A girl with 45,X/46,XX Turner syndrome and salt wasting form of congenital adrenal hyperplasia due to regulatory changes.

The incidence of Congenital Adrenal Hyperplasia (CAH) is 1:10,000 - 16,000 worldwide, of which 90% occurs in the CYP21A2 gene coding for steroid 21-hydroxylase. On the other hand, Turner's syndrome, with an incidence of 1:2500, is a form of gonadal dysgenesis which leads to early ovarian failure and other phenotypic changes such as webbed neck, widely-spaced nipples and short stature. Here, we present a girl suffering from both 45,X/46,XX Turner's syndrome and salt wasting (SW) form of CAH. Clinical and biochemical examinations were performed for the patient. Cytogentic studies and molecular testing such as allele specific PCR for eight mutations in the CYP21A2 gene, multiplex ligation probe amplification (MLPA) and direct sequencing confirmed the clinical diagnosis. Heterozygous mutations in the regulatory region at positions -316 to -264 verified SW form of 21-hydroxylase deficiency. 45,X/46,XX mosaicism proved Turner's syndrome. The SW presentation of the patient may be due to the CYP21A1P microconversion. The study of regulatory changes of the CYP21A2 and gender differentiation pathways would be possible using such patients.

Increase resistant rates and ESBL production between E. coli isolates causing urinary tract infection in young patients from Iran.

Emerging antimicrobial resistance rates and Extended-spectrum beta-lactamase producing Escherichia coli recovered from urinary tract infections (UTI) is an increasing problem in specific regions, limiting therapeutic options. One hundred E. coli isolates causing UTI in patients with age from 2 months to 12 years admitted at CMC in the period of April 2009 to March 2010 were tested for antibiotic susceptibility using the disk diffusion method. Surprisingly high resistance rates were recorded for E. coli against TMP/SMX (84%), cefalotin (66%), cefuroxime (50%), cefixime (50%) and ceftriaxone (45%). Antimicrobial susceptibility of E. coli isolates was followed by meropenem (98%), amikacin (95%), nitrofurantoin (91%) and gentamicin (68%). Extended spectrum beta-lactamase production, was observed in 32% of community and 42% of nosocomial isolates. The results of this study and numerous observations regarding the increasing resistance to these antibiotics, in several countries, emphasize the need for local population-specific surveillance for guiding empirical therapy for UTI in children.

The Causative Organisms of Bacterial Meningitis and their Antimicrobial Resistance Profiles in Iranian Children in 2011-2016.

OBJECTIVES: The study aimed to describe the identity and antimicrobial resistance patterns of the causative agents of bacterial meningitis in children referred to Children's Medical Center (CMC) Hospital, Tehran, Iran. METHODS: This retrospective study was performed at CMC Hospital during a six-year period from 2011 to 2016. The microbiological information of the patients with a diagnosis of bacterial meningitis was collected and the following data were obtained: patients' age, sex, hospital ward, the results of CSF and blood cultures, and antibiotic susceptibility profiles of isolated organisms. RESULTS: A total of 118 patients with bacterial meningitis were admitted to CMC hospital. Sixty-two percent (n=73) of the patients were male. The median age of the patients was ten months (interquartile range [IQR]: 2 months-2 years) and the majority of them (n=92, 80%) were younger than two years of age. The highest number of patients (n=47, 40%) were admitted to the surgery department. Streptococcus epidermidis was the most frequent isolated bacterium (n=27/127, 21%), followed by Klebsiella pneumoniae (n=20/127, 16%), and Staphylococcus aureus (n=16/127, 12.5%). Blood culture was positive in 28% (n=33/118) of patients. Ampicillin-sulbactam and imipenem were the most effective antibiotics against Gram-negative bacteria isolated from CSF cultures. In the case of Gram-positive organisms, ampicillinsulbactam, vancomycin, and linezolid were the best choices. Imipenem was the most active drug against Gram-negative blood pathogens. Also, ampicillin and vancomycin had the best effect on Gram-positive bacteria isolated from blood cultures. CONCLUSION: Results of this study provide valuable information about the antibiotic resistance profiles of the etiologic agents of childhood meningitis, which can be used for prescription of more effective empirical therapies.

Phenotypic and genotypic determinants of mupirocin resistance among Staphylococcus aureus isolates recovered from clinical samples of children: an Iranian hospital-based study.

BACKGROUNDS: The aim of this study was to evaluate both phenotypic and genotypic determinants of mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) and methicillin susceptible S. aureus (MSSA) strains recovered from different clinical samples of children who were admitted to the Children's Medical Center (CMC) Hospital, Tehran, Iran. MATERIALS AND METHODS: A total of 120 clinical isolates of S. aureus were collected from the microbiology laboratory of CMC Hospital. Antimicrobial susceptibility of the isolates to different antimicrobial agents was determined by disk diffusion method. The methicillin resistance phenotype (MRSA) was identified using a 30 µg cefoxitin disk. The minimum inhibitory concentration (MIC) of mupirocin was determined by broth microdilution method. Strains with mupirocin MIC between 8 and 256 µg/mL were considered as low-level mupirocin resistant (LLMR), and strains with an MIC≥512 µg/mL were considered as high-level mupirocin resistant (HLMR). The presence of genes encoding HLMR (ie, mupA and mupB genes) was evaluated by PCR method. RESULTS: Four out of 120 isolates (3%) had mupirocin MIC≥512 µg/mL and were HLMR; however, no LLMR isolate was detected. Fifty-two isolates (43%) were MRSA, and there were no differences in the distribution of mupirocin resistance among MRSA and MSSA isolates (P>0.05). The PCR method identified mupA gene in two out of four HLMR isolates, and mupB gene was not detected in any HLMR isolates. CONCLUSION: Because of discrepancies between the phenotypic and genotypic patterns of mupirocin resistance and due to the avoidance of false-negative results, it is better to determine the mupirocin resistance by both antibiotic susceptibility tests and PCR method. Considering the increasing need of mupirocin for the control of S. aureus infections, continuous checking of its susceptibility status is necessary.

Molecular Analysis of Pseudomonas aeruginosa Metallo-Beta-Lactamase: A First Report of an Iranian Referral Pediatric Hospital.

INTRODUCTION: Pseudomonas aerouginosa is an important opportunistic pathogen which causes clinical infections among ill patients. Metallo- Beta- lactamases (MBLs) are important mechanisms of carbapenem (drug of choice) resistance among Pseudomonas aerouginosa isolates. The aim of this study was to determine B- lactamases genes (bla-genes) in P. aerouginosa isolates and to detect percentage of MBLs among P. aerouginosa isolates in different wards. MATERIAL AND METHODS: Clinical isolates of P. aerouginosa in patients hospitalized at Children's Medical Center were collected in two years using a sterile swab. For differentiation and identification of strains the BHI media, Sytrymaid agar and Oxidase test were used and Kirby Baure method antibiotic susceptibility and PCR assay were performed for detection of bla-genes. RESULTS: Based on the study results from a total of 269 isolates of P. aerouginosa, 39 isolates were found to be imipenem resistant. From these isolates, 19 strains of P. aerouginosa isolates were determined to be MBL producers by phenotypic method. All of the Imipenem resistant P. aerouginosa isolates were examined by PCR for the presence of the bla-genes. All MBL- producing isolates carried bla-IMP Genes. And the results of the antibiogram showed the greatest resistance to the Nitrofurantoin, Nalidixic acid and Cotrimoxazole and Cefixime (100%) and resistance to other antibiotics was also significant. CONCLUSION: Considering the prevalence and clinical importance of MBL producing isolates, rapid identification of them and use of the appropriate infection control measures are necessary to prevent further spread of them by these organisms and to help treatment of Infections.

An Increasing Threat in an Iranian Referral Children's Hospital: Multidrug-Resistant Acinetobacter baumannii.

INTRODUCTION: Acinetobacter baumannii has emerged as an important nosocomial pathogen in the past decades. Due to the prevalence of A. baumannii across the world, suitable typing methods to investigate the epidemiological distribution of the organism have been developed. The aim of this study was to investigate the epidemiological and molecular diversity of A. baumannii strains isolated from nosocomial infections of hospitalized children in Children Medical Center Hospital (CMC), an Iranian referral hospital, in Tehran, Iran. MATERIAL AND METHODS: A total of 27 non-duplicate clinical A. baumannii isolates were collected during October 2013 to March 2014 and tested for antimicrobial resistance to several antibiotic agents. The genetic similarity of the strains was investigated by amplification of Random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) method. RESULTS: One predominant RAPD profile (type B) was identified in 15 strains (56% of all typed isolates). Other clusters depicted in the dendrogram, namely A, C, and D comprised 6 (22%), 5 (19%) and 1 (3%) isolates, respectively. All A. baumannii strains were resistant to all antibiotics except colistin. CONCLUSION: This study highlights the clonal spread of multidrug-resistant A. baumannii in our hospital. Therefore, the factors responsible for dissemination of such isolates need to be identified, controlled, and prevented to avoid major outbreaks.

Antimicrobial Resistance Patterns of the Gram-positive Bacteria Isolated from Children with Bloodstream Infection in an Iranian Referral Hospital: A 6-year Study.

BACKGROUND: Bloodstream infections (BSI) are considered as a serious cause of morbidity and mortality in children. The aim of this study was to report the common Gram-positive bacteria (GPB) responsible for bloodstream infections in children and determine their antimicrobial resistance patterns in Children Medical Center (CMC) Hospital, Tehran, Iran. METHODS: This retrospective study was conducted within a six-year period (March 2011 to September 2016) for pediatric patients with BSI. Standard bacteriological methods were performed for identification of the bacteria. Antimicrobial susceptibility tests were evaluated by using the disk diffusion method according to the CLSI recommendations. RESULTS: Among 68233 blood cultures, 2349 isolates were obtained which 59% of them (N=1393) were GPB and 41% (n=956) were Gram-negative. The most common GPB isolates were Coagulase negative Staphylococcus (CoNS) (N= 609, 44%), followed by Staphylococcus aureus (N=319, 23%), Enterococcus spp. (N=139, 10%), Streptococcus pneumonia (N= 106, 8%), Streptococci viridans (N= 180, 13%) Micrococcus spp. (N=24, 1.7%) and Streptococcus group B (N= 16, 1%). The rate of methicillin resistance in S. aureus and CoNS was 47% (N=116/246) and 91% (N=557/609), respectively. Isolates of S. pneumoniae showed high-level of resistance to trimethoprim/sulfamethoxazole (N=28/33, 85%) and erythromycin (N=59/91, 65%). S. viridans isolates and Micrococcus spp. were highly sensitive to linezolid (100%). All of the tested isolates of Streptococcus group B were sensitive to all the antibiotics used in this study. Among Enterococcus spp., 52% (N=69/133) of the m were resistant to vancomycin. CONCLUSIONS: Our results emphasize the importance of a valuable guide in identifying resistance trends and selecting appropriate antibiotic.

Virulence Factors of Staphylococcus aureus Isolates in an Iranian Referral Children's Hospital.

OBJECTIVES: The clinical importance of Staphylococcus aureus (S. aureus) is attributed to notable virulence factors, surface proteins, toxins, and enzymes as well as the rapid development of drug resistance. The aim of this study was to compare the occurrence of virulence factors produced by S. aureus strains isolated from children in an Iranian referral children's hospital. METHODS: The presence of genes encoding for the enterotoxins A (sea), B (seb), C (sec), D (sed), TSST-1 (tsst), exfoliative toxin A (eta), and exfoliative toxin B (etb) were detected by Multiplex polymerase chain reaction (PCR) using specific primers. In addition, the standardized Kirby-Bauer disc-diffusion method was performed on Mueller-Hinton agar. RESULTS: In total, 133 S. aureus isolates were obtained from different patients. Of these S. aureus isolates, 64 (48%) were methicillin-resistant S. aureus (MRSA), and all of these tested positive for the mecA gene. Regarding the classical enterotoxin genes, sea gene (40.6%) was the most prevalent followed by seb (19.6%), tsst (12.8%), eta (11.3%), etb (9%), sed (4.5%), and sec (3%). Among methicillin-susceptible S. aureus (MSSA) isolates, seb and tsst were the more prevalent toxins in comparison with MRSA isolates (p < 0.05), while the frequency of sea, sed, eta, and etb genes were higher among MRSA isolates (p > 0.05). CONCLUSION: In our study enterotoxin A was produced by 40.6% of the isolates (48% from MRSA and 33% from MSSA isolates) which was higher than in previous reports. According to our results, strict hygiene and preventative measures during food processing are highly recommended.

Acute bacterial meningitis among children admitted into an Iranian referral children's hospital.

Bacterial meningitis is a serious threat to global health, particularly in developing countries. The aim of this study was to determine the etiological agents of acute bacterial meningitis, its clinical features, and antibacterial susceptibility among Iranian children who were admitted to a referral regional children's hospital. Laboratory data as well as symptoms and signs on admission, organism identification and antibiotic susceptibility results, physical examination findings, and neurologic features of 31 patients with suspected invasive bacterial infection were evaluated, of which 20 (64.5%) had positive cerebrospinal fluid (CSF) cultures. The microorganisms most commonly associated with bacterial meningitis in children were Streptococcus pneumoniae (7 isolates, 22.5%), Haemophilus influenzae (3 isolates, 10%), and Neisseria meningitidis (3 isolates, 10%). In our study, the rate of mortality and sequelae were 10% and 35%, respectively. Ventriculomegaly hydrocephalus was found in 1 case positive for Mycobacterium tuberculosis meningitis, while other signs of meningitis were negative. According to our results, abnormalities including brain edema, subdural effusion, microabscess, and ventriculomegaly hydrocephalus were observed in 50% of the patients with confirmed bacterial meningitis; therefore, identification of predictors of early neurological complications is highly recommended. In addition, CSF culture using the BACTEC automated system is recommended for detection of the etiologic agents of bacterial meningitis, particularly in a population like ours, in which the patients receive a course of antibiotics without prescription.

Role of fecal calprotectin in differentiating between Hirschsprung's disease and functional constipation.

BACKGROUND/AIMS: Calprotectin is a 36.5 kD calcium and zinc binding protein in the S100 protein family. Fecal calprotectin levels are elevated in patients with inflammatory bowel disease and some other gastrointestinal disorders such as colorectal carcinoma. We decided to evaluate the fecal calprotectin level to see if it was able to distinguish between functional and organic causes of constipation. METHODS: Seventy-six children aged 1 to 120 months that all underwent deep rectal mucosa biopsies at Children Medical Center from November 2010 till September 2011 were recruited. Nineteen cases were diagnosed as Hirschsprung's disease and 57 of the patients had nerve ganglion cells in their biopsies. Calprotectin concentration was analyzed by the ELISA method. RESULTS: Although there was a significant difference between the median of the two groups (p=0.036), the median was not above the predetermined cutoff value of 50 µg/g. CONCLUSIONS: We propose that fecal calprotectin, using the above cutoff value, has limited value in differentiating functional constipation from Hirschsprung's disease.

Plasma ghrelin levels in children with cystic fibrosis and healthy children.

INTRODUCTION: Cystic fibrosis (CF) is a common genetic disorder as a result of mutation in the CF transmembrane conductance regulator gene. Weight loss in CF patients seems to be multifactorial and metabolic factors, inflammation, recurrent infections and poor appetite are possible candidates. Ghrelin affects energy hemostasis by stimulating growth hormone secretion, glucose and lipid metabolism alteration and inhibition of the inflammatory system. Data on the role of ghrelin in energy deficiency in CF patients are sparse and controversial. The study was done to compare the plasma levels of the acylated form of ghrelin in CF patients with healthy participants. MATERIAL AND METHODS: Thirty cystic fibrosis patients (aged 1-168 months) and thirty healthy matched participants were enrolled in the study. Plasma ghrelin and albumin levels were measured and body mass index (BMI) was calculated as well. RESULTS: Plasma levels of acylated ghrelin in CF patients were significantly higher than the control group (mean 25-75%: 14.5 vs. 2.7, p = 0.032). Body mass index measurements in CF patients were significantly lower than the control group (p < 0.001). Using regression analysis there was no statistically significant correlation between plasma ghrelin levels and serum albumin, weight, height or BMI values in CF patients and controls. CONCLUSIONS: The acylated ghrelin levels are increased in CF. So plasma levels of acylated ghrelin could be used as an indicator of food uptake and energy balance in them. Further studies should be established to find out the exact role of factors affecting energy metabolism.

Variation in plasma leptin levels in young Iranian children with cystic fibrosis.

INTRODUCTION: Poor weight gain is one of the most important mortality hazards in cystic fibrosis (CF) patients. The mechanisms that may hinder body weight regulation are not completely understood. Leptin and its role in fat mass could be related to control of weight gain in CF patients. As the previous data are conflicting, we aimed to investigate serum leptin level in Iranian CF children compared to a control group. MATERIAL AND METHODS: Forty-three CF patients aged from 3 to 120 months and 43 age-matched controls were enrolled. Patients were recruited from the outpatient clinic of the Children's Medical Center Hospital. Controls were visited in the general outpatient clinic for an annual check-up. Both groups were divided into three subgroups based on age: 3 to 12 months, 13 to 48 months, and 49 to 120 months. Body mass index (BMI) was calculated for all the participants. Serum leptin levels were measured applying a solid phase enzyme-linked immunosorbent assay (ELISA). RESULTS: Leptin levels and BMI values were significantly different between patients and controls (p = 0.02, p < 0.001, respectively) but only patients aged 13-48 months had significantly higher levels of leptin than age-matched controls (p = 0.016). Overall male patients' mean leptin level was significantly higher than in female patients (p = 0.032) and male controls (p < 0.001). CONCLUSIONS: Leptin level in our patients was significantly higher than controls. It seems that leptin levels during infancy are higher than in adult patients. Further studies are required on specific genotypes, gender and age to reveal the probable correlation with BMI and leptin levels in CF patients from different ethnic groups.

Group B streptococci urine isolates and their antimicrobial susceptibility profiles in a group of Iranian females: prevalence and seasonal variations.

Streptococcus agalactiae is one of the uropathogens responsible for urinary tract infections (UTI) in children, pregnant women, and elderly people with chronic underlying diseases. This study was performed to determine the prevalence of urinary tract isolates of group B streptococci (GBS) in a group of females referred to a referral University Hospital in Iran. In this retrospective cross-sectional study, urine analysis and urine culture results of all female subjects referred to the laboratory of the Rasoul-e-Akram Hospital, Tehran, Iran in 2010 were reviewed. Bacteriuria, colony count, pyuria and demographic data of patients were also evaluated. In this study, 10,256 females were investigated; 2061 (20.1%) of them had positive urine cultures. GBS was the isolated microorganism in 184 (8.92%) cases, yielding a prevalence of 1.79% in total study population. The mean age of subjects with positive GBS cultures was 48.24 +/- 18.8 years, with a higher prevalence recorded in the 51-60 and 21-30 age groups. The highest rates of cultures positive for GBS were seen in December and January. GBS was found to be sensitive to the following antibiotics: cephalothin (100%), norfloxacin (96.9%), ampicillin (96%), nitrofurantoin (95.5%), and vancomycin (95%). In this study, GBS showed greatest resistance to tetracycline (81.6%) and co-trimoxazole (68.9%). In conclusion, the prevalence of GBS in females with suspected UTI is relatively low; however, attention to the age and susceptibility pattern of antibiotic treatment for UTI caused by this microorganism is necessary.

Five-year evaluation of the antimicrobial susceptibility patterns of bacteria causing bloodstream infections in Iran.

INTRODUCTION: Bloodstream infections (BSI) are a serious cause of morbidity and mortality worldwide. Emerging antimicrobial drug resistance among bacterial pathogens causing BSI can limit therapeutic options and complicate patient management. METHODOLOGY: To encourage the prudent use of appropriate antibiotics in our pediatric population at Children's Medical Center Hospital, Tehran, Iran, we studied the frequency and antibiogram patterns of blood culture isolates from January 2001 to December 2005. RESULTS: Of 25,223 blood cultures examined, 2,581 (10.23 %) were positive for bacterial growth. The frequency of Gram-positive bacteria isolated was 47.6% (1228 of 2581) and that for Gram-negatives was 52.4% (1353 of 2581). The rates of methicillin (oxacillin) resistance in Staphylococcus aureus and coagulase-negative staphylococci (CoNS) were 79% and 89%, respectively. About 45% of Streptococcus pneumoniae were resistant to trimethoprim-sulfamethoxazole and approximately 66% to penicillin. Among the Gram-negative isolates, Pseudomonas aeruginosa was most frequently isolated, representing 943 (36.7%) over five years. This possibly represents an unrecognized hospital outbreak or contamination of blood culture bottles or other products such as skin disinfectants. Additionally, this pathogen showed extremely high rates of antimicrobial resistance. There were notable differences in frequency of the five most common microorganisms isolated from blood cultures, which can help set priorities for focused infection control efforts. CONCLUSIONS: Our findings underscore the need to monitor blood culture isolates and their antimicrobial resistance patterns to observe resistance trends that would influence appropriate empiric treatment and infection control strategies for bacteremic children.

High frequency of vancomycin-resistant enterococcus faecalis in an Iranian referral children medical hospital.

BACKGROUND: Enterococci have emerged in recent years as important nosocomial pathogens. Although most enterococcal human infections are caused by Enterococcus faecalis, studies on vancomycin resistance are usually limited to Enterococcus faecium isolates and a little is known about E. faecalis. Therefore we undertook this study to obtain information about the prevalence of vancomycin -resistant E. faecalis (VREF) and genes responsible for resistance. MATERIAL AND METHODS: Ninety-one E. faecalis isolates of different patients admitted at Children's Medical Center from August 2009 to June 2010 were included in this cross-sectional study. Antimicrobial testing was performed by Kirby-Bauer disk diffusion method according to Clinical Laboratories Standards Institute (CLSI). RESULTS: Among all isolates, 15 (16%) were identified as VR E. faecalis. PCR analysis revealed that all VREF isolates were positive for the vanA gene. CONCLUSION: The present study reports the highest range of VREF in Iran. The increased frequency of VREF, as seen with rapid rise in the number of VanA isolates should be considered in infection control practices.

Bilirubin/Albumin Ratio for Predicting Acute Bilirubin-induced Neurologic Dysfunction.

OBJECTIVE: The aim of this study was to evaluate the bilirubin albumin (B/A) ratio in comparison with total serum bilirubin (TSB) for predicting acute bilirubin-induced neurologic dysfunction (BIND). METHODS: Fifty two term and near term neonates requiring phototherapy and exchange transfusion for severe hyperbilirubinemia in Children's Medical Center, Tehran, Iran, during September 2007 to September 2008, were evaluated. Serum albumin and bilirubin were measured at admission. All neonates were evaluated for acute BIND based on clinical findings. FINDINGS: Acute BIND developed in 5 (3.8%) neonates. B/A ratio in patients with BIND was significantly higher than in patients without BIND (P<0.001). Receiver operation characteristics (ROC) analysis identified a TSB cut off value of 25 mg/dL [area under the curve (AUC) 0.945] with a sensitivity of 100% and specificity of 85%. Also, according to the ROC curve, B/A ratio cut off value for predicting acute BIND was 8 (bil mg/al g) (AUC 0.957) with sensitivity of 100% and specificity of 94%. CONCLUSION: Based on our results, we suggest using B/A ratio in conjunction with TSB. This can improve the specificity and prevent unnecessary invasive therapy such as exchange transfusion in icteric neonates.

Total Antioxidant Status in Patients with Major ß-Thalassemia.

OBJECTIVE: Beta-thalassemia major is an autosomal recessive disease causing severe and hemolytic anemia, which begins about 2-6 months after birth. Iron overload, which arises from recurrent transfusion and ineffective erythropoiesis, can enhance oxidative stress in thalassemic patients. The aim of this study was to evaluate the serum total antioxidant capacity of patients with ß-Thalassemia major. METHODS: Sixty six Iranian patients with ß-thalassemia major and 66 age-gender matched controls were evaluated for serum total antioxidant status (TAS), uric acid (UA), bilirubin and albumin. In addition, serum ferritin and transaminases were recorded in these subjects. FINDINGS: Significant increases of TAS, UA, and bilirubin were observed in the patient group, compared with the control group (P<0.01). Mean TAS and bilirubin in male patients was higher than in females (P=0.005 and P=0.008, respectively). There was also direct correlation between TAS and albumin (P<0.001), bilirubin (P<0.001) and UA (P=0.002). CONCLUSION: Endogenous antioxidants such as ferritin, UA and bilirubin can result in increased level of TAS in the patients with Beta-thalassemia major. Compensatory excess of TAS to oxidative stress could also be the reason for difference between our findings and previous studies.

Prevalence of IgA deficiency in children with juvenile rheumatoid arthritis.

The purpose of this study was to investigate any association between IgA deficiency (IgAD) and juvenile rheumatoid arthritis (JRA) among Iranian children.This case-control study was carried out on 83 children who were diagnosed as JRA according to American College of Rheumatology (ACR) criteria; Patients were admitted at the rheumatology clinic of Children's Medical Center, (Tehran). Serum immunoglobulins concentrations were determined by nephelometry method. Control group was 112 healthy children who were matched for age and gender. Informed consent obtained from all parents.Selective IgA deficiency (sIgAD) was found only in a boy (1.2%) among JRA children; however, partial IgA deficiency was found in 6(7.1%) of patients with JRA and in 12(10.7%) of control subjects, this difference was not statistically significant (p=0.46). Immunoglobulins levels in patients with JRA (IgM: 126.7±57.2, IgG: 1182.3±351 and IgA:169.3±98) were significantly higher than their controls (IgM: 104±52, IgG:802±220 and IgA: 94.6±47) (p<0.05). Patients with growth failure had higher IgM, IgG and IgA levels in comparison with patients without growth failure; however, this difference was significant about IgM and IgG levels (p<0.05).In contrast to other similar studies, the number of IgAD did not differ significantly between JRA patients and their control counterpart; this might be partly due to the high rate of consanguineous marriages in Iran that resulted in increased prevalence of clinically undiagnosed partial IgAD in general population. Hence, future epidemiological studies are warranted to make it clear.

Increase resistant rates and ESBL production between E. coli isolates causing urinary tract infection in young patients from Iran

Emerging antimicrobial resistance rates and Extended-spectrum beta-lactamase producing Escherichia coli recovered from urinary tract infections (UTI) is an increasing problem in specific regions, limiting therapeutic options. One hundred E. coli isolates causing UTI in patients with age from 2 months to 12 years admitted at CMC in the period of April 2009 to March 2010 were tested for antibiotic susceptibility using the disk diffusion method. Surprisingly high resistance rates were recorded for E. coli against TMP/SMX (84%), cefalotin (66%), cefuroxime (50%), cefixime (50%) and ceftriaxone (45%). Antimicrobial susceptibility of E. coli isolates was followed by meropenem (98%), amikacin (95%), nitrofurantoin (91%) and gentamicin (68%). Extended spectrum beta-lactamase production, was observed in 32% of community and 42% of nosocomial isolates. The results of this study and numerous observations regarding the increasing resistance to these antibiotics, in several countries, emphasize the need for local population-specific surveillance for guiding empirical therapy for UTI in children.