Exposure to Ascaris lumbricoides infection and risk of childhood asthma in north of Iran.

BACKGROUND: Asthma and Ascaris lumbricoides infection are common health issues affecting 250 and 700 million people worldwide, respectively. The relationship between ascariasis and asthma is a matter of substantial interest and research. METHODS: We performed a case-control study to evaluate whether the exposure to Ascaris infection is associated with asthma in children. We also assessed potential risk factors for Ascaris infection and asthma in study area. We enrolled 145 asthmatic children and 115 healthy controls. The Global Initiative for Asthma guideline was used to evaluate asthma symptoms and severity in study participants. Ascaris infection was assessed by the presence of anti-Ascaris IgG ≥ 11 IU/mL measured by enzyme-linked immunosorbent assay. RESULTS: We have found a significant relationship between exposure to Ascaris and asthma (odds ratio, 2.92; 95% CI 1.04-8.18; P value = 0.034), and this relationship remained significant after adjustment for covariates (adjusted OR, 3.36; 95% CI 1.04-13%; P value = 0.047). Ascaris infection was more frequent in children with mild sustainable asthma (13.2%; 15/113) than in children with moderate sustainable asthma (6.2%, 2/32), although there was a non-significant difference between these groups (OR, 2.3; 95% CI 0.5-10.1; P value = 0.35). Based on results of a multi-regression analysis, contact with soil (OR, 6.7; 95% CI 1.9-23.5), and drinking unsafe water (OR, 4.2; 95% CI 1.2-14.2) were significant risk factors for Ascaris infection in the study area. CONCLUSION: Results of this study suggest that A. lumbricoides infection might affect susceptibility to asthma in children. These results could be useful in prevention, early diagnosis and management of childhood asthma.

Stoss therapy using fortified biscuit for vitamin D-deficient children: a novel treatment.

BACKGROUND: To evaluate the efficacy of stoss therapy using fortified biscuit for vitamin D-deficient children. METHODS: A total of 108 children aged 30-72 months with vitamin D deficiency were studied in a randomized single-blind clinical trial. The deficient children were assigned to three groups, namely, vitamin D-fortified biscuit (BG), capsule vitamin D (CG), and ampoule vitamin D (AG). Capsules and biscuits containing 50,000 IU of cholecalciferol were consumed twice per week for 3 consecutive weeks. Ampoules with 300,000 IU of cholecalciferol were injected intramuscularly in a single dose. Three weeks after treatment, serum 25(OH)D concentrations were measured, and the three groups were compared. RESULTS: Each method of treatment could increase the mean serum 25(OH)D concentration to optimal level. Serum 25(OH)D concentrations ≥100 ng/mL were observed in six children, including four from AG and two from CG (P = 0.09). The comparison of the mean serum 25(OH)D concentrations after treatment showed between ampoule and capsule (P = 0.3) and capsule and biscuit (P = 0.62) were insignificant; however, the ampoule and biscuit groups differed significantly (P = 0.012). CONCLUSION: Stoss therapy using fortified biscuit may be an effective way to improve compliance in children who cannot take capsules without adverse effects and may also be recommended for prevention purposes.

Amoebiasis in Iran: a systematic review and meta-analysis.

A comprehensive meta-analysis study was performed to estimate the reliable national prevalence and molecular epidemiology of amoebiasis in Iran. Nine English and Persian databases were searched to achieve the relevant studies. Pooled estimates were generated and meta-regression was performed. We identified 71 eligible articles involving 330 930 subjects from 25 provinces to be included in the final analysis. Moreover, 17 studies compromising 462 polymerase chain reaction (PCR)-positive isolates performed molecular analysis to inter-species differentiation. The pooled prevalence of Entamoeba infection among Iranian population was about 1% (95% CI 0.8-2.0%). Moreover, regarding Human Development Index (HDI), a higher prevalence was observed in undeveloped provinces. Out of 462 PCR-positive isolates, 83% (95% CI 69-94%) and 12% (95% CI 3-24%) were Entamoeba dispar, Entamoeba histolytica, respectively. In subgroup analysis based on molecular results, in general, population prevalence of Entamoeba dispar and E. histolytica were 91% (95% CI 80-99%) and 7%, (95% CI 0-19%), respectively, while prevalence of these species in patients with gastrointestinal disorders were 75% (95% CI 45-96%) and 18% (95% CI 1-43%), respectively. Our findings indicate the low burden of amoebiasis in Iran. E. dispar, that is mostly non-pathogenic, was identified as most prevalent species. Nevertheless, we suggest more public health interventions in areas with lower HDI.

The Effect of Midazolam on Decreasing the Duration of Intussusception Hydrostatic Reduction in Children.

BACKGROUND AND OBJECTIVE: The use of sedative medications may be effective in the success and facilitation of the intussusception non-surgical treatment. Therefore, the purpose of this study was to examine the effect of midazolam on decreasing the duration of intussusception hydrostatic reduction in children. MATERIALS AND METHODS: In a double-blind clinical trial, 32 children were diagnosed with ileocolic intussusception based on sonographic findings, were studied and randomly divided into two groups. After obtaining written informed consent from the parents, 5 minutes before reduction, an intravenous Midazolam at the concentration of 1.0 mg/kg (up to 3 mg) was infused, and then barium reduction was performed under fluoroscopy guideline. In the control group, sterile water was injected as placebo and the remaining reduction steps were performed compared with the experiment group. RESULTS: Of 16 patients that received Midazolam, 15 patients demonstrated successful reduction; and of 16 patients that received distilled water, only 11 patients showed successful reduction (P=0.07). The mean duration of a successful reduction in the Midazolam group and placebo was 34.8±11.35 and 32.73±19.2 min, respectively (P=0.733). CONCLUSIONS: The use of Midazolam as a benzodiazepine with known sedative and muscle relaxant effects can increase the success rate of enema reduction in intussusception.

Recurrence of abdominal distension due to fluid accumulation in a child: Ascites or a cyst?

Background: Abdominal distension in children can be caused by fluid accumulation due to ascites or large cysts. Case Presentation: A 25-month-old girl was brought to the pediatric gastroenterology clinic with the chief complaint of nontraumatic acute abdominal pain. She had undergone paracentesis last year with a diagnosis of suspected ascites in another medical clinic. Moreover, a CT scan following paracentesis was reported to be normal. After a few months, she gradually developed abdominal distension again. Diagnostic evaluations along with biochemical parameters and imaging strongly suggested the presence of a cyst. The large mesenteric cyst was totally removed by surgery. Conclusion: In conclusion, in the face of recurrence of abdominal fluid accumulation, mesenteric cysts should be considered despite the fact that abdominal CT scan is normal after paracentesis.

COVID-19 and renal involvement in children: a retrospective study.

Background: The New coronavirus (SARS COV-2) can cause acute respiratory disease and also multiorgan dysfunction. There is insufficient data about kidney involvement in children. So, this study was done on children with COVID-19 to evaluate nephrological involvement. Methods: All children with confirmed or suspected COVID-19 who were admitted in Children Hospital .were enrolled. They were admitted in hospital from March 2020 to July 2020. Serum Blood Urea Nitrogen (BUN), creatinine, sodium, potassium, calcium and urinalysis were evaluated. Also, glomerular filtration rate (GFR) was calculated by Schertz's formula. All patients were evaluated by chest x-ray and/or computerized tomography scanning (CTS). The data were analyzed by SPSS software and P value less than 0.05 was determined as significant. Results: Forty-seven children with confirmed or suspected COVID-19 were enrolled to this study. At admission, 23.4% and 27.7% of children with COVID-19 infection had abnormal increase in serum BUN and creatinine, respectively. Also 78.8% and 25.5% of children had GFR less than 90 and 60 ml/min /1.732, respectively. Additionally, 13/47 (27.7%) of children had abnormal urine analysis (microscopic hematuria and/or proteinuria). There wasn't a significant relationship between pulmonary lesions and abnormal reduction of GFR (P<0/05). Conclusion: In the study, the risk of AKI (acute kidney injury) and decrease of GFR and also abnormal urinalysis is high in children with COVID-19. So, more attention for detection of kidney involvement is necessary and more conservative management for prevention of AKI and decrease of GFR are recommended.

Effect of a synbiotic on functional abdominal pain in childhood.

BACKGROUND: One of the common functional gastrointestinal disorders in children is functional abdominal pain (FAP). The aim of the present study was to determine whether the administration of a synbiotic composed of fructo-oligosaccharides (FOS) and the seven types of beneficial bacteria is useful in FAP of childhood. METHODS: In this placebo-controlled, double-blind trial, 4-15-year-old children who met the Rome III criteria for FAP were randomly divided to receive either synbiotic or placebo twice daily for 4 weeks. Primary outcome was at least 50% reduction in the number of pain episodes, and secondary outcomes were a decline of at least two scales in the pain duration and intensity based on Wong-Baker scale. Response to therapy was decrease of pain frequency/intensity. RESULTS: A total of 67 children completed the trial (35 with synbiotic). Response rate was higher with synbiotic than placebo after four weeks (53.1 vs 11.4%; p<0.001), and synbiotic had significant superiority to placebo to relieve the duration (4.56±9.12 vs12±18.59, min/day, P=0.04), frequency (0.31±0.53vs 1.17±0.7, episode/Wk., P<.001) and intensity (2.38±2.29 vs 5.49±1.83, p<0.001) of abdominal pain. CONCLUSION: Synbiotic compared to placebo significantly decreased the intensity, frequency and duration of FAP in children.

Effect of Cow's-milk-free diet on chronic constipation in children; A randomized clinical trial.

BACKGROUND: Cow's milk intolerance can lead to chronic constipation in children. The present study seeks to determine the effect of cow's milk-free diet (CMFD) on chronic constipation in children who are not responding to laxatives. METHODS: Seventy children suffering from chronic constipation (described as the Rome III criteria) were enrolled in an open-label randomized clinical study. Each group included 35 children aged 4-14 years treated with laxatives for at least three months with no improvements. The intervention group received CMFD plus calcium supplements for four weeks and the control group did not have any restrictions in consuming cow's milk and dairy products. Also, both groups received polyethylene glycol (PEG; 1 gr/kg/day) and high-fiber foods (at least 10 gr/day) for four weeks. Responsiveness was described as a reduction in symptoms and signs according to the Rome III criteria after four weeks. RESULTS: After four weeks, 25 (71.4%) children in the CMFD group responded to the treatment compared to four (11.4%) children in the control group (P<0.001). Significant differences were found between the CMFD and control groups in terms of the seven Rome III criteria post-intervention; history of large stools (25% vs. 53.6%), large fecal mass in the rectum during examination (17.1% vs. 50%), history of painful defecation (18.2% vs. 55.6%), history of retentive posturing (10% vs. 46%), ≥1 episode/week of incontinence (25 % vs. 50%, P=0.001), ≤ 2 defecations/week (17.4% vs. 52.3%) and history of thick stool with toilet obstruction (22.2% vs. 52.3%). CONCLUSION: This study showed that children with functional constipation with no response to laxatives could benefit from a cow's milk-free and dairy-free diet.

COVID-19 and Digestive System in Children: A Retrospective Study.

BACKGROUND: The aim of this study was to identify gastrointestinal (GI) and liver injury presentations in children admitted with COVID-19 infection. METHODS: In this retrospective study, we studied all children with suspected symptoms of COVID-19, referred to Amirkola Children's Hospital. Clinical manifestations of the digestive and respiratory systems and liver function tests were evaluated for all cases. RESULTS: Eighteen children were studied. The most common clinical symptoms were fever, anorexia, weakness, nausea and vomiting, cough, diarrhea, and abdominal pain, respectively. Also, 5/18 (27.8%) and 7/18 (38.9%) of cases had abnormally high alanine aminotransferase (ALT), aspartate aminotransferase (AST), respectively. Additionally, in icteric cases, direct bilirubin was raised. There was no significant relationship between pulmonary lesions and abnormal excess in ALT (P = 0.59) and AST (P = 0.62). CONCLUSION: The findings showed that there were no severe clinical GI symptoms in children with COVID-19 infection. Besides, children with increased liver enzymes did not have more respiratory involvement than those without a rise in liver enzymes.

Toxocara spp. infection and risk of childhood asthma: A systematic review and meta-analysis.

Asthma is one of the most common chronic respiratory disease worldwide, with a negative impact on quality of life and socio-economic status of patients. There are some evidences to suggest that Toxocara infection is a neglected risk factor for childhood asthma. We performed a systematic review and meta-analysis to further understanding of this relationship. Five databases include PubMed, Science Direct, Scopus, Web of Science (ISI), and Google scholar were searched (up to October 2017) to identify the relevant studies. We used random-effects meta-analysis model to estimate the pooled odds ratio (OR) and 95% confidence intervals (CI). Heterogeneity was assessed with the Q-test and I2 statistic. A total of 17 studies including 11 studies with case-control design (1139 patients and 1023 controls) and six studies with cross-sectional design (a total of 5469 participants, 872 asthmatics, and 4597 non-asthmatics children) met the eligibility criteria. An increased risk for asthma was observed in children with Toxocara infection seropositivity (OR, 1.91; 95% CI, 1.47-2.47). In sub-group analysis, the pooled ORs were (OR, 2.13; 95% CI, 1.43-3.15) and (OR, 1.73; 95% CI, 1.23-2.44) for case-control and cross-sectional studies, respectively. Moreover, considering to specific IgE seropositivity, a pooled OR of 2.36 (95% CI, 0.93-5.98) was observed. In conclusion, this meta-analysis revealed that children infected with Toxocara spp. are more likely to have asthma compared to non-infected children. More studies (especially longitudinal studies) are needed to further investigate the impact of Toxocara spp. infection on the onset or development of asthma.

Children With Vitamin D Deficiency: Is A Wrist X-Ray Necessary?

BACKGROUND: Rickets is failure in mineralization of growing bone and cartilage due to extreme vitamin D deficiency (VDD). The study aimed to identify rickets among vitamin D deficient children and determine any relationship between clinical findings and paraclinical evidence. METHODS: This study was conducted in two stages. In the first stage, blood was drawn from 406 children aged 30-72 months for measurement of 25(OH)D level. Of these children, 108 had 25(OH)D levels of <20 ng/dL and were evaluated physically for signs and symptoms scores (0-1) of VDD and rickets. Biochemical analysis and radiography of the child's left wrist and hand was performed. RESULTS: Of the 119 children (29.67%) with 25(OH)D levels of <20 ng/dL, 42 (10.3%) had vitamin D levels of ≤15 ng/dL. There was no correlation between serum 25(OH)D level and levels of calcium (Ca) (r = -0.16), alkaline phosphatase (ALP) (r = -0.12), P (r = 0.13), and parathyroid hormone (PTH) (r = -0.15,) in children with VDD. The mean of signs and symptoms scores had no significant difference between children with (1.59 ± 0.8) and without (1.73 ± 1.01) VDD (P = 0.3). None of the children with VDD had radiographic evidence of rickets. Radiographic data showed that 69.2% (72), 10.6% (11), and 20.2% (21) of the children had delayed, normal, and advanced bone age, respectively. CONCLUSION: Abnormal radiological findings of rickets were not found on wrist X-rays. Thus, this investigation is not necessary within the range of vitamin D levels described in the current study.