فهرست مطالب آذر دخت طباطبایی

Helicobacter pylori (H. pylori) is a highly prevalent, serious and chronic infection. It been associated causally with a diverse spectrum of gastrointestinal disorders including chronic gastritis, peptic ulcer disease, gastric adenocarcinoma. We conducted a study to Evaluation of the role of breastfeeding and breast milk on the colonization of H. pylori in the gastrointestinal tract of 2-24 month old.

This cross-sectional study was performed on 92 children referred to Ali Asghar Hospital of Iran University of Medical Sciences for two years (from July 2015 to June 2017). At first, a questionnaire was recorded by the neonatal specialist including demographic and clinical characteristics of the infants. Stool samples were taken from infants at 2, 6, 12, and 24 months of age. We used the H. pylori stool antigen test to detection infection in the selected group of children. H. pylori status was evaluated by an enzyme-linked immunosorbent assay (ELISA).

In the study of breastfeeding at 12 months of age, 51.1% were fed only dry milk and 28.3% were breastfed only. At 24 months, 22 infants (24%) were breastfed with supplemental feeding and 54 children (58.7%) were  formula-fed only and 8 children (8.7%) were breastfed only. In our study, the prevalence of H. pylori in infants of Tehran, at 2, 6, 12, and 24 months, were 0%, 6.5%, 15.21%, and 34.4%, respectively. Of the 92 children studied, during the first month, 25 children (27.2%) only formula-fed and 49 children (53.3%) were breastfed only and (19.6%) 18 infants were breastfed with dry milk. The prevalence of H. pylori infection was 28.3%. The prevalence of H. pylori infection was 20% in the breastfeeding group and 44% in the infant dry milk feeding group. The prevalence of H. pylori antigen was greater than 12 IU/ml in infants 2, 6, 12, and 24 months of age, including 19.92 (20.6%), 19.92 (20.6%), 24.92 (26.1%) and 21.92 (22.8%), respectively.

According to the findings of the article, breastfed children compared to formula-fed children were less infected by Helicobacter pylori.

This study was conducted to determine microbial contamination of mobile phones in Headworkers of the Rasool Akram hospital, in Tehran,Iran, and identify the most important microbial species associated with these phones .

 The analysis of a total of 130 samples was done to identify fungal and bacteria isolates. Sterile swabs were firmly passed on the handset, the buttons and the screens of mobile phones, and then inoculated into media of bacteria and fungi. Frequency distributions of isolates were calculated.

There were 34 isolated of the following bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Bacillus spp, and Enterobacter aerogenes at the rate of 23.5%,23.5%,2.9%,23.5% and 11.7%, respectively. There were 3 fungal isolates as follows: Aspergillus fumigatus, candidia spp .

The study showed that all mobile phones under consideration were infected by several microbes, most of which belonged to the natural flora of the human body as well as airborne fungi and soil. This means that it is necessary to sterilize hands after contact with a phone since it is a source of disease transmission.

Sexually transmitted infections are the most common human infections that lead to severe complications. Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) are common and important cause of genitourinary tract infections. MG is a member of genital mycoplasmas which is emerging as an important causative agent of sexually transmitted infections both in males and females. This study aimed to determine the prevalence of UU and MG in pregnant women and to assess the risk factors which may contribute to the predisposition of the individuals to the infection. In this cross-sectional study, The population of 210 pregnant women admitted to the Rasoul Akram Hospital in Tehran, were selected for the study using non-random sampling. The urine specimens were collected from 194 pregnant women from May to December, 2015. The samples were transferred to the Infectious Disease Research Center of Rasoul Akram Hospital under sterile condition. Samples were exposed to DNA extraction followed by multiplex polymerase chain reaction (PCR) to detect the infection. Data including sex, age, history of abortion, history of genitourinary tract infections were collected subsequently. The prevalence of MG and UU infections in urine samples was 5.6%, 11.2%, respectively. The mean and standard deviation of the risk of UU was 2.08 (3.56-1.22) in women with a history of abortion and 0.70 (1.03-0.47) in women without a history of abortion. There was a significant relationship between the history of sexually transmitted diseases and the frequency of UU (P<0.022). From 22 patients with UU infection, six patients had a history of sexually transmitted diseases. A significant correlation was found between prevalence of MG and UU infections. The History of abortion was significantly related with the frequency of UU and MG infections. The prevalence of MG infection is negatively correlated with pregnancy trimesters. The History of genitourinary tract infections was significantly associated with the frequency of UU. The presence of UU and MG could be associated with abortion.

Pseudomonas aeruginosa as a major threat in the hospital environment is the most frequently isolated Gram-negative organism in wound infections, pneumonia, urogenital sepsis, and severe burns. One of the most worrying characteristics of this bacterium is its low antibiotic susceptibility. Additionally, P. aeruginosa has an innate ability to adhere to surface and form biofilms particularly difficult to eradicate. Biofilm formation is an important bacterial survival strategy. In humans, biofilms are responsible for numerous pathologies usually associated with use of medical devices and antimicrobial activity. Current study is aimed to evaluate the biofilm formation potency and antimicrobial activity among P. aeruginosa isolated from patients with urinary tract infection (UTI).
Urine related isolates detected by biochemical tests such as OF, SIM, TSI and Oxidase. Susceptibility test done based on Kirby Bauer method and antibiotics were selected based on CLSI. Biofilm formation assay done by Microplate method and finally read at 495 n.m. Results analyzed by t-student method on SPSS-software version19.
81 P.aeruginosa isolates collected form UTI samples. Resistance pattern for Tobramycin (Tob), Imipenem (Imp), Gentamicin (GM), Piperacillin (Pip), Ceftazidime (Caz), Cefoxitin (CF), Ciprofloxacin (Cip) were 23.45%, 6.17%, 24.69%, 11.11%, 21%, 75.3% and 23.45%. Additionally, 25.93% isolates had no potential to form biofilm but 5.185%, 17.6% and 16.06% were (Weakness), (Moderate) and potency (Strength).
Our finding indicates 74.08% isolates had ability to form biofilm and 16.06% isolates form biofilm straightly. Most antimicrobial resistance were observed against GM and CF. Moreover, In addition to the genetic elements, biofilm formation can be considered one of the main reasons for resistance to antibiotics.

Convulsion is one of the common cause of hospital admission in children. Idiopathic seizure is when no anatomic, electrolytic, metabolic or hemorrhagic causes are found. Recently, lead poisoning, which is considered when serum lead levels are higher than the normal levels (previously 10 μg/dl changed to 5 μg/dl). Even lower levels of lead inflict harmful consequences in central nervous system (CNS) development in pediatric group. Due to air pollution and high lead level in air of Tehran, investigation the probable role of lead in producing or predisposing convulsion in children is very important. To determine the cerebrospinal fluid (CSF) lead level in children with idiopathic convulsion in compare with nonconvulsive ones (control). A case-control study upon 60 children (30 convulsive and 30 nonconvulsive control) admitted in Rasoul Akram and Ali Asghar University Hospitals, Tehran, from 2012 to 2013 had done. One ml of CSF obtained and lead level determined by atomic absorption test. The mean age between cases and controls was not different (mean= 30.18+27.36 vs 25.46±20.56 months, P= 0.1). The CSF lead level (μg/dl) had not meaningful difference between 2 groups (3.43+3.07 vs 2.78+2.77, P= 0.3), and no related to type of convulsion in cases (P= 0.7), the area under the curve (AUC) was 0.588; 1-0.433, P= 0.2). The CSF lead cutoff was 1.65 μg/dl; sensitivity of 70%, specificity of 46%, PPV and NPV was 56% and 60% respectively. The toxic blood level for lead is 3.5 μg/dl. The CSF lead level; even in little amount (1.65 μg/dl) is an acceptable sensitivity but lower specificity for differentiation the convulsive from nonconvulsive children. Although the role of genetic and other causes should be considered in idiopathic convulsion, probably, the high level of lead in CSF could predispose those children to convulsion. It can effect CNS development in children even in small amounts. Indeed, long-term effects of lead which continue to adulthood should be considered as well. Hence, it is paramount to rectify the ambient air lead pollution in Tehran.

Helicobacter pylori (H. pylori) cause various diseases especially gastrointestinal disorders. Clinical diagnosis of H. pylori infection can be done in different ways، and new diagnostic methods are under study. This study aimed to assess the levels of interleukin (IL) 6، 17 and 23 in the middle ear effusion of patients with otitis media، and the association between these levels with H. pylori infection. This cross-sectional study conducted in 40 patients who nominated for ventilation tube (VT) placement due to otitis media with effusion، and admitted to ear، nose، and throat (ENT) clinics of Tehran University of Medical Sciences from March 2012 to August 2013. All of patients underwent myringotomy with VT insertion، and then aspirated effusion sample was tested. H. pylori infection diagnosed by polymerase chain reaction (PCR) and bacterial culture. The concentration of IL-6، IL-17 and IL-23 measured by enzyme-linked immunosorbent assay (ELISA). The levels of each interleukins were compared between the two positive and negative PCR groups. In all of samples، PCR test result was positive in 22. 5%. The mean and standard deviation of IL-6 level was 10. 11±2. 95، IL-17 was 5. 89±0. 91 and IL-23 was 4. 07±1. 34. The mean±standard deviation (SD) of IL-6 level in patients with a positive PCR (H. pylori) was 22. 29±6. 40 and in patients with a negative PCR was 6. 16±3. 88 that difference was significant (P=0. 01). The mean±SD of IL-17 level in patients with a positive PCR was 6. 16±1. 29 and in patients with a negative PCR was 5. 81±1. 13 that difference was not significant (P=0. 42). The mean±SD of IL-23 level in patients with a positive PCR was 6. 15±3. 77 and in patients with a negative PCR was 3. 42±1. 33 that difference was not significant (P=0. 27). According to finding، association between H. pylori infection and increased levels of IL-6 in the middle ear effusion was approved. It is recommended to conduct researches aimed to identify other cytokines as inflammatory markers.

Cerebrospinal Fluid (CSF) culture for distinction between aseptic and bacterial meningitis can be difficult and long-term, and other diagnostic methods are under studying. This study aimed to assess the diagnostic value for the levels of Interleukin 1 (IL-1), IL-6 and IL-8 of CSF in the children and adolescent with meningitis. Fifty-one patient with meningitis between one month and 18 year included in a Cross-Sectional Studies in the Rasul Hospital, Tehran, from 2012 to 2014. All of samples underwent aspiration of CSF. The routine tests performed that include culture; coloring and biochemical of CSF. The concentrations of IL-1, IL-6 and IL-8 were determined by Enzyme-linked immunosorbant assay (ELISA) method and all of data were analyzed. Frequency of bacterial and aseptic meningitis was equal (49%). 64.7% of samples were boys and gender had not different between two bacterial and aseptic group (P=0.7). Mean (±SD) of the age in total was 358.46±858.40, and bacterial group had a higher mean of age than aseptic group (P=0.047). The level of IL-1 was 10.87±37.04 pg/ml in bacterial and 0.55±1.64 pg/ml in aseptic group, that had not different (P=0.168). The level of IL-6 was 90.51±139.3 pg/ml in bacterial and 21.36±67.84 pg/ml in aseptic group, that had significant different (P=0.030). The level of IL-8 was 365.40±765.52 pg/ml in bacterial and 50.66±59.34 pg/ml in aseptic group, that had significant different (P=0.047). Diagnostic value of IL-1 was noted in the 80.77% of bacterial and 68.00% of aseptic group that had not different (P=0.349). Diagnostic value of IL-6 was noted in the 53.85% of bacterial and 64.00% of aseptic group that had not different (P=0.572). Diagnostic value of IL-8 was noted in the 80.77% of bacterial and 28.00% of aseptic group that had significant different (P=0.000). There was not different between two group of CSF variables include coloring degree, WBC and RBC index, glucose and protein. Although the concentration of IL-6 and IL-8 was higher in bacterial meningitis than in aseptic patients, only IL-8 had suitable diagnostic value for distinction between different types of meningitis.

Assessment of the serum lead’s concentration in the newborn immediately after birth can be effective for the detection of lead poisoning in the early stages and prevent of developmental disorders and neuropsychiatric behaviors. This study aimed to assess the serum lead levels of cord blood in some of the hospitalized newborns. This cross-sectional analytic study conducted in the newborns ward of two hospitals (Rasoul Akram and Akbar Abadi) From December 2011 to October 2012 in Tehran, Iran. After non-probability sampling, 60 newborns in the first days after birth, underwent the cord blood sampling and the cord blood lead levels were measured by atomic absorption spectrophotometer. Then all of data were collected and analyzed. The serum lead concentration greater than 5 μg/dl was considered valuable. In total, 61.4% of samples were boys. The mean (±SD) of gestational age was 37.4±2.64 weeks and mean (±SD) of birth weight was 2701±642.8g. The mean (±SD) of maternal age was 29.20±6.73 years. 70% of mothers were urban. 13% of mothers had a history of drug use, and 5% were current smokers. The mean (±SD) of the serum lead level of cord blood was 2.97±2.24 μg/dl. This level was not associated with fetal gender, place of residence, drug history and current smoking. This level in the 16.7% of samples was greater than 5 μg/dl (high risk cases). High risk level was associated with maternal age, weight and fetal age (P=0.02, P=0.004, P=0.03), but this level was not associated with fetal gender, place of residence, drug history and current smoking. Serum lead level of cord blood was relatively higher than other studies, although the prevalence of the high risk newborns (serum blood lead levels greater than 5 μg/dl) was low. Further research has recommended assessing the serum lead level in other newborns in the different areas to identify risk factors of neuromotor outcome in infants to prevent.

Toxic shock syndrome (TSS)، a dangerous consequence of Toxic shock syndrome toxin-1 (TSST-1) caused by Staphylococcus aureus. The early detection for infections of Staphylococcus aureus in burned children is very important، also the prevention for consequences of TSST-1. Fever is one of the most noticeable sign in burned children. On the other hand، fever is one of the important consequences of TSST-1 production. This study aimed to assess the toxic shock syndrome toxin-1 level in the wound’s specimens of two groups febrile and afebrile in the hospitalized burned children in Motahari hospital Tehran، Iran in the year 2013. In this case-control study، 90 children who admitted to the burn unit، divided in two groups of 45 patients: febrile (cases group) and afebrile (control group). All of burned children under went wound biopsy، and then all of wound’s specimens were tested by PCR for specific primer of toxin producing genome. Finally all of data collected and statistically analyzed. This data include group febrile and afebrile، demographic characteristics، percentage of burned surface severity and result of PCR. The positive result for PCR test، production of TSST-1 in febrile burned children (cases group) was 37. 7% and in afebrile burned children (control group) was 11. 1% that this different was statistically significant (P=0. 003). The mean and standard deviation for percentage of burned surface (severity) in samples with positive result for PCR test was 30. 9±16. 93 and in samples with negative result for PCR test was 20. 09±11. 02 that this different was statistically significant (P=0. 01). There was no difference between positive PCR result and negative PCR result of age and sex. Direct association was approved between the production of TSST-1 and the occurrence of fever in burned children. Increased surface severity of burns also related to the production of TSST-1. Further research is recommended.

Severity of respiratory infection in children is depended on various fac-tors such as causative organism and the host immunologic response to the organism. Vitamins and micronutrients play an important role in this response with supporting the immune system and therefore، the response to infections. Nutritional deprivations in children، especially vitamins and micronutrients such as zinc، vitamin A and vitamin D are very common in middle east and other countries in Asia، which is due to inappro-priate diet and nutrient loss in recurrent infections. This study aimed to evaluate the se-rum levels of vitamins A، D and zinc in hospitalized children aged six months to five years. This analytic cross-sectional study was performed in 65 children aged six months to five years who were hospitalized in pediatric and surgical wards of Rasul Akram Hospital and Bahrami Hospital in Tehran. All of samples were evaluated ac-cording to WHO cri-teria for acute respiratory infection، and underwent measurement of serum vitamin A، vitamin D and zinc levels by using Atomic، Elisa and spectropho-tometer methods. Serum levels of vitamins A in patients with acute respiratory infection was 0. 27±0. 16 µg/ml and in children without infection was 0. 41±0. 2 µg/ml، that different wasn’t statistically significant (P=0. 4). Serum levels of vitamins D in patients with acute respiratory infection was 35. 37±34. 68 ng/ml and in children without infection was 45. 78±21. 05 ng/ml، that different wasn’t statistically significant (P=0. 1). Serum levels of zinc in patients with acute respiratory infection was 87. 93±23. 34 µg/dl and in chil-dren without infection was 106. 95±23. 70 µg/dl، the difference was statistically signifi-cant (P=0. 002). According to finding in this trial، there is a correlation between lower levels of zinc in serum، and chance of respiratory tract infection in children. Future larger studies could provide the correlation between serum levels of vitamins A & D and chance of respiratory tract infection.

Meningitis is one of the serious and dangerous infections in the infancy and childhood and rapid diagnosis of meningococcal disease is important، especially in infants. C-reactive protein (CRP) is a protein found in blood and is an acute phase protein. CRP sensitive reactive that used for diagnosis of infection. This study conducted to assessment of the relationship between cerebrospinal fluid C-reactive protein، and neonatal meningitis، as well as diagnostic value of test.

Forty nine hospitalized infant that suspected to meningitis were enrolled in this analytic cross sectional research via non probable accessible sampling. 28 patients (52. 7%) of all the patients were male and 21 patients (42. 8%) were female. The average age of the patients was 22. 6±11. 88 days. Data from clinical examinations and laboratory tests entered in a questionnaire and all of samples divided in two bacterial (septic) and non-bactria (aseptic) meningitis group. All data including cerebrospinal fluid CRP of newborns were statistically analyzed.

In total، the mean and standard deviation of age was 22. 6±11. 88 days. 57. 2% of infants were male and 42. 8% were female. In total، 40. 82% of infants were diagnosed with septic meningitis. There was no significant difference between septic and aseptic groups in terms of sex (P= 1. 00) also in terms of age (P= 0. 1). The mean and standard deviation of CRP level in septic meningitis group was 0. 95±0. 68 mg/L and in aseptic group was 0. 16±0. 36 mg/L. The CRP level difference in septic meningitis group compare with aseptic group was statistically significant (P<0. 000). The finding showed that cut off point for CRP level as a diagnostic test was 0. 17 mg/L، sensitivity was 95% and specificity was 86%.

In the present study، newborns with septic meningitis had higher cerebrospinal fluid CRP level than newborns with aseptic meningitis، and CSF-CRP can be used in rapid diagnosis of septic and aseptic meningitis. Although this result has been seen in many studies، but more research is needed.

Determining the etiologic agents of septic arthritis is very important. The aim of the present study was to determine group A streptococcal polysaccharide antigens in synovial fluid of patients with arthritis. A cross sectional study was conducted upon 52 cases with acute mono arthritis in Hazrat-e-Rasool Akram hospital in Tehran، Iran (2010-2012). Gram staining، culture and rapid antigen tests were performed (LPA) for H. influenza، S. pneumonia، group B streptococci، N. meningitidis، E. coli and; Group A streptococcal polysaccharide antigens (Cusabio company; Austria liscence، China، ELISA) was searched in synovial samples (negative smear and culture). p value <0. 05 was considered valuable. Septic arthitis was diagnosed in 34. 5%; that included positive culture or gram staining in 15%، positive rapid antigen test (LPA) in 5. 7%، positive group A streptococcal polysaccharide antigens in 3. 8% of cases with negative results for other tests. Septic arthitis was diagnosed in 34. 6% of cases. Only 15% of cases had positive culture or gram stain (mainly S. aureus، S. pneumonis)، 5. 7% were diagnosed by rapid antigenic tests (LPA) and group A streptococcal polysaccharide antigens (ELISA) test was positive in 3. 8% of the remaining cases (negative smear and culture). By addingthenew diagnostic methods to the conventional culture tests for detecting common bacterial antigens (especially streptococcus)، the role of infectious organisms in evolution of acute arthitis would be elucidated better. Streptococcal polysaccharide antigens in synovial fluid are not defined by the immune system. The irreversible cardiac، renal، and neurologic complications are probable. Optimal treatment of proved streptococcal cases is recommended.

Diagnosing the etiologic causes for septic arthritis is very important. The main goal of study was to determine the group A streptococcal polysaccharide antigens in synovial fluid of patients with arthritis. A cross sectional study was performed upon 52 cases with acute mono arthritis in Hazrat-e-Rasool hospital in Tehran; Iran (2010-2012). Techniques used were: Gram stain/culture and rapid antigen tests (LPA) for H. influenza، S. pneumonia، group B streptococci، N. meningitidis، and E. coli and for Group A streptococcal polysaccharide antigens (Cusabio company; Austria license، China، ELISA) were searched in synovial samples (negative smear and culture). P value <0. 05 was considered valuable. Septic arthitis was diagnosed in 34. 5% (including positive culture or gram staining in 15%، rapid antigen test (LPA) in 5. 7%)، and positive group A streptococcal polysaccharide antigens was observed in 3. 8% of cases with negative results for other tests. Septic arthitis was diagnosed in 34. 6% of cases. Also 15% of cases had positive culture or gram stain (mainly S. aureus، S. pneumonis)، 5. 7% were diagnosed by rapid antigenic tests (LPA). Group A streptococcal polysaccharide antigens (ELISA) test was positive in 3. 8% of remaining cases (negative smear and culture). By adding the new methods of searching for the common bacterial antigens (especially streptococcus) to the conventional culture tests، the role of infectious organisms in evolution of acute arthitis would be elucidated more clearly. Streptococcal polysaccharide antigen in synovial fluid is not defined by immune system. The irreversible cardiac، renal، neurologic complications are probable. Optimal treatment of the proved streptococcal cases is recommended.

Different studies have shown that Otoacoustic Emission (OAEs) is generated by Outer Hair Cells (OHCs) and these sensory cells are first structures exposed to damage of high level noise. Therefore minor impairment in OHCs can lead to lack of response of OAE. The purpose of the current study is to compare the pure tone thresholds، Transient Evoked Otoacoustic Emission (TEOAE) and Distortion Product Otoacoustic Emission (DPOAE) amplitude in industrial workers experiencing non-permissible noises and official staffs. This study was conducted as a case control paradigm. The cases included 134 workers exposed to non-permissible noise and control group that constituted 89 official staff. The threshold of pure tone، TEOAE and DPOAE amplitudes were recorded and compared among the subjects. Pure tone thresholds at frequencies of 1- 4 KHz among industrial workers were higher (worse) than the control group and these differences were significant within frequencies of 3 and 4 KHz (p< 0. 01). TEOAE amplitudes within 4 frequencies (1-4 KHz) indicated significant decrease among workers group in comparison with control group (p<0. 05). Although DPOAE amplitudes indicated decrease within 4 frequencies in the workers group، these differences were statistically significant only in 4. 4 KHz (p< 0. 01). The decrease of OAE amplitudes and increase in audiometric thresholds in workers may indicate damage to cochlea due to noise exposure. In the current study، the sensitivity and specificity of DPOAE frequency responses was estimated higher than the TEOAE. It seems that DPOAE responses may have been more homogeneic to audiometric results.

Nasal polyp (NP) is a benign mucosal mass located in both sinuses and nares which is mostly seen in association with cystic fibrosis، asthma or oversensitivity to aspirin. The prominent histological feature of NP is inflammatory cell infiltration with eosinophil predominance. Superantigens role in causing NP complications is already proven. Superantigens، which are mostly originated from Streptococci and Staphylococci، activate T cells strongly and increase the process of production and release of cytokines، and secretion of IgE from B cells، which in turn directly affects proinflammatory cells such as eosinophils، both in their tissues infiltration and functions. The samples are collected from patients referring to ENT clinic in Rasoul Akram training Hospital in Tehran after thorough clinical and paraclinical examinations. For control group the samples collected from patients undergoing rhinoplasty. All the samples kept frozen and sent to immunology lab. The DNA of the excised tissues extracted and amplified by using the superantigens specific primers and PCR product detected by gel electrophoresis. The date analyzed by using mean and SD and χ2 analytical tools. Fifteen healthy individuals، 25 patients with rhinosinusitis and 24 with polyposis entered this trial. Group A Streptococcus toxin detection was significantly more frequent in those with nasal polyp and rhinosinusitis compared to healthy individuals (P=0. 001 and 0. 005، respectively)، but the results were almost the same for those with nasal polyp and rhinosinusitis (P=0. 4). Streptococci may play an important role in induction or clinical exacerbation of polyposis and group A Streptococcus pyogenes exotoxin (SPEs) with superantigenic effects may have a crucial role in etiology and pathogenesis of polyps with or without rhinosinusitis. It is postulated that، T cells polyclonal activation by SPEs may cause recruitment of inflammatory cells in nasal mucosa. These inflammatory cells include IgE producing B cells laeding to allergic and inflammatory reactions in NP.

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 & 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.

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.

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-γ (INF-γ)، Interlukine-1 (IL-1)، IL-6، IL-8 and tumor necrosis factor-α (TNF-α) measured in cellular culture supernatant. The same cytokines measured in PBMC cultures. The data shows that there is a significant difference between IFN-γ and IL-8 amounts in adenoid tissue culture supernatant and PBMC culture of our patients. Furth-ermore، the amounts of IFN-γ، 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 cyt-okines 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.

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.

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.

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.

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.

Staphylococcus aureus secretes numerous superantigenes which trigger the inflammatory mechanisms of sinus mucosa and cause chronic rhino-sinusitis. This study was designed to evaluate the role of staphylococcus aureus superantigens in polyp tissues of patients with chronic rhino-sinusitis in comparison with a control group. Polyp tissue samples of 28 patients and mucosal specimens of 19 healthy individuals were evaluated for staphylococcus aureus bacterium superantigens, exotoxins A, B, C and D and TSST-1 with RT-PCR and ELISA methods Rasoul Akram Hospital during 2 years. Polymerase chain reaction (PCR) results revealed that 88.2% of the patients and 45.5% of the controls had at least one type of superantigen (P=0.03). Evaluation of superantigens using ELISA method showed presence of at least one type of superantigen in the nasal samples of all patients and in 35.3% of the controls (P<0.001). A relationship between staphylococcal superantigens and nasal polyps is concluded from this study which indicates the probable role of these superantigens in the pathogenesis of nasal polyposis.

Determining the etiologic causes of septic arthritis is of the most importance. Goal of this study was to investigate presence of staphylococcal enterotoxins A, B, C and Toxic Shock Staphylococcal toxin-1 in the synovial fluid of patients with arthritis. This cross-sectional study was performed in the Pediatric and Orthopedic Wards of Hazrat Rasoul Hospital in Tehran, Iran during 2008- 2010. Gram stains, conventional cultures, direct detection of soluble bacterial antigens were used to detect H. influenza, S. pneumonia, group B streptococci, and N. meningitidis while Latex particle agglutination test was used for staphylococcal supper antigens (by enzyme immunoassays) upon synovial fluid tapping of 62 individuals (5 mo to 16 yrs, mean=113.8 yrs). P<0.05 was considered statistically significant. Positive SF cultures (n=11): 5 positive cases of S. aureus; 5 S. pneumonia; 1 H. influenza, and 1 Klebsiella. Positive gram stains: 10%; and positive LPA: 4%. Staphylococcal arthritis was diagnosed in 7 (39%) cases upon positive culture or positive gram stain. The most common type was TSST-1 (47%) and the least common was enterotoxin B (18%). Isolation of S. aureus (positive culture) was correlated to presence of enterotoxin A in synovial fluid but not to enterotoxins B, C or TSST-1. Staph. aureus had a prominent role in arthritis. 47% of cases with negative culture for S. aureus had at least one type of staphylococcal super antigens in the synovial fluid. Searching for antigens of usual organisms or staphylococcal supper antigens could be helpful for diagnosis

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 & 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&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.

Recent evidence suggest that group A ß-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.

Too many studies are in the process of determining the probable role of immune system in the etiopathogenesis of nasal polyposis. This study was designed to identify the probable participation of Th1, Th2 lymphocytes in the induction and progression of nasal polyposis. Seventy-five patients, 42 male and 33 female, with nasal polyposis were examined for total serum IgE, specific serum IgE and reaction to skin test for differentiating allergic from non-allergic participants in Rasoul Akram Hospital during 2010. To determine the possible correlation of allergic reactions in the upper respiratory tract and nasal polyposis, cytokine gene expression was evaluated on the extracted RNA by RT-PCR. The data were analyzed by using c2, independent t-test, correlation and Receiver operating characteristic (ROC) curve. The mean age of participants was 38 years (18-81 years). IFN-γ and IL-4 gene expressions were more prevalent in allergic than non-allergic individuals (IFN-γ: 39.5% vs. 14.2%, P=0.3 and IL-4: 44.7% vs. 18.9%, P=0.02, respectively). IL-10 and IL-12 (P35 and P40 fractions) genes were not significantly different between the two groups. IL-10 and IL-12 (P35, P40) genes did not differ significantly either. This research suggests that overproduction of cytokines and an imbalance of Th1 and Th2 cell production may play an important role in the pathophysiology of allergic or non-allergic nasal polyp formation. Thus, although nasal polyposis is a multifactorial disease with several different etiological factors, chronic persistent inflammation is undoubtedly a major factor irrespective of the etiology.