AN UNUSUAL PATHWAY IN DIAGNOSIS OF IMMUNE DISORDER THROUGH INVASIVE PULMONARY ASPERGILLOSIS WITH HEMOPTYSIS: CASE PRESENTATION

Invasive pulmonary aspergillosis is a fungal infection caused by aspergillus fumigates that transmitted through inhalation of air conidia in most cases. Since these conidia will be removed by phagocytes, they cause rarely any diseases in people who are not immunocompromised; therefore normal and also sufficient function of macrophages and neutrophils are necessary to prevent aspergillosis. On the other hand, immunocompromised patients like CGD (Chronic Granulomatous Disease) can easily be involved in such fungal infections through exposure to high amounts of these conidia. In this article, we will introduce a girl with interesting history of BCGitis, after awhile presented by hemoptysis discovered as a beginning sign of invasive pulmonary aspergillosis. Finally out evaluations showed immune disorder in this neglected child. Regarding high mortality of invasive aspergillosis as 30-50 %; effective management is achieved by on-time suspicion to fungal infection associated by finding risky hosts and also early initiation of antifungals for reduction of invasive aspergillosis

CHRONIC COUGH IN A 10- YEAR OLD BOY AS A FIRST PRESENTATION OF INFLAMMATORY MYOFIBROBLASTIC TUMOR (IMT): A CASE REPORT

An inflammatory myofibroblastic tumor (IMT) is a rare benign tumor with an unknown origin. Its clinical and radiological manifestations are variable and nonspecific, also half of them are asymptomatic while cough, hemoptysis, dyspnea are possible to see. Therefore the diagnosis is too hard to establish unless an exact evaluation by an expert pathologist on a biopsy from surgical resection. The standard treatment for diagnostic and therapeutic reasons is a complete resection whereas incomplete resection increases the risk of recurrence. Here we report a 10-year old boy with prolonged cough and collapse-consolidation in his chest x-ray who referred to our pediatric center in the northeast of Iran. Keywords: Inflammatory myofibroblastic tumor, cough, collapse, pediatric

LARYNGOTRACHEAL CLEFTS (LC) AS AN UNCOMMON CAUSE OF STRIDOR IN AN INFANT: CASE REPORT

Stridor is conventionally thought to be of inspiratory causes in nature and usually due to airway pathology which leads upper airway obstruction in infants. The present case report illustrates that stridor would be caused by Laryngotracheal clefts (LC) which can be resulted in respiratory distress, stridor, choking episodes, coughing and recurrent croup as well as recurrent aspiration and respiratory tract infections. Keywords: stridor, Laryngotracheal clefts (LC), Infants

Screening for Depression In Hospitalized Pediatric Patients

How to Cite This Article: Esmaeeli M, Erfani Sayar R, Saghebi A, Elmi Saghi, Rahmani Sh, Elmi S, Rabbani Javadi A. Screening for Depression in Hospitalized Pediatric Patients. Iran J Child Neurol. 2014 Winter; 8(1):47-51. ObjectiveIn chronically ill children who are hospitalized, many mood changes occur. For example, in children with cancer or renal failure, prolonged hospitalization and chemotherapy can lead to depression. With the improved survival of childhoodmalignancies, the effect of treatment on child’s psychosocial well-being becomes increasingly relevant. In this study, we examined the prevalence of depression in hospitalized children with chronic and acute conditions in Dr Sheikh Pediatrics Hospital in Mashhad.Materials & MethodsAfter receiving the approval from the Ethics Committee of Mashhad University of Medical Sciences, we did this cross-sectional descriptive study, from April to June 2012 in Dr Sheikh Pediatric Hospital in Mashhad. Ninety children, aged between 8 to 16 years, were screened for depression. The sampling method was census. Children with a history of depressive or other mental disorders were excluded.Three groups of children (children with chronic renal disease, malignancy, and acute disease) were evaluated for depression using standard Children Depression Inventory Questionnaire (CDI). Two specifically trained nurses with the supervisionof a psychiatrist filled out the questionnaires at patients’ bedside. Depression scores were then analyzed by SPSS software.ResultsOf 90 children, 43(47.7%) were male and 47(52.2%) were female. The Children’s mean age was 11±2.3 years, and the mean length of hospitalization was 8±5.3 days.Depression was detected in various degrees in 63% of patients (N=57), and 36.6% of children (N=32) had no symptoms of depression. Severe depression was not seenin any of the patients with acute illness. More than half of patients with cancer and chronic kidney disease had moderate to severe depression.There was a significant statistical relationship between the duration of illness and severity of depression. There was also a significant correlation between severity of depression and frequency of hospitalization. Children who had been hospitalized more than 3 times in the last year, experienced more severe levels of depression. We also found a significant correlation between pubertal age and severity of depressionin patients with cancers and chronic renal failure.ConclusionChildren who are hospitalized due to chronic conditions are at a higher risk for mood disorders in comparison with the ones with acute conditions. It is therefore advisable to consider more practical plans to improve the care for hospitalizedchildren’s mental health.ReferencesKessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-ofonset distributions of dsm-iv disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005;62(6):593-602.Rutter M. Relationship between mental disorders in children and adulthood. Acta Psychiatr Scand 1995;91(2):73-85.Naerde A, Tambs K, Mathiesen KS Dalgard OS. Symptoms of anxiety and depression among mothers of pre-school children: effect of chronic strain related to children and child care-taking. J affect Discord 2000;58(3):181-99Ernest J, Weissflog G, Brahler E, Romer G, Götze H. Depression in children of cancer patients over time and dependence of parental distress. Prax Kinderpsychol Kinderpsychiatr 2012;61(6):432-46.Gordijn MS, van Listenburg RR, Gemke RJ, Huisman J. Sleep, fatigue, depression, and quality of life in survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2013;60(3):479-85.De Sousa A. Psychiatric issues in renal failure and dialysis. Indian J Nephrol 2008;18(2):47-50Bakr A, Amr M, Sarhan A, Hammad A. Psychiatric disorders in children with chronic renal failure. Pediatr Nephrol 2007;22(1):128-31.Goldstein SL, Rosburg NM, Warady BA, Seikaly M, McDonald R, Limbers C, et al. Pediatric end stage renal disease health-related quality of life differs by modality: a PedsQL ESRD analysis. Pediatr Nephrol 2009;24(8):1553-60.Thomalla G, Barkmann C, Romer G. Psychosocial symptoms in children of hemodialysis patients. Prax Kinderpsychol Kinderpsychiatr 2005;54(5):399-416.Laffond C, Dellatolas G, Alapetite C, Puget S, Grill J, Habrand JL, et al. Quality of life, mood and executive functioning after childhood craniopharyngioma treated with surgery and proton beam therapy. Brain Inj 2012;26(3):270-81.Chung TK, Lynch ER, Fiser CJ, Nelson DA, Agricola K, Tudor C, et al. Psychiatric coomorbidity and treatment response in patients with tuberous sclerosis complex. Ann Clin Psychiatry 2011;23(4):263-9.Kinahan KE, Sharp LK, Seidel K, Leisenring W, Didwania A, Lacouture ME, et al. Scarring, disfigurement, and quality of life in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor study. J Clin Oncol 2012;30(20):2466-74.Adduci A, Jankovic M, Strazzer S, Massimino M, Clerici C, Poggi G. Parent-child communication and psychological adjustment in children with a brain tumor. Pediatr Blood Cancer 2012;59(2):290-4Szabo A, Mezei G, Kovari E, Cserhati E. Depressive symptoms amongst asthmatic children caregivers. Peditr Allergy Immunol 2012;21(4 Pt 2):e667-73.Arabiat DH, Elliot B, Draper P. The prevalence of depression in pediatric oncology patients undergoing chemotherapy treatment in Jordan. Pediatr Oncol Nurs 2012;29(5):283-8.Li HC, Williams PD, Lopez V, Chung JO. Relationships among therapy-related symptoms, depressive symptoms, and quality of life in Chinese children hospitalized with cancer: an exploratory study. Cancer Nurs 2013;36(5):346-54

Hypoparathyroidism as the first manifestation of Kearns-sayre syndrome. A case report

Hypoparathyroidism as the First Manifestation of Kearns-Sayre Syndrome: A Case Report How to Cite This Article: Ashrafzadeh F, Ghaemi N, Akhondian J, Beiraghi Toosi M, Elmi S. Hypoparathyroidism as the First Manifestation of Kearns-Sayre Syndrome: A Case Report. Iran J Child Neurol. 2013 Autumn;7(4):53-57.  ObjectiveKearns-Sayre syndrome is a mitochondrial myopathy, which was first described by Tomas Kearn in 1958. Diagnostic symptoms include retinitis pigmentosa, chronic and progressive external ophthalmoplegia plus one or more of following factors: heart conduction system disorders, cerebellar ataxia, or cerebrospinal fluid (CSF) protein content above 100 mg/dL. The nature of this uncommon disease is yet to be clarified. In this paper, we report a case of Kearns-Sayre syndrome. According to the previous records, the first manifestation of Kearns-Sayre syndrome as hypoparathyroidism is uncommon and in this article, we report a case with this problem.ReferencesAshizawa T, Subramony SH. What is Kearns-Sayer syndrome after all? Arch Neurol 2001;58(7):1053-4.Barragan-Campos HM, Vallee JN, Lo D, Barrera-Ramirez CF, Argote-Greene M, Sanchez-Guerrero J, et al. Brain magnetic resonance imaging findings in patients with mitochondrial cytopathies. Arch Neurol 2005;62(5):737-42.Amemiya S, Hamamoto M, Goto Y, Komaki H, Nishino I, Nonaka I, et al. Psychosis and progressive dementia: presenting features of a mitochondriopathy. Neurology 2000;55(4):600-1.Katsanos KH, Pappas CJ, Patsouras D, Michalis LK, Kitsios G, Elisaf M, et al. Alarming atrioventricular block and mitral valve prolapse in the Kearns-Sayer syndrome. Int J Cardiol 2002;83(2):179-81.Tiranti V, Viscomi C, Hildebrandt T, Di Meo I, Mineri R, Tiveron C, et al. Loss of ETHE1, a mitochondrial dioxygenase, causes fatal sulfide toxicity in ethylmalonic encephalopathy. Nat Med 2009;15(2):200–5.Chinnery PF, DiMauro S, Shanske S, Schon EA, Zeviani M, Mariotti C, et al. Risk of developing a mitochondrial DNA deletion disorder. Lancet 2004;364(9434):592–6.Bosbach S, Kornblum C, Schröder R, Wagner M. Executive and visuospatial deficits in patients with chronic progressive external ophthalmoplegia and Kearns-Sayer syndrome. Brain 2003;126(Pt 5):1231-40.Berenberg RA, Pellock JM, DiMauro S, Schotland DL, Bonilla E, Eastwood A, et al. Lumping or splitting? “Ophthalmoplegia-plus” or Kearns-Sayer syndrome? Ann Neurol 1977;1(1):37-54.Welzing L, von Kleist-Retzow JC, Kribs A, Eifinger F, Huenseler C, Sreeram N. Rapid development of life threatening complete atrioventricular block in Kearns-Sayer syndrome. Eur J Pediatr 2009;168(6):757-9.Berio A, Piazzi A. Kearns-Sayer syndrome with GH deficiency. Pediatr Med Chir 2000;22:43-6.Schmiedel J, Jackson S, Schäfer J, Reichmann H. Mitochondrial cytopathies. J Neurol 2003;250(3):267-77.Chu BC, Terae S, Takahashi C, Kikuchi Y, Miyasaka K, Abe S, et al. MRI of the brain in the Kearns-Sayer syndrome: report of four cases and a review. Neuroradiology 1999;41(10):759-64.Altunbaşak S, Bingöl G, Ozbarlas N, Akçören Z, Hergüner O. Kearns-Sayer syndrome. A case report. Turk J Pediatr 1998;40(2):255-9.Chawla S, Coku J, Forbes T, Kannan S. Kearns-Sayer syndrome presenting as complete heart block. Pediatr Cardiol 2008;29(3):659-62.Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/ AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation 2002;106(16):2145-61.Basu AP, Posner E, McFarland R, Turnbull DM. Kearnsayre syndrome. Medscape reference. Feb 4, 2010.http://emedicine.medscape.com/article/950897

The Relationship between Chronic Constipation and Urinary Tract Infection in Children: A Case-Control Clinical Study

Background Urinary tract infection (UTI) is one of the most common bacterial infections in children, if not diagnosed leads to serious complications such as hypertension, chronic renal failure and renal scar. Constipation is one of the main risk factors for recurrent UTI. The aim of present study was to investigate the relationship between chronic constipation and urinary tract infection in children. Materials and Methods In this case-control study 105 patients with functional chronic constipation as case group, compared with 104 children without chronic constipation as control. The control group was matched according to gender and age. The prevalence of UTI in children with and without constipation as well as their improvement was compared after treatment. Results The prevalence of UTI in case and control groups was 13.3% and 6.7%, respectively (P=0.17). The prevalence of UTI in case group decreased to 3.8% after treatment of constipation. Escherichia coli (E coli) was the most commonly isolated organism in both groups. Conclusion Results of present study showed that despite of no significant urinary tract infection incidence between children with constipation and those without constipation, the constipation should still be considered as a predisposing risk factor for the UTI occurrence

Side Effects of Hydroxyurea in Patients with Major and Intermediat B-Thalassemia

Introduction: Patients referred to as having thalassemia major are usually those who come to medical attention in the first year of life and subsequently require regular transfusions to survive. Those who present later or who seldom need transfusions are said to have thalassemia intermediaHydroxyurea, an s-phase-specific and non-DNA-hypomethylating chemotherapeutic agents is capable of inducing HbF synthesis.Patients & Methods: The study evaluated hydroxyurea complications in a cohort of 28 patients with major (n=20) and intermediate thalassemia (n=8). HU was started in a dose of 10 mg/kg daily and then increased by 5 mg/kg daily every 4-6 weeks until toxicity occurred or clinical response was achieved.Results: We reviewed the records of 28 patients with intermediate and major b-thalassemia. The statistical analysis did not show a significant correlation between age at diagnosis, age of starting HU, duration of HU treatment, dose of HU and ethnicity.Side effects of HU have been recorded in 21 (75%) patients.Adverse effects were hair loss (n=8; 28.57%), hyper pigmentation (n=4; 14.28%), nausea and vomiting (n=2; 7.14%), abdominal pain (n=4; 14.28%), and increase in hepatic enzymes (n=2; 7.14%).Neurologic complications were headache (n=7; 25%), vertigo (n=1; 3.57%) and drowsiness (n=1; 3.57%).Conclusion: According to the results of this and other studies, it seems that HU therapy in thalassemic patients can be safely used but can be started at low doses and increased slowly , monitoring the patient's respons

Post treatment thyroid dysfunction and obesity in children with acute lymphoblastic leukemia and non-Hodgkin’s lymphoma: a brief report

Background: In most children with Acute Lymphoblastic Leukemia (ALL) and Non Hodgkin’s Lymphoma (NHL) who have received chemotherapy with and without radi-otherapy, some late effects due to treatment may occur such as endocrinopathies. Methods: We evaluated growth criteria (including short stature, obesity) and thyroid test function in 50 children with ALL (n= 25) and NHL (n= 25) 3-17 year-old in remis-sion period who randomly received chemotherapy with (n= 25) or without (n= 25) radi-ation such as our treatment groups. The values for height, weight and BMI in less than 5th or more than 95 th percentile considers abnormal. Results: Six (12%) patients were in less than 5th percentile height (short stature). Two patients (4.0%) had over-weight and 48 (96%) were in normal range of BMI. Six (12%) patients were in less than 5th and 3 (6%) were in more than 95 th weight percentile. There was no significant difference between two different treatment groups for TSH (P= 0.662 (but there was a significant difference between these groups in case of T4 (P= 0.049(. Mean and SD for T4 in patients with chemotherapy alone was less than in whom received chemotherapy plus radiotherapy. There was no significant difference between ALL and NHL groups for TSH, T4 (P= 0.567, 0.528 respectively). Two boys with ALL without history of radiation had hypothyroidism that had based on their la-boratory data. Conclusion: Regarding to effects of thyroid dysfunction on short stature and obesity in adolescent with ALL and NHL, we suggest to have more attention about growth, thy-roid test to avoid late side effect of malignancy treatment

Evaluation of Parental Attitudes toward Lumbar Puncture in their Children

Introduction:   Sometimes physicians need to assess some markers on selected children's cerebrospinal fluid specimen according to lumbar puncture (LP). Although immediate diagnosis and treatment especially for meningitis is necessary, But just at this moment, due to some incorrect believe in society, some parents may not allow physician to do LP. The reality is that most of these people, if they have enough information about this issue, will not interfere. This study aimed to assess parent 's knowledge and attitudes toward this subject.   Materials and Method: Through a cross - sectional study we evaluated 91 parents, who their child must been undergone LP as physician’s decision, selected during 18 months using purposive sampling. The data collection tool was a questionnaire including two sections of the child and the parents' knowledge and attitudes.  Scientific validity of the questionnaire was confirmed by content validity. To achieve the objectives, SPSS ver.15 and descriptive statistics and chi-square test were used.   Results: 61 parents(67%)  mentioned   fear of some side effects as the main reason of their children 's  LP discontent .The most important  cause of  fear was low back pain according to  50 (54.9%) parents 's view. 70 parents (76.9%) had some satisfaction after performing  LP .There was  statistically significant difference between proportion of satisfied parents and non-satisfied ones (