Study of changes in rs2283265 polymorphisms in dopamine receptor D2 and rs27072 in dopamine transporter gene (SLC6A3) in patients with attention-deficit hyperactivity disorder.

Objectives: Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children that lead to numerous complications. This study examined the changes in rs2283265 polymorphisms in the dopamine receptor D2 (DRD2) and rs27072 in the dopamine transporter gene (SLC6A3) in ADHD patients. Materials & Methods: This descriptive-analytical study was performed on children aged 4-12 years with ADHD. In this study, 100 patients in the ADHD group (according to DSM-IV-TR criteria and diagnosed by interview by a child and adolescent psychiatrist) and 100 children in the control group (including patients referring to the pediatrician without hyperactivity) were enrolled. Two polymorphisms rs2283265 and rs27072 in two groups were comparatively investigated using PCR-RFLP method and restriction enzymes. Data were analyzed using SPSS 17. Results: There was a significant correlation between gender and ADHD, and the disease was more common in boys (P=0.021). In this study, there was no significant relationship between ADHD types and frequency distribution of rs2283265 (DRD2) and rs27072 (SLC6A3) polymorphism genotypes (P<0.05). However, there was a significant correlation between distribution of rs2283265 (DRD2) and rs27072 (SLC6A3) polymorphisms and ADHD (P<0.05). Conclusion: It seems that the changes in DRD2 and SLC6A3 genes are associated with ADHD, and study of these genes can be helpful in diagnosis and genetic screening.

Evaluation of response to hepatitis B vaccine in Iranian 6-18-year-old students.

BACKGROUND: Hepatitis B is a dangerous disease with high morbidity and mortality rates all around the world. Vaccination is the most important way to its prevention and control. This cross-sectional study was carried out to study the levels of immunogenicity to hepatitis B vaccine in students. MATERIALS AND METHODS: Six hundred and forty-four students aged 6-18 years including 316 girls and 328 boys were selected from the Chaharmahal Va Bakhtiari province. Selected students had been received three doses of recombinant vaccine (0, 1, and 6 months). Blood samples were taken and the titers of hepatitis B surface antigen were studied. RESULTS: From a total of 644 students, 396 (61.5%) had a titer lesser than 10 mIu/ml and 248 (38.5%) had a titer higher than 10 mIu/ml. Therefore, the level of respond to vaccine with 95% confidence was 38.5% (34.7%-42.4%). Levels of respond to vaccine were related to age, body mass index (BMI), and educational level and were not related to sex and habit of students. CONCLUSION: Reverse significant relation was seen between the respond to vaccine and age and BMI in a way which the titers of antibody were lower in students with higher age and BMI.

The effect of adding ferrous sulfate to methylphenidate on attention-deficit/hyperactivity disorder in children.

Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children with several complications. This study was conducted to investigate the effect of adding ferrous sulfate to methylphenidate in decreasing ADHD symptoms. This study was a double-blind, randomized clinical trial. In this study, 42 nonanemic children with ADHD and serum ferritin below 30 mg/ml were enrolled according to convenience sampling and randomly assigned to two groups of 21 each, cases and controls. The two groups were matched for age and sex. The case group was administered with ferrous sulfate 5 mg/kg in addition to methylphenidate up to 1 mg/kg and the control group with methylphenidate alone. The scores on child symptoms inventory-4 (CSI-4) were recorded at baseline and after 2 months of treatment. Data were analyzed by t-test, Pearson's correlation coefficient, and repeated measures ANOVA in SPSS 16. The scores on CSI-4 decreased significantly at month 2 in both groups (P < 0.001). The scores on attention deficit and hyperactivity subscales of the CSI-4 were significantly lower in the case group than the control group (P < 0.05). The total score on CSI-4 decreased more markedly in the case group (P < 0.04). Use of ferrous sulfate plus methylphenidate can be effective in reducing ADHD symptoms in nonanemic children with low serum ferritin.

Blood Lead Levels in Children of Southwest Iran, Aged 2-6 Years and Associated Factors.

INTRODUCTION: Lead is one of the toxic metals that can cause several complications in children. AIM: This study was conducted to determine Blood Lead Levels (BLLs) in healthy children and its association with individual and environmental factors. MATERIALS AND METHODS: This descriptive-analytical study was conducted on 262 healthy children aged 2-6 years in Shahrekord, Southwest Iran in 2013. After taking serum samples from the children, the checklists of effective environmental factors on lead toxicity were completed after interviewing the parents. BLLs were determined by ICP-MS. Data were analysed by descriptive and analytical statistics (chi-square and ANOVA) in SPSS 16. RESULTS: BLLs ranged 0.4-52.8 (mean: 6.9±7.9) ng/ml. BLL was significantly associated with father's education level, house colour damage, canned food use and soil eating (p<0.05), but not with age, gender, economic status, proximity to factory and kohl use (p>0.05). CONCLUSION: BLL can cause serious health risks for children in Shahrekord and is associated with certain risk factors. It is necessary to screen for these risk factors.

Comparison of amoxicillin and metronidazole effect on three-drug regimen for the treatment of Helicobacter pylori infection in children.

Helicobacter pylori is an important risk factor for chronic gastritis, peptic ulcer, and gastric cancer. Three-drug regimen is the first-line treatment for this infection, but the response rate to treatment varies in different geographical regions. This study was conducted to comparatively determine the effect of amoxicillin and metronidazole on three-drug regimen to treat H. pylori infection in 1-15-year-old children. This clinical trial was conducted on 82 patients aged 1-15 years with convenience sampling referring to the Endoscopy Unit of Hajar Hospital, Shahrekord. Group 1 was administered with clarithromycin, amoxicillin, and omeprazole (CAO), and Group 2 with, clarithromycin, metronidazole, and omeprazole (CMO). One month after completion of the treatment, stool antigen test was used to study the eradication of H. pylori. Data were analyzed using SPSS software by Chi-square test. Three of the 82 patients were excluded from the study because of side effects caused by drugs. Nearly 87.2% of the patients in CAO-treated group and 92.5% in CMO-treated group had response to treatment. There was no significant difference in eradication rate between the two regimens (P = 0.43). The two regimens displayed no superiority over each other for eradicating H. pylori infection and response rate to treatment in children aged 1-15 years.

Phytotherapy with Hordeum Vulgare: A Randomized Controlled Trial on Infants with Jaundice.

INTRODUCTION: Jaundice is one of the most common causes of admission to hospital in newborns which is often associated with several complications. AIM: The present study was conducted to evaluate the effect of H. vulgare in reducing jaundice. MATERIALS AND METHODS: In this double-blind, randomized controlled trials 70 term infants hospitalized due to jaundice in 2014 were enrolled. Control group was treated with full-time phototherapy alone using LED except when the infants were breastfed and case group with phototherapy, as per the protocol in the control group, along with and topical H. vulgare seed flour three times a day. Data were analysed using and analysis of covariance (ANCOVA) and paired t-test in SPSS version 16.0. RESULTS: There was a significant difference in mean indirect bilirubin level between the two groups p<0.05, such that the mean indirect bilirubin level was higher in the control group. Furthermore, no significant difference was seen in direct bilirubin level between the two groups at discharge p>0.05. CONCLUSION: H. vulgare flour can cause decrease in indirect bilirubin. Because the rate of decrease in indirect bilirubin can be effective in preventing severe complications due to bilirubinemia, H. vulgare can be used as a complementary therapy to treat jaundice.

Association between Interleukin-10-1082 G/A and Tumor Necrosis Factor-α 308 G/A Gene Polymorphisms and Respiratory Distress Syndrome in Iranian Preterm Infants.

Cytokine polymorphisms may contribute to the prevalence of respiratory distress syndrome. The present study was done to investigate the frequency of interleukin- (IL-) 10 and tumor necrosis factor- (TNF-) α gene polymorphisms and their association with the risk of RDS in preterm infants. One-hundred and nineteen patients with RDS and 119 healthy preterm infants were enrolled. PCR restriction fragment length polymorphism was used to determine the frequency of IL-10 and TNF-α genotypes at -1082 A and -308 A, respectively. One-hundred and nineteen out of 238 infants had RDS (50%). The age of the mothers and gestational age ranged 17-45 (mean: 28.6 ± 5.3) years and 24-34 (mean: 34.3 ± 2.38) weeks, respectively. Totally, 23 deaths were recorded in the RDS group. Incidence of TNF-α-308 A/A and TNF-α-308 G/A was 84% and 16%, respectively. TNF-a-308 G/G was not found in both groups. Prevalence of IL-10-1082 G/G and IL-10-1082 G/A variants was 65.5% and 34.5%, respectively. IL-10-1082 A/A was not found in both groups. The incidence of the allele G in the IL-10-1082 polymorphism was lower in RDS group (P < 0.05). We found that the risk of RDS was correlated to sex, gestational age, and IL-10-1082.

Effect of folic acid and metformin on insulin resistance and inflammatory factors of obese children and adolescents.

BACKGROUND: Considering the increasing trend of obesity, especially in developing countries such as Iran, and the role of inflammatory factors and insulin resistance (IR) in the occurrence of obesity-related complications as well as the safety of some agents such as folic acid and metformin, this clinical trial was designed to investigate the effect of metformin and folic acid on inflammatory factors and IR among obese children. MATERIALS AND METHODS: In this randomized, double-blind, controlled clinical trial study, sixty obese children aged 6-12 years were enrolled. Selected obese children were randomly allocated in two interventional (1 mg/daily folic acid or 1000 mg metformin for 8 weeks) groups. Biochemical measurements including homeostasis model assessment of IR (HOMA-IR), homocysteine (Hcy), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) were measured between and within the groups before and after trial. RESULTS: In each group, thirty obese children were studied. The groups were age- and sex-matched. After folic acid and metformin administration, mean of Hcy, HOMA-IR, TNF-α, and IL-8 decreased significantly (P < 0.05). IL-6 decreased significantly after folic acid use (P < 0.05). CONCLUSION: The findings of this trial indicated that both metformin and folic acid could decrease IR and level of Hcy in obese children and adolescents. The effectiveness of metformin on IR was more significant than folic acid. Regarding the effectiveness of the two studied agents on inflammatory factors, it is suggested that the role of folic acid was superior to metformin. It is suggested that metformin is a proper agent for obese children with IR and folic acid is an appropriate supplement for obese children with increased inflammatory factors.

Effect of Phenobarbital on Nitric Oxide Level in Term Newborn Infants with Perinatal Asphyxia.

OBJECTIVES: Perinatal asphyxia (PA) is very significant in perinatal medicine due to the involvement of the central nervous system. This study was conducted to investigate the biochemical, clinical, and paraclinical changes associated with phenobarbital administration in neonates with PA. METHODS: In this prospective, case-control study, 30 neonates with PA in two groups of 15 each (case and control) were investigated. The case group received 20 mg/kg intravenous phenobarbital within six hours of birth, and the control group did not receive phenobarbital. Serum concentrations of nitric oxide (NO) were measured at enrollment and one week after birth in the two groups. Clinical, electroencephalography, and magnetic resonance imaging findings of the two groups were compared. RESULTS: At enrollment, the two groups did not differ in clinical severity, seizure incidence, or NO concentration. After one week, NO concentration was significantly lower in the case group (p < 0.050), but there was no significant difference in other variables between the two groups. CONCLUSIONS: Early administration of phenobarbital in term neonates with PA could protect them against encephalopathy.

Protective Effects of Hydroalcoholic Extract of Ferulago Angulata Against Gentamicin-induced Nephrotoxicity in Rats.

INTRODUCTION: Gentamicin can lead to acute tubular injury and kidney dysfunction. This study aimed to evaluate the effect of Ferulago angulata on kidney function and other markers in rats with gentamicin-induced nephrotoxicity. MATERIALS AND METHODS: Forty-eight male Wistar rats were divided into the following groups: group 1, the controls; group 2, rats receiving gentamicin (120 mg/kg body weight per day, intraperitoneal) for 7 days without treatment; groups 3, 4 and 5, rats receiving gentamicin for 7 days and oral treatment with 200 mg/kg, 400 mg/kg, and 800 mg/kg body weight per day of Ferulago angulate extract, respectively. Measurements included serum levels of creatinine, urea, uric acid, lipids, ferric-reducing antioxidant power, and protein carbonyl; kidney and serum levels of malondialdehyde; and serum and renal levels of tumor necrosis factor-α. Histopathology of kidney tissue was examined as well as renal catalase, superoxide dismutase, and vitamin C. RESULTS: Compared to treatment with gentamicin only, treatment with Ferulago angulata resulted in a significantly higher high-density lipoprotein cholesterol, ferric-reducing antioxidant plasma, renal catalase, superoxide dismutase, and vitamin C levels. It was also associated with significantly lower serum levels of creatinine, urea, uric acid, malondialdehyde, protein carbonyl, tumor necrosis factor-α, total cholesterol, triglyceride, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol. Ferulago angulate was linked with a lower renal gene expression of tumor necrosis factor-α. CONCLUSIONS: The present study suggests that Ferulago angulate extract has protective effects against nephrotoxicity due to gentamicin.

Cotoneaster: A Safe and Easy Way to Reduce Neonatal Jaundice.

INTRODUCTION: Consumption of cotoneaster may reduce neonatal jaundice. AIM: Hence this study was undertaken to determine the effect of mothers' cotoneaster consumption on treatment of their neonates' jaundice. MATERIALS AND METHODS: In this randomized clinical trial study, 120 neonates with jaundice referred to a hospital in southwest Iran were enrolled by nonprobability sampling and divided randomly into four groups. In the first group both mothers and neonates received cotoneaster; in the second group only mothers; in the third group only neonates; and in the fourth group the neonates received distilled water as placebo. Phototherapy was done under the same condition for all neonates. RESULTS: The reduction of bilirubin was significantly higher in treatment groups compared to control group (p<0.05). Bilirubin in the group of neonates whose mothers consumed cotoneaster was less compared to control group at 24 and 36 hours (p<0.05) and the highest reduction in bilirubin was observed in the first group. The mean duration of hospitalization was longer for the control group (p<0.05). CONCLUSION: Consumption of cotoneaster by both mothers and neonates caused a decrease in neonatal jaundice more rapidly compared to other groups and decreased the duration of hospitalization. Cotoneaster consumption by mothers, neonates, or both may be useful in treatment of neonatal jaundice.

Molecular characterization of nosocomial Clostridium difficile infection in pediatric ward in Iran.

Clostridium difficile is recognized as a major cause of nosocomial acquired antibiotic-associated diarrhea and pseudomembranous colitis. It is a significant financial burden on modern healthcare resources. This study aimed to assess the molecular characterization of C. difficile strains isolated from children under 5 years old suffered from nosocomial diarrhea. One hundred diarrheic and 130 non-diarrheic fecal samples were collected from pediatrics less than 5 years old. Samples were cultured and C. difficile isolates were subjected to the PCR technique to study the distribution of ribotypes of C. difficile using P3 and P5 primers. Fifty-two out of 100 samples (52 %) were positive for C. difficile. The prevalence of bacterium in healthy children was 4.61 %. Total prevalence of C. difficile in diarrheic girls and boys were 48.9 and 54.7 %, respectively. Thirteen to twenty-four month age children had the highest prevalence of C. difficile. The most commonly detected ribotypes in the C. difficile isolates of Iranian pediatrics were RT027 (11.52 %), R1 (9.61 %) and R13 (7.68 %). The ribotypes of all of the six bacterial isolates of healthy children was not diagnosed. According to the presence of C. difficile and R27 ribotype, a continued genotype surveillance of this bacterium is necessary to monitor changes in the prevalence of certain strains and to identify the emergence of new strains that could affect future vaccine strategies.

Therapeutic effects of Ventolin versus hypertonic saline 3% for acute bronchiolitis in children.

BACKGROUND: Complications of Ventolin as the most common drug used for bronchiolitis are widely known. The present study was conducted to determine the efficacy of hypertonic saline 3%, compared with Ventolin, for treatment of acute bronchiolitis in children. METHODS: This double-blinded clinical trial study was conducted in Hajar Hospital, Shahrekord, Iran, from 2011 to 2012. A total of 70 patients under the age of two years with bronchiolitis were divided into two groups of 35 each. Ventolin nebulizer and hypertonic saline 3% nebulizer three times per day were administered in the first (Ventolin) and second (Hypersaline) group, respectively. The length of recovery was compared between the two groups. The data were analyzed by SPSS software (version 22) using chi-square, t-test, paired t-test, and Mann-Whitney. RESULTS: The mean±SD length of recovery was 4.14±0.9 and 3.06±0.6 in the Ventolin and hypersaline groups, respectively. The mean duration of recovery was significantly lower in the hypersaline group (p<0.001). CONCLUSION: Hypertonic saline 3% nebulizer has more pleasant therapeutic effects on acute bronchiolitis than Ventolin. Therefore, use of hypertonic saline 3% nebulizer is recommended for the treatment of acute bronchiolitis in children under two years old.

Case Presentation of a 23-Month-old Herpes Simplex Virus-infected Girl with Brain and Oesophageal Involvement.

Herpes simplex virus (HSV) is the most common identifiable cause of serious or life threatening sporadic, endemic encephalitis. Typical HSV encephalitis in patients outside neonatal age is caused by HSV-1. A 23-month-old girl was referred to our hospital with a three-day history of fever, listlessness, slurred speech, and suspicious oesophageal foreign body impaction. Laboratory evaluations showed white blood cell count of 10900 /mm3 with 65% neutrophils. Upper endoscopy revealed diffuse severe ulceration in middle to distal third of oesophagus and no foreign body was found in oesophagus or stomach. Parenteral acyclovir was prescribed for herpes encephalitis in addition to antibiotics for central nervous system infection. Chest X-ray and brain MRI was unremarkable. Lumbar puncture revealed normal protein and glucose with 10 white cell count. She developed a raising liver enzyme tests. Total and direct bilirubin was 1.2 mg/dc and 0.2 mg/dc respectively. Because of neurological symptoms, acyclovir was adopted for our patient from the beginning. The girl did not respond to medication and died after 28 days. Progression of her disease prior to referral appears to contribute to the administered treatment inefficacy. Severe rapid progression of disease prior to referral and potential resistance to acyclovir could cause treatment failure.

Prevalence of Nosocomial Diarrhea Due to Adenoviruses 40 and 41 in a Paediatric Ward in Iran.

BACKGROUND: Enteric adenoviruses 40 (Ad40) and adenovirus 41 (Ad41) have been shown to be a significant cause of paediatric gastroenteritis worldwide, but no data are available for nosocomial diarrhea due to adenovirus in Iran. AIM: The present study was performed to determine the incidence of Ad40 and Ad41 in children less than five years with nosocomial diarrhea in Shahrekord, southwest Iran. MATERIALS AND METHODS: Adenovirus was detected by polymerase chain reaction (PCR) in stool samples collected during one year (2010-2011) from children less than five years with nosocomial diarrhea admitted to a paediatric center in Shahrekord, Iran. Nosocomial diarrhea was defined as those occurring more than 72 hours after admission to hospital for non-diarrheal causes. PCR technique was used for investigation of Ad40 and Ad41. RESULTS: In total of 100 samples, Ad40 and Ad41 DNA was found to be positive in 14/100 (14%), and 8/100 (8%) of diarrheic patients less than five years, respectively. CONCLUSION: Ad40 and Ad41 are important causes of nosocomial diarrhea in less than five-year, hospitalized Iranian children.

Prevalence of Heptavalent Vaccine-related Pneumococcal Serotypes in Nasopharyngeal carrier in children under five years old in Shahrekord, Iran by Multiplex-PCR during 2010- 2011.

BACKGROUND: Heptavalent pneumococcal vaccine which included pneumococcal serotypes 4, 6B, 9V,14, 18C, 19F and 23F has been regularly used and is effective on preventing invasive pneumococcal infection. This study aimed to determine vaccine-related serotype distribution in nasopharyngeal carrier and healthy children under five years old. MATERIALS AND METHODS: In this cross-sectional study from September 2010 to September 2011, 363 nasopharyngeal specimens were collected from healthy children in day care centers. In positive cultures of streptococcus pneumoniae (S. pneumonia) distribution, serotypes were detected by Multiplex polymerase chain reaction (PCR). Electrophoresis of PCR products was used for detection of serotypes of S. pneumoniae. RESULTS: The carrier rate of S. pneumoniae was 29.5% with 95% confidence interval as 24.8- 34.5%. Electrophoresis of PCR products for detection of serotypes of S. pneumonia revealed 430, 220, 753, 189, 573, 304, and 384 bp (s) for 4, 6B, 9V, 14, 18C, 19F, and 23F serotypes of S. pneumoniae, respectively. The frequency of 23F, 6B, 19F, and 18C serotypes were 43%, 34%, 18%, and 5% respectively, but other serotypes (4, 9V and 14) were not detected. CONCLUSION: Based on the 30% carrier rate and high prevalence of most of heptavalent pneumococcal conjugate vaccine serotypes in our study, this vaccine should be used for prevention of invasive infection in Iranian children.

A comparison of the efficacy of amoxicillin and nasal irrigation in treatment of acute sinusitis in children.

PURPOSE: The efficacy of antibiotic therapy for acute sinusitis is controversial. This study aimed to compare the efficacies of amoxicillin with nasal irrigation and nasal irrigation alone for acute sinusitis in children. METHODS: This randomized, double-blind, controlled study included 80 children aged 4-15 years with a clinical presentation of acute sinusitis. Patients were randomly assigned to receive either amoxicillin (80 mg/kg/day) in 3 divided doses orally for 14 days with saline nasal irrigation (for 5 days) and 0.25% phenylephrine (for 2 days) or the same treatment without amoxicillin. Clinical improvements in their initial symptoms were assessed on days 3, 14, 21, and 28. RESULTS: On day 3, patients in the amoxicillin with nasal irrigation group showed significant clinical improvement (P=0.001), but there was no significant difference in the degree of improvement between the amoxicillin with nasal irrigation and nasal irrigation alone groups during follow-up (P>0.05). In addition, no significant differences were seen in age, sex, and degree of improvement between groups (P>0.05). CONCLUSION: High-dose amoxicillin with saline nasal irrigation relieved acute sinusitis symptoms faster and more often than saline nasal irrigation alone. However, antibiotic treatment for acute sinusitis confers only a small therapeutic benefit over nasal irrigation.

Effects of synbiotics on treatment of children with failure to thrive: A triple blind placebo-controlled trial.

BACKGROUND: Failure to thrive (FTT) is a common problem of children especially in underdeveloped countries. In addition to its short-term adverse health effects, it is associated with long-term behavioral and cognitive defects. One of the recommended treatment modalities for FTT is using synbiotics. Due to high prevalence of FTT with undefined organic causes and failure of most medications on treatment of this type of FTT, we decided to search the effect of synbiotics on these patients. MATERIALS AND METHODS: A randomized, triple-blinded, placebo-controlled trial study was done from 2011 to 2012. A number of 84 patients were randomly assigned to intervention and control groups. The synbiotics sachets were administered to study group for 6 months. The growth indices were measured at the beginning of the trial after 3 and 6 months, and compared with control. RESULTS: Variance analysis of observations showed improvement of growth indices in both groups. The increase in weight was significantly higher in synbiotics group than in controls (P < 0.05). The corresponding figure was not significant for height and head circumference (P > 0.05). At the beginning of the trial, the mean weights were 10.25 ± 0.20 kg and 10.750 ± 0.160 kg in intervention and control groups, respectively, Meanwhile, after 6 months, the mean weights of two groups became 12.280 ± 0.190 and 11.760 ± 0.17 kg in intervention and control groups, respectively. This result has confirmed that the effect of synbiotics is significant on weight gain of our patients. CONCLUSION: Our findings support beneficial effects of synbiotics in weight gain of children with FTT.