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Objective: Congenital heart disease (CHD) is one of the common diseases of childhood, which is classified into non-cyanotic and cyanotic types. It can affect thyroid function and lead to disruptions in thyroid hormone secretion and hypofunction. This study aimed to evaluate thyroid function in patients younger than 2 years old with cyanotic and non-cyanotic CHD. Materials and Methods: In our study, 101 patients (female/male: 50/51) were included. The thyroid-stimulating hormone and thyroid hormones such as thyroxine (T4) and triiodothyronine (T3) were measured using the electrochemiluminescence method, and thyroid peroxidase antibodies were measured by an enzyme-linked immunosorbent assay. Subclinical hypothyroidism referred to normal levels of T4, with elevated levels of thyroid-stimulating hormone in the serum. Results: The frequency of subclinical hypothyroidism and hypothyroidism in patients with cyanotic CHD was estimated at 27.5% and 10%, respectively, and 1 patient had hyperthyroidism. The majority of cyanotic and non-cyanotic CHD cases were diagnosed with tetralogy of Fallot (30%) and patent ductus arteriosus (32.79%). There were no significant differences between cyanotic and non-cyanotic groups regarding T3, T4, free T3, free T4, and anti-thyroid peroxidase antibody levels (0.389, 0.142, 0.354, 0.248, and 0.333, respectively). Conclusion: Based on the present findings, subclinical hypothyroidism is a common finding in cyanotic CHD patients during childhood, which is associated with increased levels of oxygen saturation, severity of cyanosis, and age. [ABSTRACT FROM AUTHOR]

Background: Infrequent voiding is two or lower than two micturitions per day and has not any organic causes; the etiology of this condition has not been found correctly; based on this, we evaluated developmental factors as a probable etiology for infrequent voiding. Methods: In the present study, we enrolled 200 children six to seven years of age (100 cases with infrequent voiding and 100 healthy ones). Height and weight weremeasured, compatible with gender and age, and related information, including personal and social development, problem-solving, fine motor, gross motor, communication, and defining words, were obtained by the Nelson development table and ages and stages questionnaires. Results: Based on personal-social (P = 0.009), problem-solving (P = 0.006), communication (P = 0.008), and language development (P = 0.006), there are statistically significant differences. However, fine motor (P = 0.557) and gross motor (P = 0.607) do not differ statistically. On the other hand, in terms of growth indices, in the evaluation of girls’ height (P = 0.001), boys’ height (P = 0.012), girls’ weight (P = 0.014), and boys’ weight (P = 0.016), there is a statistically significant difference between two groups. Conclusions: Based on the measured odds ratio, children with infrequent voiding have a higher risk of developmental disorders; developmental disorders can also increase the prevalence of infrequent voiding. [ABSTRACT FROM AUTHOR]

Objective: Since the initiation of the thyroid screening program in Iran in 2005, 5 mIU/L has been selected as the threshold for thyroid stimulating hormone (TSH) for screening for congenital hypothyroidism. Given the specific disease pattern in the region and current controversies of the TSH cutoff point, a new cutoff point has been proposed in this study.Methods: This study was conducted on the existing database of the screening program consisting of 127,112 neonates in Markazi Province, center of Iran, during 2006-2012. Data on 614 referred neonates consisting of 414 neonates diagnosed of having hypothyroidism and 200 screened healthy neonates, were analyzed. The heel prick test had been done on the studied neonates to determine the TSH levels. The receiver-operator characteristic (ROC) curve and diagnostic values were used for data analysis.Results: The 5-mIU/L cutoff point in the study had a sensitivity and specificity and AUC of 86.5, 10 and 47%, respectively. Among the eleven selected cutoff points, 6.5 mIU/L had the appropriate sensitivity, specificity and AUC (58.9, 56.5 and 57%, respectively), negative and positive likelihood ratios (0.73 and 1.35, respectively).Conclusion: Given the very low specificity of the 5-mIU/L cutoff point for referral and with respect to the high rate of referrals and many false positive cases, we suggest to use the 6.5-mIU/L cutoff point which is more suitable. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The relation between serum and filter paper TSH level in neonates with congenital hypothyroidism," by A. H. Ayyad and colleagues in the 2014 issue.

Objective: The aim of this study was to investigate the epidemiology of congenital hypothyroidism (CH) among newborns in Markazi Province, Iran. Methods: This cross-sectional study was conducted from 2006 to 2012. Blood samples were taken between 3 to 5 days after birth from the heel. Thyroid stimulating hormone (TSH) was tested using the enzyme-linked immunosorbent assay method and was employed as the screening test. Newborns with abnormal screening results (TSH >5 mIU/L) were reexamined. The data were analyzed using SPSS. Results: A total of 127 112 infants were screened. Of these, 51.2% were male and 48.8% were female. The coverage rate of the screening program was 100%. Of 6102 recalled subjects (re-call rate 4.8%), 414 cases with CH were detected, yielding a CH prevalence of 1:307 (female:male ratio 1:0.95). The prevalence of permanent and transient CH was 1:581 and 1:628, respectively. Conclusion: This study reveals that the prevalence of CH is higher compared to worldwide levels. Comprehensive and complementary studies for recognizing related risk factors should be a priority for health system research in this province. [ABSTRACT FROM AUTHOR]

Background: Urine tract infection (UTI) is the most prevalent bacterial infection and the second prevalent infection after viral flu among children. With respect to the importance of urine culturing, we decided to assess the effect of ablution the genital area on the result of urine culturing among 3-12 years old girls referring to Amir Kabir hospital, Arak, Iran. Patients and methods: This randomized clinical trial was achieved on 620 girls referring to our hospital. Children were randomly assigned in two groups, with and without ablution. In ablution group, the appropriate technique of genital area ablution with water and soap was trained as well as how to collect middle-urine sampling, however, the other group received recommendations on how to appropriately collect middle-urine sample. Results: Of 310 children of the ablution-trained group, UTI was reported in 11 (3.5%), contamination in 3 (1%) while 296 children were normal (95.3%). However, these figures were 14 (4.7%), 6 (2%) and 290 (93.3%) in the other group, respectively. Contamination rate did not differ significantly between the 2 groups (P=0.49). Conclusion: Genital area ablution is not associated with a significant decrease in rate of urine culture contamination, hence, it should not be routinely recommended for children. [ABSTRACT FROM AUTHOR]

Background: Urine tract infection (UTI) is the most prevalent bacterial infection and the second prevalent infection after viral flu among children. With respect to the importance of urine culturing, we decided to assess the effect of ablution the genital area on the result of urine culturing among 3-12 years old girls referring to Amir Kabir hospital, Arak, Iran. Patients and methods: This randomized clinical trial was achieved on 620 girls referring to our hospital. Children were randomly assigned in two groups, with and without ablution. In ablution group, the appropriate technique of genital area ablution with water and soap was trained as well as how to collect middle-urine sampling, however, the other group received recommendations on how to appropriately collect middle-urine sample. Results: Of 310 children of the ablution-trained group, UTI was reported in 11 (3.5%), contamination in 3 (1%) while 296 children were normal (95.3%). However, these figures were 14 (4.7%), 6 (2%) and 290 (93.3%) in the other group, respectively. Contamination rate did not differ significantly between the 2 groups (P=0.49). Conclusion: Genital area ablution is not associated with a significant decrease in rate of urine culture contamination, hence, it should not be routinely recommended for children. [ABSTRACT FROM AUTHOR]

Salmonella species are a rare cause of urinary tract infection in children. They are associated with a high incidence of structural abnormalities or immunosuppressive status. We report the case of a healthy 7-year-old boy with pyelonephritis due to Salmonella group. He did not have a history of recent gastroenteritis. [ABSTRACT FROM AUTHOR]

Salmonella species are a rare cause of urinary tract infection in children. They are associated with a high incidence of structural abnormalities or immunosuppressive status. We report the case of a healthy 7-year-old boy with pyelonephritis due to Salmonella group. He did not have a history of recent gastroenteritis. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus (DM) is a major health care problem. The relationship between DM and zinc has frequently been reported in various research. The present study aims to investigate serum zinc level in patients with type 1 (IDDM) and type 2 (NIDDM). Association between glyaceted hemoglobin and level of zinc is also evaluted. Materials and Methods: This cross-sectional study was conducted on 60 subjects with DM (Type l: N=30; Type 2: N=30) who met inclusion criteria of the study. Patients' serum zinc level and HbA1c were measured. Data were analyzed using t-test and Mann-Withney U test. Results: Seventy five percent of the subjects were female. The average age of the IDDM was 15.36±5.28 years and that of NIDDM was 48.70±11.45 years. The average HbA1c of subjects was 8.06±1.64%. The average serum level of zinc in IDDM group was 95.82±14.51 µg/dl and that of NIDDM was 97.47±32.36 µg/dl, no significant difference was found between the two groups. Serum zinc difficiency was detected in 20% of the patients with NIDDM and 16.6% of the patients with IDDM. However, no significant correlation between HbA1c and serum level of zinc was detected in this study. Conclusion: Zinc deficiency was detected among a significant percentage of IDDM and NIDDM patients, but no significant correlation between serum zinc level and HbA1c was detected. [ABSTRACT FROM AUTHOR]

Montelukast by inhibiting leukotriene receptors in the bladder can prevent the activation of mast cells. We investigated the effectiveness of Montelukast in reducing the symptoms of children with bladder pain syndrome (BPS). In this randomized clinical trial, children were allocated into groups of intervention (Montelukast and oxybutynin) and the control (oxybutynin). At the beginning and after 14 days, questions from mothers of children about their urinary condition were asked about the frequency of nocturnal enuresis, frequent urination, urinary incontinence, urinary urgency, and their pain severity. There was no significant difference between two groups in terms of frequency of nocturnal enuresis, frequent urination, urinary incontinence, and urinary urgency. Regarding the frequency of pain distribution, the frequency of pain-free people in the Montelukast group was higher than control group (84.4% vs 56.3%, P = .023). The results showed that adding Montelukast to oxybutynin has a significant decrease in pain in children with BPS. [ABSTRACT FROM AUTHOR]

The antiepileptic Valproic acid (VPA) changes the oxidative/anti-oxidative balance that results in oxidative stress and maybe an increased risk of cardiac dysfunction. The aim of this study was to investigate the effect of VPA on ventricular function in epileptic children. We designed a study to evaluate ventricular function in epileptic children who had received VPA for at least one year. All subjects were evaluated using standard echocardiography, pulsed wave Doppler (PWD), and tissue Doppler imaging (TDI). This study consisted of 60 patients with epilepsy (mean age 10.30±3.21 years) and 60 healthy subjects in the control group (mean age 10.28±3.18 years). The duration of antiepilepsy medication ranged from 1.4 to 10 years, and the dose of VPA was 5-30 mg/kg. The ejection fraction and fractional shortening (P=0.841 and 0.064, respectively) were not significantly different between the two groups. The present study reports subclinical right and left ventricular systolic and diastolic dysfunction along with longitudinal ventricular motion disorder. It is recommended the evaluation of subclinical cardiac dysfunction in children treated by VPA. [ABSTRACT FROM AUTHOR]

Background: Kidney and urinary tract stones are the major health issues; in addition, proper nutrition is probably an important factor in kidney stones formation. The current study aimed at evaluating nutritional factors in kidney stones formation in children. Methods: The current cross sectional study, using the random sampling method, was conducted on 2 - 12-year-old children referred to Amir Kabir hospital. The data were collected by a 24-hour dietary recall; and calcium, oxalate, vitamin C, animal protein, and water contents in each food was calculated by a food processing software (Nutritionist4). Data were analyzed by Pearson correlation coefficient, independent t test, and regression logistic analysis with SPSS version 21. Results: Animal protein (P = 0.0001), meal water (P = 0.023) and total liquid amounts (P = 0.011) in the case group was higher than those of the control group; in addition, daily vitamin C intake was higher in the control group, but the differences were not statistically significant (P > 0.05). Conclusions: The relationship between kidney stones formation and nutritional factors was approved. Therefore, it maybe effective to examine and treat the stone formation by considering the nutritional factors. [ABSTRACT FROM AUTHOR]

Febrile convulsion (FC) is the most prevalent type of seizure in children. Febrile diseases have been associated with alterations in kidney function and urine indices. Therefore, in this study, renal function and urine analysis were examined in children with simple FC. The study comprised children with simple FC who were referred to the Amirkabir hospital in Arak between 2020 and 2021. Children were examined for urinalysis and kidney function by assessing the estimated glomerular filtration rate (eGFR). A total of 157 patients with FC were admitted. Hematuria, proteinuria, and pyuria were detected in 8.9%, 1.9%, and 5.1% of cases, respectively. The urine cultures of 2 children were positive. Moreover, it was found that in simple FC, eGFR decreases regardless of gender (P >.05), although kidney function decreases more in children older than 24 months. In conclusion, all children with FC must undergo renal function assessments. Furthermore, urinalysis and urine culture are advised to rule out infection. [ABSTRACT FROM AUTHOR]

Background: As the most prevalent noncontagious neurologic condition, epilepsy is an important cause of mortality and disability in children, and its etiology is an important issue. Objectives: Epilepsymay be induced by different risk factors, some of which maybe unclear; therefore, this study aimed to evaluate the risk factors of seizures in children. Methods: Children with seizures admitted to the Pediatric Clinic of Amir-Kabir Hospital were enrolled in this study. First, accurate biography of the parents was taken to rule out other differential diagnoses of seizures. After the diagnosis of seizures, based on the diagnosis of a pediatric neurologist, demographic information, detailed history of seizure, neurologic examination, and process of growth and development were recorded. Then, we take electroencephalogram (EEG), magnetic resonance imaging, and computed tomography scans from study cases. Results: Of the 291 evaluated cases, 54.6% were male. Variables associated with seizure and epilepsy evaluation showed that generalized tonic-clonic seizure was the most prevalent seizure in 134 children (46%). The duration of seizures was lower than 15 minutes in 266 cases; in addition, 191 children (55.5%) had a fever before seizures. Regarding underlying diseases, 268 children (92.2%) had no disease. Cerebral palsy (CP) was the most common underlying disease in 10 cases (3.4%). Conclusions: Infectious diseases (such as gastroenteritis and pneumonia) were observed as the most important possible risk factors in this study. [ABSTRACT FROM AUTHOR]

Background: Patients with mitral valve prolapse (MVP) may be prone to ventricular arrhythmias and sudden cardiac death and presence early repolarization pattern (ERP) in electrocardiography may be predict for ventricle arrhythmia. This study aimed to evaluation ERP in Children with MVP. Methods: In a cross-sectional study, we enrolled ERP in 70 MVP children with 70 age-and sex-matched healthy individuals. After echocardiography procedure for confirmation MVP, standard 12-lead electrocardiography recordings with sweeping rate of 25mm/s and an amplitude of 10mV/cm, and two cardiologists assessed who were blinded to the both groups. Result: We detected ERP in 17.14% of MVP patient's and seen in 8 case (11.43%) in control group, (P=0.23). the ERP occurred in MVP patient's mild, moderate and severe 4, 6 and 2 cases, (P=0.29). The ERP found in patients with and without chest pain 13 and 7, respectively (P=0.46) and, in patients with and without palpitations 15 and 5 cases, respectively (P=0.24). The ERP occurred 1.6 time more in patient with MVP in comparing with individual without MVP. The ERP occurred more frequently in among patients with moderate MVP in comparing with severe and mild. Chest pain and palpitation occurred more frequently in among patients with severe MVP. Conclusion: The prevalence of ERP in children with MVP has been at a higher-level incidence, especially among patients with complaining from chest pain. We suggested that children with MVP are in need of follow up considering the occurrence of arrhythmias. [ABSTRACT FROM AUTHOR]

Background: Nephrolithiasis in children is associated with a high rate of complications and recurrence. Objectives:Since some evidences reported that zinc has an important place amongst inhibitors of crystallization and crystal growth, we decided to assess the effectiveness of oral zinc sulfate as adjuvant treatment in children with nephrolithiasis. Patients and Methods: This was a randomized, double-blind, placebo-controlled clinical trial. 102 children in the age range 1 month to 11 years with first nephrolithiasis were recruited. Patients were randomly divided into two equal groups (intervention and control groups). Intervention group received conservative measures for stones and 1 mg/kg/day (maximum 20 mg/day) oral zinc sulfate syrup for 3 months. Control group received placebo in addition to conservative measures, also for 3 months. Patients were followed up by ultrasonography for 9 months, in 5 steps (at the end of 1st, 2nd, 3rd, 6th and 9th month after treatment) assessing size and number of stones in the kidneys. Results: Only at the end of the first month, the average number (intervention: 1.15 ± 3.78, control: 1.3 ± 2.84) (P = 0.001) and size (cm) (intervention: 0.51 ± 1.76, control: 0.62 ± 1.39) (P = 0.001) of stones was significantly lower in the intervention group, and in other points there was no significant therapeutic efficacy in oral zinc adjuvant treatment compared to conservative treatment alone. Also, during the 9-month follow-up, the number and size of stones in both groups decreased significantly (both: P < 0.0001) in a way that the decrease in the intervention group showed no difference with the control group. Conclusions: Adjuvant treatment with zinc is not more effective than consecutive treatment in children with nephrolithiasis. However, further studies are recommended due to the lack of clinical evidence in this field. [ABSTRACT FROM AUTHOR]

Introduction: Vesicoureteral reflux refers to the retrograde flow of the urine from the bladder to the ureter and kidney. The ureteral attachment to the bladder is normally oblique, between the bladder mucosa and detrusor muscle, creating a flap-value mechanism that prevents reflux. Reflux occurs when the submucosal tunnel between the mucosa and detrusor muscle is short or absent. The inflammatory reaction caused by pyelonephritis can result in scarring, which is also termed reflux nephropathy. Since sacral bone anomalies have a direct influence on the final function of the urinary and bowel systems, this study was performed to investigate the relationship between sacral ratio and reflux nephropathy. Materials and Methods: In this case-control study, the case -control group included 200 children under 9 years old who were referred to Amir-Kabir Hospital clinics with urinary tract infection and according to the VCUG and DMSA results, children with various grades of VUR entered the study. The sacral ratio was measured in the two groups and compared by a radiologist. The data were analyzed using Chi-2 and Mann Whitney Tests and software SPSS 16. Results: The case group included 48 males and 52 females with a mean age of 3.7 years old who had reflux nephropathy, and the control group included 47 males and 53 females with a mean age of 4.1 years who did not have reflux nephropathy. Sacral ratio abnormality was detected in 64% and 23.7% of the cases and controls respectively, which showed a significant difference (p-value=0.003). Conclusions: Sacral ratio abnormality was more common in children with vesicoureteral reflux and reflux nephropathy than children with VUR without reflux nephropathy. [ABSTRACT FROM AUTHOR]

Background : The prevalence of obesity is increasing worldwide. Obese children without hypertension are becoming an important health challenge. Aims : Complications of obesity in adults are well established, but in obese children, cardiac dysfunction has not been reported clinically. Settings and Design : The present cross-sectional study investigates subclinical systolic and diastolic dysfunction using echocardiographic modalities. Materials and Methods : Twenty-five youngsters with body mass index (BMI) >30 and 25 healthy children with BMI <25 were assigned into case and control group, respectively. In all participants, complete cardiovascular examination, electrocardiography, and echocardiography were fulfilled. Echocardiography surveys included standard, pulsed wave Doppler (PWD), and tissue Doppler imaging (TDI). Statistical Analysis Used : SPSS software, version 24. Results : The two groups were matched for age and sex. The resting heart rate and blood pressure were markedly higher in the obese group (P = 0.0001) though they were within the normal range in either category. Ejection fraction in the two groups was similar. Left ventricular (LV) mass (P = 0.0001), LV mass index (P = 0.029), left atrial-to-aortic diameter ratio (P = 0.0001), and LV end-diastolic diameter (P = 0.008) were significantly greater in the case group, indicating cardiomegaly and subclinical systolic and diastolic dysfunction. Except for the aortic velocity, all PWD variables were considerably lower in the case group, suggesting subclinical diastolic dysfunction. All TDI parameters varied significantly between the two categories. There was a direct correlation between isovolumetric relaxation time and BMI. Conclusions : Obesity in children without hypertension is associated with subclinical systolic and diastolic cardiac dysfunction. We propose the evaluation of blood pressure as well as myocardial performance using PWD and TDI in all obese children without hypertension, regularly. [ABSTRACT FROM AUTHOR]

Introduction: Vesicoureteral reflux is the backward flow of the urine from the bladder into the ureters or kidneys that may result in urinary tract infection. This paper aimed at evaluating this problem and its relationship with the children's mood, growth, and physical conditions as well as its influence on the family and school. Materials and Methods: The study population consisted of 122 children aged 4-14 years old: 61 with and 61 without VUR. The Child Behavior Checklist (CBCL) and Global Assessment of Functioning (GAF) were used to assess the parents' behavior. The data were analyzed using descriptive statistics, Chi-square test, and t test. Results: In this study, 23% of the children with and 4.9% of the children without VUR suffered depression (P value= 0.007). Moreover, 10.7% of the children with VUR showed offensive behaviors but there found no case among the children in the other group (P value=0.012). In addition, 16.4% of the children with and 1.7% of the children without VUR had intellectual problems (P value=0.008). Furthermore, 27.9% of the children with and 3.3% of the children without VUR had emotional problems (P value=0.001), and 4.9% of the parents of the children with VUR needed serious clinical measures but there were no such cases among children without VUR (P value=0.021). Conclusions: Increased behavioral problems in children with VUR and declined parental functioning require prompt treatment to prevent future behavioral problems in children. [ABSTRACT FROM AUTHOR]