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

Rapid Intravenous Rehydration to Correct Dehydration and Resolve Vomiting in Children with Acute Gastroenteritis

SUMMARYObjectivesThe objective of this study is to evaluate the effect of rapid intravenous rehydration to resolve vomiting in children with acute gastroenteritis.MethodsThis randomized control trial was conducted in the pediatric emergency department in a tertiary care center in Tabriz, North-West of Iran. The study participants' were 150 children with acute gastroenteritis and vomiting who were moderately dehydrated, had not responded to oral rehydration therapy and without any electrolyte abnormalities. 20–30 cc/kg of a crystalloid solution was given intravenously over 2 hours and the control group was admitted in the emergency department (ED) for a standard 24 hour hydration. Effectiveness of rapid intravenous rehydration in the resolution of vomiting in children with acute gastroenteritis was evaluated.ResultsIn 63 children of the intervention group (out of 75) vomiting was resolved after rapid IV rehydration and they were discharged. Among them, 12 that did not tolerate oral fluids were admitted. In the control group, 62 patients' vomiting was resolved in the first 4 hours after admission, and there was no significant difference between the two groups regarding resolution of vomiting.ConclusionsRapid intravenous rehydration in children with moderate dehydration and vomiting due to gastroenteritis is effective in reducing admission rates in the ED

Characteristics of pediatric pulmonary hydatid cyst in Mashhad, North East of Iran.

Hydatid disease is an important health problem in endemic areas like Iran. Unlike adults, the occurrence of pulmonary hydatid cyst is greater than hepatic cysts in pediatric population. In this study we evaluated the characteristics of pediatric pulmonary hydatid cyst in our region. We reviewed the medical records of all children with the diagnosis of pulmonary hydatid cyst in Dr Sheikh’s children hospital between 2015-2019. 30 patients were enrolled during the study period. Diagnosis was confirmed using imaging and serology tests.Mean age of patients was 8.5±2.1 years (range:6-14 years). 73% were male and 80% were living in rural areas. All patients were symptomatic at presentation and the most frequent symptom was cough (76%) followed by dyspnea (43%). The most frequent site of involvement was the lower lobe of the right lung (30% of patients) and bilateral involvement was seen in 16.7% of patients. 13.3% of patients had simultaneous hepatic involvement. Complications were reported as follows: pleural effusion 30%, superinfection and abscess formation 16.7% and pneumothorax in one patient. All patients underwent surgical treatment. Lobectomy was performed in 5 cases (16.6%). Pulmonary hydatid cyst must be considered in children with respiratory symptoms in endemic areas. Early diagnosis might lower the risk of complications and lobectomies

P53 Protein Expression in Dental Follicle, Dentigerous Cyst, Odontogenic Keratocyst, and Inflammatory Subtypes of Cysts: An Immunohistochemical Study

Objectives: An odontogenic keratocyst (OKC) is a developmental odontogenic cyst with aggressive clinical behavior. This cyst shows a different growth mechanism from the more common dentigerous cyst and now has been renamed as a keratocystic odontogenic tumor (KCOT). Inflammation can assist tumor growth via different mechanisms including dysregulation of the p53 gene. This study aims to assess and compare the expression of tumor suppressor gene p53 in inflamed and non-inflamed types of OKC and dentigerous cyst. Methods: Immunohistochemical expression of p53 was assessed in 14 cases of dental follicle, 34 cases of OKC (including 18 inflamed OKCs), and 31 cases of dentigerous cyst (including 16 inflamed cysts). Results: The mean percentage of p53 positive cells was 0.7% in dental follicles, 5.4% in non-inflamed OKCs, 17.3% in inflamed OKCs, 1.2% in non-inflamed dentigerous cysts, and 2.2% in inflamed dentigerous cysts. The differences between the groups were statistically significant (p < 0.050) except for the difference between inflamed and non-inflamed dentigerous cysts, and between dental follicle and non-inflamed dentigerous cyst. Conclusions: The difference in p53 expression in OKC and dentigerous cyst can explain their different growth mechanism and clinical behavior. Inflammation is responsible for the change in behavior of neoplastic epithelium of OKC via p53 overexpression

Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case

Introduction: Nasopharyngeal carcinoma (NPC) is a rare malignancy in children. Nasal obstruction, otitis media with effusion, pain in the ear, hearing problems, and unusual neck mass are among the signs and symptoms of this malignancy.   Case Report: We report the case of a 13-year-old girl with NPC who later developed acute lymphoblastic leukemia (ALL) through the course of her disease. To our knowledge, this is the first report of ALL following childhood nasopharyngeal carcinoma in the English-language literature.   Conclusion: Reports of secondary malignancies at the site of radiotherapy for NPC exist, but this is the first report of ALL following NPC

Prevalence of Bacterial Meningitis in Children with Apparent Febrile Convulsion

Background: As a pediatric emergency, febrile convulsion is the most common form of seizure in children in the age range of four months to five years. Therefore, this study aimed to investigate the prevalence of bacterial meningitis among children with simple febrile convulsion. Methods: In this retrospective study, all children aged 6 to 18 months presenting with the first episodes of simple febrile convulsions admitted to Dr. Sheikh and Imam Reza Pediatric Hospitals in Mashhad between 2011 and 2015 were tested for cerebrospinal fluid. Analysis of Age, Gender, cerebrospinal fluid, and cerebrospinal fluid culture was recorded. Results: From among 1,164 patients, 305 children were enrolled in this study. Out of them, 16 patients (5.2%) reported positive Lumbar Puncture outcomes, one (6.3%) of whom was less than one year old, and 15 (93.7 percent) were more than one year old. Six of these patients had received the MMR vaccine one to three weeks before admission. One of the patients who tested positive for Lumbar Puncture and had a negative cerebrospinal fluid culture was admitted to the hospital with personal consent. Aseptic meningitis was diagnosed with non-positive culture in the other nine patients. No bacterial meningitis was confirmed between the evaluated patients. Conclusion: It is confirmed that the incidence of bacterial meningitis in simple febrile convulsion is very low. Therefore, the results may recommend avoiding routine Lumbar Punctures in patients with simple febrile convulsion

Microbiology of Upper Respiratory Tract Pathogens in Cystic Fibrosis Patients

Cystic fibrosis (CF) is an inherited genetic disorder with chronic respiratory manifestations. The respiratory symptoms may start very early in life. The aim of this study was to evaluate the prevalence and antimicrobial susceptibility of respiratory pathogens in children with CF. In this clinical laboratory study, 100 CF patients were prospectively collected from February 2016 to March 2017. Microbiological cultures and antimicrobial susceptibility tests of the most frequently isolated upper respiratory tract bacteria were performed. According to the results of this study, Staphylococcus aureus was the most frequent microorganism 24 (24%) in CF patients followed by Pseudomonas aeruginosa 21 (21%). In children younger than one-year-old, Enterococci and Klebsiella pneumonia were the most frequently isolated pathogens. In other age groups, Staphylococcus aureus and Pseudomonas aeroginosa were most frequent. All pathogens showed more sensitivity to Ceftriaxone, Amikacin, and Ceftazidime. However, Staphylococcus aureus was most sensitive to Cefoxitin, Clindamycin, and Linezolid and Pseudomonas aeroginosa were most sensitive to Amikacin, Ceftazidime, and Ceftriaxone respectively. In conclusion, Staphylococcus aureus and Pseudomonas aeroginosa were the most frequent microorganisms in CF patients in our population. In patients younger than one-year-old, the most frequent pathogens were Enterococci and Klebsiella. All pathogens and Pseudomonas aeroginosa were sensitive to Ceftriaxone, Amikacin, and Ceftazidime but Staphylococcus aureus was most sensitive to Cefoxitin, Clindamycin, and Linezolid respectively. It seems that Ceftriaxone, Amikacin, and Ceftazidime are the most suitable antibiotics for the treatment of pulmonary infections in CF patients in our population

Proposed TART-RADS Classification for Testicular Ultrasound: Our Experience and Literature Review

Background: Testicular adrenal rest tumors (TARTs) are an important complication in patients with Congenital Adrenal Hyperplasia (CAH). Ultrasonography is the diagnostic modality of choice. In this study we examined the possibility of sonographic classification of TARTs in the Reporting and Data Systems (RADS) imaging format.Methods: 35 male patients with the diagnosis of congenital adrenal hyperplasia due to 21 hydroxylase deficiency were evaluated.Results: 19 patients had one or more sonographic findings of TARTs. No significant relation was found between 17 Hydroxyprogesterone (17 OH p), ACTH and androstenedione levels in patients with and without TARTs. Five sonographic patterns for testicular lesions were found. The five-stage classification of sonographic findings of TARTs is matched with histological classifications.Conclusion: This classification system will allow clinicians to perform more accurate approaches. In general, TARTS should be considered in male patients with CAH. Sonography is a good imaging modality for the diagnosis of TARTs. TART-RADS imaging of lesions will allow clinicians to develop more accurate and appropriate approache