فهرست مطالب hasan mahmoodi nesheli

 Urinary tract infections (UTIs) are among the most common bacterial and frequently recurring infection during childhood, especially in the ages of three months that can involve upper UTI (pyelonephritis) and lower UTI (cystitis). There are three forms of urinary tract infections include pyelonephritis, cystitis and bacteriuria without symptoms.  Approximately 10-30% of children experience a urinary tract infection in the early years of life. The prevalence of UTI has estimated 36.8% in some third world countries. Enterobacteriacea, especially Escherichia coli has been detected as the most common cause of UTI. The crucial criteria to diagnose of UTI are including: fever, pyuria, the growth of organism more than 105  colonies in culture medium. Nowadays, antibiotic resistance is a global concerning among pediatric patient with UTI. The other important issues are including, urine reflection and scar in the lining of the kidney tissue, failure in growth and function of kidney, chronic of kidney and eventually kidney graft and dialysis. So fast diagnostic and treatment of these patients to prevent of development is so important. Although DMSA scanning is a gold standard to detect of renal parenchymal tissue involvement but due to high cost, no accessible in all of the clinical centers and exposure to dangerous chemical substances of radioactive, it is used less. Some clinical symptoms, such as fever, stomachache, backache, nausea, anorexia and inflammatory markers such as white blood cell (WBC), Erythrocyte sedimentation rate (ESR),C_ Reactive Protein (CRP ) can be handy methods to detect of the site of urinary infectious, but it is not reliable method. So there is not a practical, fast and reliable method to separate of pyelonephritis and cystitis. Pyelonephritis can lead to scar and the next stages high blood pressure and kidney failure. The prevalence of kidney scars due to pyelonephritis had reported 26.5% to 49%.  Mean platelet volume (MPV) is an important index in detection of inflammatory. The aim of this study was to investigate the value of MPV in differentiation of pyelonephritis from cystitis in children with UTI.

In this analytical cross- sectional and diagnostic study which was approved by the Ethics Committee of Babol University of Medical Sciences, Babol, Iran, with the ethics code IR. MUBABOL1724132572, a total of 141 children (1 month to 18 years) with urinary tract infections hospitalized in pediatric Hospital of Amirkola, Babol were enrolled from 2015 to 2020. Inclusion criteria including positive urine culture and exclusion criteria including negative urine culture, lack of diagnosis of pyelonephritis and cystitis, lack of cooperative of patients and the history of blood disorder associated with abnormal platelets (Bernard-Soulier syndrome, gene mutation myh9, ITP).
Considering the inclusion and exclusion criteria, diagnosis of pyelonephritis and the result of positive culture, patients enrolled to this study. And then, whole blood specimens from patients were collected to detect of MPV, CRP, and ESR. According to traditional guidelines, chocolate/ blood agar (non selective medium) used for routine urine cultures.
MPV was investigated and compared between patients with pyelonephritis and cystitis. Diagnostic value of MPV by statistical indicators specificity, sensitivity and AUC were calculated and finally statistical analysis of data was carried out using the SPSS (v 16.0) software package.The statistical tests, such as chi- square test, independent t- test, Mann withney, Spearman rank correlation, ROC and Kolmogorov-Smirnov were used in this study. P-Value less than 0.05 were assumed as statistical significance. MPV was evaluated in patients with pyelonephritis and cystitis by independent t- test. Correlation analytical was used to detect of relationship between MPV, ESR, CRP and leucocytes among two groups of pyelonephritis and cystitis. ROC (Receiver Operating Characteristics Curve) was used to evaluate and comparison of sensitivity, specificity and the area under the curve for the MPV in patients with pyelonephritis and cystitis.

Among 141 patients with UTI, 63.8% with pyelonephritis and 36.2% with cystitis enrolled in this study. MPV in patients with reflux was detected 8.67± 0.95 fl and in patients without reflux was detected 8.66± 0.99 fl. This finding was no statistically significant difference between MPV and reflux (P= 0.96). In this study, according to two groups of patients with pyelonephritis and cystitis the frequency of bacteria was investigated. The most common pathogen among both groups of patients was detected Escherichia coli. There was no statistically significant between type of pathogen among two groups ( P= 0.167).  The result of laboratory variables investigation in both groups of pyelonephritis and cystitis were detected 8.7 fl and 8.5 fl, respectively. There was no statistically significant difference between two groups (P= 0.329). Although there was no statistically significant difference in platelet count (P= 0.374), leucocyte (P= 0.115) and lymphocyte (P= 0.073), but we found statistically significant differences in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) between two groups, (P= 0.001). MPV comparison results between two groups (pyelonephritis and cystitis) showed there was no statistically significant difference between two groups.  There was no statistically significant between MPV and ESR, CRP and leucocyte, (P> 0.05).

According to the result of our study, the role of MPV in differentiating pyelonephritis from acute cystitis was detected. The evidence of this study showed MPV has low diagnostic value in differentiating pyelonephritis from acute cystitis in children with UTI.  So, detection of Mean platelet volume is not an appropriate method and it needs to more studies to find Para clinical factor in diagnostic is worth wealthy.

Thalassemia is the most common genetic disorders in the world. There are more than 20. 000 beta thalassemia major patients in Iran. Most parts of the world، including Iran، apply a national program of thalassemia prevention. In our country، prenatal diagnosis and pregnancy termination has been an effective program in this area. But some studies do not consider this method appropriate. The aim of this study was to evaluate the attitude of thalassemia minor couples having a thalassemia major fetus.

This study was done on 65 thalassemia minor couples having a thalassemia major fetus from January 2008 till February 2009 and both couples answered the questionnaire in a quiet place without a questioner (a person asking question).

The ages of mothers and fathers were 17 to 35 years (24±4. 65 years) and 22 to 39 years (30. 36±5. 23) respectively. All couples except one attempted abortion and all of them were upset of having a thalassemia major fetus.

Although the legal abortion with the approval of religious leaders as long as 16 weeks of gestational age is performed in Iran، and in our study 98. 4% of cases had attempted abortion awared of thalassemia major person’s future، but all families were hurt with the happened insident. So، further investigations should be done for the couples’ complications. It is recommended to reduce the physical and psychological complications of couples using PGD method rather than CVS.

Iron-mediated cardiomyopathy is the main complication of thalassemia major (TM) patients. Therefore, there is an important clinical need in the early diagnosis and risk stratification of patients. The aim of this study was to evaluate the efficacy of tissue doppler imaging (TDI) to study cardiac iron overload in patients with TM using T2* magnetic resonance (MR) as the gold-standard non-invasive diagnostic test. A total of 100 TM patients with the mean age of 19±7 years and 100 healthy controls 18.8±7 years were evaluated. Conventional echocardiography, TDI, and cardiac MRI T2* were performed in all subjects. TDI measures included myocardial systolic (Sm), early (Em) and late (Am) diastolic velocities at basal and middle segments of septal and lateral LV wall. The TM patients were also subgrouped according to those with iron load (T2*? 20 ms) and those without (T2* > 20 ms), and also severe (T2*? 10 ms) versus the non-severe (T2*? 10 ms). Using T2* cardiovascular MR, abnormal myocardial iron load (T2*? 20 ms) was detected in 84% of the patients and among these, 50% (42/84) had severe (T2*? 10 ms) iron load. The mean T2* was 11.6±8.6 ms (5–36.7). A negative linear correlation existed between transfusion period of patients and T2* levels (r = -0.53, p=0.02). The following TDI measures were lower in patients than in controls: basal septal Am (p<0.05), mid-septal Em and Am (p<0.05), basal lateral Am (p<0.05), mid-lateral LV wall Sm (p<0.05) and Am (p<0.05). Tissue doppler imaging is helpful in predicting the presence of myocardial iron load in Thalassemia patients. Therefore, it can be used for screening of thalassemia major patients.