Aspiration of a sharp metallic pin in a child: A case report

Introduction: Foreign Body Aspiration (FBA) represents a life-threatening emergency. It occurs primarily in children below 3 years. Generally, the most common aspirated FB is organic material such as nuts or beans. Sharp Foreign Bodies (FBs) are of particular concern to the attending clinician, because of their potential to perforate the air passage and cause possible complications. Here in, we report a rare case of sharp metallic pin aspiration in a child. Case report: A 15-month-old boy was referred to our Emergency Ward due to the sudden onset of chocking and dysphagia which were transient. His mother was a tailor. He had history of ingestion of the similar pin two months ago. Chest radiography identified the radiopaque pin in the left side of chest. Rigid bronchoscopy was done and a sharp metallic pin was removed. Conclusions: Aspiration of a sharp, metallic FB is a serious injury. Pain X-ray can confirm the diagnosis. FB inhalation is preventable by creating public awareness and parenteral education to keep small objects out of children

CSWS Versus SIADH as the Probable Causes of Hyponatremia in Children With Acute CNS Disorders

How to Cite This Article: Sorkhi H, Salehi Omran MR, Barari Savadkoohi R, Baghdadi F, Nakhjavani N, Bijani A. CSWS versus SIADH as the probable Causes of Hyponatremia in Children with Acute CNS Disorders. Iran J Child Neurol. 2013 Summer;7(3): 34-39. ObjectiveThere is a major problem about the incidence, diagnosis, and differentiation of cerebral salt wasting syndrome (CSWS) and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in patients with acute central nervous system (CNS) disorders. According to rare reports of these cases, this study was performed in children with acute CNS disorders for diagnosis of CSWS versus SIADH.Materials & MethodsThis prospective study was done on children with acute CNS disorders. The definition of CSWS was hyponatremia (serum sodium ≤130 mEq/L), urine volume output ≥3 ml/kg/hr, urine specific gravity ≥1020 and urinary sodium concentration ≥100 mEq/L. Also, patients with hyponatremia (serum sodium ≤130 mEq/L), urine output < 3 ml/kg/hr, urine specific gravity ≥1020, and urinary sodium concentration >20 mEq/L were considered to have SIADH.ResultsOut of 102 patients with acute CNS disorders, 62 (60.8%) children were male with mean age of 60.47±42.39 months. Among nine children with hyponatremia (serum sodium ≥130 mEq/L), 4 children had CSWS and 3 patients had SIADH.In 2 cases, the cause of hyponatremia was not determined. The mean day of hyponatremia after admission was 5.11±3.31 days. It was 5.25±2.75 and 5.66± 7.23 days in children with CSWS and SIADH, respectively. Also, the urine sodium (mEq/L) was 190.5±73.3 and 58.7±43.8 in patients with CSWS and SIADH, respectively.ConclusionAccording to the results of this study, the incidence of CSWS was more than SIADH in children with acute CNS disorders. So, more attention is needed to differentiate CSWS versus SIADH in order to their different management.References1. 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Altered levels of immune-regulatory microRNAs in plasma samples of patients with lupus nephritis

Introduction: Lupus nephritis (LN) is a major cause of mortality and morbidity in the patients with lupus, a chronic autoimmune disease. The role of genetic and epigenetic factors is emphasized in the pathogenesis of LN. The aim of the present study was to evaluate the levels of immune-regulatory microRNAs (e.g., miR-31, miR-125a, miR-142-3p, miR-146a, and miR-155) in plasma samples of patients with LN. Methods: In this study, 26 patients with LN and 26 healthy individuals were included. The plasma levels of the microRNAs were evaluated by a quantitative real-time PCR. Moreover, the correlation of circulating plasma microRNAs with disease activity and pathological findings along with their ability to distinguish patients with LN were assessed. Results: Plasma levels of miR-125a (P = 0.048), miR-146a (P = 0.005), and miR-155 (P< 0.001) were significantly higher in comparison between the cases and controls. The plasma level of miR-146a significantly correlated with the level of anti-double strand-DNA antibody and proteinuria. Moreover, there was a significant correlation between miR-142-3p levels and disease chronicity and activity index (P <0.05). The multivariate ROC curve analysis indicated the plasma circulating miR-125a, miR-142-3p, miR-146, and miR-155 together could discriminate most of the patients with LN from controls with area an under curve (AUC) of 0.89 [95% CI, 0.80-0.98, P<0.001], 88% sensitivity, and 78% specificity. Conclusion: Based on the findings of the present study, the studied microRNAs may be involved in the pathogenesis and development of LN and have the potential to be used as diagnostic and therapeutic markers in LN

Foreign body ingestion and aspiration at a pediatric center in northern Iran

Background: Aspiration or ingestion of foreign bodies (FBs) is a common health problem leading to hospitalization of children around the world. The purpose of this study was to detect the FBS of aspirated or swallowed in children. Methods: The present cross-sectional descriptive-analytical study was conducted on 77 hospitalized children due to FBs aspirated or swallowed from 2008 to 2013 at Amirkola Childrenchr('39')s Hospital. Information including demographic profile, type of FBs and their location, clinical manifestations, treatment used and possible complications were extracted from their medical records, and the data were analyzed. Results: Out of 76 cases, 51 (67.1) were boys; 47.4 of children were 1-2 years old (mean age 2.6±2.2 years), and 67.1 of the bodies were in the gastrointestinal tract. The most common FBs were foodstuff (42.1), metallic bodies (39.5) and non-metallic bodies (18.4), respectively. The most common symptoms were cough (84) in respiratory FBs and vomiting (57) in gastrointestinal FBs. The mean duration of hospitalization was 74.8±57.1 hours in gastrointestinal FBs and 126.7±56 hours in respiratory FBs. There was a significant statistical relationship between location of FBs (p=0.000) and type of swallowed or aspirated bodies (p=0.041) with the duration of hospitalization. No mortality was observed. Conclusions: Findings show that foodstuffs are the most abundant FBs aspirated or swallowed in children aged 1-2 years. Obviously, educating parents and caregivers to take required care of children, especially while eating in this particular age group, is a key element in reducing such injuries

Evaluation of important human CYP450 isoforms and P-glycoprotein phenotype changes and genotype in type 2 diabetic patients, before and after intensifying treatment regimen using Geneva cocktail

The present study evaluates the influence of type 2 diabetes (T2D) on important CYP450 (CYP) isoforms and P-glycoprotein (Pgp) transporter activities before and 3 months after an intensifying treatment regimen involving 40 patients. Results have been compared with 21 non-T2D healthy participants (the control group). CYPs and Pgp activities were assessed after administering the Geneva cocktail. The mean metabolic ratios (MR) for CYP2B6 (1.81 ± 0.93 versus 2.68 ± 0.87), CYP2C19 (0.420 ± 0.360 versus 0.687 ± 0.558) and CYP3A4/5 (0.487 ± 0.226 versus 0.633 ± 0.254) significantly decreased in T2D patients compared to the control group (p < 0.05). CYP2C9 (0.089 ± 0.037 versus 0.069 ± 0.017) activities slightly increased in diabetic patients, and no difference was observed regarding CYP1A2 (0.154 ± 0.085 versus 0.136 ± 0.065), CYP2D6 (1.17 ± 0.56 versus 1.24 ± 0.83), and Pgp activities in comparison to the control group. Three months after the intensifying treatment regimen, MRs of CYP2C9 (0.080 ± 0.030) and CYP3A4/5 (0.592 ± 0.268) improved significantly and were not statistically different compared to the control group (P > 0.05). Several covariables, such as inflammatory markers (IL-1β and IL-6), genotypes, diabetes and demographic-related factors, were considered in the analyses. The results indicate that chronic inflammatory status associated with T2D modulates CYP450 activities in an isoform-specific manner