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BACKGROUND: Decreasing hospitalization as a result of chronic obstructive pulmonary disease (COPD) exacerbations is a major objective in an effective process of the disease management. This study aimed to investigate the association between physical activity level in COPD patients, and specific-cause hospitalization in a prospective study of patients referred to a pulmonologist office in Qazvin, Iran. MATERIALS AND METHODS: A prospective study was conducted among 150 patients with COPD from the population of Qazvin, a North West, industrialized city of Iran, from December 2017 to December 2018. Participants were enrolled among patients who referred to an outpatient respiratory care center to undertake respiratory function tests. Patients were followed up for 1 year and their related measures were gathered and recorded at two phases including baseline and 12 months. To assess the effect of several covariates on the response variable, a multivariate regression analysis was applied. Results were reported in the form of odds ratios, incident rate ratio (IRR), and their 95% confidence intervals (CIs). RESULTS: The study findings revealed that individuals with severe pulmonary obstruction (<30%) were 4.21 times more likely to be hospitalized than those with a mild level of disease. Furthermore, the likelihood of hospitalization was =3 times higher among current smokers compared with nonsmokers. The history of hospitalization due to COPD 1 year before the enrolment was another significant factor which increased 21% the odds of being hospitalized during follow-up. In a multivariate model with the number of hospitalizations as an outcome variable, patients who reported moderate level of physical activity encountered a lower risk of COPD hospitalization compared to those who had a very low level of physical activity (IRR = 0.66; 95% CI = 0.44-0.92; P = 0.001). CONCLUSIONS: To decrease the risk of hospitalization among COPD patients, it is recommended to include regular physical activity in their integrated care program. [ABSTRACT FROM AUTHOR]

Background: Congenital hypothyroidism increases the risk of sensorineural hearing loss (SNHL). Children with hearing impairment are prone to communication disorders. The present study aimed to determine the prevalence of SNHL in patients with congenital hypothyroidism in Qazvin, Iran. Methods: This cross-sectional study was conducted on children with transient or permanent congenital hypothyroidism in Qazvin province, Iran in 2015. The patients were identified through national neonatal thyroid screening during 2006-2011. Hearing loss was assessed using the auditory brainstem response (ABR). A minimum of three years of follow-up was carried out to determine the permanency of congenital hypothyroidism. Data analysis was performed using t-test and Chi-square. Results: In total, 155 children with congenital hypothyroidism were enrolled in the study, including 67 females (43.2%) and 151 cases of primary congenital hypothyroidism. Abnormal ABR was observed in 10 patients (6.45%) (6.6% in permanent cases and 6.1% in transient cases), seven of whom were female. In addition, eight patients with primary congenital hypothyroidism and two patients with central congenital hypothyroidism had abnormal ABR (P=0.165). Mean primary thyroid-stimulating hormone levels (52.45±39.91 versus 38.23±28.03 IU/l; P=0.355) and T4 (6.07±4.33 versus 6.98±3.40 μg/dl; P=0.307) had no significant differences in the children with SNHL and other patients. At the beginning of the treatment, mean age of the children with SNHL was 28.50±22.13 days, while it was 28.87±30.34 days in the other subjects (P=0.909). Conclusion: According to the results, the prevalence of SNHL was lower in the patients with congenital hypothyroidism compared to the reported rates in other countries. However, the assessment of hearing loss should be prioritized in the infants with congenital hypothyroidism. [ABSTRACT FROM AUTHOR]

There are controversies on the association of childhood allergic diseases with inflammatory bowel diseases (IBD). The aim of this study was to examine the association between food allergy, cow's milk allergy (CMA), and asthma with pediatric IBD in Iranian population. This case-control study was conducted on 200 individuals less than 18-year-old (100 with IBD and 100 as control group). Medical records, clinical presentation, and laboratory and para-clinical findings related to food allergy, CMA, and asthma were reviewed for all participants in both groups and were recorded. Among 100 children with IBD, 40 had Crohn's disease, and 60 had ulcerative colitis. The frequency of food allergy, cow's milk allergy, and asthma in children with IBD was significantly higher than the control group (P<0.001). Asthma in children with Crohn's disease was significantly more prevalent than children with ulcerative colitis (P=0.008). Food allergy (OR: 22.1, 95% CI: 5.1-95.05, P<0.001), CMA (OR: 15, 95% CI: 3-67, P<0.001), and asthma (OR: 10, 95% CI: 3-37.05, P<0.001) were significantly associated with increased risk of IBD in children. Food allergy, CMA in infancy and asthma are more prevalent in children with different subtypes of IBD. The diagnosis of these risk factors is associated with increased risk of Crohn's disease and ulcerative colitis. [ABSTRACT FROM AUTHOR]

Background: The homeostasis model assessment of insulin resistance (HOMA-IR) is a useful model for application at large epidemiologic studies. The aim of this study was to determine the HOMA cut off values to identify insulin resistance (IR) and metabolic syndrome (MS) in Qazvin, central Iran. Methods: Overall, 480 men and 502 women aged 20-72 yr attended in this cross sectional study from September 2010 to April 2011. The diagnostic criteria proposed by national cholesterol education program third adult treatment panel (ATPIII), International Diabetes Federation (IDF) and new Joint Interim Societies (JIS); were applied to define MS. Lower limit of the top quintile of HOMA values in normal subjects was considered as the threshold of IR. The receiver operating characteristic (ROC) curves of HOMA for MS diagnosis were depicted. The optimal cut point to determine MS was assessed by maximum Youden index and the shortest distance from the point (0, 1) on the ROC curve. Results: The threshold of HOMA for IR was 2.48. Fifty one percent of the subjects were insulin resistant. The cut point for diagnosis of JIS, IDF, ATP III and Persian IDF defined MS was 2.92, 2.91, 2.49 and 3.21, respectively. Sensitivity and specificity of ATP III defined MS to diagnose IR was 33.95% and 84.78%, of IDF defined MS was 39.13%, 81.29% and of JIS defined MS was 43.77% and 78.11% and of Persian IDF defined MS was 27.32% and 88.76%, in that order. Conclusions: The high prevalence of IR in the present study warns about the future burden of type 2 diabetes. Only the ATP III criteria introduced more specific cut point for putative manifestations of IR. [ABSTRACT FROM AUTHOR]

Background: Association between the vitamin D deficiency and metabolic syndrome (MetS) has previously been noted and reported to be controversial. The aim of this study was to determine the association of serum 25 (OH) D Level and Vitamin D dietary intake with MetS among Iranian population. Methods: This analytical study was conducted on 122 patients with MetS based on the ATPIII criteria and 128 subjects without MetS as control from September 2010 to April 2011. Serum levels of calcium, phosphorus and 25(OH) D were compared between the two groups. A food frequency questionnaire (FFQ) was used to calculate dietary intake. Data were analyzed using Chi- square test, t-test, Mann-Whitney U test and logistic regression analysis. Results: Serum concentrations of 25 (OH) D, calcium and phosphorus and calcium intake were significantly lower in subjects with MetS compared to the subjects without MetS. 98.4% of subjects with MetS and 88.3% without MetS had Vit. D deficiency and this difference was statistically significant (P=0.005). In regression analysis, lower concentration of serum 25 (OH) D, calcium and phosphorus and lower calcium and diary intake were predictors of MetS. Conclusions: Serum 25 (OH) D Level, calcium and phosphorus and calcium intake are associated with metabolic syndrome. However, the mechanism of this association requires further studies. [ABSTRACT FROM AUTHOR]

Objective: Puberty is a critical time between childhood and adulthood. Many studies have reported that the mean age of breast development is decreasing. The aim of this study was to provide updated data on the pubertal development of girls and to evaluate precocious puberty in our population. Methods: This cross sectional study was conducted in 6 to 16 year old school girls during 2009-2010 in Qazvin. 2240 healthy girls from all geographical regions with every socioeconomic status were selected by a stratified multistage cluster design to obtain representative sample of population. A questionnaire including demographic data, anthropometric measurements, secondary sexual characteristics, menarche status and its onset was filled out for every participant. Secondary sexual characteristics including breast development (B1-5) and pubic hair (PH1-5) were evaluated according to Marshal and Tanner recommendation. Findings: The mean±SD of height, weight, and BMI of participants was 139.7±14.5, 36.1±12.9 and 17.9±3.7 respectively. The mean age (10th - 90th percentile) of B2 and PH2 were 9.71(7.67-11.4) and 9.82 years (7.84- 11.42) respectively. Mean age of menstruation was 12.52 years. The mean BMI was significantly higher in pubertal females comparing to prepubertal girls (P<0.001). Average duration of puberty (the time from initiation of puberty to menarche) was 2.81 years. Conclusion: The mean age of pubertal onset in girls living in Qazvin is 9.71 years. Menarche occurs at mean age of 12.52 and onset of puberty earlier than 6.24 years will be precocious. We found that girls in Qazvin had a slightly earlier age of initiation of puberty and of menarche in comparison with other studies in Iran. [ABSTRACT FROM AUTHOR]

Background: Regular monitoring of height, weight and head circumference is the best indicator of the status of the individual and community health. Growth is influenced by race, genetic, environmental factors, economic status and lifestyle. The aim of this study was to determine the anthropometric indices and evaluate the performance of the CDC 2000 reference in 6 to 14 year-old girls in Qazvin, Iran. Methods: A descriptive, cross-sectional study was conducted on 2219 elementary and secondary school girls in Qazvin during 2009-10. Random cluster sampling was performed to select subjects form public and private schools considering 10 percent of the students. Eighteen students were excluded due to underlying diseases or medications intake. Height (with an accuracy of 2 mm) and weight (with an accuracy of 100 grams) were measured. Body mass index (BMI) was calculated by dividing the weight in kilograms by the square of the height in meters. BMIs below the 5th percentile, between the 5th and 85the percentile, between the 85the and 95th percentile, and above the 95th percentile were respectively considered as underweight, normal, overweight, and obese Findings: Height in 1260 students (57.24%) and weight in 1153 cases (52.38%) were below the 50th percentile. Comparing the height values with NCHS showed that 157 subjects (13.7%) were under the 5th percentile, 78 individuals (3.55%) were over the 95th percentile and 1966 cases (89.32%) had normal weight. Comparing the weight values with NCHS revealed that 217 patients (9.85%) were under the 5th percentile, 1848 cases (83.97%) had normal weight and 136 individuals (18.6%) were over the 95th percentile. When the calculated BMIs and NCHS values were compared, 206 students (9.35%) were underweight, 1553 cases (70.55%) were normal, 282 cases (12.7%) were overweight and 163 (7.4%) were obese. The study showed the growth pattern of girls in Qazvin to be different from CDC 2000 reference. Conclusion: Since the average height of girls was below the reference and their average weight was similar or slightly higher than the reference, BMI was eventually increased compared to the reference group. The study showed that the growth pattern of girls in Qazvin was different from CDC 2000 reference. Given these differences, using national standard growth curves based on ethnic and regional diversity seems to be necessary. [ABSTRACT FROM AUTHOR]

Background: Snoring is breathing with a hoarse sound during sleep caused by the vibration of membrane structures in the upper airway. Snoring can manifest as a primary snoring to obstructive sleep apnea with an apparent decrease in quality of life. The purpose of the current survey was to evaluate the clinical manifestations and polysomnographic (PSG) findings of snorers. Methods: This descriptive-analytical study included 98 snorers who referred to a sleep clinic from September 2009 to June 2010. All subjects filled a questionnaire containing demographics, clinical symptoms, the epworth sleepiness scale (ESS), comorbid diseases and medications. Full PSGs have been performed for each patient. Records were scored manually according to the guidelines of American association of sleep medicine (AASM). Finally, all data was analyzed by chi-square test and t-test. Findings: Mean weight of patients was 86 ± 18 kg and 80 individuals were overweight or obese. Moreover, 74 patients were male. According to PSG findings, 90 subjects had obstructive sleep apneahypopnea syndrome (OSAHS), 2 had upper airway resistance syndrome (UARS) and 6 suffered from primary snoring. ESS scores more than 8 were observed in 65 persons. There were significant correlations between body mass index (BMI) and OSAHS (P < 0.01) and arousal index (AI) (P < 0.01). Moreover, the correlations between excessive daytime sleepiness, feeling unrefreshed during days and apnea hypopnea index (AHI) (P < 0.01) and AI (P < 0.01) were significant. The breath pauses reported by the patient's spouse was also significantly correlated with AHI (P < 0.04). The prevalence of patients with mild, moderate and severe sleep apnea was 16.3%, 21.4% and 58.2%, respectively. Conclusion: The sensitive signs for evaluation of OSAHS are snoring, tiredness and excessive daytime sleepiness. It seems to be necessary to screen snorers for the quantity and quality of sleep in order to refer patients for PSG. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to estimate the presence of metabolic syndrome (MS) in a group of children and adolescents with a body mass index (BMI) above the 85th percentile for their age and sex in Qazvin Province, Iran; to evaluate the relationship between obesity and metabolic abnormalities; and to compare two proposed definitions of MS.Patients and Methods: The study was conducted on 100 healthy subjects aged between 6 and 16 years (average age, 10.52 ± 2.51 years) with a high BMI for their age and sex. Fifty- eight percent of subjects were female. Physical examination including evaluation of weight, height, BMI, and blood pressure measurement was performed ("overweight" was defined as a BMI between the 85th and 95th percentiles for children of the same age and sex; "obese" was defined as a BMI over the 95th percentile for children of the same age and sex). Blood levels of glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and uric acid were measured after a 12-hour overnight fast. The authors used and compared two definitions of MS: the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III) criteria and a modified definition by Weiss et al. Variables were compared using the Student's t-test and chi-square and Mann-Whitney U tests, and agreement between the two definitions was analyzed using kappa values.Results: The subjects had a mean BMI of 26.02 ± 4.38 and 80% had obesity. Insulin resistance was found in 81% of the study population. MS was present in ten (50%) of the overweight and 53 (66.2%) of the obese subjects using the NCEP ATP III criteria. MS was present in five (25%) of the overweight and 34 (42.5%) of the obese subjects using the definition by Weiss et al. The overall kappa value for the two definitions of MS was 0.533. There were no statistically significant differences between the two definitions of MS in participants.Conclusion: The prevalence of MS in children and adolescents depends on the criteria chosen and their respective cutoff points. The NCEP ATP III criteria, the parameters of which include higher cutoff values for high-density lipoprotein cholesterol and triglycerides, detected the higher prevalence and therefore the NCEP ATP III criteria are able to diagnose a larger number of children and adolescents at metabolic risk. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the diagnostic accuracy of the quantitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in urinary tract infections (UTI) among hospitalised infants and children in Qazvin, Iran. Methods: This cross-sectional study was conducted on 127 hospitalised children ranging in age from 2 months to 12 years old 31.79 months (SD 30.73) who were suspected of having a UTI and who did not receive antibiotics prior to being seen at a Qazvin teaching children's hospital between 2005 and 2006. A urine analysis (U/A) and urine culture (U/C) were performed. The blood was taken for CRP, ESR and WBC analyses. U/C has been considered the gold standard test for a UTI and dimercaptosuccinic acid renal scintigraphy (DMSA) as the gold standard for an upper UTI (pyelonephritis). These tests were used to determine the diagnostic accuracy, which is represented as the percent of correct results. Results: Within the study population, 72 patients (56.7%) were younger than two years old 9.86 months (SD 4.56) and 55 (43.3%) were older than two years old 63.58 months (SD 30.96). One hundred and two patients (80.3%) were female. There were 100 cases that had a positive U/C. Of the patients with a positive U/C, 81 had pyuria (WBC more than 5/hpf), 71 had a peripheral WBC count of more than 10 000 /mL, 95 had a CRP of more than 10 mg/L and 82 had an ESR > 10 mm/h. The sensitivity and specificity as well as the positive and negative predictive values and the accuracy of CRP when using U/C as the gold standard were, respectively, 96%, 11.1%, 80.2%, 50%, and 78%; when using ESR as the gold standard were, respectively, 55%, 40%, 77.6%, 17.2%, and 52%; and when using WBC counts as the gold standard were, respectively, 69%, 52%, 86.6%, 35.6%, and 65%. The accuracy of CRP, ESR and WBC counts when considering the DMSA as the gold standard were 58.3%, 62.8%, and 64.5%, respectively. Conclusion: Although acute phase reactants can help in the diagnosis of a UTI, they are not pathognomonic. CRP, ESR and WBC were neither completely sensitive nor specific for detecting a UTI and its localisation site in Iranian children. Therefore, in a country where advanced clinical diagnostic tests are available, the advanced test should be used in conjunction with CRP, ESR and WBC analyses. Finally, a combination of laboratory tests along with history and exact clinical examination are needed for the diagnosis of a UTI and its localisation site. [ABSTRACT FROM AUTHOR]

Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children's hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size. Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited.

Clinical signs and symptoms of non-infectious diseases are similar to those of infectious diseases during infancy. Therefore, rapid new methods for diagnosis of infections in infants are urgently needed. To examine the utility of measuring serum IL-1 beta for immediate diagnosis of sepsis in infants, in this cross-sectional epidemiological study blood samples were taken from 83 infants (41 female and 42 male) in whom infection was suspected and who were admitted to hospital. To perform serum interleukin (IL)-1 beta and quantitative C-reactive protein (CRP) tests, blood samples were placed in ice containers and delivered to the laboratory. The serum was removed from the samples at 4 degrees Celsius and stored in refrigerators at minus 30 degrees Celsius until the time of testing. The results were analysed by t tests. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of serum IL-1 beta were 27%, 71%, 25%, and 73%, respectively. Sensitivity, specificity, PPV and NPV of serum quantitative CRP were 76%, 60%, 40% and 88%, respectively. Hence quantitative serum CRP measurement for the diagnosis of infections is more efficient than measuring serum IL-1 beta levels. In general, quantitative serum CRP measurement as an alternative to other tests such as serum IL-1 beta assays might be an ideal test for diagnosing infections in infants.

Lymphadenitis and abscess formation are the most common side effects of vaccination with Bacille Calmette Guerin (BCG). The lower the child's age at the time of vaccination, the higher the incidence of BCG lymphadenitis tends to be. Although various therapeutic approaches are in use for the treatment of BCG lymphadenitis, there is no consensus on which of them is optimal. This study aimed to determine whether oral cephalexin treatment hastens recovery from BCG lymphadenitis. The study involved 40 children (24 boys and 16 girls) with BCG lymphadenitis who were referred to Qazvin Children's Hospital, Qazvin University of Medical Sciences between December 2008 and the end of September 2009. The patients were randomly assigned to two groups of 20 patients each (12 boys and 8 girls in each group): group A patients did not receive any treatment and served as controls, and group B patients were treated with 50 mg/kg/day cephalexin syrup, administered in four doses, for 10 days. In all patients, clinical examination was normal, except for lymphadenitis. In all patients, BCG vaccination had been performed at birth, and polymerase chain reaction tests were positive for tuberculous bacilli. The recovery period and requirement of fine needle aspiration did not significantly differ between the two groups (P 0.05). This study showed that treatment with cephalexin does not hasten recovery from BCG lymphadenitis.