Investigation of the Factors Affecting Bone Mineral Density in Children with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Children with celiac disease (CD) are at an increased risk of low bone mineral density (BMD) owing to malabsorption of fat-soluble vitamins, inflammation, and malnutrition. This study aimed to determine the prevalence and risk factors for low BMD in Iranian children with CD. @*Methods@#This prospective cohort study examined 149 Iranian children with CD between 2011 and 2018 at Zabol University of Medical Sciences. BMD was measured using dualenergy X-ray absorptiometry. Demographic, clinical, and laboratory data were collected from patients’ medical records. Logistic regression analysis was performed to identify the factors associated with low areal BMD (BMD-Z <−2) in the lumbar spine and femoral neck.Descriptive data were analyzed using the mean, standard deviation, and relative frequency.Data were analyzed using the chi-square test, t-test, and analysis of variance. @*Results@#Of the 149 children with CD, 27.5% had osteoporosis. The mean body mass index (BMI) Z score was −1.28±1.2. Lower BMI was associated with a higher likelihood of BMD-Z (odds ratio 2.17; p≤0.05). @*Conclusion@#Overall, the findings of this study showed that there was no correlation among Marsh classification, presence of specific human leukocyte antigens, and low BMD in Iranian children with CD. BMI can be a predictor of bone density in children with CD and may be applied clinically in early screenings to evaluate the bone health status in these children.

Lithophagia as a clue for celiac disease: a case report and literature review

Lithophagia is a type of pica that might be resulted from Iron Deficiency Anemia [IDA]which is the frequent presenting signs of Celiac Disease [CD]. A 5-year-old child with a two year history of the lithophagia with a, refractory IDA, abdominal distention and constipation. The child did not grow well and had failure to thrive. With suspicion to CD, TTg IgA level was measured and due to an incearse of TTg IgA level the patients were undergone esophagogastrodeudonoscpy and jejunal biopsy. The biopsy showed severe villous atrophy and an increase in limphoplasma cells. Biopsy confirmed diagnosis of CD and glutten free diet was initiated finally. Six months after diagnosis and commencing the gluten free diet, the lithophagia and constipation in patient eradicated completely. IDA and failure to thrive were improved and the level of TTg IgA was reached to the normal. The case demonstrated the relationship between lithophagia and CD in anemia. Therefore, in the same cases such as our case should be considered CD as the most important causes of lithophagia

Serum levels of tumor necrosis factor-a and interleukins in children with congenital heart disease

Background: Levels of anti-inflammatory cytokines in blood have a positive relationship with congenital heart disease [CHD]. We sought to assess the difference in serum cytokines levels between children with and without CHD

Methods: We recruited 60 patients with CHD and 30 healthy children, from 2013 to 2014. Patients with primary pulmonary hypertension; metabolic diseases; renal, endocrine, and chronic inflammatory diseases; fever; infection in the preceding 3 weeks; and malnutrition were excluded. Participants' demographic data were measured, and their cardiac diseases were diagnosed via echocardiography. Serum levels of tumor necrosis factor [TNF]-alpha, interleukin [IL]-6, andIL-18 were measured via ELISA

Results: Mean age of the participants was 4.28 +/- 3.44, 3.12 +/- 3.87, and 3.30 +/- 3.61 years in the cyanotic, acyanotic, and control groups, respectively [p value = 0.414]. Mean values of TNF-alpha [p value < 0.001], IL-6 [p value < 0.001], IL-18 [p value = 0.030], right ventricular pressure [p value < 0.001], and pulmonary pressure [p value = 0.015] were higher in the case group, while the BMI was higher in the controls [p value < 0.001]. Mean values of TNF-alpha [p value < 0.001], IL-6 [p value < 0.001], and right ventricular pressure [p value < 0.001] were significantly higher in the cyanotic children, whereas the BMI was higher in the controls [p value < 0.001]. Levels of TNF-alpha and IL-6 had significant correlations with right ventricular pressure

Conclusion: The present study showed a differed serum cytokines levels between children with and without CHD

Serological evaluation of celiac disease in children with congenital heart defect; a case control study

Due to the increased prevalence of celiac disease in chromosomal anomalies and other congenital anomalies, this study was conducted to evaluate the seroprevalence of celiac disease [CD] in patients with congenital heart defects [CHD]. This case-control study was done on 1002 children in two groups of CHD patients [n=402] and controls [n=600]. The serum tissue transglutamianse [TTG] levels were investigated. The two groups were compared in terms of TTG IgA levels and p<0.05 was considered as the significant level. The means of serum TTG IgA levels in children with CHD and the control groups were 19.17 +/- 46.67 and 7.77 +/- 10.02 u/mL respectively [p=0.001]. After ANOVA analysis a significant difference between two cyanotic and acyanotic subgroups of cases and control groups was observed [p=0.000]. The follow up tukey test showed only non-significant difference between the cyanotic and acyanotic cases. The frequency of TTG IgA with the consideration of 20 u/mL as cut-off point showed a significant association with groups [X2=28.31 and p=0.000]. According to the results the serum TTG IgA levels were significantly higher in patients with CHD than normal children and screening for CD in children with CHD is recommended

Serologic evaluation of celiac disease in patients with beta thalassemia major and control

This study reports evaluated prevalence of CD in patients with Beta-thalassemia major. Celiac Disease [CD] is an autoimmune disorder triggered by ingestion of gluten in genetically predisposed individuals. In this case-control study in a period of 3 years, which was performed on 620 children in two groups of Beta-thalassemia major patients [n=200] and control [n=420], serum tissue transglutamianse [tTG] IgA levels were measured. The two groups were compared together in terms of tTG IgA levels, and p<0.05 was considered significant. The means of serum tTG IgA levels in patients with Beta-thalassemia major and control groups were 28.81+/-68.44 and 6.94+/-6.68 U/mL, respectively. There was a significant difference in favor of the case group [p=0.000]. Body mass index in the two case and control groups had a significant difference [t=3.859, p=0.001]. Belonging to each group will change the probability of having less than 20 in tTG IgA [odds=0.285] and it means that belonging to the control group has a protective role. There is only a significant association in the case of all population [r=0.102, p=0.011]. Body mass index in the two case and control groups had a significant difference [t=3.859, p=0.001]. Probability of CD should be considered since the prevalence of CD is high in patients with and Beta-thalassemia major. Patients with thalassemia major are recommended for screening for CD

Evaluation of cholestasis in Iranian infants less than three months of age

The aim of this study is to find-out the possible etiologies in Iranian infants less than three months in Shiraz, South of Iran. Cholestatic jaundice most probably occurs due to a pathological condition and the most frequent causes in early infancy are neonatal hepatitis and biliary atresia. Early diagnosis and treatment of infantile cholestasis can improve prognosis of liver diseases by prevention of the complications of these disorders. In this retrospective study, 122 infants under 3 months of age with cholestasis were studied in Nemazee Hospital [affiliated to Shiraz University of Medical Sciences] during the years 2001-2011. Demographic data, duration of jaundice, liver biopsy and the causes of cholestasis were recorded. There were 76 males [62.3%] and 46 females [37.7%] with a mean age of 54.4 +/- 23.7 days. The most common clinical finding was jaundice that was seen in all patients [100%].The onset of jaundice was the first day to the fifty two days of age, with an average age of 15.6 +/- 16.1 days. Other findings included hepatomegaly in 92 patients [76.4%], clay-color stool in 54 [44.3%], and splenomegaly in 29 patients [23.8%]. In this study, the most common causes of cholestasis were biliary atresia [30=24.6%], idiopathic neonatal hepatitis [30= 24.6%] and bile ducts paucity [16=10.3]. The results of this study showed that biliary atresia and neonatal hepatitis are the most common cause infantile cholestasis in this area. It is recommended that biliary atresia should be discriminated from other form of neonatal cholestasis

Combination of erythromycin and propranolol for treatment of childhood cyclic vomiting syndrome: a novel regimen

This study aimed to evaluate the erythromycin efficacy in childhood cyclic vomiting syndrome. Cyclic vomiting syndrome [CVS] is an unusual cause of episodic emesis in children and erythromycin is an effective treatment. In this prospective study, 301 patients with a final diagnosis of CVS enrolled in two separated groups. The first group received erythromycin for 7 days and propranolol for at least 9 months [n=155]. The second group was treated with propranolol alone for at least 9 months [n=146]. These two groups were compared for response to the treatment and the recurrence of symptoms after treatment completion. Relationship of response, recurrence, and characteristics of the disease was assessed. Both groups showed a significant difference in terms of response to treatment [P=0.002], however the recurrence after treatment completion had no considerable difference [P=0.563]. There was no relationship between CVS characteristics and these two items [response and recurrence]. In our point of view, the addition of erythromycin to standard propranolol treatment can improve the response to treatment, although it has no significant effect on recurrence of CVS symptoms. We suggest the use of erythromycin for 7 days in addition to CVS standard therapy

Causes of delay in diagnosis of smear-positive pulmonary tuberculosis patients referred to the tuberculosis center of Zahedan

Tuberculosis is now the major cause of mortality in the world. This study has tried to identify the factors affecting the diagnosis of this disease by determining the relationship between delay in diagnosis and factors associated with patient and health system. This research was a cross-sectional study conducted on smear positive pulmonary tuberculosis patients referred to the tuberculosis center in the first half of 2008. Required information was completed through patient records and patient interviews. A total 98 patients were studied including 42 males and 56 females. Average age of patients was 51.6 +/- 19.57. Average delay in diagnosis was 2.8 +/- 1.78 months. The average delay of patients and health system was respectively 2.6 +/- 1.76 months and 6 +/- 4.27days. Data analysis showed that there is no relationship between the delay in diagnosis and individual variables such as age, gender, occupation, etc., and examination of sputum smears at the first visit. However, there is a significant relationship between patient delay with different factors such as education [p=0.03], marital status [p=0.03], existence of hospital or medical centers in the residence [p=0.02], distance to the medical center [p=0.02] and between health system delay and residence in the city [p=0.01], distance to this medical center [p=0.03] and obtaining chest X-ray [CXR] in the first visit [p=0.003]. The results showed that with the increase of literacy, the establishment of new hospitals and health centers in remote areas and suburbs as well as chest X-ray in the first visit, the amount of delay in diagnosis can be reduced.