Non-Parenteral Medications for Procedural Sedation in Children- A Narrative Review Article

How to Cite This Article: Fallah R, Ferdosian F, Shajari A. Non-Parenteral Medications for Procedural Sedation in Children- A NarrativeReview Article. Iran J Child Neurol. Summer 2015;9(3):1-8.AbstractProcedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non- parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist

Comparing the Conventional with Low Dose of Bupivacaine Plus Fentanyl in Spinal Anesthesia on the Neonate Apgar Score in Yazd City

Introduction: Spinal anesthesia is the preferred method of anesthesia in cesarean section, due to less complications. The augmentation of opioids to spinal anesthetics can improve the quality and increase the duration of analgesia. This study aimed to compare the conventional with low dose of bupivacaine plus fentanyl in spinal anesthesia on the neonate Apgar score in elective cesarean section. Methods: The present double-blind randomized clinical trial was conducted on 150 pregnant mothers undergoing cesarean section with the spinal anesthesia during 2017-2018. The mothers were randomly assigned to two groups of 75. The spinal anesthesia was performed in the first group with the injection of 15 mg of 0.5% hyperbaric bupivacaine plus 1 ml of normal saline, and in the second group with the injection of 12.5 mg of 0.5% hyperbaric bupivacaine plus 25 μg of fentanyl. For both groups, 1- and 5-minute neonatal Apgar scores were assessed. Finally, the data were analyzed by SPSS17 software using statistical tests. Results: The mean age of the samples was 30.1±5.19 years with a range of 18-42 years (P-value=0.246). The mean gestational age was 38 weeks, the mean 1-minute Apgar score was 8.88 and the mean 5-minute Apgar score was 9.89. Conclusion: With the augmentation of fentanyl to bupivacaine for spinal anesthesia, the conventional dose can be reduced, which not only reduces the common side effects of Marcainee, but also provides an appropriate level of anesthesia and does not affect the neonatal Apgar score

The Efficacy and Safety of Topiramate for Prophylaxis of Migraine in Children

How to Cite This Article: Fallah R, Akhavan Karbasi S, Shajari A, Fromandi M. The Efficacy and Safety of Topiramate for Prophylaxis of Migraine in Children. Iran J Child Neurol. 2013 Autumn; 7(4):7-11.Objective Migraine is the most common acute intermittent primary headache in children and prophylactic therapy is indicated in children with frequent or disabling headaches. The purpose of this study was to evaluate the efficacy and safety of topiramate (TPM) for migraine prophylaxis in children. Materials & Methods In a quasi-experimental study, monthly frequency, severity and duration of headache, migraine disability, and side-effects were evaluated in 100 children who were referred to the Pediatric Neurology Clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran from April 2011 to March 2012, and were treated with 3 mg/kg/day of TPM for three months. Results Fifty eight (57.4%) girls and 42 (41.6%) boys with the mean age of 10.46±2.11 years were evaluated. Monthly frequency, severity, and duration of headache decreased with treatment from 15.34±7.28 to 6.07±3.16 attacks, from 6.21±1.74 to 3.15±2.22, and from 2.28±1.55 to 0.94±0.35 hours, respectively, and the Pediatric Migraine Disability Assessment score reduced with TPM from 32.48±9.33 to 15.54±6.16. Transient side-effects were seen in 21% of the patients, including hyperthermia in 11%, anorexia and weight loss in 6%, and drowsiness in 4%. No serious side-effects were reported.  Conclusion TPM could be considered as a safe and effective drug in pediatric migraine prophylaxis. ReferencesHershey AD. Migraine. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE, editors Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 2040-5.The International Classification of Headache Disorders:2nd ed. Headache Classification Subcommittee of the International Headache Society. Cephalalgia 2004;24 Suppl 1:9-160.Hershey AD, Winner PK. Pediatric migraine: recognition and treatment. J Am Osteopath Assoc 2005;105(4 Suppl 2):2S-8S.Jayapal S, Maheshwari N. Question 3. Topiramate for chronic migraine in children. Arch Dis Child  2011;96(3):318-21.Fallah R. Topiramate as a new antiepileptic drug in epileptic children in Iran. Indian J Pediatr 2006;73(12):1073-5.Hershey AD, Powers SW, Vockell ALB, LeCates SL, Kabbouche MA, Maynard MK. PedMIDAS: Development of a questionnaire to assess disability of migraines in children. Neurology 2001;57(11):2034-9.Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13(4):227-36.Ashtari F, Shaygannejad V, Akbari M. A doubleblind, randomized trial of low-dose topiramate vs propranolol in migraine prophylaxis. Acta Neurol Scand 2008;118(5):301-5.Tonekaboni SH, Ghazavi A, Fayyazi A, Khajeh A, Taghdiri MM, Abdollah Gorji F, Azargashb E.Prophylaxis of childhood migraine: Topiramate versus Propranolol. Iran J Child Neurol 2013 ; 7(1):9-14.Winner P, Pearlman EM, Linder SL, Jordan DM, Fisher AC, Hulihan J; Topiramate Pediatric Migraine Study Investigators. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Headache 2005;45(10):1304-12.Lewis D, Winner P, Saper J, Ness S, Polverejan E, Wang S, et al. Randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of topiramate for migraine prevention in pediatric subjects 12 to 17 years of age. Pediatrics 2009;123(3):924-34.Borzy JC, Koch TK, Schimschock JR. Effectiveness of topiramate in the treatment of pediatric chronic daily headache. Pediatr Neurol 2005;33(5):314-6.Campistol J, Campos J, Casas C, Herranz JL. Topiramate in the prophylactic treatment of migraine in children. J Child Neurol 2005;20(3):251-3.Cruz MJ, Valencia I, Legido A, Kothare SV, Khurana DS, Yum S, et al. Efficacy and tolerability of topiramate in pediatric migraine. Pediatr Neurol 2009;41(3):167-70.Aydin M, Kabakus N, Bozdag S, Ertugrul S. Profile of children with migraine. Indian J Pediatr 2010;77(11):1247-51.Unalp A, Uran N, Oztürk A. Comparison of the effectiveness of topiramate and sodium valproate in pediatric migraine. J Child Neurol 2008;23(12):1377-81. Lakshmi CV, Singhi P, Malhi P, Ray M. Topiramate in the prophylaxis of pediatric migraine: a double-blind placebo-controlled trial. J Child Neurol 2007;22(7):829-35.Vollono C, Ferraro D, Valeriani M. Antiepileptic drugs in the preventive treatment of migraine in children and adolescents. Drug Development Research 2007;68:355-9.  19. Ferraro D, Di Trapani G. Topiramate in the prevention of pediatric migraine: literature review. J Headache Pain 2008;9(3):147-50

Update of the tolerable upper intake level for vitamin D for infants

Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to revise the tolerable upper intake level (UL) for vitamin D for infants ( 64 1 year) set in 2012. From its literature review, the Panel concluded that the available evidence on daily vitamin D intake and the risk of adverse health outcomes (hypercalciuria, hypercalcaemia, nephrocalcinosis and abnormal growth patterns) cannot be used alone for deriving the UL for infants. The Panel conducted a meta-regression analysis of collected data, to derive a dose\u2013response relationship between daily supplemental intake of vitamin D and mean achieved serum 25(OH)D concentrations. Considering that a serum 25(OH)D concentration of 200 nmol/L or below is unlikely to pose a risk of adverse health outcomes in infants, the Panel estimated the percentage of infants reaching a concentration above this value at different intakes of vitamin D. Based on the overall evidence, the Panel kept the UL of 25 \u3bcg/day for infants aged up to 6 months and set a UL of 35 \u3bcg/day for infants 6\u201312 months. The Panel was also asked to advise on the safety of the consumption of infant formulae with an increased maximum vitamin D content of 3 \u3bcg/100 kcal (Commission Delegated Regulation (EU) 2016/127 repealing Directive 2006/141/EC in 2020). For infants aged up to 4 months, the intake assessment showed that the use of infant formulae containing vitamin D at 3 \u3bcg/100 kcal may lead some infants to receive an intake above the UL of 25 \u3bcg/day from formulae alone without considering vitamin D supplemental intake. For infants aged 4\u201312 months, the 95th percentile of vitamin D intake (high consumers) estimated from formulae and foods fortified or not with vitamin D does not exceed the ULs, without considering vitamin D supplemental intake

Relationship Between Serum CA125 Level with Malnutrition and Functional Parameters in Peritoneal Dialysis Patients

Introduction: Peritoneal dialysis is one of the most efficient treatment in ESRD. Peritoneal sclerosis and malnutrition are side effects of peritoneal dialysis. Cancer antigen 125(CA125) is made by peritoneal mesothelial cells and increases during peritoneal inflammation. Peritoneal biopsy s an invasive method using for diagnosis of peritoneal sclerosis but serum CA125 is a noninvasive method used for prediction of peritoneal dialysis recently. The aim of this study was to investigate the relationship between serum CA125 with peritoneal function and malnutrition parameters. Materials and Methods:  This cross- sectional study was carried out in Yazd 2014. A total of 50 peritoneal dialysis patients were selected by convenience sampling. A questionnaire consists of malnutrition and peritoneal functional parameters and demographic characteristics of patents was completed. SPSS version 20 and T test. Anova, chi -square and logistic regression tests used for data analysis. Results: In this study, there was a direct association between serum CA125 and serum triglyceride, LDL and invers more association between CA125 and serum albumin but there was no association between CA125 and peritoneal function parameters

Correlation of preoperative stress, anxiety and depression in women undergoing cesarean section with postoperative nausea and vomiting

Background: Correlation between stress, anxiety and depression in pregnant women and post-cesarean section (C-section) complications such as nausea and vomiting is among the most important studies in the world.Since nausea and vomiting after C-section cause the mother to be in uncomfortable condition, the purpose of this study was to determine the correlation of stress, anxiety and depression with postoperative nausea and vomiting (PONV). Materials and Methods: The present descriptive-correlational study was conducted in early 2018 on 125 pregnant women under the C-section referred to Shohadaye Kargar Hospital of Yazd in Iran. After obtaining informed written consent and presenting oral explanation, the Depression Anxiety Stress Scale-21 (DASS-21) questionnaire was completed before the C-section. Then, a questionnaire was filled out after the C-section to assess the presence and intensity of nausea and vomiting. Data analysis was performed with SPSS software version 19 using analysis of variance. Results: There was no significant correlation between stress, anxiety and depression before the C-section with presence and intensity of postoperative nausea. On the other hand, there was a significant correlation between preoperative stress and postoperative vomiting (P-value=0.024), which indicates that preoperative stress leads to postoperative vomiting in this study. Conclusion: Based on the results of this study, increasing levels of stress, anxiety and depression in pregnant women under the C-section may have their own unpleasant side effects, but they do not increase the extent and intensity of postoperative nausea, and only preoperative stress can increase postoperative vomiting

Peritoneal Dialysis Associated Peritonitis in Children With End-stage Renal Disease: A Single Center Experience in Iran: Peritoneal Dialysis Associated Peritonitis in Children

Background and Aim: The present study aimed to evaluate the frequency and risk factorsof peritonitis end-stage renal disease (ESRD) pediatrics on peritoneal dialysis (PD) in YazdCity, Iran.Methods: This cross-sectional study was conducted on ESRD pediatrics on PD in ShahidSadoughi hospital, Yazd City, Iran from 2016 to 2020. Demographic characteristics, suchas age, sex, body mass index (BMI) at the commencement of PD, underlying medicalconditions, the microbiology of peritonitis, and the recovery rate were investigated. Resultswere evaluated using SPSS software, version 26 (SPSS Institute, Inc., Chicago, IL, USA).Results: A total of 23 children (56.5% females) were included in this study. The Mean±SDage was 13.30±4.38 years, and the mean BMI was 15.71±5.53. PD-associated peritonitiswas diagnosed in 18 cases (78.3%). A total of 21.7% had at least one underlying disease. Nosignificant relationship was observed between sex (P=0.9), mean age (P=0.41), mean BMI(P=0.24), and underlying condition (P=0.29) according to pediatrics with and without PDassociatedperitonitis. Bacterial and fungal infections were responsible for peritonitis in 15(62.5%) and 3 (13%) pediatrics on PD, respectively.Conclusion: The frequency of PD-associated peritonitis in the ESRD children of our studywas 78.3%

Influence of Physiological Factors on Thyroid Size Determined by Ultrasound

According to its superficial anatomical location, the thyroid gland is easily accessible by sonography. Sonography allows an exact documentation of the size and thyroid volume. The relationship between thyroid volume and anthropometric characteristics is a matter of controversy. The aim of this study was to investigate thyroid volume and its determinants in healthy adult. A cross-sectional study was performed from June2003 until April 2005 in 314 healthy adults aged over 18 years old in Yazd, Iran. Data were collected on age, sex, and weight and thyroid size by sonoraphy. Mean of thyroid volume in male and female was 9.08 ± 2.49 and 7.93 ± 3.2 milliliter which the differences was significant (P<0.003).Differences between thyroid volume and weight was significant (P=0.001). Mean of female weight and proportion of thyroid volume to their weight was 61.83 ± 12.09kg and 0.130 ± 0.33. Mean of male weight and proportion of thyroid volume to their weight was 71.41 ± 9.05kg and 0.126 ± 0.028 (P<0.003). Results of study is similar to other studies .Mean of thyroid volume in Yazd citizens is not differ from other Iranian but is different from other countries. This difference could be related to food intake habit, geographical region and daily oral iodine consumptio

Prevalence of Vitamin D Deficiency among Female Students in Secondary Guidance School in Yazd City

Vitamin D is essential for growth and vitamin D deficiency is important issue in adolescent girls as they have a limited rapid growth period .This cross sectional study was done on 167 female students in secondary guidance school in 2006. Growth Parameters, taking supplementary vitamin D, using sunscreen creams and the type of housing and their avoidance from exposure to sunlight was recorded. Symptoms such as weakness, muscle pain, cramp and early fatigability were asked. 25-Hydroxyvitamin D was measured by RIA method, level less than 20ng /ml was considered as deficiency and less than 8ng/ml as sever deficiency. Study showed only 67 girl(40%) have normal vitamin D level,60% suffered vitamin D deficiency (95% CI 52.3-67.5) and 21% out of them suffered sever deficiency (95% CI 14.8- 27.2).No correlation existed between vitamin D level and BMI in our students.There was a correlation between taking supplementary vitamin D and the serum level of 25-Hydroxyvitamin D (P &amp;lt;0.05) . People living in the houses with yards had higher vitamin D (P &amp;lt;0.05). People who run away from the sun light exposure for any reason have lower vitamin D level significantly (P &amp;lt;0.0001).There is no correlation between symptoms such as weakness, myalgia, cramp and vitamin D level (P &amp;gt;0.05)&quot;nPresent study showed that despite the fact that Yazd is a sunny city most of the days even in winter; prevalence of vitamin D deficiency among growing female is concerning and requires preventive interference

Urinary Calcium/Creatinin Ratio with Different Dosages of Vitamin D3 Prophylaxis in Infants

Objective: The requirement of vitamin D for breast-fed term infants remains an area of controversy. Different dosage is needed according to environmental factors such as sunlight exposure. Reception of more than 400 I.U. of vitamin D daily produces hypercalcemia. A random urine calcium/creatinin ratio (UCa/Cr) is a screening test for detection of hypercalciuria. Setting adequate values of vitamin D3 prophylaxis by random UCa/Cr in infant population of Yazd city in Iran, is the aim of present study. Methods: A total of 90 healthy, full term newborns of both genders were enrolled in the study. They were divided equally into three receiving vitamin D3 prophylaxis groups as follow: (I) 200 IU/daily, (II) 400 IU/daily and (III) 50000 IU two times in fifteen and sixty days after birth. A random urine specimen from each subject was analyzed for calcium, creatinin and serum 25-hydroxy-vitamin D at the end of three months of life. Findings: From all 90 studied infants, 25 (83.3%) infants with 200 IU/daily vitamin D3, 23 (76.7%) infants with 400 IU/daily vitamin D3 and 28 (93.3%) who received 50000 IU two times (76 infants, 84.4%) had hypercalciuria and 14 (15.6%) infants remained with low values of Ca/Cr ratios. Conclusion: According to high prevalence of hypercalciuria in this survey, it is recommended to evaluate the vitamin D level in infants and use proper amount of supplemented vitamin D. It seems that 200 IU/daily could be used in infants in our area