Background: The purpose of treatment of children with autism is to help them to acquire functional skills in routine life and to control behaviors that are disruptive. Objectives: In this study, the safety and efficiency of cerebrolysin was determined by childhood autism rating scale (CARS) on behavioral, verbal and nonverbal developments of children with autism referred to children's medical hospital clinic of neurology. Methods: In a quasi-experimental study, 36 children with autism were enrolled and the effect of cerebrolysin on their behavioral, nonverbal and verbal development was determined by CARS questionnaire fulfilled before and one month after complete intervention. Results: All evaluated items except level and consistency of intellectual response had favorable reduction in scores of CARS questionnaire (P = 0.001). The total score decreased from 40.6 to 36.1 showing 11.1% improvement. Despite the efficiency of cerebrolysin observed in this study, its partial use may be limited by the large number of intramuscular injections, i.e. nine per months. Sustained release formulation may alleviate this limitation, if this therapy proves to be beneficial in future studies. Conclusions: According to the obtained results, the safety and feasibility of cerebrolysin administration could be considered and be effective on behavioral, nonverbal and verbal development in children with autism.
Background: One of the important causes of childhood febrile illness is meningitis. It causes bacterial, viral, fungal, parasitic, and non-infectious agents. Pediatric bacterial meningitis is one of the most important causes of infant mortality, especially in premature infants. This study aimed to identify the outcome and mortality of children with meningitis. Methods and Materials: All children with meningitis in the Pediatric Department of Rasool Akram Hospital from December 23, 2007, to December 16, 2017, were included. Signs and symptoms (fever, consciousness, neck rigidity, and seizure) were collected and Cerebrospinal fluid analysis in children was made. Based on these findings, patients were divided into two groups, which include bacterial and non-bacterial meningitis. Then we recalled all families and examined them to discover the child’s outcome and complications at least after two years. Results: During the ten-year study period, 202 children were included in the study. Patients aged less than 12 months were found to be more frequently affected. Fever was the most common presentation (83.4%) followed by seizure (51.5%) and vomiting (49%). 119 (58.9%) of the patients were male and 83 (41.1%) were female. Definite bacterial meningitis was the final diagnosis in 35.6% (72) of patients (mean age 34.1± 48.3 months), and non-bacterial meningitis was diagnosed in 64.4% (130) of cases (mean age 46.3± 52.4 months). The most common organism in bacterial meningitis (by all methods) was Streptococcus pneumonia. Among children, 187 (92.1%) were survivors and 15 (%7.9) were non-survivors. Neurological sequelae such as motor deficit and epilepsy were identified in 9 (4.8%) and 5 (2.6%) subjects, respectively, and that they were all caused by bacterial meningitis. There was no death or neurological sequelae observed during follow-up in children with non-bacterial meningitis. Gender, age, signs and symptoms of patients at the time of admission were not significantly different between the bacterial and non-bacterial meningitis groups (p>0.05). Hydrocephalus, CSF characteristic, morbidity and mortality were significantly different between the bacterial and non-bacterial meningitis groups. Conclusion: This study showed that elevated LDH and low glucose levels in CSF are characteristic of bacterial meningitis. Increased LDH is significantly related to death in children (P-value > 0.001) with meningitis. Beneficial empirical antibiotics and sufficient follow-up by parents cause good prognosis in children with meningitis. Also in a child with fever and seizure, we should think of meningitis, even though in the absence of positive neurological examinations. It seems that increased CSF LDH, elevated CSF protein and age under one year are significant mortality risk factors in children with meningitis.
Introduction: Thrombocytopenia is a common hematologic disorder observed in many pathological conditions in critically ill patients. The current study aimed at investigating the prevalence of thrombocytopenia and its relationship with the length of stay and mortality among intensive care unit (ICU) patients. Methods: The current prospective cohort study enrolled 150 patients consecutively admitted to the medical ICU during a nine-month period. Patients' baseline characteristics and underlying diseases were recorded. Laboratory findings and admission mean platelets and platelet counts on the 3rd day of admission were obtained. Patients were divided into thrombocytopenic (platelet count of less than 150×109/L or decrease of platelet to more than 50%) and non-thrombocytopenic groups according to the 3rd day platelet count. Results: Thrombocytopenia was detected in 53(35%) patients while 13 patients (8.6%) had severe thrombocytopenia (platelets count < 50 × 109/L). ICU stay and mortality were significantly higher in patients with thrombocytopenia compared with non-thrombocytopenic patients (16 ± 2.7 vs 12 ± 2.4 days, P = 0.01) and (45.5% vs 37.3%, P = 00.1) respectively. Conclusions: Platelet might be considered as a prognosis monitor in ICU settings. Severe thrombocytopenia could be mentioned as a poor prognostic factor for increased mortality and prolonged hospitalization period in ICU patients.
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