How common is attention deficit hyperactivity disorder (ADHD) in a cohort of children with functional constipation, and does ADHD treatment improve functional constipation?

Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Functional constipation is common in children and has a significant impact on the quality of their life, affecting both physical and emotional well-being. The aim of this study was to evaluate the frequency of ADHD in functional constipation patients and its treatment effect on constipation. Material and methods: In this clinical trial study, 80 children with simultaneous ADHD and functional constipation were allocated to two equal groups by the block randomization method. One group was treated only with ADHD drugs and the second group was treated for ADHD and functional constipation. Subsequently, the treatment outcome was evaluated in both groups. Results: The frequency of ADHD in functional constipation patients was 13.87%. The frequency of functional constipation recovery in the first and second group was respectively 2 (5%) and 39 (97.5%) (p < 0.001). ADHD treatment has no significant effect on the recovery of constipation. There was no statistically significant relationship between the response to treatment with age, sex and duration of having ADHD and constipation. Conclusions: In patients with simultaneous ADHD and functional constipation, ADHD treatment did not influence the recovery of functional constipation and vice versa.

Administration in Efficacy of Melatonin Reducing Headaches in Children With Migraines and Sleep Disorders: A Randomized Clinical Trial Study.

Objectives: Migraine headache after tension headache is the most common primary headache in children, and sleep disorders can aggravate the symptoms. Melatonin has been proposed in some studies for prophylaxis of migraine headaches. This study aimed to evaluate melatonin's effect on migraine symptoms in children with migraine headaches and sleep disorders. Materials & Methods: In this randomized clinical trial study, all 30 children aged 5 to 15 years with migraine headaches and sleep disorders were referred to the Pediatric Neurology Clinic and enrolled. Patients were randomly divided into two equal groups; the intervention group was treated with melatonin (3 mg daily) and propranolol (1 mg/kg daily), and the control group was treated with propranolol alone (1 mg/kg daily). The severity of the migraine headaches was assessed with PEDMIDAS and a five-point Likert scale. The children's sleep habits questionnaire (CSHQ) assessed children's sleep disorders. The ANOVA and linear regression methods were used to analyze and compare the findings between the groups. Results: Out of 30 children participating in the study, 9 were girls, and 21 were boys. The number of daily headaches one month (P = 0.02) and four months (P = 0.03) after treatment was significantly lower in the melatonin group compared to the control group. Regarding sleep quality, there was no significant difference between the two groups. Conclusion: Melatonin and propranolol could better alleviate migraine headaches than propranolol alone in children.

Evaluation of the Relationship Between Serum and Urine Ferritin Level of Low Birth Weight Infants.

Background & Objective: Iron deficiency before birth or in infancy can cause long-term behavioral and neurological disorders. Measuring serum ferritin is an effective way to diagnose iron deficiency but requires significant blood volume from a low birth weight infant. Therefore, the present study was performed to investigate the relationship between serum and urinary ferritin levels in low birth weight infants. Methods: In this cross-sectional study, 76 infants weighing less than 2500 g were studied. To measure serum ferritin level, 1.5 mL of blood and to measure urinary ferritin level, at least 1 mL of urine was collected from each infant. Then the results were compared. Data analysis was performed using SPSS software version 16, and the significance level was considered less than 0.05. Results: Out of 76 neonates studied, 51.3% were boys, and 80.3% were premature infants. The mean birth weight of infants was 2056.31±318.74 g, and the mean serum and urinary ferritin levels were 134.77±72.35 and 85.55±70.97 ng, respectively. There was a statistically significant relationship between serum and urinary ferritin levels. Also, serum ferritin and urinary ferritin levels had a statistically significant relationship with birth weight and gestational age. The higher the birth weight as well as the age at birth, the higher the serum ferritin and urinary ferritin. Conclusion: According to the findings of this study, measurement of urinary ferritin level can be used as a noninvasive tool for iron deficiency screening in low birth weight infants instead of serum ferritin level.

Evaluation of the Levetiracetam treatment on reduction of epileptic discharges in electroencephalogram in children with epilepsy.

OBJECTIVES: Epilepsy is a relatively common disease in childhood. In some patients, the electroencephalogram (EEG) is abnormal despite the clinical control of seizures. Studies have identified the adverse effects of epileptic discharges on cognition, learning, behavior, and seizure recurrence in children. This study investigated the Levetiracetam effect on epileptic discharges in the interictal phase of EEG in epileptic children. MATERIALS & METHODS: This clinical trial was conducted on 54 epileptic children aged 2 to 15 years, whose clinical seizures were controlled by sodium valproate in the last six months but still had epileptic discharges in EEG. The participants were divided into two groups: an intervention group (21 people), for which Levetiracetam was added to sodium valproate, and a control group (33 people), for which treatment with sodium valproate alone was continued. The patients were then followed for one year. RESULTS: The percent normalization of epileptic discharges in the intervention and control groups was 66.7% and 57.1% (P = 0.500), respectively. Also, the mean time for the normalization of epileptic discharges in the intervention and control groups was 12.60±8.25 and 20.57±12.67 months (P = 0.042), respectively. CONCLUSION: In children with controlled seizures whose EEG was still abnormal, sodium valproate therapy alone and combined with Levetiracetam effectively reduced the severity of epileptic discharges. However, the addition of Levetiracetam to sodium valproate normalized EEG more rapidly.

Evaluation of Helicobacter pylori eradication on the course of childhood nephrotic syndrome and its response to treatment.

Background: Idiopathic nephrotic syndrome is one of the most common glomerular diseases, which may be secondary to infections or systemic diseases. The aim of this study was to evaluate the effect of Helicobacter pylori ( H. pylori ) eradication on childhood nephrotic syndrome. Methods: In this randomized controlled clinical trial study, 38 children with concomitant idiopathic nephrotic syndrome and H. pylori infection were divided into 2 equal groups; the intervention group received a cotreatment for both diseases and the control group received only nephrotic syndrome treatment. Patients were followed for 6 months. Data were analyzed using SPSS 21 software. Chi square test, Fisher exact test, and student t test were used. P value <0.05 was considered statistically significant. Results: The mean interval time from treatment to the recovery of nephrotic syndrome was 48.36±14.48 days in the intervention group and 51.68± 17.32 days in control groups, which was shorter in the intervention group, but not statistically significant. The recurrence of nephrotic syndrome and the mean number of recurrences in the intervention group were lower than the control group, but were not statistically significant. The frequency of diarrhea in the intervention group was significantly higher than the control group (p=0.003). Conclusion: In children with concomitant idiopathic nephrotic syndrome and H. pylori infection, the treatment of both diseases may accelerate the recovery and decrease the recurrence of nephrotic syndrome.

Developmental Screening of Children with Congenital Hypothyroidism Using Ages and Stages Questionnaires Test.

OBJECTIVES: Congenital hypothyroidism (CH) is one of the most common causes of mental retardation in children. We investigated the developmental status of children with CH screened by Ages & Stages Questionnaires (ASQ) measurement scores. MATERIALS & METHODS: In this retrospective study, neurodevelopmental status of 78 children diagnosed with CH followed up at the Outpatient Pediatric Endocrinology Clinic of Besat Hospital, Hamadan, Iran from May 2006 to Mar 2013, was evaluated by ASQ method. Data on age, sex, birth weight, birth length, head circumference, residency location, parental education level, primary venous TSH and T4 levels, age at diagnosis, treatment start age and initial levothyroxine dosage were extracted from medical records. Data were analyzed using statistical software SPSS. P-value less than 0.05 was considered statistically significant. RESULTS: Of the 78 patients, 34 (43.6%) were female, 32 (41%) had developmental disorder, and 56 (71.8%) were living in urban areas. Types of developmental impairments included: global motor delay in 13 (40.6%) patients, problem-solving in 11 (34.3%), impaired communication skills in 5 (15.6%), impaired fine motor skills in 2 (6.2%), and impairment of personal social skills in 1 (3.1%). The average ages for diagnosis and treatment were 25.65 days in patients with developmental impairment and 17.99 days in those without developmental delay. ASQ results showed significant statistical correlation with initial dose of levothyroxine (P=0.017), age of hypothyroidism diagnosis (P=0.002) and age of treatment initiation (P=0.018). CONCLUSION: Early diagnosis and treatment along with initial levothyroxine dose were most important factors of ASQ scores of children with CH. Higher dose of the levothyroxine is required at onset.

Antibacterial resistance patterns of extended spectrum ß-lactamase -producing enteropathogenic Escherichia coli strains isolated from children.

BACKGROUND AND STUDY AIM: This study aimed to determine the antibacterial resistance patterns of extended spectrum ß-lactamase (ESBL)-producing enteropathogenic Escherichia coli (EPEC) isolated from Iranian children and to investigate its genetic patterns. PATIENTS AND METHODS: 192 non-repeats EPEC isolates were collected from stool samples of the children with and without diarrhoea. The EPEC strains were isolated from 1355 stool specimens obtained from 247 children with diarrhoea (0-10 years old; mean age, 5.5 years) and 1108 children without any gastrointestinal symptoms (0-10 years old; mean age, 6.8 years) during the summer months in three Iranian provinces, Tehran, Ilam and Mazandaran. Strains biochemically identified as E. coli were selected and were identified by the presence of eaeA and bfpA as EPEC virulence genes. Antimicrobial susceptibilities were determined by disc diffusion method. The isolates were confirmed to be ESBL producers by the double disk synergy test (DDST). The ß-lactamase genes (blaTEM, blaSHV, blaCTX-M, blaOXA) and insertion sequence ISEcp1 were detected by PCR method. RESULTS: The highest antibiotic susceptibility was detected to imipenem (100%), followed by gentamicin (82.3%) and ciprofloxacin (79.2%). The highest resistance was detected to cefpodoxime (97.9%), trimethoprim (60.7%), and tetracycline (58.4%), respectively. Totally, 153 EPEC strains (79.7%) were ESBL-producing by DDST test. The PCR showed that 84 (43.8%) EPEC isolates were positive for ESBLs encoding genes. Among 153 ESBLs-producing EPEC, TEM was present in 9.2% of isolates. Also, CTX-M and SHV genes were detected in 7.2% and 7.8%, respectively. The SHV positive strains were associated with the highest resistance rate to tetracycline (56.5%), although the TEM and OXA were associated with the highest resistance rate to gentamicin (23.1%) and ciprofloxacin (21.4%). CONCLUSIONS: The study revealed that 79.7% of EPEC isolates from Iranian children were ESBL-producing and were comparable with the non ESBL-producing isolates regarding susceptibility to the antibiotics.

Helicobacter Pylori Infection in Children with Type 1 Diabetes Mellitus: A Case-Control Study.

BACKGROUND: Helicobacter pylori infection is one of the most common chronic bacterial infections. There is challenge on the real rate of prevalence of H. pylori in diabetic patients. This study was done to assess the prevalence of H. pylori infection in children suffering from type 1 insulin-dependent diabetes mellitus. METHODS: In this case-control study, 80 diabetic patients (as the target group) refer to the Endocrinology Clinic of Tabriz Educational and Treatment Center, Tabriz northwestern Iran and 80 non-diabetic patients (as the control group) from the group of children referring to the GI Clinic of the same center  were enrolled in 2012 and 2013. Then H. pylori infection was assessed in two groups using measuring antibody (IgG) and stool antigen (HpSA). RESULTS: H. pylori infection tests were positive in 48 (60%) diabetic patients and in 32 (40%) in non-diabetic patients (P=0.030). There was a meaningful correlation between the frequency of H. pylori and the longer the duration of diabetes (P<0.001). No correlation was seen between H. pylori infection and other factors such as age of the patients (P=0.840), HbA1C level (P=0.312), age at which diabetes was diagnosed (P=0.800), average daily dosage of insulin (P=0.232), and presence of GI symptoms (P=0.430). CONCLUSIONS: Type 1 diabetic children especially cases with the longer duration of diabetes, are at risk acquiring H. pylori infection. Therefore, screening of H. pylori infection is helpful on the follow up of these patients.

Demographic Characteristics of Type 1 Diabetic Children and Adolescents in Hamadan, Iran.

BACKGROUND: Type 1 diabetes mellitus is the most common endocrine disease in pediatric. We aimed to determine the demographic characteristics at presentation of childhood type 1 diabetes mellitus in Hamadan, west province of Iran. METHODS: In this cross sectional descriptive study, demographic data of children with type 1 diabetes mellitus being followed up in Pediatric Endocrinology Clinic of Besat Hospital Hamedan Iran, were analyzed. A detailed record of the required information including the age, sex, Place of living(urban, rural), season, disease presentation, parental consanguinity (1st cousin relation),The mean mother's age at delivery, BMI ,birth seasonality and birth order were collected. The data was analyzed by standard statistical package SPSS, version 15.0. Results with p-value less than 0.05 were defined as statistically significant. RESULTS: In total, 150 patients (85 boys) were included. The mean age at diagnosis was 8.47 (ranged from 2 months to 17.5 years). The peak age of presentation was 5.0 to 9.9 years. The overall male-to-female ratio of patients was similar. The majority of patients (81.3%) were urban. the frequency of disease was higher in summer (34%). BMI of 85.73% of cases was between 5th to 85th BMI percentiles. The frequency of a family history of type 1diabetes in first and second degree relatives was 10.7%. Among the studied patients, 18.7% had parental consanguinity. The mean mother's age at delivery of patients was 25.19 years. Of the studied patients, 82.7% were exclusively breastfeed during the first 6 months of life and 43% were the first child of family. About 13.33% had co -occurring endocrine disease. CONCLUSIONS: This study showed that age at diagnosis and sex of our patients was similar to the world reported. But, seasonal variation is different in our region. The frequency of a family history of type 1 diabetes in first and second degree relatives was relatively high. Hypothyroidism was the most frequently observed co-occurring endocrine disease.

The Etiology, Clinical Type, and Short Outcome of Seizures in NewbornsHospitalized in Besat Hospital/Hamadan/ Iran.

OBJECTIVE: Seizures in neonates are very different from those of older children and adults. The aim of this study was to determine the etiology, clinical presentation, and outcome of seizures in hospitalized neonates of Besat Hospital, Hamadan, Iran. MATERIAL & METHODS: In this retrospective study, we evaluated all neonates with seizures (aged 0-28 days) admitted to the Besat hospital, Hamadan, over a period of three years from September 2008 to September 2011. The data were obtained from hospital records and analyzed using SPSS 12. RESULTS: Seizures were reported in 102/1112 (9.1%) neonatal admissions. Among neonates with seizures, 57% were male and 23.5% were preterm. The mean birth weight was 2936±677 grams and the mean gestational age was 37.60±1.94 weeks. 16.7% of them were LBW and 2.9% VLBW. In terms of seizure type, subtle seizures were observed in 38.2%, tonic in 29.4%, clonic in 26.4%, and myoclonic in 5.9% of cases. The main diagnosis in neonates with seizures included hypoxic-ischemic encephalopathy (HIE) (34.3%), infections (24.4%), intracranial hemorrhage (6.9%), hypoglycemia (5.9%), hypocalcemia (2.9%), inborn error of metabolism (1%), and unknown cause (24.5%). The mortality rate was 14.7%. CONCLUSION: Neonatal seizures indicate a significant underlying disease. HIE was the most common cause of neonatal seizures in our study. Therefore, efforts should be made to improve care during childbirth.

A Study of Methadone-Poisoned Children Referred to Hamadan's Besat Hospital/Iran.

OBJECTIVE: Increasing use of methadone in withdrawal programs has increased methadone poisoning in children. This research aimed to study the causes of incidence of poisoning in children and its side-effects. MATERIALS & METHODS: In this research, The hospital records of all methadone-poisoned children referred to Hamadan's Be'sat Hospital from June 2007 to March 2013, were studied. Children with a definite history of methadone use or proven existence of methadone in their urine, were studied. RESULTS: During 5 years, 62 children with the mean age of 53.24±29.50 months were hospitalized due to methadone use. There was a significant relationship between delayed referral to hospital and increased bradypnea. According to their history, 25.8% and 58.1% of the children had been poisoned by methadone tablet and syrup, respectively. The most common initial complaint expressed by parents, was decreased consciousness (85.5%). During the initial examination, decreased consciousness, meiosis, and respiratory depression were observed in 91.9%, 82.3%, and 69.4% of the cases, respectively. Nine patients required mechanical ventilation. There was a significant relationship between the need for mechanical ventilation and seizure with initial symptom of emesis. There were two cases of death (3.2%), both of which were secondary to prolonged hypoxia and brain death. There was a significant relationship between poor patient prognosis (death) and presence of cyanosis in early symptoms, seizure, hypotension, duration of decreased consciousness, and duration of mechanical ventilation. CONCLUSION: This research indicated that the occurrence of seizure, hypotension, and cyanosis in the early stages of poisoning is associated with an increased risk of side effects and death and are serious warning signs. Early diagnosis and intervention can improve outcomes of methadone-poisoned children.

Prevalence of anabolic steroid use and associated factors among body-builders in Hamadan, West province of Iran.

BACKGROUND: Androgenic-anabolic steroids (AAS) are abused by a growing number of bodybuilders. This descriptive cross-sectional study was conducted to determine prevalence and patterns of AAS use by bodybuilders in Hamadan, western Iran. METHODS: In this cross-sectional study, participants were recruited from five gym clubs in two area of Hamadan (a total of 10 clubs). Twenty-five bodybuilders from each club were administered. Questions investigating demographic information, sport history, education level, general knowledge about AAS, and their side effects were asked. Statistical analysis was performed using SPSS 16. RESULTS: The frequency of AAS use was 28.8% (72/250). Fifty-four percent of users were 25 years or younger. AAS abuse showed a significant association with duration of exercise. The drugs were suggested mostly from peers (43.1%) and coaches (36.1%). The most commonly consumed anabolic steroid was testosterone (66.7%). The most commonly reported AAS side effect was acne (18.1%). There was not significant association between general knowledge about side effects of ASS and their use. CONCLUSIONS: The results of current survey indicate that frequency of ASS use is high in adolescents and young adult bodybuilders. Well educated bodybuilders have a higher prevalence of abuse. Awareness about the side effects of drugs is not deterrent factor for their abuse. Iranian Ministry of Sport and the Youth, and the National Council for Youth, should be urged to conduct more effective prevention strategies.

Infantile extrapancreatic pancreatoblastoma: a report on a rare infantile abdominal mass.

Pancreatoblastoma is an extremely rare tumor in children, especially under 3 months of age. This tumor may arise from any portion of the pancreas, but in more rare cases the ectopic pancreas is the origin. We are reporting a 3-month-old boy who was presented with an abdominal mass. Computed tomography images revealed a huge lobulated mass anterior to the kidneys, with internal calcification and enhancement after intravenous contrast media injection. He underwent a complete surgical resection of the mass that was located in the transverse mesocolon without any connection with the pancreas. Pathologic studies specified that the disease was pancreatoblastoma. His parents refused any chemotherapeutic regimen but continued postsurgical follow-ups.

Wrestlers' immune cells produce higher interleukin-6 and lower interleukin-12 and interleukin-13 in response to in vitro mitogen activation.

OBJECTIVES: Although recent investigations have shown chronic inflammation and inflammation-associated diseases might be ameliorated by exercise; little is known about the relation between exercise training with anti/pro-inflammatory cytokines. MATERIALS AND METHODS: This cross sectional study was conducted to compare interleukin-4 (IL-4), IL-6, IL-10, IL-12, IL-13, interferon gamma (IFN-γ ) levels in serum, and their in vitro production by whole blood (WB) cells and by peripheral blood mononuclear cells (PBMCs) in response to mitogens lipopolysaccharide and phytohemagglutinin. Twelve elite wrestlers with history of three times per week exercise training for about 9.5 years, and thirteen healthy silent controls were recruited. To analysis the cytokines by enzyme linked immunosorbent assay (ELISA), the blood samples were taken 24 hr after the last training session from the wrestlers. RESULTS: Serum analysis for IL-4, IL-6, IL-10, IL-12, IL-13 and IFN-γ indicated no statistical difference between the two groups. Meanwhile, 48 hr in vitro activation of WB and PBMCs by the mitogens revealed that IL-6 production was elevated in both WB and PBMCs. Whereas, IL-12 and IL-13 were decreased in supernatant of PBMCs and WB cells cultures, respectively. CONCLUSION: It seems that wrestling cause immune system cells to produce anti-inflammatory myokine IL-6 and decrease production of pro-inflammatory cytokine IL-12 and IL-13.

Lubrication of circumcision site for prevention of meatal stenosis in children younger than 2 years old.

INTRODUCTION: Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after circumcision in boys in order to reduce the risk of meatal stenosis. MATERIALS AND METHODS: A randomized control trial was performed, in which 2 groups of boys younger the 2 years old underwent circumcision according to the sleeve method. The parents in the study group were instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In the control group, no topical medication was used. The children were followed up regularly and evaluated for meatal stenosis, bleeding, infection, and recovery time. RESULTS: A total of 197 boys in each group completed the study. None of the children in the study group but 13 (6.6%) in the control group developed meatal stenosis (P < .001). Infection of the circumcision site was seen in 3 (1.5%) and 23 (11.7%) children of the lubricant and control groups, respectively (P < .001), and bleeding was seen in 6 (3.0%) and 37 (18.8%), respectively (P < .001). The mean time of recovery in the lubricant group was 3.8 +/- 1.2 days, while it was 6.9 +/- 4.2 days in the control group (P = .03). CONCLUSION: Based on the findings of this study, it seems logical to use a lubricant jelly for reducing postcircumcision meatal stenosis and other complications.