Aspiration of a sharp metallic pin in a child: A case report

Introduction: Foreign Body Aspiration (FBA) represents a life-threatening emergency. It occurs primarily in children below 3 years. Generally, the most common aspirated FB is organic material such as nuts or beans. Sharp Foreign Bodies (FBs) are of particular concern to the attending clinician, because of their potential to perforate the air passage and cause possible complications. Here in, we report a rare case of sharp metallic pin aspiration in a child. Case report: A 15-month-old boy was referred to our Emergency Ward due to the sudden onset of chocking and dysphagia which were transient. His mother was a tailor. He had history of ingestion of the similar pin two months ago. Chest radiography identified the radiopaque pin in the left side of chest. Rigid bronchoscopy was done and a sharp metallic pin was removed. Conclusions: Aspiration of a sharp, metallic FB is a serious injury. Pain X-ray can confirm the diagnosis. FB inhalation is preventable by creating public awareness and parenteral education to keep small objects out of children

Attention-deficit/hyperactivity disorder in children with constipation and fecal incontinence

Background and Objective: There is some evidence of a relationship between attention-deficit/hyperactivity disorder (ADHD) and functional defecation disorders (FDDs), both of which are common in childhood. The aim of the study was to investigate the frequency of ADHD in children with fecal incontinence (FI) and functional constipation (FC). Methods: This cross-sectional study was conducted on 99 children aged 4-14 years who met the Rome IV criteria to diagnose pediatric chronic FC with FI from January to May 2020. The ADHD was then assessed by the child and adolescent psychiatrist via clinical visits, DSM-5 and Conners Rating Scale (CRS). Pearson’s Chi-Square test and Mann-Whitney’s test were used to compare children with and without ADHD. A P value <0.05 was considered statistically significant. Findings: According to DM-V and clinical visits, about 24 (24.2) children with FC and FI were diagnosed with ADHD. Moreover, six and one of their relatives had anxiety/depression and schizophrenia, respectively. Children with ADHD were significantly male (83, p= 0.009), older (p= 0.003), heavier (p= 0.005), first born (79, P < 0.001) and premature (37, P=0.01) with older mothers (p=0.01). Conclusion: This study showed that there was a high prevalence of ADHD in children with FC and FI. Therefore, screening of suspected children is recommended

Comparison of oral and intra venous midazolam for sedation in children undergoing upper gastrointestinal endoscopy

Background: Selecting the best medication for upper GI endoscopy in children is a challenging issue. The goal of this study was to compare the effects of oral and intravenous midazolam for upper gastrointestinal endoscopy (UGIE) on children. Methods: In this randomized clinical trial study conducted in Amirkola Children's Hospital, 110 children were randomly assigned to oral or intravenous groups. An expert nurse recorded O2 saturation, heart rate before, during and 5 minutes after endoscopy for all patients. Sedation, separation from parents and child cooperation were recorded. Results: Heart rate before and during endoscopy was not significantly different between two groups while heart rate was significantly lower in IV group after endoscopy. Cooperation during bite block was significantly better in oral group. Cooperation during endoscopy was not significantly different between two groups. Separation from parents in both male and female ones was significantly better in oral group. Complications were reported in 7 cases in oral group and 6 in IV group. Conclusion: Oral midazolam in comparison with IV midazolam is better and may be a method of choice for pediatric UGIE purposes

Evaluation the helicobacter pylori infection in asthmatic children compared to control group

Background: Asthma is a highly prevalent chronic respiratory disease in children. Moreover, the underlying causes of asthma exacerbation are important because they are effective in controlling and preventing asthma. The aim of this study was to evaluate the helicobacter pylori infection in controlled and uncontrolled asthmatic children compared to healthy children. Methods: This case- control study was done on 120 children aged 6-14 years with moderate to severe asthma. Diagnosis of asthma was performed according to GINA criteria with respect to the history and clinical examination. In addition, 120 healthy children without asthma were considered as the control group. Helicobacter pylori stool antigen test was evaluated for all patients. In addition to the above information, age, sex, duration of asthma and gastrointestinal symptoms were also recorded for each patient. Data were analyzed using SPSS15, Chi-square and Fisher's exact test and T-test. Results: The mean age of children in the asthmatic and healthy children was 8.3±2 and 8.5±2.3, respectively (p=0.479). Totally, 57.5% and 58.3% of children were boys in the control group, and in asthmatic group, respectively. Thirty percent of children in the control group and 8.3% of children with asthma were H. pylori positive (p=0.000). Mean duration of asthma in children with H. pylori positive (3.3±1.55) and H. pylori negative (3.33±1.56) stool antigen showed no significant difference (p=0.944). Conclusions: The results of this study indicated that there was an inverse relation between helicobacter pylori infection and asthma

Effect of a synbiotic on functional abdominal pain in childhood

Background: One of the common functional gastrointestinal disorders in children is functional abdominal pain (FAP). The aim of the present study was to determine whether the administration of a synbiotic composed of fructo-oligosaccharides (FOS) and the seven types of beneficial bacteria is useful in FAP of childhood. Methods: In this placebo-controlled, double-blind trial, 4-15-year-old children who met the Rome III criteria for FAP were randomly divided to receive either synbiotic or placebo twice daily for 4 weeks. Primary outcome was at least 50 reduction in the number of pain episodes, and secondary outcomes were a decline of at least two scales in the pain duration and intensity based on Wong-Baker scale. Response to therapy was decrease of pain frequency/intensity. Results: A total of 67 children completed the trial (35 with synbiotic). Response rate was higher with synbiotic than placebo after four weeks (53.1 vs 11.4; p<0.001), and synbiotic had significant superiority to placebo to relieve the duration (4.56±9.12 vs12±18.59, min/day, P=0.04), frequency (0.31±0.53vs 1.17±0.7, episode/Wk., P<.001) and intensity (2.38±2.29 vs 5.49±1.83, p<0.001) of abdominal pain. Conclusion: Synbiotic compared to placebo significantly decreased the intensity, frequency and duration of FAP in children

Foreign body ingestion and aspiration at a pediatric center in northern Iran

Background: Aspiration or ingestion of foreign bodies (FBs) is a common health problem leading to hospitalization of children around the world. The purpose of this study was to detect the FBS of aspirated or swallowed in children. Methods: The present cross-sectional descriptive-analytical study was conducted on 77 hospitalized children due to FBs aspirated or swallowed from 2008 to 2013 at Amirkola Childrenchr('39')s Hospital. Information including demographic profile, type of FBs and their location, clinical manifestations, treatment used and possible complications were extracted from their medical records, and the data were analyzed. Results: Out of 76 cases, 51 (67.1) were boys; 47.4 of children were 1-2 years old (mean age 2.6±2.2 years), and 67.1 of the bodies were in the gastrointestinal tract. The most common FBs were foodstuff (42.1), metallic bodies (39.5) and non-metallic bodies (18.4), respectively. The most common symptoms were cough (84) in respiratory FBs and vomiting (57) in gastrointestinal FBs. The mean duration of hospitalization was 74.8±57.1 hours in gastrointestinal FBs and 126.7±56 hours in respiratory FBs. There was a significant statistical relationship between location of FBs (p=0.000) and type of swallowed or aspirated bodies (p=0.041) with the duration of hospitalization. No mortality was observed. Conclusions: Findings show that foodstuffs are the most abundant FBs aspirated or swallowed in children aged 1-2 years. Obviously, educating parents and caregivers to take required care of children, especially while eating in this particular age group, is a key element in reducing such injuries

Isolated thrombocytopenia report of a rare presentation of childhood Systemic Lupus Erythematosus

Background: Systemic lupus erythematosus (SLE) has various presentations in children. Hematologic abnormalities is common in childhood onset of SLE, however, isolated thrombocytopenia is relatively rare. Thus, we present a child with isolated thrombocytopenia as a rare presentation of SLE. Case presentation: A 12-year-old boy with chief complaints of loss of appetite, weight loss, decreased platelet count (8000/µL) and lymph node enlargement was referred to our hospital. Biopsy of lymph node showed reactive lymphadenopathy. Investigations regarding infectious disease was negative. Platelet count remained low after low dose steroidned therapy. Antinuclear antibody (ANA) and anti-double stranded DNA antibody screening tests were positive with titer of 1/62 and 1/54, respectively. Therefore, juvenile SLE was considered as the final diagnosis and raising the dose of prednisolone to 2mg/kg/day was associated with increasing platelet count to 40000/µL and a week later to 96000/µL. Conclusion: The findings of this study indicate that in cases with isolated thrombocytopenia refractory to conventional dose of steroids, SLE should be considered. This study justifies serum ANA and anti DNA assessment in children with thrombocytopeni

COVID-19 and renal involvement in children: a retrospective study

Background: The New coronavirus (SARS COV-2) can cause acute respiratory disease and also multiorgan dysfunction. There is insufficient data about kidney involvement in children. So, this study was done on children with COVID-19 to evaluate nephrological involvement. Methods: All children with confirmed or suspected COVID-19 who were admitted in Children Hospital .were enrolled. They were admitted in hospital from March 2020 to July 2020. Serum Blood Urea Nitrogen (BUN), creatinine, sodium, potassium, calcium and urinalysis were evaluated. Also, glomerular filtration rate (GFR) was calculated by Schertz's formula. All patients were evaluated by chest x-ray and/or computerized tomography scanning (CTS). The data were analyzed by SPSS software and P value less than 0.05 was determined as significant. Results: Forty-seven children with confirmed or suspected COVID-19 were enrolled to this study. At admission, 23.4 and 27.7 of children with COVID-19 had abnormal increase in serum BUN and creatinine, respectively. Also 78.8 and 25.5 of children had GFR less than 90 and 60 ml/min /1.732, respectively. Additionally, 13/47 (27.7) of children had abnormal urine analysis (microscopic hematuria and/or proteinuria). There wasn’t a significant relationship between pulmonary lesions and abnormal reduction of GFR (P<0/05). Conclusion: In the study, the risk of AKI (acute kidney injury) and decrease of GFR and also abnormal urinalysis is high in children with COVID-19. So, more attention for detection of kidney involvement is necessary and more conservative management for prevention of AKI and decrease of GFR are recommended