Effects of rhubarb (Rheum ribes L.) syrup on dysenteric diarrhea in children: a randomized, double-blind, placebo-controlled trial / 中西医结合学报

<p><b>BACKGROUND</b>Rheum ribes L. is a plant native to China, Iran, Turkey, India, and a few other countries. Antidiarrheal activity is considered to be one of its important properties according to various systems of traditional medicine. An increasing rate of bacterial resistance to antibiotics has led to treatment failure in some cases of shigellosis in children, and underlines a need for safe, efficient and valid options.</p><p><b>OBJECTIVE</b>The purpose of this study is to evaluate the efficacy of R. ribes syrup as a complementary medicine for treatment of shigellosis in children.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>This randomized, double-blind, placebo-controlled trial started with a group of 150 children aged between 12-72 months with suspected Shigella dysentery. R. ribes syrup or placebo syrup was administered to the intervention and control groups, respectively for 5 days. In addition, the standard antibiotic treatment (ceftriaxone for the first 3 days and cefixime syrup for 2 further days) was administered to both groups.</p><p><b>MAIN OUTCOME MEASURES</b>Body temperature, abdominal pain, need for antipyretics, defecation frequency, stool volume and consistency and microscopic stool examination were recorded as outcome measures. Any observed adverse effects were also recorded.</p><p><b>RESULTS</b>Mean duration of fever and diarrhea in the R. ribes group was significantly lower than that in the placebo group (P = 0.016 and 0.001, respectively). In addition, patients in the R. ribes group showed shorter duration of need for antipyretics and shorter duration of abdominal pain (P = 0.012 and 0.001, respectively). However, there were no significant differences between the two groups regarding the microscopic stool analyses. Furthermore, no adverse effect was reported.</p><p><b>CONCLUSION</b>R. ribes syrup can be recommended as a complementary treatment for children with Shigella dysentery.</p><p><b>TRIAL REGISTRATION</b>Iranian Registry of Clinical Trial: IRCT2014070518356N1.</p>

Comparison of two regimens of vitamin D supplementation for vitamin D-deficient neonates

<p><b>INTRODUCTION</b>Vitamin D deficiency is common in pregnant women, and supplementation of vitamin D is necessary for the infants of these women. This study explored the efficacy of an alternative way of vitamin D supplementation in an area with a high prevalence of vitamin D deficiency in mothers.</p><p><b>METHODS</b>This was a non-randomised clinical trial conducted in 2010 in Yazd, Iran. Full-term healthy infants born to vitamin D-deficient mothers (n = 82) were divided into the high-dose regimen (HDR; single oral bolus 30,000 IU vitamin D3, n = 34) and the standard-dose regimen (SDR; 400 IU/day vitamin D3 within two weeks of life, n = 48) groups. 25-hydroxyvitamin D (25OHD) was measured using chemiluminescent immunoassays, and 25OHD level > 20 ng/mL was deemed sufficient.</p><p><b>RESULTS</b>Over 90% of infants in the HDR group attained vitamin D sufficiency within one month, while comparable sufficiency was reached in the SDR group only after four months. At two months, the proportion of infants attaining 25OHD > 30 ng/mL was 93.3% and 27.9% in the HDR and SDR groups, respectively (p = 0.003). None of our infants achieved 25OHD levels > 100 ng/mL.</p><p><b>CONCLUSION</b>For infants born to vitamin D-deficient mothers, oral supplementation of 30,000 IU vitamin D3 during the first month of life, followed by a routine recommended dose of 400 IU/day, should be considered. The four-month lag for attaining vitamin D sufficiency in 90% of infants in the SDR group may have clinical implications and should be further investigated.</p>

Vitamin D requirement in pregnancy to prevent deficiency in neonates: a randomised trial

<p><b>INTRODUCTION</b>The exact amount of vitamin D required for pregnant women to adequately supply the foetus during pregnancy is still unclear. This randomised trial attempted to determine the optimal dose of vitamin D necessary during pregnancy in order to attain a vitamin D level > 20 ng/mL in neonates.</p><p><b>METHODS</b>A total of 51 healthy, pregnant women in Yazd, Iran, were recruited in 2009. Of these, 34 were randomised to receive either 50,000 IU (Group A) or 100,000 IU (Group B) of vitamin D3 per month from the second trimester of pregnancy. The remaining 17 pregnant women, who formed the third group (Group C) and were found to have vitamin D deficiency, were initially treated with 200,000 IU of vitamin D3, following which the dose was adjusted to 50,000 IU per month. 25-hydroxyvitamin D (25[OH]D) in cord blood was measured by chemiluminescence immunoassay, and a serum 25(OH)D level < 20 ng/mL was defined as deficiency.</p><p><b>RESULTS</b>All the pregnant women had a vitamin D level < 30 ng/mL at the beginning of the second trimester. The neonates of 76% of women from Group A had sufficient levels of 25(OH)D. All the neonates born to women in Groups B and C had 25(OH)D > 20 ng/mL. No side effects were observed in our participants during the period of vitamin D supplementation.</p><p><b>CONCLUSION</b>A vitamin D3dose > 50,000 IU/month is required during the second and third trimesters of pregnancy for vitamin D-deficient pregnant women in order for their neonates to achieve serum 25(OH)D levels > 20 ng/mL. Supplementation with < 50,000 IU/month is insufficient to ensure a vitamin D level > 20 ng/mL in all neonates born to vitamin D-deficient pregnant women.</p>

Acute glomerulonephritis: a 7 years follow up of children in center of Iran

Acute glomerulonephritis [AGN] is a type of renal disease which indicates the inflammation of glomerulus and nephrons. This study was carried on 94 children,<15 years old with the diagnosis of AGN who were admitted to Qom and Yazd's hospitals between 2000 and 2006. Data were collected using hospital records on admission, progression notes and outpatient follow up. Among 94 patients, 55.3% were male and 44.6% were female. Mean age of patients was 8.2 +/- 2.7 years old. Acute post streptococcal glomerulonephritis [APSGN] was reported in 92.5%, membranoproliferative glomerulonephritis in 4.2%, hemolytic uremic syndrome in 2.1% and IgA nephropathy in 1.06%. There was no significant differences between GN types and gender [P=0.54]. Clinical manifestation included edema in 68.8%, oliguria in 36.3%, gross hematuria in 69.1%, HTN in 61.7% and anuria in 1.06%. Microscopic hematuria was detected in all patients. In the time of follow up none of patients had hypertension, 3.1% had proteinuria and 6.3% had microscopic hematuria. APSGN is the most common causes of AGN in Qom and Yazd's children. Early diagnosis and treatment of APSGN may protect children from long term morbidity and mortality and improve quality of life

Study to evaluate two dosage regimens of vitamin d through an academic year in middle school girls: a randomized trial

Vitamin D is an essential hormone for growth and development of bones in children. There is a lot of evidence for deficiency of this vitamin in Middle East females. This study conduct to find a way to combat deficiency in girls during rapid growth phase of puberty in academic year. One hundred and two Middle School girls who had not consumed any vitamins supplement have been participated in this randomized clinical trial. They allocated randomly in two case groups who received 50, 000 or 100, 000 IU vitamin D3 in October and three months later in January or in control group who received vitamin E. At the end of winter blood samples for 25-hydroxyvitamin D were checked. The mean of 25-hydroxyvitamin D were 5.5 +/- 1.5 ng/ml, 15.2 +/- 6 ng/ml, 23.0 +/- 6.8 ng/ml in control, 50, 000 and 100, 000 IU vitamin D groups respectively [P<0.05]. Neither dosage of vitamin D could raise 25-hydroxyvitamin D above 20 ng/ml in all cases. However, none of the students in 100.000 IU of vitamin D3 had severe deficiency in winter. Headache, dizziness, and weakness were the most common complain after vitamin D consumption, but no difference between groups detected [P>0.05]. Urine calcium/creatinin ratio was equal in case and control groups [P>0.05]. 100, 000 IU of vitamin D3 every three months [equal to 800IU/day] can raise 25-hydroxyvitamin D above 12 ng/ml in all cases but for area with high prevalence of sever deficiency, dosage more than 100, 000 IU every three months or shorter interval recommended to achieve optimal level

Urinary calcium/creatinin ratio with different dosages of vitamin D3 prophylaxis in infants

The requirement of vitamin D for breast-fed term infants remains an area of controversy. Different dosage is needed according to environmental factors such as sunlight exposure. Reception of more than 400 I.U. of vitamin D daily produces hypercalcemia. A random urine calcium/creatinin ratio [UCa/Cr] is a screening test for detection of hypercalciuria. Setting adequate values of vitamin D3 prophylaxis by random UCa/Cr in infant population of Yazd city in Iran, is the aim of present study. A total of 90 healthy, full term newborns of both genders were enrolled in the study. They were divided equally into three receiving vitamin D3 prophylaxis groups as follow: [I] 200 IU/daily, [II] 400 IU/daily and [III] 50000 IU two times in fifteen and sixty days after birth. A random urine specimen from each subject was analyzed for calcium, creatinin and serum 25-hydroxy-vitamin D at the end of three months of life. From all 90 studied infants, 25 [83.3%] infants with 200 IU/daily vitamin D3, 23 [76.7%] infants with 400 IU/daily vitamin D3 and 28 [93.3%] who received 50000 IU two times [76 infants, 84.4%] had hypercalciuria and 14 [15.6%] infants remained with low values of Ca/Cr ratios. According to high prevalence of hypercalciuria in this survey, it is recommended to evaluate the vitamin D level in infants and use proper amount of supplemented vitamin D. It seems that 200 IU/daily could be used in infants in our area

[Comparative study of the effect of music distraction and Emla cream on pain of the children during intravenous cannulation]

The pain of the intravenous cannulation is considered as the major limitation in pediatric clinical care. Reducing the pain of intravenous cannulation has been the motive for many investigations. In the present study, the effect of two methods for reducing the pain of intravenous cannulation in children was compared. Ninety children between 6-12 years old who admitted in the pediatric ward were selected a randomly allocated to either Emla cream group, music distraction group or control group in equal numbers. The pains of the children were assessed by Wong pain face scale and also, general behaviors of the samples were evaluated by the researcher. Mean pain score in the Emla cream group was significantly lesser than the music and the control groups [1.36 against 3.5 and 3.56, respectively; P<0.001], but, there was no statistically significant difference between the control and music distraction groups. Sex, age and other variables had no effect on pain sensation during cannulation. In Emla cream group, the mean pain score were significantly lower in older children [over 10 years]. This study showed that Emla cream can significantly reduce the pain of intravenous cannulation in children, especially in older ones. The researchers recommend the use of Emla cream one hour before intravenous cannulation in children

Water status of breastfed infants during weaning in Yazd, Iran

To investigate the state of hydration in infants during the weaning period in dry and hot climates in the center of Iran. Using a refractometer, 162 urine specific gravity [USG] was measured from 400 infants, between 4 to 6 months old. They were chosen among infants who visited the primary clinics in the city of Yazd, Iran for routine vaccination during the summer and winter of 2005. A questionnaire was filled out on air conditioning system and diet from mothers. A USG > 1.020 was accepted as dehydrated, and a USG < 1.010 as well hydrated. Thirty-one percent of the infants were dehydrated, and 34% were well hydrated, infants were more dehydrated in summer [p < 0.05]. Twenty-seven percent of them started solid food without water supplementation, and dehydration was significant in most of them [p < 0.05]. We could not determine which type of air conditioning devices now used at home affect water status, but there was a trend toward dehydration in those using both fan and cooler [p=0.096]. In the desert area in the center of Iran, during weaning, approximately one third of the infants are exposed to the danger of dehydration. Our primary health care provider should consider the priority of water during weaning when water supplementation is safe