Determining the frequency of Helicobacter pylori in children with chronic kidney failure and its relationship to gastrointestinal symptoms.

Key Clinical Message: As there is no significant mutual relationship between Helicobacter pylori infection and chronic kidney disease in children, its routine study is not justified and is recommended only in symptomatic cases. Abstract: Children suffering from chronic kidney disease (CKD) often complain of indigestion but, if it is accompanied by abdominal pain, it is necessary to investigate and rule out Helicobacter pylori infection to confirm functional dyspepsia. Epidemiological studies in adults have conflicting results regarding the association between Helicobacter pylori infection and CKD. In this study, we determined the prevalence of H. pylori in children with kidney failure and its relationship to their gastrointestinal symptoms. In this retrospective study, 54 children with chronic kidney failure admitted to the hemodialysis ward of the Children's Medical Center, Tehran, Iran between 2012 and 2020 were studied. The mean age of our patients was 11.89 ± 3.99 years and their sex distribution was equal. H. pylori infection was reported in only three patients with 5.6%. Based on our findings, epigastric pain in children was the most common gastrointestinal symptom (70.4%). Among all patients, three patients (5.6%) died, all of them were male (P = 0.075). The most prevalent underlying cause of kidney failure in our patients was neurogenic bladder. We did not find any significant relationship between the increased risk of chronic kidney failure and co-infection with H. pylori. Investigating the cause of epigastric pain and looking for H. pylori is very important in CKD children under hemodialysis because if they receive a transplant the possibility of gastrointestinal complications will be increased with the use of steroid and immunosuppressive drugs.

Evaluating the Clinicopathologic Parameters of Tongue Squamous Cell Carcinoma based on its Local Distribution.

Background: Oral squamous cell carcinoma (OSCC) is one of the most common oral lesions and the tongue is one of the most common areas involved. The aim of this study was to evaluate the clinicopathologic feature of tongue SCCs based on its local distribution. Materials and Methods: In this cross-sectional study, clinical data such as age, gender, location, and clinical appearance were extracted from the archives of the Oral Pathology Department, Isfahan Dental School, registered with a definitive diagnosis of tongue SCC during 2005-2019. Then, 34 specimens were selected for histopathological evaluation in a simple random way. The histopathologic slides were examined to determine the grade of tumor malignancy. The data were entered into SPSS23 software and analyzed by Chi-square, Fisher exact, One-way ANOVA, and Non-parametric tests. P value <0.05 was considered significant. Results: Of the 275 OSCCs, 68 samples were tongue SCC. The mean age of patients was 61.7 ± 15 and 61.8% were women. The most common clinical manifestations were exophytic lesions (42.6%) and the most common site was the lateral border of the tongue (36.8%). The results did not show a significant relationship between the clinicopathologic feature including mean age (p = 0.766), gender (p = 0.338), clinical presentation (p = 0.434), grade of malignancy (p = 0.763) and location. But, among the histopathological parameters, the pattern of invasion (p = 0.047) was significantly associated with the local distribution. Conclusion: Given that most OSCCs had moderate differentiation of malignancy, identification of clinical features is needed. Attention to the pattern of invasion and location on the tongue can be effective in determining the therapeutic approach.

Combination therapy with nivolumab (anti-PD-1 monoclonal antibody): A new era in tumor immunotherapy.

Immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1 or CD279) have noticeably improved the treatment landscape of advanced cancer patients. Nivolumab, the most well-known genetically engineered anti-PD-1 monoclonal antibody (mAb), promotes anti-tumor immunity and shows excellent capability for treating various cancers, particularly lung cancer, renal cancer, and melanoma. Systemic administration of nivolumab could inspire durable therapeutic responses not typically seen with traditional cytotoxic anti-cancer agents. However, nivolumab monotherapy is ineffective in 60-70 percent of patients. The mechanisms leading to both primary and acquired resistance to PD-1/PD-L1 inhibition are varied and multifactorial. Recently, the rationality of adding other conventional therapies such as chemo-radiotherapy and targeted therapies such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and VEGF/VEGFR inhibitors to nivolumab has strongly been verified. These regimens overcome cancer resistance and thus boost nivolumab efficacy in cancer patients. Herein, we discuss the current status of the combination therapy with nivolumab in cancer patients, with a particular focus on the recent clinical reports.

Evaluation of the relationship between serum carnitine levels and intradialytic complications in children with kidney failure.

BACKGROUND: Carnitine plays a crucial role in the metabolism of fatty acids as well as energy production. Previous research has suggested a significant decrease in carnitine levels in patients with kidney failure and those undergoing hemodialysis. Therefore, we designed this study to assess the prevalence and characteristics of carnitine deficiency and its association with hemodialysis complications in the pediatric population. METHODS: This research was a pilot study of 29 children undergoing hemodialysis. Before hemodialysis, a 5-mL blood sample was drawn from each patient through a peripheral vein to measure serum-free carnitine levels, complete blood count with differential, blood urea nitrogen (BUN), creatinine, and electrolytes. Each patient was observed for intradialytic complications, including muscle cramps and hypotension, during 12 sessions of hemodialysis. RESULTS: We included 26 participants with a mean age of 14.23 years undergoing hemodialysis. Carnitine deficiency was revealed in 54.8% of our participants. Also, there was no significant correlation between carnitine deficiency and age, gender, and BUN levels (P = 0.698, P = 0.43, and P > 0.05, respectively). Intradialytic complications, including episodes of hypotension and muscle cramps, were more frequent in patients with carnitine deficiency (P = 0.02, P = 0.01, respectively). Other reasons for muscle cramps, such as fluid overload, nutritional status, dialysis regimen, and other important lab results (phosphorus, magnesium, etc.), were ruled out. CONCLUSION: In conclusion, we found a higher prevalence of carnitine deficiency in pediatric hemodialysis patients. Carnitine deficiency was significantly associated with increased intradialytic symptoms, including muscle spasms and hypotension. Our results could support a potential role of carnitine supplementation in pediatric patients with kidney failure for controlling intradialytic complications, but this requires further investigation. A higher resolution version of the Graphical abstract is available as Supplementary information.

Efficacy of rituximab therapy in children with nephrotic syndrome: a 10-year experience from an Iranian pediatric hospital.

BACKGROUND: There are controversy results in the optimal management of children with steroid-dependent and steroid-resistant nephrotic syndrome (SDNS, SRNS). This study aimed to determine the efficacy and safety of rituximab (RTX) in these pediatric patients. METHODS: Medical records of 1-18-year-old Iranian children with SDNS (n = 26) and SRNS (n = 22) with a follow-up for at least 24 months were included from 2009 to 2019. The short- and long-term responses to RTX were respectively evaluated to determine the random protein-to-creatinine ratio after 6 and 24 months and classified as complete (CR) and partial (PR) remission or no response. RESULTS: Male patients (n = 26) were slightly predominate. The median age of patients at the time of RTX therapy was 8.6 ± 4.01 years. At the end of the 6-month follow-up, CR and PR occurred in 23 (47.9%) and 12 (25%) patients, respectively. Of 23 patients with CR, 18 (69.2%) and 5(22.7%) had SDNS and SRNS, respectively (p < 0.005). However, only 18 (37.5%) of patients after 24 months had been in CR. No significant difference in the CR rate was found between the two groups. RTX was more effective when administered during the proteinuria-free period (p = 0.001). CONCLUSION: In the short term, RTX significantly was efficient in inducing complete or PR in SDNS and SRNS patients. However, the favorable response rate in a long-term follow-up was insignificantly lower between the two groups.

Contrast-enhanced voiding urosonography, a possible candidate for the diagnosis of vesicoureteral reflux in children and adolescents; a systematic review and meta-analysis.

INTRODUCTION: The diagnostic value of contrast-enhanced voiding urosonography (ceVUS) in the diagnosis of vesicoureteral reflux (VUR) is still a subject of dispute. OBJECTIVE: Assessing the diagnostic value of ceVUS in VUR, performing a systematic review and meta-analysis. METHODS: An extensive search on Medline, Embase, Scopus and Web of Science databases was conducted by the end of 2020. The inclusion criteria were studies on the diagnostic value of ceVUS for VUR. Two independent researchers summarized the included articles and the findings were reported as area under the curve (AUC), sensitivity and specificity with a 95% confidence interval (95% CI). RESULTS: Finally, the data of 36 articles were included in the present meta-analysis (2768 children). The VUS assessment showed that 1297 of the cases were true positives, 3661 were true negatives, 398 were false positives and 169 were false negatives. The AUC, sensitivity and specificity of ceVUS with the first-generation contrast agent in the diagnosis of VUR in children and adolescents were obtained as 0.97 (95% CI: 0.95, 0.98), 0.92 (95% CI: 0.86, 0.96) and 0.94 (95% CI: 0.95, 0.98), respectively. Moreover, AUC, sensitivity and specificity of ceVUS with the second-generation contrast agent were 0.97 (95% CI: 0.95, 0.98), 0.93 (95% CI: 0.86, 0.97) and 0.91 (95% CI: 0.86, 0.95). CONCLUSION: The findings of the present study showed that diagnostic value of ceVUS with both first-generation and second-generation contrast agents for VUR, is in an excellent range. Although it seems that ceVUS may be applied as a radiation-free alternative to imaging techniques such as VCUG, the presence of 3% of false negatives in this test is a limitation. Since the lack of punctual management of VUR is associated with serious renal complications in children, future studies are recommended to be focused on the evaluation of the Benefit-risk evaluation of ceVUS.

The Effect of Oral Cyclophosphamide in the Treatment of Children with Refractory Idiopathic Nephrotic Syndrome.

INTRODUCTION: Nephrotic syndrome (NS) is the most common chronic kidney disease in children. Patients who do not respond to steroids are steroid resistance nephrotic syndrome (SRNS). Cyclophosphamide (CP) has been used in the treatment of SRNS, but its effectiveness has been questioned. The aim of this study was to evaluate the drug response and side effects of CP in the treatment of SRNS. METHODS: This study performed as a historical cohort (1997 to 2017) in idiopathic SRNS patients over one year of age who did not enter remission and used oral. All patients were followed up with CBC and regular visits to control drug side effects. RESULTS: In this study, 52 SRNS patients with a mean age of 5.3 ± 5.3 years were studied, of whom 24 (46%) were male and 22 (54%) were female. The follow-up period of patients was 1 to 264 months. In this study, 38.5% of patients were sensitive to CP and 61.5% of patients were resistant to CP. The response to CP was not significantly different between the ages of higher 6 years and under (P > .05). There was no significant relationship between remission rate and type of pathology and CP addition to treatment. But there was a significant difference between ESRD and CP resistance. CONCLUSION: It can be concluded that CP has no significant effect on the remission of SRNS patients, but has made a significant difference in the development of ESRD in patients.

Chronic Kidney Disease in Iran: First Report of the National Registry in Children and Adolescences.

PURPOSE: Knowing the epidemiological aspects of chronic kidney disease (CKD) in children is crucial for early recognition, identification of reversible causes, and prognosis. Here, we report the epidemiological characteristics of childhood CKD in Iran. MATERIALS AND METHODS: This cross-sectional study was conducted during 1991 - 2009. The data were collected using the information in the Iranian Pediatric Registry of Chronic Kidney Disease (IPRCKD) core dataset. RESULTS: A total of 1247 children were registered. The mean age of the children at registration was 0.69 ± 4.72 years (range, 0.25 -18 years), 7.79 ± 3.18 years for hemodialysis (HD), 4.24 ± 1.86 years for continuous ambulatory peritoneal dialysis (CAPD), and 3.4±1.95 years for the children who underwent the renal transplantation (RT) (P < .001). The mean year of follow-up was 7.19 ± 4.65 years. The mean annual incidence of CKD 2-5 stages was 3.34 per million age-related population (pmarp). The mean prevalence of CKD 2-5 stages was 21.95 (pmarp). The cumulative 1-, 5-, and 10-year patients' survival rates were 98.3%, 90.7%, and 84.8%, respectively. The etiology of the CKD included the congenital anomalies of the kidney and urinary tract (CAKUT) (40.01%), glomerulopathy (19.00%), unknown cause (18.28%), and cystic/hereditary/congenital disease (11.14%). CONCLUSION: The incidence and prevalence rate of pediatric CKD in Iran is relatively lower than those reported in Europe and other similar studies. CAKUT was the main cause of the CKD. Appropriate management of CAKUT including early urological intervention is required to preserve the renal function. Herein, the long-term survival rate was higher among the children with CKD than the literature.

Discriminatory Precision of Neutrophil Gelatinase-Associated Lipocalin in Detection of Urinary Tract Infection in Children: a Systematic Review and Meta-Analysis.

INTRODUCTION: There is a significant discrepancy between studies on diagnostic precision of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis of urinary tract infection (UTI). Therefore, the present systematic review and meta-analysis was designed to assess the diagnostic value of NGAL in diagnosis of UTI in children and adolescents. METHODS: An extensive search was performed on Medline, Embase, Scopus and Web of Science databases by the end of 2019. Two independent researchers screened and summarized the data. Discriminatory precision of urinary and serum NGAL was assessed by reporting area under the curve, sensitivity, specificity and diagnostic odds ratio with 95% confidence interval (95% CI). RESULTS: Data from 12 studies were included. The area under the curve of urinary and serum NGAL for diagnosis of UTI in children and adolescents at the best cut-off point (between 30-39.9 ng/ml) was 0.95 (95% CI: 0.93 to 0.97) and 0.83 (95% CI: 0.80 to 0.86), respectively. Sensitivity, specificity and diagnostic odds ratio on urinary NGAL at these cut-off points were 0.89 (95% CI: 0.64 to 0.97), 0.89 (95% CI: 0.71 to 0.97) and 67 (95% CI: 5 to 891), respectively. Sensitivity, specificity and diagnostic odds ratio of serum NGAL in UTI detection were 0.85 (95% CI: 0.70 to 0.90), 0.81 (95% CI: 0.69 to 0.88) and 9.53 (95% CI: 1.52 to 59.65), respectively. CONCLUSION: The present meta-analysis showed that urinary NGAL had a high diagnostic value in detection of UTI in children and adolescents with an optimum cut-off point in the range of 30-39.9 ng/ml.

Discriminatory Precision of Renal Angina Index in Predicting Acute Kidney Injury in Children; a Systematic Review and Meta-Analysis.

INTRODUCTION: There is still controversy over the value of renal angina index (RAI) in predicting acute renal failure (AKI) in children. Therefore, the present study aims to provide evidence by conducting a systematic review and meta-analysis on the value of RAI in this regard. METHODS: An extensive search of Medline, Embase, Scopus and Web of Science databases was conducted by the end of January 2020 using words related to RAI and AKI. Two independent reviewers screened and summarized the related studies. Data were analysed using STATA 14.0 statistical program and discriminatory precision of RAI was assessed. RESULTS: Data from 11 studies were included. These studies included data from 3701 children (60.41% boys). There were 752 children with AKI and 2949 non-AKI children. Pooled analysis showed that the area under the ROC curve of RAI in prediction of AKI was 0.88 [95% confidence interval (CI): 0.85 to 0.91]. Sensitivity and specificity of this tool in predicting AKI were 0.85% (95% CI: 0.74% to 0.92%) and 0.79% (95% CI: 0.69% to 0.89%), respectively. The diagnostic odds ratio of RAI was 20.40 (95% CI: 9.62 to 43.25). CONCLUSION: The findings of the present meta-analysis showed that RAI is a reliable tool in predicting AKI in children.

Age-Period-Cohort Analysis of Abdominal Obesity in Iranian Children and Adolescents: The CASPIAN Study.

BACKGROUND: The assessment of the trend of changes in the prevalence of abdominal obesity can provide useful health information. OBJECTIVES: This study aimed to conduct an age-period-cohort (APC) analysis to provide the trend of the prevalence of abdominal obesity in the Iranian pediatric population through the three temporal dimensions of age, period, and cohort. METHODS: Data were gathered from a total number of 53,962 Iranian children and adolescents aged 5 to 19 years through four surveys of a national surveillance program (the CASPIAN study) conducted in 2003, 2007, 2011, and 2015. Abdominal obesity was defined as a waist-to-height ratio of ≥ 0.5. The APC analysis was performed using the "apc_ie"command in STATA software. RESULTS: A significant correlation existed between age, period, and cohort effects and the prevalence of abdominal obesity in children and adolescents. With increasing age, regardless of considerable fluctuations, the prevalence of abdominal obesity followed an overall increasing trend in both genders. The age effect coefficient increased from -2.1 in the age group of 5 - 9 years to 1.1 in the age group of 10 - 14 years and then decreased to 1.0 in the age group of 15 - 19 years among boys; figures followed an increasing trend in girls from -2.2 to 0.8 and 1.5, respectively. As for the period effect, in both boys and girls, the prevalence of abdominal obesity followed an increasing trend when coming from the earlier periods to the recent ones (from -4.6 to 4.0 in boys and from -4.1 to 2.4 in girls). Likewise, this prevalence increased from earlier birth cohorts to the recent ones in both genders. CONCLUSIONS: The prevalence of abdominal obesity is increasing among Iranian children and adolescents and this rising trend is affected by age, period, and birth cohort effects. The findings of this study emphasize the necessity of implementing comprehensive interventions for tackling the epidemic of childhood obesity.

Bacillus Calmette-Guérin (BCG)-associated hemophagocytic lymphohistiocytosis in the setting of IFN-γR1 deficiency: A diagnostic dilemma.

Hemophagocytic lymphohistiocytosis (HLH) disease is a severe immune dysregulation caused by mutations in genes required for lymphocyte cytotoxicity function. However, HLH-like syndrome may develop secondary to infections, malignancy, and autoimmunity. Primary immunodeficiencies (PIDs) could predispose to HLH syndrome after uncontrolled infections. Mendelian susceptibility to mycobacterial disease (MSMD) is a PID characterized by a predisposition to clinical disease caused by weakly virulent mycobacteria, such as bacillus Calmette-Guérin (BCG). Inborn errors of interferon-γ immunity caused by mutations in 16 genes, underly MSMD development. Here, we report a case of fatal interferon-γ receptor 1 deficiency with disseminated BCG infection, which was initially diagnosed with HLH disease. We also include a review of cases reported in the literature.

Metabolic Disorders in Iranian Children with Urolithiasis.

Background:Children with urolithiasis have a wide range of metabolic disorders which should be carefully considered. The response to medical treatment could predict recurrence and need for surgical interventions. Objectives:The goal of this retrospective study is to determine the prevalence of metabolic disorders in Iranian children and assess patients' response to treatment based on the etiology of their urolithiasis. Materials and methods:Medical record of 100 children with urolithiasis who were referred to Bahrami hospital (affiliated hospital of Tehran University of Medical Sciences) between 2007 and 2017. Data regarding age, sex, family history, symptoms, size of the stones, type of treatments, response to treatment, and recurrence were recorded for all cases Results:Subjects had a mean age of 36 ±36 months and 62 (62%) of them were females. Twenty-two percent had a family history of urolithiasis. The mean age was 37.2±35 months in the complete response group, 38±44.4 months in the partial group, and 30±33.1 months in the no response group (p=0.7). There was no significant difference regarding sex and age with treatment response (p=0.8). In the complete response group, nearly 72% of cases had stones with sizes less than 3 mm. Three cases had surgical interventions and 18 had recurrence. Conclusions:Hypercalciuria followed by hyperoxaluria were the most common metabolic disorders in Iranian children with urolithiasis. Stone size plays an important role in the response to treatment.

Antiviral ARGONAUTEs Against Turnip Crinkle Virus Revealed by Image-Based Trait Analysis.

RNA-based silencing functions as an important antiviral immunity mechanism in plants. Plant viruses evolved to encode viral suppressors of RNA silencing (VSRs) that interfere with the function of key components in the silencing pathway. As effectors in the RNA silencing pathway, ARGONAUTE (AGO) proteins are targeted by some VSRs, such as that encoded by Turnip crinkle virus (TCV). A VSR-deficient TCV mutant was used to identify AGO proteins with antiviral activities during infection. A quantitative phenotyping protocol using an image-based color trait analysis pipeline on the PlantCV platform, with temporal red, green, and blue imaging and a computational segmentation algorithm, was used to measure plant disease after TCV inoculation. This process captured and analyzed growth and leaf color of Arabidopsis (Arabidopsis thaliana) plants in response to virus infection over time. By combining this quantitative phenotypic data with molecular assays to detect local and systemic virus accumulation, AGO2, AGO3, and AGO7 were shown to play antiviral roles during TCV infection. In leaves, AGO2 and AGO7 functioned as prominent nonadditive, anti-TCV effectors, whereas AGO3 played a minor role. Other AGOs were required to protect inflorescence tissues against TCV. Overall, these results indicate that distinct AGO proteins have specialized, modular roles in antiviral defense across different tissues, and demonstrate the effectiveness of image-based phenotyping to quantify disease progression.

Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C in Early Detection of Pediatric Acute Kidney Injury; a Diagnostic Accuracy Study.

INTRODUCTION: There is a controversy regarding accuracy of neutrophil gelatinase-associated lipocalin (NGAL) and Cystatin C in early detection of acute kidney injury (AKI). The present study aimed to compare the diagnostic value of two biomarkers in this regard. METHOD: In the present diagnostic accuracy study, all children between the ages of 1 month to 14 years were entered. Pediatric Risk, Injury Failure, Loss, End-stage renal disease (pRIFLE) criteria was used for identification of children with AKI as the reference test. Blood samples were taken from all patients at baseline and 48 hours after admission to assess serum creatinine and Cystatin C level. In addition, a urine sample was obtained within 6 hours of admission in order to measure NGAL level. In the end, area under the receiving operating characteristics (ROC) curve, sensitivity, and specificity of urine NGAL (uNGAL) and Cystatin C in early detection of AKI were compared. RESULTS: Data from 96 children with the mean age of 27.31±36.24 months were entered (56.25% girls). Area under the ROC curve of uNGAL level in diagnosis of AKI in children was 0.91 (95% CI: 0.80 to 1.00) and area under the ROC of Cystatin C was 0.90 (95% CI: 0.77 to 1.00). Both tests had the same value in diagnosis of AKI (p=0.89). The best cut-off point of uNGAL for diagnosing AKI was 125 mg/L. uNGAL had a sensitivity and specificity of 0.92 (0.62 to 0.99) and 0.69 (0.57 to 0.78), respectively. The best cut-off point of serum Cystatin C level was 0.4 mg/L. Cystatin C had a sensitivity and specificity of 0.92 (0.62 to 0.99) and 0.64 (0.52 to 0.74), respectively. CONCLUSION: The present study showed that uNGAL level has the same value as serum Cystatin C level in early diagnosis of AKI.

PlantCV v2: Image analysis software for high-throughput plant phenotyping.

Systems for collecting image data in conjunction with computer vision techniques are a powerful tool for increasing the temporal resolution at which plant phenotypes can be measured non-destructively. Computational tools that are flexible and extendable are needed to address the diversity of plant phenotyping problems. We previously described the Plant Computer Vision (PlantCV) software package, which is an image processing toolkit for plant phenotyping analysis. The goal of the PlantCV project is to develop a set of modular, reusable, and repurposable tools for plant image analysis that are open-source and community-developed. Here we present the details and rationale for major developments in the second major release of PlantCV. In addition to overall improvements in the organization of the PlantCV project, new functionality includes a set of new image processing and normalization tools, support for analyzing images that include multiple plants, leaf segmentation, landmark identification tools for morphometrics, and modules for machine learning.

Blood Pressure Nomograms for Children and Adolescents by Age and Body Mass Index in Tehran, Iran.

BACKGROUND: Normal standard references of blood pressure (BP) for children and adolescents should be constructed according to anthropometric indices. Therefore, we aimed to produce BP reference percentiles by body mass index (BMI). METHODS: Data on demographic characteristics, anthropometric indices and BP values of 16246 3-18-year-old children and adolescents from 3 cross-sectional studies conducted in Tehran were included. To justify the need for BMI adjustment, quantile regression model was applied for different percentiles of systolic and diastolic BPs with age, sex, and the corresponding BMI percentiles. Then, Age- and sex-specific BP nomograms were constructed according to BMI. RESULTS: All regression coefficients for BMI percentiles were significant in quantile regression of BPs, confirming the necessity for BMI-adjusted nomograms of BP. The BP percentiles for each gender by age and BMI are presented. All the BP percentiles rose steadily in all BMI percentiles with minor discrepancies between the two genders. As observed, the prevalence of hypertension is estimated to be lower among the lean subjects and higher among overweighs when the BMI-adjusted BP curves are considered. CONCLUSION: The reference database constructed in this survey is the first Iranian BP reference by age and BMI in children and adolescents, from it concluded that BMI-adjusted BP curves depict a more precise picture of the hypertension prevalence and present a more reliable classification standard for hypertension.

Accuracy of cystatin C in prediction of acute kidney injury in children; serum or urine levels: which one works better? A systematic review and meta-analysis.

BACKGROUND: There is still an ongoing discussion on the prognostic value of cystatin C in assessment of kidney function. Accordingly, the present study aimed to conduct a meta-analysis to provide evidence for the prognostic value of this biomarker for acute kidney injury (AKI) in children. METHODS: An extensive search was performed in electronic databases of Medline, Embase, ISI Web of Science, Cochrane library and Scopus until the end of 2015. Standardized mean difference (SMD) with a 95% of confidence interval (95% CI) and the prognostic performance characteristics of cystatin C in prediction of AKI were assessed. Analyses were stratified based on the sample in which the level of cystatin C was measured (serum vs. urine). RESULTS: A total of 24 articles were included in the meta-analysis [1948 children (1302 non-AKI children and 645 AKI cases)]. Serum (SMD = 0.96; 95% CI: 0.68-1.24; p < 0.0001) and urine (SMD = 0.54; 95% CI:0.34-0.75; p < 0.0001) levels of cystatin C were significantly higher in children with AKI. Overall area under the curve of serum cystatin C and urine cystatin C in prediction of AKI were 0.83 (95% CI: 0.80-0.86) and 0.85 (95% CI: 0.81-0.88), respectively. The best sensitivity (value = 0.85; 95% CI: 0.78-0.90) and specificity (value = 0.61; 95% CI: 0.48-0.73), were observed for the serum concentration of this protein and in the cut-off points between 0.4-1.0 mg/L. CONCLUSION: The findings of the present study showed that cystatin C has an acceptable prognostic value for prediction of AKI in children. Since the serum level of cystatin C rises within the first 24 h of admission in patients with AKI, this biomarker can be a suitable alternative for traditional diagnostic measures.

Age-Period-Cohort Analysis of Obesity and Overweight in Iranian Children and Adolescents.

BACKGROUND: To date, few studies looked upon obesity and overweight in children and adolescents through the 3 different temporal dimensions of age, period, and cohort. The current study aimed at evaluating the trends of these health issues among children under 19 years old using the age-period-cohort (APC) analysis. METHODS: Data gathered through 5 cross sectional studies including 2 national health surveillance (1990 - 91 and 1999), and 3 CASPIAN surveys (2003, 2009, and 2011). Subjects were classified by their body mass index (BMI) into 3 groups of normal (BMI < 85th percentile), overweight-obese (85th percentile < BMI < 95th percentile), and obese (95th percentile < BMI). Intrinsic estimator method was used to analyze the effects of age, period, and birth cohort on obesity and overweight among the subjects. RESULTS: A total of 80,698 children and adolescents under 19 years old, including 40,419 (50.09%) males and 40,279 (49.91%) females, were evaluated. The prevalence of obesity decreased progressively by age in males and females with minor discrepancies. It increased from 1990 to 2009 in both genders, but from that point on remained quite constant in males and dropped significantly in females. The prevalence of obesity was steady in earlier birth cohorts, but increased significantly after the birth cohorts from 1986 to 1990. CONCLUSIONS: Environmental factors and social stresses during neonatal and infantile periods (birth cohort effect) along with other variables influencing the children later in their lives (period effect) affect the prevalence of overweight and obesity substantially. Moreover, a decrease in the prevalence of obesity and overweight was observed by age increase (age effect).

Neck Circumference Percentiles of Iranian Children and Adolescents: The Weight Disorders Survey of CASPIAN IV Study.

BACKGROUND: Neck circumference (NC), emerging as a key morphological index for pediatric obesity, is associated with obesity- and overweight-related detrimental conditions in children. In this study, we aimed to provide the age- and sex-specific percentile reference values for neck circumference of the Iranian children and adolescents. METHODS: We used the data gathered through the weight disorders survey of CASPIAN IV study conducted in 2011 - 2012 in Iran, including a total of 21954 Iranian children and adolescents, composed of 10750 girls and 11204 boys, aged 7 - 18 years old. We presented the interval of NC percentile in three age groups of 7 - 10 years, 11 - 14 years, and 15 - 18 years. Finally, age-specific nomograms of NC for both genders in the Iranian and Canadian populations were compared. RESULTS: The intervals of 90th percentile of NC for boys in the three periods of school age (7 - 10 years), pre-adolescence (11 - 14 years), and adolescence (15 - 18 years) were 24.2 - 30.0 cm, 26.6 - 33.2 cm, and 30.1 - 38.5 cm, respectively. These intervals for girls were 23.7 - 30.1 cm, 26.5 - 33.7 cm, and 28.5 - 36.0 cm, respectively. NC increased with age in both boys and girls and its variability showed an increasing trend with age. CONCLUSIONS: We demonstrated for the first time the NC reference values for the Iranian children and adolescents aged 7 - 18 years old. Considering the significant differences between our national NC references and the values reported from the Canadian population, it seems logical to use these national percentiles not only for epidemiologic studies but also for routine clinical examinations.