Background The incidence of acute pancreatitis in children is increasing, but causes and diagnostic and therapeutic methods are various in different centers. The aim of this study was to investigate the common causes and routine diagnostic and therapeutic methods of acute pancreatitis in children in a pediatric gastrointestinal referral center and its accordance with existing guidelines. Methods In this retrospective, cross-sectional study, a total of 60 children with a diagnosis of acute pancreatitis, were studied. Results The most common causes of acute pancreatitis were systemic and metabolic diseases and medications. CT scan was performed for 36% of patients, but 31% of patients, for whom a CT scan was performed had no clear indication of CT scan. Only half of the patients received fluid 1.5 times their maintenance in the first 24 h. Antibiotic therapy was performed for 48% of patients but medical indications for antibiotic treatment were found in only 34% of cases. During the COVID-19 pandemic, the relative incidence of acute pancreatitis was increased. Conclusions In children with systemic and metabolic disease and using anticonvulsant drugs, it is important to consider the incidence of this disease. In clinical education, the risks of radiation due to unnecessary CT scans and inappropriate prescription of antibiotics need to be emphasized. More research should be done to study the association between COVID-19 and acute pancreatitis.

Introduction Febrile seizures are one of the most common diseases that physicians encounter in pediatric emergency departments. Two important aspects of managing patients presenting with a febrile seizure are meningitis exclusion and co-infection investigation. This study was designed to determine any infection that occurs concomitantly with a febrile seizure episode and also to assess the frequency of meningitis among children presenting with febrile seizures. Methods This retrospective cross-sectional study was conducted at the Children’s Medical Center, an Iranian pediatric referral hospital. All patients aged 6 months to 5 years presenting with febrile seizures from 2020 to 2021 were included. Patients’ data were collected from the medical report files. The presence of respiratory, gastrointestinal, and urinary infections was evaluated. Moreover, the detection of SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) was performed for suspicious cases. The results of urine and stool analysis, as well as blood, urine, and stool cultures were checked. The frequency of lumbar puncture (LP) performance and its results were studied. The relationship between white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein in meningitis was evaluated. Results A total of 290 patients were referred to the Children’s Medical Center, Tehran, Iran, due to fever and seizures. The mean age of the patients was 21.5 ± 13.0 months, and 134 (46.2%) were female. Out of 290 patients, 17% presented with respiratory infections. Nasopharyngeal SARS-CoV-2 RT-PCR was requested for 50 patients (17%), of which nine (3%) were reported positive and two patients had multi-inflammatory syndrome in children (MIS-C). Fever without local signs, gastroenteritis, and urinary tract infections were found in 40%, 19%, and 14% of the patients, respectively. LP was requested for 97 participants (33.4%) to evaluate central nervous system infection, of which 22 cases were suggestive of aseptic meningitis. Among laboratory tests, leukocytosis was significantly related to aseptic meningitis (odds ratio = 11.1, 95% CI = 3.0- 41.5). The blood culture testing result was positive in seven patients; all of them were due to skin contamination. Conclusion Evaluation of patients for possible meningitis is necessary for febrile seizure management. Although the prevalence of bacterial meningitis in these patients is not high, according to this study and other studies conducted in Iran, aseptic meningitis, especially after Measles, Mumps, and Rubella (MMR) vaccination should be considered. Leukocytosis and increased CRP can predict the occurrence of aseptic meningitis in these patients. However, further studies with a larger sample size are highly recommended. Moreover, during the COVID-19 pandemic, it is recommended to pay attention to an acute COVID-19 infection or evidence of MIS-C in children with fever and seizure.

Background:Flexible Fiber-optic Bronchoscopy (FFB) is a diagnostic and therapeutic tool for respiratory diseases and evaluation. One of its major advantages is in the diagnosis and treatment of foreign body aspiration.Objectives:This study reports the indications, outcomes, and possible complications of FFB in patients suspected of foreign body aspiration diagnosis in the Iranian population.Methods:The data for this study was gathered from medical records of the patients in Children’s Medical Centre, which is a tertiary pediatric hospital affiliated with Tehran University of Medical Sciences (TUMS), from August 2015 to February 2021.Results:Of the 358 FFBs that were performed for patients suspected of foreign body aspiration diagnosis, major indications included choking (158, 44.13%), coughing (157, 43.58%), wheezing (34, 9.49%), and stridor (6, 1.67%). Nuts were the most common foreign body that was removed among airways in these patients (116, 65.16%). In 15 (4.18%) cases the foreign object was extracted via re-bronchoscopy. The location of 130 foreign objects was identified which right bronchus (52, 40%), left bronchus (38, 29.23%), trachea (8, 6.15%), and carina (6, 4.61%). In 358 procedures that were performed, a total of 27 cases (7.54%) developed complications include hypoxia and laryngospasm. The mean interval from the first sign of choking and the admission of the child into the hospital was 44.43 days ± 10.88 (range: 1 to 1095 days, 95% CI: 22.87-65.99). There was a significant association between later days of admission and the necessity for re-bronchoscopy according to the logistic regression test (p-value=0.012).Conclusion:Our results show that by early diagnosis and hospitalization and so performing flexible fiber-optic bronchoscopy in an earlier time than foreign body aspiration can increase the number of successful procedures.

Background: the incidence of acute pancreatitis in children is increasingو but causes and diagnostic and therapeutic methods are different in different centers. The aim of this study was to investigate the common causes and routine diagnostic and therapeutic methods of acute pancreatitis in children in a pediatric gastrointestinal referral center and its compliance with existing guidelines. Methods: In this retrospective, cross-sectional study, a total of 60 children with a diagnosis of acute pancreatitis, were studied.Results: The most common causes of acute pancreatitis were systemic and metabolic diseases and medications. CT scan was performed for 36% of patients, but 31% of patients, for whom a CT scan was performed had no clear indication of CT scan. Only half of the patients received fluid 1.5 times their maintenance in the first 24 hours. Antibiotic therapy was performed for 48% of patients but medical indications for antibiotic treatment were found in only 34% of cases. During the COVID-19 pandemic, the relative incidence of acute pancreatitis was increased.Conclusions: In children with systemic and metabolic disease and using anticonvulsant drugs, it is important to consider the incidence of this disease. In clinical education, the risks of radiation due to unnecessary CT scans and inappropriate prescription of antibiotics need to be emphasized. More research should be done to study the association between COVID-19 and acute pancreatitis.