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Background: Functional constipation (FC) is a common major problem in children. This study compared Jujube paste and polyethylene glycol (PEG) as laxative drugs in children with FC. Ziziphus Jujuba Mill (Jujube) was selected according to traditional Iranian medicine because it is native to Iran and a large extent of Asia, is safe and easy to access, with acceptable taste to children. Methods: This randomized controlled clinical trial was performed on 128 children aged 2 to 12 with FC according to Rome IV criteria. Patients were randomly divided into two groups of Jujube paste and PEG and underwent four weeks of treatment. The efficacy, safety, and tolerability of the Jujube oral product were compared with PEG. Results: Following four weeks of therapy, all clinical symptoms of constipation according to Rome IV criteria were improved significantly in both groups (P < 0.05). In all the seven criteria of Rome IV, Jujube paste was as effective as PEG and even stronger in reducing stool stiffness (P < 0.0001). No hazardous side effect was reported in the two groups. Moreover, the medication acceptance rate was higher in the group receiving Jujube paste than in the group receiving PEG. Conclusions: Jujube paste is as effective as PEG in pediatric FC. This product has high nutritional value and antioxidant properties, so it can be a safe substitute for PEG in pediatric FC.

To compare the effects of functional electrical stimulation (FES) with conventional therapy and conventional therapy alone on improvement of faecal incontinence (FI) symptoms in a number of children with functional non-retentive FI.Data of 28 children with FI were accepted for this retrospective study. The case group (n = 14) underwent FES + conventional therapy and the control group (n = 14) received conventional therapy only. Data of children with faecal retention, inflammatory, anatomic, metabolic and neurological disorders were excluded. Children were assessed with a paediatric FI score questionnaire, and a bowel habit diary both before treatment sessions, after they ended, and after 6 months. A FI quality of life questionnaire was completed before and after treatment for all children.Full response to the treatment (100% reduction in FI episodes) was significantly observed in 8/14 (57.1%) of children in the case group compared to 2/14 (14.2%) of children in the control group after the ending of treatment sessions (P = 0.005). The baseline mean ± SD of FI episodes per week was 3.7 ± 2.1 among both groups which significantly decreased after the ending of treatment sessions in the case group compared to the control group (1.4 ± 2.1 vs 3 ± 2.7; P = 0.05). Mean ± SD of FI score was significantly reduced in the case group compared to the controls after the ending of treatment sessions (3.9 ± 4.5 vs 8 ± 4.7; P = 0.02) and maintained after 6 months (P = 0.05).Functional electrical stimulation is a safe, effective, non-invasive, inexpensive, reproducible and easy-to-use modality for treatment of functional non-retentive faecal incintinence in children.

Background: Functional constipation is a common disorder in pediatrics and affects about 30 percent of children, causing several physical and emotional complications and having a considerable impact on health expenses and quality of life. Biofeedback is a behavioral therapy that gives the patient information about the activity of pelvic floor muscles and teaches the patients how to properly contract and relax the sphincter. Biofeedback therapy is the most effective in those with constipation due to pelvic floor dyssynergia, which is the abnormal function of sphincter muscles and affects 40% of children with constipation. Objectives: This study aimed to evaluate the effect of biofeedback therapy in children with chronic functional constipation unresponsive to medical and conventional treatments. Methods: Forty-four children with functional constipation (according to ROME 4 criteria) unresponsive to at least six months of taking medical treatment and pelvic floor dyssynergia according to anorectal manometry were selected for biofeedback therapy. After six months, symptoms of patients and the need for laxative consumption were compared to those before therapy. Results: Considering ROME 4 criteria, clinical improvement was achieved in 59.1% of patients. Comparison of symptoms shows improvement in 52 - 89 % of cases. Conclusions: In pediatric patients with functional constipation and pelvic floor dyssynergia who do not respond to conventional treatments, biofeedback therapy could be an alternative therapy, and its effects last for at least six months.

Introduction and aim. Autoimmune hepatitis (AIH) is an immune-mediated destruction of liver cells, in recognition of interface hepatitis, seropositivity for autoantibodies, and interface hepatitis in histology sections. Hepatocyte destruction in AIH is the direct result of CD4+ T-cell destruction. Yet, Th17 mediated immune attach and a diversity of cytokine networks, including pro-inflammatory cytokines such as Interleukin 1 (IL-1) and Interleukin 6 (IL-6), set the stage for the destructive liver damage. Material and method. Peripheral blood samples from 57 patients, with AIH, recruited from referrals to the main pediatric hospital in Tehran. Single nucleotide polymorphisms for the following cytokines genes, were evaluated through, polymerase chain reaction with sequence-specific primers (PCR-SSP) assay: IL-1a (C/T -889), IL-Ια (C/T -511), IL-1 β (C/T +3962), IL-1 receptor (IL-1R; C/T Pst-I 1970), IL-1RA (C/T Mspa-I 11100), and IL-6 (C/G -174 and A/G nt565). Results. Significant higher frequency of genotype AA was detected in patients in IL-6 at position nt565 (15.8% in AIH patients vs. 2.9% in controls, p = 0.003). The haplotype GA of IL-6 at -174 and nt565, was significantly overrepresented in the AIH group, compared to (20.9% of AIH vs. 1.4% in controls p Conclusion. Results of our study, indicate significant deviation toward high yield IL-6 polymorphisms, in AIH patients. These data could bring new insights in pathophysiology of disease, which could contribute to developing novel treatments for AIH.

Autoimmune hepatitis (AIH) is a chronic inflammation in hepatocellular tissues associated with circulating autoantibodies. Imbalance in T-cells population and dysregulation in several cytokine profiles has been implicated in pathogenesis of AIH. This study was performed to assess potential association of AIH with interleukin-2 (IL-2) and interferon-gamma (IFN-γ) genes single nucleotide polymorphisms (SNPs).Fifty-six patients with AIH and 139 healthy individuals were enrolled in this study. IL-2 and IFN-γ typing was performed, using polymerase chain reaction with sequence-specific primers (PCR-SSP) assay. The frequencies of alleles, genotypes and haplotypes in AIH patients were compared to healthy controls.IL-2 T allele at position +166 (rs2069763) showed significant higher frequency in AIH group (36%), compared to the controls (21%) (OR=2.06; 95% CI, 1.24-3.43, P-value0.01). The frequency of IL-2 TT genotype at +166 position was also associated with AIH (OR=18.68, 95% CI 3.74-126.04, P-value0.01). G/T alleles of IL-2 at -330 (rs2069762) and A/T alleles on UTR +5644 position at IFN-γ and their subsequent haplotypes, did not show significant association with AIH.This study identified IL-2T allele at +166 position and TT genotype as susceptibility gene in AIH which would provide better understandings into the mechanisms of AIH and potential immune modulation therapies.

Background: Constipation is a frequent complication in pediatrics, most of which is habitual, comprising 25% of visits in pediatric gastroenterology clinics. Objectives: The main object of this study was to investigate clustering of habitual constipation among families of pediatric patients. Methods: This case-control study was conducted on families of 150 children < 18 years old with chronic habitual constipation alongside families of 150 healthy children as controls. The cases were enrolled in the study according to the Rome IV criteria for constipation. The parents and siblings were evaluated regarding constipation. Data were analyzed using SPSS-16, χ2 and t-test were used for comparison. Results: A total of 300 children and their families participated in the study. No significant differences were found between the study and the control groups in age, sex, or BMI. However, the siblings or parents from the study group had significantly higher rates of constipation compared with the control group. Conclusions: Considering different survey findings, a correlation between “habitual constipation” and “familial background” seems to exist in children. A clear pathophysiological explanation for this phenomenon is not yet available.

Summary Eosinophilic esophagitis (EoE) is a chronic allergen/immune-mediated disease leading to esophageal dysfunction. Food allergens play critical roles in the pathogenesis and treatment of EoE via different mechanisms. This study aimed to present the characteristics and evaluate the ability of skin prick test (SPT), skin prick to prick test (SPP) (IgE-mediated), and atopic patch test (APT) (cell-mediated) individually or simultaneously to diagnose food allergy in patients suffering from EoE. This prospective study was conducted on 58 patients with EoE. Seven patients (12.1%) were positive to only one, 3 (5.2%) were simultaneously positive to two, and 32 (55.2%) were simultaneously positive to three tests. Single and double sensitizations were totally 10.4% in IgE-mediated reactions, while 36.5% in cell-mediated reactions. In contrast, poly sensitization (> 2 allergens) was 51.7% in IgE-mediated tests and 20.7% in the cell-mediated test. Multiple sensitization findings showed egg white, milk, yolk, and soy were the most frequent allergens. Our findings indicate that EoE is early onset and associated with multiple food sensitizations, particularly via IgE-mediated mechanisms. These immune-mediated responses encompass both IgE-mediated (SPT and SPP) and cell-mediated (APT) reactions simultaneously not individually. Therefore, employing multiple assays may strengthen the diagnosis of food sensitization.

Background: There are some evidences suggesting functional constipation-related growth retardation in children, especially in early childhood. Considering high prevalence of constipation, early diagnosis and treatment of constipated patients may improve the quality of life in these children. In this study, weight and height of Iranian children aged 2 to 12 years with functional constipation was evaluated compared to healthy children. Methods: A total of 130 Iranian children aged 2-12 years, 65 with functional constipation and 65 as healthy children referred to pediatric gastroenterology clinic during Jan to Dec of 2016, were enrolled in this case-control study. Functional constipation was defined as Rome III criteria. The growth status was evaluated using the growth charts, and Z scores of weight and height for age were recorded, with the consent of parents and child willingness. Results: 65 constipated patients (44 boys, 21 girls) with the mean age of 8.28 ± 3.24 years and 65 healthy children (25 boys, 40 girls) with the mean age of 8.32 ± 3.42 years were evaluated. The mean weight of case group was 23.69 ± 4.14 kg and mean height 126.49 ± 10.34 cm. The mean weight of control group with 31.62 ± 4.85 kg and mean height 153.47 ± 13.88 cm, demonstrated significant difference with the case group. The observed mean weight and height were significantly lower in constipated group and the differences of height-for-age and weight-for-age Z scores were statistically meaningful in constipated and healthy children. Conclusions: Functional constipation in children aged 2 to 12 years may retard their weight and height growth, so early diagnosis and treatment of children with constipation is beneficial in their adequate growth status. © 2019, Author(s).

Background: Autoimmune hepatitis (AIH) is a chronic long-lasting hepatocellular inflammation associated with circulating auto antibodies. In addition to the genetic component, several cytokines have been implicated to be involved in AIH. This study was performed to investigate potential associations of AIH with IL4 gene variants.Method: The studied alleles and genotypes included: IL4G/T allele polymorphisms at position -1098 and C/T allele polymorphisms at two positions (-33 and -590) on the IL4 gene, in addition to the A/G allele polymorphisms at position +1902 on the IL4RA gene.Result: The IL4 C allele and CC genotype at position -590 and TT genotype at position -33 had a significantly higher frequency in AIH patients.Conclusion: This study identified the IL4 C allele and CC genotype susceptibility gene in AIH, which will provide better insights into the mechanisms of AIH and potential therapeutic interventions.

Background: High resistance to common antibiotics has become a huge global dilemma in eradicating Helicobacter Pylori infection in both children and adults. The great concern is about the resistance to different classes of antibiotics especially Clarithromycin because of its widespread use. Objective: The present survey aimed to assess the resistance rate to Clarithromycin in Helicobacter Pylori isolated in patients aged less than 15 years as compared to patients older than 15 years of age. Methods: In this cross-sectional study, total 72 patients with upper gastrointestinal symptoms requiring diagnostic endoscopy referred to Rasoul-e-Akram Hospital in Tehran during one year (August 2015 to August 2016). Helicobacter Pylori infection was diagnosed in patients using the Rapid Urease Test. The antibiotics resistance was detected in genomes using the real-time polymerase chain reaction (PCR) on 23S rRNA gene. Results: In total 72 patients, 36 cases aged less than or equal to 15 years and 36 patients were older than 15 years. Of all patients in this study, 17 cases were detected with gene mutations or polymorphisms related to resistance to Clarithromycin. Overall prevalence rate of resistance was reported 23.61%. Three polymorphisms on 23S rRNA gene including A2142G, A2142C, and A2143G were revealed in 47.1%, 5.9%, and 47.1% of patients, respectively. The bacterial resistance to Clarithromycin was observed more prevalent in patients that aged older than 15 years compared to patients younger than 15 years of age. Also, frequent consumption of any type of antibiotics was significantly associated with the higher resistance of bacterium to Clarithromycin. Conclusion: The results of our study regarding the resistance of Helicobacter Pylori to Clarithromycin were similar to findings of other studies around the world. But, the Clarithromycin resistance rate was reported higher in patients older than 15 years of age and those patients who repeatedly received different types of antibiotics regardless of their age. Of all mutations in bacterial genome, the prominent mutations responsible for bacterial resistance to Clarithromycin included A2142C, A2142G, and A2143G nucleotide polymorphism on 23S rRNA gene.

Summary Background and aims Autoimmune hepatitis is a chronic immune-mediated liver injury caused by dysregulated immune response to liver antigens. Genetic susceptibility is affected by multiple single nucleotide polymorphisms in immune-related genes. There are few reports on the association of TGF-β and IL-10 genetic variants with autoimmune hepatitis. Methods Allele frequency and genotype status of IL-10 −1082, −819, −592 and TGF-β +869 and +915 polymorphisms were investigated in 57 unrelated patients with autoimmune hepatitis and 140 healthy controls by polymerase chain reaction with sequence-specific primers. Results IL-10 −592 and −819 allele frequencies and genotypes were not associated with autoimmune hepatitis in our population, while IL-10 −1082 genotypes were. IL-10 −1082/−819/−592 “high-producing” haplotype GCC was significantly less frequent in patients. TGF-β +869 “high-producing” allele C and genotype CC were significantly more in autoimmune hepatitis, compared to controls; whereas, TGF-β +915 “low-producing” allele C and genotype CC were significantly more in autoimmune hepatitis compared to control. TGF-β +869/+915 haplotype TG was significantly less frequent in patients while CC haplotype was significantly more frequently observed in patients. Conclusion We identified a significant association between IL-10 −1082/−819 and TGF-β +869/+915 genotypes and haplotypes with autoimmune hepatitis in Iranians.

چکیده: روزه داری در ماه رمضان یک تکلیف مذهبی و یک باور اعتقادی است که برای تمام افراد مسلمان ، سالم و بالغ در ماه رمضان واجب است. روزه داری فقر غذایی یا دریافت ناکافی مواد غذایی نیست بلکه مکانیسم تطابق بدن انسان را بهبود بخشیده با افزایش و کاهش اکسیداسیون ،چربی ها و کربوهیدراتها ارتباط دارد . مطالعات زيادی پيرامون تاثیر روزه داری برفاکتورهای بيوشيميایی خون انجام شده ونظرات متعدد ومتنوعی را ارائه کرده اند. در این مطالعه که با هدف بررسی تاثیر یک ماه روزه داری بر برخی از عوامل بیوشیمیایی خون مردان انجام شد، 40 نفر از کارکنان مرد دانشکده علوم پزشکی بجنورد که داوطلب و متعهد به انجام یک ماه روزه داری بوده ، هیچگونه بیماری متابولیک نداشته و داروی خاصی مصرف نمی کردند در این پژوهش شرکت داده شدند.مدت مطالعه 29 روز و طول مدت روزه داری در هر روز حدود 11 ساعت بود.هر کدام از واحد های پژوهش از نظر عوامل بيو شیمیایی خون شامل : قند ،اسید اوريک ، آلبومین ، کلسترول ، LDL,HDL تری گلیسیرید در ابتدا و انتهای ماه مبارک رمضان مورد اندازه گیری قرار گرفتند.نتایج حاصله با استفاده از نرم افزار11 SPSS و مقایسه میانگین متغیر ها به کمک آزمون T زوج شده و مورد تجزیه و تحلیل قرار گرفت. يافته های حاصل ازاين مطالعه، میانگین سن واحدهای پژوهش را(602/8+ 11/39) نشان داد. میانگین قند ، اسید اوریک ، تری گلیسیرید و LDL پس از یک ماه روزه داری کاهش معنی دارآماری در سطحp

Cystic fibrosis (CF) is a common autosomal recessive disorder with different clinical manifestations, mainly in the gastrointestinal and respiratory tracts. This study was performed to access the effect of probiotics in the status of intestinal inflammation in a group of children with CF by measuring the calprotectin level in the fecal samples. Forty-seven patients with CF were enrolled in this study. The fecal calprotectin levels were measured by enzyme linked immunosorbent assay. In a randomized systematic method, the children were divided into two groups - one group received probiotic powder and another received placebo for four weeks. After this period, fecal calprotectin was re-measured. Thirty-one of 47 enrolled patients (65.9%) had abnormal fecal calprotectin levels (50 g/g). After the intervention, the fecal calprotectin levels decreased in 29 patients (21 patients in the drug group, and only 8 patients in the placebo group; p0.001). This study showed that about two-thirds of patients with CF had intestinal inflammation based on fecal calprotectin levels. Probiotic administration was shown to decrease calprotectin concentrations and subsequently intestinal inflammation in CF patients.

Erythropoietic protoporphyria (EPP) is an inherited defect of mitochondrial ferrochelatase. This defect results in accumulation of protoporphyrin in erythrocytes, plasma, liver, and skin, which causes severe photosensitivity. Liver disease can occur in 1-4% of the patients with EPP, usually after at least a decade of photosensitivity. Herein, we describe a 1.5-year-old child with EPP with severe photosensitivity, heart abnormalities and early onset of cholestatic liver disease, whose clinical condition improved gradually after using ursodeoxycholic acid. It seems that liver disease in EPP patients is not limited to the late phases of the disease and could develop in childhood and early phases of EPP. Awareness among physicians has a major role in the early detection and prevention of mistreatment of EPP in case of its combination with other abnormalities.