Seizure Induced by Defecation in a 15-Year Old Autistic Patient: A Case Report and Literature Review

AbstractEpilepsy in autism is a relatively common phenomenon. However, reflex seizures provoked by multifactorial stimuli are rare occasions in autistic patients. We reported the first case of defecation induced seizure in a 15 years old girl with autism. The patient had been diagnosed with epilepsy within first year after birth, however, seizures induced by bowel movements were found at the present time in her fifteenth. Reflex seizures showed a tonic pattern that changed to mioclonic represented with one-sided neck deflection. EEG pattern showed abnormal polyspikes and wave during defecation, while the patterns were normal between the attacks. The Patient was responsiveness to adrenocorticotropic hormone therapy with reduced frequency of both reflex and generalized seizures. Although seizure is commonly encountered in autism, reflexed seizures induced by defecation has not been previously reported in this condition

An Investigation on the Incidence and Clinical Importance of Atypical Complications in Children with Acute Hepatitis A Infection

  Introduction: Atypical presentations in hepatitis A virus (HAV) infection are uncommonly encountered; nevertheless, they may lead to serious clinical complications. The present study reported the frequency of atypical presentations among children with acute HAV infection in south-east of Iran. Materials and Methods: This prospective (cohort) study was conducted in the gastroenterology clinic of Amir-Al-Momenin Hospital (Zabol, Sistan and Baluchestan province, Iran). A total of 294 children with positive anti-HAV IgM test were enrolled during 2015-2018. They were prospectively monitored for the incidence of any atypical presentation. Results: Out of 294 children, 152 (51.7%) were males, and the mean age was 7.3±3.5. Nausea and vomiting (41.8%) constituted the most frequent clinical presentations. Overall, atypical presentations were observed in 38 (12.8%). The atypical presentations included autoimmune hepatitis (AIH) (15, 5.1%), pancytopenia (11, 3.7%), non-immune hemolytic anemia (5, 1.7%), Wilson disease (3, 1%), prolonged cholestasis (3, 1%), and gallbladder hydrops (1, 0.3%). The mean level of alanine aminotransferase at diagnosis was significantly lower in patients with atypical presentations compared with those without such complications (801.28±986.61 vs. 1119.09±1109.98 IU/l, P=0.01). Patients with atypical manifestations also had significantly lower levels of total bilirubin (3.77±2.88 vs. 5.57±5.28 mg/dl, P=0.03) and direct bilirubin (2.03±2.06 vs. 2.91±3.20 mg/dl, P=0.04). Conclusion: Atypical manifestations are relatively common among children with acute HAV infection and should be routinely screened. With timely and appropriate interventions, clinical outcomes may not be significantly different from patients with typical presentation.     &nbsp

The Role of Immune System in Thalassemia Major: A Narrative Review

Abstract Context: Thalassemia is a genetic disorder of hemoglobin production. Patients with thalassemia major (TM) require regular blood transfusions to keep a compatible hemoglobin level for oxygenating organs. These patients suffer from different complications such as infections, autoimmunity and alloimmunization due to transfusion. Such complications link the immune system to TM pathogenesis. In the present study, we have reviewed the latest data available on interactions of TM pathophysiologic determinants and immune system components. Evidence Acquisition: A comprehensive search was performed on PubMed, Scopous, and Web of Knowledge databases using keywords thalassemia, immune system, autoimmune, alloimmune, adaptive immunity, innate immunity, complications, and immunesenescnce. Results: It seems that persistent antigenic stimulation and oxidative stress from excessive iron are the 2 main pathophysiologic factors of TM impacting the immune system. Regarding innate immunity, functional activity of neutrophils, and natural killer cells (NKCs) is decreased in TM. On the other hand, higher levels of TNF-α and IL-1β, IL-6, IL-8, and C-reactive protein proinflammatory cytokines have been observed in the serum of patients. TM patients have demonstrated higher ratios of regulatory B lymphocytes (CD19+, CD38+, CD24+), helper T cells, suppressor T cells, and T regulatory (CD4+/CD25+/Foxp3+) lymphocytes. TM patients have shown significant higher levels of IgA immunoglobin respective to normal counterparts that may predispose them to diabetes and coeliac disease. Immune cells, however, rendered lower than optimal activity in TM patients, which may be due to nutritional insuf- ficiencies. Potential relationships have been suggested between immune system and various thalassemia compilations including heart infraction, hypertension, atherosclerosis, diabetes, thyroid dysfunction, and osteoporosis. Conclusions: Immune genetic determinants may be involved in modulating the clinical picture of TM. TM patients generally represents with higher immune cell counts, likely as a result of persistent antigenic challenge from blood transfusions. However, these patients face compromised immune cell functions. The role of immunologic interactions in pathogenesis of TM needs to be further divulged in future studies

Comparison between Brain Natriuretic Peptide and Calcitonin Gene Related Peptide in Children with Dilated Cardiomyopathy

Background: Dilated cardiomyopathy (DCM) is revealed with the left ventricular dilatation and systolic dysfunction. This study was performed to determine the level of Calcitonin Gene Related Peptide (CGRP) and Brain Natriuretic Peptide (BNP) in children with dilated cardiomyopathy and controls and comparison of these two biomarkers in patients. Materials and Methods: This case-control study was performed from April 2014 to March 2015 on patients with DCM. The levels of BNP and CGRP were measured by ELISA and final amounts of biomarkers were compared with echocardiographic finding.37 DCM patients compared with 30 healthy children selected randomly from those who referred to the hospital for routine checkup. Results: In this study the mean age was 10.567± 5.50 and 12.135 ± 4.626 years for controls and cases, respectively (P=0.321). The majority of echocardiography indices in the left and right heart had different means in case and controls (

Cikličko povraćanje: kasna komplikacija bolesti COVID-19

The novel corona virus disease (COVID-19) has caused a great pandemic since the end of 2019. A variety of symptoms has been identified for this disease. In this case series we report 5 patients in different age groups who presented with cyclic vomiting as a late complication of COVID-19. All patients have gone through complete diagnostic process for cyclic vomiting syndrome (CVS) including endoscopy. However, they all showed normal findings. The diagnosis of cyclic vomiting syndrome was made based on the symptoms and normal endoscopic and laboratory findings. We treated all of the patients applying the guideline we previously published regarding treatment of CVS patients. According to the results of the present study, CVS might be a late complication of COVID-19 infection. So, it is necessary for physicians to consider it as a differential diagnosis in patients with recent COVID-19 infection and to be aware of its management in each phase.Novi koronavirus izazvao je pandemiju bolesti COVID-19 od konca 2019. Identificiran je niz simptoma povezanih s ovom bolesti. U seriji slučajeva izvještavamo o pet bolesnika različitih dobnih skupina u kojih se cikličko povraćanje pojavljuje kao kasna komplikacija COVID-19. Svi pacijenti su obavili kompletan dijagnostički postupak za sindrom cikličkog povraćanja (SCP) uključujući endoskopiju. Međutim, nalazi su bili u granicama normale. Dijagnoza sindroma cikličkog povraćanja postavljena je na temelju simptoma i normalnih endoskopskih i laboratorijskih nalaza. Svi su bolesnici liječeni prema prethodno publiciranim smjernicama za liječenje bolesnika sa SCP-om. Rezultati ovog istraživanja ukazuju da bi se SCP mogao smatrati kasnom komplikacijom infekcije COVID-19. Stoga je potrebno razmotriti ovaj sindrom kao diferencijalnu dijagnozu kod bolesnika koji su nedavno preboljeli infekciju COVID-19 i primijeniti odgovarajuće liječenje u svakoj njegovoj fazi

A case report and literature review of the late presenting congenital diaphragmatic hernia

Late presenting congenital diaphragmatic hernia is a disease associated with defective diaphragm and penetration of different organs into the thoracic cavity. In the present case, a 3-year-old boy was referred to our hospital complaining of acute abdominal pain. No other gastrointestinal symptoms including nausea, vomiting, or constipation were observed. The patient represented no respiratory problems such as dyspnea or respiratory distress syndrome. Radiograph of the thoracic and abdominal cavities showed bowel loops occupying the entire space of the left hemithorax and right-shifted mediastinum. The patient was referred to the pediatric surgery center. The defect was resolved by prompt surgical intervention. A follow-up radiograph within 6 months of surgery showed complete recovery.Keywords: congenital diaphragmatic hernia, pediatric, surger

Opium use and covid-19 infection, a retrospective study in Iran

The situation of Covid-19 patients with opium consumption has not been comprehensively investigated especially in Iran. This study is aimed to investigate the effect of current opium addiction on the severity and outcome of the Covid-19 infection. During a retrospective cohort study, clinical, demographic and all variables related to the severity and death due to the Corona virus infection were collected from the medical records of patients hospitalized from February 2020 to June 2021 in the study area. The role of current addiction in the severity and outcome of the disease was investigated using Cox, logistic and linear regression models. Of 939 confirmed Covid-19 cases admitted during the study period, 70 (7.5%) patients were currently addicted. Multivariate regression models showed that current opium addiction significantly increased the chance of endotracheal intubation (OR=2.96, p=0.005) and reduced the mean length of stay in hospital (beta coefficient =-0.42, p<0.0001). However, opium addiction did not change the risk of death (HR= 1.54, p=0.063) or O2 saturation (OR=1, p>0.99). Opium addiction can be associated with the severity of Covid-19 infection, but does not play a considerable role in the mortality of the patients

Evaluation of Liver Enzymes in Normal Pregnancies in a University Hospital of Zabol Iran: A Cross-Sectional Study

Objective: Changes in endocrine, nervous, renal, cardiovascular, and respiratory systems during pregnancy have been studied, but changes in liver function have been poorly studied. Therefore, the purpose of this study was to investigate the trend of changes in liver enzymes in normal pregnancy. Materials and methods: This prospective longitudinal study included 68 pregnant women who were referred to the Obstetrics and Gynecology Clinic of Amiral Momenin Hospital in Zabol in 2021. In terms of the trimester of pregnancy, the presence of underlying diseases, history of previous pregnancies, disorders of the enzymes of recent patients, the patients were evaluated, and the information from the patients' files was analyzed. Results: The average AST levels in pregnant women in the first, second, and third trimesters were 16.82, 17.47, and 18.00, respectively, which show that garlic consumption is increasing. The average PT in pregnant women decreased in the first, second, and third trimesters. The average direct and total bilirubin levels in pregnant women in the first and second trimesters showed a constant trend. The amount of total protein increased in pregnant women during the first, second, and third trimesters. In the second and third trimesters, the enzyme level was significantly higher in pregnant women than in nonpregnant women. The level of GGT in pregnant women in the first, second, and third trimesters showed a different trend. Conclusion: Accurate evaluation of patients, especially in the third trimester, is necessary from the point of view of increasing enzyme levels in other countries.

Kliničko značenje povišene razine olova u krvi u ovisnika o opijumu s jakom boli u području abdomena

There are inconsistencies regarding the association of blood lead level (BLL) in opium addicts with severe abdominal pain. In present study, we aimed to assess BLL in opium addicts presented with severe abdominal pain. This cross-sectional study was conducted on 60 opium-addicted individuals admitted to our rehabilitation center in Zabol city during February-October 2016. BLL was measured using potentiometric-stripping analysis (PSA) method. Statistical analysis was conducted in SPSS 20 software. From 60 addicts re-cruited, 47 (78.3%) were males. The mean age was 40.3±18.1 years old. The mean BLL was 43.1±117.4 µg/ dl. Considering a threshold of 18 µg/dl, 22 (37.6%) of the addicts had elevated BLL. The mean BLL in addicts with oral, inhalation and mixed method of consumptions were 54.9±1.5 µg/dl, 47.4±9.2 µg/dl, and 10.1±95 µg/dl respectively (P=0.5). No differences were found regarding the mean BLL among different age groups or between different genders. Furthermore, there were no significant difference in neither hematological pa-rameters or liver enzyme in addicts with normal and elevated BLL. The BLL was not of significant difference in addicts with different methods of opium usage and severe abdominal pain. It is recommended to investigate the effects of factors such as the duration of opium usage and the concentration of lead in opium to influ-ence BLL.Postoje nedosljednosti u vezi povezanosti razine olova u krvi (OUK) u ovisnika o opijumu s jakim bolovima na području abdomena. U ovome radu nam je bio cilj odrediti OUK u ovisnika o opijumu s jakim bolovima u trbuhu. Provedeno je presječno instraživanje na 60 ovisnika o opijumu primljenih u naš rehabilit-acijski centar u gradu Zabol od veljače do listopada 2016. OUK je mjereno metodom potenciometrijske strip-ing analize. Statističke analize su učinjene programom SPSS 20. Od ispitanih 60 ovisnika, 47 (78,3 %) su bili muškarci. Srednja dob je bila 40.3 ± 18.1 godina. Srednja vrijednost OUK je bila 43.1 ± 117.4 μg/DL. S obzirom na prag od 18 μg/DL, 22 (37,6 %) ovisnika imalo je povišeno OUK. Srednje vrijednosti OUK u ovisnika koji su sredstvo konzumirali peroralno, inhalacijski i mješano su iznosile 54.9 ± 1,5 μg/DL, 47.4 ± 9,2 μg/DL i 10.1 ± 95 μg/DL (P = 0,5). Nisu pronađene značajne razlike srednje vrijednosti OUK među različitim dobnim skupinama ili između spolova. Nadalje, nije bilo značajne razlike ni u hematološkim parametrima ili jetrenim enzimima u ovisnika s normalnim i povišenim OUK. OUK se nije značajno razlikovalo u ovisnika s različitim načinima konzu-miranja droge i jakim bolovima u trbuhu. Preporuča se istražiti kako čimbenici kao što su trajanje konzumacije opijuma i koncentracija olova u opijum utječu na razinu OUK

Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center’s Experience

Background: Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP.Methods: This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the t test, Fisher’s exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant.Results: The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by Escherichia coli (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures.Conclusion: Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region’s bacterial resistance features