BREATH-HOLDING SPELLS: AN ANALYSIS OF 43 CASES

Objective:Breath holding spells, very often misinterpreted as epileptic seizures, are most common in children aged 6 months to 6 years of age. In this investigation, we sought to prospectively document the natural history of breath holding spells (BHS) among children with cyanotic, pallid and mixed type BHS referred for neurological consultation.Materials & Methods:This was a cross-sectional study in which a total of 43 children (23 boys, 20 girls) with BHS, admitted to the out patient clinic of the Children's Hospital Medical Center, between Sept 1998 and June 1999, were enrolled. A structured interview was under taken at the time of initial consultation to confirm BHS and its type, associated phenomenon, family history, sex and age at initiation of spells. Laboratory, electroencephalographic and electrocardiographic tests were done.Results:Patients were between 1.7 and 42.8 months (mean age 18.4 months). In 76.8% of cases, BHS began during the first 12 months of age. Anger and pain were the most common triggering factors (65.1 %). A positive family history of BHS was identified in 51% and parental consanguinity was found in 30% of cases. The spells were cyanotic in 79.1% (34 children). 78% of cases were iron deficient and 53% of cases had iron deficiency anemia.Conclusion:The results of this study emphasize the role of genetic factors in BHS; measurement of hemoglobin and serum ferritin is recommended all such cases.Key words: Breath-holding spells, Iron deficiency, Anemia, Serum ferriti

Designer Exosomes: A New Platform for Biotechnology Therapeutics

Abstract: Desirable features of exosomes have made them a suitable manipulative platform for biomedical applications, including targeted drug delivery, gene therapy, cancer diagnosis and therapy, development of vaccines, and tissue regeneration. Although natural exosomes have various potentials, their clinical application is associated with some inherent limitations. Recently, these limitations inspired various attempts to engineer exosomes and develop designer exosomes. Mostly, designer exosomes are being developed to overcome the natural limitations of exosomes for targeted delivery of drugs and functional molecules to wounds, neurons, and the cardiovascular system for healing of damage. In this review, we summarize the possible improvements of natural exosomes by means of two main approaches: parental cell-based or pre-isolation exosome engineering and direct or post-isolation exosome engineering. Parental cell-based engineering methods use genetic engineering for loading of therapeutic molecules into the lumen or displaying them on the surface of exosomes. On the other hand, the post-isolation exosome engineering approach uses several chemical and mechanical methods including click chemistry, cloaking, bio-conjugation, sonication, extrusion, and electroporation. This review focuses on the latest research, mostly aimed at the development of designer exosomes using parental cell-based engineering and their application in cancer treatment and regenerative medicine. Graphic Abstract: Figure not available: see fulltext. © 2020, Springer Nature Switzerland AG

THE INCIDENCE OF BIRTHMARKS IN IRANIAN NEONATES

A number of innocent rashes occurs in neonates. They are usually transient and self limited and thus require no therapy but early recognition is important to distinguish these lesions from more serious disorders. In this study, our purpose was to determine the frequency of birthmarks in Iranian neonates. The presence of various types of birthmarks was determined in 503 Iranian neonates under 72 hour of age. The physiological skin changes observed in order to frequency were Epstein pearls in 444 (88.27%), Mongolian spot in 409 (81%), erythema toxicum in 272 (54%), sucking blisters in 264 (52.1%), Salmon patch in 262 (52%), milia in 232 (46%), petechia in 41(0.08%) and mottling in 29 (0.06%). Petechia was seen more commonly in vaginal delivery and in babies with more birth weight. Mottling was more common in premature and low birth babies. Our data suggest that the incidence of birthmarks in Iranian neonates is similar to the prevalence reported by others in white neonates

Report of a Pediatric Case of Hemorrhagic Stroke

Stroke, though rare in children is among the top 10 causes of death in childhood. Incidence of ischemic and hemorrhagic stroke is the same in children .We report a case of hemorrhagic stroke in a two year old girl who presented with a limp, inability to stand on the left leg and left hemiparesia. Her complaint began 10 days ago after a bout of left clonic seizure. She had been admitted to the hospital for a week due to delayed hemorrhage of the umbilical stump at the age of 18 days. Brain CT scan showed a round, hyper dense area with mass effect in the right supraparietal region. Craniotomy revealed a hemorrhage and report of pathology was hematoma. Considering the delayed umbilical cord bleeding and normality of usual tests for hemostasis and partial deficiency of factor XIII in both parents, the problem was diagnosed as homozygote severe deficiency of factor XIII

Prevalence of congenital malformations observed in neonates in Shariati Hospital (1381-1383)

Background: Congenital malformations are one of the most important problems in pediatrics. The estimation of the prevalence of malformations and some probable determinants were the purpose of this study. Methods: In this retrospective study, all of the newborns that were born during three years (2002-4) were included. Hospital files of 3840 newborns were studied retrospectively and the data were collected in checklist. Finding: 118 cases had at least a major or minor malformation. Over all the prevalence of malformations was 3.1%. Male newborns showed a higher prevalence of malformations than females but with no statistical significance. The skeletal system had the highest rate of malformations, while the genitourinary system and the head and neck deformities were in the second and third position. There were no significant relations between the prevalence of malformations and the maternal age, the height and weight of the newborns and the season of birth. Conclusion: The prevalence of malformations in this study was similar to previous studies

The relation of increasing serum bilirubin during 24-48 hours of birth and birth season

Background: The relationship between season of birth and human diseases is well known and such a relationship could be mediated by seasonal and environmental effects on early events of extrauterine life Empirical neonatological experience suggests that prevalence and degree of neonatal jaundice might be dependent on seasonal variation, mainly due to the sunshine duration. However, evidence based data on this issue are scarce. Thus, we have analyzed the seasonal effect on the rise of serum bilirubin level during the neonatal period.Methods: A prospective cohort study was done on a sample of 629 term and healthy&nbsp; infants born consecutively in Shariati Hospital, Tehran, Iran, during the years 2008-2009. The cord bilirubin level and then the serum bilirubin level near to 48 hour of age were measured. Seasonal differences in rise of serum bilirubin were studied.Results: Rise of serum bilirubin in spring was 3.951.4 mg/dl, in summer 3.761.69 mg/dl, in fall 3.511.60 mg/dl and in winter 4.791.99 mg/dl. Serum bilirubin level in cord blood did not appear to be correlated with season of birth. After correction for the possible effect of these variables the relation between season of birth and rise of serum bilirubin remained significant. The rise of serum bilirubin in winter was significantly higher than other season (P<0.0001).Conclusion: Season acts as an independent etiological factor of neonatal hyperbilirubinemia. Mean rise of serum bilirubin in winter is higher than other season. This provided information to improve education for nurses in identifying risk factors and the prevention of hyperbilirubinemia readmissions