Overview of hydatid disease in Iranian children

Background: Hydatid disease (HD) is still an important health hazard in the world. This disease is a parasitic infestation endemic in many sheep- and cattle-raising areas such as Iran. Objectives: This study aimed to review the clinical manifestations, laboratory aspects, imaging findings, and management of HD. Patients and Methods: Data were collected from the medical records of patients diagnosed with HD in eight referral hospitals in different provinces of Iran from 2001 to 2014. Results: Overall, 161 children at a mean age of 9.25 ± 3.37 years (age range = 1 - 15 years old) hospitalized with a definite diagnosis of the hydatid cyst between 2001 and 2014 were studied. The male-to-female ratio was 1.6:1. The most commonly involved organ was the lung (67.1), followed by the liver (44.1) and a combined liver and lung involvement was found in 15.5 of the patients. The cysts were found more frequently in the right lobe of the liver and lung than in the left lobe. The most frequent complaints were fever (35.4) and abdominal pain (31.7), and the most frequent sign was an abdominal mass in the liver involvement and cough in the lung involvement. There was a high eosinophil count (> 500/micL) in 41 of our cases. A high erythrocyte sedimentation rate (> 30) or positive C-reactive protein (based on the qualitative method) was found in 18.6 of the patients and leukocytosis > 15000/micL in 29.2 of the children. Ultrasonography was the main imaging test, with an accuracy rate of 96, and chest X-ray was helpful in 88.6 of the cases. Surgery was performed in 89 of the patients, and selective patients underwent percutaneous aspiration-injection-reaspiration drainage or medical treatment. Conclusions: The lung was the most commonly involved organ in the children recruited in the present study. Given the high probability of multiple organ involvement, we recommend that patients with HD be assessed via ultrasonography and chest X-ray. In endemic regions, unexplained eosinophilia should be considered as a parasitic disease like HD and its complications. © 2015 Pediartric Infections Research Center

Advances in understanding and treating ADHD

Attention deficit hyperactivity disorder (ADHD) is a neurocognitive behavioral developmental disorder most commonly seen in childhood and adolescence, which often extends to the adult years. Relative to a decade ago, there has been extensive research into understanding the factors underlying ADHD, leading to far more treatment options available for both adolescents and adults with this disorder. Novel stimulant formulations have made it possible to tailor treatment to the duration of efficacy required by patients, and to help mitigate the potential for abuse, misuse and diversion. Several new non-stimulant options have also emerged in the past few years. Among these, cognitive behavioral interventions have proven popular in the treatment of adult ADHD, especially within the adult population who cannot or will not use medications, along with the many medication-treated patients who continue to show residual disability

Designing and evaluation of rapid molecular assays for first and second-line anti-tuberculosis drugs

Introduction: The four basic or “first-line” TB drugs are Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. For the treatment of drug-resistant TB, the current TB drugs are grouped according to their effectiveness and experience of use, such as Streptomycin, pyrazinamide, rifabutin, kanamycin, amikacin, ofloxacin, etc. The drug susceptibility test (DST) is a time-consuming and costly method. Rapid molecular tests may be used by detection of related mutations. The aim of this study is to design and evaluate the quickest methods of detection. Materials and Methods: 120 resistant and susceptible clinical isolates of Mycobacterium tuberculosis (MTB) were evaluated for probable mutations in resistance-related genes. Molecular methods of polymerase chain reaction (PCR)-RFLP, AS-PCR and MAS-PCR as nested or semi-nested forms were used for mutation detection in katG, rpoB, pncA, rpsL, gyrA,inh, rrs, inhA and embA. Evaluation of ethA and pncA genes in the isolates was accomplished by sequencing. Furthermore, the sequencing method was used for all the genes as the golden standard. Results: 88% prevalence of the katG315 mutation was detected in INH-resistant isolates by AS-PCR and 95.6% by PCR-RFLP. In 93% of rifampin-resistant isolates point mutation at codons 516, 526 or 531 were detected by MAS-PCR method and 75% by AS-PCR method. In rapid detection of resistance to injectable drugs, the sensitivity and specificity of PCR-RFLP method for mutation detection in rrs gene by BSTFNI enzyme were 95/65% and 70/83%, by AJIi enzyme were 60% and 90/62% and by MAS-PCR method were 50% and 70/58%, respectively. Ofloxacin resistance was detected in 84.6% of resistant isolates by 4 endonuclease enzymes in PCR-RFLP method and sensitivity and specificity of a MAS-PCR method were 86/11% and 100%, respectively. Sensitivity and specificity of a MAS-PCR method for pncA were 66% and 90% and for PCR-RFLP method for rpsL were 90% and 95%, 36.5% (CI:0.09–0.45) and 100% only for one resistance-related codon for emb gene, respectively. Ethionamide and Pyrazinamide resistance in resistant isolates was proved by 100% sensitivity by the sequence method. Conclusion: Molecular methods of PCR-RFLP, MAS-PCR and sequencing were successfully used for rapid detection of first- and second-line antimycobacterial drugs

Surveillance of antibiotic consumption point prevalence survey 2014: Antimicrobial prescribing in pediatrics wards of 16 Iranian hospitals

Background: Antibiotics are among the most commonly prescribed drugs in pediatrics. Due to lack of uniformity in pediatric antimicrobial prescribing and the emergence of antibiotic resistance, appropriate drug utilization studies have been found to be crucial to evaluate whether these drugs are properly used. Methods: Data were collected between January 2014 and February 2014 in 16 Iranian pediatric hospitals using a standardized method. The point prevalence survey included all inpatient beds. Results: Of 858 children, 571 (66.6) received one or more antimicrobials. The indications were therapeutic in 60.6. The parenteral route was used in 92.5 of therapeutic indications. Ceftriaxone was the most prescribed antimicrobials for therapeutic indications (32.4) and combination-therapy was the most type of therapy in pediatric intelligent care unit (PICU). Conclusion: According to results of this study, antibiotics� prescribing in pediatrics wards of Iranian hospitals is empirical. Therefore, for quality improvement of antimicrobial use in children continuous audit process and antibiotic prescriptions require further investigation. © 2016, Academy of Medical Sciences of I.R. Iran. All right resvrved

A comparative analysis of clinical characteristics and laboratory findings of covid-19 between intensive care unit and non-intensive care unit pediatric patients: A multicenter, retrospective, observational study from iranian network for research in viral diseases (inrvd)

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1�5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9 vs. 1.9, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions. © 2021 Tehran University of Medical Sciences

A multicenter retrospective study of clinical features, laboratory characteristics, and outcomes of 166 hospitalized children with coronavirus disease 2019 (COVID-19): A preliminary report from Iranian Network for Research in Viral Diseases (INRVD)

Background: The objectives of this study were to analyze the clinical features and laboratory profiles and risk factors associated with critical illness of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: One hundred and sixty-six coronavirus disease 2019 (COVID-19) Iranian pediatric patients were recruited through a collaborative research network between March and May 2020. Demographics, clinical, laboratory, and radiological results were obtained from patient files. Results: Of 166 patients, 102 (61) and 64 (39) were males and females, respectively. Ninety-six (57.8) and 70 (42.2), had moderate and severe conditions, respectively. Thirty (18) of patients died. The common symptoms were fever (73), cough (54), and shortness of breath, headache decrease in neutrophil and platelet counts; increase values in lactate dehydrogenase, decrease in the blood pH and HCO3 were significantly associated with the disease severity. 54 and 56 of patients showed abnormal radiographic appearance in Chest X-ray and in chest computed tomography scan, respectively. Sixty-one (36.7) of patients were referred to intensive care unit (ICU). The coexistence of comorbidity was the main factor associated with ICU admission, shock, arrhythmia, acute kidney injury, acute respiratory distress syndrome, acute cardiac injury, and death. Conclusions: We describe a higher than previously recognized rate of COVID-19 mortality in Iranian pediatric patients. Epidemiological factors, such as the relatively high case fatality rate in the country and the presence of underlying diseases were the main factors for the high death rate. © 2021 Wiley Periodicals LL