Quality of life and psychiatric comorbidity in children and adolescents with functional constipation: a case-control study

Background: The behavioral and psychological problems associated with chronic constipation include a wide range of disorders, which lead to impaired quality of life. The purpose of the current study was to evaluate psychiatric disorders and quality of life in children and adolescents suffering from chronic functional constipation

Materials and Methods: In a case-control clinical trial, 55 children and adolescents with functional constipation and 55 individuals without constipation were included into case and control groups, respectively. After taking medical history and physical examination, three questionnaires including demographic information, pediatric quality of life [PedsQL] questionnaire, and strengths and difficulties questionnaire [SDQ] were provided to parents, children, and adolescents. Collected data were coded and analyzed using SPSS software

Results: The mean child self-reported and parent-reported scores of PedsQL were 54.67+/-3.9 and 49.86+/-3.2 in the case group, while it was 63.26+/-4 and 66.09+/-3.4 in the controls. Only parent-reported quality of life score was statistically different among case and control participants [p =0.014]

The emotional performance of quality of life was statistically different based on both self and parents' reports [p=Q.Ol6 and 0.024, respectively]

Total SDQ score was in abnormal levels in 93% and 83% of the case and control participants, which was insignificant [p =0.631]

There was no statistically difference in SDQ subgroups between the two groups

Conclusion: Quality of life and emotional performance are impaired in children with functional constipation and they should be screened for consequent disorders. Treatment and management of these patients can be improved through evaluating constipation related indices, quality of life, and referring at risk patients to related specialists

Analysis of MTHFR gene C.677C>T and C.1298A>C polymorphisms in Iranian patients with non-syndromic cleft lip and palate

Non-syndromic cleft lip with or without cleft palate [nsCL/P] is one of the most common congenital abnormalities of the orofacial region with a multifactorial etiology. The present study aimed to investigate the association of two common polymorphisms of methylenetetrahydrofolate reductase [MTHFR] gene [c.677C>T and c.1298A>C] with the occurrence of nsCL/P in an Iranian population. Forty-five nsCL/P patients, 43 mothers of patients, and 101 unrelated controls participated in the present study. Analysis of c.677C>T and c.1298A>C polymorphisms in MTHFR gene was conducted using polymerase chain reaction and restriction enzyme digestions. There was no statistical difference in genotype and allele frequencies for c.677C>T variants between patients or their mothers and the control group. However, differences in the frequencies of alleles and genotypes of c.1298A>C polymorphism were statistically significant between patients and control group [P=0.01 for alleles and P=0.005 for genotypes]. The odds ratios [OR] for the CC versus AA homozygotes were 6.1 [95% CI 1.8-20.5] and 4.2 [95% CI 1.1-15.4], in patients and mothers, respectively. We found no association between genetic polymorphism of MTHFR c.677C>T and the risk of nsCL/P in the population studied. Yet the results suggested that c.1298A>C polymorphism of MTHFR gene may be a risk factor for the occurrence of nsCL/P in the Iranian population

Utility of modeling end-stage liver disease in children with chronic liver disease

Chronic liver diseases consist of wide spectrum disorders that may be complicated by cirrhosis and therefore need to transplantation. The pediatric end-stage liver disease [PELD] score and model of endstage liver disease [MELD] score has been used as predictors of mortality chronic liver diseases listed for liver transplantation. The aim of this study is evaluation of relation between PELD MELD score and evidence of cirrhosis in children with choronic liver disease. This cross-sectional study conducted on 106 patients of chronic liver disease referred to Ghaem haspital, Mashhad university of medical science, Iran during 24 months period [2010-2013]. PELD and MELD score were calculated for all patients. Clincal and patholoogical findings of cirrhosis were recorded. Mean age of patients was 68/3 +/- 41.8 months. Mean PELD MELD score was -1/59 +/- 9/64. There was significant correlation between PELD MELD score and clinical icter, spelenomegaly, evidence of hepatopulminary syndrome, esophageal varices, evidence of cirrhosis in tissue specimences. PELD MELD score appear to be benefit for detection of cirrhotic children among paients with choronic liver disease

[Endocrine disorder in children with chronic liver diseases]

An important consequence of chronic liver disease [CLD] is endocrine disorders. The main object of this study was to assess serum hormones in children with CLD. In a cross sectional study between 2007-2009, 57 children with chronic liver disease were enrolled. Levels of serum triiodothyronine [T3], thyroxin [T4], thyroid stimulating hormone [TSH], parathormon [PTH], calcium[c], phosphor [P], alkalanephosphatase [ALP],growth hormone[GH] and insulin like growth factor-1[IGF-1], albumin [ALB] and total protein, triglyceride [TG] and cholesterol [CHOL], fasting blood sugar [FBS] and liver function tests were measured. In this study, most patients' thyroid hormones and fasting blood sugar were at normal range. But there was a significant decline in serum IGF- 1 levels in this patients. 28 percent of children had PTH levels higher than normal range for age and 24 percent had serum phosphor levels lower than normal range .1/3 of these patients were bone fracture. Overt diabetics did not obsereve in our children. Children with CLD are GH resistant and might be at risk of osteopenia and bone fracture. So serum hormone levels should be carefully monitored in children with CLD

role of zinc sulfate in acute bronchiolitis in patients aged 2 to 23 months

Evaluating the effect of zinc sulfate in improving the clinical manifestations of acute bronchiolitis in children younger than 2 years. This was a double blind pilot trial on 50 patients aged 2 to 23 months at Ghaem and Dr. Sheikh Hospitals in Mashhad from January 2008 to March 2009. Patients were randomly divided into two groups: a case group received oral zinc sulfate and to the control group was given placebo. Mean age of case group was 168.0 +/- 108.6 days and control group 169.2 +/- 90.4 days [P=0.98] with male predominance in both groups. At first there was no statistically significant difference between the two groups in reducing the symptoms. But 24 hours after treating, improvement of some important manifestations including tachypnea, subcostal and intercostal retraction, wheezing and cyanosis revealed statistically significant difference in control group in comparison with case group [P=0.04]. Zinc sulfate has no benefit in improving clinical manifestations of acute bronchiolitis

[Diagnostic accuracy of polyclonal stool antigen for detection of helicobacter pylori infection in children]

Helicobacter pylori infection has various clinical features. One of the most common presentations of this infection is upper abdominal pain. Complications such as gastritis, gastric ulcer, gastric carcinoma and MALT lymphoma mandate early diagnosis of H.P infection by a low cost and non invasive manner. The aim of this study was to evaluate the diagnostic role of H.P stool antigen detection as a simple and non invasive method for diagnosis of this infection. Upper endoscopy with gastric biopsy was done on all patients between 6 months to 18 years old with upper abdominal pain. Stool test was done by polyclonal anti-h.p antibody. Results of stool Test were compared with results of RUT and histologic examination Overall 110 patients [57 boys, 53 girls] were studied, 32 patients were Helicobacter pylori positive and 78 patients were Helicobacter pylori negative based on RUT and histologic examination. Stool antigen testing was positive for 39 patients. Sensitivity and specificity of stool Ag were 100% and 91% respectively Stool Ag test has high sensitivity and negatity predictive value for diagnosis of Helicobacter pylori infection

[Children sedation during gastrointestinal endoscopy comparison of two methods]

Endoscopy is an invasive and painful procedure in children. Since children can not tolerate pain and stress, sedation is necessary in pediatric endoscopy. The aim of this study was comparison of propofol versus intravenous midazolam for reducing anxiety in children. In this study, 103 patients [2-14 years old] in whom endoscopy was indicated were divided into three groups. In the first group, patients received propofol, in the second group, intravenous midazolam was given and patients in the third group received no sedation. Procedures were performed in the endoscopy room. Heart rate, respiratory rate and oxygen saturation were recorded before and during endoscopy in 1 minute intervals. Tremor, sweating and pain scores were recorded by using Visual Analogue Scale [VAS]. A significant increase in heart rate was documented in all groups [p=0.038]. Respiratory rate also increased in all groups. Too Oxygen saturation decreased in the propofol group, but it was not statistically significant [p=0.17]. Pain score in propofol group was significantly lower than those receiving midazolam [20 +/- 22 vs 50 +/- 27, p<0.001]. No noticeable side effect was seen in the propofol group. It seems that propofol is a very useful and effective drug for reducing pain and stress in children and its administration leads to a safe sedation in pediatric endoscopy

Cryptosporidium infection in pediatric patients with lymphohematopoietic malignancies

Cryptosporidium parvum is a common protozoan pathogen with worldwide distribution. It localizes on the intestinal cells and prolonged diarrhea in immunocompromised patients. The aim of this study was to estimate the prevalence and the clinical features of enteric cryptosporidiosis in pediatric patients with lymphohematopoietic malignancies. in this cross-sectional study stool samples were collected from 100 children [67 boys, 33girls] with lymphohematopoietic malignancies who underwent chemotherapy between the ages of 6 months and 17 years [mean age 7.5 years]. All of the specimens were examined for the oocysts of C. parvum by modified Ziehl Neelsen [MZN] staining technique and coproantigens of C. parvum by EL IS A. Cryptosporidium infection was detected in 22 patients. 16 [72.7%] of the infected patients were male and 6 [27.3] female. 7 [31.8%] patients were <5 years, 8 [36.4%] 5-10 years and 7 [31.8] >10 years old. Parasites were detected in 19/85 [86.4%] patients with ALL, 2 of 5 [9.1%] with AML, and 1 of 10 [4.5%] with NHL. Clinical symptoms were found in 11 [50%] of the patients. We found longer duration of chemotherapy in patients who were positive for Cryptosporidium infection [Mean=2067 days] in comparison to negative group [Mean=258.5 days] [ANOVA, f=2.82, P=0.04]. The incidence of Cryptosporidium infection was 22% among pediatric patients with lymphohematopoietic malignancies. We recommend evaluation of these patients with at least two different diagnostic methods in order to prevent possible life threatening outcomes