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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: International Journal of Pediatrics
- نوع مقاله: Journal Article
- کلمات کلیدی: Pediatric,Pneumonia,Microbial sensitivity Test,Ventilator-Associated
- چکیده:
- چکیده انگلیسی: Background
Choosing a unique empiric treatment for ventilator associated pneumonia (VAP) can be challenging. We aimed to determine the antimicrobial susceptibility pattern of Intensive Care Unit (ICU) of the only referral pediatric hospital in Isfahan in order to design the optimal empiric treatment protocol.
Materials and Methods: In this cross-sectional study 343 isolates were detected from 243 pediatric patients, from August 2017 to December 2018 in Imam Hossein Hospital, Isfahan, Iran. In suspicious cases of VAP, sampling was performed via non-Bronchoscopic Bronchoalveolar Lavage (NB-BAL). Microbial susceptibility and resistance were assessed. The treatment protocol of VAP was prepared based on existing guidelines.
Results: Out of 343 isolates 42 (12.2%) of the positive cultures were Candida albicans and 301 (87.8%) were bacterial isolates. Gram-negative bacteria were the most common organisms with the cumulative percentage of 62.9% of bacterial isolates. When tested with oxacillin, 61.5% of Staphylococcus aureus were MSSA and 38.5% were MRSA. The mentioned common gram-negative organisms had more than 25% resistance to at least one antibiotic from three or more antibiotic classes. However, P. aeruginosa showed below 20% resistance to majority of antibiotics. Twenty-seven (11.1%) of patients had VAP, 25 (92.6%) of whom were gram-negative infections.
Conclusion: The limited time period and sample size without any follow-up, made it impossible to define an effective treatment protocol. We defined our antibiogram in accordance with the existing standard guidelines and we designed a local protocol. An effective antibiotic against MRSA should be used in the empiric treatment of VAP. Also, in presence or absence of multidrug-resistant (MDR) pathogen risk-factors, it is necessary to use two effective antipseudomonal antibiotics from different antibiotic classes.- انتشار مقاله: 25-08-1398
- نویسندگان: Majid Keivanfar,Nazanin Zibanejad,Hamid Rahimi,Sharareh Babaei,Monir Sadat Emadoleslami,Mohsen Reisi
- مشاهده
- جایگاه : پژوهشی
- مجله: International Journal of Pediatrics
- نوع مقاله: Journal Article
- کلمات کلیدی: children,Spirometry,Cystic fibrosis,Tissue Doppler Echocardiography
- چکیده:
- چکیده انگلیسی: Background:Cystic Fibrosis (CF) is a systemic disease affecting extra pulmonary dysfunction as a result of CF-related lung disease. Because of lack of enough studies in this field and utilization of TDE in this field, we aimed to evaluate the cardiac involvement in children with CF and compare it with healthy children.
Materials and Methods: In this cross sectional study, children diagnosed with cystic fibrosis aged less than 15 years who referred to Emam Hossein Children’s Hospital, affiliated to Isfahan University of Medical Sciences, Iran, during 2018, were enrolled. Participants were 2 groups: case and control. In this study 27 children with mild cystic fibrosis lung disease and 27 healthy children were evaluated. Case groups were consisted of children with CF, and control group were healthy children. FEV1, FVC, and FEV1 / FVC of all participants were recorded based on their spirometry findings. Cardiac function tests including electrocardiogram and Doppler echocardiography were evaluated by an expert pediatric cardiologist. Spirometry and Doppler echocardiography findings in two studied groups were compared.
Results: Lateral wall tissue Doppler echocardiographic evaluation, annular peak velocity during systole and E’/A’ ratio was significantly higher in children with CF than healthy children (P<0.05). In the right ventricle (septal wall) tissue Doppler echocardiographic evaluation peak velocity during early diastole, peak velocity during late diastole and annular peak velocity during systole was significantly higher in healthy children than those with CF (P<0.01). E’/A’ ratio in the right ventricle (septal wall) tissue Doppler echocardiographic evaluation was significantly higher in children with CF than healthy children (P<0.01).
Conclusion
Based on the results, it is recommended to consider tissue Doppler echocardiography in the earlier period of CF patients’ follow- up program.- انتشار مقاله: 11-04-1398
- نویسندگان: Mehdi Ghaderian,Majid Keivanfar,Shiva Barani Beiranvand,Mohsen Reisi
- مشاهده
- جایگاه : پژوهشی
- مجله: International Journal of Pediatrics
- نوع مقاله: Journal Article
- کلمات کلیدی: children,Prevalence,mutations,Cystic fibrosis,sweat test
- چکیده:
- چکیده انگلیسی: Background: Cystic fibrosis (CF) is the most common lethal genetic disorder of Cystic Fibrosis Trans-membrane Conductance (CFTR) Regulator gene mutations. We aimed to investigate common mutations in CF patients and to assess its possible relationship with clinical presentations.
Materials and Methods: This cross sectional study was conducted on 36 CF patients who were referred to a tertiary pediatric hospital in Isfahan, Iran. They were evaluated for 34 common mutations in CFTR gene by using reverse dot blot strip assay. Other parameters such as the age of diagnosis, the sweat chloride level, and clinical manifestations due to lung involvement and pancreatic insufficiency were also assessed. According to genotype mutations, children were divided in three groups: ΔF508 mutation (group 1), non-ΔF508 mutation (group 2), without current mutations (group 3). Finally, genotype, and phenotype relationship were reported.
Results: The mean age of patients was 8.1+2.3 months, and 23 of them (63%) were male. CFTR mutations were found in fourteen patients (38.8%). ΔF508 mutation has the highest prevalence in the studied samples with allele frequency of 15.27%, and c. 2183 AA>G was in the second standing. Furthermore, p.R553X, p.G542X, C.1766+1, p.N1303K mutated alleles also were obtained in lower level. Mean age at the diagnosis time of CF, sweat chloride level and pancreatic insufficiency were not different between groups but lung complications were significant in children with common mutations.
Conclusion: Our findings showed that commercial kit designed to identify 34 common CFTR mutations failed to detect 61.2% of alleles of our patients. This necessitates designing local diagnostic kits for proper diagnosis of CF in Iranian children.- انتشار مقاله: 27-08-1397
- نویسندگان: Mohsen Reisi,Mahdiyeh Behnam,Seyed Javad Sayedi,Farzaneh Salimi,Pegah Kargar,Mansoor Salehi,Hossein Saneian,Iman Kashani,Roya Kelishadi
- مشاهده
- جایگاه : پژوهشی
- مجله: International Journal of Pediatrics
- نوع مقاله: Journal Article
- کلمات کلیدی: children,length of stay,Bronchiolitis,Saline solution
- چکیده:
- چکیده انگلیسی: Background
We aimed to compare the efficacy of nebulized hypertonic (3%, 5% and 7%) saline with normal saline in hospitalized infants with acute bronchiolitis.
Materials and Methods
In this triple-blinded randomized clinical trial, 120 children with moderate to severe bronchiolitis randomly assigned into four groups to receive nebulized normal saline (group A), saline 3% (group B), saline 5% (group C), and saline 7% (group D). The length of hospital stay (LOS) as primary outcome and the use of oxygen, temperature, oxygen saturation (SPO2), pulse rate (PR), respiratory rate (RR), and bronchiolitis severity score were measured in the beginning of the study and during hospitalization.
Results
The mean age of patients was 5 + 0.423 months and 79 of them (65%) were male. The length of hospital stay (LOS), and use of oxygen supplementation was not different between group A and B (P=0.36), but significantly lower than group C and D (P<0.001). Vital signs, improvement in severity score and oxygen saturation were similar between groups.
Conclusion
Our study demonstrated that nebulization with 3% hypertonic saline and 0.9% saline can significantly reduce hospitalization rate compared nebulization with 5% and 7% hypertonic saline.- انتشار مقاله: 21-01-1397
- نویسندگان: Mohsen Reisi,Narges Afkande,Hasan Golmakani,Majid Khademian
- مشاهده
- جایگاه : پژوهشی
- مجله: International Journal of Pediatrics
- نوع مقاله: Journal Article
- کلمات کلیدی: Sleep disorders,Iran,Performance,Education,adolescents,Sleep
- چکیده:
- چکیده انگلیسی: Background: Although sleep disorders are common problems among families and they affect the learning, memory processes and academic performance of children, there is no evaluation of these disorders in Iran. The aim of this study was to assess the prevalence of sleep disorders and its association with academic performance of school age children.
Materials and Methods: A cross-sectional study was conducted on 1,100 middle school students of Isfahan city of Iran during 2012-2013. Multi-stage random cluster sampling method was performed and five girl’s schools and five boy’s schools were selected. The data gathered with a validated questionnaire to evaluate the academic performance and sleep disorders.
Results: The mean duration of nocturnal sleep was 8.38±1.17 which was significantly higher in the group with excellent academic performance (8.86±1.18 hours), than the other two groups (8.14±1.17 hours for average academic performance and 7.90±1.15 hours for poor academic performance). Academic performance was significantly associated with age, gender, parental occupation, nocturnal sleep time, sleep latency and sleep disorders (P<0.05).
Conclusion: This study revealed that sleep disorders negatively affect the academic performance and highlighted the importance of proper sleep among children and students.- انتشار مقاله: 26-10-1395
- نویسندگان: Mohsen Reisi,Rozita Jalilian,Gholamreza Azizi,Afsane Rashti,Jamal Faghihi Nia,Mojtaba Akbari,Nazanin Babaei,Seyed Javad Sayedi,Nima Rezaei,Mohammad Reza Modaresi
- مشاهده
- جایگاه : پژوهشی
- مجله: International Journal of Pediatrics
- نوع مقاله: Journal Article
- کلمات کلیدی: children,Asthma,Right ventricular function,Tissue Doppler Echocardiography
- چکیده:
- چکیده انگلیسی: Background
Asthma is the most chronic inflammatory disorder of the airways in children and asthmatic patients can experience cardiac dysfunction, pulmonary hypertension and finally cor pulmonale later in life. We aimed to investigate Right Ventricular (RV) functions in asthmatic children by conventional and tissue Doppler echocardiography (TDE).
Materials and Methods
Pulmonary function tests, conventional and TDE examinations were performed on 42 asthmatic and 42 age- and gender matched healthy controls subjects (n=42).
Results
Compared with healthy children the RV wall was statistically thicker among asthmatic patients (P= 0.01). Conventional echocardiography had not significant difference between cases and controls, but TDE had significant difference between these two groups. Peak E’ velocity, A’ velocity, E’/A’ ratio and S’ in lateral and medial sites of tricuspid annulus valve, were significantly differ from control group in our patients (P<0.01). Isovolemic relaxation time and isovolemic contraction time were higher in asthmatic patients than the controls (P<0.01). Tie index or Myocardial performance index (MPI) had higher value in asthmatic patients (P<0.01). There was no difference in deceleration time between patients and cases (P=0.12).
Conclusion
Our study showed that although the conventional echocardiography and clinical finding were apparently normal in asthmatic children, TDE could showed subclinical dysfunction of the right ventricle in these patients. Our findings signify the diagnostic value of tissue Doppler- echocardiography superior to conventional echocardiography for the early evaluation, detection and monitoring of ventricular dysfunction among asthmatic patients.- انتشار مقاله: 19-08-1395
- نویسندگان: Mehdi Ghaderian,Seyed Javad Sayedi,Tooba Momen,Zahra Zadi,Mohsen Reisi
- مشاهده
- جایگاه : پژوهشی
- مجله: International Journal of Pediatrics
- نوع مقاله: Journal Article
- کلمات کلیدی: children,Ventilation,Extubation,spontaneous breathing test
- چکیده:
- چکیده انگلیسی: Background: Successful weaning of the ventilator is a major challenge, especially in children. This study was conducted to compare the criteria of readiness for extubation and daily spontaneous breathing test (SBT) on the duration of mechanical ventilation and extubation failure rates.
Materials and Methods
This randomized clinical trial was conducted in the pediatric intensive care unit (PICU) of a teaching hospital (Imam Hossein Hospital) in Isfahan, Iran. Overall, 68 patients were assigned into two groups of equal number. In the intervention group, if all the readiness criteria were met the spontaneous breathing test (SPONT/PSV) was performed, and the tracheal tube was removed if the test was successful. In the control group, extubation was performed based on the physician's clinical judgment. Duration of mechanical ventilation and extubation failure rates were compared between groups.
Results: The percentage of extubation failure was higher in the control group than in the intervention (26.4% vs. 11.7%, respectively, P=0.04). The two groups were not significantly different in terms of the percentage of reintubation (11.7% vs. 5.8%), and only the percentage of using noninvasive mechanical ventilation (NIMV) was higher in controls (14.7% vs. 5.8%, respectively, P=0.05). No significant difference was observed between the two groups in terms of the median duration of mechanical ventilation in patients with successful extubation (P=0.12). Likewise, the long-term outcomes, i.e. the length of stay in PICU and hospital were not different in the two groups (P>0.05).
Conclusion
According to the results, daily SPONT/PSV test reduce extubation failure more than physician's clinical judgment in pediatric population. However, type of extubation protocol did not affect mortality, the duration of mechanical ventilation and stay in the PICU.- انتشار مقاله: 31-04-1398
- نویسندگان: Majid Keivanfar,Atefeh Sadeghizadeh,Mohsen Reisi,Mohammadreza Habibzadeh,Sharareh Babaei
- مشاهده