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

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

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.

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

Studying the Effect of Injected Dexamethasone and Inhaled Epinephrine on Inhaled Salbutamol-Treated Children with Acute Bronchiolitis

Abstract Background: Acute bronchiolitis is the most common lower respiratory tract infection in infant and one of their hospital admission reasons. Due to the high prevalence of the disease and unclear effectiveness of existing treatments, the present study was designed to evaluate the therapeutic effect of single dose of injected dexamethasone and inhaled epinephrine in patients with acute bronchiolitis treated with inhaled salbutamol. Materials and Methods: In this double-blinded clinical trial, 90 infants with age of 2-24 months who were admitted to hospital with acute bronchiolitis were studied. All patients received inhaled salbutamol (0.15 mg/kg) and then were randomly assigned to three groups (n=30) of dexamethasone (0.6 mg/kg), inhaled epinephrine (0.15 mg/kg) and control (distillated water). Heart rate (HR) and respiratory rate (RR), arterial blood oxygen saturation (O2 sat) and respiratory distress scores (RDS) of children at baseline, 30, 60,120 minutes and, 24 hours after intervention were recorded and compared between groups. Results: The mean of HR, RR and RDS had significant improvement and the mean of O2 sat had significant rising trend and improvement during the study in all groups (p<0.05). The mean of HR in epinephrine group was upper than placebo in all measurements (p<0.001). RDS in epinephrine group was significantly upper than dexamethasone (p=0.002, CI95%=0.58- 2.69) and placebo (p=0.014, CI95%=0.27-2.8) Conclusion: Based on the result of present study, it seems that inhaled epinephrine or injected dexamethasone have no superiority to placebo in treating infantile acute bronchiolitis and their administration is not recommended

A randomized controlled trial of the effects of hydrochlorothiazide on overactive bladder and idiopathic hypercalciuria

Overactive bladder is a stressful condition which affects around 15%—20% of 5- year-old and up to 2% of young adults. One of the most common causes of overactive bladder is hypercalciuria. Our study investigated the effect of hydrochlorothiazide (HCTZ) on overactive bladder and hypercalciuria. This randomized controlled trial was conducted on 88 patients with overactive bladder and idiopathic hypercalciuria. They were randomly divided into the intervention group receiving 1 mg/kg/day of HCTZ for 3 months, and the control group receiving training without any intervention. Treatment compliance and response were reviewed monthly in each patient using a 30-day bedwetting diary. In the 1st month, the mean of bedwetting was 14.47 ± 7.06 and 12.61 ± 7.57 in the intervention and control groups, respectively (P = 0.23). In the 2nd month, it was 10.04 ± 6.32 and 10.79 ± 7.83 in the intervention and control groups, respectively (P = 0.62); and in the 3rd month, it was 6.49 ± 7.13 and 7.64 ± 7.95 in the intervention and control groups, respectively (P = 0.59). There was no significant difference between the two groups. Thus, use of HCTZ was not found to be better than urine retention control training. Therefore, one may conclude that treating hypercalciuria with HCTZ had no demonstrable effect on overactive bladder

J Clin Res Pediatr Endocrinol 2014;6(2):105-110 DOI: 10.4274/jcrpe.1287 Original Article Epidemiology of Congenital Hypothyroidism in

ABSTRACT Objective: The aim of this study was to investigate the epidemiology of congenital hypothyroidism (CH) among newborns in Markazi Province, Iran

Omega-3 and Zinc supplementation as complementary therapies in children with attention-deficit/hyperactivity disorder

Objective: The aim of this study is to evaluate the effect of zinc and omega-3 supplements as adjunctive drugs in the treatment of attention-deficit/hyperactivity disorder (ADHD) of children. Methods: This study is a randomized, double-blind clinical trial conducted on 150 children aged 6–15 years old that diagnosed as new cases of ADHD. Study subjects were evaluated for 8 weeks. Besides of drug of choice (methylphenidate) for the ADHD, patients received placebo in the control group (n = 50), zinc sulfate in second group (n = 50), and omega-3 (n = 50) in third group. Clinical improvement was checking by Conners' Parent and Teacher Rating Scales before and in 2nd, 4th, and 8th week of treatment. Results were analyzed with SPSS version 16 software. Findings: In this study, mean scores of Conners' scale showed significant improvement during treatment in the zinc group compared to control group in children that affected to attention-deficit disorder subtype of ADHD (P = 0.02). Moreover, in omega-3 group, better clinical response was seen than other groups (P < 0.05). However, there was no significant difference between omega-3 group compared to placebo group in the mean scores of Conners' scale (P = 0.89). Conclusion: Zinc supplementation accompanied by the main treatment significantly improves symptom of attention-deficit disorder subtype of ADHD. However, omega-3 supplementation was superior to zinc and placebo in the clinical improvement of ADHD