[Cardiovascular risk factors in obese children and adolescents]

Background: obesity is one of the most important health problems in many countries which increase the incidence of cardiovascular diseases. Although cardiovascular findings are specific to adulthood, but identification of cardiovascular risk factors in childhood is necessary to prevent damage to target organs in adulthood The aim of this study was to evaluate the frequency of cardiovascular risk factors in obese children and adolescents

Methods: this cross-sectional descriptive study was performed on 442 children and adolescents aged 4 to 16 years old. After the clinical examination, blood pressure, height and weight were measured. The body mass index over than 95th percentile for age and sex or BMI Z-Score equal or more than 2] was defined as obesity. After 12 hours of fasting, the blood samples were taken for measurement of serum lipid profiles, insulin and glucose levels

Results: of the total obese subjects, 15.8% [n=70] had no risk factors for cardiovascular disease, while 22.2% had one, 32.4% had two, 22.4% had three, 2.5% had four and 1.6% had five risk factors. The most common risk factor was hypertriglyceridemia [52.3 %] and the second risk factor was impaired fasting blood glucose [34.9%]

Conclusion: the prevalence of cardiovascular risk factors is high in obese children and adolescents

[Recombinant human growth hormone effects on growth in cystic fibrosis]

Background: Growth retardation is a common finding in cystic fibrosis [CF] patients. Recombinant human growth hormone [rhGH] has shown promising results in improving weight, height and clinical status of CF patients. In this study we aim to evaluate efficacy of rhGH on physical growth, clinical status and pulmonary function in CF patients

Methods: In this prospective clinical trial we recruited 34 CF patients with mean age of 62.05 31.11 month. Patients were followed for 6 months and then were treated with rhGH 0.35 mg/kg/week for the next six month. Measurements included height, weight, growth velocity, pulmonary function, hospitalizations, outpatient antibiotic use and Insulin-like growth factor-1 [IgF1] before and after rhGH therapy

Results: Growth velocity, Insulin-like growth factor-1 levels, hospitalization and antibiotic therapy were significantly improved after rhGH treatment. Pulmonary function evaluations including forced vital capacity [FVC] and forced expiratory volume [FEV1] showed no significant difference, before and after rhGH therapy

Conclusions: These results show significant effects of rhGH treatment on growth and clinical status of CF patients, but didn't positive effect on Pulmonary function

[Rare MEFV mutations in patients with henoch schonlein purpura from north west of country]

Background and Objectives: coexistence of Familial Mediterranean Fever [FMF] with various systemic vasculitides, such as Henoch Schonlein Purpura [HSP] and other inflammatory disorders has been reported and MEFV gene has been suggested to play a significant role in the pathogenesis of this association. In This study, the rare MEFV mutations in patients with HSP from north west of country and its association with clinical symptoms of disease were evaluated

Material and Methods: Forty unrelated patients were referred by specialists to the Molecular Medical Genetic Center of Tabriz. Clinical diagnosis of HSP was made according to published criteria. The control group consists of 200 ethnically matched persons apparently healthy without any king of inflammatory diseases. screening for the 3 mutations; R761H, P396S and R408Q were performed by using amplification refractory mutation system polymerase chain reaction [ARMS-PCR[and polymerase chain reaction restriction fragment length polymorphism [PCR-RFLP]. Chi[2] test and Fisher's exact test were used to statistical analysis

Results: Of 40 patients studied, 37 [92.5%] showed without mutation, while 3 [7.5%] had MEFV mutation that three of them were compound heterozygous for the P396S/R408Q mutations. There was a statistically significant difference between the patient group and healthy individuals regarding P396S and R408Q mutations [p= 0.0043]. findings suggest that P396 and R408Q mutations always together occurred and not only contribute to the susceptibility to HSP, also associated with clinical symptom of fever

Conclusion: Our results suggest that some MEFV mutations could be a contributory genetic factor to HSP in the north west of the country

[Evaluation of prevalence and risk factors for hepatitis E in pediatric patients in Tabriz children hospital]

Background and Objectives: Hepatitis E is usually self-limited, but may be associated with high mortality in some situations. Hepatitis E virus [HEV] has a fecal-oral transmission cycle and is transmitted through environmental contamination, mainly water. Previous studies have shown that, HEV is responsible for more than 50% of acute hepatitis cases in young patients in developing countries. This study was aimed to determine the prevalence of anti-HEV antibodies among pediatric patients in Tabriz Children Hospital

Materials and Methods: The study was a cross sectional and descriptive-analytical survey on the children who had been referred to clinic of Tabriz children hospital. For each patient, demographic data including age, sex, area of residence, method of sewage and waste disposal and type of water supply, history of animal contact, history of surgery, blood transfusion and parent's addiction were recorded in questionnaires. Serum levels of specific anti-HEV IgG antibody were measured. The relationshiop between seropositivity and demographic characteristics was investigated

Results: A total of 252 children aged 2-16 years were studied. In 9 patients [3.6%], the sample was positive for anti-HEV IgG antibody consisting of 5 boys [2%] and 4 girls [1.6%]. There was no significant statistic relationship between our demographic characteristics and seropositivity

Conclusion: This study revealed 3.6% seropositivity for anti HEV antibody in children living in Tabriz. According to the present study, the prevalence of HEV is considerable in Iran. Thus HEV study is strongly recommended in the approach to all clinical hepatitis cases

Helicobacter pylori infection in children with type 1 diabetes mellitus: a case-control study

Background: Helicobacter pylori infection is one of the most common chronic bacterial infections

There is challenge on the real rate of prevalence of H. pylori in diabetic patients

This study was done to assess the prevalence of H. pylori infection in children suffering from type 1 insulin-dependent diabetes mellitus

Methods: In this case-control study, 80 diabetic patients [as the target group] refer to the Endocrinology Clinic of Tabriz Educational and Treatment Center, Tabriz northwestern Iran and 80 non-diabetic patients [as the control group] from the group of children referring to the Gl Clinic of the same center were enrolled in 2012 and 2013. Then H. pylori infection was assessed in two groups using measuring antibody [IgG] and stool antigen [HpSA]

Results: H. pylori infection tests were positive in 48 [60%] diabetic patients and in 32 [40%] in non-diabetic patients [P=0.030]

There was a meaningful correlation between the frequency of H. pylori and the longer the duration of diabetes [P<0.001]. No correlation was seen between H. pylori infection and other factors such as age of the patients [P=0.840], HbA1C level [P=0.312], age at which diabetes was diagnosed [P=0.800], average daily dosage of insulin [P=0.232], and presence of Gl symptoms [P=0.430]

Conclusions: Type 1 diabetic children especially cases with the longer duration of diabetes, are at risk acquiring H. pylori infection

Therefore, screening of H. pylori infection is helpful on the follow up of these patients

Gender Differences in Clinical Presentations of Cystic Fibrosis Patients in Azeri Turkish Population / 결핵및호흡기질환

BACKGROUND: Cystic fibrosis (CF) is an autosomal recessive disorder with several clinical presentations. This study was undertaken in the Azeri Turkish population in Iran, to investigate gender differences in the age at onset and diagnosis, age of death, and duration of illness of CF. METHODS: The data of 331 CF patients from 2001 to 2015 was surveyed. Parameters including age, sex, ΔF508 mutation, age at onset, age at diagnosis, age of death and clinical presentations were evaluated for both sexes, using descriptive analysis. The association of gender with these variables was studied using logistic regression, chi-square test and Mann-Whitney U test by SPSS version 18. Odds ratio with a confidence interval of 95% and p≤0.05 was considered statistically significant. RESULTS: The study included 191 males (57.7%) and 140 females (42.3%), all showing statistically significant difference (p<0.001). Age duration differed between genders. Male and female patients were further under 9 and 4 years, respectively. The occurrence of ΔF508 mutation was 0.51 times more in females than in males. Age, diagnosis and sex were closely associated: males were diagnosed at a significantly later age than females (p=0.05). While this compression performed based on clinical presentations, males with respiratory disease had a later median age at diagnosis than females at lifespan (p=0.001). The risk of infertility in males was approximately two times greater than in females (p=0.02). CONCLUSION: These findings indicate gender differences in CF patients. Future studies are needed to establish other differences and evaluate the causes for the gender variations.

Efficacy of proton pump inhibitors and H2 blocker in the treatment of symptomatic gastroesophageal reflux disease in infants / 소아과

PURPOSE: Gastroesophageal reflux disease (GERD) occurs in pediatric patients when reflux of gastric contents presents with troublesome symptoms. The present study compared the effects of omeprazole and ranitidine for the treatment of symptomatic GERD in infants of 2-12 months. METHODS: This study was a clinical randomized double-blind trial and parallel-group comparison of omeprazole and ranitidine performed at Children Training Hospital in Tabriz, Iran. Patients received a standard treatment for 2 weeks. After 2 weeks, the patients with persistent symptoms were enrolled in this randomized study. RESULTS: We enrolled 76 patients in the present study and excluded 16 patients. Thirty patients each were included in group A (ranitidine) and in group B (omeprazole). GERD symptom score for groups A and B was 47.17±5.62 and 51.93±5.42, respectively, with a P value of 0.54, before the treatment and 2.47±0.58 and 2.43±1.15, respectively, after the treatment (P=0.98). No statistically significant differences were found between ranitidine and omeprazole in their efficacy for the treatment of GERD. CONCLUSION: The safety and efficacy of ranitidine and omeprazole have been demonstrated in infants. Both groups of infants showed a statistically significant decrease in the score of clinical variables after the treatment.

Intercontinental comparison of caustic ingestion in children / 소아과

PURPOSE: To investigate the caustic ingestion in children among different continents according to demographic characteristics (core purpose), main symptoms, common caustic agents, signs and symptoms, management, treatment and complications. METHODS: This systematic review was performed by searching the databases Science Direct, ProQuest, Google Scholar, and PubMed, electronically and manually. We included studies that were published from 1980 to 2013, at University of Medical Sciences of Tabriz, Iran. A strategic search was performed with keywords including caustic, corrosive, ingestion and children, and was limited to articles in English and Persian. Statistical analysis was performed by SPSS ver. 18. RESULTS: Of 63 selected articles of caustic ingestion with 9,888 samples, the proportion of Africa was 3 articles (4.8%) and 95 samples (1%), America 9 articles (14.3%) and 305 sample (3%), Asia 29 articles (46%) and 2,780 samples (28.1%), Europe 17 articles (27%) and 3,002 samples (30.4%), and Oceania 5 articles (7.9%) and 3,706 samples (37.5%). The average age was in the Africa 3.07+/-2.02 years, America 3.17+/-1.83 years, Asia 3.34+/-1.58 years, Europe 3.58+/-2.09 years and Oceania 3.52+/-2.02 years. Sex distribution was in Africa 76 males (0.91%) and 19 females (0.23%), America 49 males (0.58%) and 41 females (0.49%), Asia 1,575 males (18.76%) and 1,087 females (12.95%), Europe 1,018 males (12.13%) and 823 females (9.8%), and Oceania 1,918 males (22.85%) and 1,788 females (21.3%). Statistical analysis of the data indicated higher consumption in Europe and Oceania in the boys with higher average age of years. CONCLUSION: The comparison of caustic ingestion indicated that the cause substances of caustic ingestion in children are different among continents, therefore prevention strategy and different treatment guidelines among continents will be needed.

Allergic eosinophilic gastroenteritiswith rectorrhagia

Eosinophilic gastroenteritis [EGE] was a rare gastrointestinal disease that was seen in all ages usually associated with dyspepsia, diarrhea, vomiting, abdominal pain, blood loss in stools and malabsorption. We reported a six-month-old boy with rectorrhagia, family history of allergy, elevated IgE and eosinophil in blood with normal endoscopy. Because of eosinophilic infiltration in lamina properia in colon, diagnosis of EGE confirmed and oral corticosteroid initiated. Patient had symptomatic response and was doing well. The heterogeneity in the clinical presentation of EGE determined by the site and depth of eosinophilic intestinal infiltration and lower gastrointestinal bleeding, although was rare but may be one the clinical manifestations of disease in patients with allergic eosinophilic gastroenteritis [AEG]

Association between helicobacter pylori, cagA, and vacA status and clinical presentation in Iranian children

Seroprevalence of H. pylori infection in Iran exceeds 65% of pediatric population. In this study, we intended to find association between the virulence genes [cagA and vacA] and clinical presentations. H. pylori isolates were achieved from the gastric mucosa of children. In each case, the gastric biopsy specimens were cultured and the organisms identified. Detection of different genotypes was carried out by PCR method. A total of 106 biopsy specimens were cultured and 33 H. pylori isolates obtained. Among these 33 H. pylori strains 24 [73%] were cog/1-positive. Genotypes of vacA slm2, slml, s2m2, and s2ml were 45.5%, 30.3%, 21.2%, and 3%, respectively. Most female patients were infected with genotype slm2. The vacA-ml strains were significantly more common in patients with nodular gastritis. There were no statistical differences between the vacA and cagA genotypes and clinical outcomes. The frequency of cagA genotype was high. In this study, nodular gastritis was a common finding and was rather significantly associated with ml allele of vacA

Infant boy with microcephaly gastroesophageal reflux and nephrotic syndrome [galloway-mowat syndrome]: a case report

In this case report, we present the first diagnosed case of Galloway-Mowat syndrome in Iran. A 7 month old infant boy with microcephaly that had prominently stunted head growth after birth, gastroesophageal reflux, multiple craniofascial characters, hypothyroidism and nephrotic syndrome diagnosed at 5 months of age associated with rapid decline in renal function and heavy proteinuria in 2 months

Glucose-galactose malabsorbtion syndrome presenting as congenital diarrhea

We describe the clinical history, diagnostic evaluation, and management of an infant who had congenital Glucose Galactose Malabsorption [GGM], a rare disorder thought to be inherited as an autosomol recessive trait. This infant experienced persistant diarrhea and hypernatemic dehydration during the first months of life and then renal stone on three months follow-up. Diagnosis is based on oral glucose tolerance test, stool reducing substances and rule out other diseases with use of laboratory investigations, small-bowel biopsy, and histology. Parentral education about dietary managemented with fructose based formula and solid food feedings was important component of this patients treatment

Enhanced susceptibility of low-density lipoprotein to oxidation in wet type age-related macular degeneration in male patients

To determine the susceptibility of low-density lipoprotein [LDL] to oxidation in the plasma of male patients with wet type age related macular degeneration [AMD] and in a similar control group, in order to evaluate the LDL oxidative status as risk factor of AMD. We conducted this study in the Retina Service, Department of Ophthalmology, Nikookari Eye Hospital ' Drug of Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran during the period between October 2004 and December 2005. Sixty male patients with AMD [mean age 67 +/- 16 years] with BMI 4.1 +/- 1.3 were selected as the patient group. The control group consisted of 60 males, apparently healthy, and without ophthalmologic signs and family history of AMD. Low-density lipoprotein was isolated by gradient ultracentrifugation and susceptibility of LDL to in vitro copper-mediated oxidation was assayed by measuring conjugated dienes production [lag phase duration] at 234 nm. Lipid and lipoproteins were determined by standard methods. Comparing with control, significant reduction in the duration of lag phase [p<0.004] and a significant increase in LDL-C concentrations [p=0.006], were noticed. No significant change in cholesterol [p>0.3], triglyceride [p>0.1] and high density lipoprotein cholesterol [p>0.1] levels were found between control and patient groups. A significant negative correlation between Lag phase and LDL-C levels [p=0.004, r=-0.364] was found in the patient group. The increased LDL concentration and enhanced susceptibility of LDL to oxidation may play a roll in the wet type AMD process

Acute gastric perforation in neonatal period

Gastric perforation is a rare abdominal catastrophe with a high mortality, usually occurring in neonatal intensive care unit setting [1]. We report a premature neonate with extensive gastric perforation located in the greater curvature. As a result of necrosis in the rims of rupture, significant gastric resection was performed