Clinical Manifestations, Laboratory Findings, and Therapeutic Regimen in Hospitalized Children with Brucellosis in an Iranian Referral Children Medical Centre

Brucellosis is considered a known widespread zoonotic disease and is endemic in Mediterranean region, like Iran. This study reviewed the clinical manifestations, laboratory findings, and therapeutic regimen in childhood brucellosis in Iran. In this retrospective study, we reviewed hospital-records of 34 consecutive children with a confirmed diagnosis of brucellosis among a total number of 10,864 patients admitted to Children\u2019s Medical Center, Tehran, Iran, between 2002 and 2010. Among the patients diagnosed with brucellosis, 22 (65%) were admitted during spring and summer. Clinical findings of these patients at admission were arthritis, splenomegaly, hepatomegaly, lymphadenopathy, maculopapular skin rashes, and fever. Anaemia (53%) and leukopenia (33%) were the most common findings in the children. Only one patient had presented with leukocytosis. Four children (12%) were thrombocytopenic, and none of patients had pancytopenia. Blood cultures were positive in 5 patients (23%). Only one patient underwent bone-marrow aspiration and had positive culture for Brucella spp. Positive titres were found in 33 cases (97%) in Wright test, 23 cases (96%) in Coombs test, and 16 patients (72.7%) in 2ME (2-Mercaptoethanol) test. In one case, Wright and Coombs test titres were below 1:80 while Brucella spp. were isolated from blood at the same time. It is concluded, prolonged fever with joint involvement and organomegaly may increase possibility of infection with Brucella spp. Appropriate treatment regimen by more tolerable oral drugs, with a duration of at least 8 weeks, is recommended

The Attitude of Residents, Interns and Clerkship Students towards Teaching Role of Residents

Introduction: Appropriate and effective education for medical students is critically important in promoting and maintaining society's health and the role of residents is undeniable in medical students' education. The aim of this study was to determine the attitude of clerkship students, Interns and residents towards the teaching role of residents in Sari Medical School in 2007. Methods: In this descriptive cross-sectional study, the statistical population included all clerkship students, interns, and residents (n=250) in all wards having residents in medical school of Mazandaran University of Medical Sciences in 2007. Using census sampling method, 192 persons were investigated. The data gather-ing tool was a questionnaire including 4 demographic and 20 attitude items. The data was analyzed by SPSS software using descriptive statistics, Chi², and ANOVA. Results: Among respondents, 47%, 39% and 13% were clerkship students, interns, and residents , respect-ively. The participants' attitudes were dissimilar in different clinical departments. The most positive attitude belonged to psychiatry department (70% with positive attitude) and after that in pediatrics, gynecology, internal medicine, and surgery departments, 50% or less had a positive attitude. The attitude of residents was much more positive than that of clerkship students and interns. So that, 23% of clerkship students, 38% of interns, and 58% of residents had a positive attitude and none of the residents had a negative attitude toward their own education. Conclusion: The attitude of participants towards the teaching role of residents was dissimilar in different wards and the attitude of residents was much dissimilar to that of clerkship students and interns. It is necessary to pay more attention to the teaching role of residents

Ataxia-telangiectasia With Acute Rheumatic Fever: A Case Report

Background: Ataxia-telangiectasia is a multi-organ disease. It is due to a mutation of the Exon No. 5 ataxia telangiectasia mutated gene (c.381delA: p.v128fls). Complications including recurrent infections, progressive cerebellar ataxia, and varying degrees of humoral and cellular immunodeficiency arise.  Case Presentation: We report a 7-year-old girl patient with A-T who developed acute rheumatic fever.  Conclusion: Rheumatoid disorders and or infectious diseases such as acute rheumatic fever could be observed in A-T patient

Comparing Watchful Waiting Approach vs. Antibiotic Therapy in Children with Nonsevere Acute Otitis Media: A Randomized Clinical Trial

Objective. To compare both approaches for the treatment of nonsevere acute otitis media (AOM) in Iran. Methods. This randomized clinical trial was performed at a pediatric infectious diseases clinic in Buali tertiary hospital in Sari, north of Iran, from 2016 to 2018. All participants in this study were previously healthy children with AOM diagnosis, who were 6 months to 6 years old. The patients were randomly assigned into two groups: the intervention (80 mg/kg/day amoxicillin for 7-10 days) and the control group (watchful waiting approach). AOM recovery and adverse drug reactions were evaluated after 72 hours, and the patients were followed for the frequency of AOM and middle ear effusion 1 and 3 months’ postintervention. Results. A total of 396 children have participated in this study. AOM recovery was significantly different in the two groups (73% vs. 44% in the intervention and control groups, respectively). Recurrence of AOM and middle ear effusion (MEE) persistence, one month following the intervention, have not shown any significant differences between the two groups. However, the AOM recurrence between 1 and 3 months was more frequent in the control group. The frequency of diarrhea was also higher in the intervention group compared to the control but no significant difference was found between the two groups regarding vomiting and skin rash. Conclusion. The faster recovery from AOM is achieved when an antibiotic treatment regimen is applied, although the risk of potential side effects should be considered

Apparent Life-Threatening Events in Neonatal Period: Clinical Manifestations and Diagnostic Challenges in a Pediatric Referral Center

Objective: Apparent Life-Threatening Events (ALTEs) is an episode that is frightening to the observer and is characterized by some combination of apnea, color change, altered muscle tone, choking, and gagging. This study was designed to evaluate and follow up neonates who presented with clinical manifestation of an ALTE in a year. Methods: In this prospective observational study, all of the neonates with episode of ALTE who were admitted to the Children's Medical Center (CMC) in Tehran, from June 15th 2010 to May 14th 2011 were enrolled in the study. Data from patients consisting of history, physical examinations, and paraclinical findings were recorded in a checklist and all followed up 3 to 6 months after discharge. Findings: During the study period 18 neonates were admitted due to ALTE episode(s) with mean age of 15±13 days. Nine (50%) neonates had previous attacks of ALTE. The most frequent complaint was cyanosis in 12 (67%) and apnea in 8 (44%) patients. In 10 (56%) the event lasted less than one minute, 13 (72%) were awake, 17 (95%) in supine position and 13 (72%) on their parent's lap. Primary antagonistic impression on admission was sepsis in 11 (61%) and concomitant seizure in 5 (28%). The most common final diagnosis according to repeated physical examinations, result of paraclinical investigations and follow up was sepsis 4 (22%) and aspiration 9 (50%). ALTE recurred in none of the neonates during follow up. Conclusion The rate of ALTE seems to be higher than in this study owing to high incidence of recurrent ALTE. Although most of these attacks regress spontaneously, more attention should be paid for the underlying diseases

Apparent Life-Threatening Events in Neonatal Period: Clinical Manifestations and Diagnostic Challenges in a Pediatric Referral Center

Objective: Apparent Life-Threatening Events (ALTEs) is an episode that is frightening to the observer and is characterized by some combination of apnea, color change, altered muscle tone, choking, and gagging. This study was designed to evaluate and follow up neonates who presented with clinical manifestation of an ALTE in a year. Methods: In this prospective observational study, all of the neonates with episode of ALTE who were admitted to the Children's Medical Center (CMC) in Tehran, from June 15th 2010 to May 14th 2011 were enrolled in the study. Data from patients consisting of history, physical examinations, and paraclinical findings were recorded in a checklist and all followed up 3 to 6 months after discharge. Findings: During the study period 18 neonates were admitted due to ALTE episode(s) with mean age of 15±13 days. Nine (50%) neonates had previous attacks of ALTE. The most frequent complaint was cyanosis in 12 (67%) and apnea in 8 (44%) patients. In 10 (56%) the event lasted less than one minute, 13 (72%) were awake, 17 (95%) in supine position and 13 (72%) on their parent's lap. Primary antagonistic impression on admission was sepsis in 11 (61%) and concomitant seizure in 5 (28%). The most common final diagnosis according to repeated physical examinations, result of paraclinical investigations and follow up was sepsis 4 (22%) and aspiration 9 (50%). ALTE recurred in none of the neonates during follow up. Conclusion The rate of ALTE seems to be higher than in this study owing to high incidence of recurrent ALTE. Although most of these attacks regress spontaneously, more attention should be paid for the underlying diseases

Clinical signs and symptoms in Kawasaki- like MIS-C and MIS-C patients.

Clinical signs and symptoms in Kawasaki- like MIS-C and MIS-C patients.</p