Vitamin D deficiency in school-age Iranian children with attention-deficit/hyperactivity disorder (ADHD) symptoms: A critical comparison with healthy controls.

The associations between serum vitamin D levels and the severity of attention-deficit/hyperactivity disorder (ADHD) symptoms were assessed among Iranian hospitalized children (50 ADHD cases and 50 healthy (non-ADHD) controls) during 2014-2015. Levels of ADHD severity and serum 25-hydroxyvitamin D (25OHD) were determined by the Conners' Parent Rating Scale (CPRS) test and an ELISA kit, respectively. The serum 25OHD concentrations of <10, 10-29, and >30 ng/mL were respectively considered as deficient (severe deficiency), insufficient (mild deficiency), and sufficient levels of vitamin D. The association of nutrient bioavailability with ADHD was evaluated by statistical and regression analyses.There was no significant difference in the mean of socio-demographic variables (e.g., gender, age, weight, BMI, daily intake of dairy products, and daily sunlight exposure) between ADHD and non-ADHD subjects. The mean serum 25OHD concentration (16.57 ± 9.09 ng/mL) was found to be significantly lower in ADHD children with more parathyroid hormone (PTH) levels as compared to controls (22.01 ± 12.67ng/mL). The sufficient 25OHD concentration was more predominant in the controls than the cases (p = 0.002). A severe deficiency of vitamin D was more found in children with ADHD (3.36 times). There was a negative and significant association between the participants' age and their serum 25OHD levels. Although 25OHD levels in boys were significantly more than those in girls, the reduction of serum 25OHD concentration among boys with ADHD was more severe compared to the patient girls(p = 0.014). The results support the importance of vitamins D role in ADHD patients through the regular monitoring of serum 25OHD levels.

Overweight adolescents: a group at risk for metabolic syndrome (Tehran adolescent obesity study).

BACKGROUND: Metabolic syndrome not only is a serious problem for adults, but is also afflicting an increasing number of children and adolescents. This syndrome is a risk factor for type 2 diabetes mellitus and cardiovascular diseases. The aim of this study was to estimate the prevalence of metabolic syndrome in a sample of Iranian adolescents. METHODS: A total of 554 overweight adolescents (aged 11 - 17 years) participated in a community-based cross sectional survey. Anthropometric examinations including height, weight, body mass index, and blood pressure were assessed. A fasting blood sample was taken for measurement of glucose and lipid profile. Metabolic syndrome was determined by the definition released by the National Cholesterol Education Program Adult Treatment Panel III, which was modified for age. RESULTS: The overall prevalence of metabolic syndrome was 26.6%. There was no gender difference in the distribution of metabolic syndrome. When stratified by body mass index, 22.5% were overweight (BMI> or =95th percentile) besides having the criteria for metabolic syndrome, while the remaining 4.1% of the adolescents were at risk for overweight (BMI between 85th and 95th percentile) together with metabolic syndrome. Hypertriglyceridemia was the most common and high-density lipoprotein was the least common constituent of metabolic syndrome. CONCLUSION: This study suggests a high prevalence of metabolic syndrome among overweight Iranian adolescents. This poses a serious threat to the current and future health of Iranian youth.

Prevalence of growth and puberty failure with respect to growth hormone and gonadotropins secretion in beta-thalassemia major.

BACKGROUND: Present transfusion protocols have increased the life expectancy of patients with beta-thalassemia major, but siderosis is a major clinical complication of the treatment. Short stature and hypogonadism are extremely frequent in patients with thalassemia. To investigate the influence of age at the onset of blood transfusion, iron chelation therapy, and serum ferritin levels on growth and pubertal development in thalassemic patients, and the prevalence of these endocrine complications with respect to pituitary somatotropic and gonadotropic functions, this study was designed. METHODS: Clinical data of 158 patients (82 females and 76 males) with thalassemia major, aged 10 - 20 years (mean age: 15.1 +/- 4.8 years) were collected from a pediatric hematology clinic in Tehran. Height was measured and stages of puberty were determined by a pediatric endocrinologist. Serum ferritin concentration, liver function tests, serum calcium and phosphorus, blood sugar, free thyroxine (FT4), TSH, FSH, LH, dehydroepiandrosterone sulfate, testosterone (in boys), estradiol (in girls), and insulin-like growth factor I were measured after overnight fasting. In patients with a height more than 2 standard deviation below the mean, the growth hormone stimulation test was considered. Bone age was determined in all patients. RESULTS: Thalassemic patients in this study showed a high prevalence of short stature (62%) and hypogonadism (69%). We found a low serum level of gonadotropins (FSH and LH) in over 14-year-old patients with impaired puberty, which indicated that hypogonadotropic hypogonadism is responsible for this complication. Results of growth hormone provocative tests and serum insulin-like growth factor I levels in short stature patients showed a reduced growth hormone response in 38% and low insulin-like growth factor I levels in 42% of thalassemic patients. Short stature and hypogonadism were more common in patients with serum ferritin levels above 2000 microg/L and these complications were significantly more frequent in patients who started treatment later than that of the patients who started treatment in the first years of life (P < 0.001). CONCLUSION: Short stature and hypogonadism are extremely frequent in our patients with thalassemia, but correct blood transfusion and appropriate iron chelation therapy can prevent or limit these complications. These data support the need for vigilant follow-up of patients with thalassemia in order to treat endocrine dysfunction at an appropriate age.

Cytomegalovirus infection-associated hemophagocytic syndrome.

Infection-associated hemophagocytic syndrome is a life-threatening condition characterized by prolonged fever, hepatosplenomegaly, and cytopenia-most commonly, thrombocytopenia and anemia. It is characterized by proliferation and activation of benign histiocytes, causing dysfunction of various organs. Herein, we report on a 5-month-old boy whose clinical picture and laboratory findings were consistent with cytomegalovirus infection-associated hemophagocytic syndrome. The patient was successfully treated with intravenous administration of immune globulin and ganciclovir. He remained well 6 months later.

Gastroesophagial reflux disease and asthma in pregnant women with dyspnea.

Asthma and gastroesophageal reflux disease (GERD) are two common problems in pregnancy and they affect pregnancy in several ways. In this study, we aimed to evaluate GERD and asthma in pregnant women who referred for prenatal care visits. One-hundred and seventy three pregnant women with a complaint of dyspnea were included in the study. A questionnaire was filled and lung function tests were performed. All patients were visited by a respiratory specialist and questionnaires were evaluated by a gastroenterologist. Out of the total number of women studied, 37% were diagnosed to have asthma and 36.4% were non-asthmatics. Twenty six percent of the pregnant women who had symptoms and signs of asthma with normal spirometry were classified as probable to have asthma. GERD was diagnosed in 80.9% of the pregnant women, but it was not significantly higher in asthmatic or probable asthmatic women compared to non-asthmatic ones. However, severity of GERD was significantly higher in asthmatic pregnant women compared to the others. In conclusion, the prevalence of GERD was quite high in pregnant women, irrespective of the fact that they were asthmatic or non-asthmatic. Further studies evaluating women throughout pregnancy will inform us more about this relationship.

A cross-sectional study to determine the prevalence of calcium metabolic disorder in malignant childhood cancers in patients admitted to the pediatric ward of Vali-Asr Hospital.

Calcium metabolic disorders, such as hypercalcemia is a potentially life-threatening disorder especially when coupled with an already compromised condition. The aim of this study was to determine the prevalence of metabolic calcium disorders in childhood cancers of patients admitted to the pediatric ward of Vali-Asr Hospital from the year 2001-2008. The study was carried out by reviewing hospital records of these patients from the hospital archives. Range of age was between 1 and 18 years. Inclusion criteria for the study population were the presence of total serum calcium evaluated at least once; and for the hypercalcemia subgroup, at least two occasions of elevated calcium levels. The prevalence of hypercalcemia and other metabolic abnormalities of phosphorus, alkaline phosphatase, urea and creatinine; the prevalence of parameters such as age, gender, type and duration of cancer were determined within these groups. Median of elevated calcium levels was also determined to classify hypercalcemia into moderate and severe hypercalcemia. Median was 11.7 mg/dl, therefore, severe hypercalcemia was ≥11.7 mg/dl and moderate hypercalcemia, a range between the upper limit of normal, 10.8 and 10.2 mg/dl for the child and adolescent respectively, and 11.7 mg/dl. Relationship between hypercalcemia and the other metabolic disorders and parameters were analyzed by the SPSS V.17 program. The population of study consisted of 148 cases. Hypercalcemia was found in 8 (5.4%) patients. Half of the cases were associated with severe hypercalcemia and acute lymphoblastic leukemia (ALL). Out of 148 cases, there were 92 (62%) boys and 56 (38%) girls. Mean and median ages were 10.9 and 11 years respectively. Mean duration of cancer was 12.8 and median 6 months. There were 57 (38.5%) cases of leukemia and 91 (61.5%) cases of solid tumors. The most common cancers were ALL, 44 cases (29.7%) followed by brain tumors, 19 cases (12.8%); non-Hodgkin's lymphoma, 16 cases (10.8%); 13 cases of acute myeloid leukemia (AML) (8.8%); 13 cases of Ewing sarcoma (8.8%); osteosarcoma, 9 cases (6.1%); Hodgkin's lymphoma, 6 cases (4.1%); others, 19.1%. There was no significant difference between hypercalcemia and the metabolic disorders and parameters. Metabolic calcium disorder, especially hypercalcemia, is not a rare finding in pediatric cancers. ALL, the commonest pediatric cancer, is most often associated with this disorder.

Dietary intakes in asthmatic and non-asthmatic female pupils of Tehran.

Dietary factors are suggested to be involved in recent increases in the prevalence of asthma. The differences in dietary intake of 23 asthmatic and 317 non-asthmatic students were investigated, who were chosen by multistage stratified cluster sampling. The dietary data were assessed by food frequency questionnaire and a 24-h recall form. Total calorie and fat intake were similar. Daily intake of Saturated and poly-unsaturated fatty acids, and calcium and sodium were significantly higher in asthmatics. There was no significant difference between dietary antioxidant intake of asthmatic and non asthmatics. It seems that in this age, the type of consumed fat may be more important than the amount of fat intake in inducing asthma. For accurate results, n-6 and n-3 fatty acid intake must be assessed. Higher sodium and calcium intake may also be associated with asthma. Randomized controlled trials with restricting diets can help to elucidate the results.

Prevalence of asthma related to BMI in adolescents in Tehran, Iran, 2004-2005.

Both asthma and obesity have become more common in affluent societies during the recent decades, and several studies have shown a correlation between the presence of asthma and obesity.

Overweight and obesity and their associated factors in adolescents in Tehran, Iran, 2004-2005.

OVERVIEW: Obesity is a significant health crisis around the world. Of great concern are the data pointing to the recent increase in the prevalence of obesity irregardless of age group and country. Overweight and obesity in adolescence are markers of overweight and obesity in adults, respectively. Very little data are currently available on the prevalence of childhood obesity in Iran, and more research on the risk factors is required before preventive public health programs can be formulated and put into practice. OBJECTIVE: The objective of this study was to quantify the prevalence of overweight and obesity and their associated factors in adolescent children living in Tehran. MATERIALS AND METHODS: During a multistage stratified cluster sampling, 2900 students (1200 males and 1700 females) aged 11-17 years were selected from 20 secondary schools in the school year of 2004-2005. A questionnaire was filled, and weight and height were measured. DISCUSSIONS AND CONCLUSIONS: The body mass index (BMI) was calculated and adjusted for age and sex. Prevalences of overweight and obesity were 17.9 and 7.1%, respectively. BMI increased with age, and it was higher in those who had lower levels of physical activity. Age at menarche was negatively associated with BMI. There was no relationship between macro- and micronutrient intake and overweight and obesity. This study highlights the high prevalence of overweight and obesity in adolescent children in Tehran.