Incidence and etiology of stroke among hospitalized children, a case-series study

Objectives: Stroke is a sudden blockage or rupture of brain vessels resulting neural defect or impairment. This study aimed to investigate the incidence and causes of stroke in hospitalized children (Tehran-Iran, 2008-13). Methods: One month to 15 years old admitted children due to stroke entered this case series study. Diagnosis was confirmed with brain imaging. Participants' demographic data, potential risk factors and neuroimaging findings were obtained from Hospital Reporting System. Recorded data were studied and considered regarding to the incidence of stroke and its causes. Indeed we investigated cardiological causes as well as different items related hematological disorders. Results: Of 20000 admitted subjects in Imam Hospital during 5 years, stroke was diagnosed in 15 cases. The incidence among the population study was 0.75 per 100000 children. Stroke was more frequent in males than female ( ). The most common age of stroke was 4-6 years and mean age of stroke was 58.8 months equal to 4.9 years. The most frequent stroke was hemorrhagic stroke (26%), followed by vascular (20%) and coagulopathy disorders (20%). Conclusion: The incidence of stroke in children was 0.75 per 100000. Hemorrhagic stroke due to major trauma, coagulopathy and vasculopathy were observed as most frequent causes that necessitate implementing some strategies for prevention, earlier diagnosis and treatment

Активность микрофлоры как показатель токсичности морских донных отложений шельфовой зоны Черного моря и Керченского пролива

Изучена потенциальная активность донной микрофлоры в местах утечки остатков химических токсикантов, затопленных в период Второй Мировой войны ХХ в. Отмечены особенности восстановления жизнедеятельности микрофлоры при различных уровнях загрязнения донных отложений мышьяком и хлорированными органическими сульфидами. Полученные результаты перспективно использовать при оценке экологического состояния донных отложений в загрязненных прибрежных акваториях

Cardiovascular Malformations in Infants of Diabetic Mothers: A Retrospective Case-Control Study

Maternal diabetes has teratogenic effects on the evolution of the fetal cardiovascular system; as a consequence, cardiovascular malformations are the most common anomalies in infants of diabetic mothers. The present study focuses on the association of all types of diabetes in mothers with the incidence of congenital cardiovascular malformations in their infants. In this retrospective case-control study performed between the years 2008 and 2010, 35 infants of diabetic mothers were selected as a case group, and another 35 infants of mothers with normal blood glucose levels were selected as a control group. Data has been extracted from patients’ files and registered. Finally, the association of data has been performed according to statistical analysis. According to the results, the prevalence of cardiovascular anomalies was significantly higher in infants of diabetic mothers (P=0.018). The most common malformations in the case group were PDA 10%, hypertrophic cardiomyopathy 9% and PFO 8%. Maternal diabetes type (overt or gestational diabetes), duration and control method did not correspond with any significant differences in the prevalence of cardiac anomalies. The results of this study indicate that diabetes in pregnant women plays an important role in the incidence of certain types of cardiac anomalies, such as PFO, HCMPT, and PDA. As a result, the performance of diagnostic procedures (like embryonic echo, before and after birth), provision of special prenatal care to diabetic mothers, and providing supportive and therapeutic care to symptomatic infants seems highly advisable in such cases

Risk Factors for post-Cardiac Surgery Diaphragmatic Paralysis in Children with Congenital Heart Disease

Background: Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis (DP) in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics. Methods: This cross-sectional study, conducted in a 2-year period (2006–2008), included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated. Results: Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months (28.2 ± 33.4 months), 25 (5.5%) infants (60% male and 40% female, age range = 15 days to 132 months, 41.2 ± 28.1 months) had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery.  The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock–Taussig shunt surgery, respectively. Thirteen (52%) of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% (6 patients). Conclusion: DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases

Incidence and Etiology of Chylothorax after Congenital Heart Surgery in Children

Background: Chylothorax is a rare but serious postoperative condition with a high rate of morbidity and may lead to the mortality of children undergoing congenital heart disease (CHD) surgery. This study evaluated the specific surgical procedures associated with the higher risk of postoperative chylothorax. Methods: We assessed 435 cases undergoing CHD surgery between April 2003 and May 2006. We detected postoperative chylothorax in 6 patients. The diagnosis of chylothorax was established based on the presence of an odorless fluid with the characteristic milky appearance of the fluid (except when the patients were fasting in the immediate postoperative period), a triglyceride level greater than 110 mg/dL or between 50 and 110 mg/dL with a pleural fluid white cell count greater than 1000, and more than 80% lymphocytes on differential when the pleural fluid was not chylous. Results: Over a 37-month period, 435 (mean age = 51.6 months; 232 males) patients underwent various types of surgical procedures for CHD; 6 patients developed chylothorax after the Fontan operation; one patient died due to severe chylothorax;3 patients were managed by nutritional modifications, diuretics, and thoracocentesis; and  2 patients required thoracic duct ligation. The Fisher exact test analysis showed a significant association between the Fontan operation and postoperative chylothorax (p value < 0.0001). Conclusion: Our study showed a significant association between the Fontan surgery and chylothorax

Evaluation of Pulse Oximetry in the Early Diagnosis of Cardiac and NonCardiac Diseases in Healthy Newborns

Background: Critical congenital heart diseases (CCHDs) are among the most common birth malformations. This study aimed to determine the cardiac and noncardiac diseases in the Iranian healthy newborns using pulse oximetry (POX) as a suggested screening method.Methods: In this cross-sectional study, healthy term and near term neonates who were born from October 2017 to March 2018 were evaluated. Preductal and postductal POX was performed in all asymptomatic healthy newborns after 24 hours of life or at any time before discharge from the nursery. Oxygen saturation (SPO2) was considered normal if SPO2 was 95%, and the difference between preductal O2 saturation and postductal POX was obtained at ≤ 3%. The POX was repeated after 2 hours for abnormal patients. In the case of the same results in both repeated measures, echocardiography, chest X-ray, sepsis screening, and blood glucose were conducted.Results: A total of 413 asymptomatic healthy term and near term neonates underwent the pulse oximetry screening (POX). The mean birth weight and gestational age of the neonates were 3256.31±509.62 gr and 38.2 weeks, respectively. The POX was performed averagely 19.5 hours after birth. Finally, a total of 10 cases were detected with abnormal POX. Among these 10 patients, three cases had cardiac diseases (i.e., transposition of the great arteries, ventricular septal defect/pulmonary atresia, and ventricular septal defect/pulmonary hypertension), three cases had noncardiac diseases (i.e., esophageal stenosis, hypoglycemia, and persistent pulmonary hypertension/sepsis), and four subjects were healthy.Conclusion: The obtained findings showed that routine pox, along with clinical examinations could be applied, especially in developing countries for the early detection of cardiac and noncardiac diseases in asymptomatic newborns