[Frequency of overtreatment and undertreatment in children with congenital hypothyroidism in Qom Province, Iran]

Congenital hypothyroidism [CH] is one of the most important preventable causes of mental retardation in the world. In the recent years, overtreatment and under treatment episodes are considered as one of the most important causes of neurocognitive developmental disorders in patients with CH, which have been taken into consideration in recent years. The current study aimed to evaluate the frequency of overtreatment, undertreatment and dose of respective drug in these in patient with CH in Qom city. In a study performed according to the existing data [Routine Data Base Study] in Mirei Clinic of Qom city, 201 medical records and 823 thyroid function tests were extracted from 2006 to 2011. The data were analyzed using independent t- and chi-square tests. The significance level was considered p < 0.05. Of 201 patients whose records were complete, respectively, 173 patients [86.07%] and 69 patients [34.3%] had at least one episode of overtreatment and undertreatment. In 151 [87.2%] and 30 [43%] patients, respectively, at least one episode of overtreatment and one episode of undertreatment were reported before 6 months of age. The mean weight and primary T4 in undertreatment patients were significantly higher. There was no significant difference between two sexes in the two groups of overtreatment and undertreatment. 449 [83%] out of 538 overtreatment episodes were in patients who took the treatment dose lower than recommended dose. According to the results of this study, the prevalence of overtreatment and undertreatment in first 6 month of treatment was more common. The highest incidence of overtreatment occurred with lower than recommended dose. Also, the weight and primary T4 can be a guide for adjustment of drug doses in patients with CH

Stool antigen tests for the detection of Helicobacter pylori in children

Reliable non-invasive methods for detection of Helicobacter pylori [H. pylori] infection are required to investigate the incidence, transmission, and clearance of infection in childhood. Detecting bacterial antigens in stool offer an alternative noninvasive diagnostic test. However its accuracy in developing countries is not well established. The aim of this study was to evaluate the performance of stool antigen test for H pylori in Iranian children with recurrent abdominal pain necessitating endoscopy. One hundred three children enrolled in this study. Endoscopy and biopsy was done on all patients providing a criterion standard for validation of the H. pylori stool antigen [HpSA] tests. The presence of H. pylori organisms in stool was determined by an enzyme-linked immunosorbent assay using a commercially available polyclonal antibody. HpSA sensitivity, specificity, and positive and negative likelihood ratios were determined with reference to the results of cultures of gastric biopsy. Of the 103 children tested 41 [39.8%] and 39 [37.8%] were positive for H. pylori according to the results of cultures of gastric biopsy and HpSA, respectively. The sensitivity, specificity, and positive and negative likelihood ratios of HpSA were found to be 85%, 93%, 89.7%, and 90%, respectively. In this pilot study, a low-cost and rapid diagnostic technique, stool antigen test proved to be highly sensitive and specific for detecting H pylori infection in children with recurrent abdominal pain. Our results are comparable to those reported elsewhere in children and demonstrate that the HpSA test can replace endoscopy and biopsy for detecting H. pylori infection

[Doxepin is more effective than nortriptyline and placebo for the treatment of diarrhea-predominant irritable bowel syndrome: a randomized triple-blind placebo-controlled trial]

The current treatment of IBS is often unsatisfactory and frustrating. Several controlled trials have demonstrated benefits of tricyclic antidepressants for irritable bowel syndrome, especially when pain is a prominent symptom but the efficacy of antidepressants in irritable bowel syndrome is controversial. The aim of this study was to compare the effect of doxepin and nortriptyline on diarrhea-predominant irritable bowel syndrome. Seventy-five patients with IBS according to Rome III criteria were treated for two months. The patients were randomly assigned to one of three groups treated with doxepin, nortriptyline or placebo. Subjects were assessed clinically one month and two months after treatment. The symptoms and adverse effects of the drugs were recorded in the questionnaire. The total score was considered as the number of the symptoms for each patient, which ranged between zero and six. Improvements in abdominal pain and bloating in the doxepin group were significantly higher than the nortriptyline or the placebo groups [P=0.001 and P=0.012, respectively]. However, improvement in diarrhea in patients on nortriptyline was significantly higher than the other groups [P=0.018]. The average improvement of symptoms in the patients after two months of treatment in doxepin, nortriptyline and placebo groups, respectively were 2.56, 2 and 0.6 [P<0.05]. Both doxepin and nortriptyline are effective for the treatment of diarrhea-predominant irritable bowel syndrome in a period of two months but doxepin seems to be more efficacious than nortriptyline in this regard. However, larger comparative trials are suggested

Infectious diseases in hospitalized children of central Iran

Despite dramatic progress in their treatment and prevention, infectious diseases remain a major cause of death and debility around the world. We planned this study to determine the epidemiologic features of infectious diseases in children [0 to 12 years] admitted to the Fatemieh Hospital in Qom, Central Iran. In this retrospective descriptive study the data were collected from medical records of 892 patients with infectious diseases admitted to the Fatemieh Hospital in Qom during summer 2007 [22 June through 22 September]. The epidemiologic features were analyzed using SPSS software. Eight hundred ninety two out of 2105 [42%] admitted cases to the Fatemieh Hospital during summer 2007 [22 June through 22 September] were infectious diseases. The most frequent infections were gastroenteritis, pneumonia and urinary tract infection; 57.6%, 11% and 7.1%, respectively. Mortality rate of infectious diseases was 0.3%. This study confirms the continuing importance of pediatric infectious diseases in central Iran especially gastroenteritis and pneumonia. Improvement of hygienic conditions of water supply and routine use of pneumococcal and Haemophilus influenzae vaccines are suggested