Evaluation of the Effect of Intravenous Ondansetron versus Placebo before Anesthesia on Vomiting after Endoscopy and Colonoscopy Procedures

Background: Vomiting is a common complication after endoscopic procedures in children. Different medications could be administered to control vomiting after endoscopy. The goal of this study is to evaluate anti-emetic effects of ondansetron in children who undergo endoscopic procedures.Methods: In this clinical randomized trial, 198 children (103 female/95 male) were randomly assigned into one of the following two studied groups. Case group (G1): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + ondansetron 0.15 mg/kg and control group (G2): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + 2 cc normal saline.Results: The mean age was 6.3 ± 3.5 years (6.2 ± 3.6 years in G1 vs. 6.4 ± 3.5 years in G2). The most common cause of endoscopy procedure in both groups was hematochezia. Vomiting, recovery time, Paediatric Anesthesia Emergence Delirium (PAED), and Aldrete scores were compared. Rate of vomiting after recovery and Aldrete score were significantly different between the two groups.Conclusions:Ondansetron is effective in controlling vomiting after colonoscopy and upper gastrointestinal endoscopic procedures. Also, patients in intervention group experienced better recovery time

Prevalence of Attention Deficit Hyperactivity Disorder in Pediatrics Patients Newly Diagnosed with Gastroesophageal Reflux Disease

Background: Gastroesophageal reflux disease (GERD) is associated with a number of comorbidities in pediatrics. However, its association with attention deficit hyperactivity disorder (ADHD) has not been reported. The aim of the present study was to investigate the prevalence of ADHD in pediatric patients newly diagnosed with GERD. Materials and Methods: Sixty newly-diagnosed treatment naive GERD patients and sixty healthy controls aging between 5 to 12 years referring to the Children and Adolescent’s medical center, Tehran, Iran were recruited in a case-control study during the year 2015. Then patients were evaluated for ADHD by a psychiatrist according to the DSM-IV criteria. The revised Conners' Parent Rating Scale (CPRS-R) was used for assessment of the symptoms of ADHD. To screen for psychiatry disorders other than ADHD, the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL) questionnaire was used. Logistic regression analysis was used for modeling the association between GERD and ADHD in the study sample. Results: The mean age of GERD patients was 5.77±2.27 and for non-GERD controls was 6.03±2.52 (P= 0.543). Thirty-three out of 60 (55%) GERD patients and 37 out of 60(61.66%) non-GERD controls were male (P: 0.579). Prevalence of ADHD was 33.60 (55%) in GERD patients and 10.60 (16.66%) in non-GERD (

COVID-19 Infection and Seropositivity in Multiple Sclerosis Patients in Guilan in 2021

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. COVID-19 has presented a significant challenge to the care providers of patients with MS. Objectives: The present study aimed to investigate the frequency of COVID-19 infection and its seropositivity in MS patients in Guilan, Iran, in 2021. Materials & Methods: In this analytical-cross-sectional study, all patients with relapsing-remitting MS registered in the Guilan MS Association with an expanded disability status scale of less than 5 who were referred for evaluation participated in the study. Information related to the clinical and serological symptoms of COVID-19 infection, changes in drug use, and the occurrence of new attacks were collected. Serological results of COVID-19 (IgG) among them were registered. Results: In total, 260 patients with MS (78.8% women, and 21.2% men) with a Mean±SD age of 38.7±9.9 years, and a Mean±SD duration of MS of 8.9±4.9 years were investigated. The most commonly used drugs were Dimethyl fumarate, Interferon, and Rituximab, respectively. Thirty-three patients (12.6%) had a clinical COVID-19 infection, of which 32 people had a mild and only one had a critical infection. Eight patients (1.3%) had positive COVID-19 IgG tests. No significant relationship was found between the COVID-19 infection with the type of medication, medication change, clinical attack of MS, and co-morbidities (P>0.05). Conclusion: A few patients had positive COVID-19 IgG tests and clinical COVID-19 infection. The vast majority had mild disease, and the clinical attack was not related to COVID-19 infection

The Etiology of Persistent Diarrhea in Hospitalized Patients at Children's Medical Center in Tehran

Objective: The objective of this study was to determine the causes of persistent diarrhea in hospitalized patients at Children's Medical Center in Tehran. Material & Methods: Primarily we determined the 41 different etiologies of persistent diarrhea which were recognizable in Iran at the time of study. then we studied all hospitalized patients with these diagnoses between the years 1992 till 1998. Findings: During the period of study there were 1300 patients who had been hospitalized in children's hospital. Among these patients 215 had persistent diarrhea. 10 most common etiologies of persistent diarrhea were celiac disease, cystic fibrosis, ulcerative colitis, malnutrition, immune deficiencies, urinary tract infections, giardiasis, gastroenteritis, cow milk allergy, and intestinal lymphangiectasia. Conclusion: Based on the results of this study, in approaching patients with persistent diarrhea, it is better to consider more common and probable etiologies primarily to avoid unnecessary costs and then perform suitable diagnostic studies

Success Rate of Furazolidone-Based Triple Therapy for Eradication of Helicobacter Pylori in Children

Objective: Helicobacter pylori (H. Pylori) is now recognized as a major etiological factor in the pathogenesis of gastritis and peptic ulcer disease. There is concrete evidence that eradication of the bacterium reverses histological gastritis, and results in significant reduction of duodenal and gastric ulcer recurrence. Poor compliance and antibiotic resistance are the main causes for failure of anti H. pylori therapy. In this study we determined efficacy of omeprazole based triple therapy with b.i.d. dosing of furazolidone, amoxicillin for 2 weeks and omeprazole in Iranian children. Methods: This prospective study included 37 children, in whom H. Pylori infection was diagnosed endoscopically. H.Pylori positive children were treated with a two weeks course of furazoidone (6 mg/kg/day) and amoxicillin (50 mg/kg/day) plus omeprazole (1-2 mg/kg/day). Eradication was assessed by 13C UBT. Findings: Mean age of patients was 10.2 yr (5-15 yr), 25 (67.5%) patients were boys. H. Pylori was eradicated in 34 children (per patient 91.9%, per protocol 86%). Side effects occurred in 3 (8.1%) patients, but these were mild and it was not necessary to discontinue treatment. Three children (8.1%) remained H. pylori positive. Conclusion: Our study showed that the association of furazolidone plus amoxicillin with a proton-pump inhibitor could be a valuable alternative for eradication of H. Pylori infection in children. It is an effective, affordable treatment that allows good compliance and produces low adverse effect rates

The Clinical Manifestations, Treatment Efficacy and Adverse Drug Reactions in 62 Iranian Child with Wilson Disease

Introduction: The Wilson disease is an autosomal recessive disease in which the liver, central nervous system, eyes, blood and other parts of the body involved. Timely diagnosis and appropriate treatment of the disease requires awareness of the clinical presentations of this disease in children.Methods: This case series study included 62 patients with Wilson disease who admitted to children's Medical Center in the years 2012-2003.Results: 56% of patients were male. The average age of diagnosis was 9.73 years old (5-17 years) and this was higher in patients with early neurologic symptoms (P = 0.85.( 64.5% of the patients had the hepatic symptoms at the time of diagnosis and the most common type of hepatic involvement was cirrhosis (39.3%) and hepatitis (17.5%) respectively. 17.7% of the patients also had early neurological symptoms. A positive family history for the Wilson Disease were found in 27.4% of patients. 74.2% of patients had KF ring and the frequency of these symptom was higher in patients with early neurological involvement. 83.9% of patients were treated successfully with D-penicillamine and In 30% of patients, adverse drug reactions were seen.Conclusion: Children with unknown liver disease should be evaluated for Wilson disease and the first-degree relatives of patients should be screened. . D-penicillamine have important side effects, but due to the low cost and the availability is an appropriate drug to treat the Wilson disease..Key words: Wilson Disease, Hepatic Involvement, Neurologic Involvement , KF ring ,D-Penicillamine

Association of Food Allergies, Cow’s Milk Allergy, and Asthma With Pediatric Inflammatory Bowel Disease

There are controversies on the association of childhood allergic diseases with inflammatory bowel diseases (IBD). The aim of this study was to examine the association between food allergy, cow’s milk allergy (CMA), and asthma with pediatric IBD in Iranian population. This case-control study was conducted on 200 individuals less than 18-year-old (100 with IBD and 100 as control group). Medical records, clinical presentation, and laboratory and para-clinical findings related to food allergy, CMA, and asthma were reviewed for all participants in both groups and were recorded. Among 100 children with IBD, 40 had Crohn's disease, and 60 had ulcerative colitis. The frequency of food allergy, cow's milk allergy, and asthma in children with IBD was significantly higher than the control group (P<0.001). Asthma in children with Crohn's disease was significantly more prevalent than children with ulcerative colitis (P=0.008). Food allergy (OR: 22.1, 95% CI: 5.1-95.05, P<0.001), CMA (OR: 15, 95% CI: 3-67, P<0.001), and asthma (OR: 10, 95% CI: 3-37.05, P<0.001) were significantly associated with increased risk of IBD in children. Food allergy, CMA in infancy and asthma are more prevalent in children with different subtypes of IBD. The diagnosis of these risk factors is associated with increased risk of Crohn's disease and ulcerative colitis

The effect of probiotics on fecal calprotectin of patients with cystic fibrosis

Background - Cystic fibrosis (CF) is a common autosomal recessive disorder with different clinical manifestations, mainly in the gastrointestinal and respiratory tracts. This study was performed to access the effect of probiotic in status of intestinal inflammation in a group of children with CF by measuring the calprotectin level of the fecal samples. Methods - Forty seven patients with CF were enrolled in this study. The fecal calprotectin levels were measured by enzyme linked immunosorbent assay. In a randomized systematic method, the children divided into two groups; one received probiotic powder and another received placebo for 4 weeks. After this period, the fecal calprotectin was re-measured. Findings - Thirty one of 47 enrolled patients (65.9%) had abnormal fecal calprotectin levels (>50g/g). After intervention, the fecal calprotectin levels decreased in just 29 patients that 21 patients were in the drug group, while only 8 patients were in the placebo group (PConclusion - This study showed that about two third of patients with CF had intestinal inflammation based on fecal calprotectin levels, while probiotic administration could decrease calprotectin concentrations and subsequently intestinal inflammation in CF patients

The effect of probiotics on fecal calprotectin in patients with cystic fibrosis

Cystic fibrosis (CF) is a common autosomal recessive disorder with different clinical manifestations, mainly in the gastrointestinal and respiratory tracts. This study was performed to access the effect of probiotics in the status of intestinal inflammation in a group of children with CF by measuring the calprotectin level in the fecal samples. Forty-seven patients with CF were enrolled in this study. The fecal calprotectin levels were measured by enzyme linked immunosorbent assay. In a randomized systematic method, the children were divided into two groups - one group received probiotic powder and another received placebo for four weeks. After this period, fecal calprotectin was re-measured. Thirty-one of 47 enrolled patients (65.9%) had abnormal fecal calprotectin levels (>50 μg/g). After the intervention, the fecal calprotectin levels decreased in 29 patients (21 patients in the drug group, and only 8 patients in the placebo group; p<0.001). This study showed that about two-thirds of patients with CF had intestinal inflammation based on fecal calprotectin levels. Probiotic administration was shown to decrease calprotectin concentrations and subsequently intestinal inflammation in CF patients