The role of IL-6 for predicting neonatal sepsis: A systematic review and meta-analysis

Objective: Neonatal sepsis (NS) is a common and life-threatening disorder in infants. Previous studies showed that interleukin-6 (IL-6) may be a valid non-invasive and rapid method for diagnosis of NS. We conducted this review to assess the validity of IL-6 for predicting NS. Methods: This was a systematic review with meta-analysis. Embase, Medline and Web of Science databases were searched between January 1990 and December 2009. The search terms used were "cytokine", "neonate", "sepsis" and "interleukin-6". We used standard methods recommended for meta analyses of diagnostic test evaluations. The analysis was based on a summary ROC (SROC) curve. Meta-regression analysis was used to assess the effects of some confounding factors on the results of meta-analysis. Potential presence of publication bias was tested using funnel plots and the Egger test. Findings: Meta-analysis was performed on 13 publications including 353 infants with sepsis and 691 control infants. The pooled sensitivity and specificity of IL-6 was 0.79 and 0.84, respectively. The maximum joint sensitivity and specificity (i.e., the Q value) in SROC curve was 0.82 and the area under curve (AUC) was 0.89 (95% CI: 0.84-0.94). Meta-regression analysis showed that the diagnostic accuracy of IL-6 was not affected by confounding variables. The evaluation of publication bias showed that the Egger test was not significant (P=0.07). Conclusion: IL-6 seems to be a valid marker for predicting NS. It may be considered for early diagnosis of sepsis in neonatal care units. © 2011 by Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, All rights reserved

Unusual Presentation of Pulmonary Interstitial Glycogenosis: A Case Report Study

Introduction: Pulmonary interstitial glycogenosis (PIG) is a kind of children�s interstitial lung disease (ChILD). This is exclusively limited to neonates and infants. Often, PIG is diagnosed in the lung biopsy in a short time after birth (usually < 6 months). Most cases of PIG in infants are symptomatic within the first days to weeks of life. PIG expresses itself with diverse clinical symptoms such as tachypnea and hypoxia and may lead to acute respiratory failure in neonates. Case Presentation: In this case report study, we presented a 1.5-year-old boy with the chief complaint of stage 4 clubbing in fingers and toes. Mild chest deformity was observed in his physical exam. No evidence of respiratory and cardiac complications was observed. Initial lab tests and further specific studies were normal. His parents did not mention the history of any diseases in this patient. His chest X-ray (CXR) showed hyperinflated lungs, diffuse bilateral interstitial infiltration, and hazy opacities. Ground glass opacities (GGO) and interlobular septal thickening and cystic changes with reversed halo sign in both lungs were observed in his chest computerized tomography (CT). Finally, pulmonary biopsy showed a high level of glycogen-laden mesenchymal cells in the interstitium of alveoli, and vimentin-positive interstitial infiltration in lung parenchyma confirmed the PIG diagnosis. Conclusions: The new manifestation of PIG, which has been reported in this case, can be beneficial for future diagnoses of PIG. Copyright © 2021, Author(s)

A case report of ROHHAD syndrome in an 8-year-old Iranian Boy

Introduction: Rapid-onset obesity concurrently with hypoventilation, hypothalamic, autonomic dysregulation (ROHHAD) is an uncommon disease that presents with multiorgan disorders during early childhood, with fewer than 100 cases reported around the world. We aim to present a case of ROHHAD syndrome admitting with rare neurologic symptoms. We also present our treatment regimen. Case Presentation: An 8-year-old boy was admitted to our department with ataxia and gait disturbance that led us to the final diagnosis after a thorough investigation. He had multiple admissions and was treated for other diagnoses. His first symptoms started from age 5 with obstructive apnea. He underwent an adenectomy surgery at that time, but the symptoms continued. A year after the surgery, he was admitted again due to his somnolence but was diagnosed only with hypothyroidism and anemia. At the age of 7 years and 8 months, he was admitted to our department with ataxia and abnormal gait from the past year with instability and numerous falls. He also had shown hyperphagia that had been resulted in 10 kilograms of weight gain in six months. He was experiencing gradual behavioral symptoms, including episodes of self and hetero aggression and impulsivity. His other symptoms included fatigue, somnolence, gastrointestinal dysmotility, hyperhidrosis, central hypothyroidism, polyuria, precocious puberty, and rapid obesity. His laboratory investigation revealed hyperprolactinemia. Conclusions: Our case indicates that ROHHAD is a complex disease with divergent signs and symptoms that needs to be kept in mind for diagnosis and should be treated with a high level of collaboration of various medical specialties. Since late diagnosis of this syndrome leads to a magnificent increase in morbidity and mortality rates, it is vital to pay extreme attention to this syndrome. The diagnosis should be considered even more in children over two years old with rapid-onset obesity, which is accompanied by other symptoms. Here, our patient�s complaint was ataxia that revealed the underlying cause after investigation. Copyright © 2021, International Journal of Endocrinology and Metabolism. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited

Scimitar Syndrome in a Newborn

Introduction: Scimitar syndrome is a rare congenital condition that is usually presented in two major types, the infantile type as a severe condition with a poor outcome (median age: 2 months) and the adult type with a better condition and good outcome. It also has a wide spectrum of clinical presentations, from being asymptomatic in the adult type to cardiac and respiratory failure and pulmonary hypertension in the infantile type. Case Presentation: In this case report, we present a 43-day-old female case referred to Taleghani Children Hospital, Gorgan, Iran, with respiratory symptoms. In a physical examination, the case had a grade II/VI murmur, dextrocardia, and respiratory distress. In evaluations, the patient had severe stenosis proximal to the left common carotid artery after its origin. The heart and mediastinum were displaced to the right side, and the thoracic aorta was normal in size and orientation. bovine type of supra-aortic arch branches in the left-sided aortic arch, hypoplasia of the right upper lobe with severe hypoplasia of the right lower lobe were seen as well. There was sequestration adjacent to the right lower lobe with a dual feeder artery directly from the abdominal aorta and celiac branch and dual draining veins. Partial anomalous pulmonary venous connection was detected in the neck, and mediastinal computed tomography (CT) angiography with reconstructed views.. Bronchoscopy revealed right main bronchus hypoplasia and right lower lobe hypoplasia. Then, with the help of angiography, scimitar syndrome diagnosis was confirmed for the patient. Conclusions: Although scimitar syndrome is an uncommon condition, it has serious complications and poor outcomes in some patients. It is necessary to be aware of this rare congenital condition and use helpful methods, such as CT angiography and angiography, to confirm the diagnosis. Copyright © 2022, Author(s)

Comparison of the Effects of Salbutamol, Epinephrine, and 5 Inhaled Hypertonic Saline on Infants with Acute Bronchiolitis

Background: Bronchiolitis is a lower respiratory tract infection and one of the major health concerns and hospitalization factors in infants. Objectives: This study aimed to address inconsistencies in treating this disease. Methods: This study is a double-blind clinical trial investigating the effect of salbutamol, epinephrine, and 5 inhaled hypertonic saline on treating infants with bronchiolitis referred to the Taleghani Pediatrics Hospital in Gorgan, Iran, during 2019 - 2020. The clinical results of the treatments and hospitalization stay were also evaluated. Results: In this study, the study sample encompassed 18 girls and 39 boys. There was no significant difference between the three groups regarding age, gender, parental literacy level, and history of allergies. Salbutamol and epinephrine, in comparison to hypertonic saline, were effective in shortening patients� hospital stay (P = 0.004). Moreover, there was a significant difference between the oxygen saturation of in the patients 48 h after treatment in the salbutamol and epinephrine groups compared to the saline group (P = 0.001). Conclusions: In comparison to hypertonic saline, salbutamol and epinephrine can be selected to treat children with acute bronchiolitis since they can shorten hospital stay improve O2 saturation, and decrease treatment costs imposed on the health care system and families. © 2022 KOWSAR Medical Publishing Company. All rights reserved

Comparative study of urinary minerals and their effect on stone formation in two groups of cystic fibrosis (Cf) and healthy children

Background: Cystic Fibrosis (CF) is a systemic autosomal disorder and the most important chronic lung disease in children. Oxalate is the end product of vitamin C metabolism, which increases the risk of kidney stones, urinary bladder stones, and calcium deposits in CF patients. Objectives: Considering the increased mineral excretion and the rate of stone formation in the urinary tract, examining the excretion of minerals will greatly help resolve clinical problems. Methods: This descriptive-analytical study was performed on CF and healthy children in Gorgan in 2018-19. In this study, 40 CF children and 40 healthy children were randomly selected. After obtaining informed consent from the parents of the children, a random urine sample was collected to evaluate urine minerals. Children with abnormal urinary mineral excretion underwent ul-trasonography. The data were analyzed by SPSS 18 using descriptive indices (mean ± SD, frequency, and percentage) and statistical tests (independent t-test, chi-square test, and nonparametric tests). Results: Out of 80 CF and healthy children, 34 were girls, and the rest was boys. The mean age of the patients was 4.34 ± 3.38. The age difference was not significant between the groups (P > 0.05). The mean urinary levels of phosphorus, uric acid, magnesium, and citrate were 0.87 ± 1.01, 1.16 ± 0.68, 0.23 ± 0.18, 2.37 ± 3.13 mg/mg of creatinine. In the pediatric patient group, respectively (P 0.05). Hyperoxaluria, hyperuricosuria, hypomagnesiuria, and hypocitraturia occurred in 35, 30, 62, and 7.5 of the CF patients, respectively. Among the urinary minerals studied, hyperoxaluria was found to be a major determinant of stone formation risk in CF. No correlation was observed between the formation of stones and the rate of excretion of minerals (P > 0.05). Conclusions: In summary, CF patients are at an increased risk of developing citrate and calcium stones compared to the healthy group, which is associated with hyperuricosuria, hypocitraturia, and hyperoxaluria. © 2020 Global Research Online. All rights reserved

A case series of pediatric COVID-19 with complicated symptoms in Iran

People in different age groups are susceptible to SARS-CoV-2 infection as a newly emerging virus. However, the clinical course, symptoms and disease outcome vary from case to case. Although COVID-19 is usually milder in children than adults, some studies reported nonspecific symptoms. Here, we report eight pediatric cases of COVID-19 admitted in the Taleghani Children Hospital in Gorgan city, north of Iran, with complicated symptoms. The current case series poses several challenges to the pediatricians regarding the pediatric cases of COVID-19. As most literature relating to adults are not always transferable to children, clinicians should be warned about such presentations among children with COVID-19. © 2021 Future Medicine Ltd

Organic fertilizer sources improve the yield and quality attributes of maize (Zea mays L.) hybrids by improving soil properties and nutrient uptake under drought stress

In abiotic stresses, drought is the main problem in agricultural production which inhibits the plants to show off their genetic potential. Maize is not only the cereal crop of the world but also 3rd important cereal crop in Pakistan. Maize is drought-sensitive and affected at each growth and development stage. So, the organic amendment is not only the solution to mitigate the drought stress due to long-lasting moisture availability but also improves the growth, yield, quality, and nutrient uptake with improving soil properties. Therefore, a two-year field experiment during 2018 and 2019 was laid out at Agronomy Research Area, Department of Agronomy, Bahauddin Zakariya University, Multan, Pakistan. Treatments included pre-screened maize hybrids: P-1429 (drought-sensitive) and Dk-6724 (drought-tolerant); pre-optimized levels of each organic fertilizer source (OFS); recommended chemical fertilizer source (CS), 10 t/ha biochar (BC), 10 t/ha farmyard manure (F.M) and 10 t/ha poultry manure (P.M); and irrigation regimes i.e normal irrigation (Ck) 100 % field capacity and severe drought (SD) 50 % field capacity. The Experiment was designed in a randomized complete block design (RCBD) with a split-split plot arrangement and was replicated three times. Irrigation regimes were put in the main plot, organic fertilizer sources were put in the subplot and maize hybrids were put in the sub-sub plot. Different agronomic growth and yield attributes, quality attributes, crop physiology, soil physical properties, nutrient uptake, and activity of antioxidant enzymes were assessed. It resulted that in organic fertilizer sources application, 10 t/ha poultry manure and farmyard manure followed by biochar improved the growth and yield of maize hybrids significantly, under normal irrigation and severe drought. These also improve the quality of maize by improving the nutrient uptake and soil physical properties like increasing the soil porosity and decreasing the soil bulk density during consecutive years 2018 and 2019. It was also noticed that the application of organic fertilizers mitigated the adverse effect of drought by the antioxidant defense system with the production of SOD, POD and CAT