Functional constipation in children: does maternal personality matter?

<p>Abstract</p> <p>Aim</p> <p>To identify personality dimensions of mothers with a constipated child and compare it with those mothers of children without defecation problems.</p> <p>Methods</p> <p>We compared mothers of 150 children with functional constipation to mothers of 150 children with no such a problem attending to pediatric hospital of Tabriz University of medical sciences. Personality dimensions were evaluated by NEO five factor inventory after excluding any psychiatric disorders by an interview.</p> <p>Results</p> <p>Mean age (SD) was 28.8(18.6) months in constipated children and 20.0(19.3) months in controls, 54.6% of constipated children and 56.7% of controls were male. Mean age (SD) was 30.9(7.1) years in mothers of children with functional constipation and 30.1(7.6) years in controls.</p> <p>Mothers of children with functional constipation scored lower in neuroticism and scored higher in extraversion, conscientiousness and agreeableness. Conscientiousness was the dominant dimension of personality in both groups.</p> <p>Conclusion</p> <p>Our results suggest the maternal personality as a factor to directly influence toileting behavior of their children resulting in functional constipation.</p

Efficacy of proton pump inhibitors and H2 blocker in the treatment of symptomatic gastroesophageal reflux disease in infants

PurposeGastroesophageal reflux disease (GERD) occurs in pediatric patients when reflux of gastric contents presents with troublesome symptoms. The present study compared the effects of omeprazole and ranitidine for the treatment of symptomatic GERD in infants of 2-12 months.MethodsThis study was a clinical randomized double-blind trial and parallel-group comparison of omeprazole and ranitidine performed at Children Training Hospital in Tabriz, Iran. Patients received a standard treatment for 2 weeks. After 2 weeks, the patients with persistent symptoms were enrolled in this randomized study.ResultsWe enrolled 76 patients in the present study and excluded 16 patients. Thirty patients each were included in group A (ranitidine) and in group B (omeprazole). GERD symptom score for groups A and B was 47.17±5.62 and 51.93±5.42, respectively, with a P value of 0.54, before the treatment and 2.47±0.58 and 2.43±1.15, respectively, after the treatment (P=0.98). No statistically significant differences were found between ranitidine and omeprazole in their efficacy for the treatment of GERD.ConclusionThe safety and efficacy of ranitidine and omeprazole have been demonstrated in infants. Both groups of infants showed a statistically significant decrease in the score of clinical variables after the treatment

Fatty liver in children

Mandana Rafeey1, Fakhrossadat Mortazavi2, Nafiseh Mogaddasi2, Ghergherehchi Robabeh2, Shamsi Ghaffari2, Alka Hasani31Liver and gastrointestinal Research Center; 2Tabriz University (Medical Science) Tabriz, Iran; 3Research Center of Infectious Diseases and Tropical MedicineAims: The aim of this study is to investigate the clinical and laboratory characteristics of nonalcoholic fatty liver disease (NAFLD) in a referral center of pediatrics in the northwest of Iran.Methods: In this cross-sectional study all subjects aged between six months to 15 years that were referred to the sonography unit, were investigated for fatty liver from March 2005 to August 2006. Patients with fatty liver change underwent detailed clinical and laboratory evaluation.Results: From 1500 children who were investigated, 34 subjects with sonographic evidence of fatty liver were enrolled in this study (2.3%). The mean age was 6.53 &amp;plusmn; 3.07 years. Elevated aspartate aminotransferase and alanine aminotransferase was detected in 38.2% and 47.1% of patients, respectively. The mean level of cholesterol was 461 &amp;plusmn; 182.23 mg/dl and 94.1% of patients had hypercholesterolemia. Total cholesterol level and serum aminotransferase levels had a significant positive correlation with severity of fatty liver (p &amp;lt; 0.05). Mean body mass index was significantly higher in patients with severe fatty liver (p &amp;lt; 0.05).Conclusion: The epidemiology of pediatric NAFLD should inform future attempts to develop evaluated screening protocols. Moreover, these data should guide efforts to delineate the pathophysiology of fatty liver in children.Keywords: nonalcoholic fatty liver disease, steatohepatitis, obesity, childre

A multicentre development and evaluation of a dietetic referral score for nutritional risk in sick infants

Background &amp; aims: Unrecognized nutritional issues may delay recovery in hospitalized infants. It has been proposed that nutritional risk screening should be performed at hospital admission, but few tools include infants. The aim of this study was to develop and test a tool to identify sick infants in need of dietetic input. Methods: Hospitalised infants were recruited from hospitals in the United Kingdom (UK), Greece and Iran. Weight, skinfold thickness and mid upper arm circumference (MUAC) were measured, with detailed dietetic assessment in the UK and Greece. Simple screening questions were used in the UK cohort to formulate a score (infant early nutrition warning score-iNEWS) which was then validated in the Greek and Iranian groups. Results: After dietetic assessment, 20 (9.6%) UK and 22 (22%) Greek infants were rated as needing dietetic input. Underweight, poor weight gain/loss and reduced intake were all independent predictors of perceived need for dietetic input in stepwise multivariate regression analysis. The score based on these items (iNEWS), had 84% sensitivity, 91% specificity and 49% positive predictive value to predict need for dietetic input in the UK cohort. In the Greek cohort this was 86%, 78% and 53% respectively. In all three countries, infants with high iNEWS had significantly lower average skinfold thickness (between −1 and −1.8 SD, p &lt; 0.0001) and MUAC (between −1.8 and −2 SD, p &lt; 0.0001) than those at low risk. Conclusions: iNEWS, a simple nutritional risk tool, identifies most hospitalised infants who need dietetic input. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT03323957

Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in north-west of Iran

<p>Abstract</p> <p>Background</p> <p>Adverse reactions induced by BCG vaccination are rare, disseminated mycobacterial BCG infection in particular, which is often fatal and results from impaired immunity. The aim of this study is to determine the nature of the immunodeficiences in patients with disseminated BCG infection in northwest region of Iran.</p> <p>Materials and methods</p> <p>Through 2 years all infants with BCG adenitis or other complications of this vaccine that had suspicious BCG infection were referred to children's hospital and health centers of Tabriz.</p> <p>Evaluation of immune system and in some cases genetic survey was performed in infants with evidence of histopathologic demonstration of acid-fast bacilli. Then frequency of infants who had disseminated BCG infection with immunodeficiency was defined.</p> <p>Results</p> <p>From 48 selected infants with complications of BCG vaccine in the range of 2 to 62 months, 28 infants (58.3%) were male and 20 infants (41.7%) were female. Disseminated BCG infection was diagnosed in 11 cases, almost all of whom had immunodeficiency as follows:</p> <p>Seven cases had severe combined immunodeficiency and one cases had chronic granulomatous disease. MSMD in two cases and IL12 R deficiency in another one was diagnosed.</p> <p>Overall, the mortality rate was 72.8% (8 cases) which 7 cases of them were SCID and another one CGD</p> <p>Consanguineous was found in more than half (7 cases) of patients and family history of disseminated BCG infection or immunodeficiency was found in nearly one third (3 cases) of patients.</p> <p>Discussion</p> <p>BCG vaccine is administered world wide to prevent tuberculosis and is considered to have excellent safety profile. However in some immunodeficient patients it can cause severe and fatal complications, like in our region, where all cases of disseminated BCG infection with severe immunodeficiency died.</p> <p>Conclusion</p> <p>BCG vaccination is necessary in some countries such as Iran, so it seems that development of a more safer vaccine and change of vaccine program in the families with history of inherited immunodeficiency can be identifies such high risk infants and prophylaxis of severe complications or dead in such patients.</p

Prevalence and risk factors of Hepatitis A in children in Tabriz, Iran

Introduction: Hepatitis A is the most common viral hepatitis during childhood especially in developing countries. It is, usually, self-limiting, but may be associated with severe complications in some patients particularly those with comorbidities. This study was aimed to determine the seroprevalence of hepatitis A in 2-16 years old children in Tabriz, Iran. Methods: The study was a cross-sectional survey on all children who were referred to the clinic of Tabriz children hospital. For every subject, demographic data, including age, sex, method of sewage and waste disposal/type of water supply, history of blood transfusion and parent’s addiction were recorded. Immunoglobulin G (IgG) antibodies against hepatitis A virus (anti-HAV) were measured in sera by enzyme-linked immunosorbent assay. The association between seropositivity and demographic characteristics was studied. Results: This cross-sectional study was performed on 252 children aged 2-16 years in Tabriz city during 2012. Totally, 32.9% of children were seropositive for IgG antibody (anti-HAV) There was a significant difference in the history of blood product transfusion between two groups (P = 0.001). A total of 3% of case-patients had poor type of water supply. The discrepancy between two groups was statistically significant (P = 0.040). There was no significant statistic correlation in seroprevalence of hepatitis A relative to parent’s addiction (P = 0.480), age (P = 0.650) and sex (P = 0.890). Conclusion: According to this study, hepatitis A is prevalent in the pediatric population, and it must be considered in the approach to all susceptible cases of acute hepatitis. Considering the difficulties for the control of environmental sources, we need to have a protocol for routine vaccination of children in our country

Effective Factors in Evaluation of University Professors’ Teaching: Clinical Residents’ Point of View in Tabriz University of Medical Sciences

Introduction: One approach for the promotion of medical education is to evaluate the university professors’ teaching performance. A commonly-used technique is the student-based evaluation. This study aimed at determining the effective factors in the student-based evaluation of the university teachers’ performance in clinical education. Methods:This is a descriptive cross-sectional survey performed on medical residents in Tabriz University of Medical Sciences in June 2009. Data was collected by a questionnaire containing 44 items arranged in two sections. The respondents evaluated the statements on a five level Likert scale. The collected data were analyzed by SPSS-16. Results: In the clinical education domain, 94.4% of residents evaluated "the education during operation" as the most important factor. Other important factors were "the explanation ability" (86%) in the teaching ability domain, the "professors' knowledge ability and expertise" (93.5%) in the knowledge and skill domain, and "non-judgmental and non-humiliating behavior" (79%) in the personal characteristics and comportment domain. From the residents’ viewpoint, the most important educational domain affecting the evaluation of the academic members were the clinical education domain (average 4.39%) and the professors' knowledge ability and expertise (average 4.29%). Conclusion: Considering the nature of residency, practical training is of great importance. This study indicated that residents also consider practical training factors influential in evaluating their professors’ performance. The study pinpointed clinical education, teaching ability, comportment and personal characteristics, and knowledge and skill domain as important domains in evaluating university professors