Cytomegalovirus and toxoplasma gondii: Common causes of profound sensori neural hearing loss in children with cochlear implant surgery in a highly immune population: Tehran; Iran

Background: Iranian population is highly immune from T.Gondii and CMV infection. Objective: To determine the immunity to T.Gondii and CMV in children with the cochlear implant surgery accompanied with the profound Idiopathic type of SNHL Methods and Materials: We studied 45 cases with the cochlear implant surgery (Idiopathic profound SNHL) and 30 controls with the normal OAEs in a cross-sectional study in Rasoul Akram Hospital in Tehran (2010-2012). Blood samples (2 ml) were centrifuged and were kept frozen at-20°C. Sera searched for the specific antibodies against CMV and T.Gondii. The enzyme-linked immunosorbent assay (ELISA; BioChem Immune System) was calculated qualitatively. (P value< 0.05) Results: Range of age in cases with profound SNHL (<95 dB) was 6 months-to-14 years; mean=3.4+3.16 y; Idiopathic type of SNHL children diagnosed in 45 cases were younger than cases with non-Idiopathic SNHL (mean age=20 months; PV=0.05). Positive T.Gondii-IgM was found in 8 /45 (17.7) and also one of these cases (2.2) had positive T.Gondii �IgG test. Positive CMV-IgM & IgG were determined in 23 and 51 of cases, respectively. Positive T.Gondii �IgG was observed in 60 (18/30) of controls but none of them had positive T.Gondii � IgM. Positive CMV-IgM & IgG in controls was 3.3 and 90, respectively. Conclusion: CMV infection is one of the most common infections found in profound idiopathic SNHL children especially in younger cases (< 2 years) even in highly immune Iranian populations. Probably, T.Gondii infection has a relative role in younger cases with profound SNHL but a higher role in mild to moderate SNHL in our pediatric population. Most of the T.Gondii infected SNHL cases never require cochlear implant surgery. In future, a cohort study for prenatal diagnosis of the intrauterine infection and the role of infection in producing SNHLwould be very helpful. It has been recommended to search the specific antibodies against these two common infections in all types of SNHL in pediatric groups which are treatable especially in younger cases (<2 year). © 2019 Noorbakhsh et al

Acute nonbacterial gastroenteritis in hospitalized children: A cross sectional study

Background: Viral acute gastroenteritis (AGE) is a major cause of morbidity in childhood and leads to hospitalization in developed countries, such as Iran. Objectives: The aim of this study was to determine the prevalence and viral types (rotavirus, adenovirus, human parechoviruses-1, and human bocavirus) of acute nonbacterial gastroenteritis in hospitalized children. Patients and Materials: This was a across-sectional prospective study performed at the Pediatric Department of Rasoul Hospital, Tehran, Iran (2009-2011) on 80 hospitalized children with viral AGE. All Stool samples were collected on viral transport media. Human bocavirus (HBoV) was detected using the Real-time PCR TaqMan method. Molecular detection of human parechovirus type 1 (HPeV-1) RNA in stool samples was done using a specific nested reverse transcription PCR (RT-PCR). Rota and adeno virus antigens were sought by rapid chromatographic tests. P values less than 0.05 were considered statistically significant. Results: Fever was determined in 47.5 of cases (38), nausea and vomiting in 42.5 (34), respiratory symptoms in 16.3 (13), abdominal pain in 76. Duration of diarrhea was 1-30 days (mean = 6.3 + 4.3 days). No dehydration was observed in 43.5 of subjects, mild dehydration in 33.8, moderate dehydration in 17.5 and severe dehydration in 5 of cases. Positive rotavirus was found in 48.8 of cases (39), adenovirus in 20 (16), HBoV in 8 (6) and HPeV-1 in 23.2 (19), and adeno and rotaviruses co-infection in 6 (4). The frequency of positive HBoV was significantly lower than adeno and rotaviruses infection (P value = 0.0001). Rotavirus was more frequent in males (P value = 0.003) and in young children (17.49 months vs. 21.44 months) P value = 0.03, CI = -13.4, 5.5. Rotavirus infection was related to the degree of dehydration (P value = 0.001) but was not related to the presence of vomiting or fever (P value > 0.5). Conclusions: This study indicates that viral agents, especially rotavirus (48.8%), HPeV-1 (23.2%) and adenovirus (20%) are the most important causes for viral AGE in children while HBoV (8%) is infrequent during childhood. Determination of various viral pathogens of AGE is very important in planning diarrhea disease control strategies in our country where rotavirus vaccination in not routinely used. © 2014, Ahvaz Jundishapur University of Medical Sciences

Diagnostic value of CRP, procalcitonin, and ferritin levels in cerebrospinal fluid of children with meningitis

Background and Objective: Bacterial meningitis is a serious disease with high rate of mortality and morbidity in children. Invasion of pathogens causes brain and meningeal inflammation, which leads to the release of biomarkers into cerebrospinal fluid (CSF). Identification of these biomarkers can help the physicians to differentiate between bacterial and aseptic meningitis. In the current study, some of these biomarkers such as Procalcitonin, C reactive protein (CRP), and Ferritin, were compared in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis. Methods: In a prospective cross sectional study in a referral children hospital in Tehran during 2011-2013, the CSF levels of Procalcitonin, Ferritin, and CRP were measured in 57 children with clinically suspected meningitis. The Mann-Whitney u test and the chi-square test were used to compare two groups, children with bacterial and aseptic meningitis. The cut-offs of biomarker levels for differentiation between the 2 groups were constructed by receiver-operating � characteristic curve (ROC). Results: 57 subjects (30 bacterial and 27 aseptic meningitis), were enrolled in this survey. In comparing the two groups, the CSF levels of Ferritin, CRP, and procalcitonin in bacterial meningitis were significantly higher than in aseptic meningitis (P values=�0.001, 0.001, �0.001respectively), with sen-sitivity/specificity being 92.9 / 68, 92.9 / 84, and 96.4 / 80, respectively. Positive Predictive Values (PPV) were, correspondingly, 96.4, 92.8, and 92.8 for procalcitonin, Ferritin, and CRP. Corresponding Negative Predictive Values (NPV) were, respectively equal to 95.4, 70, and 88. Conclusion: CSF of children with bacterial meningitis contains higher levels of inflammatory mediators including Procalcitonin, Ferritin, and CRP, compared to aseptic meningitis The biomarkers provided high sensitivity (especially PCT) and specificity (especially CRP). Using these complementary biomarkers would be useful for early diagnosis of bacterial meningitis and selection of appropriate treatment. © 2018 Bentham Science Publishers

Diagnostic value of CRP, procalcitonin, and ferritin levels in cerebrospinal fluid of children with meningitis

Background and objective: Bacterial meningitis is a serious disease with high rate of mortality and morbidity in children. Invasion of pathogens causes brain and meningeal inflammation, which leads to the release of biomarkers into cerebrospinal fluid (CSF). Identification of these biomarkers can help the physicians to differentiate between bacterial and aseptic meningitis. In the current study, some of these biomarkers such as Procalcitonin, C reactive protein (CRP), and Ferritin, were compared in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis. Methods: in a prospective cross sectional study in a referral children hospital in Tehran during 2011-2013, the CSF levels of Procalcitonin, Ferritin, and CRP were measured in 57 children with clinically suspected meningitis. The Mann-Whitney u test and the chi-square test were used to compare two groups, children with bacterial and aseptic meningitis. The cutoffs of biomarker levels for differentiation between the 2 groups were constructed by receiver-operating � characteristic curve (ROC). Results: 57 subjects (30 bacterial and 27 aseptic meningitis), were enrolled in this survey. In comparing the two groups, the CSF levels of Ferritin, CRP, and procalcitonin in bacterial meningitis were significantly higher than in aseptic meningitis (P values=�0.001, 0.001, �0.001respectively), with sensitivity/specificity being 92.9 / 68, 92.9 / 84, and 96.4 / 80, respectively. Positive predictive values (PPV) were, correspondingly, 96.4, 92.8, and 92.8 for procalcitonin, Ferritin, and CRP. Corresponding negative predictive values (NPV) were, respectively equal to 95.4, 70, and 88. Conclusion: CSF of children with bacterial meningitis contains higher levels of inflammatory mediators including Procalcitonin, Ferritin, and CRP, compared to aseptic meningitis The biomarkers provided high sensitivity (especially PCT) and specificity (especially CRP). Using these complementary biomarkers would be useful for early diagnosis of bacterial meningitis and selection of appropriate treatment. © 2016 Bentham Science Publishers

Diagnostic value of CRP, procalcitonin, and ferritin levels in cerebrospinal fluid of children with meningitis

Background and Objective: Bacterial meningitis is a serious disease with high rate of mortality and morbidity in children. Invasion of pathogens causes brain and meningeal inflammation, which leads to the release of biomarkers into cerebrospinal fluid (CSF). Identification of these biomarkers can help the physicians to differentiate between bacterial and aseptic meningitis. In the current study, some of these biomarkers such as Procalcitonin, C reactive protein (CRP), and Ferritin, were compared in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis. Methods: In a prospective cross sectional study in a referral children hospital in Tehran during 2011-2013, the CSF levels of Procalcitonin, Ferritin, and CRP were measured in 57 children with clinically suspected meningitis. The Mann-Whitney u test and the chi-square test were used to compare two groups, children with bacterial and aseptic meningitis. The cut-offs of biomarker levels for differentiation between the 2 groups were constructed by receiver-operating � characteristic curve (ROC). Results: 57 subjects (30 bacterial and 27 aseptic meningitis), were enrolled in this survey. In comparing the two groups, the CSF levels of Ferritin, CRP, and procalcitonin in bacterial meningitis were significantly higher than in aseptic meningitis (P values=�0.001, 0.001, �0.001respectively), with sen-sitivity/specificity being 92.9 / 68, 92.9 / 84, and 96.4 / 80, respectively. Positive Predictive Values (PPV) were, correspondingly, 96.4, 92.8, and 92.8 for procalcitonin, Ferritin, and CRP. Corresponding Negative Predictive Values (NPV) were, respectively equal to 95.4, 70, and 88. Conclusion: CSF of children with bacterial meningitis contains higher levels of inflammatory mediators including Procalcitonin, Ferritin, and CRP, compared to aseptic meningitis The biomarkers provided high sensitivity (especially PCT) and specificity (especially CRP). Using these complementary biomarkers would be useful for early diagnosis of bacterial meningitis and selection of appropriate treatment. © 2018 Bentham Science Publishers

A comparative analysis of clinical characteristics and laboratory findings of covid-19 between intensive care unit and non-intensive care unit pediatric patients: A multicenter, retrospective, observational study from iranian network for research in viral diseases (inrvd)

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1�5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9 vs. 1.9, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions. © 2021 Tehran University of Medical Sciences

A multicenter retrospective study of clinical features, laboratory characteristics, and outcomes of 166 hospitalized children with coronavirus disease 2019 (COVID-19): A preliminary report from Iranian Network for Research in Viral Diseases (INRVD)

Background: The objectives of this study were to analyze the clinical features and laboratory profiles and risk factors associated with critical illness of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: One hundred and sixty-six coronavirus disease 2019 (COVID-19) Iranian pediatric patients were recruited through a collaborative research network between March and May 2020. Demographics, clinical, laboratory, and radiological results were obtained from patient files. Results: Of 166 patients, 102 (61) and 64 (39) were males and females, respectively. Ninety-six (57.8) and 70 (42.2), had moderate and severe conditions, respectively. Thirty (18) of patients died. The common symptoms were fever (73), cough (54), and shortness of breath, headache decrease in neutrophil and platelet counts; increase values in lactate dehydrogenase, decrease in the blood pH and HCO3 were significantly associated with the disease severity. 54 and 56 of patients showed abnormal radiographic appearance in Chest X-ray and in chest computed tomography scan, respectively. Sixty-one (36.7) of patients were referred to intensive care unit (ICU). The coexistence of comorbidity was the main factor associated with ICU admission, shock, arrhythmia, acute kidney injury, acute respiratory distress syndrome, acute cardiac injury, and death. Conclusions: We describe a higher than previously recognized rate of COVID-19 mortality in Iranian pediatric patients. Epidemiological factors, such as the relatively high case fatality rate in the country and the presence of underlying diseases were the main factors for the high death rate. © 2021 Wiley Periodicals LL