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.

Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Clinical and laboratory data in pediatric autoimmune hepatitis: study from referral center in Iran / Datos clínicos y de laboratorio en hepatitis autoinmune pediátrica: estudio del centro de referencia en Irán

ABSTARCT Background : Autoimmune hepatitis (AIH) is an auto-inflammatory liver disease of children and adults, affecting patients of any age, sex, race or ethnicity, with more prevalence in females. Objective : The aim of this study was to evaluate clinical manifestation, laboratory findings, and outcome of children with autoimmune hepatitis. Materials and methods : We evaluated 86 patients treated and followed with final diagnosis of AIH between years 2010 to 2018. Physical findings (including jaundice, hepatomegaly, splenomegaly and encephalopathy), liver enzymes, liver histology and autoantibodies (including ANA, Anti LKM-1 and ASMA) were extracted from medical files. Then the patients were followed for their final outcome (including response to medical treatment or successful treatment withdrawal, liver transplantation or death). Results : Among 86 patients with AIH with mean age 9.10±4.36 years old, 66.27% were females. Jaundice (75.6%) and hepatomegaly (46.5%) were the most frequent physical findings, followed by splenomegaly (32.6%) and encephalopathy (17.4%). Aminotransferases including AST and ALT were elevated at least 3 times more than upper limit of normal in most of the patients (61.6% and 55.81%, respectively). Autoantibodies were available in 53 of 86 patients, 24.5% had AIH-1, 3.8% had AIH-II and 67.9% were seronegative. Medical treatment including prednisolone and azathioprine was started for patients, 53 of 86 cases (61.6%) had remission and 11 of 86 (13.7%) tolerated medication withdrawal successfully. Among all cases, 26 (30.2%) patients needed liver transplantation. Mortality rate was 9 among 86 cases (10.5%). Conclusion : Jaundice and hepatomegaly was the most frequent clinical findings. Mortality rate was 10.5%.

RESUMEN Antecedentes : La hepatitis autoinmune (AIH) es una enfermedad hepática autoinflamatoria de niños y adultos, que afecta a pacientes de cualquier edad, sexo, raza u origen étnico, con mayor prevalencia en las mujeres. Objetivo : El objetivo de este estudio fue evaluar la manifestación clínica, los hallazgos de laboratorio y el resultado de los niños con hepatitis autoinmune. Materiales y métodos : Evaluamos 86 pacientes tratados y seguidos con el diagnóstico final de AIH entre los años 2010 a 2018. Los hallazgos físicos (incluyendo ictericia, hepatomegalia, esplenomegalia y encefalopatía), enzimas hepáticas, histología hepática y autoanticuerpos (incluidos ANA, Anti LKM-1 y ASMA) se extrajeron de las historias médicas. Luego, los pacientes fueron seguidos para su resultado final (incluida la respuesta al tratamiento médico o la retirada exitosa del tratamiento, el trasplante de hígado o la muerte). Resultados : Entre 86 pacientes con AIH con una edad media de 9,10 ± 4,36 años, el 66,27% eran mujeres. La ictericia (75,6%) y la hepatomegalia (46,5%) fueron los hallazgos físicos más frecuentes, seguidos de esplenomegalia (32,6%) y encefalopatía (17,4%). Las aminotransferasas que incluyen AST y ALT se elevaron al menos 3 veces más que el límite superior de la normalidad en la mayoría de los pacientes (61,6% y 55,81%, respectivamente). Los autoanticuerpos estaban disponibles en 53 de 86 pacientes, 24,5% tenían AIH-1, 3,8% tenían AIH-II y 67,9% eran seronegativos. Se inició tratamiento médico que incluyó prednisolona y azatioprina, 53 de 86 casos (61,6%) tuvieron remisión y 11 de 86 (13,7%) toleraron el retiro de medicamentos con éxito. Entre todos los casos, 26 (30,2%) pacientes necesitaron un trasplante de hígado. La tasa de mortalidad fue de 9 entre 86 casos (10,5%). Conclusión : la ictericia y la hepatomegalia fueron los hallazgos clínicos más frecuentes. La tasa de mortalidad fue del 10,5%.

Complications After endoscopic balloon dilatation of esophageal strictures in children. Experience from a tertiary center in Shiraz - Iran (Nemazee Teaching Hospital) / Complicaciones posteriores a dilatación endoscópica con balón en niños con estenosis esofágica. Experiencia de un centro de referencia en Shiraz - Iran (Nemazee Teaching Hospital)

Background: Esophageal stricture is one of the most important complication of the caustic ingestion. Objective: The aim of this study was to evaluate complications of balloon dilatation among children with esophageal stenosis. Material and methods: In this retrospective study 82 children were included. Children who underwent balloon dilatation for esophageal stenosis were included in our study. Duration of study was 14 year starting from 2001. Mean age of the cases was 3.95±0.4 year (Min: 15 days, Max: 14 year). Chart review and telephone calling were the methods of data collection. Data was analyzed using SPSS. Results: In this study, 47% of the patients were male and 53% of the cases were female. Caustic ingestion (33.7%) was the most common etiology for the esophageal stricture. Vomiting (87.8%) was the most common presenting symptom. Among our cases, 76.8% had no compliant after esophageal dilatation. Chest pain was the most common compliant after esophageal dilatation. Response rate was similar among boys and girls. Toddler age had the best treatment response after esophageal dilatation. Conclusion: Among our cases, 76.8% had no post procedural compliant after esophageal dilatation. Esophageal perforation was seen in 4.9% of the cases. Chest pain was the most common post dilatation complication.

Antecedentes: La estenosis esofágica es una de las más importantes complicaciones de la ingesta de caústicos. Objetivo: El objetivo del estudio fue evaluar las complicaciones de la dilatación endoscópica con balón en niños con estenosis esofágica. Material y métodos: En este estudio retrospectivo se incluyeron 82 niños. Se incluyeron todos los niños que se sometieron a una dilatación endoscópica con balón por estenosis esofágica. La duración del estudio fue 14 años iniciando en el año 2001. La edad media de los pacientes fue 3,95 +/- 0,4 años (Min. 15 días, Máx. 14 años). La recolección de datos se realizó revisando las historias clínicas y con llamadas telefónicas. Los datos se analizaron con el Sistema SPSS. Resultados: En este estudio, 47% de los casos fueron varones y 53% fueron mujeres. La ingesta de caústicos fue la causa más frecuente de estenosis esofágica (33,7%). El síntoma más común fueron los vómitos (87,8%). Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. El dolor torácico fue la molestia más común luego de la dilatación esofágica. La tasa de respuesta al tratamiento fue similar entre hombres y mujeres. Los niños pequeños tuvieron la mejor respuesta al tratamiento luego de la dilatación esofágica. Conclusiones: Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. La perforación esofágica se presentó en 4,9% de los casos. El dolor torácico fue la complicación más común posterior a la dilatación.

Percutaneous endoscopic gastrostomy in children: a single center study at Tertiary hospital Iran / Gastrostomía percutánea en niños: reporte de un hospital terciario de Iran

Introduction: The aim of this study was to evaluate complications after percutaneous endoscopic gastrostomy among children who underwent percutaneous endoscopic gastrostomy in Nemazee hospital. Materials and methods: All children who underwent percutaneous endoscopic gastrostomy were included in the current study. Place of the study was department of pediatric gastroenterology of Nemazee children hospital of Shiraz university of medical sciences. Duration of the study was 5 year starting from 2008. All drugs such as aspirin, NSAIDS, and heparin were discontinued 1-7 days before procedures. All patients were kept NPO 6-8 hours before procedure according to the age. Single dose antibiotic was prescribed for all cases before procedure. During procedure, all patients were sedated using propofol and or midazolam. Some patients required intubation. Results: Of 39 cases who underwent PEG, 4 (10.2%) patients showed complication. The most common indication for PEG insertion were neurologic problem (84.6%) and metabolic disease (10.2%). Of our patients, 84.6% of the cases had the weight below third percentile. Conclusion: The most common indication for percutaneous endoscopic gastrostomy was cerebral palsy. The complication rate in our study was 10.2%. Celulitis was the most common complication

Introducción: El objetivo de este estudio fue evaluar las complicaciones luego de una gastrostomía endoscópica percutánea (PEG) en niños realizada en el hospital Nemazee. Material y métodos: Se incluyeron al estudio todos los niños que se realizaron PEG en el hospital. El lugar del estudio fue el departamento de gastroenterología pediátrica del Hospital para niños Nemazee de la Universidad Shiraz de ciencias médicas. La duración del estudio fue cinco años, iniciando en el año 2008. Todas las drogas como aspirina, AINES y heparina fueron suspendidas entre 1 a 7 días previos al procedimiento. Todos los pacientes estuvieron entre 6 a 8 horas del examen en ayunas dependiendo de la edad. Se prescribió una dosis de antibioterapia profiláctica en todos los casos previo al procedimiento. Durante el procedimiento, todos los pacientes fueron sedados usando propofol y/o midazolam. Algunos pacientes necesitaron intubación. Resultados: De 39 casos que se sometieron a PEG, 4 (10,2%) tuvieron alguna complicación. La indicación más frecuente de PEG fueron los problemas neurológicos (84,6%) y luego las enfermedades metabólicas (10,2%). De nuestros pacientes, 84,6% de los casos estuvieron por debajo del tercer percentile. Conclusión: La indicación más común de gastrostomía endoscópica percutánea fue la parálisis cerebral. La tasa de complicación en nuestro estudio fue 10,2%. La celulitis fue la complicación más común

Effect of sequential therapy on treatment of Helicobacter pylori infection in children / Efecto de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori en niños

Background: Helicobacter pylori infection which plays a major role in the etiology of chronic gastritis and duodenal ulcers in children and adults is one of the commonest chronic infection worldwide. Cure of the infection leads to healing of gastric inflammation and prevention of peptic ulcer. Objective: The aim of this study was to evaluate the efficacy of the sequential therapy for treatment of Helicobacter pylori infection. Materials and methods: In this study, 40 children with symptoms of H. Pylori that the infection was proved by endoscopy and biopsy and rapid urease test (UBT) were enrolled, and received sequential therapy (Lansoprazol, Amoxicillin) for 5 days and (Lansoprazol, Metronidazole and Clarithromycin) for next 5 days. The eradication rate of therapy was evaluated by stool antigen test 6 weeks after completion of therapy. This study was carried out in Pediatric Gastroenterology Clinic of Shiraz University of Medical Sciences, Shiraz, Iran. This study was approved by ethic committee of Shiraz University of Medical Sciences. Results: Forty children with mean age of (10.8±4 years) were evaluated. The most common symptom on first admission was epigastric pain (82.5%), with mean duration of symptoms (16±14.5 month). The most common endoscopic findings was redness and erosion of the antrum (55%) and the most pathologic findings was chronic gastritis (77.5%). The most drug adverse effect was nausea (22.5%). The eradication rate of sequential therapy was 82.5%. Conclusion: Eradication rate of sequential therapy was 82.5% among our cases.

Antecedentes: La infección por Helicobacter pylori, que juega un rol principal en la etiología de la gastritis crónica y las úlceras duodenales en niños y adultos, es una de las infecciones crónicas más comunes en el mundo. La cura de esta infección lleva a la cura de la inflamación gástrica y a la prevención de la úlcera péptica. Objetivo: Evaluar la eficacia de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori. Material y métodos: En este estudio, se enrolaron 40 niños con síntomas en los que la infección por H. pylori se demostró por endocopía con biopsia y prueba rápida de ureasa (UBT) y recibieron terapia secuencial (Lansoprazol, Amoxicilina) por 5 días y (lansoprazol, metronidazol y clarotromicina) por otros 5 días. La tasa de erradicación de la terapia se evaluó por prueba de antígeno en heces 6 semanas después de terminar la terapia. Este estudio se llevó a cabo en la Clínica de Gastroenterología Pediátrica de la Universidad de Ciencias Médicas de Shiraz, Irán. El estudio fue aprobado por el comité de ética de la Universidad de Ciencias Médicas de Shiraz. Resultados: Se evaluaron cuarenta niños con una edad media de (10,8±4 años). El síntoma más común al ingreso fue dolor epigástrico (82,5%) con una duración media de síntomas de (16±14,5 meses). El hallazgo endoscópico más común fue enrojecimiento y erosión del antro (55%) y el hallazgo patológico más común fue gastritis crónica (77,5%). El evento adverso más común fue náusea (22,5%). La tasa de erradicación de la terapia secuencial fue 82,5%. Conclusión: La tasa de erradicación de la terapia secuencial fue de 82,5% en nuestros casos.

The effect of gluten-free diet among celiac patients aged 3-12 years old on BMI during 2006 to 2014 at Nemazee Teaching hospital / El efecto de la dieta libre de gluten en pacientes celiacos de 3 a 12 años en su índice de masa corporal desde el 2006 al 2014 en el hospital universitario de Nemazee

Introduction: Celiac disease (CD) is increasingly diagnosed and weight changes are common after adoption of a gluten- free diet (GFD) and there is concern that patients might gain further weight on a GFD. Objectives: This study examined to evaluate the impact of a GFD on the body mass index (BMI), whether favorable or unfavorable. Materials and methods: In this retrospective study, we reviewed electronic records of 44 patients with serologic study and intestinal biopsy confirmed CD who was visited in Nemazee hospital, Shiraz. All patients were put on GFD for 2 years and followed closely by pediatric gastroenterologist. BMIs were categories to four group underweight, normal weight, overweight and obese. Initial BMI and follow-up BMI was comparing together and also compared with general population. Result: At diagnosis, 27.27% of subjects were underweight, 63.64% normal and 9.09% were obese. On a GFD, 66.66% of underweight patients gained weight and became normal weight and 25% of normal weight and 75% of obese patients had increase weight; and the rest of the patients, BMI remained stable. The follow-up BMIs were statistically higher than initial BMIs (mean 17.17 vs. 15.62, p <0.0001). Conclusion: Individuals with celiac disease have lower BMI than the regional population at diagnosis. On the GFD, BMI is increased significantly in all categories

Introducción: La enfermedad celiaca está siendo cada vez más diagnosticada y los cambios en el peso corporal son comunes después de ponerlos en una dieta libre de Gluten (DLG) y hay preocupación de que sigan ganando peso con esta dieta. Objetivos: Este estudio evalúa el impacto de la DLG en el índice de masa corporal (IMC) ya sea este favorable o desfavorable. Materiales y métodos: En este estudio retrospectivo se revisaron las historias de 44 pacientes con estudio serológico y biopsia intestinal confirmatorios de enfermedad celiaca que llegaron al hospital en Nemazee en Shiraz. A todos los pacientes se les puso en una DLG por 2 años y fueron seguidos por un gastroenterólogo pediatra. El IMC fue dividido en cuatro categorías, peso bajo, normal, sobrepeso y obesos. El IMC inicial y su seguimiento fueron comparados también con la población general. Resultados: Al momento del diagnóstico, el 27,27% estaban con bajo peso, el 63,64% con peso normal y el 9,09% eran obesos. En una DLG, el 66,66% de los pacientes con bajo peso llegaron a su peso normal y el 25% de los de peso normal y el 75% de los obesos también ganaron peso. Esta variación de IMC fue estadísticamente significativa (media 17,17 vs. 15,62, p <0,0001). El resto de los pacientes permaneció con su IMC estable. Conclusión: Las personas con enfermedad celiaca tienen el IMC más bajo que la población de la región al momento del diagnóstico. Puestas en la DLG, el IMC aumenta significativamente en todas las categorías

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

Endoscopic pyloroplasty for severe gastric outlet obstruction due to alkali ingestion in a child

A common belief is that alkali ingestion causes severe esophageal damage and limited gastric injury due to the buffering action of acid. Gastric injury has been observed in patients who ingested alkali. Gastric outlet obstruction [GOO] secondary to caustic ingestion occurs due to fibrosis after resolution of the acute injury and inflammation, most commonly 6 to 12 weeks after initial ingestion. The traditional treatment for GOO related to ingestion of corrosive agents is surgery. Experience with endoscopic balloon dilation of corrosive-induced GOO is limited in children. This is the first report of endoscopic pyloroplasty in a child with GOO due to caustic alkalis ingestion that was treated with balloon dilation [using TTS balloon ranging from 6-15 mm] in Iran. Four dilation sessions were required for symptomatic relief of dysphagia. After one year of follow up, weight gain was normal

seroepidemiology of hepatitis c infection in drug abusers referring to shiraz drug rehabilitation centers

Background: Drug abusers are one of the most at risk populations for hepatitis C virus [HCV] transmission worldwide. The aims of this study were to measure the seroprevalence of HCV and to compare certain related risk factors in participants who were referred to drug rehabilitation centers affiliated to Shiraz University of Medical Sciences, Shiraz, Iran

Materials and Methods: Blood samples and interviews containing questions about age, sex, level of education, house status, jobs, history of imprisonment and psychiatric problems, age at the first drug and first intravenous [IV] drug uses, safe and unsafe sexual activity, and time and duration of IV drug use in the past 30 days were obtained from 1116 participants in rehabilitation centers. The sera were tested for anti-HCV antibody using enzyme immunoassay. The data were analyzed using independent samples t test and one way ANOVA for quantitative variables and Chi-square and Fisher's exact tests for qualitative variables

Results: Among the 844 participants who agreed to blood sampling, the prevalence of HCV infection was 14.2%. The significant positive associations were detected between anti-HCV antibody positivity and higher levels of education [p =0.008], no history of imprisonment [p<0.001], having a job [p =0.006], having a partner [p <0.001], and higher age at the first drug use [p<0.001]

Conclusion: The seroprevalence of HCV infection among drug abuser was very high in comparison with the general population of Iran. Making policies to prevent transmission of HCV infection among this high risk subpopulation is highly recommended

effects of the natural coagulant Moringa oleifera and alum in wastewater treatment at the Bandar Abbas Oil Refinery

Background: the refining process generates large volumes of wastewater containing a variety of chemical contaminants. The use of natural substitutes in treating wastewater which have fewer harmful effects is considered an effective step towards protecting the environment and sustaining the development of these industries. This study focused on the use of Moringa oleifera and alum at the Wastewater Unit at Bandar Abbas Refinery

Methods: this study was performed in 2014 in a laboratory using jar apparatus. These experiments were conducted in batch system and effective parameters including pH, coagulant dose and contact time were investigated on the wastewater obtained from Bandar Abbas Oil Refinery

Results: the jar test experiment showed that M. oleifera at 70 mg/L, optimum temperature, pH, and mixing speed could remove 38.60% of chemical oxygen demand [COD], 63.70% of turbidity, and 62.05% of total suspended solids [TSS]. Also, alum at 40 mg/L removed COD, turbidity, and TSS by 51.72%, 92.16%, and 85.26% respectively from the refinery wastewater. Moreover, when M. oleifera and alum was used together with a 2:1 dosage ratio [alum at 80 mg/L and M. oleifera at 70 mg/L], they will remove COD, turbidity, and TSS by up to 50.41%, 86.14%, and 81.52% respectively

Conclusion: the use of M. oleifera as a natural coagulant is important in treating refinery wastewater not only from an environmental but also an economic point of view

Heavy metals in the imported and Iranian rice consumed in Hormozgan Province

Background: Given that the share of imported rice from India and Pakistan, the current study was conducted to determine the concentration of lead, arsenic and cadmium in the rice imported from the two mentioned countries in comparison to Iranian rice

Methods: This cross-sectional study was conducted in 2014 in Bandar Abbas, using a completely randomized block design. Five samples of each brand [India,Pakistan and Iran] and a total of 75 samples were selected. To measure the amount of arsenic in them, atomic spectrum poll and to determine the amount of lead and cadmium, the graphite furnace atomic absorption spectrometer optical-compliant were used. To analyze the data, we applied descriptive statistics and analysis of variance using SPSS software

Results: The mean of Cd, As and Pb were 0.045, 0.057, and 0.022 mg/kg, respectively. There was a significant difference for Cd in the local and imported rice [P=0.002]. Difference for As in the local and imported rice was not significant [P=0.218]. A statistically significant difference was found between the imported and Iranian rice [P=0.354]. There were no significant differences among all the measured heavy metals in the tested samples of India and Pakistan rice, both legally and illegally [P=0.144]

Conclusion: It was found that the rice was contaminated with heavy elements; it is recommended that measures should be taken to promote healthy rice production, including periodic monitoring of heavy metals in the water and rice seeds, establishing an appropriate operating system to reduce heavy metal emissions, using international experiences on the effects and complications of heavy metals in water resources and farming, and performing quality control measures on the imported rice

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

Clinical manifestations among children with chronic functional constipation

Constipation is one of the most frequent cause of patient visits to pediatric gastroenterology clinics. Early diagnosis and treatment is important. There are few studies about clinical manifestations of constipation in children. We aimed to find the relative frequency of gastrointestinal manifestations of constipation among constipated children. This cross-sectional study was carried out on children aged < 18 years old with chronic functional constipation referred to Imam Reza Clinic of Shiraz University of Medical Sciences. Children with organic causes of chronic constipation were excluded from study. Rome III criteria were used for defining constipation. The duration of study was 1 year starting from September 2010. Abdominal pain, fecal mass, rectal bleeding, anorexia, fecal soiling, retentive posture, withholding behavior, anal fissure, and pen-anal erythema were recorded for each case based on history and physical examination. Data were analyzed using SPSS software, version 13.0 [Chicago, IL, USA]. Of 222 children with functional constipation, 124[55.9%] were girls and 98 [44.1%] were boys with a mean +/- SD age of 5 +/- 3.12 years. The mean +/- SD duration of constipation was 2.2 +/- 1.9 years. Large and hard stool was present in 93.7% of the patients. Painful defecation and withholding behavior were seen in 92.3% and 91.9% of the patients, respectively. Fecal impaction was more frequent among boys compared with girls [p<0.01]. Fecal soiling was present in 40.8% of the boys and 28.2% of the girls [p=0.04]. Large and hard stool, painful defecation and withholding behavior were the most frequent signs or symptoms among children with chronic functional constipation. Fresh rectal bleeding and anal fissure were the least frequent signs and symptoms in this group

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

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

Complications of blind versus ultrasound-guided percutaneous liver biopsy in children

Background and study aims: Liver biopsy is a well-established procedure in the diagnosis and follow-up of liver diseases. Complications of liver biopsy are rare but potentially lethal. The aim of this study was to evaluate the complications of percutaneous liver biopsy and to compare the complications of blind and ultrasound-guided percutaneous liver biopsy in paediatric wards of Nemazee Hospital of Shiraz in the south of Iran

Patient and method: To complete the questionnaire, registered information of liver biopsies due to different causes in paediatric patients between 2008 and 2012 was retrospectively reviewed. All children aged between 0 and 18 years, who underwent liver biopsy [due to any indication], participated in this study

Results: Liver biopsies were obtained from 210 patients. Seven of 210 cases were excluded due to unreliable data. A total of 209 liver biopsies were done in the rest of the cases [n = 203]. Of all cases of liver biopsies, 22 [10.5%] experienced complications after biopsy. Pain [n = 7] was the most frequent complication in 22 cases of liver biopsy. Mortality rate was one [0.5%] due to rupture of subcapsular haematoma. In terms of complication [p = 0.592], there was no significant difference statistically between patients with blind liver biopsy [n = 16] and patients with ultrasound-guided liver biopsy [n = 6]

Conclusion: In terms of complications, there was no significant difference when the patients were evaluated with and without ultrasound-guided biopsy

Frequency of celiac disease in children with chronic functional constipation in Shiraz-Iran

Celiac disease is an autoimmune mediated small intestine inflammation which occurs due to hypersensitivity reaction to gluten and related proteins in diet in genetically predisposed individuals. Prevalence of celiac among the population is about 0.5 - 1 % in most countries. Frequency of celiac disease in children is the subject of a few research. In this study, we aim to determine the frequency of celiac disease in patients presenting with functional constipation. This cross-sectional study was conducted on children referring to Imam Reza Clinic, affiliated to Shiraz University of Medical Sciences during one year starting from 2011, March 20. One hundred and one children 2-18 years of age with constipation for more than 2 months according to ROME III criteria. The entire participants underwent serologic studies of Total IgA and IgA TTG. Serum IgG TTG was measured in cases with reported values of Total IgA below the lowest normal limits. Moreover, endoscopic biopsy of the small intestine was also performed for patients with positive serology. Of all the 101 studied participants, only four individuals [3.96 %] had positive test results for IgA TTG [potential celiac disease]. One of these patients refused to do endoscopy and endoscopic small intestine biopsy was performed for 3 patients. Two of them had normal pathology and one of them [0.99 %] was confirmed for celiac disease. The frequency of celiac disease in children with chronic constipation is slightly higher than general population but without significant difference 0.99% VS 0.6% ; p=0.64]. So the screening serologic test for celiac disease is not recommended in children with chronic constipation