Is there any association between passive smoking and esophagitis in pediatrics?

Exposure to environmental tobacco smoke [ETS] is one of the major factors of predisposing children to develop several hazardous health problems. We decided to investigate the association between nicotinine, one of the nicotine metabolites and esophagitis in children with gastroesophageal reflux disease [GERD]. In a case control study 46 children suffering from esophagitis referred to endoscopy ward were recruited. The control group consisted of 45 healthy children. Urine samples were collected and urinary cotinine level [UCL] measured. The mean age of esophagitis and control groups were 5.11 +/- 2.93 and 6.72 +/- 2.8 respectively. Sixty children were passive smokers; 31 of them had non-smoker parents. In control group, 32 [71.1%] children and in esophagitis group 29 [63%] children had non-smoker parents. The mean value of UCL in patients suffering from esophagitis was significantly higher than those in normal group [P=0.04, 24.98 +/- 6.4 ng/ml vs. 15.16 +/- 3.9 ng/ml]. Considering 50ng/ml as a cutoff point for UCL, it was significantly higher in passive smoker group than in non smoker group [P=0.02]. The mean cotinine level differed significantly in esophagitis and control group. Our results indicate the increased risk of developing esophagitis in children with ETS exposure

Role of Fecal Calprotectin in Differentiating between Hirschsprung's Disease and Functional Constipation / 대한소화기학회지

BACKGROUND/AIMS: Calprotectin is a 36.5 kD calcium and zinc binding protein in the S100 protein family. Fecal calprotectin levels are elevated in patients with inflammatory bowel disease and some other gastrointestinal disorders such as colorectal carcinoma. We decided to evaluate the fecal calprotectin level to see if it was able to distinguish between functional and organic causes of constipation. METHODS: Seventy-six children aged 1 to 120 months that all underwent deep rectal mucosa biopsies at Children Medical Center from November 2010 till September 2011 were recruited. Nineteen cases were diagnosed as Hirschsprung's disease and 57 of the patients had nerve ganglion cells in their biopsies. Calprotectin concentration was analyzed by the ELISA method. RESULTS: Although there was a significant difference between the median of the two groups (p=0.036), the median was not above the predetermined cutoff value of 50 microg/g. CONCLUSIONS: We propose that fecal calprotectin, using the above cutoff value, has limited value in differentiating functional constipation from Hirschsprung's disease.

Analysis of colonic mucosa mast cell count in patients with chronic diarrhea

Chronic diarrhea is defined as a decrease in fecal consistency lasting for four or more weeks. Prevalence of this complication in the general population is 5%. Mast cells that play an important role in the regulation of gastrointestinal visceral sensitivity and vascular permeability may be involved in functional chronic diarrhea. In this study we tried to evaluate mast cells density in colonic mucosa of patients with chronic diarrhea. 50 patients with chronic diarrhea and 50 persons as control group were investigated. All specimens were immunohistochemically stained for mast cell tryptase [MCT] with monoclonal mouse anti-human MCT as well as toluidine blue. Mean number of mucosal mast cells were counted in 10 high power microscopic fields of patients and control groups. In patients group [age range, 15-78 years; 26 females], the number of mast cells per high power field in the immunohistochemistry staining was 21.3 +/- 4.8 compared to 14.2 +/- 3.4 in the control group [age range, 18-78 years; 24 females] [P < 0.001]. Also number of mast cells in toluidine blue staining was 10.3 +/- 3.6 per high power field in cases and 7.1 +/- 2.4 in the control group [P < 0.001]. Elevated number of colonic mast cells exist in patients with chronic diarrhea. Further research should be considered on application of these findings for new therapeutic opportunities.

Comparison of classic sweat test and crystallization test in diagnosis of cystic fibrosis

Sweat chloride measurement is considered a standard diagnostic tool for cystic fibrosis [CF]. This study was performed to compare sweat chloride values obtained by quantitative pilocarpine iontophoresis [classic test] with sweat crystallization detected by direct observation of a drop of perspiration under light microscopy in patients with and without CF. The tests using both techniques were performed simultaneously in patients with and without CF. Cutoff values of >/= 60 mmol/L of chloride concentration for the classic sweat test was considered for diagnosis of CF. In crystallization method, observation of typical dendritic forms of salt crystals under light microscopy was interpreted positive. Sixty patients suspected to CF [31 males and 29 females] with age range of 9 months to 2 years underwent the sweat test using both techniques. Median sweat chloride values was 26.13+10.85 in group with negative and 72.76+12.78 mmol/L in group with positive sweat test, respectively. All the patients who had positive sweat test in classic method showed typical dendritic forms of salt crystal in sweat crystallization test, which provided the test with 100% sensitivity [95%CI: 93.1-100]. Only one of the 31 subjects with negative results for classic sweat test had positive result for crystallization sweat test, which provided the test with 96.7% specificity [95%CI: 92.9-100]. Time spent to perform the crystallization test was significantly shorter than the classic method whereas its cost was also lower than the second method. There was a good correspondence between two studied methods of sweat test. These results suggested the sweat crystallization test as an alternative test for detecting CF disease with high sensitivity and specificity

Molecular diagnosis of congenital adrenal hyperplasia in Iran: focusing on CYP21A2 gene

Congenital adrenal hyperplasia [CAH] is characterized by impaired biosynthesis of cortisol. 21-hydroxylase deficiency is the most common cause of CAH affecting 1 in 10000-15000 live births over the world. The frequency of the disorder is very high in Iran due to frequent consanguineous marriages. Although biochemical tests are used to confirm the clinical diagnosis, molecular methods could help to define accurate diagnosis of the genetic defect. Recent molecular approaches such as polymerase chain reaction based methods could be used to detect carriers and identify different genotypes of the affected individuals in Iran which may cause variable degrees of clinical expression of the condition. Molecular tests are also applied for prenatal diagnosis, and genetic counseling of the affected families. Here, we are willing to delineate mechanisms underlying the disease, genetic causes of CAH, genetic approaches being used in the country and recommendations for health care improvement on the basis of the molecular and clinical genetics to control and diminish such a high prevalent disorder in Iran. Also, the previous studies on CAH in Iran are gathered and a diagnostic algorithm for the genetic causes is proposed

Total antioxidant status in patients with major beta-thalassemia

Beta-thalassemia major is an autosomal recessive disease causing severe and hemolytic anemia, which begins about 2-6 months after birth. Iron overload, which arises from recurrent transfusion and ineffective erythropoiesis, can enhance oxidative stress in thalassemic patients. The aim of this study was to evaluate the serum total antioxidant capacity of patients with beta-Thalassemia major. Sixty six Iranian patients with beta-thalassemia major and 66 age-gender matched controls were evaluated for serum total antioxidant status [TAS], uric acid [UA], bilirubin and albumin. In addition, serum ferritin and transaminases were recorded in these subjects. Significant increases of TAS, UA, and bilirubin were observed in the patient group, compared with the control group [P<0.01]. Mean TAS and bilirubin in male patients was higher than in females [P=0.005 and P=0.008, respectively]. There was also direct correlation between TAS and albumin [P<0.001], bilirubin [P<0.001] and UA [P=0.002]. Endogenous antioxidants such as ferritin, UA and bilirubin can result in increased level of TAS in the patients with Beta-thalassemia major. Compensatory excess of TAS to oxidative stress could also be the reason for difference between our findings and previous studies

Bilirubin/albumin ratio for predicting acute bilirubin-induced neurologic dysfunction

The aim of this study was to evaluate the bilirubin albumin [B/A] ratio in comparison with total serum bilirubin [TSB] for predicting acute bilirubin-induced neurologic dysfunction [BIND]. Fifty two term and near term neonates requiring phototherapy and exchange transfusion for severe hyperbilirubinemia in Children's Medical Center, Tehran, Iran, during September 2007 to September 2008, were evaluated. Serum albumin and bilirubin were measured at admission. All neonates were evaluated for acute BIND based on clinical findings. Acute BIND developed in 5 [3.8%] neonates. B/A ratio in patients with BIND was significantly higher than in patients without BIND [P<0.001]. Receiver operation characteristics [ROC] analysis identified a TSB cut off value of 25 mg/dL [area under the curve [AUC] 0.945] with a sensitivity of 100% and specificity of 85%. Also, according to the ROC curve, B/A ratio cut off value for predicting acute BIND was 8 [bil mg/al g] [AUC 0.957] with sensitivity of 100% and specificity of 94%. Based on our results, we suggest using B/A ratio in conjunction with TSB. This can improve the specificity and prevent unnecessary invasive therapy such as exchange transfusion in icteric neonates

Normal range determination of lymphocytes subsets in normal adults in Iran

Immunophenotyping of lymphocytes is very essential for evaluation of immune system. Due to the effect of environmental factors and ethnical diversity on immune system, establishment of an internal normal range of lymphocyte subsets is a necessity for each population. The aim of this study was to determine the normal range of T and B lymphocytes, and NK cells in normal Iranian adults. Two hundred and thirty three Iranian normal adult volunteers took part in this study. Complete Blood Count [CBC] was performed for them with Sysmex [KX21] and cells with CD3, CD4, CD8, CD19 and CD16/56 surface markers were simultaneously detected by flow cytometry method with FACstar system. Their percentile and absolute count were determined. The volunteers were 150 male and 83 female. Mean percentages of lymphocyte subpopulation were: CD3 [67.66 +/- 7.76], CD19 [14.41 +/- 5.09], CD4 [39.22 +/- 6.7], CD8 [25.42 +/- 5.4] and CD16/56 [10.14 +/- 6.42]. Also, their mean absolute count of lymphocyte bearing. CD3, CD19, CD4 and CD8 were l,504 +/- 505/microl, 332 +/- 186/microl, 827 +/- 313/microl and 522 +/- 185/microl, respectively. Our results are comparable with similar Asian results from other Asian population, but are different from European population, we therefore conclude that it is necessary for each laboratory to establish an internal normal range for the lymphocytes bearing above-mentioned markers

Colorectal polyps: a clinical, endoscopic and pathologic study in Iranian children

To study the clinical presentation, histology and colonoscopic features of lower gastrointestinal polyps in Iranian children. Medical reports of children with colorectal polyps were retrospectively reviewed from 1996 to 2005 at the Children's Medical Center Hospital, Iran. A total of 563 cases were studied. Data related to age, sex, family history, signs and symptoms, the size, location, polyp types and associated lesions were collected and analyzed. The mean age of children was 5.66 +/- 2.88 years [range 2 months to 17 years], with a male-to-female ratio of 1.61:1.0. The highest incidence was between ages 2 and 10 years [85.1%]. Rectal bleeding was the presenting symptom in 78.5% cases. The polyps were solitary in 94% of cases. A majority of polyps [86.3%] were juvenile and 86.7% located in the rectosigmoid area. Three percent of cases had a positive family history. One case of Turcot syndrome was also identified. Juvenile polyps remain the most common polyps in Iranian children. Although the presence of a solitary polyp in the rectosigmoid colon is more prevalent, in a significant number of cases they are multiple and located in proximal parts. Polyps must be removed even when asymptomatic because of their probable neoplastic potential

[Study on variation of the sera folic acid, vitamin B12 and iron level in the 6-12 years old patients infected with Giardia lamblia in south Tehran]

Protozoa Giardia lambelia is caused to diarrhea in human and other mammals in worldwide. Giardia colonizes in duodenum and earliest jejunum. It can cover the intestinal surface and causes the stateorrhea, malabsorbtion syndrome and absorb disorder of vitamins A, E and D. Investigation the effect of Giardia on the vitamin B12, folic acid and iron of patients were the purpose of this study. A total of 30 children with giardiasis, aged between 6-12 years-old, selected from 3000 patients, who were admitted to the Emam Khomeiny hospital and diagnosed by stool examinations [direct and formalin-ether methods]. Blood of patients and control were collected. Amount of vitamin B12 and folic acid were evaluated with radioimmunoassay and iron was evaluated with Ferene method. According to the data, folic acid in the patient had no significant difference against control but vitamin B12 and iron in the patient with giardiosis was less than control and the differences were significant [P=0.01, P=0.04 respectively]. According to the results diagnosis of giardiosis in the early stage may prohibit intestinal damage and clinical symptoms due to vitamins and mineral elements shortage in the children

[Selenium and glutathione peroxidase deficiency in epileptic children]

To cease the increasing damage to the brain neurons following epileptic seizures, natural anti-oxidative systems play the main role. One of the most important detoxifying systems is composed of the trace element selenium and its dependent detoxifying enzyme, glutathione peroxidase. The object of this study was to evaluate serum selenium and red blood cell glutathione peroxidase activity in pediatric epileptics and compare it with that of healthy children. Patients suffering from various types of epilepsy were studied during a 15-month period. Control group consisted of healthy children with no history of any neurologic disease. Serum selenium level and RBC Glutathione peroxidase activity was evaluated and the results compared. Fifty three epileptic patients with a mean age of 5.5 years and 57 healthy children with a mean age of 5.6 years were enrolled in this study. Statistically significant differences in the mean values for serum selenium level [72.9 vs. 86.0 ng/ml, P=0.017] and also RBC glutathione peroxidase activity [440.6 vs. 801.0 nmol/min/ml, P=0.000] between the two groups were observed. On the other hand, after analyzing the study results, trying to introduce a value for GPx activity, which could be accepted as a reliable indicator for serum selenium deficiency in patients, was not successful. Findings of the present study strongly support the proposed crucial role for the trace element selenium and deficiency of its dependent enzyme, glutathione peroxidase, in epilepsy pathogenesis