Evaluation of Microbial Resistance Pattern in Children with Urinary Tract Infection in Bushehr between 2017 and 2018

Background and Aim: Urinary tract infection is one of the most common childhood illnesses that can lead to complications such as hypertension and kidney failure. The aim of this study was to evaluate microbial resistance and sensitivity and to determine the relationship between urinary tract abnormalities and prior antibiotic use with microbial resistance. Methods: This is a descriptive-analytic study on 90 patients with a positive urine culture. Urine culture samples were taken using one of the sampling methods (midstream clean catch, catheterization, urine bag, suprapubic aspiration) and ultrasonography was requested for all patients to evaluate urinary system abnormalities. Also, a history of prior antibiotic use was asked and recorded. Results: Of all patients, 55.6% showed E.coli and 44.4% showed other bacteria in urine culture. 97.7% of patients' cultures were sensitive to imipenem, 82.2% to nitrofurantoin, and 77.8% to cefixime. 65% of patients' cultures showed resistance to nalidixic acid, 56.7% to co-trimoxazole, and 38.9% to ceftriaxone. There was a significant relationship between cefixime and amikacin antibiotic resistance with abnormal ultrasound and there was a significant relationship between antibiotic resistance to cefixime, ceftriaxone, co-trimoxazole, and duration of prior antibiotic use (p-value <0.05). Conclusion: The most common pathogen in UTI was E.coli. The highest sensitivity was to imipenem, nitrofurantoin, and cefixime, and the highest resistance was to nalidixic acid, co-trimoxazole, and ceftriaxone. There was a relationship between urinary tract abnormalities and prior antibiotic use with microbial resistance, so it is suggested to use kidney ultrasound in all patients with urinary tract infection

Serum Folate and Vitamin B12 Levels in Survivors of Childhood Malignancy in Southern Iran

Background: Folate and vitamin B12 have a number of biologic roles that make them important in hematological disorders and malignancy. In the present study, we have assessed serum folate and vitamin B12 levels and their associated variables in patients with leukemia, lymphoma, and solid tumors. Methods: This cross-section study investigated 98 patients (57 with leukemia, 16 lymphoma, and 25 solid tumors) between April 2015 and March 2016 in Southern Iran. Complete blood counts and serum levels of folate, vitamin B12, lactate dehydrogenase, and homocysteine were measured. Clinical characteristics of the patients were also gathered from their medical records. Results: Patients had the following mean serum levels: serum folate (12.27±6.69 ng/ml), vitamin B12 (331.81±183.22 pg/ml), and homocysteine (11.74±26.67 μmole/L). Vitamin B12 showed a significant negative correlation with homocysteine levels (r= -0.223, P=0.043). Overall, there were 21(21.9%) vitamin B12 and 9 (9.8%) folate deficient patients. Vitamin B12 patients had a longer remission time (time from off therapy until study entry) of 18±16.97 months compared to those with normal vitamin B12 levels (8.81±8.08 months, P=025). However, logistic regression analysis showed that only mean corpuscular volume had a significant correlation with vitamin B12 deficiency (B= -0.105, odds ratio=0.9, 95% CI: 0.819-0.990, P=0.03). None of the variables showed significant correlation with folate deficiency (P>0.05). Conclusion: Vitamin B12 and folate deficiency are frequently seen in survivors of childhood malignancy, mainly due to the effects of chemotherapy. These vitamins have important roles in hematopoiesis, as well as development and maintenance of the nervous system; therefore, timely detection of their deficiencies is of utmost importance. It is highly recommended to check the serum levels of these vitamins in children who successfully survive their cancer treatments

Acute Progressive Visual Loss in a Case of Acute Myeloid Leukemia: Challenges in the Utility of Molecular Tests in Early Diagnose of Cytomegalovirus Retinitis

Cytomegalovirus (CMV) retinitis is one of the rare but debilitating presentations of the CMV infection in children with leukemia. Herein, we report a 12-year-old boy with acute myeloid leukemia complicated by rapid progressive visual loss during relapse of leukemia. The definite diagnosis of CMV retinitis was made after vitreous aspiration. Despite prompt treatment and ophthalmologic intervention, he died because of AML relapse. Viral infections, especially cytomegalovirus infection, may present with vague clinical pictures during any time of chemotherapy, which may not be easily distinguishable from bacterial or fungal retinitis and also chemotherapy-induced retinopathies. Clinician should consider CMV retinitis in seropositive patients especially those without detectable viremia

An evaluation of ascitic calprotectin for diagnosis of ascitic fluid infection in children with cirrhosis

The most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The present study aims to assess the value of calprotectin in ascitic fluid in the diagnosis of ascitic fluid infection in children with liver cirrhosis. Materials and methods In this cross-section study, 80 children with underlying liver disease who attended the Hepatology and Emergency Department in Shiraz University Hospitals were studied. All the patients were evaluated by a thorough history, clinical examination, laboratory investigations, diagnostic paracentesis with PMNLs count, and Calprotectin, which was measured in 1 mL ascitic fluid by ELISA. Results Thirty-five patients (43.75%) were diagnosed with ascitic fluid infection. Of these children 6 cases had positive ascitic fluid culture (SBP). Calprotectin was high in AFI patients with a statistically significant difference in AFI patients compared to non-AFI patients. The cut-off levels were 91.55 mg /L and the area under the curve was 0.971. So it can serve as a sensitive and specific diagnostic test for detection of AFI in children with underlying liver disease. Conclusion Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of AFI and are considered a surrogate marker for PMN

Parameters of tissue iron overload and cardiac function in patients with thalassemia major and intermedia

BackgroundNoninvasive T2* magnetic resonance imaging (MRI) assessment can stratify the risk of subsequent cardiac dysfunction in β-thalassemia major (TM) and β-thalassemia intermedia (TI) patients. The normal level of N-terminal pro B-type natriuretic peptides (NT-proBNP) can rule out acute heart failure. AimWe aim to investigate the relation of NT-proBNP level, T2* MRI, and echocardiographic findings in TM and TI patients. Materials and methodsIn this cross-sectional study, 41 TM patients, 41 TI patients, and 41 healthy individuals (HI) were enrolled. NT-proBNP level, T2* MRI, and two-dimensional echocardiography were assessed for all patients and controls. ResultsThere was statistically significant correlation between NT-proBNP levels and mitral inflow late diastolic velocity ( = −0.538; = 0.006) in TM group. There was statistically significant correlation between NT-proBNP levels and tricuspid annulus systolic velocity ( = −0.438; = 0.028), systolic velocity of septum ( = −0.472; = 0.020), and mitral inflow early-to-late diastolic wave ratio ( = 0.592; = 0.002) in TM group. ConclusionEarly diagnosis and treatment of myocardial iron overload are likely to prevent the mortality in patients with established ventricular dysfunction. Since NT-proBNP levels were not significantly increased in documented left ventricular (LV) diastolic dysfunction, this factor may not be sensitive for the detection of latent LV diastolic dysfunction in the early stages of disease progression

Neurological Crises after Discontinuation of Nitisinone (NTBC) Treatment in 3 Cases of Tyrosinemia

Tyrosinemia Type 1 is a hereditary disorder with liver, kidney and nervous system involvement. We report 3 children developed diaphragmatic paralysis requiring mechanical ventilation after discontinuation of NTBC treatment. In patients with Tyrosinemia type 1, combined treatment with NTBC and a low-tyrosine diet have prevented neurological crises. Treatment with NTBC in the first months of life protects against hepatic and neurologic complications. Neurological crises can occur in tyrosinemia without treatment and also occur when treatment stops. We report three patients that developed diaphragmatic paralysis after interruption of NTBC treatment, which finally required mechanical ventilation. It should be emphasized that discontinuation of NTBC can induce diaphragmatic paralysis and respiratory failure. So we should advise patients to use NTBC for long term and not interrupted it

DIAGNOSTIC ACCURACY OF UREA BREATH TEST FOR HELICOBACTER PYLORI INFECTION IN CHILDREN WITH DYSPEPSIA IN COMPARISON TO HISTOPATHOLOGY

ABSTRACT Background - Helicobacter pylori infection is the gram negative bacillus with the close association with chronic antral gastritis. Objective - In this study, we evaluate the accuracy of urea breath test (UBT) with carbon isotope 13 in comparison with histopathology of gastric antrum for detection of H. pylori infection in children with dyspepsia. Methods - This cross-sectional study was performed at specialized laboratory of Shiraz Gastroenterohepatology Research Center and Nemazee Hospital, Iran, during a 12-months period. This study investigated the sensitivity, specificity, and positive and negative predictive values of UBT in comparison with biopsy-based tests. We included a consecutive selection of 60 children who fulfilled Rome III criteria for dyspepsia. All children were referred for performing UBT with carbon isotope 13 (C13) as well as endoscopy. Biopsies were taken from antrum of stomach and duodenum. The pathologic diagnosis was considered as the standard test. Results - The mean age of the participants was 10.1±2.6 (range 7-17 years). From our total 60 patients, 28 (46.7%) had positive UBT results and 32 (53.3%) had negative UBT results. Pathologic report of 16 (57.1%) out of 28 patients who had positive UBT were positive for H. pylori and 12 (42.9%) ones were negative. Sensitivity and specificity of C13-UBT for detection of H. pylori infection were 76.2% and 69.2% respectively. Conclusion - Sensitivity and specificity of C13-UBT for detection of H. pylori infection were 76.2% and 69.2% respectively. Another multicenter study from our country is recommended