Thyroid scintigraphy in three-year-old children with congenital hypothyroidism in correlation with neonatal TSH

Introduction: A large number of congenital hypothyroidism (CH) cases in Iran are transient. This study was designed to investigate the aetiology of permanent CH (PCH) by thyroid scintigraphy (TS) and its relationship with the first diagnostic thyrotropin (TSH).Material and methods: During 12 years (2005–2017) of CH screening in southwest Iran, all infants referred with the diagnosis of CH were followed until their third birthday, when they were re-evaluated for serum T4, TSH after discontinuing the treatment for 3–4 weeks. If the last test indicated a PCH state (TSH >10 mU/L with any levels of T4), TS was performed, and, based on the results, the patients were categorised as agenesis, dysgenesis (sublingual, thyroglossal cyst), and normal/diffuse goitre (indicating dyshormonogenesis).Results: After excluding all transient CH subjects, 224 permanent CH cases were enrolled (52.7% female). Seasonal distributions were as follows: spring: 25.7%, summer: 27.9%, autumn: 20.3%, and winter: 26.1%. No significant differences were found between females and males and the different modes of delivery (55.4% were delivered by caesarean section) regarding T4, TSH (p > 0.05). Of a total of 213 performed scans, 20.7% had agenesis, 36.2% had dysgenesis, and 43.2% were normal or goitrous. Those with agenesis/dysgenetic thyroidhad a lower T4 and a higher TSH than those with normal scans. However, the differences were not significant. Compared to those who had TSH < 40 mU/L, patients with TSH ≥ 40mU/L had 46% (95% CI: 1.06–2.02) more risk of agenesis or dysgenesis in TS.Conclusions: More than 40% of PCH are caused by dyshormonogenesis in Iran. Having a TSH ≥ 40 mU/L after the first week of life significantly raises the probability of thyroid agenesis/dysgenesis as the cause

Higher prevalence of permanent congenital hypothyroidism in the Southwest of Iran mostly caused by dyshormonogenesis: a five-year follow-up study

ABSTRACT Objective: The incidence of congenital hypothyroidism (CH) varies globally. This 5-year study aimed to determine the prevalence of permanent CH in the southwest of Iran. Materials and methods: Between January 2007 and December 2009, all newborns in Ahvaz, the biggest city in the southwest of Iran, were screened for CH using a heel-prick sample for thyrotropin (TSH) levels. Subjects with TSH ≥ 5 mU/L were evaluated for T4-TSH. Infants with T4 10 mU/L, and normal T4 but persistent (> 60 days) high TSH were considered to have CH. After the third birthday, treatment was discontinued, and T4-TSH was reevaluated; subjects with TSH ≥ 10 mU/L were investigated using thyroid Tc99 scintigraphy (TS). Based on TS, they were classified as normal, dysgenetic, or athyretic (agenesis). Results: Screening was performed for 86,567 neonates, and 194 were confirmed to have CH (100 males; F/M = 0.94; overall incidence 1:446). After the third birthday, reevaluation was performed in all (except 18 that were not accessible). From 176 patients, 81 (46%) were diagnosed with permanent CH, and 95 were discharged as transient. Considering the same percentage in the lost cases, the prevalence of permanent CH was found to be 1:970. TS performed for 53 of the permanent subjects found agenesis/dysgenesis in 25 (F:M = 15:10) and a normal result in 28 (F:M = 11:17), indicating dyshormonogenesis as the cause in more than 50% of subjects. Conclusions: The incidence of CH in this area was found to be higher than that in other countries but less than the incidence rate reported in central Iran. The large number of transient cases of CH suggests environmental or maternal causes for the incidence rather than a genetic basis

Transient Hyperammonemia of the Newborn: A Case Study

Background: Transient hyperammonemia of the newborn (THAN) is an overwhelming condition presenting with coma within 2-3 days of life and requiring immediate treatment. The etiology of this condition remains unknown. Duration of coma determines the degree of neurologic impairment and developmental delay in hyperammonemia. Case report: A newborn (BW=2900 g) was presented with a clear prenatal and perinatal medical history, poor sucking, refusal to feed, and deep coma within 72 hours of birth; the infant required ventilator assistance. On admission, physical examinations showed normal conditions, except for mild generalized weakness. Moreover, there was no history of consanguinity or maternal or obstetrics illnesses. However, the laboratory tests revealed marked hyperammonemia (plasma ammonia > 397 μg/dL, normal: 27-102 µg/dl) and elevated lactate (36.1 mg/dl, normal < 20 mg/dl). With aggressive therapy (no dialysis), he survived and was discharged without any complications.  The follow-up examinations during the next six months showed that his development was within the normal range without any signs of delay. Conclusion: Hyperammonemia should be considered in infants presenting with neurological deterioration as timely and appropriate intervention could result in good prognosis

Obesity in chronic functional constipation compared to healthy children

Introduction: Childhood obesity and chronic functional constipation (CFC) are common public health problems. This study was designed to compare the prevalence of obesity in children with and without CFC.Materials and Methods: All children referred with constipation (2009-2010) were evaluated, and were enrolled if they were diagnosed as CFC. Children with mild illnesses, but without GI problem, were selected as controls.Their age and sex matched. Data about age, sex, weight, height, body mass index (BMI), duration of breast feeding, duration of constipation, incontinence, daily consumption of fiber and dairy products, daily activity, and family history of CFC were recorded for both groups.Results: 208 constipated children (51% male; mean age: 4.73 yr) and 208 healthy controls were enrolled. 19.7% of patients and 17.8% of controls (P>0.05) were obese (BMI>95%). Patients had: less average (>2 hr) daily activity (80.3% vs. 95.2%; P<0.001); shorter period of breast feeding (16.3 mo. vs. 18.24 mo.; P≈0.017) and more frequently diet with inadequate fiber (58.7% vs. 28.8%; P<0.001). There was no difference for dairy consumption (P≈0/94). Family history of CFC found to be more in patients (28.8% vs. 8.2%; P<0.001). In patient group, mean duration of constipation was longer in obese subjects (in comparison to non-obese ones; 31.4 mo. vs. 21 mo.; P<0.01).Conclusion: Although the prevalence of obesity in children with CFC was similar to healthy age matched population, they were differed by duration of breastfeeding, average daily fiber consumption, average daily physical activity and family history of constipation

Clinical correlation between hypercalciuria and nocturnal enuresis

Hypercalciuria may present with dysuria, urinary incontinence and nocturnal enuresis (NE). To determine the frequency of hypercalciuria in NE patients and normally continent children, we studied 122 consecutive pre- school children with NE referred to our nephrology clinic during two years, from September 2007 to August 2009. We measured the 24- hour urinary calcium. Furthermore, we compared the response to nasal desmopressin in hypercalciuric and normocalciuric patients. Hypercalciuria was found in 26 (21.3 %) of the NE patients as compared with five (4.5%) of 110 continent children [(P 0.05). The response to desmopressin above 90% occurred within one month of therapy without a significant change in the levels of hypercalciuria. We conclude that these results suggest that hypercalciuria has a significant association with NE and does not interfere with the desmopressin therapy

Activation of Persulfate Using an Industrial Iron-Rich Sludge as an Efficient Nanocatalyst for Landfill Leachate Treatment

In this research, the performance of nanomaterials obtained from the converter sludge (CS) of Esfahan Steel Company, Iran was investigated for the activation of persulfate (PS). The experiments were conducted on real and synthetic leachates. CS showed high catalytic activity for removal of chemical oxygen demand COD and NH3 because of its high iron oxide content. The effects of pH, CS dosage, and PS/COD ratio, temperature, and reaction time on the removal of COD and NH3 were evaluated to optimize operational conditions (pH 2, CS dosage: 1.2 g L&minus;1, PS/COD: 4, and reaction time: 60 min). Maximum COD and NH3 removal efficiencies were 73.56 and 63.87%, respectively. Finally, the optimized process was applied for treatment of a real leachate sample. Although the treated leachate was not suitable to discharge into the environment, an increase in the 5-day biochemical oxygen demand (BOD5) and biodegradability (BOD5/COD) of leachate after treatment indicated that the effluent can be biologically treated. As a consequence, it can be combined with sewage or can be returned to the landfill

Neck Circumference as a Useful Marker for Screening Overweight and Obesity in Children and Adolescents

Objectives: Overweight and obesity at an early age are an important criterion for predicting chronic diseases. Each anthropometric method available to assess obesity has its limitations. Recently, one of the indices proposed to better detect this complication is neck circumference (NC). The aim of this study was to investigate the relationship between NC, and body mass index (BMI), and to find a cutoff NC size to identify children with a high BMI. Methods: In this cross-sectional study, we enrolled 864 students aged 6–17 years from the schools in Ahvaz, Iran. Measurements, including height, weight, neck, mid-arm, and waist circumference (WC), and clinical information were collected by trained physicians. Pearson’s correlation coefficient was calculated between NC and other obesity indices, and receiver operating characteristic curve analysis was used to determine the best cutoff value of NC in predicting high BMI. Results: NC in both genders was significantly correlated with BMI, WC, and mid-arm circumference. The best cutoff value of NC to identify boys with a high BMI was 27.5–38.3 cm, and for girls was 26.7–33.4 cm. Conclusions: NC is significantly correlated with overweight and obesity. It can be used with great reliability to screen overweight and obesity in children, and to identify those with a high BMI

Lipid and Glucose Serum Levels in Children with Congenital Heart Disease

Background: Coronary artery disease is one of the most common causes of morbidity and mortality in developed countries. Atherosclerosis begins in early childhood and progresses through life. With advances in pediatric cardiology, the prevalence of congenital heart disease in adults has increased in relation to children. A great deal of research has been conducted on serum glucose and lipid concentrations in patients with congenital heart disease, but comparison has yet to be made between congenital patients and the general population, especially in pediatric groups. The aim of this study was to compare the serum concentrations of glucose and lipids between pediatric congenital heart disease patients and a healthy age and sex-matched control group. Methods: We measured and compared the total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (TG), and plasma glucose concentrations of 100 pediatric congenital heart disease patients (cases) and 100 individuals matched for age and sex (controls) during a period of 7 months between November 2011 and June 2012. Results: Total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol concentrations were significantly higher in the patients than in the control group (p value < 0.05). Blood sugar levels in both groups had no significant difference (p value = 0.25). In the case group, the cholesterol level was higher in the males than in the females (p value = 0.30); moreover, the TG and HDL cholesterol levels were lower in the males than in the females and the LDL cholesterol and blood sugar levels had no statistically significant difference. In the control group, there was no difference between the males and females in terms of the cholesterol, HDL cholesterol, LDL cholesterol, TG, and blood sugar levels. Conclusion: The results of this study showed that our pediatric congenital heart disease patients had significantly higher levels of serum lipids than did their age and sex-matched controls. In light of these results, we recommend that the lipid profile be screened in children with congenital heart disease so as to reduce the risk of atherosclerosis

Comparison between maternal and neonatal serum vitamin D levels in term jaundiced and nonjaundiced cases

Background: Neonatal jaundice is the result of an imbalance between the production and conjugation of bilirubin. Considering the multiple roles of vitamin D, lower levels of vitamin D in these cases may be associated with neonatal jaundice. The present study was undertaken for the purpose of comparing serum vitamin D levels in healthy term jaundiced and nonjaundiced newborns and their mothers. Methods: This case–control study was conducted in 60 term newborns and their mothers from a teaching and referral children’s hospital in the southwestern region of Iran, from December 22, 2013 through March 22, 2014. Neonatal and maternal blood samples were obtained and sent to the laboratory. Results: The mean serum 25-hydroxy vitamin D levels of newborns and their mothers in both the case and the control groups were not significantly associated with their serum bilirubin levels. The mean of laboratory indices (calcium, phosphorus, alkaline phosphates, parathyroid hormone, and 25-hydroxy vitamin D) in mothers and newborns of the case group were nonsignificantly higher than that of the control group, but the mean vitamin D level was significantly lower among newborn cases compared with the controls (p<0.05). Conclusion: Newborn vitamin D levels were significantly lower in jaundiced cases compared with those in the nonjaundiced healthy groups, which may reveal an association between indirect hyperbilirubinemia and serum vitamin D levels. We suggest that more studies should be conducted including follow-up after 15 days of age, when jaundice has typically been resolved, and before starting vitamin D supplementation