Streptococcus Pneumonia-Associated Hemolytic Uremic Syndrome: A Case Report

Hemolytic uremic syndrome (HUS), a disease that destroys red blood cells, is the most common cause of sudden, short term acute kidney failure in children. By far, the commonest subgroup (>90% of childhood HUS) is induced by shiga toxin producing bacteria, usually enterohemorrhagic Escherichia coli (EHEC). These patients typically have a prodrome of diarrhea. Another important subgroup that is readily identified on clinical grounds follows invasive Streptococcus pneumonia infection. These infants tend to be younger than those with D + HUS, and the syndrome is very rare after the age of 4 years. They present with pneumonia, empyema, meningitis, and less often, isolated septicemia. Another group of patients may have mutations in complement regulators, and less often, inherited deficiency of von Willebrand protease or an inborn error of cobalamin metabolism. We report a 6-month-old child who developed hemolytic uremic syndrome following S. pneumonia meningitis.Keywords: Hemolytic-Uremic Syndrome; Meningitis; Streptococcus pneumonia; Chil

Electronically tunable silicon photonic delay lines

Electronically tunable optical true-time delay lines are proposed. The devices utilize the combination of apodised gratings and the free-carrier plasma effect to tune the enhanced delay of silicon waveguides at a fixed wavelength. Three variations of the proposed scheme are studied and compared. The compact and integrable devices can achieve tuning ranges as high as similar to 660 ps with a loss of \u3c 2.2 dB when operated in the reflection mode of the gratings. A delay of similar to 40 ps with a loss of \u3c 10 dB and an estimated operation bit rate of similar to 20 Gb/s can be achieved

Meningitis after MMR vaccination in Mashhad, Iran

Background: More than 20 years after the introduction of the mumps vaccine in the Iranian national vaccination program, there are concerns about meningitis induced by the Measles, Mumps, and Rubella (MMR) vaccine. The aim of this study is to virologically determine the incidence of MMR-induced meningitis in Mashhad, Iran. Method: This is an observational prospective study during which all children who were admitted (in all hospitals of Mashhad) under the clinical suspicion of meningitis and had a history of MMR vaccination during the past 45 days were included. A polymerase chain reaction (PCR) test for mumps virus and enterovirus (EV) was done on cerebrospinal fluid (CSF) samples with pleocytosis. Results: During 13 months of study, 55 children were hospitalized for suspicion of meningitis and had a history of recent MMR shots (94% presented with a febrile seizure). Meningitis was confirmed by CSF pleocytosis in 23 (2 bacterial and 21 aseptic) cases (44.2%). All incidents of meningitis had occurred after the first MMR. The incidence of any kind of aseptic meningitis, EV meningitis, and mumps meningitis during 45 days after the first MMR was, respectively, 19.9, 5.71, and 1.9 per 100,000 cases. The number of meningitis cases during the first 3 months after MMR was, respectively, 4.5 and 2 times more than the cases that occurred during the 3 months before and 3-6 months after MMR. Conclusion: Around 40% of all cases of meningitis (between 4 and 43 months of age) occur during the first 3 months after the first MMR vaccination (12-15 months). The disproportionate increase of aseptic meningitis after the first MMR is strong epidemiologic evidence in favor of mumps vaccine induced meningitis

Association of MS4A6A, CD33, and TREM2 gene polymorphisms with the late-onset Alzheimer’s disease

Introduction: Alzheimer’s disease (AD), which is a progressive neurodegenerative disorder, causes structural and functional brain disruption. MS4A6A, TREM2, and CD33 gene polymorphisms loci have been found to be associated with the pathobiology of late-onset AD (LOAD). In the present study, we tested the hypothesis of association of LOAD with rs983392, rs75932628, and rs3865444 polymorphisms in MS4A6A, TREM2, CD33 genes, respectively. Methods: In the present study, 113 LOAD patients and 100 healthy unrelated age- and gender-matched controls were selected. DNA was extracted from blood samples by the salting-out method and the genotyping was performed by RFLP-PCR. Electrophoresis was carried out on agarose gel. Sequencing was thereafter utilized for the confirmation of the results. Results: Only CD33 rs3865444 polymorphism revealed a significant difference in the genotypic frequencies of GG (P = 0.001) and GT (P = 0.001), and allelic frequencies of G (P = 0.033) and T (P = 0.03) between LOAD patients and controls. Conclusion: The evidence from the present study suggests that T allele of CD33 rs3865444 polymorphism is associated with LOAD in the studied Iranian population

The effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

PURPOSE: The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus. METHODOLOGY: In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran. KEY FINDINGS: According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index >/=1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index >/=0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively. CONCLUSION: Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections

Clinical Features and Long Term Prognosis of Childhood Brucellosis in Northeast Iran

Objective: Brucellosis is a prevalent disorder in children of developing countries. The aim of this study is to describe the epidemiology and long term prognosis of Brucellosis in Khorasan, Iran. Methods: This is a descriptive cross sectional study (from November 2003 up to February 2006), the subjects of which are composed of 82 patients (from Imam Reza hospital, Mashhad, and Health Center of Kashmar). In this study the diagnosis of Brucellosis is based on serology accompanied with clinical signs and symptoms. Our strategy for duration of treatment was to treat all patients for at least 6 weeks. We followed the patients by phone and if necessary by visiting. Findings: During 38 months we had 82 children with Brucellosis. The mean age was 8.02 y, and 40% of them were girls (M/F=1.21). Summer with 45.9% of the cases was the peak season. History of consuming raw dairy products, close contact with farm animals, living in village and Brucellosis in family was found in 91.6%, 76%, 70.24% and 41.1% of the cases respectively. The presenting symptom in 79.7% of the cases was joint pain, 72.9% had history of fever during the course of the disease. Arthritis, splenomegaly and lymphadenopathy were found in 60.97%, 16.9%, 7.5%, of patients respectively. The therapeutic regimen of 48.7% of our patients was Co-trimoxazole and rifampin. We followed 74% of the patients for at least 3 years which showed the relapse rate of 6.5 %. There was a case of reinfection, a patient with residual sequel and one death related to Brucellosis in our case series. Conclusion: Brucellosis is still a common disease in our children and at least a risk factor for it can be found in the history of almost all cases of pediatric Brucellosis. With at least six weeks treatment with two antibiotics and with close follow up, we can decrease the relapse rate in pediatric Brucellosis to zero, even without repeating the serology during or after treatment

The pattern of antibiotic administration for toddlers and infants with acute respiratory infections (Mashhad- Iran)

ABSTRACT Background: Acute respiratory infections (ARI) are the main cause for antibiotic (AB) use in all age groups specially the first two years of life. The local information about the pattern of AB prescription in ARI is a necessary part for any program which aims logical use of AB. The current study was designed to find the frequency and types of AB administration for ARI in young children (<2years) in Mashhad, Iran. Method: This is an observational cohort study which was started in November 2005 and ended up at May 2006. The study group was composed of 1000 infants between 6 month and 20 months old. The children were followed monthly by telephone calls (up to six month after the first interview) and were asked about signs and symptoms of acute respiratory infection and systemic antibiotic use during each month. Results: The average monthly incidence of ARI was 34.5% in the study population, 66.3 %( mean) of the children with ARI were visited by a doctor, which led to AB prescription in 32.7 %( mean) of times. The frequency of inject able antibiotics was almost two times of oral Abs, and benzatin penicillin was the most prescribed AB (54%of all Abs). Conclusion: The rate of AB administration for infants with ARI is not very high in Mashad, but the frequency of AB injections is unacceptable

اپیدمیولوژی آنسفالیت کودکان در مشهد

مقدمه  آنسفالیت از علل نسبتاً ناشایع بستری در بخش‌های کودکان است که با عوارض ناتوان‌کننده درازمدت همراه است. هدف از مطالعه حاضر تعیین فروانی و علت شناسی آنسفالیت در بخش اعصاب کودکان بیمارستان قائم مشهد است. روش کار مطالعه حاضر یک تحقیق گذشته‌نگر توصیفی درباره کودکانی است که با تشخیص آنسفالیت (در بازه زمانی فروردین 1387 تا شهریور 1393) از بخش نورولوژی کودکان بیمارستان قائم مشهد (تنها بخش نورولوژی کودکان در شرق کشور) مرخص شده‌اند. اطلاعات از طریق مراجعه به پرونده بیماران به­ دست آمده است. تنها آزمایش ویروس‌شناسی به کار گرفته‌شده در این مطالعه HSV PCR مایع نخاعی می‌باشد. برای تعیین میزان عوارض عصبی آنسفالیت ، با خانواده  بیماران (در دسترس) تماس تلفنی گرفته شد و پرسشنامه مربوط به عوراض  تکمیل شد. نتایج در مدت 6 سال و 5 ماه، 55 کودک با تشخیص آنسفالیت از بخش اعصاب کودکان مرخص شدند که میانگین سنی آن‌ها 4 سال و 10 ماه بود و 51% پسر و 74% ساکن شهر بودند. کمترین فراوانی آنسفالیت در بهار مشاهده شد (14%). پلئوسیتوز مایع نخاع(3mm5> WBC) در 41% موارد وجود داشت. HSV PCR مایع نخاع در49% بیماران انجام شد که در 3 بیمار مثبت بود. علت‌های آنسفالیت در این بررسی عبارتند از: ADEM* 16%، ویروس تب‌خال (HSV) 16% که موارد  PCR مثبت 5% (مورد قطعی) و 11% با PCR منفی (مورد محتمل)، آنسفالیت آبله‌مرغان3% و 63% ناشناخته.آسیکلویر در 20% بیماران در طول بستری  تجویز نشد. شروع آسیکلویر در اولین بیمارستان در 77 % موارد بود. نتیجه­گیری ADEM شایع­ترین علت آنسفالیت کودکان در خراسان است. متخصصین کودکان خراسان در اکثر موارد در مواجهه ابتدایی با کودک مبتلا به آنسفالیت، اسیکلوویر را شروع می‌کنند