Effect of a newly developed ready-to-use supplementary food on growth indicators in children with mild to moderate malnutrition.

OBJECTIVES: Malnutrition is one of the leading causes of death among children younger than five years. In this study, we aimed to formulate a ready-to-use supplementary food (RUSF), based on local food products, and investigate its efficacy on growth indicators in children with mild to moderate malnutrition. STUDY DESIGN: This is a randomized controlled clinical trial. METHODS: This study was performed in six health centers in Shahr-e-Rey, Tehran, Iran, between April and October 2017. One hundred children, aged 24-59 months, with mild to moderate malnutrition (weight-for-height Z-score [WHZ] between -3 and -1) were randomly assigned to two groups to receive either 1-3 sachets of RUSF or normal diet for 8 weeks. All mothers and caregivers received nutrition education. Growth indicators including weight and height, WHZ, and body mass index (BMI), along with clinical outcomes, were assessed. RESULTS: Children who received RUSF had a significant increase in weight (1.44 ± 0.38 vs 0.7 ± 0.32 kg, respectively, P < 0.001), and BMI (1.2 ± 0.47 vs 0.35 ± 0.33 kg/m2, respectively, P < 0.001) compared with the control group. There was a greater daily weight gain during the first 4 weeks (P < 0.001) and throughout the study (P = 0.013) in the RUSF group. Daily height gain was considerably higher in the RUSF group during the first 4 weeks (P = 0.027). Children in the RUSF group had more improvement in WHZ (1.18 ± 0.41 vs 0.41 ± 0.31, P < 0.001) after supplementation. Besides, 92% of the RUSF and 12% of the control group reached to WHZ > -1 at the end of the study (P < 0.001). There was lower prevalence of diarrhea (12% vs 28.6%, respectively, P = 0.01) and marginally lower fever (16% vs 36.7%, respectively, P = 0.05) in the intervention than in the control group. CONCLUSIONS: A newly developed RUSF improved growth indicators and clinical outcomes in children with mild to moderate malnutrition. CLINICAL TRIAL REGISTRY NUMBER: IRCT2017021315536N6 (registered at www.irct.ir).

Assessment of Thiopurine-based drugs according to Thiopurine S-methyltransferase genotype in patients with Acute Lymphoblastic Leukemia.

For the past half century, thiopurines have earned themselves a reputation as effective anti-cancer and immunosuppressive drugs. Thiopurine S-methyltransferase (TPMT) is involved in the metabolism of all thiopurines and is one of the main enzymes that inactivates mercaptopurine. 6-MP is now used as a combination therapies for maintenance therapy of children with acute lymphocytic leukemia (ALL). In all patients receiving mercaptopurine, there is a risk of bone marrow suppression. TPMT activity is inherited as a monogenic, co-dominant trait. More than 25 variants are known. Genetic testing is available for several TPMT variant alleles. Most commonly TPMT*2, *3A, and *3C are tested for, which account for >90% of inactivating alleles. Differences in DNA that alter the expression or function of proteins that are targeted by drugs can contribute significantly to variation in the responses of individuals.Genotyping may become part of routine investigations to help clinicians tailor drug treatment effectively. This success is mainly due to the development of combination therapies and stratification of patients according to risk of treatment failure and relapse, rather than the discovery of new drugs. The aim of this study was to investigate the effect of genotype or methyltransferase enzyme activity before starting therapy in children with ALL. This can prevent the side effect of thiopurine drugs. In fact, the common polymorphism of this enzyme in population could be a prognostic factor in relation to drug use and treatment of patients with ALL.

The epicardial fat pad sign: analysis of frontal and lateral chest radiographs in patients with pericardial effusion.

The epicardial fat pad sign (EFPS) has been useful in the diagnosis of pericardial effusion on plain frontal and lateral chest radiographs. In this series of 100 cases, including patients with small pericardial effusions, it was positive in 52% of cases, being seen on the lateral view in 41%, on the frontal view in 23%, and on both views in 12%. The authors consider this sign to be the most reliable plain-radiograph finding in the diagnosis of pericardial effusion.

Ultrasonic diagnosis of tumor thrombosis of right renal vein.

Ultrasonography was employeed to diagnose tumor thrombosis of the renal vein and inferior vena cava in a patient with an infiltrating renal cell carcinoma of the right kidney.

Ultrasound evaluation of the nonvisualized gallbladder.

Grey-scale ultrasonography is a relatively new diagnostic modality which can be employed to evaluate the cholecystographically nonvisualized gallbladder and the jaundiced patient. The procedure is simple to perform and causes no discomfort to the patient. Ultrasonography can detect gallstones and differentiate obstructive (surgical) from hepatocellular (medical) jaundice. Frequently, it is also instrumental in diagnosing the cause of biliary obstruction in the patient wiht obstructive jaundice. Eleven illustrative cases are presented in which ultrasonography played a key role in establishing the correct diagnosis.

Calcification of the intrarenal branches of the renal arteries.

Mild to extensive calcification of the intrarenal branches of the renal arteries seen in 13 patients over a period of 12 months is described. This type of renal vascular calcification appeared to be associated with generalised atherosclerosis in patients of advancing age. The association of diabetes mellitus and intrarenal arterial calcification could not be supported by the cases presented here.

Intestinal perforation. An infrequent complication of ventriculo-peritoneal shunts.

Bowel perforation by ventriculo-peritoneal shunts occurred in two children with no abdominal symptoms. The diagnosis in each instance was confirmed by opacification of the colon in one child and the small bowel in the other via contrast medium injection of the distal shunt tubing. "Shuntograms" are recommended for all patients with no readily evident cause of dysfunctioning cerebrospinal fluid-peritoneal shunts.

Congenital renal dysplasia: Osathanondh-Potter type ii polycystic kidneys.

Congenital renal dysplasia represents a group of nonhereditary kidney malformations frequently encountered in infants and children. The dysplasia may involve one or both kidneys totally or segmentally. The clinical presentation and prognosis depend on the extent of renal involvement and further development of the dysplastic renal tissue as well as the severity of coexisting malformations in other organs. The unifying factor in each instance is the characteristic histologic appearance of the dysplastic renal tissue. Congenital multicystic kidney and multilocular renal cyst are the best known members of the group. Radiologic features in conjunction with the clinical picture can suggest the correct diagnosis in most cases.

Ultrasonic evaluation of the unilateral nonvisualized kidney.

There are several techniques for evaluating the nonvisualized kidney. Nephrotomography may be helpful in those patients who have some remaining renal function. Radionuclide renal flow and imaging studies are more sensitive than nephrotomography in detecting hydronephrosis, the most common cause of unilateral renal nonvisualization, but also require some renal function to be of diagnostic value. Diagnostic ultrasound, since it is independent of renal function, is an even more sinsitive indicator of urinary obstruction, detecting those cases where no functioning renal parenchyma is present. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion. When ultrasonography demonstrates a solid mass in the renal fossa, angiography is recommended for definitive diagnosis. When no kidney is identified renal venography may be useful in differentiating between a small nonfunctioning kidney and renal agenesis.

Calcification in undifferentiated abdominal malignancies.

Four cases of undifferentiated abdominal malignancy are reported with a pattern of bizarre dystrophic calcifications. All of the cases had confusing histology and were long-term survivors; two being still alive. We feel that the radial, conglomerate masses of calcification, which do not conform to any organ, should suggest the diagnosis of an undifferentiated malignancy. The differential diagnosis and distinction from other causes of abdominal calcification is discussed.

Ultrasound in diagnosis of congenital hydronephrosis due to obstruction of pelviureteric junction.

The use of ultrasonography in the diagnosis of upper abdominal masses with nonfunctioning kidneys is described. Two cases of congential hydronephrosis due to obstruction of the pelviuretic junction are presented, both of which were diagnosed by B-scan ultrasound examination. Diagnostic ultrasound is a simple, noninvasive and reliable method of differentiating cystic from solid lesions and of assessing whether or not a mass is renal or extrarenal. It is recommended that all patients seen with an upper abdominal mass and/or nonfunctioning kidney be examined by ultrasound.