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Background Few results have shown that renal parenchymal echogenicity increases in pediatric patients with no concurrent renal diseases. This study aimed to investigate the relation between non-renal diseases and renal cortical echogenicity in children with acute abdominal pain. Materials and Methods This cross- sectional study was conducted among 100 children referred to Amirkola Children’s Hospital (Babol city, Iran) with complain of acute abdominal pain during July 2015-July 2016. Patients with a known history of renal disease or urinary tract infections were excluded. All patients were examined with sonography. The parenchymal echogenicity of kidney was evaluated by comparison with that of liver and was divided into three categories: group 1, renal cortex echogenicity less than liver parenchyma echogenicity; group 2, renal cortex echogenicity similar to that of liver parenchyma; and group 3, renal cortex echogenicity greater than that of liver parenchyma. Results: Of 93 children finally assessed, 52 (55.9%) were boy; the mean age of patients was 6.45 years old. The diagnosed causes of abdominal pain included acute appendicitis (n=43, 46.2%), mesenteric adenitis (n=8, 8.6%), gastroenteritis (n=4, 4.3%), and invagination (n=2, 2.2%). Eighteen cases (19.4%) had abnormal renal echogenicity (equal to or more than that of liver). A significant relationship was found between non-renal diseases and renal cortical hyperechogenicity (p=0.03). After follow-up of 12 patients with renal hyperechogenicity for 1-2 weeks, all of them had normal findings in re-evaluation. Conclusion The results showed that renal hyperechogenicity is a non-specific and transient finding in children with acute abdominal pain and in favor of disorders other than renal diseases.

Idiopathic colon perforation is rare in children. It is more common at the extremes of age. Splenic flextures, ileocecal and lower sigmoid regions are the most common sites of perforation. Delay in proper management of this condition is associated with high mortality and morbidity rate. We report on the case of a 2.5 years old girl who presented with fever, diarrhea, nausea and vomiting and progressive abdominal distention.Finally, she underwent an exploratory laparotomy for suspected peritonitis because of the patient's worsening condition. An area of perforation was found in the sigmoid colon that segmental resection and an end double barrel colostomy was done.

Background This study aimed to determine effects of synbiotics on treatment of functional constipation in children aged 2-10 years old. Materials and Methods This randomized single blind clinical trial study carried out on children who had functional constipation based on the Rome III criteria. The polyethylene glycol + synbiotic group (P+S group, n=38)received the synbiotic with polyethylene glycol 0.6 gr/kg daily for 4 weeksfollowed bytonly polyethylene glycol for the following four weeks. The polyethylene glycol group (P group n=41) received polyethylene glycol for eight weeks. Then 8 after treatment, frequency of defecation, stool consistency, pain during defecation, fecal constipation and the percentage of patients who needed to continue their drug after 12 weeks treatment were compared between two groups. Results The differences in the mean frequencies of defecation (P=0.36), stool consistency (P>0.05), pain during defecation (P>0.05), incontinence (P>0.05) between the two groups at the end of eight weeks were not significant (P>0.05). The end of 12 weeks, 27.8% of (P + S) group and 15.6% of (P) group needed to continue medication more than one time /week (P>0.05). Conclusion In this study,adding synbiotic to polyethylene was not more effective than only polyethylene in the treatment of childhood functional constipation.

Background: There are controversies regarding relationship between Helicobacter pylori (H. pylori) and upper gastro-intestinal bleeding (UGIB) in children. The goal of this study was to assess the relationship between H. pylori infection and UGIB in Northern Iranian children. Material and method: One hundred children who had UGIB indicated for upper gastrointestinal endoscopy and 100 children without UGIBwho were candidate for upper endoscopy because of chronic abdominal pain considered as their controls. After stabling vital sign, nasogastric tube inserted and washing was done then within 24 hours of admission, endoscopy conducted for all children in the case group (under general anesthesia). Upper endoscopy was done for all participants by a children gastroenterologist. A single pathologist reviewed all specimens. Results: Mean age of cases was 6.2±3.2 years and mean age of controls was 7.1±2.9 years respectively. There was no relationship between H. pylori and UGIB .Erosion in fondus was significantly higher in cases (0.001) and erythema in antrum was significantly higher in controls( p

Background: Type 1 diabetes mellitus (T1DM) as an autoimmune disorder is associated with other autoimmune diseases such as autoimmune thyroid (AIT) disease. The aim of this study was to determine the prevalence of AIT in children who were referred to Amirkola Endocrine Clinic (north of Iran). Methods: This cross-sectional study was carried out on 100 diabetic children aged 1-15 years during 2008-2013, who were referred to the pediatric endocrine clinic. Serum levels of anti-thyroid peroxidase (Anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies and Thyrotropin Stimulating Hormone (TSH) were measured by Immune Chemiluminescence assay, and demographic information was obtained from patients'medical records. The collected data were analyzed using SPSS 18. Results: AIT was found in 13% of patients (8% female and 5% male). Significant levels were found for Anti-TPO (3%), anti-Tg (2%), and both antibodies (8%) in patients with AIT. Thyroid dysfunction was observed in 8 of 13 patients with AIT versus 2 of 87 patients without AIT (P

Cystic fibrosis (CF) is the most common severe autosomal recessive disorder caused by a wide spectrum of mutations in the gene encoding for the cystic fibrosis transmembrane conductance regulator (CFTR) protein. The frequencies, types and distributions of mutations vary widely between different populations and ethnic groups. The aim of this study was to perform a comprehensive analysis of the CFTR gene in an Iranian heterogeneous population. 20 CF patients diagnosed according to clinical evaluation and elevated sweat chloride value and presenting no common CFTR mutation, were analyzed for mutations and polymorphisms in exons 7, 20 and 21 and parts of introns 6, 7, 19, 20 and 21 of CFTR gene using PCR-sequencing. Sequencing of exon 7 revealed the presence of two variations c.864G>A (rs766189605) and c.910C>T (rs121909011) with the frequencies of 10% and 2.5%, respectively. c.864G>A is a synonymous variant that happens in amino acid valine 318 (GTG/GTA) and c.910C>T is a pathogenic missense variant that occurs at amino acid 334 (R334W) of CFTR protein leading to the change of arginine to tryptophan. Two variations c.3780A>G (rs1800130) and c.3783+117T>G (rs10155917) were also found in exon 20 and intron 20 with the frequencies of 7.5% and 5%, respectively. No mutation or polymorphism was found in exon 21. Ascertainment of CFTR mutation carrier frequencies and CF incidence among heterogeneous Iranian populations seems to be a necessity.

Background: There are few effective drugs for pediatric functional constipation (FC). Objectives: Comparing the effectiveness of Cassia fistula’s emulsion (CFE) with Polyethylene glycol (PEG4000) in FC; and evaluation of safety of both drugs in the treatment of FC. Materials and Methods: A randomized open label, prospective, controlled, parallel-group clinical trial was carried on 109 children (M/F: 63/46; mean age ± SD: 59.7 ± 28.8 months) in Amirkola children’s hospital, Babol, Iran. The inclusion criteria were based on diagnosis of FC according to the Rome III criteria and age range between 2 - 15 years. They received CFE or PEG randomly for 4 weeks. Frequencies of defecation, severity of pain, consistency of stool, fecal incontinence and retentive posturing were compared between the two groups and with baselines. Children were counted as improved when they exited from Rome III criteria of FC. Results: Fifty seven patients were assigned to receive PEG and 52 patients received CFE. After 4weeks of medication, 86.5% of children in CFE group and 77.1% in PEG group (RR = 1.121, CI95%:0.939 - 1.338) exited from the criteria of FC. All measurable criteria improved in both groups without any significant difference, except in the frequency of defecation that in CFE group (10.96 ± 5.7) was significantly more than PEG group (6.9 ± 3.5) (P < 0.0001). Compliances of PEG were significantly better in the 2 first weeks (P = 0.002, 0.008) but not in third and fourth week (P = 0.061, 0.062). None of these two drugs cause clinically significant side effects. Conclusions: CFE can be as effective as PEG in the 4-weeks treatment of children with FC.

Background:: Intussusception represents as the invagination of a part of the intestine into itself and is the most common cause of intestinal obstruction in infants and children between 6 months to 3-years-old. Objectives:: The objective of this study was to determine the recurrence rate and predisposing factors of recurrent intussusception. Patients and Methods:: The medical records of children aged less than 13-years-old with confirmed intussusception who underwent reduction at a tertiary academic care in northern Iran (Mazandran), from 2001 to 2013 were reviewed. Data were extracted and recurrence rate was determined. The two groups were compared by chi square, Fisher, Mann-Whitney and t-test. Diagnosed cases of intussusception consisted of 237 children. Results:: Average age of the patients was 19.57 ± 19.43 months with a peak of 3 to 30 months. Male to female ratio was 1.65 and this increased by aging. Recurrence rate was 16% (38 cases). 87 (36.7%) underwent surgery. These were mainly children under one year old. In 71% (40) of episodes recurrence occurred 1 to 7 times within 6 months. The recurrence occurred in 29 (23.5%) children in whom a first reduction was achieved with barium enema (BE) and 5 (5.7%) children who had an operative reduction (P < 0.001) in the first episode. Pathological leading points (PLPs) were observed in 5 cases; 2.6% in recurrence group versus 2% in non-recurrence group (P = 0.91). Three patients had intestinal polyp, 2 patient’s lymphoma and Mackle’s diverticulum. Age (P = 0.77) and sex (P = 0.38) showed no difference between the two groups. PLPs were observed in 1.4% of children aged 3 months to 5 years. This was 13.3%, in older children (P = 0.02). Conclusions:: The recurrence of intussusception was related to the method of treatment in the first episode and it was 5-fold higher in children with BE than in operative reduction. Recurrent intussusceptions were not associated with PLPs, they were more idiopathic.

Background and Objective: Cystic fibrosis (CF) is the most common inherited disorder in Caucasian populations caused by mutation in cystic fibrosis transmembrane conductance regulator (CFTR). The type of mutations and their distributions varies widely between different countries and/or ethnic groups. The aim of this study was to characterize mutations involved in this disease in Mazandaran province, Iran. Materials and Methods: In this descriptive study thirty unrelated Iranian cystic fibrosis patients were screened for deltaF508, N1303K, G542X, R347H and W1282X mutations in the CFTR gene using Reverse Dot Blot method during 2004-06. This technique uses biotinilated PCR products for simultaneous hybridization with several normal and mutant probes specific to known mutations fixed on Biodyne C membranes. Results: DeltaF508 mutation was found in 13 (21.66%) alleles. 6 patients were homozygote and one was compound heterozygote for this mutation. Conclusion: These findings reveal an important heterogeneity of CFTR gene mutations in Mazandaran Province. Thus regarding the relative low rate of detectable mutations, it is necessary to undertake larger studies for molecular diagnosis of cystic fibrosis in this province.

Background and Objectives: The present study aimed to evaluate the effect of classical and azithromycin-containing triple therapy eradication regimen against H. Pylori in children, and to determine the level of patients’ tolerance. Patients and Methods: This single clinical trial was performed in 2014 on 2 to 15 years old children. All children, in whom H. Pylori infection was confirmed through multiple biopsies of the stomach and required treatment, were enrolled in the study. H. Pylori-positive patients were treated alternately with two different drug regimens; Group OCA received clarithromycin 7.5 mg/kg/day every 12 hours for 10 days, amoxicillin 50 mg/kg/day every 12 hours for 10 days, and omeprazole 1 mg/kg/day every 12 hours for two weeks, and Group OAA received azithromycin 10 mg/kg/day once a day (before meal) for 6 days along with amoxicillin and omeprazole. Four to six weeks after completion of treatment, patients’ stool was tested for H. Pylori through the monoclonal method using the Helicobacter antigen quick kit. Results: There were no significant differences between the two groups regarding gender and age of patients. Based on ITT analysis, the therapeutic response in the OAA and OCA groups were 56.2% and 62.5%, respectively (P = 0.40). Drug adverse effects were 15.6% in the OCA and 3.1% in the OAA group (P = 0.19). Conclusions: The therapeutic response was seen in more than half of the patients treated with triple therapy of H. Pylori eradication regimen including azithromycin or clarithromycin, and there was no significant difference between the two treatment groups.

Introduction: Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC. Materials and Methods: In this study which was conducted in Children’s Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline. Results: Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation. Conclusion: Pelvic floor muscle exercise is an effective nonpharmacologic treatment for Paediatric FC.

Background: Epidemiology of hepatitis A virus (HAV) is changing over time. Giving awareness of this issue can be developed as a plan to prevent complications of the disease; it is especially very helpful in high risk children, such as those with chronic liver disease. Objectives: The current study aimed to investigate the seroprevalenceof anti-HAV antibodies in children with and without chronic liver diseases during two different periods. Patients and Methods: Two studies were conducted on anti-HAV seroprevalence antibodies in children aged one to fifteen years who were referred to Amirkola Children’s Hospital (Babol, North of Iran). The first study was conducted on 73 patients with chronic liver disease (CLD) in 2006, and the second study on 180 cases without it (NCLD) in 2011. Blood samples were collected from children and the sera were evaluated for anti-HAV antibodies via ELISA assay by Dia. Pro kit. Results: Seroprevalence of HAV was 17.8% and 10% in the first and second study, respectively. There was no significant difference in age, sex, and place of residence between anti-HAV negative and positive subjects in the studies. Conclusions: It appears that anti-HAV antibody seroprevalence has declined among children below 15 years with and without chronic liver disease, and it is likely that more children would be susceptible to HAV infection. Therefore, it is important to employ preventative strategies against HAV in chronic liver diseases.

Cystic fibrosis (CF) is a life-limiting autosomal recessive disorder affecting principally respiratory and digestive system. It is caused by cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation. The aim of this study was to determine the extent of repeat numbers and the degree of heterozygosity for c.3499+200TA(7_56) and D7S523 located in intron 17b and 1 cM proximal to the CFTR gene respectively. Both microsatellites were analyzed by direct electrophoresis of PCR product on 20% polyacrylamide gel in 40 Normal subjects and 40 CF patients originating from North Iran. 9 different alleles were found for D7S523 ranging from 16 to 24 repeats alleles. (CA)20 was the most prevalent allele both in normal individuals and CF patients with 21.3% and 20% frequencies respectively. Heterozygosity frequency of D7S523 in normal individuals and CF patients was 97.5% and 90% respectively. Eighteen different alleles were found for c.3499+200TA(7_56) ranging from 8 to 38 repeats alleles. (TA)9 was the most prevalent allele both in normal individuals and CF patients with 30% and 23.5% frequencies respectively. All normal subjects and 97.5% of CF patients showed heterozyous genotype. The high heterozygosity of the two studied microsatellites witnesses the dynamism of such markers. High degree of heterozygosity of c.3499+200TA(7_56) and D7S523 make these markers, a very useful tool for prenatal diagnosis especially in Iranian population.

Infectious diarrhea is one of common cause of children diarrhea causing mortality and morbidity worldwide. This study was performed to identify the common bacteria and their antimicrobial susceptibility in children with diarrhea.Children under 14 years old with acute diarrhea who referred to Amirkola Children's Hospital, Mazandaran, North of Iran, were enrolled during the summer and fall of 2009. From each patient, two fecal specimens were collected. Samples were cultured and bacterial isolation was done by conventional methods. Antimicrobial susceptibility was identified by disk diffusion and micro dilution methods.One hundred-seventy two patients with the mean age of 41.8±37.6 months were evaluated. The bacteria were isolated in 48 (27.9%) cases. The most common isolated bacteria was E.coli and then shigella in both bloody and nonbloody diarrheal patients. There was a significant difference between bacteria positive specimens and WBC in stool smear (p=0.003). All isolated shigella were susceptible to Ceftizoxime and ciprofloxacin and were resistant to Cefixime. Resistant to Nalidixic acid was seen in 14% of them.The results show that E.coli was the most frequently isolated pathogen in children with bloody and nonbloody diarrhea. Ceftizoxime is a good antibiotic for shigellosis in children in our area but Cefixime is not appropriate.

Objective Cholelithiasis rarely occurs in children but the increased use of ultrasonography has led to increased detection of gallstones in patients. The epidemiology and predisposing factors of cholelithiasis vary in different populations. The aim of this study was to describe the clinical presentation, predisposing factors and to evaluate management and outcome of patients referred to Amirkola Children's Hospital jn Babol. Methods This cohort study was performed on children with cholelithiasis referred during 2000 to 2011. Cholelithiasis was diagnosed with ultrasonography. The data was obtained based on history, physical exam, clinical and paraclinical investigations and analyzed by SPSS version 18. P-value

Background: Hepatitis c virus (HCV) is a hepatotrop virus which causes chronic hepatitis and some important complications.One of important way for spreading of this virus is blood products transfusion.In Iran,the donor's blood in blood transfusion organization has been screened for HCV from 1996. We decided to determine the frequency of this disease in persons who received blood products before 1996 due to acute illness accidentally. Methods: This study was performed a case-control in persons between 7–18 years of age in two equal groups which attend in Amirkola children hospital in Babol for any reason during 2003 In case group there were persons who received different kinds of blood products,but no person in control group received any blood products.The first,2cc of venous blood sample from each person in two groups was prepared and screened for HCV antibody by Eliza and then the positive one was examined by PCR.Exclusion criterias in our study were age less than 7 and greater than 18 years old, immunocompromised patients,who received multiple blood transfusion for their chronic diseases and also patients who received multiple blood transfusion for their chronic disease and also patients who received blood products after 1996.Statistical analysis with SPSS software and fisher test was performed. P value