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

Predicting number of traumas using the seasonal time series model

Background: Road accidents and casualties resulted are among the current challenges of human societies, which have imposed a high cost on the economies of countries. Objectives: Prediction of accidents caused by driving incidents helps planners achieve a suitable model to reduce the occurrence of traumas resulted from the driving accidents. Materials and Methods: In this study, a seasonal time series model was used for predicting the number of road accident traumas. Data related to the patients referring to Imam Khomeini Hospital in Ilam Province were evaluated from March 2012 to June 2017. Results: The results showed that during November and October in 2015 and 2016, we had the highest number of accidents due to high traffic during New Year's Vacation, summer trips, and religious pilgrimages including the Arbaeen. Moreover, the results depicted that the seasonal Arima model was effective in predicting the number of traumas due to accidents. Furthermore, forecasting the model showed an ascending trend in the number of accidents in the following 3 years. Conclusion: The number of accident traumas in the forthcoming months can be predicted through time series models. Of course, these models can be used by managers as appropriate tools for traffic analysis. Furthermore, the increasing trend in the number of traumas indicates that serious consideration for planning and managing such events seems necessary for the administrators in the near future

Prevalence of Celiac in Children and Adolescents with Seizure Referring to Amir Hospital in Zabol during 2016

Introduction: Celiac is an autoimmune disease that in addition to gastrointestinal complications has extra-intestinal complications such as neurological manifestations including seizure, encephalopathy, and ataxia.  This study was conducted to determine the prevalence of celiac in children with seizure.   Materials & Methods: This descriptive cross-sectional study was performed on 100 children with seizure during 1395. Blood samples were taken from all patients to assay IgA tissue transglutaminase (IgA anti tTG). Then, all patients with elevated levels of TTgIGA were subjected to endoscopy and biopsy to confirm the diagnosis of celiac. The results were analyzed using the SPSS 21 software package and frequency distribution. Findings: In this study, 100 children and adolescents aged 2 to 18 years with seizure were studied. The average age of these patients was 16.1±1.12 years. 54% of patients had generalized tonic-clonic seizures and 46% had paroxysmal seizures. Three people with generalized tonic-clonic seizures and 2 subjects with parasitic seizures tested IgA tTg-positive. The prevalence of celiac disease among patients with seizure was 5%.   Discussion & Conclusions: Due to accompaniment of celiac with neurological manifestations, patients with neurological symptoms and gastrointestinal symptoms should be examined for celia

EVALUATION OF LEUKOCYTE ESTERASE REAGENT STRIPS TEST IN THE DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS IN CHILDREN WITH CIRRHOSIS

BackgroundSpontaneous bacterial peritonitis is defined as an ascetic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate; therefore, early diagnosis and treatment of spontaneous bacterial peritonitis is necessary for survival. Leukocyte esterase reagent can rapidly diagnose the spontaneous bacterial peritonitis.ObjectiveThis study aimed to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis.MethodsA single centered hospital-based cross-sectional study was conducted during July 2013 to August 2014 on children with cirrhotic liver disease and ascites who were admitted in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated to Shiraz University of Medical Sciences (Iran). All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, leukocyte esterase reagent strip test (Combiscreen SL10) and culture. Spontaneous bacterial peritonitis was defined as having a polymorphonuclear count (PMN ≥250/m3) in ascitic fluid. Sensitivity, specificity, positive predictive value and negative predictive value of leukocyte esterase test were calculated according to the formula.ResultsTotally, 150 ascitic fluid sample of cirrhotic male patients (53.2%) and their mean age (4.33±1.88 years) were analyzed. Biliary atresia (n=44, 29.4%) and idiopathic neonatal hepatitis (n=29, 19.3%) were the most frequent etiology of cirrhosis. Also, abdominal pain (68.6%) and distension (64%) were the most common presenting complaint. Of all cases, 41patients (27.35%) were diagnosed to have spontaneous bacterial peritonitis (PMN ≥250/mm3). Sensitivity and specificity of leukocyte esterase reagent test according to PMNs ≥250mm3 were 87.80% and 91.74%, also on ascitic fluid culture results were 88.23% and 77.44%. Positive predictive value and negative predictive value of this test in PMNs ≥250mm3 were 80% and 95.23% and in cases with positive culture 33.33% and 98.09% were obtained, respectively. Efficiency of leukocyte esterase reagent test in diagnosing spontaneous bacterial peritonitis, according to PMNs ≥250mm3 and culture results were 90.66% and 78.66%.ConclusionThe leukocyte esterase strip test may be used as rapid test for diagnosis of spontaneous bacterial peritonitis due to its high diagnostic validity

Hydroxycitric acid ameliorates inflammation and oxidative stress in mouse models of multiple sclerosis

Hydroxycitric acid (HCA) is derived primarily from the Garcinia plant and is widely used for its anti-inflammatory effects. Multiple sclerosis can cause an inflammatory demyelination and axonal damage. In this study, to validate the hypothesis that HCA exhibits therapeutic effects on multiple sclerosis, we established female C57BL/6 mouse models of multiple sclerosis, i.e., experimental autoimmune encephalomyelitis, using Complete Freund′s Adjuvant (CFA) emulsion containing myelin oligodendrocyte glycoprotein (35-55). Treatment with HCA at 2 g/kg/d for 3 weeks obviously improved the symptoms of nerve injury of experimental autoimmune encephalomyelitis mice, decreased serum interleulin-6, tumor necrosis factor alpha, nitric oxide, and malondialdehyde levels, and increased superoxide dismutase and glutathione reductase activities. These findings suggest that HCA exhibits neuroprotective effects on multiple sclerosis-caused nerve injury through ameliorating inflammation and oxidative stress

EVALUATION OF LEUKOCYTE ESTERASE REAGENT STRIPS TEST IN THE DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS IN CHILDREN WITH CIRRHOSIS

BACKGROUND: Spontaneous bacterial peritonitis is defined as an ascetic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate; therefore, early diagnosis and treatment of spontaneous bacterial peritonitis is necessary for survival. Leukocyte esterase reagent can rapidly diagnose the spontaneous bacterial peritonitis. OBJECTIVE: This study aimed to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis. METHODS: A single centered hospital-based cross-sectional study was conducted during July 2013 to August 2014 on children with cirrhotic liver disease and ascites who were admitted in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated to Shiraz University of Medical Sciences (Iran). All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, leukocyte esterase reagent strip test (Combiscreen SL10) and culture. Spontaneous bacterial peritonitis was defined as having a polymorphonuclear count (PMN >/=250/m3) in ascitic fluid. Sensitivity, specificity, positive predictive value and negative predictive value of leukocyte esterase test were calculated according to the formula. RESULTS: Totally, 150 ascitic fluid sample of cirrhotic male patients (53.2) and their mean age (4.33+/-1.88 years) were analyzed. Biliary atresia (n=44, 29.4) and idiopathic neonatal hepatitis (n=29, 19.3) were the most frequent etiology of cirrhosis. Also, abdominal pain (68.6) and distension (64) were the most common presenting complaint. Of all cases, 41 patients (27.35) were diagnosed to have spontaneous bacterial peritonitis (PMN >/=250/mm3). Sensitivity and specificity of leukocyte esterase reagent test according to PMNs >/=250 mm3 were 87.80 and 91.74, also on ascitic fluid culture results were 88.23 and 77.44. Positive predictive value and negative predictive value of this test in PMNs >/=250 mm3 were 80 and 95.23 and in cases with positive culture 33.33 and 98.09 were obtained, respectively. Efficiency of leukocyte esterase reagent test in diagnosing spontaneous bacterial peritonitis, according to PMNs >/=250 mm3 and culture results were 90.66 and 78.66. CONCLUSION: The leukocyte esterase strip test may be used as rapid test for diagnosis of spontaneous bacterial peritonitis due to its high diagnostic validity