rhGH Therapy in Chronic Kidney Diseases

In children with chronic kidney disease (CKD), growth retardation is not a rare problem. Factors such as malnutrition, anemia, metabolic acidosis, inadequate dialysis and growth hormone resistance may cause growth failure in these children. Growth stimulation in these children can be done by supraphysiologic doses of recombinant human GH (rhGH). It stimulates growth in prepubertal CKD children, in end-stage renal disease, and after kidney transplantation. Its underlying mechanism may be the reversal of hypercatabolic state of uremia or increases in the circulating level of insulin-like growth factor (IGF). We recommend starting the treatment when the patient height falls below the third percentile and spontaneous catch-up growth does not happen despite stabilization of other contributing factors. It is better to start rhGH therapy at a young age because there is a better response in preterminal CKD than those on dialysis. We use rhGH in CKD children at a dose of 0.045 to 0.05 mg/kg/day subcutaneously every evening and a height taller than the third percentile of the general population is our minimal goal.  Keywords: Chronic Kidney Diseases; PEG-rhGH; Growth Disorders;Body Height

The association between failure to thrive or anemia and febrile seizures in children between 6 months to 6 years old age

Objectives: Febrile seizure is the most common seizure disorder in childhood. Anemia or failure to thrive can predispose children to Febrile seizure by affecting the nervous system function. The current study investigates the association between febrile seizures and Anemia or failure to thrive.Materials and Methods: This case-control study was performed on 307children 6 months to 6 years old age hospitalized at the Ali Asghar children`s Hospital from 2011 to 2014 divided into two groups: a case group including 158 children with febrile seizures and a control group including 149 febrile children without seizure. The amount of Hgb, Hct, RBC count, MCV, MCH, and MCHC was recorded and weight-for-age and weight-for-height was calculated based on the WHO Z-Score charts.The date were compared between two groups.Results: There were no differences regarding  age and sex between the groups. Statistically significant differences were found regarding the mean RBC count between the case group (4.38×106 ± 0.72×106) and the control group (4.24×106 ± 0.84×106) (p=0.013), as well as about the mean MCV that was 78.73 ± 0.97 and 76.78 ± 1.00 in the case and control groups respectively(p=0.005). Anemia was seen in 28.5% of the case and 42.3% of control group which was statistically significant (p=0.012). There was not statistically significant difference regarding  failure to thrive between two groups.Conclusion: in children with febrile seizures anemia was lower comparing with febrile children without seizure. Moreover, there was not any association between failure to thrive and febrile seizures.

Prevalence of Failure to Thrive in Iranian Children with Chronic Kidney Disease

Introduction: Malnutrition and inflammation are considered risk factors of morbidity, hospitalization, and mortality in chronic kidney disease (CKD) children. The aim of this study was to determine the prevalence and severity of failure to thrive (FTT) in children with moderate to severe CKD.Materials and Methods: This cross-sectional study was conducted in 84 children with CKD (30 female, 54 males) aged 2-16 years old from June 2014 to June 2015.The inclusion criteria were eGFR less than 90 ml/min/1.73m2, being healthy in the month before the visit, and lack other chronic diseases except CKD. Anthropometric data including the body mass index, height, weight, and mid upper arm circumference were collected. Protein wasting energy was scored and the severity of failure to thrive was estimated using Gomez and Jelliffe classifications. P-values less than 0.05 were considered significantResults: Glomerulopathy and hereditary tubulopathy were the main causes of underlying disease. About 79% of CKD children had FTT and the rate increased with a decline in the renal function (p-value< 0.05). Using modified PWE, 65.5% were identified to score ≥2, which was more frequent in eGFR less than 30 (P>0.05). A quarter of the patients with FTT were classified as no PWE and vice versa.Conclusion: The majority of the children with moderate to severe chronic kidney disease had failure to thrive and protein wasting energy. There was no correlation between inflammatory markers and the severity of CKD or the presence of failure to thrive.Keywords: Failure to Thrive; Renal Insufficiency; Chronic; Child

Association between Serum Ferritin and Goitre in Iranian School Children

Despite long-standing supplementation of iodine in Iran, the prevalence of goitre among general people remains high in some regions. The study investigated the role of iron status in the aetiology of goitre in school children in Isfahan, Iran. Two thousand three hundred and thirty-one school children were selected by multi-stage random sampling. Thyroid size was estimated by inspection and palpation. Urinary iodine concentration (UIC) and serum ferritin (SF) were measured. Overall, 32.9% of the children had goitre. The median UIC was 195.5 μg/L. The mean±SD of SF in the goitrous and non-goitrous children was 47.65±42.51 and 44.55±37.07 μg/L respectively (p=0.52). The prevalence of iron deficiency in goitrous and non-goitrous children was 9.6% and 3.1% respectively (p=0.007). Goitre is still prevalent in school children of Isfahan. However, their median UIC was well in the accepted range. Iron deficiency is associated with goitre in a small group of goitrous children. The role of goitrogens should also be investigated in this region

Sonographic and functional characteristics of thyroid nodules in a population of adult people in Isfahan

Wstęp: Celem badania była ocena cech sonograficznych zmian ogniskowych tarczycy u mieszkańców Isfahanu, obszaru w cenralnym Iranie, który wcześniej charakteryzował się niedoborem jodu. Materiał i metody: W przekrojowym badaniu przeprowadzonym w 2006 roku wybrano próbę liczącą 2523 dorosłych osób (wiek > 20 lat) metodą wielostopniowego losowania grupowego. Spośród tej grupy, 263 ochotników poddano badaniom sonograficznym. Badanie tarczycy przeprowadzili doświadczeni specjaliści w zakresie ultrasonografii. Ponadto oznaczono stężenia T3, T4, T3RU, TSH, TPO Ab i Tg Ab w surowicy oraz wydalanie jodu z moczem. Wyniki: Kobiety stanowiły 46% grupy poddanej badaniom sonograficznym (n = 263). Średnia wieku wynosiła 35,5 lat (zakres 20-64 lat). Mediana stężenia jodu w moczu wynosiła 19.4 μg/dl. Obecność zmian ogniskowych tarczycy wykazano w badaniu sonograficznym u 22,4% osób z badanej grupy; u 30% kobiet i 16,3% mężczyzn (OR = 2,2; p = 0,01). Częstość występowania zmian ogniskowych tarczycy zwiększała się z wiekiem (p = 0,006). Zmiany ogniskowe tarczycy występowały częściej u osób z niedoczynnością tarczycy niż w grupie z eutyreozą (35,1% v. 20,5%, OR = 2,1; p = 0,04). Nie stwierdzono korelacji między stężeniem jodu w moczu ani stężeniem autoprzeciwciał a występowaniem zmian ogniskowych tarczycy w badaniu sonograficznym. Wnioski: Częstość występowania zmian ogniskowych tarczycy oceniana na podstawie wyników badania sonograficznego jest nadal duża w badanej populacji, mimo prawidłowego stężenia jodu w moczu. (Endokrynol Pol 2010; 61 (2): 188-191)Introduction: The aim of this study was to investigate the current status of sonographic characteristics of thyroid nodules in Isfahan, a previously iodine deficient area in central Iran. Material and methods: In a cross-sectional study conducted in 2006, 2523 adult people (age > 20 years) were selected by a multistage clustering sampling method. Of these people, 263 volunteered persons were underwent sonographic evaluation. Thyroid examination was done by two expert sonographers. Serum T3, T3, T3RU, TSH, TPO Ab and Tg Ab, and urinary iodine were measured. Results: Forty-six per cent of the 263 people were women. Their mean age was 35.5 years with a range of 20-64 years. Median urinary iodine was 19.4 μg/dL. The prevalence of thyroid nodules on sonography was 22.4% in the whole group; 30% in women and 16.3% in men (OR = 2.2, P = 0.01). The prevalence of thyroid nodules increased with age (P = 0.006). The prevalence of thyroid nodules was higher in hypothyroid people than in euthyroid people (35.1% v. 20.5%, OR = 2.1, P = 0.04). Neither urinary iodine nor autoantibody concentrations correlated with the prevalence of thyroid nodules in sonography. Conclusions: The prevalence of thyroid nodule by sonography is still high despite relatively normal urinary iodine in this population. (Pol J Endocrinol 2010; 61 (2): 188-191

Pamidronate therapy for hypercalcemia and congenital mesoblastic nephroma: a case report

Hypercalcemia can causes life threatening complications. We report an infant with severe hypercalcemia due to congenital mesoblastic nephroma. Hypercalcemia was corrected before nephrectomy by pamidronate. According to our knowledge this is a rare case with severe neoplasm induced hypercalcemia among neonates who treated by bisphosphonates. The aim of this report is to define new approach to neoplasm induced neonatal hypercalcemia

Association between Serum Ferritin and Goitre in Iranian School Children

Despite long-standing supplementation of iodine in Iran, the prevalence of goitre among general people remains high in some regions. The study investigated the role of iron status in the aetiology of goitre in school children in Isfahan, Iran. Two thousand three hundred and thirty-one school children were selected by multi-stage random sampling. Thyroid size was estimated by inspection and palpation. Urinary iodine concentration (UIC) and serum ferritin (SF) were measured. Overall, 32.9% of the children had goitre. The median UIC was 195.5 \u3bcg/L. The mean\ub1SD of SF in the goitrous and non-goitrous children was 47.65\ub142.51 and 44.55\ub137.07 \u3bcg/L respectively (p=0.52). The prevalence of iron deficiency in goitrous and non-goitrous children was 9.6% and 3.1% respectively (p=0.007). Goitre is still prevalent in school children of Isfahan. However, their median UIC was well in the accepted range. Iron deficiency is associated with goitre in a small group of goitrous children. The role of goitrogens should also be investigated in this region

Thyroid Peroxidase Gene Mutation in Patients with Congenital Hypothyroidism in Isfahan, Iran

Background. Thyroid peroxidase gene (TPO) mutations are one of the most common causes of thyroid dyshormonogenesis in patients with congenital hypothyroidism (CH). In this study, the prevalence of TPO gene mutations in patients with thyroid dyshormonogenesis in Isfahan was investigated. Methods. In this cross-sectional study, genomic DNA of 41 patients with permanent CH due to thyroid dyshormonogenesis was extracted using the salting out method. The 17 exonic regions of the TPO gene were amplified. SSCP technique was performed for scanning of the exonic regions of the TPO gene, except exon 8. DNA sequencing was performed for those with different migration patterns in SSCP by chain termination method. Exon 8 was sequenced directly in all patients. In 4 patients, all fragments were also sequenced. Results. One missense mutation c.2669G>A (NM_000547.5) at exon 15 (14th coding exon) in one patient in homozygous form and seven different single nucleotide polymorphisms (SNPs) in exons 1, 7, 8, 11, and 15 of TPO gene. Conclusion. The TPO gene mutations among CH patients with dyshormonogenesis in Isfahan were less frequent in comparison with other similar studies. It may be due to the presence of other unknown gene mutations which could not be detected by SSCP and sequencing methods

Prevalence of Obesity and Overweight in Preschool Children in Northwest of Tehran, Iran

Background: Nowadays childhood overweight and obesity are considered as a global epidemic, the prevalence of childhood obesity is increasing in the Iran. Aim and Objectives: For prevention and control the disease, knowledge of population statistics of obesity and overweight is essential, so this study aimed to determine the prevalence obesity and overweight and related factor in preschool children in northwest of Tehran in 2015. Material and Methods: This crosssectional study was performed on 17484 preschool children aged 5-7 in northwest of Tehran (Regions 2, 5 and 6 of Tehran Municipality), capital of Iran. Data collection was performed by 11 general practitioner and 24 trained experts that measuring height by Nonelastic tape measure with an accuracy of 1 cm, and weight by Analog scales SECA brand with accuracy 100 g between May until the end of October 2014, and WHO Child Growth Standards is used to classify overweight and obesity. Data analysis is done by using SPSS.11.5 software and chi-square test. Results: The prevalence of overweight and obesity in children was respectively 20 and 6.8, prevalence of obesity and overweight was different based on sex (p=0.001), so the prevalence of obesity in girls was higher than boys and the prevalence of overweight in boys was higher than girls. Also prevalence of obesity children in 7 year age was higher compared children 5, 6 years old. Conclusion: Our findings showed a relatively high prevalence of overweight and obesity in preschool children, therefore, the plan for the control and prevention of the problem must be a high priority for health policy maker, also further epidemiological studies into the etiology and trend are essential

The relationship between body mass index (BMI) and quality of life in Iranian primary school students in Tehran, Iran

Background: This study aimed to investigate the relationship between Body Mass Index (BMI) and quality of life in primary school students in Tehran. Method: In this cross-sectional study 829 primary school children and their parents participated. Healthrelated quality of life (HROOL) was evaluated with the Persian version of Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire. According to objective measures of height and weight, children BMI computed, and adapted for age and gender. For data analysis we used Pearson correlation test, Independentsample t-test and ANOVA using SPSS version 18. Results: Mean of children self-reported HRQOL total score was 82.05 ± 12.04 and mean of parent proxyreported HRQOL total score was 81.66 ± 12.81. Based on HRQOL subscale scores, social functioning was the highest subscale score of HRQOL (84.67 ± 15.07) and the emotional subscale score was the lowest (77.79 ± 17.26). Lower HRQOL scores were significantly correlated with Higher BMI and normal weight children had significantly higher HRQOL total score than obese children (P < 0.05). The difference between normal weight and overweight children in HRQOL total scores were not significant. Same results were obtained from parent proxy-reports and a good harmony between children self-report and parent proxy-report of HRQOL was perceived. Conclusion: This study showed that HRQOL of obese children were at the lower level in comparison to normal weight and overweight children. At further interventional studies these outcomes can be very important for improving quality of life in obese children