Micronutrients in infants suffering from cow's milk allergy fed with dietary formulas and breast milk.

INTRODUCTION: Cow's milk allergy (CMA) is the most common food allergy in infants. As this food allergy indicates a wide range of clinical syndromes due to immunological reactions to cow's milk proteins, we aimed to evaluate the status of micronutrients in infants suffering from cow's milk allergy. METHODS: In this historical cohort study, infants with CMA were divided into two equal groups: breastfeeding and diet formula feeding. Data were gathered by a form, including the micronutrients such as iron, selenium, calcium, phosphorus, zinc, and vitamin D. Groups were compared and data were analyzed by the IBM SPSS version 21. RESULTS: This study involved 60 six-month-old infants, and the findings revealed no significant difference between the two groups concerning magnesium, phosphorus, zinc, and vitamin D. However, infants in the formula-feeding group exhibited significantly elevated mean serum levels of iron and selenium, whereas breastfed infants displayed higher levels of calcium. CONCLUSION: The findings of this research revealed a significant difference in calcium, selenium, and iron levels between formula-fed and breastfed infants, even though all variables were within the normal range for both groups. In light of these results, conducting further studies with a larger sample size and extended follow-up periods becomes imperative.

Correlation between cystatin C-based formulas, Schwartz formula and urinary creatinine clearance for glomerular filtration rate estimation in children with kidney disease.

INTRODUCTION: Assessment of glomerular filtration rate (GFR) is an important tool for monitoring renal function. OBJECTIVES: Regarding to limitations in available methods, we intended to calculate GFR by cystatin C (Cys C) based formulas and determine correlation rate of them with current methods. PATIENTS AND METHODS: We studied 72 children (38 boys and 34 girls) with renal disorders. The 24 hour urinary creatinine (Cr) clearance was the gold standard method. GFR was measured with Schwartz formula and Cys C-based formulas (Grubb, Hoek, Larsson and Simple). Then correlation rates of these formulas were determined. RESULTS: Using Pearson correlation coefficient, a significant positive correlation between all formulas and the standard method was seen (R(2) for Schwartz, Hoek, Larsson, Grubb and Simple formula was 0.639, 0.722, 0.705, 0.712, 0.722, respectively) (P<0.001). Cys C-based formulas could predict the variance of standard method results with high power. These formulas had correlation with Schwarz formula by R(2) 0.62-0.65 (intermediate correlation). Using linear regression and constant (y-intercept), it revealed that Larsson, Hoek and Grubb formulas can estimate GFR amounts with no statistical difference compared with standard method; but Schwartz and Simple formulas overestimate GFR. CONCLUSION: This study shows that Cys C-based formulas have strong relationship with 24 hour urinary Cr clearance. Hence, they can determine GFR in children with kidney injury, easier and with enough accuracy. It helps the physician to diagnosis of renal disease in early stages and improves the prognosis.

The effect of phototherapy on urinary calcium excretion in term neonates.

Phototherapy is the most common, most effective, and least dangerous treatment method for neonatal hyperbilirubinemia and is the treatment of the first choice for neonatal icterus. Hypocalcemia is one of the lesser-known complications of phototherapy. Some studies have shown a relationship between increased urinary calcium excretion and phototherapy-induced hypocalcemia. We aimed to assess the effect of phototherapy on urinary calcium excretion in term neonates. This before-after study was performed on 80 term neonates having hyper- bilirubinemia referred to the 17(th) Shahrivar Hospital, Rasht, Guilan Province, Northern Iran, over a one-year period from May 2013 to May 2014. Electrocardiography was performed to measure QTc in all neonates at admission and 48 h after phototherapy. Blood and urine samples were taken from all neonates before and 48 h after phototherapy. Phototherapy was performed using four lamps with similar wavelengths from a distance of 20 cm. The serum and urinary calcium and sodium levels and urinary creatinine level before and after phototherapy were measured and compared. Data were analyzed using SPSS software, version 16. The mean age of the study subjects was 7.01 ± 4.13 days. We did not find any significant difference between urinary calcium levels (P = 0.0001), urinary creatinine levels (P = 0.954), or the calcium/creatinine ratio (P = 0.086) before and after phototherapy. The neonates' mean ± standard deviation plasma as well as urinary sodium levels differed before and after phototherapy; the difference was not statistically significant (P = 0.658). Phototherapy might increase urinary calcium excretion although it does not cause hypocalcemia.

Primary Antibiotic Resistance to Helicobacter pylori Strains Isolated From Children in Northern Iran: A Single Center Study.

BACKGROUND: Initial resistance to antibiotics is the main reason for the failure of Helicobacter pylori (H. pylori) eradication in children. OBJECTIVES: As we commonly face high antibiotic resistance rates in children, we aimed to determine the susceptibility of H. pylori to common antibiotics. PATIENTS AND METHODS: In this cross-sectional in vitro study, 169 children younger than 14 years with clinical diagnosis of peptic ulcer underwent upper gastrointestinal endoscopy. Biopsy specimens from stomach and duodenum were cultured. In isolated colonies, tests of catalase, urease, and oxidase as well as gram staining were performed. After confirming the colonies as H. pylori, the antibiogram was obtained using disk diffusion method. RESULTS: Culture for H. pylori was positive in 12.3% of the specimens, urease test in 21.3%, serological test in 18.9% and stool antigen test was positive in 21.9%. We could show high specificity but moderate sensitivity of both histological and H. pylori stool antigen tests to detect H. pylori. The overall susceptibility to metronidazole was 42.9%, amoxicillin 95.2%, clarithromycin 85.7%, furazolidone 61.9%, azithromycin 81.0%, and tetracycline 76.2% with the highest resistance to metronidazole and the lowest to clarithromycin. CONCLUSIONS: In our region, there is high resistance of H. pylori to some antibiotics including metronidazole and furazolidone among affected children. To reduce the prevalence of this antibiotic resistance, more controlled use of antibiotics should be considered in children.

Hypercalciuria in school-aged children of Rasht: a single-center study.

Hypercalciuria is the most common identifiable metabolic cause of calcium kidney calculus disease. Idiopathic hypercalciuria is defined as hypercalciuria with normal serum electrolytes levels in the absence of any known underlying disease responsible for increased urinary calcium excretion. The aim of the present survey was to study the prevalence of urinary tract signs and symptoms of idiopathic hypercalciuria in a healthy group of primary school children living in Rasht, a city in north of Iran. The prevalence of idiopathic hypercalciuria in our study was estimated to be 5.6%. This is a first report of idiopathic hypercalciuria in Guilan province.

Evaluation of serum lead levels in children with constipation and normal controls in northern iran.

OBJECTIVE: Constipation is a major debilitating problem in children. We aimed to assess the serum lead levels of 2-13 year-old children complaining from constipation who referred to our center in Guilan province, Northern Iran. METHODS: This cross-sectional study was done on ninety 2-13 year-old children referring to 17(th) Shahrivar Hospital, complaining from constipation (case group) and 90 healthy children The demographic data as well as the children's serum lead levels were evaluated and recorded. Data were analyzed using SPSS software. Chi-square test was used as applicable. FINDINGS: Lead poisoning was significantly more frequent in the case group (37.8%) compared with the control group (8.9%). The frequency of lead poisoning in the case group compared with the control group, was significantly higher in children <7 years old (40.2% vs. 10%), boys (40.9% vs. 9.3%), girls (34.8% vs 8.3%), residents of old houses (43.1% vs. 9.7%), residents of new houses (28.1% vs. 8.5%), residents of low-traffic areas (26.8% vs. 5.3%), urban residents (40.5% vs. 9.9%), children whose fathers had low risk (33.3% vs. 10.9%) and high risk jobs (40.7% vs. 3.8%). CONCLUSION: The frequency of lead poisoning was higher in children suffering from constipation.No significant difference was found between the two groups with respect to their sex, age, father's job, and living in urban or rural areas.

Clinical outcome and follow-up of prenatal hydronephrosis.

Hydronephrosis is probably the most common congenital abnormality detected prenatally by ultrasonography This study was performed to determine the cause and outcome of prenatal hydronephrosis in our hospital. A total of 45 infants, with 57 prenatally hydronephrotic renal units, were enrolled into this study. For the purpose of this study, the degree of hydronephrosis was defined as mild, moderate or severe. Postnatal ultrasonography was performed as soon as possible in those with bilateral hyronephrosis and 3-7 days after birth in those with unilateral hydronephrosis. Voiding cystourethrogram was performed in 6-8 weeks time. In the absence of vesicoureteral reflux (VUR), diethylenetriamene penta acetate scan was performed to exclude obstructive uropathy. There were 29 males and 16 females (male:female ratio 1.8:1), and unilateral and bilateral hydronephrosis were seen in 33 (73%) and 12 (27%) of the cases, respectively. Hydronephrosis was caused by ureteropelvic junction obstruction (UPJO) in 20 (44.5%), VUR in 10 (22.2%), ureterovesical junction obstruction in four (8.9 %), posteriorurethral valves in four (8.9 %), UPJO with VUR in two (4.4%) and non-VUR non-obstructive in one (2.2%). During follow-up, 16 patients (35.5%) required operative intervention while seven (15.5%) improved spontaneously. Fetal hydronephrosis needs close follow-up during both ante-natal and postnatal periods. In this study, the most common cause for hydronephrosis were UPJO and VUR. Also seen in this study is the noteworthy point that mild fetal hydronephrosis is relatively benign and does not require surgical intervention in most cases and surgery should be performed only if there is renal function compromise. Prenatal consultation with a pediatric nephrologist and urologist is useful in decreasing parental anxiety and facilitating postnatal management.

Pediatric urolithiasis: an experience of a single center.

INTRODUCTION: The aim of this study was to evaluate the clinical features and metabolic and anatomic risk factors of urolithiasis in children. MATERIALS AND METHODS: Between 2004 and 2009, a total of 84 children (35 girls and 49 boys) had been treated because of urolithiasis. Clinical presentation, urinary tract infection, calculus localization, family history, presence of anatomic abnormalities, and urinary metabolic risk factors were evaluated, retrospectively. RESULTS: The children were between 6 months and 16 years of age (mean age, 5.25 ± 3.61 years). The calculus diameter was 3.2 mm to 31 mm (mean, 7.31 ± 4.64 mm). In 90.6% of the cases, the calculus was located only in the kidneys and in 2.4% it was only in the bladder. The most common presentations were urinary tract infection, restlessness, and abdominal pain. A positive family history of urinary calculi was detected in 27.3%; urinary tract infection, in 23.8%; and anatomic abnormality, in 10.7% of the patients. Metabolic evaluation, which was carried out in 78 patients, revealed that 52.6% of them had a metabolic risk factor including normocalcemic hypercalciuria (21.7%), hyperuricosuria (11.5%), cystinuria (3.8%), and hyperoxaluria (5.1%). CONCLUSIONS: We think that urolithiasis remains a serious problem in children in our country. Family history of urolithiasis, urologic abnormalities, especially under the age of 5 years, metabolic disorders, and urinary tract infections tend to be associated with childhood urolithiasis.

Diabetic ketoacidosis and its complications among children.

In order to recognize of DKA and its complications among children with DM type I, we conducted a descriptive study and all of the children with the final diagnosis of DKA. Data regarding their demographics, disease characteristics, treatment features and outcome derived from patients' medical files and registered in a data sheet. Data were analyzed using SPSS 11.0 and exhibited in the form of frequency tables and charts. There were 33 females and 30 males (53.1% and 46.9%, respectively). They were involved with ketoacidosis most commonly in summer (42.2%). Autumn, winter and spring seasons were in the next turns (29.7%, 15.6%, and 12.5%, respectively). Data analysis showed a clear improvement in the time taken to correct the acidosis with respect to the date of admission (more than 40 hours in the initial year to less than 28 hours at the final year). It seems that the management of diabetic ketoacidosis has improved during recent years. We concluded to consider ketoacidosis even in the first admission of a diabetic child.

Diagnostic value of Helicobacter pylori serologic test in pediatric population with abdominal pain.

The aim of this study was to determine the diagnostic value of a serologic test for Helicobacter pylori (H. pylori) in pediatric population presenting with abdominal pain suspected of peptic disease. We conducted a preospective cross sectional study. There were 202 children with abdominal pain. Serologic BM test using Helisual Quick test kit was performed. All patients then underwent endoscopic examination. The calculated sensitivity, specificity, positive and negative predictive values of the applied serologic BM test were 72.4%, 64.8%, 44.6% and 85.7%, respectively. We concluded that a positive result from serologic test could not be judged independently. Thus, in symptomatic patients, other diagnostic methods (e.g. endoscopy and UBT) should be applied prior to the therapeutic decisions.

Helicobacter pylori culture and antimicrobial resistance in Iran.

OBJECTIVE: Helicobacter pylori is considered as an important etiologic factor in pathogenesis of peptic ulcer disease, chronic gastritis and gastric cancer. To eradicate this micro-organism, numerous regimens containing various antimicrobial agents have been suggested. However, H pylori antimicrobial resistance is a leading factor to treatment failure and recurrence of the disease. The aim of the study was to evaluate the prevalence of H pylori resistance to metronidazole, clarithromycin, tetracycline, amoxicillin, erythromycin and furazolidone in authors pediatric patients. METHODS: Antral biopsy of all pediatric patients with negative history of receiving anti-H pylori regimen and endoscopic findings of nodular gastritis or peptic ulcer without previous history of NSAID consumption, burning and trauma were performed for H pylori histology, urease test and culture. All positive cultures were tested for antimicrobial susceptibility. RESULTS: Twenty four patients (14 male and 10 female) between 3.5 and 14 years of age were culture positive. 54.16% of the isolates were resistant to metronidazole, 8.33% to amoxicillin, 4.16% to erythromycin and 4.16% to clarithromycin. None of authors patients were resistant to tetracycline and furazolidone. CONCLUSION: H. pylori antimicrobial resistance could be a major contributor to failure of H pylori eradication. Continuous prospective surveillance of H. Pylori is essential. Moreover, culture and antimicrobial susceptibility test is recommended for resistant cases after the first failure to therapy.