1 2322-4398 Mazandaran University of Medical Sciences 120 Electrostimulation to Increase Peroneal Muscle Strength in Pediatric Patients With Postsurgical Clubfoot Morales-Osorio Guadalupe b Lomeli-Gonzalez Joel c Hernandez-Valadez Noemi Isela d Arellano Saldana Elena e Luz Arenas-Sordo Maria f b Pediatric Rehabilitation Department, National Institute of Rehabilitation, Mexico City, Mexico c Research Department, Medicine School, National Polytechnic Institute, Mexico City, Mexico d Electro diagnostic Department, National Institute of Rehabilitation, Mexico City, Mexico e Pediatric Rehabilitation Department, National Institute of Rehabilitation, Mexico City, Mexico f Genetics Department, National Institute of Rehabilitation, Mexico City, Mexico 1 1 2016 4 1 0 0 11 06 2015 16 09 2015 Background: Idiopathic congenital clubfoot is a deformity with various components. Its treatment can be conservative and or surgical in order to eliminate the deformity and to obtain a pain-free foot allowing for adequate mobility. Objectives: Our objective was to evaluate whether neuromuscular electrostimulation is useful for improving peroneal muscle strength in post-operative congenital clubfoot in children. Patients and Methods: An experimental, prospective, longitudinal, and comparative study was carried out on 10 patients with congenital clubfoot in the experimental group, and on 10 for historical controls. Initial and post-treatment clinical evaluations were conducted on patients in both groups. Surface electromyography (SEMG) was used for the experimental group; each patient received 30 sessions of treatment with neuromuscular electrostimulation in order to obtain muscular contraction. Results: In both groups, there were more males with the average age or 5.5 years (ranging from 3 to 8 years of age). Peroneal muscular strength evaluated through the Daniels and Worthingham’s test increased post-treatment only in the experimental group, and comparing these results to those of the historical group, a significance level of P = 0.001 was obtained. The motor unit potential amplitude in the SEMG increased in the experimental group with a significance level of P < 0.05. Conclusions: Neuromuscular electrostimulation can be used to increase muscle strength, and it is a safe and painless treatment.
114 Epigenetic Diabetic Vascular Complications Ahmadzadeh-Amiri Ali g Ahmadzadeh-Amiri Ahmad h g Student Research Committee, Tehran University of Medical Sciences, Tehran, IR Iran h Diabetes Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran 1 1 2016 4 1 0 0 04 07 2015 14 10 2015 Diabetic vascular complications (DVC) influence several vital organ systems including cardiovascular, renal, ocular and nervous systems making it a major public health problem. Although extensive researches were performed in this field, the exact mechanisms responsible for these organ damages in diabetes remain obscure. Several metabolic disturbances have been involved in its complication and change in genes associated with these pathways occurred. Gene expression to produce a biologically active protein can be controlled by transcriptional and translational alteration on the head of genes without change in nucleotide composition. These epigenetic adjustments are steady, but possibly reversible and can be transmitted to future generation. Gene expression can be regulated by three epigenetic mechanisms including DNA methylation, histone modifications and noncoding microRNAs (miRNAs) activity. Epigenetic studies must be directed to better realize the role of epigenetic changes to the etiology of DVC and knowledge of epigenetic would play a pivotal role in the application of individualized medicine. Application and development of high technology sequencing combined with more sensitive and advanced methodologies for epigenome studying help to determine specific epigenetic events that stimulate gene responses in patients with diabetes mellitus. 122 Acute Disseminated Encephalomyelitis: A Review of Eleven Cases in Childhood in North of Iran Nikkhah Ali i Salehiomran Mohammad Reza j i Non-Communicable Pediatric Diseases Research Center, Amirkola Children’s Hospital, Babol University of Medical Sciences, Babol, IR Iran j Non-Communicable Pediatric Diseases Research Center, Amirkola Children’s Hospital, Babol University of Medical Sciences, Babol, IR Iran 1 1 2016 4 1 0 0 14 09 2015 18 10 2015 Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder. The pathogenesis is unclear, but it is thought to be immune-mediated. The prognosis is favorable, with most children making a full recovery. Objectives: The present report analyzed different clinical presentations, response to treatment and outcome in a series of 11 patients with ADEM who referred to our tertiary center in north of Iran from 2010 to 2014. Materials and Methods: In this retrospective simple descriptive review, eleven cases with ADEM admitted in the neurology ward from 2010 to 2014 were enrolled. The clinical findings and laboratory and imaging results of patients were reviewed. All of these cases were evaluated with neurological examination, serologic tests for bacterial meningitis and viral encephalitis (especially, herpes simplex virus) and brain MRI without contrast. After discharge, patients were followed for at least six months (6 to 12 months) clinically and radiologically. Results: Of 11 children, 8 were male and 3 female. Their ages ranged between 4 and 10 years. The mean interval between the preceding infection and symptoms of encephalomyelitis was nine days. The most common presenting symptoms were ataxia in 45.4%, fever and headache in 36.4% and altered consciousness in 18.2% of patients. Neurological examination revealed pyramidal motor signs such as brisk deep tendon reflexes (hyperreflexia) (81.8%), cranial nerve involvement (18.2%), dysarthria (9.1%) and abnormal movements (9.1%). We followed up these patients in long-term for 6 to 12 months. Only in 1 child who received IVIG, mild ataxia had reminded. Conclusions: The prognosis of acute disseminated encephalomyelitis (ADEM) is favorable. Early diagnosis and prompt treatment of ADEM would probably reduce morbidity. 116 Gastrointestinal Complaints and Treatment of Helicobacter pylori in Children: A Narrative Review Sobhani Shahmirzadi Mohammad k Ghasemi-Kebria Fatemeh l Roshandel Gholamreza m k Department of Pediatrics, Golestan University of Medical Sciences, Gorgan, IR Iran l Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, IR Iran m Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, IR Iran 1 1 2016 4 1 0 0 25 07 2015 16 11 2015 Context: The role of Helicobacter pylori infection in children’s problems is considered in recent years. Helicobacter pylori, a gram negative spiral flagellate organism has diverse effects and consequences on children’s health, but in some issues especially in chronic abdominal pain its role continues to debate. The prevalence of H. pylori infection and remedial measures against it in Iranian children is increasing. Evidence Acquisition: Diagnostic tests are divided into two categories: Invasive and noninvasive. Diagnostic methods are available and although invasive methods are more accurate and reliable; non-invasive methods are more acceptable and practical for children. Serological diagnosis assays are not worth much in the pediatric fields. Results: It is important to emphasize that diagnostic methods for H. pylori are revised and in some conditions, such as chronic abdominal pain, contrary to the impression, no treatment is required. Conclusions: Triple therapy is a reasonable method to eradicate H. pylori in the first stage, but different combinations and one week courses in the Iranian studies were successful. 118 Outlines and Outcomes of Instrumented Posterior Fusion in the Pediatric Cervical Spine: A Review Article Haddadi Kaveh n n Department of Neurosurgery, Imam Khomeini Hospital, Diabetes Research Center, Mazandaran University of Medical Science, Sari, IR Iran 1 1 2016 4 1 0 0 21 11 2015 16 12 2015 Context: The most common source of cervical spine arthrodesis in the pediatric populace is the instability related to congenital or traumatic damage. Surgery of cervical spine can be challenging given slighter anatomical constructions, fewer hardened bone, and upcoming growth potential and growth. Evidence Acquisition: Trainings in adult patients recommended that consuming screw constructs results in enhanced consequences with inferior amounts of instrumentation catastrophe. But, the pediatric literature is inadequate for minor retrospective series. Authors reviewed the existing pediatric cervical spine arthrodesis literature. They studied 184 abstracts from January 1976 to December 2014. An entire of 883 patients in 82 articles were involved in the evaluation. Patients were characterized as taking either posterior cervical fusion with wiring or posterior cervical fusion with screws or occipitocervical fusion. Results: The etiologies faced most frequently were inherited abnormalities (54%) shadowed by trauma (28%), Down syndrome (8%), and infectious, oncological, iatrogenic, or mixed causes (10%). The mean duration of follow-up was 32.5 months. Conclusions: The consequences of this training are restricted by deviations in construct policy, usage of orthoses, follow-up period and fresher adjuvant produces stimulating fusions. But, a literature review recommend that instrumentation of the cervical spine in children may be harmless and more effective than using screw concepts rather than wiring methods. 113 Road Traffic Injuries Among Iranian Children and Adolescents: An Epidemiological Review Behzadnia Salar o Shahmohammadi Soheila p o Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, IR Iran p Research Fellow, Infectious Disease Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, IR Iran 1 1 2016 4 1 0 0 22 11 2015 21 12 2015 Context: Road traffic injuries (RTIs) are the leading cause of death and globally kill 1.2 million people every year and leave 20 - 50 million people injured and disabled. In Iran, traffic related fatalities are the leading cause of death among all inadvertent fatal injuries imposed on children under five. Herein, authors review the epidemiological studies performed on vehicle accidents among Iranian children and adolescents to improve the knowledge about these preventable events. Evidence Acquisition: International databases including PubMed, Google scholar, science direct Cochrane library, and national data bases such as scientific information database (SID) were searched for terms; children, motor vehicle accident, road traffic injuries, Iran 2000 - 2015. Publication in Persian or English language related to the subject including Iranian children and adolescent's age groups were included. Among the 312 articles, 11 (two abstracts and nine full texts) were selected. Nine full texts were reviewed. Results: From 22865 victims, about 3578 children and adolescents under 19 years old were identified. Males were more affected than females. Pedestrian injury with 43.66% was the most common case of road traffic injuries. Head trauma was the most common cause of injuries reported by eight of the reviewed articles. Most of the accidents occurred between 1:00 - 6:00 PM. Most of RTIs occurred in summer. Care by emergency medical services (EMS) (29.14%) was reported by five out of the nine reviewed article. Conclusions: Most of the road traffic injuries among Iranian children and adolescents are preventable using appropriate preventive strategies such as safety facilities, safe vehicles, and safe traffic behavior, and establishing comprehensive public education programs for older children and their parents. 121 Primary Intestinal Lymphangiectasia and its Association With Generalized Lymphatic Anomaly María Díaz Marugán Victoria Carlos Lopez-Gutierrez Juan Pintores Health Center, Madrid, Spain Department of Pediatric Surgery, La Paz Hospital, Madrid, Spain 1 1 2016 4 1 0 0 22 11 2015 06 01 2016 Background: Lymph is a fluid originating in the interstitial spaces of the body that contains cells, proteins, particles, chylomicrons, and sometimes bacteria. Objectives: The aim of the present study is to demonstrate that primary intestinal lymphangiectasia (PIL) results from a disruption of lymphatic circulation, thus corresponding to a secondary rather than a primary event in the context of generalized lymphatic anomaly. Materials and Methods: In this case series and record review, an analysis of intestinal lymphatic involvement was performed on patients diagnosed with PIL between 1965 and 2013. Of the 21 patients included in the study, 10 had been diagnosed before 5 years of age (1 prenatal), 8 between 5 and 18 years of age, and 3 while older than 18 years of age. The follow-up period varied between 1 and 34 years. Clinical data, blood and fecal parameters, imaging studies, endoscopy results, biopsy analyses, treatment details, and outcome information were collected from medical records. Endoscopy, histological studies, magnetic resonance imaging, and lymphoscintigraphy were performed on all patients. Dynamic intranodal lymphangiography was performed on 8 patients. Results: Central lymphatic channel obstruction was identified in 12 patients (57%). Associated lymphatic malformation (LM) was present in 16, diarrhea in 10, chylothorax in 11, chylous ascites in 10, pericardial effusion in 6, coagulopathy in 3, and osteolysis in 7. Conclusions: We consider intestinal lymphangiectasia not as an entity in itself, but as a consequence of lymphatic flow impairment in the thoracic duct, producing chylous reflux into the intestinal lymphatics. 115 Biomarkers, Trauma, and Sepsis in Pediatrics: A Review Frieri Marianne Kumar Krishan Boutin Anthony Division of Allergy Immunology, Department of Medicine, Nassau University Medical Center, East Meadow, New York, USA Division of Pediatric, Department of Emergency Medicine, Nassau University Medical Center, East Meadow, New York, USA Division of Adult Emergency Medicine, Department of Emergency Medicine, Nassau University Medical Center, Hempstead Turnpike, New York, USA 1 1 2016 4 1 0 0 21 11 2015 12 01 2016 Context: There is a logical connection with biomarkers, trauma, and sepsis. This review paper provides new information and clinical practice implications. Biomarkers are very important especially in pediatrics. Procalcitonin and other biomarkers are helpful in identifying neonatal sepsis, defense mechanisms of the immune system. Pediatric trauma and sepsis is very important both in infants and in children. Stress management both in trauma is based upon the notion that stress causes an immune imbalance in susceptible individuals. Evidence Acquisition: Data sources included studies indexed in PubMed, a meta- analysis, predictive values, research strategies, and quality assessments. A recent paper by one of the authors stated marked increase in serum procalcitonin during the course of a septic process often indicates an exacerbation of the illness, and a decreasing level is a sign of improvement. A review of epidemiologic studies on pediatric soccer patients was also addressed. Keywords for searching included biomarkers, immunity, trauma, and sepsis. Results: Of 50 reviewed articles, 34 eligible articles were selected including biomarkers, predictive values for procalcitonin, identifying children at risk for intra-abdominal injuries, blunt trauma, and epidemiology, a meta-analysis. Of neonatal associated sepsis, the NF-kappa B pathway by inflammatory stimuli in human neutrophils, predictive value of gelsolin for the outcomes of preterm neonates, a meta-analysis interleukin-8 for neonatal sepsis diagnosis. Conclusions: Biomarkers are very important especially in pediatrics. Procalcitonin and other biomarkers are helpful in identifying neonatal sepsis, defense mechanisms, and physiological functions of the immune system. Pediatric trauma and sepsis is very important both in infants and in children. Various topics were covered such as biomarkers, trauma, sepsis, inflammation, innate immunity, role of neutrophils and IL-8, reactive oxygen species, neonatal hypoxia, NF-kappa B related to inflammation. These topics are clearly linked and are very important for pediatricians, pulmonologists, and immunologists in academic centers and in practice. 119 Hyperimmunoglobulin-D Syndrome in Children: A Review Article Golpour Masoud Ghaffari Javad Associated Professor of Dermatology, Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran Professor of Allergy and Clinical Immunology, Infectious Disease Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, IR Iran 1 1 2016 4 1 0 0 03 11 2015 21 01 2016 Hyperimmunoglobulin-D syndrome (HIDS) is a rare, autosomal recessively inherited autoinflammatory disease caused by mutations in the mevalonate kinase gene. HIDS usually starts in infancy with recurrent fever episodes lasting three to seven days and recurring every three to six weeks, with only partial symptom decrease in adulthood. Fever is typically accompanied by abdominal pain, vomiting, diarrhea and cervical lymphadenopathy, and sometimes by skin and joint symptoms. Blood leukocytes and serum C-reactive protein (CRP) are elevated during the episode, and in addition, high levels of interleukine-1 (IL-1), IL-6 and tumor necrosis factor (TNF) and respective soluble receptors are measured. Currently, there is no established treatment for HIDS. So far, four children have been successfully treated by TNF-alpha inhibitor (etanercept) and three children with IL-1 receptor antagonist (anakinra). The current study is a narrative review about the updates of HIDS. 117 Pediatric Lumbar Disc Herniation: A Review of Manifestations, Diagnosis and Management Haddadi Kaveh Department of Neurosurgery, Diabetes Research Center, Imam Khomeini Hospital, Mazandaran University Of Medical Sciences, Sari, IR Iran 1 1 2016 4 1 0 0 17 11 2015 26 01 2016 Lumbar disc herniation (LDH) is a public complaint among adults with degenerated lumbar intervertebral discs. However, its incidence in childhood and adolescence is abundant. This dissimilarity designates that children are distant from being just little adults. Findings recommended that pediatric LDH is, in numerous ways, dissimilar from that in adults. The occurrence, the etiological and the diagnostic topographies of pediatric LDH have been entirely described in the text, while the features concerning the treatment have not been yet studied in details. It was confirmed that pediatric patients respond to conventional management less positively as matched with adults. Also, the consequences of the operation continued to be acceptable for at least 10 years after the first surgery, even though it seems to decline somewhat. The purpose of the current review is to offer a comparative view on the management of pediatric LDH.