Recurrence and complications of pediatric inguinal hernia repair over 5 years

Introduction and aim Inguinal hernia is one of the most common pediatric diseases in children and it presents most commonly during the first year of life. The aim of this study was to determine epidemiologic indexes and complications of inguinal hernia repair in pediatric patients who underwent inguinal hernia surgery.Patients and methods This retrospective study was carried out in the Imam Khomeini and the Abuzar hospitals. All inpatients who underwent surgery for inguinal hernia from 2003 to 2004 were included in this study. Their hospital records were reviewed till 2007 for age, sex, wound infection, recurrence, and other complications. The v2-test was used for analysis using SPSS, version 13.0.Results In this study, 269 children were included. Of all the patients, 237 (88.1%) were boys and 32 (11.9%) were girls (P < 0.001). The median age at the first reference to the surgeon was 2.93 years. Right-side and left-side inguinal hernia was observed in 136 (50.55%) and 92 (34.20%) cases, respectively. Bilateral inguinal hernia was observed in 41 (15.25%) cases. The frequency of recurrence was 2.2%, and was observed only in boys. Postoperative complications were observed in 5.2% of the cases. The most common of them was anesthetic complication.Conclusion Most of the cases involved male patients. All of the recurrences were in male patients. Postoperative complications were observed in 5.2% of the cases. Keywords: complication, inguinal hernia, pediatric, recurrenc

Evaluation of epidemiologic indices of neonate’s diseases in the Pediatric Surgery Ward of the Ahvaz Jundishapur University hospitals during the period 1993–1996 and 2002–2005

Introduction and aim The neonatal period is a critical time for infants, and 2/3 of first-year mortality occurs during this period. In developing countries, surgical diseases are the most important cause of neonatal mortality. Mortality was reduced in the past decade due to the availability of well-trained pediatric surgeons and the development of sophisticated instruments. The aim of this study was to show neonatal mortality and other indices in the period when there were no pediatric surgeons compared with the period when pediatric surgeons were available. Patients and methods This retrospective study was conducted in the Imam Khomeini and Abuzar Hospital during the period 1993–1996 and 2002–2005. All neonates admitted in the surgical wards of the Imam Khomeini and Abuzar Hospital were included in this study. Only cases of those patients who died before data accumulation was completed or discharged against medical advice were excluded from our study. In the first period, no pediatric surgeon was available and all surgeries were performed by general surgeons. In the second period, pediatric surgeons were available. Data were statistically analyzed and χ2-test was used to compare noncategorical data. A P value of less than 0.05 was considered to be significant. This study was approved by the ethics committee of the hospital, and no intervention was used. Results In our study, 88 cases (males = 60.2%, female =39.8%) in the first period and 452 cases (males =61.7%, females= 38.3%) in the second period were included. The mean age at admission time in the first and second period was 6 days for both groups. The mean weights in the first and second period were 2886 ±766 g and 2915± 658 g, respectively. The mean lengths of hospital stay in the first and second period were 5 days and 10.5 days, respectively. In the first period, 68 cases (37.3%) were admitted in the first 7 days of life and 54 cases (61.4%) had a birth weight of 2500–3500 g. Of the 88 cases, 40 cases died (45.5%). In the second period, 353 cases (78.1%) were admitted in the first 7 days of life and 278 cases (61.5%) had a birth weight of 2500–3500 g. Of the 452 cases, 101 cases died (22.3%). Conclusion In our study, the most common surgical diseases in both the periods were imperforate anus, esophageal atresia with or without tracheoesophageal fistula (TEF), Hirschsprung’s disease, and jejunoileal atresia; these were similar to results found in other studies.Keywords: Hirschsprung’s disease, imperforate anus, inguinal hernia, pediatric, surger

Etiology of acute scrotal pain in children and adolescent patients admitted in Ahvaz Educational Hospitals

Purpose Acute scrotum is an emergency condition requiring rapid intervention. The aim of this study was to evaluate the clinical and epidemiological specifications of acute scrotum.Patients and methods This retrospective study was carried out on patients less than 21 years admitted with a diagnosis of acute scrotum in the surgical and medical wards from 2009 to 2010. One hundred and thirty-nine patients were included in this study. Epi-info version 6.4 (CDC) was used for data analysis.Results The final diagnoses were as follows: spermatic cord torsion (n =57, 41.00%), incarcerated inguinal hernia (n =30, 21.60%), epididymo-orchitis (n= 28, 20.14%), missed torsion (n =15, 10.79%), testicular trauma (n=5, 3.60%), and torsion of the appendix of the testis (n= 4, 2.87%). The most common age groups in relation to the diagnoses were as follows: testicular torsion and missed torsion (10–15 years, 34.7%), torsion of appendix testis (10–15 years, 100%), epididymo-orchitis (15–21 years, 85.71%), and incarcerated inguinal hernia with two peaks of age ( <5 years, 46.7%). Fifty-eight patients (41.72%) visited the hospital less than 6 h after the onset of pain. Twenty-eight patients underwent orchiectomy or orchiopexy and 38 patients underwent detorsion and bilateral orchiopexy. A herniotomy was performed in 15 patients and herniorraphy in 10 patients. An appendectomy was performed in four patients. Other procedures were carried out in seven patients. Out of 72 patients diagnosed with torsion (57 patients) or missed torsion (15 patients), 38 patients (52.7%) underwent a testicular salvage surgery (detorsion and orchiopexy). Out of all patients (139 patients), 92 patients underwent surgery and the rest (47 patients) were treated conservatively. These 47 patients had epididymo-orchitis (n= 28), testicular trauma (n =4), incarcerated inguinal hernia (n= 5), and missed torsion and testicular torsion (n= 10). Out of 27 patients with abnormal urinary findings, 19 patients had epididymo-orchitis.Conclusion The most common important differential diagnosis for acute scrotum is spermatic cord torsion. Most of the abnormal urinary findings were observed in patients with epididymo-orchitis. Most of the patients underwent surgery less than 6 h of disease onset. In patients with spermatic cord torsion, the affected testis has to be evaluated and treated during the first 6 h of presentation.Keywords: epididymitis, epididymo-orchitis, herniotomy, hydrocele, inguinal hernia, orchiopexy, scrotum, testicular torsion, traum

Foreign body impacted in the Jejunum

We present a case with protracted vomiting which admitted to our hospital. After radiologic investigation, patients underwent laparotomy, were a foreign body was found impacted in the jejunum. Index Word: foreign body, jejunum, impaction, intestinal obstruction

Study of Intraventricular Hemorrhage in VLBW Neonates Admitted in Al-Zahra Hospital, Tabriz, Iran

Introduction and Aim: Intra-ventricular hemorrhage (IVH) is an important predictor of adverse neurodevelopmental outcome. IVH risk factor identification may conduct improvement of quality of care in Neonatal Intensive Care Units. The aim of the current study was to determine possible risk factors associated with IVH in VLBW neonates admitted in our hospital. Patients and Methods: All neonates with birth weight below 1500 gr admitted to NICU. Cranial ultrasonography was done for premature neonates weighed <1000 g in 3 to 5 days and in 1 month again. In premature infants weighed >1000 g, sonography was done in 7 days and 30 days of life respectively. If there is any conditions such as apnea, seizure, significant decrease in level of hemoglobin, increased head circumference, increased oxygen consumption, and other significant changes another sonography was done again. Exclusion criteria were cerebral malformations, metabolic disturbances, chromosomal anomalies, central nervous system infection, and genetic syndromes. Data was analyzed by SPSS ver 16.0 (SPSS Inc, Chicago, IL, USA) Results: In this study 64 cases with IVH and 110 without IVH were included. Mean of gestational age was 28.78±2.08. From neonates, 54.6% were boys and 45.4% were girls. Vaginal delivery and cesarean section was done in 56 (32.2%) and 118(67.8%) cases respectively. Mean±SD of pH in cases with IVH and without IVH was 7.19±0.22 and 7.30±0.12 respectively(p=0.001). Mean ±SD of pco2 in cases with IVH and without IVH was 65.15±29.89 and 49.88±40.89 respectively(p=0.001). Mean of 5th min APGAR score in patients required CPR was 7.36±1.57 and in patients without CPR was 8.68±1.25(P=0.001). From cases with IVH, hydrocephaly was detected in 20 cases. From cases without IVH, hydrocephaly was detected in 6 cases. Result of chi-square showed significant correlation between IVH and prematurity( X2=21.94, df=1, P<0.001). From cases with IVH, 18 cases (28.1%) expired. From cases without IVH, 11 cases(10%) expired(X2=9.398, df=1, P=0.002). Results of chi-square test showed that there were a correlation between IVH and PDA, pressure support, surfactant therapy, inotrop drug administration, vaginal delivery, neonatal resuscitation, and antenatal corticosteroid therapy(p<0.05). Hyaline membrane disease, history of preclampsia in mother was significantly higher in cases without IVH(Chi-square, p<0.05). Conclusion: PDA, pressure support, surfactant therapy, inotrop drug administration, vaginal delivery, neonatal resuscitation, and antenatal corticosteroid therapy were significantly higher in cases with IVH. Hyaline membrane disease and preeclampsia in mother was significantly higher in cases without IVH.Keywords: Intraventricular hemorrhage, APGAR, low birth weight, hyaline membrane disease, corticosteroid, surfactant, inotrop, pre-eclampsi

Hyalomma anatolicum as the main infesting tick in an important livestock rearing region, central area of iran

Background: This study was carried out to determine the infestation of domestic ruminants to ticks in an important livestock-rearing region, located in central part of Iran. Methods: Ticks were collected from cattle, sheep, and goats and then were identified with appropriate identification keys to species level in two different ecological regions of plains and mountain in 4 seasons in 2015. Results: Totally 492 ticks from cattle, sheep, and goats in 34 herds were collected. Totally, 18.53 of domestic animals were infected by ticks. All ticks were belonged to family Ixodidae and classified into three genera and six species comprising Hyalomma anatolicum (38.83), Hy. Asiaticum (23.37), Hy. marginatum (2.85), Hy. sp. (3.45), Rhipicephalus sanguineus (14.02) and Haemaphysalis sulcata (10.98). Sex ratio of the collected specimens showed 241 (48.99) male, 219 (44.51) female and 32 (6.5) nymph Conclusion: Studied area is important for production of livestock and dairy products. Annually, many livestock products are exported to other parts from this region; therefore, it is very important to identify the infection rate of tick-borne diseases as well as safety factors on livestock. © 2018, Iranian Journal of Public Health. All rights reserved

Hyalomma anatolicum as the main infesting tick in an important livestock rearing region, central area of iran

Background: This study was carried out to determine the infestation of domestic ruminants to ticks in an important livestock-rearing region, located in central part of Iran. Methods: Ticks were collected from cattle, sheep, and goats and then were identified with appropriate identification keys to species level in two different ecological regions of plains and mountain in 4 seasons in 2015. Results: Totally 492 ticks from cattle, sheep, and goats in 34 herds were collected. Totally, 18.53 of domestic animals were infected by ticks. All ticks were belonged to family Ixodidae and classified into three genera and six species comprising Hyalomma anatolicum (38.83), Hy. Asiaticum (23.37), Hy. marginatum (2.85), Hy. sp. (3.45), Rhipicephalus sanguineus (14.02) and Haemaphysalis sulcata (10.98). Sex ratio of the collected specimens showed 241 (48.99) male, 219 (44.51) female and 32 (6.5) nymph Conclusion: Studied area is important for production of livestock and dairy products. Annually, many livestock products are exported to other parts from this region; therefore, it is very important to identify the infection rate of tick-borne diseases as well as safety factors on livestock. © 2018, Iranian Journal of Public Health. All rights reserved

Which is Better for Pain Reduction before Venipuncture: Glucose, Lidocaine or Expressed Breast Milk? Introduction and Aim

Abstract Aim: The aim of this study was to compare effects of 2 cc oral glucose (50%), topical application of lidocaine, 2 cc of expressed breast milk (EBM), and nothing per oral for reducing of pain before painful procedures. Patients and methods: In this case-control study, 121 term neonates were included. There were 3 groups of cases and one control group. Inclusion criteria were: term neonates (38-42 weeks); stable condition; per oral feeding; five minutes APGAR>7; and no history of narcotic usage. Neonates were randomly divided in 4 groups. Two milliliter of glucose solution (50%), topical application of lidocaine, and 2 cc of expressed breast milk via syringe were used for group I, II, and III respectively. Group IV is the control group. For control group, no additional measure was done. Data analysis was performed using SPSS ver 11.0 (SPSS Inc, Chicago, IL, USA). Chi-square, t-test, and ANOVA were used for analysis. P<0.05 was considered significant. Results: Score of Douleur Aiguë Nouveau-né was significantly lower in group III compared to other group (P<0.05, Tukey). Crying time in group III was significantly lower than group IV. Respiratory rate in group II was significantly lower than group IV (P=0.018). Pulse rate was significantly lower in group III compared to other group. Conclusion: Expressed breast milk is the safe and natural agents for reducing pain of neonates. Another clinical trial study with more samples is recommended

Study of Serological and Clinical Factors among Juvenile Rheumatoid Arthritis Cases Admitted to Mofid Children's Hospital and Imam Hossein Hospitail, Tehran, IRAN

No Abstrac

Isolation and antibiotic susceptibility of Shigella species from stool samples among hospitalized children in Abadan, Iran

AIM: The aim of this study was to determine the incidence of Shigella species and their antimicrobial susceptibility patterns in hospitalized children with Shigellosis in Abadan, Iran. BACKGROUND: Shigellosis is caused by different species of Shigella and one of the most common causes of diarrhea in children. This disease is endemic in many developing countries including Iran. PATIENTS AND METHODS: This prospective cross sectional study was conducted in a teaching hospital in Abadan, Iran during June 2011 to May 2013. Stool specimens were collected from pediatric age group. All isolates were confirmed as Shigella species by biochemical and serologic tests. Antibiotic sensitivity pattern of these isolates was studied by disk diffusion Method. RESULTS: Among all 705 stool samples, 36 (5.1) yielded Shigella. Of cases, 392 (55.6) were girl and 313 (44.4) were boy. The most common Shigella isolates were S. flexneri (n=19, 52.7) followed by S. sonnei (n=11, 30.5), S. boydii (n=4, 11.1) and S. dysenteriae 2(5.5). Of the Shigella isolates, 47.2 showed resistance to two or more antimicrobial agents. Resistance pattern against various antimicrobials were as follows: trimethoprim-sulphamethoxazole (80.5), ampicillin (63.8), tetracycline (58.3), chloramphenicol (33.3), nalidixic acid (27.7), and cefixime (16.6). There was no resistance against ciprofloxacin and ceftriaxone. CONCLUSION: The most common isolates were S. flexneri followed by S. Sonnei. There was no antibiotic resistance against ciprofloxacin and ceftriaxone. TMP-SMZ showed highest resistance pattern