Frequency and Clinical Manifestations of Pediatric Brucellosis in Iran: A Systematic Review

Background Brucellosis is a zoonotic disease that is widely distributed throughout the developing countries. Children are considered as at risk groups for infection. The aim of this study was to assess the frequency and clinical manifestations of Brucellosis in Iranian children and adolescents. Materials and Methods: We systematically searched international databases; ISI, Medline (via PubMed), Scopus, and national databases Irandoc, Barakat knowledge network system, Magiran, and Scientific Information Database (SID). The search strategy was developed based on main terms of "Brucellosis," "Brucella fever", "Gibraltar", "Rock Fever", "Undulant Fever", "Cyprus Fever", "Malta Fever", and "Bang Disease". Results: A total of 885 studies were identified, from them a total of 12 studies that were conducted between 2001 and 2016 were included. Following the relevancy assessments and quality control, data from the 1,429 participants were presented in our review. The age of the patients ranged from 2 to 18 years. Only one out of twelve studies provided the prevalence of 4.30% and 3.4 incidence. Studies varied greatly in reporting high risk behavior of animal contact (8.4 to76.0%) and unpasteurized dairy (22.4 to 91.6%). Conclusion Our finding reveals the disparity of reported prevalence and clinical manifestations of Brucellosis in Iranian children. Fever and joint pain were the most frequent reported signs. Differences in study design, measurement tools and methods, and sub population sampling, does not provide the possibility of aggregation of data for more comprehensive inference

The Effect of Vitamin C on Endothelial Function of Children with Type 1 Diabetes: An Experimental Study

Background: Considering the importance of improvement of endothelial function in patients with type 1 diabetes mellitus (DM) and to prevent its related micro- and macro-vascular complications; in this study, the effect of vitamin C administration on improving endothelial function of children with type 1 diabetes was investigated. Methods: In this analytic-experimental study, children with type 1 DM aged 6-18 years and a group of healthy children enrolled. Vitamin C (250 mg/daily) administrated for the two studied groups for 1-month. Endothelial function evaluated by flow-mediated dilatation (FMD) and intima-media thickness (IMT) measurement using vascular Doppler ultrasonography, before and after trial. Results: In this study, 18 patients with type 1 diabetes (DM) and 19 normal children as the control group were studied. After vitamin C administration IMT reduced in all studied groups (P 0.05). Mean differences of IMT 2 - IMT 1, FMD 2 - FMD 1, LV mass 2 - LV mass 1 and BP were not significantly different in patients with HbA1c ≤ 7 g/dl and those with HbA1c >7 g/dl and control group (P > 0.05). Conclusions: The findings of the current study indicated that vitamin C may have a protective effect on endothelial dysfunction, but regarding its effectiveness among the high-risk population such as diabetic patients with and without appropriate glycemic control the study was not sufficiently powered due to its small sample size

Does Vitamin C improve endothelial function in patients with Kawasaki disease?

Background: Improvement of endothelial dysfunction could prevent or delay the occurrence of the atherosclerosis process in patients with Kawasaki disease (KD). It is suggested that Vitamin C could improve endothelial dysfunction. In this study, we investigated whether administration of Vitamin C as a water-soluble antioxidant could be effective in this regard among patients with KD. Materials and Methods: In this case control analytic-experimental study, children aged 3-18 years with KD, and a group of healthy children evaluated. Vitamin C (250 mg/daily) administrated for the two studied groups for 1 month. Endothelial function evaluated by flow-mediated dilatation (FMD) and intima-media thickness (IMT) measurement using vascular Doppler ultrasonography, before and after trial. Results: In this study, 16 patients with KD and 19 normal children were studied. At baseline mean of IMT and FMD was not different in the two studied groups (P > 0.05). After Vitamin C administration IMT decreased significantly in two studied groups (from 27.06 ± 6.27 to 21.56 ± 3.77 in KD group and from 27.66 ± 5.66 to 23.33 ± 3.66 in control group [P < 0.05]). FMD increased in two studied groups, but the difference was significant in the control group (from 6.84 ± 2.51 to 7.03 ± 2.87 in KD group and from 6.53 ± 2.36 to 7.82 ± 2.14 in the control group). Conclusion: Vitamin C might improve the endothelial function of patients with KD

Association of Matrix Metalloproteinases-2, Metalloproteinases-9, and Endothelial Dysfunction with Carotid Intima-Media Thickness and Left Ventricular Mass Index in Children with End-Stage Renal Disease

Background and Aim: Cardiovascular disease (CVD) has been recognized as a major cause of death among children with end-stage renal disease (ESRD). Matrix metalloproteinases (MMP-2 and MMP-9) and endothelial dysfunction play a significant role in the development of CVD in these children. This study was conducted to assess the association of MMP-2 and 9 and endothelial dysfunction markers (sE-selectin and brachial flow mediated dilatation (FMD)) with carotid intima media thickness (c-IMT) and left ventricular mass index (LVMI).Methods: Thirty-one pediatric ESRD patients and 18 healthy controls were included in this research. The case and control groups were matched in terms of sex and age. Serum levels of MMP-2, MMP-9, sE-selectin, and other biochemical parameters were measured. Brachial FMD, c-IMT and LVMI were also measured in the two groups.Results: C-IMT had a positive correlation with diastolic blood pressure, MMP-2, MMP-9, low-density lipoprotein (LDL), triglyceride, phosphorus, PTH, and calcium × phosphorus (Ca × P) product, and a negative correlation with FMD, high-density lipoprotein (HDL), and calcium. LVMI demonstrated correlations with systolic blood pressure, MMP-2, FMD, cholesterol, triglyceride, HDL, phosphorus, PTH, and Ca × P product. The area under the curve (AUC) in ROC curve analysis was used to determine the abnormal c-IMT and LVH values for MMP-2, which was 0.76 and 0.71, respectively (p&lt;0.05).Conclusion: C-IMT and LVMI are two major CVD markers in pediatric ESRD patients. These two markers correlated with MMP-2, MMP-9 and endothelial dysfunction markers. According to this study, MMP-2 may determine abnormal c-IMT and LVH in ESRD children. Keywords: End-stage renal disease; Cardiovascular disease; Left ventricular hypertrophy; Atherosclerosis; Matrix metalloproteinases