The effect of oral probiotics on glycated haemoglobin levels in children with type 1 diabetes mellitus - a randomized clinical trial.

INTRODUCTION: Proper control of blood glucose in children with type 1 diabetes has a direct effect on their metabolism and quality of life by reducing the risk of complications. The use of probiotics may have a beneficial effect on glucose levels. PURPOSE: The aim of this study was to evaluate the effect of oral consumption of probiotics on glycosylated haemoglobin in children with type 1 diabetes. MATERIAL AND METHODS: In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes were studied. We created 2 groups of 26 individuals each. The probiotic group received a daily probiotic capsule for 90 days, in addition to routine insulin therapy. The control group received only insulin therapy. Blood samples were taken to measure HbA1c, fasting plasma glucose, and lipid profiles at the beginning and end of the trial. RESULTS: The study showed that HbA1c was high in both groups, but this increase was lower in the probiotic group than in the control group. This difference was not statistically significant. The mean level of fasting plasma glucose in the probiotic group was significantly reduced compared to the control group (p = 0.016). CONCLUSIONS: According to the results of our study, consumption of oral probiotics has no significant effect on HbA1c levels in children with type 1 diabetes mellitus.

Acute infantile liver failure syndrome type 2 in a 2.5-year-old boy: A case report.

Key Clinical Message: Infantile liver failure type 2 is described as repeated attacks of liver dysfunction with remission. This syndrome should be considered in the differential diagnosis of any child with symptoms of recurrent hepatic encephalopathy. Abstract: Infantile liver failure syndrome 2 is described as recurrent attacks of liver dysfunction. ILFS2 should be included in the differential diagnosis of children with frequent and acute liver failure. We present a 2.5-year-old boy with clinical manifestation of acute liver failure. In past, he had two similar attacks.

Anabolic-androgenic anabolic steroids as a probable risk factor for hepatoblastoma in infants.

Key Clinical Message: The etiology of hepatoblastoma (HB) is still unknown; several risk factors have been identified. The only risk factor for the development of HB in presented case was the child's father using anabolic androgenic steroids. It may be a risk factor for developing HB in their children. Abstract: HB is the most common primary liver cancer in children. Its etiology is still unclear. The patient's father's use of androgenic anabolic steroids could be a risk factor for developing HB in his child. A 14-month-old girl was hospitalized with intermittent fever, severe abdominal distention, and anorexia. On initial examination, she was cachectic and pale. There were two hemangioma-like skin lesions in the back. Huge hepatomegaly was found and the ultrasound showed a hepatic hemangioma. The possibility of malignancy was considered due to the severe enlargement of the liver and the increased levels of the alpha-fetoprotein. An abdominopelvic CT scan was performed and finally, the diagnosis of HB was confirmed by pathology. There was no history of congenital anomalies or risk factors for HB.Also we did not find any risk factors in the mother's history either. The only positive finding in the father's history was the use of anabolic steroids for bodybuilding. Anabolic-androgenic anabolic steroids may be one of the possible causes of HB in children.

Evaluation of the risk of malnutrition in hospitalized children by PYMS, STAMP, and STRONGkids tools and comparison with their anthropometric indices: a cross-sectional study.

BACKGROUND: Malnutrition is a determining factor of pediatric mortality and morbidity, especially in low and middle-income countries. Hospitalized children are at a higher risk of malnutrition. Several malnutrition screening tools have been used, among which STAMP, PYMS, and STRONGkids are valid tools with high sensitivity and specificity. The aim of this study was to compare these screening tools to find the best ones in identifying the risk of malnutrition in hospitalized children. METHODS: This is a cross-sectional study performed on hospitalized children aged 1 to 16 years. The questionnaires of PYMS, STAMP, STRONGkids malnutrition risk assessment tools were filled. The weight for height and BMI for age Z-scores were calculated. The data were analyzed by SPSS. Sensitivity, specificity, positive predictive value, and negative predictive values of the risk scores based on weight for height and BMI for age Z-scores were calculated. RESULTS: Ninety-three patients with a mean age of 5.53 ± 3.9 years were included. The frequency of malnutrition was reported as 26% and 39% according to weight for height and BMI for age Z-scores, respectively. A significant relationship was found between PYMS and Weight for height Z-score (P-value < 0.001), and BMI for age Z-score (P-value < 0.001). Moreover, STRONGkids was found to be associated with weight for height Z-score (P-value: 0.017). CONCLUSION: The PYMS is a practical and beneficial tool in early identifying the risk of severe malnutrition in hospitalized patients. It is a suitable method for patients in our settings.

Clinical and Paraclinical Screening for Celiac Disease in Children with Intractable Epilepsy.

BACKGROUND: Celiac disease is the inflammatory entropy caused by hypersensitivity to gluten, which occurs in susceptible individuals. Some studies have suggested a link between celiac disease and epilepsy in children. Our aim was to screen for clinical and paraclinical features of celiac disease in children with intractable epilepsy. METHODS: This was a cross-sectional study. Children aged 2 to 18 years with refractory epilepsy that referred to the pediatric neurology clinic within one year (2018-2019) were enrolled. Demographic and clinical characteristics of patients, especially clinical manifestations of celiac disease, were recorded in a questionnaire. A venous blood sample was sent to determine the total IgA, anti-tTG (IgA), and anti-endomysial antibody (IgA). Endoscopy was performed in cases where the celiac serological test was positive. RESULTS: Seventy children with idiopathic drug-resistant epilepsy (44 boys) were evaluated. The height-for-age index was 49.2% and the weight-for-age index was 38.2% less than normal. Constipation (48.6%), anorexia (25.7%), and abdominal pain (21.4%) were the most common gastrointestinal symptoms. Celiac serological tests were negative in all children. Therefore, endoscopy and bowel biopsy were not performed in any case. CONCLUSION: Celiac disease was not found in any patient with intractable epilepsy. Gastrointestinal symptoms and growth disorders in this group may be related to the underlying disease or medications and not to celiac disease.

Croup Is One of the Clinical Manifestations of Novel Coronavirus in Children.

The manifestations of novel coronavirus are diverse and can manifest through respiratory, gastrointestinal, and even nervous symptoms. Respiratory involvement is usually an upper tract infection or pneumonia but can also present as other forms of pulmonary disorders. A 3-year-old boy presented with cough, hoarseness, and stridor. He was treated with dexamethasone and nebulized adrenaline and a clinical diagnosis of croup was established. After treatment, his symptoms improved for a short time, but suddenly cough exacerbated and was accompanied by respiratory failure and seizures. He was then intubated and mechanically ventilated. Because of the coronavirus epidemic, Reverse-Transcription Polymerase Chain Reaction (RT-PCR) assay was taken from the pharyngeal secretions and was positive. The child was isolated. Due to excessive respiratory secretions and worsening of the general condition, bronchoscopy was performed depicting an image compatible with bacterial tracheitis. He was treated with broad-spectrum antibiotics, antivirals, and supportive care. Finally, after 4 weeks of treatment, the child was discharged in good general condition. Croup is one of the respiratory symptoms of novel coronavirus and can be a risk factor for bacterial tracheitis. Therefore, the presence of clinical manifestations of croup indicates the need for coronavirus PCR testing.

Assessment of Sexual Maturation Among Girls With Special Needs in Tehran, Iran.

BACKGROUND: There is limited data on sexual maturation among girls with intellectual, sensory, or physical disabilities. OBJECTIVES: The present cross-sectional study was conducted to assess the sexual maturation of girls with these disabilities in special schools. METHODS: In this cross-sectional study, we evaluated the onset and progression of sexual maturation in 642 six to 18-year-old girls with intellectual, sensory, or physical disabilities from special schools in Tehran. The participants were selected by multi-stage random sampling. Pubertal stages were assessed by visual inspection and palpation based on the rating scales of Tanner. Stage two (breast budding and pubic hair growth) and stage five were considered the onset and end of puberty, respectively. RESULTS: The mean ages of onset of puberty indicated by breast budding (B2 stage) and by pubic hair growth (P2 stage) were 10.8 ± 1.48 and 10.79 ± 1.64 years, respectively. The process of puberty based on breast budding and pubic hair growth was completed at 15.58 ± 1.85 and 15.59 ± 1.8 years, respectively. The average height at the onset of puberty (stage B2) among participants was 128 ± 28.79 cm and the average weight was 8.31 ± 36.47 kg. CONCLUSIONS: Among our patients, the mean ages of onset of puberty indicated by breast budding (B2 stage) and by pubic hair growth (P2 stage) were 10.8 ± 1.48 and 10.79 ± 1.64 years, respectively. Compared to the data from healthy Iranian girls, our findings indicate that the mean age of pubertal onset among schoolgirls with disabilities is slightly higher than that of their healthy counterparts.