[Evaluation of triple therapy regimens with metronidazole or clarithromycin for helicobacter pylori eradication in children]

Half of the world's population is infected with helicobacter pylori. This organism is one of the main causes of peptic ulcer disease, gastritis and gastric cancer. This infection is most frequently acquired in childhood. There is strong evidence that eradication of infection improves healing and reduces the risk of recurrence and rebleeding in patients with duodenal or gastric ulcer. There is no consensus as to treat infected children without ulcer. The aim of this study was to compare the efficacy of two therapeutic regimens in eradication of infection in children. This study was a double-blind randomized clinical trial conducted in Tabriz Children Hospital. A total of seventy children aged 4 to 15 years were studied. These patients were referred to Endoscopy Unit and upper endoscopy and biopsy were performed. They were positive for helicobacter pylori by histological confirmation. The patients were randomly enrolled in two therapeutic groups: group-A[n=41] received omeprazole as a proton pump inhibitor, amoxicillin and metronidazole [PAM] and group-B [n=36] received omeprazole, amoxicillin and clarithromycin [PAC]. The duration of treatment was two weeks in both groups. To confirm eradication, UBT was performed after 8 weeks of treatment. Data were analyzed using SPSS package version 15. P-value <0.05 was considered significant. Mean age in PAM and PAC groups were 8.8 +/- 2.5 and 9.6 +/- 2.9 years, respectively. The age difference was not statistically significant [P=0.24]. The most common initial symptom was chronic abdominal pain in both PAM and PAC groups [81.3% and 76.3%, respectively]. There was no statistical difference in frequency of initial symptom between the two groups [P=0.41]. Side effects during treatment were seen in both PAM and PAC groups [23.7% and 19.7%, respectively]. Most patients in both groups experienced symptoms improvement after treatment whether complete or partial. In PAM and PAC groups, symptoms improvement was seen in 92.1% and 91.2%, respectively. There was no significant statistical difference between the two groups [P=0.64]. The intention to treat analysis in PAC and PAM groups were 75%and 73%, respectively and per-protocol analyses were 87% and 78.9%, respectively. There was no statistical difference in helicobacter pylori eradication rates between the two groups [P=0.39]. Our study suggested that both PAM and PAC regimens are effective in eradication of infection. Eradication of infection also can cause significant improvement of initial symptoms

Genotype-phenotype correlation in patients with Familial Mediterranean Fever: Evaluation of E148Q and M694V mutations

Familial Mediterranean Fever [FMF] is an autosomal recessive disorder characterized by self-limited episodes of fevere and painful recurrent polyserositis that predominantly affects Mediterranean races. In recent years some reports have shown high prevalence of FMF in North-west Iran, with M694V and E148Q being most frequent reported mutations. The aim of this study is to evaluate the clinical manifestations of FMF in patients with these mutations. A cross sectional- descriptive study was performed in a 1 year period [January 2007. January 2008] 71 patients younger than 18 years with clinical diagnosis of disease proved in Children Hospital of Tabriz-Iran were referred to genetic lab for mutation analysis. ARMS-PCR and PCR-RFLP were used to detect mutations. Only 45 patients were shown to have identified mutations and 41 patients among them had M694V and E148Q mutations which were assessed for various clinical manifestations. M694V and E148Q mutations were seen in 55.7 and 35.5 patients respectively. Patients homozygous for M694V were found to have earlier age of onset, longer duration of attacks, higher prevalence of positive family history and more complications. In our patients, prevalence of some manifestations differed from other ethnic groups reported previously. M694V mutation in FMF patients especially in homozygous state is accompanied with more severe disease and more complications

comparison of the antibody response against Hepatitis B vaccine surface antigen between preterm and full term neonates

Infection with hepatitis B virus is one of the most common causes of chronic hepatitis, cirrhosis and hepatic cell carcinoma in IRAN. Thirty percents of Iranian population are the carriers of hepatitis B virus. Forty percent have history of previous contact with this virus and three percent of them will have chronic hepatitis. The common routes for transmission is blood transfusion and it's products, feto- maternal route and sexual contact. To compare response of premature and full term infants to hepatitis B vaccine this study was performed. The immunginicity of hepatitis B vaccine was assessed. In 70 preterm infants immunized soon after birth, and compared with that in 80 term infants. Hepatitis B surface antibody [anti HBS] was measured at three months after the third dose of vaccine [1 year]. The significance of differences between the term and preterm groups was determined using routine statistical test. Similar proportion of infants in both preterm and term groups attained protective titers of hepatitis B antibodies [98/7%vs 97/1%, p=NS]. Mean antibody level to hepatitis B surface antigen in preterm infants was 217.6 +/- 244.2 mIU/mL and in term infants was 235.8 +/- 207.1 mIU/mL. Independent T test did not exhibit statistically significant difference in two groups of infants. The antibody response of preterm infants was similar to that of term newborns. Hepatitis B vaccination can be initiated on the first day of life in preterm newborns, following the same shame recommended for term newborns. However, anti HBS titers should be monitored in one year old. It may be advisable to determine the immune response before school age and repeat the vaccine if it is necessary

Detection of Helicobacter pylori antigen in stool samples for diagnosis of infection in children

The study evaluated a non-invasive antigen test of stool samples for the diagnosis of Helicobacter pylori infection in children compared with histopathology of gastric biopsies [gold standard]. The study included 96 children aged 1-5 years old with dyspeptic symptoms referred for endoscopy at Tabriz Children's Hospital, Tabriz, Islamic Republic of Iran from May 2003 to March 2004. Of 62 children who were positive by histology, 34 were H. pylori stool antigen positive and of 34 patients with negative histology, 27 had negative stool test. The sensitivity and specificity of the test were low [54.8% and 79.4% respectively] compared with the gold standard and the positive and negative predictive values were 82.9% and 49.9%. However, the test may be useful for mass screening for H. pylori

[Neonatal cholestasis]

Neonatal cholestasis syndrome includes a wide spectrum of clinical conditions ranging from congenital malformations of the hepatobiliary tree, infections, and inborn errors of metabolism to some clinical conditions with or without genetic predilection. The aim of this study is the survey of epidemiological and clinical findings of cholestasis in our center for a better approach and management of cholestatic newborns.We undertook a retrospective analysis of the medical notes of all infants treated for cholestosis at our center between 1999-2004.Male to female ratio of 61 analyzed cases of neonatal cholestasis syndrome was 2/1. Intrahepatic causes were responsible for 73.3% of cholestasis cases consisting of neonatal hepatitis 2, inspissated bile syndrome 1, and histiocytosis 1 cases. Extrahepatic cholestasis was diagnosed in 20/3% of cases as choledocal cyst in 2, and billiary atresia in 14 cases.Intrahepatic cholestasis is commonest form of neonatal cholestasis in our center. Early diagnosis and management of neonatal cholestasis is of great importance for good results of treatment. This can be achieved by instructing the parents and health personnel to refer the suspected newborns to neonatology center as soon as possible

[Incidence and epidemiology of esophagitis in children admitted to endoscopy unit medical center of children In Tehran]

Background: There has been a little attention to pediatrics esophagus problems until recent years. The term esoghagitis can be used to described chemical, infectious, inflammatory, ischemic, immunologic and degenerative abnormalities. Prevalence of reflux esophagitis varies between 2 to 5 percent of general population but little data about its incidence in pediatric age groups. The aim of this study was to evaluate the epidemiology and prevalence of esophagitis and study of symptom, diagnostic measures, therapeutic intervention and prevention of its complication

Materials and Methods: In this prospective and cross sectional study 500 patient under16 years with upper digestive complaints or alteration of their state of health under went upper endoscopy, with special attention paid to esophagus

Results: Among 500 children [205 male, 207 female], pathology reported esophagi is in 325 cases. Majority of the patient were 8 to12 years. Most common complaints was abdominal pain [45/7%] and the second complaints was vomiting [13%], but most common complaints in severe esophagitis was melena [66%] and hematemes [18/8%]. Most of patient [63%] had a mild grade of esophagitis. When difference between endoscopy and pathology compared: Mild esophagitis in endoscopy [67%], but in pathology was [63%], moderate esophagitis [14/7%] in endoscopy was [17%] in pathology and severe form 2/8% in endoscopy but [4/9%] in pathology

Conclusion: According to results of our study in children age group with chronic abdominal pain, vomiting, excessive regurgitation, failure to thrive, we noticed that esophagitis is common etiologic factor. Histological esophagitis frequently occur in the absence of gross endoscopic findings and we need biopsy and histological examination to confirm diagnosis