Primary Vesicoureteral Reflux in Iranian Children

Fateme Ghane Sharbaf, Mohamad Hosein Fallahzadeh* Ali Reza Modaerresi, Mohamad Esmaeilli

From the Department of pediatric, Dr . Shikh Haspital, Mashhad University of Medical Science and Nemazee Hospital, Shiraz University of Medical Sciences, Iran

Background: Experience with vesicoureteral reflux (VUR) different centers and there are plenty of controversies. Objective: The aim of this study was to evaluate the outcome of primary VUR complications and the rate of recurrence of UTI.

Methods: The medical charts of all infants and children with primary VUR who were followed up by two nephrologists were reviewed. During 19 years (1985-2004),330 patients (271 females, 59 males) with 496 refluxing ureters were followed up as primary VUR.

Results: The patients age at diagnosis was 54 days to 16 years (Mean:4.1 years) and the mean duration of follow-up was 4.5 years. Urinary tract infection(UTI) was the presenting symptom in 95% and fever was recorded in 35% of and 12% for grades I to V, respectively. Recurrence of UTI in VUR of grades I to V, were 22.2% 18.1%, 20% 23.4%, 23.4% and 17.9% respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 55%, improvement in 27.5% , no change in 12% and deterioration in 5.5%.Comlocations such as chronic renal failure and hypertension were observed in 13 and 13 patients, respective that symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR.

Keywords: Urinary tract, Vesicoureteral reflux

 

 

Effects of indomethacin on systemic and renal haemodynamics in conscious lambs

Kesavarao Kumar Ebenzar, Fatemeh Sharbef Ghane and Francine Gabriel Smith

Department of physiology & Biophysics, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada

Both prostaglandins (PGs) PGE₂ and PGI₂ can act as renal vasodilators, these effects being exacerbated when the rennin-angiotensin system is activated. Therefore, we hypothesized that PGs would play more predominant role in modulating renal haemodynamics in the newborn period, when the rennin-angiotensin system is activated. To this end, the role of endogenously produced PGs in modulating systemic and renal haemodynamics was investigated in two groups of conscious lambs aged~1 and~6 weeks. Arterial pressure, venous pressure and renal blood flow were measured for 5 min before (control) and for 20 min after intravenous injection of vehicle (experiment 1).Twenty-four hours later, this protocol was repeated with intravenous injection of the non-selective cyclo-oxygenase inhibitor indomethacin (1 mg kg^-1, experiment 2). Heart rate was calculated from the systolic peak of the arterial pressure waveform, and renal vascular resistance (RVR) was calculated from the measured variables. In response to indomethacin but not vehicle, in both age groups of lambs there was an increase in mean arterial pressure and pulse interval, as well as a marked increase in RVR. These responses to indomethacin were, however, transient, with baseline levels being resumed within minutes . Although the hypothesis that PGs play a greater role in modulating renal haemodynamics early in life is not supported, these data do provide evidence that endogenously produced PGs modulate systemic and renal haemodynamics during postnatal maturation . It is apparent, however, that other vasoactive factors must be rapidly recruited in order to the circulatory responses to removal of vasodilatory PGs in the developing newborn.

 

 

Acute Rheumatic Fever in the North East of Iran : A Study of 80 Cases

Eftekhar Mahmudi, MD, Farah Ashrafzadeh, MD, Saeed Talebi, MD, Fatemeh Ghaneh,MD, Vahid Jafari, MD

Abstract

Background: To evaluate the frequency, clinical presentation and cardiac involvement of children with RF in the North-East of Iran

Methods: A case series analysis was conducted on 80 patients with acute rheumatic fever (ARF), who were hospitalized at Ghaem hospital in Mashad between 1994 and 2000, were studied, Laboratory tests and results from echocardiographic examination, and clinical findings were analyzed . All patients received standard care for children with ARF. The X² test was used for comparison of binary data.

Results: When compared to similar studies from developed countries, our study demonstrates a decreased frequency of RF in North- East Iran over the past few over. However, it is still a major health problem and most common cause of acquired heart disease in childhood. The distribution of the major modified Jones criteria in our study is slightly different from that described in the literature, with a higher incidence of carditis.

Conclusion: It appears that carditis is endemic in this region. Considering the high morbidity and complications involved in this disease, there is an immediate need for effective preventive programs for the initiating cause streptococcal infections, especially since it is treatable.

The Journal of Tehran Heart Center 3 (2006)151-154

Keywords: Rheumatic fever. Developing country. Children. Carditis

 

 

 

Usefulness of the Head- Up Tilt Test in Distinguishing Neural Mediated Syncope and Epilepsy in Children Aged 5-20 Years Old

M.R. Sabri, T. Mahmodiian, H.Sadri

Pediatric Department, Alzahra Hospital, Isfahan University of Medical Sciences

Abstract:

Objective: Many nonepileptic disorders may mimic epilepsy by history or clinical presentation, Neurally mediated syncope is one of the most of the important conditions that might be difficult to differentiate from epilepsy on olinical grounds. We nvestigated.

The value of the head-up tilt test (HUT) to diagnose syncope in epileptic children.

Methods: We studied 40 patients (18 girls and 22 boys) between 5 and 20 years old (mean, 11.5±3.5) who had a previous diagnosis of epilepsy . All patients underwent a HUT test.

Results: The HUT test was positive in 26patients (65%). No statistical difference was observed between the tilt positive and negative in sex, age, provocating factors, associated symptoms, family history of syncope and heart disease, findings in physical examination, and electroencephalogram result to 14% of tilt negative patients (p<0.05). Also, family history of seizure was more frequent with a positive patients (p<0.05) After 18±6 months of follow-up, 18 of 26 patients with a positive tilt test were completely asymptomatic.

Conclusion: Inadequate history taking and overemphasis on positive, family history for seizures were important causes of misdiagnosis of epilepsy in our study of the HUT test is a simple, noninvasive diagnostic tool for distinguishing syncope and epilepsy in children and should be considered early in the diagnostic plan and for determining nanagement of selected patients with a history of drop attack and loss of consciousness.

Key words: Head-up tilt test, Syncope, Epilepsy