BREATH-HOLDING SPELLS: AN ANALYSIS OF 43 CASES

Objective:Breath holding spells, very often misinterpreted as epileptic seizures, are most common in children aged 6 months to 6 years of age. In this investigation, we sought to prospectively document the natural history of breath holding spells (BHS) among children with cyanotic, pallid and mixed type BHS referred for neurological consultation.Materials & Methods:This was a cross-sectional study in which a total of 43 children (23 boys, 20 girls) with BHS, admitted to the out patient clinic of the Children's Hospital Medical Center, between Sept 1998 and June 1999, were enrolled. A structured interview was under taken at the time of initial consultation to confirm BHS and its type, associated phenomenon, family history, sex and age at initiation of spells. Laboratory, electroencephalographic and electrocardiographic tests were done.Results:Patients were between 1.7 and 42.8 months (mean age 18.4 months). In 76.8% of cases, BHS began during the first 12 months of age. Anger and pain were the most common triggering factors (65.1 %). A positive family history of BHS was identified in 51% and parental consanguinity was found in 30% of cases. The spells were cyanotic in 79.1% (34 children). 78% of cases were iron deficient and 53% of cases had iron deficiency anemia.Conclusion:The results of this study emphasize the role of genetic factors in BHS; measurement of hemoglobin and serum ferritin is recommended all such cases.Key words: Breath-holding spells, Iron deficiency, Anemia, Serum ferriti

Designer Exosomes: A New Platform for Biotechnology Therapeutics

Abstract: Desirable features of exosomes have made them a suitable manipulative platform for biomedical applications, including targeted drug delivery, gene therapy, cancer diagnosis and therapy, development of vaccines, and tissue regeneration. Although natural exosomes have various potentials, their clinical application is associated with some inherent limitations. Recently, these limitations inspired various attempts to engineer exosomes and develop designer exosomes. Mostly, designer exosomes are being developed to overcome the natural limitations of exosomes for targeted delivery of drugs and functional molecules to wounds, neurons, and the cardiovascular system for healing of damage. In this review, we summarize the possible improvements of natural exosomes by means of two main approaches: parental cell-based or pre-isolation exosome engineering and direct or post-isolation exosome engineering. Parental cell-based engineering methods use genetic engineering for loading of therapeutic molecules into the lumen or displaying them on the surface of exosomes. On the other hand, the post-isolation exosome engineering approach uses several chemical and mechanical methods including click chemistry, cloaking, bio-conjugation, sonication, extrusion, and electroporation. This review focuses on the latest research, mostly aimed at the development of designer exosomes using parental cell-based engineering and their application in cancer treatment and regenerative medicine. Graphic Abstract: Figure not available: see fulltext. © 2020, Springer Nature Switzerland AG

COST BENEFIT OF THE ROUTINE URINALYSIS

In the present health care environment, cost-benefit analysis is extremely important. In this screening program, the minimal cost of screening dipstick urinalysis in 1601 asymptomatic school children was determined. The process of screening was similar to all the studies. The minimal cost utilizing 3 general physicians was calculated. Costs were determined by using current charge for supplies ordered to perform tests, charges for tests performed by a commercial laboratory, and the cost of a final evaluation by a pediatric nephrologist. Initial abnormal urinalysis was found in 4.7% (76/1601) of patients. Upon retesting 1.37% (22/1601) of patients were calculated to have a persistent abnormality. The calculated cost was 1/530/000 Rials (164.5 $) to initially screen all 1601 patients with a dipstick urinalysis or 850 Rials (0.09$) per patient. The calculated cost to evaluate the 22 patients with any persistent abnormality on repeat dipstick urinalysis was 246/840 Rials (26.5 $) or 11.220 Rials (1.2$) per patient. This is the calculated cost for a single screening of 1601 asymptomatic pediatric patients. Multiple screening dipstick urinalysis in asymptomatic pediatric are costly and should be discontinued. We purpose that a single screening dipstick urinalysis be obtained at school entry age, between 6 and 7 years old , in all asymptomatic children

THE INCIDENCE OF BIRTHMARKS IN IRANIAN NEONATES

A number of innocent rashes occurs in neonates. They are usually transient and self limited and thus require no therapy but early recognition is important to distinguish these lesions from more serious disorders. In this study, our purpose was to determine the frequency of birthmarks in Iranian neonates. The presence of various types of birthmarks was determined in 503 Iranian neonates under 72 hour of age. The physiological skin changes observed in order to frequency were Epstein pearls in 444 (88.27%), Mongolian spot in 409 (81%), erythema toxicum in 272 (54%), sucking blisters in 264 (52.1%), Salmon patch in 262 (52%), milia in 232 (46%), petechia in 41(0.08%) and mottling in 29 (0.06%). Petechia was seen more commonly in vaginal delivery and in babies with more birth weight. Mottling was more common in premature and low birth babies. Our data suggest that the incidence of birthmarks in Iranian neonates is similar to the prevalence reported by others in white neonates

Ultrasonic Findings of Intraventricular Hemorrhage in Preterm Newborns in Shariati Hospital (1391-1392)

Background and Objective: Intracranial hemorrhage (ICH) can affect newborn of all gestational ages and often is clinically silent. Germinal matrix hemorrhage and intraventricular hemorrhage (GM-IVH) is most common in the premature population. Estimated of frequency have changed over the last 20 years. Currently, large series report a 15% prevalence in infants 1250g at birth Material and Methods: All the newborns whom met the inclusion criteria were included in the study, they all had a brain sonography in the first 48 hrs after, and in case of finding any abnormality sonography was performed every week until discharge. For those who had a normal sonography, no further sonography was performed an expert pediatric radiologist performed the sonographies in sagittal and coronal planes the size of corpus collosum, lateral ventricles, inter hemispheric fissure and subarachnoid spaces were measured. (My lab 70 Esaote) Abnormal cystic regions in white and grey matter were evaluated and abnormal findings were documented. Results: Finally, 100 cases were included in the study GMH had a frequency of 28(28%) in our study. Among those with GMH 18 were male and 10 were female. There were no significant differences between the two sex groups in this regard. (P value=0.5.2), 7 of these infants were delivered through normal vaginal delivery and 21 through c/section. There was no significant difference between the two groups in this regard. (p value=0.010). Mean gestational age among the group with positive history of bleeding was 29 weeks and 31 weeks among those with negative history of bleeding. (p value=0.005). Mean birth weight with positive history of bleeding was 1292 gr and 1490 gr with no bleeding. (p value=0.035) in both groups the highest frequency belonged to first time pregnancies. (p value=0.667). Regarding the grade of bleeding, grade I with 23 cases (82.1%) had the highest frequency, grade 3 and 4 each had cases (7.1%) and grade 2 had 1 cases (3.6%). Regarding the frequency of PVL, only 6 infants (6%) had cystic PVL were detected. Conclusion: The prevalence of IVH in our study was close to other studies conducted in Iran, but was significantly higher than the western studies. Also studies showed that the prevalence of IVH decreased during to higher quality of perinatal care and delivery.&nbsp

Prevalence of congenital malformations observed in neonates in Shariati Hospital (1381-1383)

Background: Congenital malformations are one of the most important problems in pediatrics. The estimation of the prevalence of malformations and some probable determinants were the purpose of this study. Methods: In this retrospective study, all of the newborns that were born during three years (2002-4) were included. Hospital files of 3840 newborns were studied retrospectively and the data were collected in checklist. Finding: 118 cases had at least a major or minor malformation. Over all the prevalence of malformations was 3.1%. Male newborns showed a higher prevalence of malformations than females but with no statistical significance. The skeletal system had the highest rate of malformations, while the genitourinary system and the head and neck deformities were in the second and third position. There were no significant relations between the prevalence of malformations and the maternal age, the height and weight of the newborns and the season of birth. Conclusion: The prevalence of malformations in this study was similar to previous studies

"Oral Nifedipine Therapy On Ultrasonographic Cord Blood Flow Parameters In Pregnant Women With Short Cervix Length "

Background and Aim: In obstetrics, calcium antagonists, in particular nifedipine, have become increasingly popular for the management of preterm labor and are more effective tocolytic agents than beta 2-sympathomimetics. Our aim was to evaluate the effects of oral nifedipine therapy on ultrasonographic cord blood flow parameters in pregnant women with short cervical length. Materials and Methods: In a case-series study, 20 patients at risk of preterm labor with shortening cervix in serial examinations were included. Patients received oral nifedipine administered 40 mg per day until 37w of gestational age (GA). Umbilical artery Doppler parameters including systolic/diastolic ratio (SD) and pulsatility index (PI) were recorded before and biweekly after nifedipine prescription. Results: The mean of age was 25.55±4.58 years. The mean cervical length was 19.68±6.32. nifedipine consumption was initiated at the 26.4±4.12w and was terminated at 36.10±2.65w. The side effects of nifedipine were occurred in 2 patients (10%). In no patient no SD and PI measure get out of normal values. In contrast to PI, after nifedipine consumption SD was significantly higher than before (2.28±0.45 vs. 2.65±0.21). Two neonates (10%) were delivered before 37w and less than 2500gr. Just one neonate needed NICU stay. Conclusion: Oral nifedipine can be used as a safe and effective tocolytic treatment in patients at risk of preterm labor with shortened cervical length

Internal evaluation in Department of Pediatrics Faculty of Medicine, Tehran University of Medical Sciences

Background: Evaluation is a systematic process for collecting, analyzing and interpretation of the obtained information for the purpose of investigating how many the objectives in mind can be achieved. Education in an academic educational system means bringing about proper and increasing changes that affect the outcome of this system, that is affecting the students, and the aim of such evaluation was promotion of the quality of an education process. Methods: In this study, Department of Pediatrics Faculty of Medicine, Tehran University of Medical Sciences Tehran University of Medical Sciences, benefiting from opinion poll of university lectures, student and graduates have evaluated their system of educational in the years of 2003- 2004 and their aim was to remodel and adjust educational system with the society’s needs and promotion of the quality of such educations. The employed method was cross sectional and descriptive and analytical on the basis of 10 procedural steps and with in 8 sections dealing with evaluated factors. Such as faculty board members, management and organizational capability, students, manpower and logistic affairs, educational environments research work centers, health and therapeutic sections, educational equipment, research equipment, laboratory and diagnosis centers, educational courses and programs, teaching and learning process as well as satisfaction expressed by students.Findings: the results of the research showed that general average of 8 investigating sections in 2003 and 11 investigating sections in 2004, based on SWOTs model were respectively %53.3, %75.3 that may well be interpreted as a desirable research work. So 80% graduates of this group were satisfaction from their educational programs. Conclusion: Internal evaluation is the best indicator showing how much we should go to achieve certain aims, analyzes quality of the activity if such a system and by which we achieve logical and routine results

The relation of increasing serum bilirubin during 24-48 hours of birth and birth season

Background: The relationship between season of birth and human diseases is well known and such a relationship could be mediated by seasonal and environmental effects on early events of extrauterine life Empirical neonatological experience suggests that prevalence and degree of neonatal jaundice might be dependent on seasonal variation, mainly due to the sunshine duration. However, evidence based data on this issue are scarce. Thus, we have analyzed the seasonal effect on the rise of serum bilirubin level during the neonatal period.Methods: A prospective cohort study was done on a sample of 629 term and healthy&nbsp; infants born consecutively in Shariati Hospital, Tehran, Iran, during the years 2008-2009. The cord bilirubin level and then the serum bilirubin level near to 48 hour of age were measured. Seasonal differences in rise of serum bilirubin were studied.Results: Rise of serum bilirubin in spring was 3.951.4 mg/dl, in summer 3.761.69 mg/dl, in fall 3.511.60 mg/dl and in winter 4.791.99 mg/dl. Serum bilirubin level in cord blood did not appear to be correlated with season of birth. After correction for the possible effect of these variables the relation between season of birth and rise of serum bilirubin remained significant. The rise of serum bilirubin in winter was significantly higher than other season (P<0.0001).Conclusion: Season acts as an independent etiological factor of neonatal hyperbilirubinemia. Mean rise of serum bilirubin in winter is higher than other season. This provided information to improve education for nurses in identifying risk factors and the prevention of hyperbilirubinemia readmissions