gholam reza khatami

There are controversies on the association of childhood allergic diseases with inflammatory bowel diseases (IBD). The aim of this study was to examine the association between food allergy, cow’s milk allergy (CMA), and asthma with pediatric IBD in Iranian population. This case-control study was conducted on 200 individuals less than 18-year-old (100 with IBD and 100 as control group). Medical records, clinical presentation, and laboratory and para-clinical findings related to food allergy, CMA, and asthma were reviewed for all participants in both groups and were recorded. Among 100 children with IBD, 40 had Crohn's disease, and 60 had ulcerative colitis. The frequency of food allergy, cow's milk allergy, and asthma in children with IBD was significantly higher than the control group (P

Liver disease is increasingly common in pediatric cystic fibrosis (CF). Liver dysfunction in CF patients is an early complication and relatively common which may progress silently.. The purpose of this study was to determine the prevalence of abnormal liver architecture by Ultrasonography (US) and their associations to abnormal liver function tests particularly abnormal Gamma Glutamyl Transpeptidase (GGT), Alanine Aminotransferase (ALT), and Aspartate Aminotransferase (AST) level for its early detection before the complications occur..Patients and This study as a cross-sectional study was performed at the Children''s Medical Center Hospital, Pediatrics Center of Excellence in Tehran, Iran. In all, 114 patients with cystic fibrosis (70 boys, 44 girls) were enrolled. Sample blood test including AST, ALT, GGT and abdominal Sonography was obtained from all patients. Abnormal liver function test was defined by two consecutive occasions; ALT and/or AST levels were ≥ 2 times the upper limit of normal values. GGT normal values were defined by patient age. Data were analyzed using χ2 test and independent T test. Statistical significance was defined as P values of < 0.05 by SPSS ver.19 software.. Abnormal liver function test was detected in CF patients. As well, liver sonogram was abnormal in approximately one-third of the patients. This study showed a higher prevalence of biochemical abnormality in patients with abnormal livers ultrasonography.. Noninvasive paraclinical evaluation methods could be recommended in the patients with CF for early detection of silent liver abnormalities before progression to end stage liver disease..

Several studies have shown the prevalence of celiac disease (CD) to be around 1% in Iran, which is similar to the worldwide prevalence. There is scant information on occult CD in apparently healthy school age children. This study, as the first such study in Iran, aims to determine the prevalence of occult CD in healthy Iranian school age children. In this cross-sectional study, we screened healthy school age children for CD by serum IgA and IgA anti-tissue transglutaminase antibody (tTG) levels. Measurement of these antibodies was by enzyme linked immunosorbent assay. A recheck of positive tTG tests was performed and patients who tested positive underwent endoscopic duodenal biopsies. The biopsy samples were scored according to the Marsh classification by an experienced pathologist. A total of 634 children (314 males, 320 females; mean age: 12.8 years) were included in the study. All children and/or their parents completed a questionnaire and children underwent an initial physical examination to determine study eligibility. Positive serum tTG was noted in 3 (0.5%; 2 females) out of 634 patients. Duodenal biopsies were consistent with CD in these 3 subjects. The mean age of patients with CD was 14.3 years (range: 12–17 years). The female to male ratio was 2:1. These cases had no signs and symptoms, but a gluten-free diet was recommended according to pathologic changes in their small bowels and results of the tTG test. The prevalence of occult CD in these children is 0.5%, which is half of the prevalence of CD in Iranian adults. The anti-tTG concentration at initial serological CD screening is highly informative in determining occult cases of CD. The question is whether all non-symptomatic cases should be treated with a gluten-free diet or not.

Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems. The value of commonly used diagnostic tests for GER is examined to define the most sensitive and specific test that is the least invasive as well. We conducted this cross sectional prospective study to compare the accuracy of barium meal (BM) and sonography (US) in diagnosing GER with the gold standard test, PH monitoring (pH-m). Fifty children (1 mo- 15 yr) with GERD symptoms were enrolled. After filling the informed by their parents, BM, US and 24 hr PH-m were done by one physician who were blinded to each others. Patients with positive pH-m had Positive US and BM 90% (p = 0.004) and 50% (0.02) respectively and in those with negative pH-m the negative rate of us was 60% (p = 0.004) and negative rate of BM was 65% (P = 0.02). The rates of false positive and false negative were 60% and 10% in US and 65% and 50% in barium meal respectively. True positive and negative results were 90% and 40% for US and 50% and 35% for BM, respectively. The sensitivity and specificity rates were 90% and 40% for US and 50% and 35% for BM. The positive and negative predictive values were 69% and 72% for US and 53% and 31% for BM respectively. Ultrasonography is much more sensitive and specific than barium meal in diagnosing GER with higher positive and negative predictive value. US is a safe, reliable and cost- effective procedure, so it could be used as the primary mode in diagnosing GER and use 24 hr pHm for follow up of resistant to treat patients.

Caustic ingestion can result in severe gastrointestinal tract burns and important complications such as esophageal stricture. early diagnostic endoscopy is usually recommended routinely in all children after caustic ingestion. The aim of this study was to determine the predictive value of clinical symptoms and ingested material types and quantity as markers of severe esophagogastric lesions and eventual complications. 72 children were admitted after accidental caustic ingestion. The clinical symptoms; ingested product type and quantities, endoscopic data and outcome were prospectively analyzed. 36 patients had no symptoms (group B), others presented with one or more early symptoms (vomiting, hematemesis, drooling, respiratory distress) and/or oropharyngeal burns (group A). In group A, stronger substances were ingested in higher quantities. In group B, 23 patients ingested ‹20cc and 13 patients |"|20cc and in group A, one patient ‹20cc and 35 patients ingested |"|20cc. The proportion between patients who ingested ›20cc was 2.7 more in group A to B (35/13=2.7). In group A the relationship between the amount of the caustic agent and degree of GI damage was pvalue=0.036, but it was pvalue=0.492 in group B. Severe GI injuries in endosocpy were seen in 32 cases (77.8%), and 17 of them developed complications (47.2%). 3 patients had esophageal perforation in acute phase, in one case of them perforation was in both esophageal and gastric. 17 patients had stenosis (16 cases had esophageal stenosis and one case was associated with gastric inlet obstruction and in another one with esophago-pleural fistula) and one case had gastric outlet obstruction. In group B no severe burn and complication were seen. Between substance property and quantity, early symptoms with GI burn and complication was coherence (p‹0.05). In conclusion, diagnostic endoscopy is not necessary in asymptomatic children after accidental caustic ingestion.

Generalized lipodystrophy is a rare disorder in children characterized by absence of subcutaneous adipose tissue. We evaluated 10 patients with generalized lipodystrophy by skin and liver biopsy. Eight patients with steatohepatitis and cirrhosis were treated with Ursobile (uorsodeoxycholic acid) and vitamin E. In follow-up, serum triglyceride level was decreased.

Colonoscopy is used for both diagnostic as well as therapeutic purposes in patients with lower GI symptoms. The aim of this study was to assess the clinical manifestations and to determine the colonoscopic findings of children with lower GI symptoms attending a pediatric hospital in Tehran. During a 5-year period (1996-2001), all children less than 16 years of age, who had undergone colonoscopy in the Gastroenterology Department of the Children's Hospital Medical Center in Tehran (Iran), were studied in respect to presenting symptoms, colonoscopic and pathologic findings, and the size, number and site of polyps if they were present. Among the 694 children (431 boys, 263 girls) less than 16 years of age who entered this study, 49.4%, who underwent colonoscopy, were aged between 1 and 5 years. Hematochezia, rectal prolapse, diarrhea, constipation, abdominal pain, fever, growth retardation, Clubbing, history of ulcerative colitis and polyps were present in 93.2%, 5.9%, 2.7%, 0.6%, 3.7%, 2.6%, 1.4%, 0.6%, 1.4%, 0.7% of the patients, respectively. Polyps, nodular lymphoid hyperplasia (NLH), granularity ulceration (suggestive for ulcerative colitis), suggestive for crohn's disease, mucosal edema, fragility, ulcer, solitary rectal ulcer, cobblestone appearance, vascular disorders, fissure, fistula and anal tags were present in 34.6%, 16.7%, 15.1%, 0.9%, 1.9%, 0.6%, 2.4%, 3.7%, 0.4%, 0.6%, 3%, 0.6% of the patients, respectively; 23.1% of the children had normal colonoscopic findings. Among the 240 cases found to have polyps on colonoscopy, 209, 18, 7, 4, 2 cases were reported as juvenile polyps, hamartoma, hyperplastic, lymphoid and necrotic in type, respectively. Of the 232 patients with polyps, 197 had a solitary polyp, 22 had 2 to 4 polyps, and 13 had more than 5 polyps. In respect to site, polyps were more frequent in the rectum, rectosigmoid region, left colon, diffuse, and right colon in decreasing order of occurrence. Colonoscopy is performed more frequently in children with hematochezia and rectal prolapse. Polyps, NLH and ulcerative colitis were the most frequent findings in the colonoscopies performed.

To study the effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome. Garlic powder in a capsule form was given to 15 children with hepatopulmonary syndrome (confirmed by contrast echocardiography) at the dosage of 1 g/1.73 m2 per day. Patients were evaluated clinically and by arterial blood gas every four weeks. The garlic capsule was administered to 15 patients with hepatopulmonary syndrome. There were 10 boys and 5 girls with a mean age of 9.4 ± 3.9 years. The underlying problems were biliary tract atresia (4 patients), autoimmune hepatitis (4 patients), cryptogenic cirrhosis (4 patients) and presinusoidal portal hypertension (3 patients). Eight patients (53.3%) showed an increase of 10 mmHg in their mean arterial oxygen pressure. The baseline PaO2 was 65.6 ± 12.1 mmHg in the responder group and 47.1 ± 11.2 mmHg in non-responder group. At the end of treatment the mean PaO2 in responders and non-responders was 92.2 ± 7.75 mmHg and 47.5 ± 11.87 mmHg, respectively (P ‹ 0.01). Garlic may increase oxygenation and improve dyspnea in children with hepatopulmonary syndrome.

To investigate the importance of endoscopic nodular gastritis associated With Helicobacter pylori infection in children. In this prospective study, 220 consecutive patients (age range 2 to 15 years, mean age 9. 02 ±3. 3), 118 of them males (53. 6%) underwent upper endoscopy during evaluation of chronic abdominal pain. The appearance of nodular gastritis was observed during endoscopy by the author. Culture, rapid urease test and staining were carried out on gastric mucosal biopsies. With histological examination the presence of Helicobacter pylori and the nature of inflammation was assessed. H. pylori infection was identified in 110 (50%) patients. Endoscopic nodular gastritis was seen in 100 patients (45.5%), and was significantly associated with active chronic gastritis. Nodularity in the stomach showed a sensitivity of72. 7% and a specificity of81.8% and a ppv of 80% for the diagnosis of H. pylori infection and was observed in 80 (72. 7% of) H. pylori positive cases. Antral nodularity was associated with increasing risk of infection with H. pylori (OR=12, 95% CI: 6.3-22.7). Endoscopic findings of antral nodularity in children may suggest the presence of H. pylori infection.

There is a well-recognized relationship between aplastic anemia and viral hepatitis. Clinically apparent hepatitis precedes aplastic anemia by a period of weeks to months. Hepatitis is an infrequent cause of aplastic anemia and is usually severe and fatal if untreated. The clinical features and, particularly the response to immunosuppressive therapy strongly suggest that immune mechanisms mediate the marrow aplasia. The cause of the hepatitis is unknown, but it does not appear to be due to any of the known hepatitis viruses. In this study we present two cases of hepatitis associated aplastic anemia (HAAA) at the ages of 10-11 years old. They both received immunosuppressive therapy, Anti thrombocytic globulin and Cyclosporine. They achieved a persistent clinicohematological remission.

A 34 day-old girl infant was admitted for poor feeding and cholestasis. She had a bulging fontanelle, with no evidence of intracranial infection or hemorrhage. Investigations demonstrated that she had galactosemia. Computed tomographic scans demonstrated the presence of diffuse cerebral edema. After treatment the edema resolved.