A Study on Causes and Types of Abnormal Increase in Infants’ Head Circumference in Kashan/Iran

How to Cite This Article: Talebian A, Soltani B, Moravveji AR, Salamati L, Davami M. A Study on Causes and Types of Abnormal Increase in infants’ Head Circumference in Kashan/Iran. Iran J Child Neurol. 2013 Summer; 7(3): 28- 33. ObjectiveHead circumference is a valuable index of brain growth and its disturbances can indicate different disorders of nervous system. Abnormal increased head circumference (macrocephaly) is common and observed in about 2% of infants. In this study, the causes and clinical types of abnormal increase in infants’ head circumference were investigated in Kashan, Iran.Materials & MethodsThis cross-sectional study was performed on 90 infants less than 2 years of age with abnormal increase in head circumference in Kashan, during 2009- 2011. The data were collected by history taking, physical examination, growth chart, and imaging.Results65 (72%) cases out of 90 infants were male and 25 ( 28%) cases were female. Fifty-three (58.8%) cases had familial megalencephaly, 30 (33.4%) had hydrocephalus, and other causes were observed in 7 (7.8%) cases. Eighty-three percent of Infants with familial megalencephaly and 50% with hydrocephalus had normal fontanels. In 90.6% of cases withfamilial megalencephaly, family history for large head was positive. Motor development was normal in 100% of cases with familial megalencephaly and 76.7% of hydrocephalic infants.Conclusion Familial megalencephaly was the most common cause of macrocephaly in the studied infants, and most of them had normal physical examination and development, so, parental head circumferences should be considered in the interpretation of infant’s head circumference and in cases of abnormal physical examination or development, other diagnostic modalities, including brain imaging should be done. References1. Lunde A, Melve KK, Gjessing HK, Skjaerven R, Irgens LM. 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Nelson textbook of pediatrics. 19th ed. Philadelphia, PA: Elsevier/Saunders, Philadelphia; 2011. p. 2008-11.6. Nard, JA. Abnormal head size and shape. In: Gartner JC,Zitelli BJ, editors. Common and Chronic Symptoms in Pediatrics. St. Louis: Mosby; 1997.7. Menkes JH, Sarnat HB, Flores-Sarnat L. Malformations of the central nervous system. In: Menkes JH, Sarnat HB, Maria BL, editors. Child Neurology. 7th ed. Philadelphia:  Lippincott Williams & Wilkins; 2006. p. 284.8. Williams CA, Dagli A, Battaglia A. Genetic disorders associated with macrocephaly. Am J Med Genet A 2008;146A(15):2023-37.9. Varma R, Williams SD, Wessel HB. Neurology. In: Zitelli BJ, Davis HW, edtors. Atlas of Pediatric Physical Diagnosis. 5th ed. Philadelphia: Mosby Elsevier; 2007. p. 563.10. Rekate HL. Hydrocephalus in children. In: Winn HR, Youmans JR, editors. Youmans Neurological Surgery. 5th ed. St Louis: Saunders. 2003. 3387-404.11. Gupta SN, Belay B. Intracranial incidental findings on brain MR images in a pediatric neurology practice: a retrospective study. J Neurol Sci 2008;264(1-2):34-7.12. Alper G, Ekinci G, Yilmaz Y, Arikan C, Telyar G, Erzen C. Magnetic resonance imaging characteristics of benign macrocephaly in children. J Child Neurol 1999;14(10):678-82.13. Smith R, Leonidas JC, Maytal J. The value of head ultrasound in infants with macrocephaly. Pediatr Radiol 1998;28(3):143-6.14. Day RE, Schutt WH. Normal children with large heads benign familial megalencephaly. Arch Dis Child 1979;54(7):512-7.15. Kumar R. External hydrocephalus in small children. Childs Nerv Syst 2006;22(10):1237-41.16. Rollins JD, Collins JS, Holden KR. United states head circumference growth reference charts: birth to 21 years. J Pediatr 2010;156(6):907-13.17. Medina LS, Frawley K, Zurakowski D, Buttros D, DeGrauw AJ, Crone KR. Children with macrocrania: Clinical and imaging predictors of disorders requiring surgery. 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Acute Myocardial Infarction Due to Dissection of the Coronary Arteries Associated with Premature Atherosclerosis in Late Postpartum: A Case Report of Maternal Death

AbstractIntroduction: Atherosclerotic coronary artery disease is the most common form of heart disease that is associated with high rates of acute myocardial infarction (AMI) and death in young people.Methods: Given the importance of pregnancy and the postpartum period and the fact that AMI is associated with poor maternal outcomes in postpartum, the present study reports acute myocardial infarction due to dissection of the coronary arteries associated with premature atherosclerosis in late postpartum.Results: The case was the maternal death of a 34-year-old woman at 42 days postpartum without any history of underlying diseases or symptoms, whose autopsy report read AMI due to coronary artery dissection associated with atherosclerosis.Conclusions: This report emphasizes the importance of postpartum care and attention to any symptoms witnessed during this period

Effects of Atomoxetine for Cognitive Function in Methamphetamine-dependent Patients: A Randomized Controlled Trial

Background: A substantial body of evidence indicates that methamphetamine abuse can lead to persistent and severe cognitive dysfunction. Preclinical studies and early pilot clinical investigations suggested that atomoxetine, a cognitive enhancer, may improve cognitive dysfunction. The present study evaluated whether atomoxetine would affect cognitive dysfunction in methamphetamine-dependent patients.Methods: Participants with methamphetamine dependence (N=86) under Methadone Maintenance Therapy (MMT) were enrolled in a double-blind, placebo-controlled, randomized clinical trial. This investigation was performed on 86 subjects to consume either 40 mg/day atomoxetine (n=45) or placebo (n=41) for 8 weeks. Between January 2016 and June 2017, volunteers were selected from methamphetamine abusers in MMT centers in Kashan City, Iran. They completed the Cognitive Abilities Questionnaire at the first and each monthly visit to assess the cognitive functions. The collected data were analyzed using the Independent Samples t-test, Mann Whitney U test, and Chi-square in SPSS software.Results: This study revealed that atomoxetine treatment improved some cognitive dysfunctions in methamphetamine users, including memory, inhibitory control, selective attention, decision-making, planning, sustained attention, and cognitive flexibility in methamphetamine users (P<0.05); however, social cognition improvement was less than others (P=0.107). There were only mild adverse effects in the placebo and atomoxetine groups.Conclusion: The obtained findings indicated the efficacy of atomoxetine for improving cognitive dysfunction in methamphetamine users and suggest the potential effectiveness of atomoxetine for treating them

Changing in Thyroid Function Test in Children Underwent Antiepileptic Therapy

ObjectiveTo determine the changes in thyroid function tests in children who underwent antiepileptic therapy in Shahid Beheshti Hospital, Kashan, in 2008.Materials & MethodsThis analytical-observational study was carried out in a cohort fashion without an external control group (self controlled) on 45 children with new onset epilepsy who had not been previously treated with antiepileptic medications. Three subjects were excluded from the study because of presenting clinical symptoms of hypothyroidism. Plasma levels of TSH, T3, FT3, T4 and FT4 hormones were measured and compared at baseline and 3 and 6 months after treatment.ResultsThe results of Mann-Whitney statistical analysis suggested that the increase in the plasma level of TSH was significant only in the Sodium Valproate group.The plasma level of T3 significantly decreased 3 and 6 months after treatment in the Phenobarbital group while the plasma level of FT3 significantly decreased only in the Sodium Valproate group. The decrease in T4 plasma level was significant in all groups (Carbamazepine group, Sodium Valproate group and Phenobarbital group) 3 and 6 months after the onset of treatment but the decreasing in FT4 plasma level was only significant in the Carbamazepine group 6 months after the commencement of treatment.ConclusionPhenobarbital had the least effect on thyroid hormones. Considering the effect of such medications on thyroid function tests, it seems necessary to check the plasma levels of hormones periodically after beginning the treatment

Mental Health of Young Couples Referred to Premarriage Consulting Center of Kashan

Background and Objective: Marriage is base of family creation and human race reproduction. Evaluation mental health of couples; diagnosis and treatment of mental disorder are essential and should be considered before marriage. The aim of this study was to investigate the mental health in young couple referred to consulting center before marriage.Materials and Methods: This cross-sectional study was carried out on 194 young couples. The data collection instruments included the Goldberg's General Health Questionnaire (which has 4 subunits depression, anxiety, somatic symptoms and function) and a questionnaire form consist of personal information and factors associated with mental health. Data were analyzed using, Chi-Square or Fisher exact test and t- tests.Results: The mean (SD) total GHQ score was 22.3 (8.8) in females and 18.7 (8.5) in men (P=0.004). 29.9 % men and 37% women had mental health problem. The mean (SD) total GHQ score was 21.9 (9.1) in the age group 21 to 25 which was higher than the other age groups, and in those with a higher diploma degree was 23.3 (11.7) which was higher than the other educational groups (P= 0.005).Conclusion: Young couples with age 21-25 years old, females and couples with high educational levels had lower mental health than other groups. Therefore, early screening and diagnosis of these problems can prevent impact of these disorders on job performance and social and interpersonal relationship.</p

Status of ocular trauma in hospitalized patients in Kashan, 2011: As a sample of industrial city

Purpose: Ocular trauma is the third leading cause of hospitalization in ophthalmology patients, imposing direct and indirect physical and psychological costs on society. This study aims to investigate the status of ocular trauma in hospitalized patients in the industrialized city of Kashan in 2011. Methods: This cross-sectional descriptive applied study was conducted in 2012 on patients hospitalized for ocular trauma. Data, including age, gender, occupation, education, timing of admission following accident, location of accident, type of injury, damaging instrument, and type of trauma, were collected using a questionnaire designed by a trained nurse, and analyzed using SPSS-16 software by means of means ± standard deviation, frequency, and percentage for descriptive data and t-test, one-way analysis of variance, Chi-square and Fisher exact test for analysis at significance level of p < 0.05. Results: In total, 82 patients were hospitalized due to ocular traumas. The majority of patients were male (65 patients, 79.3%). Their mean age was (25.4 ± 21.4) years, with an age range of 20–40 years (30 patients, 36.6%). Hyphema was the most common injury (26 patients, 25.5%), home was the most frequent incident location (32 patients, 39%), and knife or other cutting tools were mostly responsible for injuries (18 patients, 21.9%). Patients were hospitalized for 1–6 days, and the average length of stay in hospital was 2.63 days. Frequency distribution of injuries based on whether or not ruptures differed significantly among different age groups. Conclusion: The majority of ocular trauma occurred in young males. Knife was the principle culprit for eye injuries, followed by vehicles. To reduce such incidents, it is recommended that people be trained to avoid high-risk behaviors when using knives and to better heed driving rules and regulations

Association of Interferon-alpha and bone density in patients with hepatitis C

Background: Chronic hepatitis is a variety of liver dysfunctions with different causes and severities in which inflammation and necrosis last for at least six months. Choice treatment for all chronic viral hepatitis is interferon Alpha (IFN-&alpha;). Decreasing bone mass density (BMD) may lead to some complications such as non-traumatic spontaneous fractures. Regarding the decreased bone mass complications and existed dilemma, we conducted the current study to compare the BMD in chronic hepatitis patients before and after the IFN-&alpha; treatment. Material and Methods: In a cohort study a total of 22 patients with chronic C- hepatitis needed to be treated with IFN-&alpha; were evaluated. All the patients underwent bone mineral densitometry at lumbar spine and femoral neck before and six months after the IFN-&alpha; treatment. The BMD result was recorded in information sheet. After the treatment, patients were evaluated again by BMD. All the necessary information such as age, sex, co-morbidity and another medication history were asked and recorded. IFN-&alpha; dosage was three million IU three times a week. The gathered data were entered SPSS version 14 and analyzed through Chi-Square and Wilcoxon tests to compare the means. Results: Among 22 patients 21 (95.5%) were male. Mean age was 34.04&plusmn;7.83 years and half of the patients were in 30 to 35 years age group. The participants had not significant difference in bone mass density indices (Z-score and T-score) before and after treatment with IFN-&alpha; (P-value>0.05). The bone mass density indices had not significant difference between different age groups of hepatitis C patients before and after treatment with IFN-&alpha; (P-value>0.05). Conclusion: In the current study IFN-&alpha; used in the treatment of patients with hepatitis C, had no significant effect on both femoral neck and lumbar spine BMD in them. To evaluate the long term effects of IFN-&alpha; it is suggested to do more studies with longer duration, however, the BMD may improve when the inflammation been alleviated long term

Prevalence and Risk Factors associated with Extended Spectrum Beta Lactamase Producing Escherichia coli and Klebsiella pneumoniae Isolates in Hospitalized Patients in Kashan (Iran)

Introduction: Production of extended spectrum beta lactamase (ESBL) is an important mechanism of antimicrobial resistance in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates. This study was performed to determine the prevalence and risk factors associated with ESBL producing strains of E. coli and K. pneumoniae. Methods: In this cross-sectional study, 250 strains (134 E. coli and 116 K. pneumoniae) were obtained, and ESBL producing isolates were detected by the combination disk test in Shahid Beheshti Hospital in Kashan, Iran, from February 2012 to June 2013. Antimicrobial resistance was screened by the disk diffusion method and was confirmed by E-test. Furthermore, risk factors of ESBL producing E. coli and K. pneumoniae microorganisms were determined. Data were analyzed by SPSS version 16, using descriptive statistics, chi-squared, independent- samples t-test, and logistic regression analysis. Results: One hundred and two (40.8%) of all strains were ESBL producers, of which 54 (52.9%) were E. coli and 48 (47.1%) were K. pneumoniae (p = 0.86). Furthermore, 40.3% of E. coli and 41.4% of K. pneumoniae isolates were ESBL producers (p = 0.86). The most antimicrobial resistance was to ampicillin, and no imipenem resistance was detected. Risk factors for ESBL producing E. coli included admission duration exceeding 7 days (p = 0.011) and antibiotic use in the last month (p < 0.001), and the associated risk factor for ESBL producing K. pneumoniae was antibiotic use during the recent month (p = 0.002). Conclusion: This study identified a relatively high prevalence of ESBL production among E. coli and K. pneumoniae strains. Furthermore, anti-bimicrobial use and admission duration were risk factors for ESBL producing isolates. Therefore, more comprehensive investigations are needed for the development of new strategies to control the dissemination of these microbes

Determine relation between serum levels of interleukin-6 and CRP with pulmonary involvement in progressive systemic sclerosis

Background: Systemic sclerosis (SSc) is a connective tissue disorder characterized by excessive collagen deposition in skin and internal organs. Interstitial lung disease (ILD) is a late demonstration of SSc and cytokines can contribute to the disease pathology. This study aimed to determine relation between serum levels of interleukin-6 and CRP with pulmonary involvement in SSc. Materials and Methods: After obtaining consent, demographic data and serum levels of interleukin-6 were determined in 30 SSc with (case) and 30 without pulmonary involvement (control). Duration and activity status of disease, C-reactive protein (CRP), Chest x-ray and high resolution CT-scan (HRCT), ejection fraction (EF) and echocardiography findings and pulmonary artery pressure (PAP) were determined in two groups. Data analyzed with Mann-Whitney test, Chi-square test and Fisher’s exact test. Results: Mean age of case and control group ranged 52.5±9.3 and 43.9±9.7 years respectively (P=0.001). The serum levels of IL-6 in case and control groups were 73.1±95.4 and 46.7±83.6 pg/ml (P=0.267), respectively. IL-6 levels was significantly higher in male case compared to male control (P=0.007). Duration of SSc in case and control groups was 11.6±6.4 and 7.4±4.2 years (P=0.002). Also Quantitative CRP and PAP was significantly higher in case (P=0.01 and P<0.001, respectively). In the Case group 66.7% of them had reticulo-nodular pattern, whereas 28 (93.3%) of control had normal CXR (P<0.001). Conclusion: In SSc with pulmonary involvement serum, IL-6 levels is higher than without involvement but not statistically significant. Also, the CRP and PAP are benefit for evaluation of pulmonary involvement

Evaluation of Educational Departments of Kashan Shahid Beheshti Teaching Hospital

Introduction: Medical education quality improvement is a major issue in Iran’s medical education system. One of the strategies for medical education quality improvement is evaluation of the status quo and identification of the weaknesses. The purpose of the present study was to evaluate educational departments of Kashan Shahid Beheshti Teaching Hospital according to clinical education standards in line with the education reform plan and accreditation package. Methods: This cross-sectional study was performed on 210 stagers and interns of Shahid Beheshti Teaching Hospital of Kashan University of Medical Sciences in 2016. Subjects were selected by means of census method and data collection tool was a researcher-made questionnaire. The viewpoints of stagers and interns about the conformity of educational programs (round, grand round and morning report) with clinical education standards in departments of pediatrics, internal medicine, general surgery, cardiology, infectious diseases, neurology and specific surgery were assessed. Results: The highest rate of desirability of round from the viewpoints of stagers was related to infectious diseases (77.3%) and cardiology (66.7%) departments and from the viewpoints of interns was related to infectious diseases (60%) and neurology (40%) departments. The highest rate of desirability of grand round from the viewpoints of both stagers and interns was related to infectious diseases department (86.7% and 80% respectively). The highest rate of desirability of morning report from the viewpoints of both stagers and interns was related to the infectious diseases department (46.7% and 80% respectively). Conclusion: Given the moderately desirable status of educational programs in most of the departments, faculty members should get familiarized with new trends in medical education and clinical education standards through holding clinical education workshops and be encouraged to follow these standards. Moreover, departments should make efforts to eliminate weaknesses and achieve the desirable status