[Comparison of vitamin A, D and zinc serum levels between children with urinary tract infection and control group in two university hospital]

Urinary tract infection [UTI] is one of the most common infections in infants and children, especially in their first decade of life. These patients are more susceptible to renal scars and other possible complications like growth retardation, arterial hypertension, proteinuria, isostenuria, and finally chronic renal failure. Trace elements like vitamins and minerals are essential for efficient metabolism and proper function of various body systems namely immune system. In this trial we compared the relation between serum levels of zinc, vitamins A and D in children inflicted with UTI and control group. This was a cross-sectional study on 25 patients with UTI admitted to pediatric wards of Rasul Akram Hospital and Bahrami Hospital. They were compared to 40 other patients admitted in surgical wards for elective surgery. Serum levels of zinc, vitamins A and D were measured in both groups. Seventy two percent of the patients were male and 28% female. The average age was 2.17. Despite the lower levels of vitamins A and D in cases than controls, the difference was not significant [P=0.4 and P=0.9, respectively]. However, serum levels of zinc were significantly lower in cases than controls [P<0.05]. Vitamins A and D may play some role in patients' vulnerability to UTI, but this supposition needs more research on larger samples, considering differences among patients of various age groups and their nutritional status. According to the study, lower levels of zinc were associated with susceptibility to UTI; thence, its administration might be helpful

[Prevalence of congenital toxoplasmosis in two university hospitals: a brief report]

The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma. Gondii infection and describe the clinical presentation from birth and follow up them. We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran [Rasoul akram and Akbar Abadi] during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged, transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T.Gondii- antibodies [IGG, IGM] evaluated by ELISA methods. Neonates with positive T.Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease. Gestational age of newborns was between 28-41 weeks. Positive T.Gondii - IGM and T.Gondii -IGG determined in 1.5%, 44.1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement [50%], and brain disorders [50%]. Positive PCR had not found in cerebrospinal fluids of seropositive [IgM] cases. One and a half percent of newborns were seropositive for T.Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests [IGM] to neonatal screening test is recommended strongly.

Searching Mycoplasma pneumonia by serology and PCR in children with adenoid hypertrophy and rhinosinusitis: a case control study, Tehran, Iran

Chronic infection in childhood is a leading cause of adeno-tonsillectomy. The aim of this study was to determine the role of M. pneumoniae in children with rhino sinusitis and adenoid hypertrophy. This case - control study was carried out in the pediatric and ENT wards of Hazrat Rasul Hospital, Tehran, Iran [2007-2009]. In this trial, we investigated 40 cases with adenoid surgery and 32 controls.We looked for M pneumoniae -DNA [PCR] in adenoid tissues resected from cases and 31 nasopharyngeal swabs in controls and IgM and IgG antibodies [ELISA] were compared between the 2 groups, P < 0.05 was considered to show a significant value. Positive PCR results were observed in 35% of cases and none of controls, positive-IgG was seen in 20% of cases and 6.4% of controls [P = 0.71] which was higher in older cases [6 vs. 4 years, p < 0.05]. Positive -IgM was seen in 10% of cases vs. 9.7% of controls, [P = 0.74]; without any difference for age [6.2/ 5.3 years, p = 0.1]. A positive PCR result was not related to positive IgG [p = 0.014], but to a positive IgM [p = 0.1]. M. pneumoniae infection was found serologically [IgM and IgG] in 10% and 20% of cases, respectively. These numbers along with positive PCR in adenoid tissue of cases [30%] indicates the prominent role for M pneumoniae in adenoid hypertrophy. We concluded that children in Iran will have been infected with M pneumoniae and would have obtained immunity between the ages of 6 and 8. Adenoid tissue might act as a reservoir for M. pneumoniae and cause rhino sinusitis concomitant with adenoid hypertrophy in infected children. Theoretically, suitable M pneumoniae eradicating antibiotics before adenoid surgery [with rhino sinusitis or chronic ear infection] might be helpful treatment, but it needs future RCT studies to be proven

[Prevalence of streptococcus group B in tracheal tube secretions of neonates with respiratory distress: a brief report]

Background: Infection with group B streptococcus [GBS] can present with respiratory distress, Pneumonia, meningitis and Osteomyelitis in neonates. The aim of this study was to determine the prevalence of GBS colonization in trachea of intubated neonates

Methods: This observational analytic study was performed upon 33 intubated neonates due to respiratory distress in neonatal intensive care unit [NICU] Rasoul Hospital in Tehran, Iran during 2010-2012. Tracheal secretions cultured upon TODD-HEWITT BROTH and sheep blood agar 5%., chi-square test was used for compare the qualitative variables. P<0.05 was considered meaningful

Results: Three cases had positive streptococcal culture [9.1%] and four cases had posi-tive culture for non-streptococcal organisms. no meaningful relation observed between positive GBS culture and neonatal gender, kind of delivery, PROM

Conclusion: Prevalence of GBS positive results [9%] in present study is very close to GBS colonization in pregnant women although the higher colonization rate of pregnant women are expected

[Staphylococcal superantigens toxic shock syndrome toxin-1 and enterotoxins in pediatric otitis media effusion: a brief report]

Background: Staphylococcal superantigens [Sag and aposs] may have some role in otitis media with effusion [OME]. The aim of this study was the search of staphylococcal Sag and aposs in middle ear effusion of children with OME

Methods: This cross sectional-analytic study was done in ENT and pediatric wards upon 64 children with otitis media with effusion [OME] between 1-15 years, [mean age=7.42+4 years] of Rasoul Akram University Hospital, Tehran, Iran in 2009-2011. Fifty six percent [36] of cases were male, 43.8% [28] were female. Staphylococcal Sag and aposs Toxic Shock Syndrome Toxin-1 [TSST-1], Staphylococcal enterotoxin A, B, C, D [Enzyme immune assay, AB Cam, USA] were detected in middle ear effusion samples after conventional culture

Results: None type of Sag and aposs found in 39% of OME cases, enterotoxin B found in: 22% enterotoxin A: 17%, enterotoxin C: 15.6%, enterotoxin D: 12.5%, Toxic Shock Syndrome Toxin-1 [TSST-1]: 7.8% Mean age of cases with positive TSST-1, enterotoxin A, B, C, and D was: 1, 5, 8.6, 9.6 and 9.6 years respectively. Positive TSST had no agreement with positive enterotoxin A and C but had weak agreement with type B and D. Mean age of cases with positive TSST was one years which had significant difference with [7.9 years] in cases with negative TSST test [P<0.0001]

Conclusion: At least one or more type of staphylococcal toxins had found in middle ear effusion of 70% of OME cases with negative culture for Staphylococcus aureus. Even in culture negative cases, staphylococcal toxins might have some immunologic role in middle ear effusion forming. Finding the SAgandaposs [at least one type] are important for treatment of immunosuppressive or corticosteroid in cases with resistant OME

Identification of bacterial antigens and super antigens in synovial fluid of patients with arthritis: a cross sectional study

An accurate and prompt diagnosis of bacterial arthritis is essential for earlier treatment and a good outcome. Superantigens produced by Staph. Aureus are among the most lethal toxins. The paper objective was Identification of common bacterial antigens and S. aureus superantigens in synovial fluid [SF] of children with negative culture and direct smear for other bacteria except for S. aureus. In this cross-sectional study a total of 62 patients with a mean age of 11 +/- 3.8 years [range: 5 months-16 years] with acute arthritis in pediatric and orthopedic wards of Rasoul Hospital [2008-2010] were studied. Three common bacterial antigens [e.g. S.pneumonia, H.influenza, N. meningitis] using LPA [latex particle antigen] and Staphylococcal superantigens [TSSTl; Enterotoxin A; B; C] using ELISA method [ABcam; USA] were identified in 60 adequate SF samples with negative culture and negative direct smears [for other bacteria except for S. aureus. Staphylococcal superantigens were compared with S. aureus infection [positive culture or direct smear]. Positive bacterial antigens [LPA test] were found in 4 cases including two S. Pneumonia, one N. meningitis, and one H.influenza. S.aureus was diagnosed in 7 cases including 4 positive cultures and 3 positive smears. Staphylococcal superantigens [toxins] were found in 73% of SF samples. Some cases had 2 or 3 types of toxins. S. aureus toxins were reported in 47% of culture negative SF samples. Positive TSSTl, Enterotoxin B, Enterotoxin A, and Enterotoxin C were found in 47% [n= 28], 18% [n= 10], 39% [n= 22], and 39% [n=21] of cases respectively. The most common type of superantigens was TSSTl; and Enterotoxin A was the less common type. Except for Enterotoxin A, no relation between positive S. aureus culture and positive tests for superantigens in SF was found. S. aureus has a prominent role in septic arthritis. S.aureus toxins might have a prominent role in arthritis with negative SF culture. Rapid identification of bacterial antigens [LPA] or S.aureus superantigens [toxins] are valuable for diagnosis in cases with negative cultures. We recommend usage of complementary methods [e.g. antigen detection tests] in children. Those tests are cheaper and easier in comparison with PCR as a complex and time-taking method. Identification of S. aureus superantigens in SF of all cases with negative culture, or treatment with antagonist drugs needs further clinical trial studies

[Inflammatory cytokine detection in adenotonsill and peripheral blood mononuclear cells-culture in adenotonsillectomy patients: a comparative study]

Tonsils and adenoid hypertrophy is a major respiratory symptom in children which is partly due to recruitment of inflammatory cells in upper airway lymph nodes as a result of the effects of synthesis and release of different inflammatory cytokines. It seems that infections play role in concert with these cytokines leading to tonsilar hypertrophy and other pathologic consequences. It is proposed that cellular infiltrate of tonsils and adenoids may secrete different quantities of these cytokines compared with peripheral blood mononuclear cells [PBMC] cultures. Among patients who were admitted for adenotonsillectomy to the ENT ward, 37 patients, under 1-12 years old patients with fulfill criteria selected to include the study. Excised adenoid and tonsils cultured and inflammatory cytokines Interferon-gamma [INF-gamma], Interlukine-1 [IL-1], IL-6, IL-8 and tumor necrosis factor-alpha [TNF-alpha] measured in cellular culture supernatant. The same cytokines measured in PBMC cultures. The data shows that there is a significant difference between IFN-gamma and IL-8 amounts in adenoid tissue culture supernatant and PBMC culture of our patients. Furthermore, the amounts of IFN-gamma, IL-1 and IL-8 showed considerable difference between tonsilar tissue culture supernatant and PBMC culture of these patients. Although there is a significant correlation between IL-6 amounts in tissue culture supernatant and PBMC culture [P=0.02], the respective data for TNF is only almost significant. Inflammatory cytokines may have significant role in the early provoke of inflammation occurred in hypertrophied tonsils and adenoid. The majority of these cytokines increase the expression of adhesion molecules on epithelial cells and influence the recruitment of leucocytes and inflamed tonsils. On the other hand lack of sufficient cytokine release may lead to persistent infections and may cause chronic inflammation and hypertrophied tissue

[ comparative study of streptococal infection in children with PANDAS: a case-control study]

Recent evidence suggest that group A beta-hemolytic streptococcal [GABHS] infection may increase the risk of pediatric autoimmune neuropsychiatric disorders [PANDAS] composed of the clinical signs of obsessive-compulsive and attention deficit hyperactivity disorders. The objective of this study was to compare the titer of antibodies against GABHS between children with PANDS and the controls. This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran during 2008-2010. We compared serum antibodies streptolysin O, deoxyribonuclease B, and streptokinase against GABHS quantitatively in 79 cases with PANDAS and 39 age-matched controls. The area under ROC curve, sensitivity, specificity and positive predictive value [PPV] of tests were calculated. Most cases were studied in summer [57%] and spring [23%]. The three aforesaid antibodies were higher in the cases [P=0.001]. Antisterptolysin O [cut-off point 195] had a 90% sensitivity, 82% specificity and a 92% PPV, [CI=95%, 0.99-0.91]. Anti streptokinase [cut-off point 223] had an 82% sensitivity, 82% specificity and a 95% PPV, [CI=95%, 0.934-0.735]. Anti-DNase [cut-off point 140] had an 82% sensitivity, 82% specificity and a 95% PPV, [CI=95%, 0.99-0.91]. The study demonstrated a possible role for streptococcal infection in PANDAS. We found a significantly higher antibody titer against GABHS in OCD and ADHD cases in comparison with healthy children. Treatment of streptococcal infection is achievable by the use of long-acting penicillin. Use of aggressive treatment schedules like plasmaphresis, IVIG, etc needs further RCT studies

[Determination of STREM-1 level in synovial fluid for diagnosis of septic arthritis in children]

Triggering receptors expressed on myeloid cells i.e soluble triggering expressed on myeloid cells-1 [STREM-1] is inducible on monocyte/macrophages and neutrophils and accelerates tissue destruction by propagating inflammatory responses in disease related to bacterial infections. The aim of this study was to investigate the role of STREM-1 in the synovial fluid to identify septic arthritis from aseptic ones. A cross sectional study [2007-2009] was conducted in the Pediatric and Orthopedic wards of Hazrat-e-Rasool Akram hospital, Tehran . Synovial fluid was aspirated in 53 cases with arthitis and searched for diagnosis of bacterial arthritis by conventional diagnostic tests. About 0.5-3cc of synovial fluid was stored at -70°C, and quantification of STREM-1 was done in 53 synovial fluid samples [Quantikine, R and D systems, USA] by EIA; results were compared between septic and aseptic arthritis. Septic arthritis was detected in 49% [26/53] and aseptic arthritis in 51%[27/53]. Positive synovial fluid culture was detected in 20.3%, and positive latex particle agglutination for bacteria was found in 8.5%. Positve direct smear was obtained in 10.5% of the cases. Cut off level 825 pg/ml for SF-STREM-1 yielded 50% sensitivity, 70% specificity, 64% Positive Predictive Value [PPV], and 64%, Negative Predictive Value [NPV]. Poor agreement was seen between SF -STREM-1 levels and positive culture [p value: 0.037; Kappa=0.28]. The area under the ROC curve for discriminating between septic and aseptic arthitis was 0.603 [95% CI; 0.757-0.448, p = 0.1]. SF-STREM-1 level with cutoff 825pg/ml had 50% sensitivity, and 70% specifity in discriminating between proved cases with septic arthitis from aseptic ones. Searching for bacterial antigens in synovial fluid [Latex Particle Aagglutination test] and synovial fluid -STREM-1 level could potentially assist clinicians in better diagnosis of septic arthitis if added to the conventional tests including smear and routine analysis of synovial fluid. It might prevent unnecessary empiric antibiotic theray in children with arthritis. In clinical decision making; randomized studies on the potential synovial fluid - STREM-1 -level guided antimicrobial therapy in bacterial arthritis would be useful.

Cytomegalovirus a common cause of intrauterine infection: a case-control study

Congenital cytomegalovirus [CM.V] infection affects nearly 1% of live births in the United States. Ten percent of these infants have symptoms at birth and another 10 to 15% develop hearing loss or developmental problems. The aim of this study was to compare CMV infection [IgM and IgG] rate in infants suspected for intrauterine infection with the control group. A case-control study was performed in the Pediatrics Department of Hazrat Rasool Akram Hospital in Tehran. The study population included 74 suspected cases of intrauterine infection [mean age, 4.7 +/- 3.7 months] and 65 normal healthy controls [mean age, 5.3 +/- 3.1 months]. We compared serum CMV antibodies [IgM, IgG] with ELISA kits. Acute and previous immunity to CMV [IgM and IgG] was found in 41.9% [31/74] and 74% [54/74] of cases, respectively. These figures were 6.2% [4/65] and 95.4% [62/65] in controls, respectively. Acute infection [CMV-IgM.] was more common among cases [p<0.0001], but previous immunity [CMV-IgG] was more prevalent among controls [p<0.00l]. We concluded that CMV is the most common cause of intrauterine infection in infants aged less than 6 months as compared to the healthy ones. We prefer, at least in our country, to consider seropositive [CMV-lgM] infants suspected of intrauterine infection [less than 6 months] as congenital form. To arrest the natural progression of congenital CMV, we recommend prolonged course of oral analogues of ganciclovir for children with symptomatic congenital CMV

Infection in childhood sensory hearing loss

To evaluate the possible role of infectious agents on the occurrence of idiopathic sensorineural hearing loss [SNHL] in children. This case control study was carried out at Rasul Hospital in Tehran, Iran from 2002-2003. We compared specific serum antibodies [IgG, IgM] measured by enzyme linked immunosorbent assay in 95 sensory hearing loss cases and 63 controls. Acute infections [IgM] detected in cases included: cytomegalovirus [CMV] 34.6%, toxoplasma 11.5%, mumps 8.7%, rubella 5.3%, and herpes simplex 5.3%. Previous infections [IgG] detected in cases included CMV 72%, herpes 6.6%, toxoplasma 26%, mumps 23.3%, and rubella 17.2%. Acute CMV and toxoplasma infections were more frequent in cases. Previous CMV, toxoplasma, rubella, and herpes infections were higher in controls. There was no significant difference for acute mumps, rubella, and herpes infections between cases and controls. These data are compatible with infectious agents having a significant role in the studied idiopathic SNHL cases, but association does not prove causation. We recommend specific drugs for confirmed active infections [CMV, toxoplasma, herpes] in idiopathic SNHL infants diagnosed before their first birthday. Mumps and rubella induced SNHL are preventable with routine vaccination