Comparison of the frequency and complications of inappropriate antidiuretic hormone secretion in patients with septic and aseptic meningitis

Objective Due to the high prevalence of syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). This study was carried out to evaluate the prevalence and relevant parameters of SIADH in children with septic and aseptic memingitis hospitalized at Kashan Shahid Beheshti Hospital between 1996 and 2006. Materials & Methods This descriptive study was conducted on 230 patients with meningitis hospitalized in the pediatric wards of Kashan Shahid Beheshti Hospital between 1996 and 2006. Relevant information (age, gender, type of meningitis, serum sodium and potassium, urine specific gravity (USG), blood sugar, blood urea nitrogen, serum creatinin, hydration condition) was collected from patients' records. Datawas analyzed using Mann-Whitney and K2 tests. Results Out of 230 patients with meningitis, 33 had incomplete records and only 197 patients were recruited for this study. Sixty eight cases (34.5) suffered from SIADH. It was more frequent among 1-2 year old children. According to this research, SIADH was diagnosed in 57 of the 121 patients with hyponatremia, 58.7 of the 167 patients with USG > 1.004, 74 of the 93 patients with serum osmolity < 280 mOs/L and 100 of the patients with BUN < 10 mg. Conclusion Due to the high prevalence of SIADH in septic and aseptic meningitis and its complication, it is recommended to restrict fluid therapy and monitor serum sodium, urine specific gravity and other diagnostic tests for SIADH

The Effect of Synbiotic Supplementation on Growth Parameters in Mild to Moderate FTT Children Aged 2�5 Years

Synbiotic (probiotic bacteria and prebiotic) has beneficial effects on the gastrointestinal tract. This study was designed to investigate the effect of synbiotic supplementation on the growth of mild to moderate failure to thrive (FTT) children. A randomized, triple-blind, placebo-controlled trial was conducted involving 80 children aged 2�5 years with mild to moderate FTT, who were assigned at random to receive synbiotic supplementation (109 colony-forming units) or placebo for 30 days. The weights, height, and BMI were recorded in a structured diary, and the questionnaires were completed to monitor the numbers of infection episodes, gastrointestinal problems, admission to hospital, and appetite improvement during the study. Sixty-nine children completed the study. There were no differences in the demographic characteristic between the two groups. The mean weight was similar at baseline. After 30 days of intervention, the mean weight of the participants in the synbiotic group increased significantly than those in the placebo group (600 ± 37 vs. 74 ± 32 g/month P 0.000). BMI changes in synbiotic and placebo group were 0.44 and 0.07 kg/m2, and that the differences among the two groups were significant.(P 0.045) Furthermore, the height increment in synbiotic and placebo group was 0.41 and 0.37 cm respectively with no significant difference (P 0.761). Administration of 30-day synbiotic supplementation may significantly improve weight and BMI in Iranian children with mild to moderate FTT, but there is no effect on the height in this study. Further studies should be designed to found out the effect of synbiotic on growth parameters in undernourished and well-nourished children. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

The Effect of Synbiotic Supplementation on Growth Parameters in Mild to Moderate FTT Children Aged 2–5 Years

Synbiotic (probiotic bacteria and prebiotic) has beneficial effects on the gastrointestinal tract. This study was designed to investigate the effect of synbiotic supplementation on the growth of mild to moderate failure to thrive (FTT) children. A randomized, triple-blind, placebo-controlled trial was conducted involving 80 children aged 2–5 years with mild to moderate FTT, who were assigned at random to receive synbiotic supplementation (109 colony-forming units) or placebo for 30 days. The weights, height, and BMI were recorded in a structured diary, and the questionnaires were completed to monitor the numbers of infection episodes, gastrointestinal problems, admission to hospital, and appetite improvement during the study. Sixty-nine children completed the study. There were no differences in the demographic characteristic between the two groups. The mean weight was similar at baseline. After 30 days of intervention, the mean weight of the participants in the synbiotic group increased significantly than those in the placebo group (600 ± 37 vs. 74 ± 32 g/month P 0.000). BMI changes in synbiotic and placebo group were 0.44 and 0.07 kg/m2, and that the differences among the two groups were significant.(P 0.045) Furthermore, the height increment in synbiotic and placebo group was 0.41 and 0.37 cm respectively with no significant difference (P 0.761). Administration of 30-day synbiotic supplementation may significantly improve weight and BMI in Iranian children with mild to moderate FTT, but there is no effect on the height in this study. Further studies should be designed to found out the effect of synbiotic on growth parameters in undernourished and well-nourished children. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Diagnostic Challenges in AIH

Autoimmune hepatitis is a chronic hepatitis that occurs in children and adults of all ages. Diagnosis is based upon characteristic serologic and histologic findings and the exclusion of other forms of chronic liver disease. Guidelines issued by the AASLD suggest the following diagnostic considerations: The diagnosis should be made in patients with compatible clinical signs, symptoms, and laboratory abnormalities. Other conditions that can cause chronic hepatitis should be excluded. In unclear cases a standardized scoring system should be used in the assessment. In those who are negative for conventional autoantibodies, additional autoantibodies should be sought. All patients with autoimmune hepatitis and inflammatory bowel disease should undergo cholangiographic studies to exclude primary sclerosing cholangitis.   Scoring systems- A scoring system developed and subsequently revised by the International Autoimmune Hepatitis Group to standardize the diagnosis with using simplified criteria based upon titers of autoantibodies, IgG levels, liver histology, and the exclusion of viral hepatitis. Autoantibodies: assign one point if the ANA or SMA are 1:40 OR assign two points if the ANA or SMA are ≥1:80 (OR if the LKM ≥1:40 OR if the SLA is positive). IgG: assign one point if the IgG is > the upper limit of normal OR assign two points if the IgG is >1.10 times the upper limit of normal. Liver histology: assign one point if the histological features are compatible with autoimmune hepatitis OR two points if the histological features are typical of autoimmune hepatitis. Absence of viral hepatitis A probable diagnosis of autoimmune hepatitis is made if the total points are six, while a definite diagnosis is made if the total points are ≥seven.

Evaluation of association between hyperlipidemia and periodontitis

Statement of Problem: Hyperlipidemia is a major risk factor for cardiovascular disease. In recent years some evidence has been presented regarding the association between periodontal and cardiovascular diseases. Purpose: The aim of this study was the evaluation of association between hyperlipidemia and periodontitis. Materials and Methods: In this case-control study, levels of plasma lipids in 40 subjects with periodontitis (CPITN score III or IV) were measured and compared with 40 age and sex matched controls. Data were analyzed using t-student test with P&lt;0.05 as the limit of significance. Results: Total cholesterol (CHL) and triglyceride (TG) were significantly higher in case group compared with control group. (P=0.045 and P=0.016 respectively). HDL and LDL cholesterols were higher in cases but showed no significant differences with controls. The relative frequency of pathologic values of CHL and TG were significantly greater in cases compared with control group (P=0.005 and P=0.001 respectively). Conclusion: Based on the findings of this study, hyperlipidemia may be associated with periodontitis in medically healthy peoples but whether periodontitis causes an increase in levels of serum lipids or whether hyperlipidemia is a risk factor for both periodontitis and cardiovascular disease need to be further investigated

Role of acetaminophen on the complications of DTP vaccine

Background: Parents worry about the complications of DTP vaccine. However, there are some reports demonstrating the positive effect of acetaminophen on DTP vaccine complications. The present study was conducted on children referring to Kashan health care centers to determine the role of acetaminophen on the complications of DTP vaccine. Materials and methods : For this clinical trial, 324 children aged 1.5month-6 years who had received DTP vaccine produced by Razi institute in 1378 were selected. They were assigned randomly in two groups of case and control. The case group have received acetaminophen at the dosage of 15mg/kg/dose at the time of vaccine injection and then each 6 hours for 48 hours. Then, complications were recorded after 48 hours and analyzed by chi square. Results : Groups were matched according to the sex and age. Of 324 children, 281 (86.7%) developed complications. This was 88.9% for the control and 84.6% for the case group, respectively (NS). Fever was the most common complication (66.1% for the control vs. 46.9% for the case group, p<0.0007). On the other hand, pain at the site of injection was the most common local complication occurred in 58% of controls and 35.21% of cases (p<0.0001). Conclusion : Acetaminophen may reduce some complications of DTP vaccine, thus, it is recommended following the vaccine injection

Evaluation of antibiotic sensitivity of Shigella, Salmonella, and Vibrio Cholera in patients with acute diarrhea referred to reference laboratory of Kashan University of Medical Sciences from 2000 to 2001

History and Objectives: Inappropriate antibiotic treatment can lead to resistance with various incidences in different populations and is one of the major problems facing treatment of diarrhea. This study was carried out to determine the incidence of antibiotic resistance in referrals of reference laboratory of Kashan University of Medical Sciences from 2000 to 2001. Materials and Methods: The descriptive strategy of this study was conducted on 1800 patients with acute diarrhea. Fecal specimens were collected and transferred to specific culture medium. Antibiotic discs of ciprofloxacin, ceftizoxime, chloramphenicol, co-trimoxazole, nalidixic acid, doxycyclin, tetracycline, cephazolin, furazolidone, cephalotin and amikacin were used for determination of sensitivity of Shigella, Salmonella, Vibrio cholera. Results: Out of 1800 fecal specimens, there was a growth rate of 11.9 (215 cases), that is 58.1 (125 cases), 30.7 (66 cases) and 11.2 (24 cases) for Shigella, Salmonella and Vibrio cholera respectively. For Shigella, the sensitivity to ciprofloxacin, ceftizoxime, chloramphenicol, nalidixic acid, co-trimoxazole, doxycyclin, cephazolin, furazolidone, ampicillin and cephalotin was 99, 97, 84, 74, 58, 54, 47, 35, 23 and 22 respectively. For Salmonella, the sensitivity to ciprofloxacin, chloramphenicol, ceftizoxime, co-trimoxazole, cephazolin and furazolidone was 100, 96, 78, 20 and 12 respectively. For Vibrio cholera, the sensitivity to ciprofloxacin, doxycyclin, tetracycline, ceftizoxime, co-trimoxazole, nalidixic acid, furazolidone, cephazolin, cephalotin and ampicillin was 100, 100, 100, 95.8, 87.5, 83.3, 79.2, 79.2, 75 and 62.5 respectively. Conclusion and Recommendations: Considering the incremental trend for antibiotic resistance for Shigella, Salmonella and Vibrio cholera, it is strongly recommended to avoid inappropriate and unnecessary use of antibiotics in patients with diarrhea

Seroepidemiology of hepatitis B and C in blood donors in Kashan, 1996-2001

Background: Hepatitis B and C viruses are the most common causes of viral hepatitis, chronic hepatic disorders and cirrhosis. Since the true profile of hepatitis B and C was unknown in Kashan, the present study was performed on blood donors in Kashan during a 6-year period, 1996-2001.Materials and methods : For this descriptive study, all blood donors were included. Having their inclusion criteria fulfilled, they were asked for another 7cc venous blood before the cannula removed. HBSAg and HCVAb were determined using ELISA technique. Results : Of 43731 blood donors, 273 (0.6) were HBSAg positive. The prevalence of hepatitis B was revealed to be 0.49-0.82. Meanwhile, 477 subjects (1.1) were AntiHCV positive, thus the prevalence was 0.38-1.71. Conclusion : With respect to the prevalence of hepatitis C, this should be considered as a social health problem in Kashan. Fortunately, hepatitis B was controlled during the recent decade due to vaccination, observing health issues and improved monitoring of blood products

Cutaneous lesions of the groin area and its related factors, Razi hospital, Tehran

Background: The traditional classification of dermatologic diseases is based on etiology and clinical appearance, however, regional approach could be an appropriate alternatrive in clinical or research affairs. The present study was conducted in a dermatologic clinic in Razi hospital, Tehran to determine the frequency of cutaneous lesions of groin area and proposed the importance of a regional approach.Materials and methods : This cross sectional study was performed on 3401 patients referring consecutively. Diagnosis was made by clinical and paraclinical studies, if necessary biopsy was also taken. Meanwhile, sex, age and body mass index were all recorded. Results: Of 3401 patients, 3.9 had cutaneous lesions of groin area. Dermatophytosis, erythrasma, and seborrheic dermatitis were reported in 17.2, 14.9, and 14.9 of individuals. Lesions had shown significant differences according to the sex, and type of lesions.Conclusion : Cutaneous lesions of groin area are relatively common. Further regional approach studies are strongly recommended

An epidemiologic survey on drowning and near-drowning in children and adolescents admitted in Kashan Beheshti Hospital during 1993-2005.

Background: Submersion and subsequent drowning in children and adolescents is a preventable unintentional accident which may result in death and neurological injuries due to hypoxia and ischemia. The aim of this study was to determine the epidemiologic pattern of drowning and near-drowning among children and adolescents admitted in Kashan Beheshti Hospital during 1993-2005. Materials and Methods: In this descriptive study the medical records of all drowned and near-drowned cases admitted in Beheshti Hospital during a 12 year period were studied. All data (e.g., sex, age, nationality, season of the event, location of the drowning, any drug usage, background disease and the fate of victims) were collected and analyzed carefully. Results: Among all 47 victims, 6 (12.8) were drowned and remaining 41 (87.2) were near-drowned. Thirty-three (70.2) of the cases were male and children (aged 1-4 years) with the highest rate of submersion. Male drowned victims at all ages were more than the females. The nationality of 40 and 7 of the cases were Iranian and Afghani, respectively. The most common sites of submersion were ponds (72.5), swimming pools (8.5), streams or rivers (8.5), wells (4.2) and others (6.3). The most common seasons of drowning were spring and summer each one with a rate of 27.7. There was no history of drug consumption or background diseases in drowned or near drowned victims. Thirty-nine (83) out of the total (47) cases, completely recovery and 8 (17) were expired. While all the drowned children were expired, near-drowned, except for 2, were survived. Mortality was more common in children (aged 1-4) male Iranian victims for submersion accidents taking place in ponds. Conclusion: As children (< 5 years, esp. 1-4 year age group) are among the high risk groups for drowning, these groups should be the focus of preventive programs. In addition, as a health priority, the control and prevention of accidents in children should be considered by health professionals