Gęstość mineralna kości u dorosłych chorych na talasemię major: własne doświadczenia i krótki przegląd piśmiennictwa

Introduction: Metabolic bone disease represents a major cause of morbidity in patients with thalassaemia major. The aim of our study was to assess the prevalence and underlying contributory factors of osteopenia/osteoporosis in a randomly selected population of adult patients with thalassaemia major. Patients and methods: The study population was selected using the random sampling method from the patients’ database of our thalassaemia clinic. Only transfusion-dependent beta-thalassaemia patients aged over 17 and with no history of treatment with bisphosphonates were included. BMD of lumbar spine and right femoral neck were measured by means of the calibrated dual energy X-ray absorption method. Independent factors likely to be associated with low bone mass were determined and included in the analysis to ascertain possible associations. Results: Our study included 40 patients (19 female and 21 male; mean age: 23.0 ± 4.1). The mean Z score of the right femoral neck was –1.2 (95% CI: –0.9 to –1.5) and for lumbar spine was –2.1 (95% CI: –1.7 to –2.5). The prevalences of osteopenia and osteoporosis involving the right femoral neck were 37.5%, and 12.5%, respectively. The respective prevalence rates for lumbar spine were 47.5% and 37.5%. Our study showed patient’s weight, age, duration of the disease and history of hypogonadism or concurrent hypothyroidism are significant contributory factors or predictors of bone mineral loss. Conclusions: Regarding the high prevalence of osteopenia/osteoporosis in patients with thalassaemia major, all patients should be screened periodically for bone disease. The uncertainty and disagreements as to the possible role of different factors indicate the necessity for further studies in order to recognise the pathophysiologic fundamentals of this serious complication of thalassaemia major.Wstęp: Zaburzenia metabolizmu tkanki kostnej są główna przyczyną chorobowości u pacjentów z talasemią major. Celem niniejszego badania była ocena częstości osteopenii/osteoporozy i określenie czynników przyczyniających się do ich rozwoju w losowo wybranej grupie chorych na talasemię major. Pacjenci i metody: Uczestników badania wybrano losowo z bazy danych pacjentów poradni leczenia talasemii. Do analizy włączono jedynie chorych w wieku powyżej 17 lat z transfuzjozależną talasemią beta, nieleczonych wcześniej bisfosfonianami. Metodą absorpcjometrii podwójnej wiązki promieniowania rentgenowskiego zmierzono BMD odcinka lędźwiowego kręgosłupa i szyjki prawej kości biodrowej. Określono niezależne czynniki, które mogły wpływać na niską masę kostną i uwzględniono je w analizie, aby wykryć wszelkie możliwe związki. Wyniki: Do badania włączono 40 chorych (19 kobiet i 21 mężczyzn, średnia wieku 23,0 ± 4,1 roku). Średnie wartości Z score wynosiły –1,2 (95% CI: od –0,9 do –1,5) dla szyjki prawej kości biodrowej i –2,1 (95% CI: od –1,7 do –2,5) dla kręgosłupa lędźwiowego. Częstość osteopenii i osteoporozy, oceniana na podstawie gęstości mineralnej szyjki prawej kości udowej, wynosiła odpowiednio 37,5%, i 12,5%. W badaniu wykazano, że masa ciała, wiek, czas trwania choroby i hipogonadyzm w wywiadzie lub współistniejąca niedoczynność tarczycy są istotnymi czynnikami ryzyka lub predyktorami utraty minerału kostnego. Wnioski: W związku z częstym występowaniem osteopenii/osteoporozy u wszystkich chorych na talasemię major należy okresowo przeprowadzać badania w kierunku chorób kości. Wątpliwości i rozbieżne opinie na temat potencjalnej roli różnych czynników w rozwoju tych poważnych powikłań talasemii major wskazują na konieczność prowadzenia dalszych badań w celu poznania ich patofizjologii

Spinal Fluid Lactate Dehydrogenase Level Differentiates between Structural and Metabolic Etiologies of Altered Mental Status in Children

How to Cite This Article: Khosroshahi N, Alizadeh P, Khosravi M, Salamati P, Kamrani K. Spinal Fluid Lactate Dehydrogenase Level Differentiates between Structural and Metabolic Etiologies of Altered Mental Status in Children. Iran J Child Neurol. 2015 Winter;9(1):31-36.AbstractObjectiveAltered mental status is a common cause of intensive care unit admission inchildren. Differentiating structural causes of altered mental status from metabolic etiologies is of utmost importance in diagnostic approach and management of the patients. Among many biomarkers proposed to help stratifying patients with altered mental status, spinal fluid lactate dehydrogenase appears to be the most promising biomarker to predict cellular necrosis.Materials & MethodsIn this cross sectional study we measured spinal fluid level of lactatedehydrogenase in children 2 months to 12 years of age admitted to a single center intensive care unit over one year. Spinal fluid level of lactate dehydrogenase in 40 pediatric cases of febrile seizure was also determined as the control group.ResultsThe study group included 35 boys (58.3%) and 25 girls (41.7%). Their meanage was 2.7+/-3 years and their mean spinal fluid lactate dehydrogenase levelwas 613.8+/-190.4 units/liter. The control group included 24 boys (55.8%) and19 girls (44.2%). Their mean age was 1.3+/-1.2 years and their mean spinalfluid lactate dehydrogenase level was 18.9+/-7.5 units/liter. The mean spinalfluid lactate dehydrogenase level in children with abnormal head CT scan was246.3+/-351.5 units/liter compared to 164.5+/-705.7 in those with normal CTscan of the head (p=0.001).ConclusionSpinal fluid lactate dehydrogenase level is useful in differentiating structural andmetabolic causes of altered mental status in children. ReferencesFesk SK. Coma and confusional states: emergency diagnosis and management. Neurol Clin 1998; 16: 237- 56.Cucchiara BL, Kanser SE, Wolk DA, et al. Early impairment in consciousness Predicts mortality after hemispheric ischemic stroke. Crit care med 2004; 32: 241-5.Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974; 2: 81-4.Wityk RJ, Stern BJ. Ischemic stroke: today and tomorrow. Crit care med 1994; 22: 1278-93.Vázquez Jorge Alejandro, Adducci Maria del Carmen, Monzón Daniel Godoy, Iserson Kenneth V. Lactic dehyrogenase in cerebrospinal fluid may differentiate between structural and non-strucfiular central nervous system lesion in patient with diminished levels of consciousness. The Journal of Emergency Medicine2009; 37(1): 93–97.Kärkelä J, Pasanen M, Kaukinen S, Mörsky P, Harmoinen A. Evaluation of hypoxic brain injury with spinal fluid enzymes, lactate, and pyruvate. Crit Care Med. 1992 Mar; 20(3):378-86. 2007: pp. 835. ISBN 0-7817-7087-4.DV Kamat, BP Chakravorty. Comparative values of CSF-LDH isoenzymes in neurological disorders. Indian Journal of Medical Sciences 1999; 53 (1): 1-6.Pollak AN, Gupton CL. Emergency Care and Transportation of the Sick and Injured. Boston: Jones and Bartlett 2002: pp. 140. ISBN 0-7637-1666-9.Nayak BS, Bhat R. Cerebrospinal fluid lactate dehydrogenase and glutamine in meningitis. Indian J Physiol Pharmacol. 2005 Jan; 49(1):108-10.A Twijnstra, A P van Zanten, A A Hart, et al. al. Serial lumbar and ventricle cerebrospinal fluid lactate dehydrogenase activities in patients with leptomeningeal metastases from solid and haematological tumours. J Neurol Neurosurg Psychiatry 1987 50: 313-320.Nussinovitch M, Finkelstein Y, Politi K, Harel D, Klinger G, Razon Y, Nussinovitch U, Nussinovitch N. Cerebrospinal fluid lactate dehydrogenase isoenzymes in children with bacterial and aseptic meningitis. Translational Research 2009. 154 (4): 214-218.Feldman William E. Cerebrospinal Fluid Lactic Acid Dehydrogenase Activity. Levels in Untreated and Partially Antibiotic-Treated Meningitis. Am J Dis Child. 1975; 129(1): 77-80.Lutsar I, Haldre S, Topman M, Talvik T. Enzymatic changes in the cerebrospinal fluid in patients with infections ofthe central nervous system. Acta Paediatr 1994; 83(11):1146-1150.Kepa L, Oczko-Grzesik B, Błedowski D. Evaluation of cerebrospinal fluid and plasma lactate dehydrogenase activity in patients with purulent, bacterial meningoencephalitis. Przegl Epidemiol. 2006; 60(2):291-8.Ruzak-Skocir B, Trbojevic-Cepe M. Study of serum and cerebrospinal fluid enzymes in diagnosis and differential diagnosis of cerebrovascular diseases. Neurologija. 1990; 39(4):239-50.Nand N, Sharma M, Saini DS. Evaluation of lactic dehydrogenase in cases of meningitis. Indian J Med Sci. 1993; 47(4): 96-100.Neches William, Platt Martin. Cerebrospinal Fluid LDH in 287 Children, Including 53 Cases of Meningitis of Bacterial and non-Bacterial Etiology. Pediatrics 1968; 41:1097-1103.Engelke S; Bridgers S, Saldanha R, Trought W. Cerebrospinal Fluid Lactate Dehydrogenase in Neonatal Intracranial Hemorrhage. American Journal of the Medical Sciences 1986; 291 (6): 391-395.Parakh N, Gupta HL, Jain A. Evaluation of enzymes in serum and cerebrospinal fluid in cases of stroke. Neurology India 2002; 50 (4): 518-9.Lampl Y, Paniri Y, Eshel Y, Sarova-Pinhas I. Cerebrospinal fluid lactate dehydrogenase levels in early stroke and transient ischemic attacks. Stroke 1990; 21: 854-857.Hall Robert T., Kulkarni Prakash B., Sheehan Michael B., Rhodes Philip G. Cerebrospinal Fluid Lactate Dehydrogenase in Infants with Perinatal Asphyxia. Developmental Medicine & Child Neurology 1980. 22 (3): 300-307.Nussinovitch M, Volovitz B, Finkelstein Y, Amir J, Harel D. Lactic dehydrogenase isoenzymes in cerebrospinal fluid associated with hydrocephalus. Acta Paediatr 2001; 90: 972-974

Determining a National Trauma Prognostic Scale (TPS) to Predict Preventable Trauma Death in Iran: the Research Protocol

Methods: A 7-phases methodology will be applied to conduct this study as following; 1- Identification of trauma severity parameters and scales predicting mortality from literature, 2- Developing a data collection tool for research data collection), 3- Data collection in selected clinical settings, 4- Statistical modeling, 5- Model adaptation with three levels of trauma care settings including pre-hospitals, general hospitals and trauma specialty hospitals, 6- Scale-up and extrapolation, and 7- comparison with international models and selection of Iranian national model. Results: The content validity of the tool was confirmed with a total scale-level content validity (S-CVI) = 0.93. The reliability of the final instrument was calculated using the Pearson correlation coefficient and the Spearman correlation was evaluated above 0.7 for all cases. Up to date April 2020, From the hospital of the study, 210 patients participated in the study. The mean and standard age deviation of patients was 35.18 ± 18.44 and 165 (78.57 %) of these patients were male. The most important cause of trauma in patients was a motorcycle accident (27.62 %). Keywords: Trauma, Modeling, Injury severity assessment, Mortality predictor, Trauma scal

Determining a National Trauma Prognostic Scale (TPS) to Predict Preventable Trauma Death in Iran: the Research Protocol

Methods: A 7-phases methodology will be applied to conduct this study as following; 1- Identification of trauma severity parameters and scales predicting mortality from literature, 2- Developing a data collection tool for research data collection), 3- Data collection in selected clinical settings, 4- Statistical modeling, 5- Model adaptation with three levels of trauma care settings including pre-hospitals, general hospitals and trauma specialty hospitals, 6- Scale-up and extrapolation, and 7- comparison with international models and selection of Iranian national model. Results: The content validity of the tool was confirmed with a total scale-level content validity (S-CVI) = 0.93. The reliability of the final instrument was calculated using the Pearson correlation coefficient and the Spearman correlation was evaluated above 0.7 for all cases. Up to date April 2020, From the hospital of the study, 210 patients participated in the study. The mean and standard age deviation of patients was 35.18 ± 18.44 and 165 (78.57 %) of these patients were male. The most important cause of trauma in patients was a motorcycle accident (27.62 %). Keywords: Trauma, Modeling, Injury severity assessment, Mortality predictor, Trauma scal

Lifelong learning; why do we need it?

AbstractOur world is changing around us in such a frantic pace that if we do not continue to grow and develop; we will soon be left behind. In the 21st century, we all need to be lifelong learners. We need to continually keep our skills sharp and up to date so that we have an edge in all we do. Of course, we all have a natural desire to learn for adapting to change, enriching and fulfilling our lives. This review article is an attempt to present the main advantages which follow lifelong learning

Is Ceftizoxime an Appropriate Surrogate for Amikacin in Neonatal Sepsis Treatment? A Randomized Clinical Trial

Neonatal sepsis, a life-threatening condition, presents with non-specific clinical manifestations and needs immediate empirical antimicrobial therapy. Choosing an appropriate antibiotic regimen covering the most probable pathogens is an important issue. In this study we compared the effectiveness of ceftizoxime and amikacin in the treatment of neonatal sepsis both in combination with ampicillin. In a randomized clinical trial, all term neonates with suspected sepsis referred to Bahrami hospital during March 2008 to March 2010 were evaluated. Patients were randomly recruited into two groups; one group receiving ampicillin and amikacin and the other ampicillin and ceftizoxime. Blood, urine and cerebrospinal fluid cultures, leukocyte count and C-reactive protein level were measured in all neonates. A total of 135 neonates were evaluated, 65 in amikacin group and 70 in ceftizoxime group. 60 neonates (85.7%) in ceftizoxime group and 54 neonates (83.1%) in amikacin group responded to the treatment (P= 0.673 and χ2 = 0.178). Only 24 (18%) blood samples had a report of positive blood culture. The most frequent pathogen was coagulase negative staphylococcus with the frequency of 58.32% of all positive blood samples. Ceftizoxime in combination with ampicillin is an appropriate antimicrobial regimen for surrogating the combination of ampicillin and amikacin to prevent bacterial resistance against them

Leukocyte Count and Erythrocyte Sedimentation Rate as Diagnostic Factors in Febrile Convulsion

"nFebrile convulsion (FC) is the most common seizure disorder in childhood. white blood cell (WBC) and erythrocyte sedimentation rate (ESR) are commonly measured in FC. Trauma, vomiting and bleeding can also lead to WBC and ESR so the blood tests must carefully be interpreted by the clinician. In this cross sectional study 410 children(163 with FC), aged 6 months to 5 years, admitted to Bahrami Children hospital in the first 48 hours of their febrile disease, either with or without seizure, were evaluated over an 18 months period. Age, sex, temperature; history of vomiting, bleeding or trauma; WBC, ESR and hemoglobin were recorded in all children. There was a significant increase of WBC (P<0.001) in children with FC so we can deduct that leukocytosis encountered in children with FC can be due to convulsion in itself. There was no significant difference regarding ESR (P=0.113) between the two groups. In fact, elevated ESR is a result of underlying pathology. In stable patients who don't have any indication of lumbar puncture, there's no need to assess WBC and ESR as an indicator of underlying infection. If the patient is transferred to pediatric ward and still there's no reason to suspect a bacterial infection, there is no need for WBC test

Adverse Drug Reactions; As a Cause for Admissions to a Childrenerved 12.6

Objective: The aim of this study was to investigate the adverse drug reactions (ADR) in pediatrics and determine the predominant symptoms of adverse drug reactions in children. Material & Methods: This case series study was carried out at the Bahrami Pediatric Hospital, Tehran where the files of 25 admitted patients with the diagnosis of adverse drug reaction 1998 to 2005 were studied. Findings: The average age was 4.6 (±3.7) years and symptoms of adverse drug reactions were observed 12.6 (±14.3) days after initiation of the drug intake. Skin rash was seen in all patients more in form of maculopapular rash followed by urticaria. Arthralgia was the next common symptom observed in 44% of patients. The common abnormal laboratory data was high erythrocyte sedimentation rate which was seen in 40% of patients. The most common ingested drugs were phenothiazine and sulfasalazine (each of them seen in 28% of patients) followed by penicillin (16%), furazolidone (16%), cephalosporins (4%) and valproic acid (4%). In 28% of patients poly-pharmacy was responsible for ADR.Conclusion: Awareness of the problem, observation of poly-pharmacy and potential drug-drug interactions, and continuous re-evaluation of the ongoing individual pharmacotherapy is important, especially in children, to reduce ADRs

Predictive power of Pediatric Trauma Score (PTS) in predicting of child’s mortality : Predictive power of Pediatric Trauma Score (PTS)

Introduction: Trauma is a serious global health issue, and children are among the world's most vulnerable victims. Pediatric Trauma Score (PTS) is a rating for the prediction of death in pediatric with trauma .This study aimed to evaluate the predictive power of PTS in predicting death in children with trauma. Methods: This prospective study was part of a national study to develop a primary model for estimating mortality by adjusting the severity of injury in Iran. Which was performed on 92 pediatric trauma participants. To predict the predictive power of PTS, the Area under the Curve (AUC), 95 % confidence interval (95 % CI), sensitivity, specificity, coefficient of determination and, odds ratio were utilized. All tests were carried out with a significance level of 0.05. Results: The mean age of patients participating in this study was 11.86 ± 4.94 years and 68 (73.91%) of them were male. The most common injury type was head and face (53.26%) trauma and the most common cause of trauma was motorcycle accidents (27.17%), respectively. The AUC value for PTS score was 0.911 and its coefficient of determination (R2) was 38%. Conclusion: PTS is a good score for predicting trauma death in children in Iran. PTS can be used especially for triage of children with trauma in hospitals

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214337 [58%] were transport related) and 31.1 million DALYs (of which 16.2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34.4% (from 17.5 to 11.5 per 100 000) for transport injuries, and by 47.7% (from 15.9 to 8.3 per 100000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80.5% to 42 774 for transport injuries and by 39.4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16.7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48.5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0.2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury