Frequency of Genotype With ΔF508 Mutation in CFTR Gene Among Iranian Cystic Fibrosis Patients With Pancreatic Insufficiency

Background:

Cystic fibrosis (CF) is the most prevalent lethal autosomal recessive disease with a broad spectrum of phenotypes. Mutation of ΔF508 in the CFTR gene is the most important and lethal mutation in CF, which contains 70% of all predisposing mutations for CF worldwide.

Objectives:

Determining frequency of genotypes with ΔF508 mutation in CFTR gene, and evaluation of correlation between genotype and phenotype of Iranian patients with CF.

Patients and Methods:

Thirty six patients were included in this cross sectional study. ΔF508 mutations in both alleles of the CFTR gene were checked.

Results:

Among 36 pediatric patients, ΔF508 mutation was detected in 9 (25%) patients; 2 patients were heterozygous, and 7 patients homozygous for this mutation. From overall 72 tracked alleles, 11 (15.2%) were found to have ΔF508 mutations. Differences in prevalence of dyspnea and bronchiectasis were significant in homozygote group, compared with non-mutated group for ΔF508.

Conclusions:

It seems that more ΔF508 mutated alleles lead to more severe symptoms of CF.     

Is There Any Association between Spina bifida occulta and Primary Vesicoureteral Reflux?

Objective

Spina bifida occulta (SBO) has been largely considered a benign entity without clinical significance; however, there has been dispute among various authorities, and some believe that the lesion may be linked with various neurologic conditions like urologic dysfunctions. Vesicoureteral reflux (VUR) and lower urinary tract dysfunction are closely related. We examined whether the existence of SBO is related to the prevalence and severity of VUR in children.

Methods

We investigated 359 children, 2–14 years old, referred to radiology department for obtaining voiding cystourethrogram after the first attack of febrile urinary tract infection. After treatment of infection, with written order of responsible physicians all underwent a standard voiding cystourethrogram to detect VUR and other lower urinary tract anomalies. The patients were divided into two groups: group1 patients who had not SBO and group 2 patients with SBO in postvoiding or KUB films. In each group the presence and severity of VUR was determined in relation to the location of SBO.

Findings

Out of 359 children, 228 (63.5%) had normal spine and 131 (36.5%) had SBO. Fifty four (23.7%) out of 228 children with normal spine had VUR and 40 (30.5%) out of 131 children with SBO had VUR. The prevalence of VUR in children without SBO and children with SBO was not statistically different. Also we compared the severity of VUR between the two groups and there was no significant difference or trend between presence of SBO and severity of reflux (Chi² for trend). VUR was more common in children with SBO in L5-S1 (38.3%). There was no significant relation between location of SBO and prevalence of VUR.

Conclusion

Location of SBO and prevalence of VUR are not related.     

Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule

Aims

To test the reproducibility of a highly sensitive clinical decision rule proposed to predict vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children. This rule combines clinical (family history of uropathology, male gender, young age), biological (raised C reactive protein), and radiological (urinary tract dilation on renal ultrasound) predictors in a score, and provides 100% sensitivity.

Methods

A retrospective hospital based cohort study included all children, 1 month to 4 years old, with a first febrile urinary tract infection. The sensitivities and specificities of the rule at the two previously proposed score thresholds (⩽0 and ⩽5) to predict respectively, all‐grade or grade ⩾3 VUR, were calculated.

Results

A total of 149 children were included. VUR prevalence was 25%. The rule yielded 100% sensitivity and 3% specificity for all‐grade VUR, and 93% sensitivity and 13% specificity for grade ⩾3 VUR. Some methodological weaknesses explain this lack of reproducibility.

Conclusions

The reproducibility of the previously proposed decision rule was poor and its potential contribution to clinical management of children with febrile urinary tract infection seems to be modest.     

Agreement of Mixed Venous Carbon Dioxide Tension (PvCO2) and Transcutaneous Carbon Dioxide (PtCO2) Measurements in Ventilated Infants

Background:

Noninvasive transcutaneous carbon dioxide monitoring has been shown to be accurate in infants and children, limited data are available to show the usefulness and limitations of partial transcutaneous carbon dioxide tension (PtCO₂) value.

Objectives:

The current study prospectively determines the effectiveness and accuracy of PtCO₂ measurements in newborns.

Materials and Methods:

Venous blood gas sampling and monitoring of the PtCO₂ level (TCM TOSCA, Radiometer) were done simultaneously. All measurements are performed on mechanically ventilated infants. Partial venous carbon dioxide tension (PvCO₂) values divided into three groups according to hypocapnia (Group 1: < 4.68 kPa), normocapnia (Group 2: 4.68–7.33 kPa), hypercapnia (Group 3: > 7.33 kPa) and then PvCO₂ and PtCO₂ data within each group were compared separately.

Results:

A total of 168 measurements of each PvCO₂ and PtCO₂ data were compared in three separated groups simultaneously (13 in Group 1, 118 in Group 2, and 37 in Group 3). A bias of more than ± 0.7 kPa was considered unacceptable. PtCO₂ was related to PvCO₂ with acceptable results between the two measurements in hypocapnia (mean difference 0.20 ± 0.19 kPa) and normocapnia (0.002 ± 0.30 kPa) groups. On the other hand in hypercapnia group PtCO₂ values were statistically significant (P < 0.001) and lower than PvCO₂ data (mean difference 0.81 ± 1.19 kPa)

Conclusions:

PtCO₂ measurements have generally good agreement with PvCO₂ in hypocapnic and normocapnic intubated infants but there are some limitations especially with high level of CO₂ tension. Monitoring of PtCO₂ is generally a useful non-invasive indicator of PvCO₂ in hypocapnic and normocapnic infants.     

Significance of Postnatal Follow-up of Infants with Vesicoureteral Reflux Having Antenatal Hydronephrosis

Objective

To evaluate the frequency of urinary tract infections (UTIs) and degree of renal parenchymal damage as well as the parameters of growth, development and nutritional status in antenatal hydronephrosis cases with vesicoureteral reflux (VUR).

Methods

Infants, whose antenatal ultrasonography (US) showed a fetal renal pelvic diameter of 5 mm or greater were investigated. Of the 277 infants with antenatal HN, 36 [56 renal units (RUs)] were diagnosed with VUR. All cases with VUR were evaluated in terms of the frequency of UTIs, scars appearing on ^99mTechnetium-dimercaptosuccinic acid scan (DMSA), growth and development [height and weight standard deviation scores (HSDS and WSDS)], and nutritional status [relative weight (RW)]. Statistical evaluation was performed using the Chi-squared test.

Findings

Of these 36 patients with VUR, 25 (69.4%) were males and 11 (30.6%) females. Of the 56 RUs, 48 (85.7%) had severe VUR (≥ Grade III). The mean duration of postnatal follow-up was 37.8±24.50 months. The annual UTI frequency was found to be 1.25±0.83 episodes/year. Of these 36 infants, 32 (88.8%) recovered from VUR following either medical (17 patients, 47.2%) or surgical (15 patients, 41.6%) treatment. The initial DMSA showed parenchymal defects in 16 (44.4%) RUs, and 4 RUs showed recovery in the final DMSA. Although statistically insignificant (P>0.05), initial growth and development (HSDS: -0.17±0.86; WSDS: 0.00±0.14) and nutritional status (RW: 98.19±8.81) values gradually improved (0.05±1.06, 0.06±1.071 and 101.97±14.85, respectively).

Conclusion

Postnatal early diagnosis and appropriate management of VUR in infants with antenatal hydronephrosis can prevent the occurrence of frequent UTIs, renal scarring and malnutrition, enabling normal growth and development.     

Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children

Background:

Ureteropelvic junction obstruction (UPJO) is one of the most common causes of urinary tract obstruction in children. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography (US), intravenous pyelogram (IVP), diuretic renography (DR), magnetic resonance urography (MRU) and antegrade or retrograde pyelography. Nowadays it is suggested to use diuretic renography as the best method for diagnosing of UPJO. There is no comparative study between IVP and DR scan for diagnosis of UPJO in children.

Objectives:

The aim of the present study was to compare IVP with furosemide injection and diuretic renography in diagnosis of clinically significant UPJO.

Patients and Methods:

This was a cross sectional study performed in 153 UPJO suspected children (121 boys, 32 girls) based on US findings in cases presented with urinary tract infection (UTI), prenatal hydronephrosis, abdominal/flank pain, abdominal mass and hematuria. Renal ultrasound was used as an initial screening tool for detection of urinary tract abnormality. Vesicoureteral reflux (VUR) was ruled out by voiding cystourethrography (VCUG). Serum creatinin, blood urea nitrogen, urinalysis and urine culture was screened in all cases. IVP with furosemide and DR were performed as soon as possible after the mentioned workup.

Results:

During a five year period, 46 out of 153 patients were diagnosed as UPJO based on diuretic renography: the age ranged from 4 months to 13 years (mean: 3.1 ± 0.78 years). There was a significant higher (76%) proportion of UPJO in the boys and in the left side (78%). The sensitivity of IVP with furosemide injection in diagnosis of UPJO was 91.3% whereas DR was accepted as standard for diagnostic procedure in diagnosis of UPJO.

Conclusions:

Although DR is accepted as the best method for diagnosis of UPJO, we found a small sensitivity difference between IVP and DR in kidneys with normal or near normal function. In many settings such as small cities lacking facilities for advanced isotope imaging technology, use of IVP with diuretic maybe an acceptable procedure for diagnosis of UPJO.     

Deflazacort Versus Prednisolone: Randomized Controlled Trial in Treatment of Children With Idiopathic Nephrotic Syndrome

Background:

Corticosteroids are the main therapy of nephrotic syndrome and goal of corticosteroid therapy is to obtain maximum clinical benefit with minimum adverse effects. Children are more vulnerable to side effects of corticosteroids related to growth and adrenal suppression, so a search for an alternative steroid with fewer side-effects is underway. Deflazacort is an oxazoline derivative and preliminary data suggest reduced osteoporosis, lesser growth retardation and weight gain with deflazacort.

Objectives:

This study was done to compare the effectiveness and safety of deflazacort in idiopathic nephrotic syndrome.

Patients and Methods:

Twenty five children with age between 2 to 12 years, with idiopathic nephrotic syndrome were enrolled. They were randomly assigned to receive deflazacort (Group A, n = 12) or prednisolone (Group B, n = 13) and were followed up for six months.

Results:

All children of group A and 11 of group B had remission. Two children from group B were steroid resistant. Mean time taken to induce remission was significantly (P = 0.012) less in group A (10.25 ± 2.41 days) than group B (12.55 ± 1.44 days). One patient in group A had relapse on follow up as compared to 3 in group B (P = 0.58). Statistically significant difference (P = 0.03) in change in mean height was found between group A (2.13 ± 0.50cm) and B (1.44 ± 0.45 cm), with group B gaining less height.

Conclusions:

Remission rate in both groups was comparable although time taken to induce remission was shorter in deflazacort group and there was a significant difference in change of mean height on follow up with prednisolone group gaining lesser height.     

Outcome of Vesicoureteral Reflux in Infants: Impact of Prenatal Diagnosis

Objective

Vesicoureteral reflux (VUR) is an important disorder that could be diagnosed in antenatal or postnatal period. The natural history of VUR seems to be different between prenatal or postnatal forms of the disease. We compared the natural history and outcome of vesicoureteral reflux in infants less than one year old diagnosed prenatally or postnatally.

Methods

All infants less than 12 months old with VUR were enrolled in two groups. Group 1 composed of patients with antenatal hydronephrosis and group2, infants with diagnosis of VUR because of UTI or other postnatal problems. We followed patients for an average of 33 months. Outcome was assessed by several factors: somatic growth, need for surgery, resolution, occurrence of UTI and scar formation.

Findings

We studied 236 renal units in 152 patients (70 boys, 82girls), 67 patients in group 1 and 85 patients in group2. Occurrence of recurrent UTI was 10.6% with no significant difference between two groups. Reflux resolved in postnatal group more significantly than in the other group (73% vs 49%). Scar developed similarly in both groups (15% vs 25% of renal units). Surgery performed in 7 (8.2%) of postnatal and 4 (6%) of prenatal group with no significant differences between the two groups.

Conclusion

VUR diagnosed prenatally has similar importance and outcome as postnatal diagnosed one. We suggest performing the same imaging and treatment procedures for prenatally and postnatally diagnosed VUR.     

Gentamicin in neonates at risk for sepsis – peak serum concentrations are not necessary

BACKGROUND:

Serum gentamicin concentrations (GSCs) are frequently obtained before and after gentamicin administration to newborns with, or at high risk for, sepsis.

OBJECTIVE:

To determine whether performing a peak GSC assay when the trough GSC is within the guidelines for care would add clinically relevant information for health care workers.

METHODS:

A retrospective review of the IWK Health Centre (Halifax, Nova Scotia) laboratory database for peak and trough GSC for infants <28 days after birth was performed.

RESULTS:

Of 5253 paired samples of trough and peak GSCs, 3001 (57%) had trough GSCs ≤2 μg/mL. Of these, only nine (0.3%) had a peak GSC >10 μg/mL.

CONCLUSIONS:

Performing a peak GSC measurement does not provide further clinically important data and increases patient morbidity and hospital costs.     

Efficacy of Preoperative Chemotherapy in Treatment of Children With Wilms’ Tumor: A Meta-Analysis

Context:

To assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups.

Objectives:

In the presence of these controversies, a meta-analysis that examines the efficacy of preoperative chemotherapy in Wilms’ tumor patients and specific subgroups is needed to clarify these issues. The objective of this meta-analysis is to assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups.

Data Sources:

Computer-based systematic search with “preoperative chemotherapy”, “Neoadjuvant Therapy” and “Wilms’ tumor” as search terms till January 2013 was performed.

Study Selection:

No language restrictions were applied. Searches were limited to randomized clinical trials (RCTs) or retrospective studies in human participants under 18 years. A manual examination of references in selected articles was also performed.

Data Extraction:

Relative Risk (RR) and their 95% Confidence Interval (CI) for Tumor Shrinkage (TS), total Tumor Resection (TR), Event-Free Survival (EFS) and details of subgroup analysis were extracted. Meta-analysis was carried out with the help of the software STATA 11.0. Finally, four original Randomized Clinical Trials (RCTs) and 28 retrospective studies with 2375 patients were included.

Results:

For preoperative chemotherapy vs. up-front surgery (PC vs. SU) group, the pooled RR was 9.109 for TS (95% CI: 5.109 - 16.241; P < 0.001), 1.291 for TR (95% CI: 1.124 - 1.483; P < 0.001) and 1.101 for EFS (95% CI: 0.980 - 1.238; P = 0.106). For subgroup short course vs. long course (SC vs. LC), the pooled RR was 1.097 for TS (95% CI: 0.784 - 1.563; P = 0.587), 1.197 for TR (95% CI: 0.960 - 1.493; P = 0.110) and 1.006 for EFS (95% CI: 0.910 - 1.250; P = 0.430).

Conclusions:

Short course preoperative chemotherapy is as effective as long course and preoperative chemotherapy only benefits Wilms’ tumor patients in tumor shrinkage and resection but not event-free survival.     

Unilateral multicystic dysplastic kidney: long term outcomes

Aims

To report the long term follow up of children with antenatally detected unilateral multicystic dysplastic kidney (MCDK) with documentation of complications, involution rate with time, and renal function at 10 years.

Methods

Data were retrieved from a prospective regional registry of patients with MCDK between 1985 and 2004. Children were followed using a common protocol of investigation with follow up ultrasound scans (USS) at 2 (165 patients), 5 (117 patients), and 10 years (43 patients).

Results

Serial USS showed that 33% of the MCDK kidneys had completely involuted at 2 years of age, 47% at 5 years, and 59% at 10 years. No patients developed hypertension, significant proteinuria, or malignancy, but two developed pelviureteric junction obstruction in the contralateral kidney. Twenty seven of 143 children (19%) had vesicoureteric reflux (VUR) (96% mild to moderate VUR) into the contralateral kidney with no difference in the incidence of urinary tract infections or renal scarring between those with or without VUR. The mean estimated glomerular filtration rate (GFR) was 86.4 ml/min/1.73 m² (range 48–125) in 31 of 43 patients followed to 10 years.

Conclusions

Conservative management of unilateral MCDK is justified with clinical review and infrequent USS but longer term follow up continues in the 41% still with renal remnants at 10 years and those with impaired GFR. It is suggested that the initial micturating cystogram is deferred unless abnormal USS features are present in the contralateral kidney or ureter.     

Clinical and Genetic Features in Patients with Cystic Fibrosis in Southwestern Iran

Objective

Cystic fibrosis (CF) is a common autosomal recessive genetic disease caused by a mutation in the CF transmembrane conductance regulatory (CFTR) gene. This study attempted to identify the most common CFTR mutations and any correlations between certain mutations and the clinical presentation of the disease in CF patients in southwestern Iran.

Methods

Twenty nine common CFTR gene mutations were examined in 45 CF patients.

Findings

Chronic cough, intestinal obstruction, dehydration, heat exhaustion and steatorrhea were the most common early clinical symptoms among our patients. The most common mutation was ΔF508, with an allele frequency of 21%. The homozygous ΔF508 mutation was observed in eight patients (18%), and three patients (7%) were ΔF508 carriers. The 2183AA > G mutation was observed in four patients, one of whom was also a ΔF508 carrier. The R1162X mutation was detected in two patients. The G542X, R334W and N1303K mutations were detected each in one patient, the first of whom was also a ΔF508 carrier.

Conclusion

Out of 45 patients, 27 (60%) had none of the CFTR gene mutations we tested for. The most frequent mutations in southwestern Iranian patients with CF should be identified by sequencing the entire CFTR gene in order to optimize the design of a diagnostic kit for common regional mutations.     

Diagnostic Value of Serum Procalcitonin Level in Differentiating Bacterial from Nonbacterial Meningitis in Children

Objective:

Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis.

Methods:

45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients).

Findings:

Serum procalcitonin levels were significantly higher in bacterial meningitis group (637±325 pg/ml) compared with non-bacterial meningitis (380±170 pg/ml); P<0.001. Procalcitonin levels were more sensitive and specific (79%, 81%) than C-reactive protein (76%, 75%) and white blood cell count (72%, 75%) in the diagnosis of bacterial meningitis.

Conclusion:

Elevated serum procalcitonin level could be a predictor of bacterial causes of meningitis and is more sensitive and specific than other diagnostic predictors.     

Polymerase chain reaction detection of Kingella kingae in children with culture-negative septic arthritis in eastern Ontario

BACKGROUND:

The bacterium Kingella kingae may be an under-recognized cause of septic arthritis in Canadian children because it is difficult to grow in culture and best detected using molecular methods.

OBJECTIVES:

To determine whether K kingae is present in culture-negative joint fluid specimens from children in eastern Ontario using polymerase chain reaction (PCR) detection methods.

METHODS:

K kingae PCR testing was performed using residual bacterial culture-negative joint fluid collected from 2010 to 2013 at a children’s hospital in Ottawa, Ontario. The clinical features of children with infections caused by K kingae were compared with those of children with infections caused by the ‘typical’ septic arthritis bacteria, Staphylococcus aureus and Streptococcus pyogenes.

RESULTS:

A total of 50 joint fluid specimens were submitted over the study period. Ten were culture-positive, eight for S aureus and two for S pyogenes. Residual joint fluid was available for 27 of the 40 culture-negative specimens and K kingae was detected using PCR in seven (25.93%) of these samples. Children with K kingae were significantly younger (median age 1.7 versus 11.3 years; P=0.01) and had lower C-reactive protein levels (median 23.8 mg/L versus 117.6. mg/L; P=0.01) than those infected with other bacteria.

CONCLUSIONS:

K kingae was frequently detected using PCR in culture-negative joint fluid specimens from children in eastern Ontario. K kingae PCR testing of culture-negative joint samples in children appears to be warranted.     

Noninvasive Evaluation of Myocardial Systolic Dysfunction in the Early Stage of Kawasaki Disease: A Speckle-Tracking Echocardiography Study

Background:

Evaluation of myocardial function by speckle-tracking echocardiography is a new method for the early diagnosis of systolic dysfunction.

Objectives:

We aimed to determine myocardial speckle-tracking echocardiography indices in Kawasaki Disease (KD) patients and compare them with the same indices in control subjects.

Patients and Methods:

Thirty-two patients (65.5% males) with KD and 19 control subjects with normal echocardiography participated in this study. After their demographic characteristics and clinical findings were recorded, all the participants underwent transthoracic echocardiography. Strain (S), Strain Rate (SR), Time to Peak Strain (TPS), and Strain Rate (TPSR), longitudinal velocity and view point velocity images in the two, three, and four-chamber views were semi-automatically obtained via speckle-tracking echocardiography.

Results:

Among the patients, Twenty-four cases (75%) were younger than 4 years. Mean global S and SR was significantly reduced in the KD patients compared to controls (17.03 ± 1.28 vs. 20.22 ± 2.14% and 1.66 ± 0.16 vs. 1.97 ± 0.25 1/second, respectively), while there were no significant differences regarding mean TPS, TPSR, longitudinal velocity and view point velocity. Using repeated measure of analysis of variances, we observed that S and SR decreased from base to apical level in both groups. The change in the pattern of age adjusted mean S and SR across levels was significantly different between the groups (P < 0.001 for both parameters).

Conclusions:

We showed changes in S and SR assessed in KD patients versus control subjects in the acute phase of KD. However, we suggest that further studies be undertaken to compare S and SR in the acute phase and thereafter in KD patients.     

Development and validation of a self-efficacy scale for clinical decision-making in general paediatrics

BACKGROUND:

Success in a task is not only related to skill, but it is also related to ‘self-efficacy’, or belief in one’s capability to perform that task. No tool currently exists to measure self-efficacy in clinical decision-making in general paediatrics.

OBJECTIVE:

To develop and provide validity evidence for the General Pediatrics-specific Self-Efficacy (GPedsSE) scale.

METHODS:

The five-item GPedsSE scale, developed using an expert panel, was matched to the New General Self-Efficacy (NGSE) scale’s structure for validity analysis purposes. Thirty-six postgraduate year 1 to postgraduate year 5 paediatric residents of the Montreal Children’s Hospital (Montreal, Quebec) completed the GPedsSE and NGSE scales, with items interspersed.

RESULTS:

The mean (± SD) GPedsSE score was 18.6±2.6 of 25. Total GPedsSE and NGSE scores were moderately correlated (r=0.54, P<0.005). On planned comparison, the GPedsSE score increased with training year (F[1.3]=6.62; P<0.001), while the NGSE score did not (F<0.37). Exploratory factor analysis showed two components, each aligning with a scale.

CONCLUSION:

The GPedsSE scale contextualizes an existing tool to general paediatrics, a novel concurrent validity approach.     

Do Term Newborns Respond Similarly to Different Painful Procedures?

Objective:

Although many methods for pain assessment in newborns are available, none of them are widely accepted. Our aim was to answer the question: do newborns respond similarly to different painful procedures?

Methods:

Sixty term newborns were involved in non-randomized prospective study. They were classified into 2 groups: Group A (n=30) who needed intubation and Group B (n=30) who necessitated umbilical vein catheterization. Close observation prior to and 10 minutes after the painful procedures was performed for recording of physiological and behavioral indicators. Plasma renin activity (PRA) was measured before and 10 minutes after the painful procedures.

Findings:

There was statistically significant difference between the 2 groups as regards physiological and hormonal responses to pain (P<0.05). Apart from palmar sweating and crying, there was no significant difference in behavioral response (P>0.05). The median pre- and post-intubation levels of PRA were 3.04 and 12.05 ng/ml/hour, respectively. There was significant (P<0.001) increase of PRA after intubation. On the other hand, the median pre- and post-catheterization levels of PRA were 5.21 and 9.19 ng/ml/hour, respectively. There was significant (P<0.001) increase of PRA after umbilical vein catheterization. We found that PRA was the only indicator of pain in group A (P=0.047). On the other hand, we did not find any indicator of pain in group B.

Conclusion:

We concluded that full-term newborns vary in their physiological and hormonal responses to different painful procedures but their behavioral response is the same.     

Evaluation of Oxidative Stress and Erythrocyte Properties in Children with Henoch-Shoenlein Purpura

Objective

Pathogenesis of Henoch-Schönlein purpura (HSP) is not clearly defined. The present study was conducted to investigate the alterations in erythrocyte deformability and oxidative stress in HSP and to examine the possible relationship between erythrocyte deformability and organ involvement in this disease.

Methods

Plasma malondialdehyde (MDA) levels, total antioxidant status (TAS), erythrocyte deformability and aggregation were measured in 21 children with HSP at the disease onset and during the remission period in comparison with healthy subjects.

Findings

HSP patients at the active stage had significantly higher MDA and lower TAS levels (P<0.05). Erythrocyte deformability was decreased at the active-stage and increased again at the remission period of HSP (P<0.05). Erythrocyte deformability was significantly decreased at four different shear stresses in patients with gastrointestinal system or renal involvement; and decreased at six different shear stresses in patients with gastrointestinal system, and renal involvement compared to the patients without organ involvement (P<0.05). No significant difference was observed in aggregation parameters (P>0.05).

Conclusion

The present findings emphasize the association between impaired erythrocyte deformability and organ involvement in HSP.     

Prediction of Vesicoureteral Reflux in Children with First Urinary Tract Infection by Dimercaptosuccinic Acid and Ultrasonography

Objective

Urinary tract infection (UTI) is one of the most common causes of febrile pediatric diseases. Also, vesicoureteral reflux (VUR) is a significant risk factor for UTI. Voiding cystourethrography (VCUG) is the method of choice for evaluation of VUR. This study was done to predict VUR by DMSA scan (technetium 99 m-labeled dimercaptosuccinic acid) and ultrasonography (US).

Methods

In a prospective study, all children with first time acute pyelonephritis were selected and evaluated by DMSA scan and US. Then VCUG was done with negative urine culture. All children with final diagnosis of obstructive congenital anomaly were excluded. The sensitivity, specifity, positive predictive values, negative predictive values, Confidence Interval of DMSA scan and US were calculated for prediction or exclusion of VUR.

Findings

Among 100 children with UTI diagnosis, VUR was detected in 39 children and 63 (31.5%) kidneys. DMSA scan was abnormal in 103 (51.5%) units, 45 units had VUR (PPV=44%), 79 units with normal DMSA scan had no VUR (NPV=81%). Of kidney units that were abnormal by DMSA or US, 51 units had VUR. PPV and NPV were 44% and 56%, respectively.

Conclusion

DMSA scan alone or with US cannot predict VUR (especially low grade VUR). But according to NPV, it seems that absence of VUR can be predicted. So, more studies are needed to determine the usefulness of DMSA scan and US instead of VCUG for detection of VUR.     

Childhood exposure to ionizing radiation from computed tomography imaging in Nova Scotia

BACKGROUND:

Examining radiation dose in the paediatric population is particularly important due to the vulnerability of paediatric patients (increased radiosensitive tissues and postexposure life-years) and risk for future radiogenic malignancy.

OBJECTIVES:

To evaluate trends in paediatric computed tomography (CT) use and ionizing radiation exposure using population-based data from Nova Scotia.

METHODS:

A retrospective, population-based cohort study of CT use in patients <20 years of age, from January 1, 2004 to December 31, 2011, was performed in Nova Scotia. CT examination data were retrieved from a provincial imaging repository. Trends in CT use were described, and both annual and cumulative effective dose exposures were calculated.

RESULTS:

In total, 29,452 CT events, involving up to 22,867 individuals were retrieved. Overall annual paediatric CT examination rates remained static (range 17.4 to 18.8 per 1000 per year). However, use in children <10 years of age decreased by >50% (P<0.001); this was counterbalanced by a steady increase among 15- to 19-year-olds (P<0.0001). Overall, 15.4% of scanned patients underwent ≥2 examinations, of which 58 patients (1.6%) exceeded 50 mSv of exposure.

CONCLUSIONS:

Despite a static rate in CT imaging among the entire cohort, children <15 years of age and, particularly, those <10 years of age displayed marked reductions in CT use. This may reflect increased awareness of campaigns emphasizing judicious CT use, revised clinical practice guidelines and increased availability of alternative modalities. A small subgroup demonstrated high-dose exposure (>50 mSv), and rates in individuals >15 years of age steadily increased, suggesting further exposure reduction efforts are necessary.