The Association Between Hyponatremia and Reflux-Related Renal Injury in Acute Pyelonephritis

Introduction: The kidney regulates sodium balance and is the principal site of sodium excretion. Sodium is unique among electrolytes because water balance, not sodium balance, usually determines its concentration. Although water balance is usually regulated by osmolality, volume depletion stimulates thirst, renal protection of water and ADH secretion. Volume reduction has priority over osmolality; volume depletion stimulates ADH secretion, even if a patient has hyponatremia. The aim of this study was to consider scar nephropathy in children with UTI and hyponatremia and compare it with children without hyponatremia.Material and Methods: 200 children with pyelonephritis were included in this case–control study as case and control groups, respectively. Subjects were selected from children referred to the pediatric clinic of our hospital in Arak, Iran. Case group included children with hyponatremia and UTI (with VUR) and control group included children with UTI (With VUR) and normal serum sodium. Data was analyzed using SPSS ver.18Results: Among 200 (100%) children in both groups, 5 children (5%) had normal sodium and reflux nephropathy and 23 children had hyponatremia and reflux nephropathy.Conclusions: Hyponatremia in children with reflux nephropathy was significantly more common than children without reflux nephropathy. The observed correlation between reflux-related injury and hyponatremia necessitates evaluation of electrolytes in children with pyelonephritis.Keywords: Pyelonephritis; Child; Hyponatremia; Vesico-Ureteral Reflux

Mean Platelet Volume as a Predictive Marker for Poor Prognosis of Acute Renal Failure in children

Introduction: Acute renal failure (ARF) is a clinical syndrome in which a sudden deterioration in renal function results in the inability of the kidneys to maintain fluid and electrolyte homeostasis. A classification system has been proposed to standardize the definition of acute kidney injury in adults. These criteria of risk, injury, failure, loss and end-stage renal disease were given the acronym of RIFLE. Our goal was to study the mean platelet volume (MPV) as a prognostic predictor of ARF in children. Mean platelet volume (MPV) is a machine-calculated measurement of the average size of platelets in blood and typically included in blood tests as part of CBC (Complete Blood Count). Since the average platelet size is larger when the body is producing increased numbers of platelets, MPV can be used to make inferences about platelet production in bone marrow or platelet destruction problems.Material and Methods: The records of 200 patients with ARF were investigated prospectively. Complete blood count including MPV, erythrocyte sedimentation rate, serum C-reactive protein and electrolytes of patients were measured and compared.Results: MPV values were low in loss (p=0.0012) and failure (p<0.005). The sensitivity and specificity of MPV for the diagnosis of loss and failure were higher than those of the other inflammation markers. MPV<8.2 fL was significantly associated with poor prognosis in renal functions.Conclusions: MPV is a fast and reliable measurement with considerable predictive value for prediction of prognosis in acute renal failure.Keywords: Acute Kidney Injury; Mean Platelet Volume; Blood Platelets; Acute Kidney Injury; Prognosis

Evaluation of the Relationship between T2*CMR and Cardiac Depolarization and Repolarization Parameters in Beta-Thalassemia Patients

Background: Cardiac iron overload causes severe cardiac complications and is a leading cause of death in beta-thalassemia major patient. T2*CMR can detect preclinical cardiac iron overload. We evaluated the ability of 12-lead electrocardiographic atrial and ventricular depolarization and repolarization parameters to predict cardiac iron loading in TM.Materials and methods: This cross-sectional study was conducted on Patients with Beta thalassemia major; all participants underwent standard 12 lead electrocardiogram during a single study visit and the depolarization and repolarization parameters of ECG were measured and compared to the cardiac iron level detected by T2*CMR, with a detectable cardiac iron cutoff of T2*less than 20 ms.Results: A total of 26 patients (mean 26.19 years old, 34.62% male) were included. Mean T2*CMR values were 21.53 ms (46.15% <20 ms, 53.85% ≥20 ms). Among ECG parameters, only Pwd, QTc and QTcd (p: 0.026, 0.030, and 0.006 respectively) were significantly prolonged in patients with T2* < 20 ms compared to patients with T2*≥ 20 ms. There was a statistically negative Correlation between T2 * CMR and Pwd and QTcd (p: 0.028, and 0.021 respectively). Moreover, no correlation was found between Tp-e, Tp-e d, JTc, JTcd, Tp-e/QT, Tp-e/JT, Tp-e/JTc and T2* values.Conclusions: PWD and QTcd can be used as an alternative to T2*CMR to predict cardiac iron load levels in patients with beta thalassemia major

Assessment of Blood Pressure in Primary Monosymptomatic Nocturnal Enuresis

Introduction: Enuresis is defined as the repeated voiding of urine into bed at least twice a week for at least 3 consecutive months in a child who is at least 5 years of age. Primary enuresis occurs in children who have never been consistently dry through the night.  Monosymptomatic enuresis has no associated daytime symptoms. Increased nocturnal urine production in primary nocturnal enuretic patients could possibly be associated with autonomic nervous system dysfunction. The aim of this study was to investigate autonomic nervous system function in enuretic children.Materials and Methods: In this study, children with monosymptomatic primary nocturnal enuresis (MPNE) and healthy children without MPNE were enrolled and their blood pressure was measured twice a day (in the morning and afternoon). Urinalysis, urine electrolyte levels, urinary culture, and urinary system ultrasound were performed in all the children. They were also requested to have a diary about daily fluid intake and the volume of daily urine.Results: The MPNE group comprised 100 children (M/F: 58/42) and the control group included 100 healthy children (M/F: 51/49). The mean age of the children was 8.1±2.3 and (8.9±2.53 years in MPNE and control groups, respectively. The mean diastolic blood pressure (DBP) during the nighttime and daytime did not differ between the groups (p-value&gt;0.05); however, the mean systolic blood pressure (SBP) was significantly higher in the nighttime in the MPNE group (p-value&lt;0.05) but did not differ between the groups during the daytime (p-value&gt;0.05).Conclusions: Nighttime SBP was significantly higher in children with MPNE. These subtle abnormalities of the circadian blood pressure regulation may reflect autonomic nervous system dysfunction and contribute to the pathogenesis of MPNE.Keywords: Child; Enuresis; Blood pressure; Autonomic dysfunctio

A Case Report of Neonatal Atrial Flutter with Poor Feeding and Tachypnea

Background: Arrhythmias in neonates are not common and usually affect newborns with a normal heart or those that suffer from structural heart disease. A malignant type of arrhythmias is supraventricular tachycardia. Meanwhile, one uncommon type of supraventricular arrhythmias is atrial flutter (AFL), which is founded upon reentry mechanisms in the atrium. The AFL may result in heart failure or even death, but the majority of its cases have revealed favorable prognosis in the event of early prenatal diagnosis and immediate treatment.Case report: A four-day term male newborn with a birth weight of 4,560 g born to a 43-year-old multiparous mother was delivered through cesarean section. The patient’s admission to the hospital was on account of her poor feeding and tachypnea. The results of physical checkup exhibited tachycardia with 210 beats/min, and electrocardiogram (ECG) indicated a narrow QRS complex tachycardia with P-waves in the leads II and III that showed AFL. The adenosine injection revealed atrioventricular conduction 2.1. Therefore, oral propranolol therapy with a dosage of 3 mg/kg/day was prescribed for the patient. Given the recurrence of AFL, cardioversion was conducted with 0.25 joule/kg until the rhythm was restored to normal. Later, the normal sinus rhythm was observed on ECG. Fifteen days after birth, the patient was discharged with a perfect general state. The results of a 6-month follow-up did not show any AFL.Conclusion: Despite its rare occurrence, AFL must be considered in the differential diagnosis of newborns with poor feeding with tachypnea and tachycardia

Conservative Management in a Ventilated Preterm Neonate with Pneumopericardium, Pleural Effusion, and Pulmonary Collapse: A Case Report

Background: Neonatal pneumopericardium (PPC) is a rare clinical condition usually associated with other air leak syndromes. It increases morbidity and mortality due to cardiac tamponade. Case report: A preterm male neonate weighing 1260 g was born with the gestational age of 28 weeks. Cardiopulmonary resuscitation was routinely performed without any medical therapy. The newborn was transferred to the neonatal intensive care unit due to marked respiratory distress with tachypnea and cyanosis. Pulse oximetry showed oxygen saturation of 70%. A whiteout of the lung and air-bronchogram pattern was found on the chest X-ray. The arterial blood gases demonstrated PH=7.14, PCo2=51 mmHg, Po2=36 mmHg, bicarbonate=15.8 mg. The neonate was intubated with a tracheal tube size 2.5 and mechanical ventilation was initiated with 90% fraction of inspired oxygen (FiO2), PIP=14 cmH2O, and PEEP=4 cmH2O. After intubation, the newborn received two doses of surfactant. On the third day, patent ductus arteriosus was established and appropriate treatment was performed. After five days, the chest X-ray was repeated due to increasing respiratory distress and an increasing FiO2, which revealed a pneumopericardium with right-sided pleural effusion and left upper lobe collapse. Afterwards, pleurocentesis was performed. Left ventricular ejection fraction (65%) was preserved and no evidence of cardiac tamponade was observed. Serial chest X-ray and echocardiography were performed daily. After the next seven days, the chest radiograph demonstrated a complete resolution of the pneumopericardium, pleural effusion, and lung collapse. Conclusion: The present case study presented a preterm neonate suffering from pneumopericardium along with pleural effusion and lung collapse. Despite the complexity, the PPC was asymptomatic and eventually resolved without pericardiocentesis

Isolated Right Ventricular Non-compaction in a Neonate Born to a Mother with Gestational Diabetes: A Case Report

Background: Ventricular non-compaction, which is a rare congenital cardiomyopathy, results from an arrest in normal endomyocardial embryogenesis. It is characterized by a pattern of prominent trabecular meshwork and deep inter-trabecular recesses. The clinical manifestations include systolic and diastolic dysfunctions, heart failure, ventricular arrhythmias, and cardioembolic events.Case report: Here we present the case of a neonate (38 weeks, weighing 2580 gr) born to a mother with gestational diabetes (GDM) with isolated right ventricular non-compaction (IRVNC) and systolic and diastolic right heart dysfunction due to meconium aspiration syndrome and tension pneumothorax. A 4-month follow-up demonstrated a complete improvement in the newborn.Conclusion: It is of paramount importance to consider RVNC cardiomyopathy a differential diagnosis of cyanosis and respiratory distress due to meconium aspiration syndrome in neonate s born to mothers with GDM. Apart from RV cardiac dysfunction, RVNC could cause such complications as pulmonary hypertension and tension pneumothorax. It can be also spontaneously improved in GMD

Coronary-subclavian steal syndrome following CABG: A case report and literature review

Introduction: Coronary-subclavian steal syndrome (CSSS) is not a common complication but it can cause recurrent angina following coronary artery bypass grafting(CABG). CSSS results from proximal subclavian artery stenosis causing reversal of blood flow in apatent in situ internal thoracic artery utilized as a conduit in CABG, leading to myocardial ischemia. Case Presentation: We present a case of CSSS successfully treated with carotid-subclavian bypass (CSB). A review of articles on the subject has also been conducted. Conclusions: Although CSSS is not a common condition, it should be strongly considered as a possibility in CABG patients presenting with recur- rent chest pain not to be confused with perioperative myocardial infarction (PMI). If indicated, carotid-subclavian bypass maybe performed as an effective treatment option with acceptable outcomes

Oral Health and Coronary Artery Disease, A Review Article

Atherosclerosis is the most common cause of myocardial infarction and ischemic stroke. Various risk factors have been identified for atherosclerosis. Recently, bacterial and viral organisms, which are involved in chronic inflammatory processes, have been also implicated in atherosclerosis development. Individuals with a prior history of periodontal diseases and/or tooth loss are considered to be at a higher risk for peripheral arterial disease, compared to those without periodontal diseases or tooth loss. Evidence suggests that periodontitis contributes to the overall burden of infection and inflammation and may lead to cardiovascular events and stroke in susceptible patients. In this article, we aimed to review the available data on the relationship between periodontal diseases and cardiovascular diseases, especially coronary artery disease. At least sixty papers were reviewed during 2014-15. Of these, 44 were included in our study

Complete Congenital Heart Block in a Neonatal Lupus Erythematosus Associated with Pulmonary Involvement without Pacemaker Implantation: A Case Report

Background: Neonatal lupus erythematosus is an uncommon disease. Congenital complete heart block (CCHB) usually happens in neonates with maternal systemic lupus erythematosus. The most prevalent presentation of CCHBis bradycardiathatcanbediagnosed through an electrocardiogram. Case report: Here in, we present the case of a full-term male neonate with gestational age of 37 weeks and birth weight of 2200 g, whose mother had positive anti-Ro/SSA antibodies. The mother was asymptomatic without any criteria of systemic lupus erythematosus. The newborn presented with bradycardia, respiratory distressand narrow QRS complex without structural heart disease. He was connected to mechanical ventilator and did not need pacemaker implantation. Conclusion: This case report was conducted on a newborn with CCHB associated with pulmonary disorder. The newborn was intubated due to respiratory distress and did not need pacemaker implantation; however, after 8-month follow up, excellent outcomes were observed. It seems that atelectasis and mechanical ventilation can intolerance, and pacemaker implantation did not need in NLE with CCHB with narrowing QRS complex