The Role of Helicobacter Pylori in Upper Gastrointestinal Bleeding after Using Ibuprofen in Children Aged 1-14 Years Old

Background Non-Steroidal Anti-Inflammatory Drugs(NSAIDs) including Ibuprofen is one of the most currently used drugs in all age groups and finding the relation between upper gastrointestinal bleeding and Helicobacter pylori (H. pylori) in children who used Ibuprofen, is our topic of research. Materials and Methods During the two years of the study, ten children with upper GI bleeding after Ibuprofen were selected as case group and twenty children with upper GI bleeding without history of drug usage were the control group. Their histories were obtained and compared. Helicobacter pylori (H. pylori) infection prevalence and other factors were compared by means of SPSS software, T independent test and chi square, P value less than 0.05 was significant. Results H. pylori was detected in 40% of case group and 8% of control group (P= 0.1) haemoglobin (mean ± standard deviation) in case group was lower than control group 10.5±2.1 vs 11.9 ±1.2 g/dl (P= 0.08). This level (Hb) in H pylori infected was 8.3±1.3 vs. 12 ±0.5 (P= 0.0001) in non- infected children. Conclusion Upper GI bleeding following Ibuprofen prescription is a complex matter in children. H pylori infection is more common in bleeding episodes following Ibuprofen users which show lower haemoglobin levels compared to non- infected patients

Evaluation of Aseptic Meningitis Following Measles-Mumps-Rubella Vaccine in Children Admitted due to Febrile Convulsion

Background Febrile convulsion (FC) is the most common neurological problem in children which can occur in 2 to 5% of this population. The most important issue is to identify the cause of fever and rule out bacterial meningitis. The purpose of this study was to evaluate the association of aseptic meningitis due to Measles-Mumps-Rubella (MMR) vaccine in admitted children with febrile convulsion. Materials and Methods This study was a retrospective cross-sectional. Children aged 6 months to 5 years old with FC that admitted to Mousavi Hospital in Zanjan, Iran, during one year (from 2016 to 2017) were enrolled. The demographic information of patients and laboratory parameters of meningitis in their CSF fluid were recorded in a researcher made questionnaire. Results A total of 275 children were admitted due to FC. Of these children, 36.3% had respiratory infections, 33.8% nonspecific febrile infections, 16% gastroenteritis, 5.8% urinary tract infection, 5.1% acute otitis media and 2.2% meningitis. All cases of meningitis were aseptic without evidence of bacterial compromise. There was a significant relationship between the age of febrile convulsion and meningitis (P=0.012). The age of children with meningitis were between 385 to 395 days (equivalent one year and 20- 30 days), which coincide with 20 to 30 days after receiving the MMR vaccine. Conclusion In the study, all cases of meningitis occurred 20 to 30 days after the MMR vaccine at one year of age. It is strongly suspected the association between aseptic meningitis and the MMR vaccine. LP is recommended in children with febrile convulsions in this age range

Comparison of Paraffin versus Polyethylene Glycol (PEG) in Children with Chronic Functional Constipation

Background Constipation is one of the most common disorders in children. The purpose of this study was to compare paraffin and polyethylene glycol (PEG) in the treatment of children with chronic constipation. Materials and Methods This study is a double-blind randomized trial. Total 160 children aged 2-12 years old with chronic constipation attending the pediatric clinic of Mousavi Hospital in Zanjan (Iran) were examined by the same pediatric gastroenterologist. They randomly received PEG solution (1cc/kg/day divided in two doses) or paraffin at the same dose. Patients were assessed regularly once a week up to one month and then monthly until 6 months. Data were analyzed by SPSS version 16 software. Results From children enrolled in the study, 43.1% were boys with mean age 5.27±1.3 years. The male to female ratio in Paraffin and PEG groups was similar (35/45 vs. 34/46; respectively, P-value= 1.27). The mean age of the participants in paraffin group and PEG group were 5.28±1.4 and 5.24±1.9 years, respectively. The good and intermediate response to PEG in comparison to paraffin were 11.3% and 38.8% vs. 23.8% and 35%; respectively (P=0.111). In children lower than 3 years old, the improvement after receiving paraffin was significantly higher (P=0.048). The frequency of adverse effects was similar and didn’t differ significantly between the two groups. Conclusion There was no significant difference between two groups (PEG and Paraffin groups) in terms of gender and adverse effects of drugs. However paraffin had better therapeutic effect among children less than 3 years of age

Recurrent Epistaxis and Bleeding as the Initial Manifestation of Brucellosis

Severe thrombocytopenia with bleeding is rarely reported in children with brucellosis, and recurrent epistaxis is extremely rare. Brucellosis with hemorrhage should be differentiated from viral hemorrhagic fever, malignancy, and other blood disorders. Bone marrow aspiration (BMA) is mandatory to differentiate from other blood diseases. An 8-year-old boy was admitted with recurrent epistaxis, petechiae and purpura on face and extremities and bleeding from the gums. During the hospitalization, he was febrile and complained of muscle pain. Leukopenias associated with thrombocytopenia were observed. BMA showed to be normal. Among the multiple tests requested, only serum agglutination test (SAT) and 2-MercaptoEthanol test (2-ME) were positive. He was treated with Intravenous immunoglobulin (IVIG) associated with co-trimoxazole and rifampin. Finally, fever subsided, and he was discharged with good condition and normal platelet count. Brucellosis should be a differential diagnosis in patients with fever and bleeding disorders and a history of consumption of unpasteurized dairy, in endemic areas

Hepatic Failure following Metronidazole in Children with Cockayne Syndrome

Cockayne syndrome is an uncommon autosomal recessive disease characterized by microcephaly, abnormal growth, and pathologic premature aging. The purpose of this report is to evaluate liver failure in children with Cockayne syndrome following metronidazole administration. The first case was a 2-year-old boy with Cockayne syndrome. He had been treated with metronidazole for gastroenteritis. 48 hours after treatment initiation, he was hospitalized due to jaundice, intractable vomiting, and agitation. Unfortunately, he died of acute liver failure. The second case was a 5-year-old boy with Cockayne syndrome as well, who had been treated with amoxicillin and metronidazole for a dental infection. He developed jaundice, drowsiness, lethargy, and anorexia after treatment. At hospital, the child received supportive treatment, and his general condition gradually improved. The liver enzyme levels decreased. He was finally discharged in good general condition. The mortality after metronidazole consumption in patients with Cockayne syndrome due to liver failure is very high. The awareness of the dangers of using metronidazole in these patients is valuable

Familial achalasia, a case report

Background: Although achalasia is a relatively rare disease in pediatric age group, it must be considered for differential diagnosis of esophageal disorders in children with positive family history even in the absence of typical clinical manifestations. Case Presentation: A 5-month old boy was hospitalized for cough and mild respiratory distress. Because of positive history of achalasia in his mother, achalasia was detected in esophgagography. Pneumatic dilation through endoscopy was successful. A 12-month follow-up revealed no problem. Conclusion: Achalasia must be considered for differential diagnosis in children with positive family history of achalasia even in the absence of typical clinical manifestations. An autosomal recessive mode of inheritance is probable. We suggest further researches and genetic studies to establish the pattern of inheritance

Comparing the Safety and Efficacy of Two Different Synbiotics in the Treatment of Infantile Functional Constipation Resistant to Non-Pharmacological Therapy: A Randomized Clinical Trial

Background: Recent evidence emphasizes the positive effect of probiotics and synbiotics in the treatment of functional constipation in childhood, but no study has surveyed the effectiveness of synbiotics in improving the clinical conditions in infants ≤6 months suffering from functional constipation, so we performed this study. Aims: Comparing the efficacy and safety of two types of synbiotics including PediLact® (Zist-Takhmir Co., Tehran, Iran) drop containing Bifidobacterium infantis, Lactobacillus reuteri, Lactobacillus rhamnosus plus fructooligosaccharides with BBCare® (Zist-Takhmir Co., Tehran, Iran) drop containing Bifidobacterium lactis BB-12 plus fructooligosaccharides in the treatment of infantile functional constipation. Study Design: This trial was performed on infants less than 6 months of age who met the ROME IV criteria for infantile functional constipation. The patients were randomly assigned to receive PediLact drop (n = 44) or BB-Care drop (n = 45) for one month and were evaluated on the seventh day and at the end of the first month. Results: A significant downward trend was revealed in the responsive rate of every clinical symptom in both intervention groups but BB-Care was more effective than PediLact in improving the frequency of weekly defecation. Both synbiotics also improved significantly all symptoms of constipation in all types of feeding methods after one week and one month of intervention (primary outcomes). There was no side effect of synbiotics through intervention (secondary outcome). Conclusions: This study shows that both synbiotics improved significantly all symptoms of functional constipation after one week and one month of intervention apart from type of feeding method in infants less than 6 months of age. Due to the greater effectiveness of BB-care in increasing stool frequency, B. lactis may play a more prominent role in this age group. This study has been registered at the Iranian Registry of Clinical Trails (IRCT20160827029535N7)

The Safety and Efficacy of Lansoprazole plus Metoclopramide among Neonates with Gastroesophageal Reflux Disease Resistant to Conservative Therapy and Monotherapy: A Clinical Trial

Background. Gastroesophageal reflux disease (GERD) is one of the most common problems in neonates. The main clinical manifestations of neonatal GERD are frequent regurgitation or vomiting associated with irritability, crying, anorexia or feeding refusal, failure to thrive, arching of the back, and sleep disturbance. Aims. The efficacy and safety of ranitidine plus metoclopramide and lansoprazole plus metoclopramide in reducing clinical GERD symptoms based on I-GERQ-R scores in neonatal GERD resistant to conservative and monotherapy. Study Design. This study was a randomized clinical trial of term neonates with GERD diagnosis (according to the final version of the I-GERQ-R), resistant to conservative and monotherapy admitted to Bahrami Children Hospital during 2017-2019. Totally, 120 term neonates (mean age 10.91±7.17 days; girls 54.63%) were randomly assigned to a double-blind trial with either oral ranitidine plus metoclopramide (group A) or oral lansoprazole plus metoclopramide (group B). The changes of the symptoms and signs were recorded after one week and one month. At the end, fifty-four neonates in each group completed the study and their data were analyzed. Results. There was no significant difference in demographic and baseline characteristics between the two groups. The response rate of “lansoprazole plus metoclopramide” was significantly higher than “ranitidine plus metoclopramide” (7.44±3.86 score vs. 9.3±4.57 score, p=0.018) after one week and (2.41±3.06 score vs. 4.5±4.12 score, p=0.003) after one month (primary outcome). There were no drug adverse effects in either group during intervention (secondary outcome). Conclusions. The response rate was significant in each group after one week and one month of treatment, but it was significantly higher in the “lansoprazole plus metoclopramide” group compared with the “ranitidine plus metoclopramide” group. The combination of each acid suppressant with metoclopramide led to a higher response rate in comparison with monotherapy used before intervention. This study has been registered at the Iranian Registry of Clinical Trails (RCT20160827029535N3)

Risk factors for mortality in fulminant acute necrotizing encephalopathy following influenza A in an adolescent boy

Key clinical Message Acknowledging the risk factors of mortality and morbidity of each disease is effective for its final outcome. Recognizing these cases can have the value of preventing the occurrence of unfortunate events, such as not recommending the use diclofenac in an influenza epidemic

Croup Is One of the Clinical Manifestations of Novel Coronavirus in Children

The manifestations of novel coronavirus are diverse and can manifest through respiratory, gastrointestinal, and even nervous symptoms. Respiratory involvement is usually an upper tract infection or pneumonia but can also present as other forms of pulmonary disorders. A 3-year-old boy presented with cough, hoarseness, and stridor. He was treated with dexamethasone and nebulized adrenaline and a clinical diagnosis of croup was established. After treatment, his symptoms improved for a short time, but suddenly cough exacerbated and was accompanied by respiratory failure and seizures. He was then intubated and mechanically ventilated. Because of the coronavirus epidemic, Reverse-Transcription Polymerase Chain Reaction (RT-PCR) assay was taken from the pharyngeal secretions and was positive. The child was isolated. Due to excessive respiratory secretions and worsening of the general condition, bronchoscopy was performed depicting an image compatible with bacterial tracheitis. He was treated with broad-spectrum antibiotics, antivirals, and supportive care. Finally, after 4 weeks of treatment, the child was discharged in good general condition. Croup is one of the respiratory symptoms of novel coronavirus and can be a risk factor for bacterial tracheitis. Therefore, the presence of clinical manifestations of croup indicates the need for coronavirus PCR testing