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The growth assessment of very low birth weight infant at corrected two years old
Get PDFBackground: The aim of this study was to determine the growth status of very low birth infant at corrected age of two years. Methods: This cross-sectional study was performed on all babies with birth weight ≤1500 gr without any congenital anomalies, genetic disturbance and chronic disease (e.g. cardiopulmonary insufficiency, cholestasis, malabsorption). They were called at corrected age 2 years, namely the calendar age by month + (40-gestational age by week). Their height, weight and head circumference were recorded and a nutritional check list was prepared. The values were entered into the WHO Standard Growth Curve Chart for male and female genders (CDC, November 2009) in the <10th, 10-49th, 50-89th and ≥90th percentiles. Results: Forty-three children with mean gestational age of 30.08±3.23 weeks and mean birth weight of 1163.95±240.77 g were studied. Thirteen cases (30.2) in length, 10 cases (23.3) in weight, 6 cases (14) in head circumference and 17 cases (39.5) in weight-for-height were below the 10th percentile. There was no significant difference between the sex, gestation age and the birth weight of these children below and above the 10th percentile (P<0.05). Conclusions: According to the findings of this study, about one-third of infants born ≤1500 grams were below 10th percentile for height, and nearly a quarter of them were under10th percentile for weight at corrected 2 years old. Therefore, their growth should be more accurately controlled by health care centers based on the growth curve in the first year and any problem case should be referred to specialized centers
Letter to Editor: Hepatitis A in children at Amirkola Childrenś Hospital, Northern Iran; experience for a decade
Get PDFDear Editor, Hepatitis A virus (HAV) is a single-stranded RNA virus belonging to the Picornaviridae family that is the most common form of acute viral hepatitis worldwide with around 1.5 million clinical cases each year, but the rate is apparently ten folds higher because of underreporting 1, 2. The clinical spectrum of HAV infection ranges from asymptomatic to sever hepatitis A 3. Severe hepatic damage can lead to acute liver failure (fulminant hepatitis) and death in some subjects, which is strongly dependent on the age of the patients 4, 5. In the last two decades, improved sanitary condition and hygiene practices among developing countries have led to reduced transmission of HAV, and this viral infection has shifted from childhood to adolescence with more severe and even life-threatening course 1, 6, 7. Here, we aimed to report clinical and serological features of all cases of hepatitis A, hospitalized at Amirkola Children’s Hospital (North of Iran) from February 2009 to July 2019. During the 10-year period, 16 children aged 1-13 years old (7±3 years) were admitted with diagnosis of hepatitis A. Among them, 12 (75%) were male and 4 (25%) lived in rural areas. Glucose-6-phosphate dehydrogenase (G6PD) deficiency was observed in 31% 5 cases. History of contact with a person infected with hepatitis A and recent travelling were 31% 5 and 37% 6, respectively. In a study, HAV infection was more common in males than females 8, and another one found seroprevalence of HAV which was significantly lower in urban than rural populations (73.3% vs. 82.2%) 9. More common symptoms were jaundice 93% (15), fever 81% (13), dark urine 81% (13), pale stools 81% (13), nausea and vomiting 62% (10), abdominal discomfort 62% (10) and less common symptoms included loss of appetite 25% (4), diarrhea 18% (3) and cough 6% (3). Mean± standard deviation of laboratory tests in study group revealed total bilirubin of 10±5 mg/dl, direct bilirubin 7.08±4.09 mg/dl, total protein 13±19 g/dl, albumin 5±7 g/dl, alkaline phosphatase of 886±409 IU/l, serum aspartate aminotransferase of 1268 ± 997 IU/l, alanine aminotransferase of 1546 ± 991 IU/l, prothrombin time of 13±2 second (s) and partial thromboplastin time of 43±12 s. Asymptomatic HAV infection has been observed in about 70% of children < 6 years old, in contrast, symptomatic infection is usually associated with jaundice and remarkably high levels of serum aminotransferases 3. Fever, malaise, nausea, vomiting, abdominal discomfort, dark urine, and jaundice are typical symptoms of acute hepatitis A and myalgia, pruritus, diarrhea, arthralgia, and skin rash are less common symptoms. Biochemical tests have shown elevated total bilirubin (mean peak 7 mg/dl), alkaline phosphatase (mean peak 319 IU/l), serum aspartate aminotransferase of 1,754 IU/l, and alanine aminotransferase of 1,952 IU/l 3.   Among 16 children, fulminant hepatitis A occurred in one boy 5.5 years old with the history of febrile seizure and without the history of any chronic liver disease so that liver transplant was done for him, but post-transplant lymphoproliferative disorder (PTLD) developed and led to his death. In 0.01% of acute hepatitis A cases, fulminate hepatitis can occur with an estimated mortality rate of 60–80% 10. Although hepatitis A infection is usually asymptomatic in children, acute liver failure due to the hepatitis A may occur in patients with preexisting chronic liver disease 2. A study from Latin America indicated that the mean age of population with acute liver failure (ALF) was 5 years and 43% of them had acute HAV infection. The HAV was the main etiology of ALF in these patients 11 and other study from Argentina stated that 61% of children with ALF had hepatitis A infection 12. A study of north of Iran mentioned that the anti-HAV antibody seroprevalence declined among children <15 years with and without chronic liver disease; so, it is important to employ preventative strategies against HAV in chronic liver diseases 2. This study demonstrated that though during 10-year period, fulminate hepatitis occurred just for one child infected with hepatitis A, but this infection might lead to liver failure even in children without preexisting chronic liver disease; therefore, the preventative strategies against HAV should be planned in children population. So, universal vaccination plan for all children above one year old and health tips observation are recommended
Rare presentation of renal failure related to tumor lysis syndrome
Get PDFBackground: Tumor lysis syndrome (TLS) which mostly occurs in lymphoproliferative malignancies after the start of chemotherapy is an oncologic emergency. Manifestations of metabolic imbalance including increasing hyperkalemia, hyperphosphatemia, hyperuricemia and hypocalcemia are common presentation of TLS. Case report: We present two cases of spontaneous TLS; a rare presentation of TLS before cytotoxic chemotherapy. These cases were admitted with presentation of TLS without any history of chemotherapy with mediastinal mass in chest X-ray (CXR) and subsequent diagnosis of lymphoblastic lymphoma and T-cell acute lymphocytic leukemia (ALL). After several hemodialysis sessions, their conditions were improved and they underwent chemotherapy. Conclusions: It was found that the presentation of mediastinal mass in cases of lymphoma and acute leukemia might be associated with TLS before chemotherapy. In addition, it is important to pay attention to CXR, when we face to a patient with acute renal failure related to TLS
Inflammatory myopathies in a patient with Darier disease, a possible association
Get PDFBackground: Darier disease (DD) is an autosomal dominant genetic disorder which develops from a mutation in the ATP2A2 gene. Inflammatory myopathies (IM) are the largest group of potentially treatable myopathies. In this case, we report development of IM in a patient with DD for the second time in the literature.
Case presentation: The patient is a 59-year-old female, a known case of DD, who developed proximal muscle weakness 2 weeks prior to admission. Elevated muscle-enzymes, as well as typical electromyographic and radiologic confirmed the diagnosis of IM.
Conclusions: Abnormalities in intracellular calcium homeostasis may explain the association between DM and DD, therefore it is noteworthy to keep this association in mind and conduct more research regarding this issue
Serum ferritin levels and bone mineral density in the elderly
Get PDFBackground: Iron overload influences negatively on bone mineral density (BMD) but the results of studies regarding serum ferritin (SF) and BMD are conflicting.This study aimed to determine the association of SF and BMD in the elderly.
Methods: All participants of the Amirkola cohort selected between 2011-2012, aged > 60 years were classified as high or normal (<200ng/ml) SF. BMD at femoral neck and lumbar spine was determined by dual energy x-ray absorptiometry (DXA) and the results were expressed as BMD g/cm2 and BMDT-score. Multiple logistic regression analysis with calculation of odds ratio (OR) and 95% confidence interval was used to estimate the association of low BMD (LBMD) defined as BMD T-score < -1 with SF.
Results: 1089 subjects (women, 44.7%) were studied. High SF was observed in 366 (33.6%) and LBMD in 874 (80.2%) subjects. The two groups of SF were similar regarding biochemical parameters and demographic characteristics except MetS, overweight /obesity and diabetes which were more prevalent in high SFgroup. BMD g/cm2 at both measurement sites was significantly higher (P=0.001 for both) and the prevalence of LBMD was significantly lower (74.1% vs 83.1%, P=0.001) in high SF group by OR= 0.60 (0.44-0.81). After adjustment for all biochemical and demographic variables, the association remained significant by adjusted OR= 0. 68 (0.49-0.94).
Conclusions: These findings show a negative association between high SF and LBMD indicating a beneficial effect of high SF in the elderly. Regarding detrimental effect of iron overload on bone mass, these findings require further studies
Insulin resistance and adverse metabolic profile in overweight/obese and normal weight of young women with polycystic ovary syndrome
Get PDFBackground: Polycystic ovary syndrome (PCOs) is an endocrine-metabolic disorder. This study intends to determine the comparison of insulin resistance (IR) and metabolic disturbance in overweight/obese and normal-weight of young women with polycystic ovary syndrome.
Methods: Using a comparative cross-sectional study design in 2015, 27 normal weight (18<BMI<25) and 85 overweight/obese (BMI≥25) aged 18 and 35 underwent clinical measures of HOMA (IR) as insulin resistance and QUICKI as insulin sensitivity tools in Fatemezahra Infertility Research Center of Babol. Lipid profile and hormonal parameters were evaluated between two groups.
Results: 112 women with PCOS participated in this study. The mean age was 22.4±3.48 years in the normal PCOS group (n=27) and 24.4±5.06 years in the overweight/obese PCOS patients (n=85). BMI had a significant straight correlation with insulin resistance (p3.15) vs. 8.3% (5) in the normal group (P13µU/ml) vs. 10.3% (7) in the control group (p<0.001).
Conclusions: Overweight/obese PCOs patients revealed higher insulin resistance and lower insulin sensitivity, and also greater TG and LDL cholesterol. Priority of management of insulin resistance and lipid profile should be considered on identifying these potentially major complications
The Effect of Training Pregnant Women and Their Husbands on Health Promoting Behaviors during Pregnancy and Postpartum Period
Get PDFBACKGROUND AND OBJECTIVE: Health promoting lifestyle is any kind of action that is taken to maintain the health of the individual. Healthy lifestyle plays an important role in improving the maternal-fetal outcomes. The aim of this study is to determine the effect of training pregnant women and their husbands on health promoting lifestyle.
METHODS: This clinical trial was conducted among 189 pregnant women in the city of Bukan, Iran. Participants were categorized into three groups: the recipients of the training along with their husbands (the first intervention group), the recipients of the training without their husbands (the second group of intervention) and the routine care recipients (control group). Four sessions of group training were held for mothers of both interventional groups and one group training session was held for the mothers of the first intervention group regarding sleep health, nutrition, physical activity, self-image and sexual issues. Health promoting lifestyle questionnaire (score range: 52 - 208) was completed and assessed before the intervention, eight weeks after the intervention and six weeks after delivery.
FINDINGS: There was no statistically significant difference between the groups before the intervention in terms of the total score of health promoting lifestyle. Eight weeks after the intervention, the mean score of health promoting lifestyle was 162.2±2.5 in the first group, 153.6±2.5 in the second group and 133.4±2.4 in the control group, which was significantly higher in both intervention groups compared to the control group (p<0.001). Six weeks after delivery, the mean score of health promoting lifestyle was 159.8±3.0 in the first group of intervention, 143.1±3.0 in the second group and 133.7±3.0 in the control group, which was significantly higher in the first group of intervention compared to the second group of intervention (p=0.003) and control group (p<0.001).
CONCLUSION: The results of the study showed that training pregnant women along with their husbands or training the women alone improves lifestyle. However, training pregnant women along with their husbands proved to be more effective than training the women alone
The Evaluation of the Anatomical Variations of Osteomeatal Complex in Cone Beam Computed Tomography Images
Get PDFBACKGROUND AND OBJECTIVE: Anatomical variations of ostiomeatal complex have an imperative role in pathologies of sinonasal complex, ventilation obstruction and success of surgical treatments. The purpose of this study was to evaluate the anatomical variations of osteomeatal complex in cone beam computed tomography images in North of Iran.
METHODS: In this cross-sectional retrospective study, 159 CBCT images were analyzed. Anatomical variations evaluated included Concha bullosa, Paradoxical middle turbinate, Uncinate process hypertrophy and pneumatization, hypertrophied Bulla ethmoidalis, Agger nasi cell, Maxilo-ethmoidal cell (Haller's cell) which were assessed based on the frequency, gender, unilateral/bilateral appearance and the involved side in unilateral cases (left/right). Also, two observers evaluated the data simultaneously and the result of final agreement was recorded on the checklists.The data were analyzed descriptively and analytically.
FINDINGS: From among 159 subjects, 76 (47.8%) were female and 83 (52.2%) were male. The patients were 18-80 years old (mean: 34.96±14.50 years). Agger nasi cell and concha bullosa which were observed in 143 (98.9%) and 151 (95%) cases, respectively, were the most common findings and often appeared bilaterally. The least frequency belonged to hypertrophied bulla ethmoidalis which was 9 (5.7%) and uncinate process hypertrophy which was 12 (7.5%). Paradoxical middle turbinate, uncinate process pneumatization, and Haller's cell were observed in 28 (17.6%), 57 (35.8%), and 61 (38.4%) cases, respectively. No significant relationship was found between gender and the anatomical variations. (p>0.05)
CONCLUSION: In the present study, Concha Bullosa and Agger Nasi Cell were the most common anatomical variations in CBCT images of paranasal sinuses, which were reported bilaterall
The frequency of pap and sfa genes among Escherichia coli strains isolated from hospitalized patients of Rouhani hospital in babol, Iran
Get PDFBACKGROUND AND OBJECTIVE: Escherichia coli urinary tract infections are known as one of the most important nosocomial infections. Adhesion genes such as sfa and pap which are important in bacterial attachment and colonization in epithelial cells have a significant role in bacterial pathogenecity. The aim of this study was to investigate the frequency of mentioned genes among E. coli strains isolated from hospitalized patients of Rouhani hospital in Babol city.
METHODS: A total of 70 E. coli strains were isolated from urinary specimens of Rouhani hospitalized patients and then identified and confirmed with differential tests by using MacConkey agar, TSI, Oxidase test and etc. Thereafter, antimicrobial pattern were carried out by disk diffusion method. Finally the bacterial genomic DNA was extracted and the frequency of genes was determined by molecular method.
FINDINGS: In this study resistance to Erythromycin (65.7%) and Trimethoprim-sulfamethoxazole (57%) had the highest resistance ratio. On the other hand the frequency of sfa and pap genes was 60% and 27% respectively.
CONCLUSION: The results of this study showed the sfa and pap genes have a high prevalence and antibiotic resistance also needs special attention
A rare case of Kikuchi-Fujimoto disease (case report)
Get PDFBackground: Kikuchi disease is a rare, benign, self-limited disease characterized primarily by fever and cervical lymphadenopathy. Diagnosis is based on excisional biopsy and pathologic study. We report a case of an atypical axillary lymph node enlargement.
Case report: This patient was a 12-year-old boy with clinical characteristics including axillary lymph adenopathy, fever and fatigue. He became asymptomatic after excisional biopsy. Histologic study reported necrotizing lymphadenitis without neutrophils (Kikuchi disease).
Conclusions: These findings are important for diagnosis, because of the disease rarity, clinical features (such as lymphadenopathy, prolonged fever) and unidentified etiology