Prevalence of occult celiac disease in healthy Iranian school age children

Several studies have shown the prevalence of celiac disease [CD] to be around 1% in Iran, which is similar to the worldwide prevalence. There is scant information on occult CD in apparently healthy school age children. This study, as the first such study in Iran, aims to determine the prevalence of occult CD in healthy Iranian school age children. In this cross-sectional study, we screened healthy school age children for CD by serum IgA and IgA anti-tissue transglutaminase antibody [tTG] levels. Measurement of these antibodies was by enzyme linked immunosorbent assay. A recheck of positive tTG tests was performed and patients who tested positive underwent endoscopic duodenal biopsies. The biopsy samples were scored according to the Marsh classification by an experienced pathologist. A total of 634 children [314 males, 320 females; mean age: 12.8 years] were included in the study. All children and/or their parents completed a questionnaire and children underwent an initial physical examination to determine study eligibility. Positive serum tTG was noted in 3 [0.5%; 2 females] out of 634 patients. Duodenal biopsies were consistent with CD in these 3 subjects. The mean age of patients with CD was 14.3 years [range: 12-17 years]. The female to male ratio was 2:1. These cases had no signs and symptoms, but a gluten-free diet was recommended according to pathologic changes in their small bowels and results of the tTG test. The prevalence of occult CD in these children is 0.5%, which is half of the prevalence of CD in Iranian adults. The anti-tTG concentration at initial serological CD screening is highly informative in determining occult cases of CD. The question is whether all non-symptomatic cases should be treated with a gluten-free diet or not

Colorectal polyps: a clinical, endoscopic and pathologic study in Iranian children

To study the clinical presentation, histology and colonoscopic features of lower gastrointestinal polyps in Iranian children. Medical reports of children with colorectal polyps were retrospectively reviewed from 1996 to 2005 at the Children's Medical Center Hospital, Iran. A total of 563 cases were studied. Data related to age, sex, family history, signs and symptoms, the size, location, polyp types and associated lesions were collected and analyzed. The mean age of children was 5.66 +/- 2.88 years [range 2 months to 17 years], with a male-to-female ratio of 1.61:1.0. The highest incidence was between ages 2 and 10 years [85.1%]. Rectal bleeding was the presenting symptom in 78.5% cases. The polyps were solitary in 94% of cases. A majority of polyps [86.3%] were juvenile and 86.7% located in the rectosigmoid area. Three percent of cases had a positive family history. One case of Turcot syndrome was also identified. Juvenile polyps remain the most common polyps in Iranian children. Although the presence of a solitary polyp in the rectosigmoid colon is more prevalent, in a significant number of cases they are multiple and located in proximal parts. Polyps must be removed even when asymptomatic because of their probable neoplastic potential

Recurrent abdominal pain: an etiological study among in a referreal children's medical center in Iran

Recurrent abdominal pain [RAP] affects a significant number of children each year. It can be defined as experience of at least three episodes of pain, severe enough to affect activities, over a period of three months. The purpose of this study was to determine the organic and non-organic causes of RAP. Also, evaluate different variables of RAP such as age, sex, location and duration of pain, accompanying symptoms and stressful life events in two groups. During one year period from October 2003 to September 2004, 70 children [aged 4-12 years], were investigated in a referral Children's Center in Tehran. All patients underwent a thorough interview and complete physical examination and an initial sample of blood, urine, and stool evaluation. If any evidence of alarm symptoms [such as vomiting and night pain] were observed, additional studies were performed including abdominal ultrasonography, radiography, and/ or upper gastrointestinal Endoscopy. An organic cause was found in 21 [30%] patients and non-organic cause was identified in 49 [70%] cases. Main observations in non-organic groups were: more periumblical pain location, positive history for stressful life events in child and their family. Also, gastrointestinal problems were the most common organic causes in 60% of children. Other organic causes were urinary tract infections 10%, kidney stone 10%, cholelitiasis [5%], Giardiasis [15%], and abdominal migraine [5%]. Endoscopy seems to be a safe and reliable method in diagnosis of a number of organic lesions otherwise not detected by ordinary investigations. Our data suggest that among the children with RAP, non-organic causes are more commons [70%] than organic causes [30%]. This study showed that in spite of accessing to better instruments in medical sciences in recent decades, the percentage of nonorganic RAP in children is still high

Cerebral edema: a rare complication in galactosemia

A 34 day-old girl infant was admitted for poor feeding and cholestasis. She had a bulging fontanelle, with no evidence of intracranial infection or hemorrhage. Investigations demonstrated that she had galactosemia. Computed tomographic scans demonstrated the presence of diffuse cerebral edema. After treatment the edema resolved

Colonoscopic finding in children with lower gastrointestinal complaints

Colonoscopy is used for both diagnostic as well as therapeutic purposes in patients with lower GI symptoms. The aim of this study was to assess the clinical manifestations and to determine the colonoscopic findings of children with lower GI symptoms attending a pediatric hospital in Tehran. During a 5-year period [1996-2001], all children less than 16 years of age, who had undergone colonoscopy in the Gastroenterology Department of the Children's Hospital Medical Center in Tehran [Iran], were studied in respect to presenting symptoms, colonoscopic and pathologic findings, and the size, number and site of polyps if they were present. Among the 694 children [431 boys, 263 girls] less than 16 years of age who entered this study, 49.4%, who underwent colonoscopy, were aged between 1 and 5 years. Hematochezia, rectal prolapse, diarrhea, constipation, abdominal pain, fever, growth retardation, Clubbing, history of ulcerative colitis and polyps were present in 93.2%, 5.9%, 2.7%, 0.6%, 3.7%, 2.6%, 1.4%, 0.6%, 1.4%, 0.7% of the patients, respectively. Polyps, nodular lymphoid hyperplasia [NLH], granularity ulceration [suggestive for ulcerative colitis], suggestive for crohn's disease, mucosal edema, fragility, ulcer, solitary rectal ulcer, cobblestone appearance, vascular disorders, fissure, fistula and anal tags were present in 34.6%, 16.7%, 15.1%, 0.9%, 1.9%, 0.6%, 2.4%, 3.7%, 0.4%, 0.6%, 3%, 0.6% of the patients, respectively; 23.1% of the children had normal colonoscopic findings. Among the 240 cases found to have polyps on colonoscopy, 209, 18, 7, 4, 2 cases were reported as juvenile polyps, hamartoma, hyperplastic, lymphoid and necrotic in type, respectively. Of the 232 patients with polyps, 197 had a solitary polyp, 22 had 2 to 4 polyps, and 13 had more than 5 polyps. In respect to site, polyps were more frequent in the rectum, rectosigmoid region, left colon, diffuse, and right colon in decreasing order of occurrence. Colonoscopy is performed more frequently in children with hematochezia and rectal prolapse. Polyps, NLH and ulcerative colitis were the most frequent findings in the colonoscopies performed

Report of congenital generalized lipodystrophy in children's medical center, Tehram, Iran

Generalized lipodystrophy is a rare disorder in children characterized by absence of subcutaneous adipose tissue. We evaluated 10 patients with generalized lipodystrophy by skin and liver biopsy. Eight patients with steatohepatitis and cirrhosis were treated with Ursobile [uorsodeoxycholic acid] and vitamin E. In follow-up, serum triglyceride level was decreased

Detection of burkholderia cepacia complex in patients with cystic fibrosis

Background: Damaging of the lung function in patients with cystic fibrosis is the most frequent cause of death in these patients. Recently, Burkholderia cepacia has been emerged as an important opportunistic pathogen in these patients; because of its increased isolation from patients with cystic fibrosis since late1970s, the capacity for spread of infection among the cystic fibrosis patient community, its role in damaging lung functions, and its innate multiantibiotic resistance. These different aspects make isolation of Burkholderia cepacia an important task in cystic fibrosis health care settings

Materials and Methods: We examined the capacity of Burkholderia cepacia selective agar [BCSA] as a medium for primary isolation of Burkholderia cepacia samples. Biochemical tests were used to confirm the identification

Results: Burkholderia cepacia strains were isolated from 6 out of 53 respiratory samples as confirmed with biochemical tests

Conclusion: Results of the present study suggest that BCSA can be used as a selective medium with high specificity for primary isolation and identification of Burkholderia cepacia complex bacteria