made them last longer. There was no difference in other parameters like abdominal pain and urine culture in 3 stages.Conclusions: Based on our study, the intake of excessive amounts of water has no significant effects on the results of the UTI treatment. However, due to lack of adequate evidence, further studies should be conducted in this field.Keywords: Urinary Tract Infection; Child; Fluid Therapy

Evaluation of the Parents' Functioning and Behavioral Disorders in Children with and without Vesicoureteral Reflux

Introduction: Vesicoureteral reflux is the backward flow of the urine from the bladder into the ureters or kidneys that may result in urinary tract infection. This paper aimed at evaluating this problem and its relationship with the children's mood, growth, and physical conditions as well as its influence on the family and school.Materials and Methods: The study population consisted of 122 children aged 4-14 years old: 61 with and 61 without VUR. The Child Behavior Checklist (CBCL) and Global Assessment of Functioning (GAF) were used to assess the parents' behavior. The data were analyzed using descriptive statistics, Chi-square test, and t test.Results: In this study, 23% of the children with and 4.9% of the children without VUR suffered depression (P value= 0.007). Moreover, 10.7% of the children with VUR showed offensive behaviors but there found no case among the children in the other group (P value=0.012). In addition, 16.4% of the children with and 1.7% of the children without VUR had intellectual problems (P value=0.008). Furthermore, 27.9% of the children with and 3.3% of the children without VUR had emotional problems (P value=0.001), and 4.9% of the parents of the children with VUR needed serious clinical measures but there were no such cases among children without VUR (P value=0.021).Conclusions: Increased behavioral problems in children with VUR and declined parental functioning require prompt treatment to prevent future behavioral problems in children.Keywords: Behavioral Problems; Vesico-Ureteral Reflux; Parents; Child.

Correlation of Sacral Ratio and Reflux-Related Renal Injury in Children with Vesicoureteral reflux with and without Nephropathy

Introduction: Vesicoureteral reflux refers to the retrograde flow of the urine from the bladder to the ureter and kidney. The ureteral attachment to the bladder is normally oblique, between the bladder mucosa and detrusor muscle, creating a flap-value mechanism that prevents reflux. Reflux occurs when the submucosal tunnel between the mucosa and detrusor muscle is short or absent. The inflammatory reaction caused by pyelonephritis can result in scarring, which is also termed reflux nephropathy. Since sacral bone anomalies have a direct influence on the final function of the urinary and bowel systems, this study was performed to investigate the relationship between sacral ratio and reflux nephropathy.Materials and Methods: In this case–control study, the case -control group included 200 children under 9 years old who were referred to Amir-Kabir Hospital clinics with urinary tract infection and according to the VCUG and DMSA results, children with various grades of VUR entered the study. The sacral ratio was measured in the two groups and compared by a radiologist. The data were analyzed using Chi-2 and Mann Whitney Tests and software SPSS 16.Results: The case group included 48 males and 52 females with a mean age of 3.7 years old who had reflux nephropathy, and the control group included 47 males and 53 females with a mean age of 4.1 years who did not have reflux nephropathy. Sacral ratio abnormality was detected in 64% and 23.7% of the cases and controls respectively, which showed a significant difference (p-value=0.003).Conclusions: Sacral ratio abnormality was more common in children with vesicoureteral reflux and reflux nephropathy than children with VUR without reflux nephropathy.Keywords: Vesico-Ureteral  Reflux;  Sacral agenesis; Child;  Diagnostic imaging

Analyzing the Effect of Narcissism in the Poems of Mehdi Akhavan Sales

Mehdi Akhavan Sales is a famous contemporary poet who has experimented with various forms of poetry. His idealistic and narcissistic personality has special and worthy dimensions. The research answers the question of whether narcissism has had a significant effect on the quality and quantity of Akhavan's illustrations? In the present article, the psychological reasons for composing his narcissistic poems were investigated. The Akhavan's thirst for approval, reaching an ideal society, staying away from the manifestations of the modern world, and uniting with mythical characters who are the normal and abnormal branches of narcissism, back to the hallmarks of his personal life. The research method is descriptive and analytical. According to the research results, various levels of narcissism such as boastfulness, arrogance, praise of artistic status, Qalandari's thoughts, etc., have played a significant role in promoting the quality and quantity of artistic aspects of M. Omid's themes and literary images; in a way, if we remove or reduce these innovations, a large part of the content of his works will be lost and will naturally affect some of the concepts of contemporary literature

High prevalence of hypovitaminosis D3 among pregnant women in central Iran: correlation with newborn vitamin D3 levels and negative association with gestational age

Objective Hypovitaminosis D3 is a significant concern among pregnant women and their newborns because vitamin D3 (Vit-D3) plays a crucial role in embryonic growth, development, and health. This study aimed to evaluate the Vit-D3 status of a group of pregnant Iranian women and its association with newborn Vit-D3 levels, medical and clinical indices after delivery. Methods A total of 206 pregnant women and their newborns were assessed for Vit-D3 levels and their correlation with gestational age. Mean±standard deviation (SD) or the orders (non-parametric tests) of variables were compared, and correlation estimations were performed to elucidate any differences or associations between groups, with a confidence interval of at least 0.95. Results The mean±SD of mothers’ age and gestational age were 29.65±6.18 years and 35.59±1.6 weeks, respectively. Neonatal Vit-D3 levels were associated with maternal age. Using a 30 ng/mL cutoff point for serum Vit-D3 levels, 83.5% of pregnant women and 84.7% of newborns had hypovitaminosis D3. The average Vit-D3 levels of mothers and newborns at delivery time were 23.5±8.07 ng/mL and 20.76±9.14 ng/mL, respectively. Newborn Vit-D3 levels were positively correlated with maternal Vit-D3 serum levels (R=0.744; P<0.001) and gestational age (R=0.161; P=0.022). In newborns, head circumference was inversely correlated with bilirubin level (R=−0.302; P<0.001) but directly associated with weight (R=0.640; P<0.001). Conclusion Hypovitaminosis D3 remains a significant challenge for pregnant Iranian women. Maternal Vit-D3 levels provide for the newborn’s needs, particularly in the late stages of pregnancy. Therefore, Vit-D3 supplementation and regular monitoring are essential for pregnant women and their newborns

Efficacy of montelukast for prevention of upper respiratory tract infection in children: A randomized, placebo-controlled trial

Background: Upper Respiratory tract infection (URTI) or common cold is very prevalent in children particularly in young children. Leukotriene receptor antagonists (LTRAs) like montelukast are effective drugs in asthma and some other respiratory diseases. Our purpose was to study preventive effects of montelukast on pediatric URTI. Methods: This randomized, placebo-controlled, and double blind trial was performed on 450 healthy children aged 1-5 year in Amir Kabir Hospital, Arak, Iran. Children were randomized 1:1 to placebo group or montelukast group for 12 weeks. Number of URTI episodes and duration were the primary end points and were compared at baseline and after termination of treatment. Results: Mean age was 28 ± 12.3 months. Mean of URTI episodes was 0.7 ± 0.57 in children treated with montelukast and 1.27 ± 0.72 in children treated with placebo, respectively. Differences were statistically significant (P =0.01). A significant difference was seen in URTI duration between two study groups (6.3 ± 6.1 vs 4.1 ± 3.9, P = 0.05). In addition, duration of fever was shorter in children receiving montelukast (P=0.001). Conclusion: Our study indicates that 3 month treatment with montelukast is effective for reducing the incidence of URTI in young children. This treatment has an acceptable safety without any serious concern. © 2020 Tabriz University of Medical Sciences. All rights reserved