Evaluation of discontinuation of antibacterial prophylaxis in children with vesicoureteral reflux

زمینه و هدف: ریفلاکس وزیکویورترال ( VUR ) مهمترین علت زمینه ساز عفونت ادراری در کودکان است. جهت جلوگیری از عفونت ادراری در کودکان با ریفلاکس وزیکویورترال، از آنتی بیوتیک پروفیلاکسی استفاده می شود که می تواند با عدم پذیرش خانواده به دلیل مصرف طولانی مدت دارو همراه باشد. این مطالعه با هدف مقایسه قطع و عدم قطع داروی پروفیلاکسی در کودکان با ریفلاکس وزیکویورترال درجه 1 و 2 انجام شده است. روش بررسی: در این مطالعه نیمه تجربی 54 کودک مبتلا به ریفلاکس وزیکویورترال درجه 1 یا 2 و بالای 5 سال که طی یکسال گذشته فاقد عفونت ادراری بودند به روش در دسترس انتخاب شدند. کودکان به صورت یک در میان به دو گروه قطع (32 کودک) و ادامه (21 کودک) درمان تقسیم و حداقل به مدت 12 ماه پیگیری شدند. میزان عود عفونت در دو گروه مورد مقایسه قرار گرفت. جهت بررسی آماری از آزمون های آماری کای دو ، t ، Logrank و تحلیل رگرسیون کاکسی استفاده شد. یافته ها: میانگین سن کودکان 5/2 ± 8/7 سال و 8/77 دختر بودند. در گروه قطع درمان 5 مورد و در گروه ادامه درمان 7 مورد عود عفونت وجود داشت (05/0 P> ). شانس عود عفونت در دختران 5/1 برابر پسران (05/0 P> ) و در کودکان زیر 7 سال 5 برابر کودکان بالای 7 سال بود (033/0= P ). نتیجه گیری: قطع دارو در کودکان بالای 5 سال با ریفلاکس وزیکویورترال درجه 1یا2 ریسک عود عفونت ادراری را افزایش نداده و قطع درمان پروفیلاکسی می تواند یک روش مطمئن و بی خطر باشد

Rubinstein-Taybi Syndrome; A Case Report

ObjectiveRubinstein-Taybi Syndrome is a rare genetic disorder with characteristic featuresincluding downward slanting palpebral fissures, broad thumbs and halluces,and mental retardation. Systemic features may involve cardiac, auditory,ophthalmic, endocrine, nervous, renal and respiratory systems. This syndromeis sporadic in nature and has been linked to microdeletion at 16p 13.3 encodingCREB-binding protein gene (CREBBP). We report a 15-years-old girl, a knowncase of chronic renal failure, with downward slanting palpebral fissures towardthe ears, hypertelorism, short stature, beaked nose, micrognathia, strabismus,dental anomalies, large toes, broad thumbs, and mental retardation.Key words: Rubinstein-Taybi syndrome; chromosome 16p 13.3; mentalretardation; CBP gene.  

Causes of Recurrent Urinary Tract Infection in Children on Prophylaxis

 Introduction: Urinary tract infection (UTI) is a common pediatric problem. It has been estimated that 8% of girls and 2% of boys suffer from UTI during childhood. So, prevention of scar formation in high risk children is very important. This study was performed to evaluate the causes of recurrent urinary tract infection in children on prophylaxis. Materials & Methods: This study was performed on 141 cases in 126 children with recurrent UTI. A questionnaire was prepared and data including sex, age, grade of vesicoureteral reflux, and antibiotic used for prophylaxis were collected. Results: The mean age of the patients was 46.6±41.1 months; 24 % of the participants were male and 76% were female. The most common predisposing factor of recurrent UTI was vesicoureteral reflux. E.coli was the microorganism responsible for most of the cases (85.5%). In 85.5% of the children, Co-trimoxazole was used as prophylaxis. Drug resistance was the most common reason of recurrence. Conclusions: We conclude that girls are at higher risk of recurrent infection and regarding the high prevalence of Co-trimoxazole resistance, administration of this drug should be limited and with caution. Keywords: Urinary tract infections; Vesico-Ureteral Reflux; Drug resistance; Chil

A case report of nephrotic syndrome with hemorrhage of intracerebral in cerebral venous thrombosis

Introduction: Cerebral vein thrombosis is a rare complication of nephrotic syndrome (NS).We report a known case of NS with hemorrhagic thrombosis. Case report: A boy with previous history of NS was admitted with headache and decrease of level of consciousness and his brain images were revealed hemorrhagic thrombosis Conclusions: Cerebral vein thrombosis must be considered in patients with history of NS (especially in new cases and during of relapses) and prevention of hemoconcentration is very important to decrease thrombosis risk

Tacrolimus and diabetic ketoacidosis after kidney transplantation in a 15-year-old girl (Case Report)

Tacrolimus is a main drug for induction and maintenance immunosuppression for patients with kidney transplants in many centers. One of important side effect of drug is post-transplant diabetes mellitus. Of course, diabetes ketoacidosis (DKA) is rare. In this report, a 12-year-old girl with DKA was presented after 45 days of kidney transplantation

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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Glomerular filtration rate determination by creatinine and cystatin-C in patients with acute pyelonephritis

Background: Measurement of glomerular filtration rate (GFR) and monitoring of it in any patient on nephrotoxic drugs is very important. Recently, cystatin C (cys-C) has been introduced as a better marker for determining and monitoring renal function than creatinine especially in a mild decrease of GFR. This study was done to assess the change of GFR measurement based on serum Cys-C and creatinine and their comparison in children with acute pyelonephritis on amikacin. Methods: All children with acute pyelonephritis who were admitted in Nephrology ward were enrolled in this study. Serum creatinine, serum cys-C and the GFR calculation based on them were measured in patients on the day of admission (day zero) and then on days 3 and 7 after the start of treatment with amikacin and p-value less than 0.05 was considered significant. Results: Among the 70 children, 61 patients were females and the others were males. Mean age was 42.66±41.53 months. Estimated GFR based on creatinine on day 0 (before amikacin administration), 3 and 7 were 72.41±20.89 ml/min/1.73 m2, 78.42±21.15 ml/min/1.73 m2 and 80.5±22.43 ml/min/1.73 m2, respectively. Moreover, GFR based on cys-C during these days were 116.23±58.9 ml/min/1.73 m2, 116.49±53.31 ml/min/1.73 m2 and 108.37±51.02 ml/min/1.73 m2, respectively (p<0.05). Conclusions: According to this study, decrease of GFR calculation based on Cys-C was seen and estimated GFR was not changed according to creatinine. So, we recommend the use of cys-C for the monitoring of renal function in any patient treated with nephrotoxic drugs such as amikacin

Comparison of urinary tract infection after kidney transplantation between adult and children

Background: Urinary tract infection (UTI) is an important complication after kidney transplantation (KT). UTI may cause kidney damage and dysfunction especially in children. Therefore, the aim of this study was to evaluate the risk of UTI after KT in adult and children and compare of them. Methods: This study was done in Shaheed Beheshti Hospital (Babol Medical University). All patients, after KT and during one month after their operation were followed and divided to two groups (according their ages): more than 18 years old (adults) and under 18 years old (Children). Then, their urine samples were sent for culture every 2-3 days during admition and every week after discharged and more than 100000 single colony count were defined positive culture. Data were analyzed using t-test and p<0.05 was considered important. Results: There were 508 cases and 450 patients were adult and others were children. Among them, 109 (24%) adult and 8(13.8%) children had positive urine culture, respectively (P>0.05) .In adult groups, 62 (21.6%) male and 47(28.8%) female patients had positive culture. However, in children group, 2 (6.3%) boys and 6 (23.1%) girls had positive culture, respectively (P<0.05). Conclusions: According to positive culture, there was no difference between adult and children, but females had higher risk of positive U/C than males .So, more attention was needed after KT in females

Bacterial Agents and Antibiotic Resistance Profile in Pyelonephritis; A Comparison between Children with and without Urinary Tract Abnormalities in the North of Iran

Background:      Pyelonephritis in children is a serious condition that is commonly encountered in clinical practice. Urinary tract abnormalities increase the risk of urinary tract infections (UTIs) and consequently antibiotic resistance. Our study aimed to evaluate the local trend in terms of bacterial uropathogen resistance in Babol, Iran, in children with pyelonephritis considering urinary tract abnormalities. Methods:      We recruited pediatric cases aged 1 month to 18 years who were admitted to Amirkola hospital with a diagnosis of pyelonephritis from 2016 to 2019. Children with negative urine cultures or incomplete imaging were excluded from the study. Causative agents were identified based on biochemical features. Antimicrobial in vitro resistance tests were performed using the disk diffusion agar test. Results:      A total of 105 children were included in the study. E. coli was the most common causative agent found in 93 (88.6%) patients. Most of the bacterial isolates were sensitive to amikacin and imipenem, and only 12.4% and 13.3% of isolates were resistant to this antibiotic. On the other hand, nalidixic acid represented the least effective treatment, with a resistance rate of 88.6%. A statistically significant difference was observed in resistance to nitrofurantoin and nalidixic acid between children with and without anomalies (p < 0.05). Conclusion:      High antibiotic resistance, especially in children with urinary tract anomalies, was identified for frequently used antibiotics. Our findings provide important implications regarding local patterns of uropathogens and antibiotic resistance in children with pyelonephritis