sanaz mehrabani

Children with cholestasis experience a wide spectrum of disease, ranging from transient liver function abnormalities to life-threatening conditions. These children may require hospitalization or specialized care at various times due to liver enzyme disorders and associated clinical issues. In severe cases, liver damage can lead to acute liver failure, necessitating liver transplantation or resulting in death. Early diagnosis of the etiology of cholestasis can be crucial for improving prognosis. This study aimed to determine the frequency, causes, and outcomes of cholestasis in infants referred to Amir Kola Children's Hospital.

This retrospective descriptive study included all infants with cholestasis admitted to AmirKola Children's Hospital between 2012 and 2022. Inclusion criteria were infants under 2 years of age diagnosed with cholestasis. Infants with incomplete medical records were excluded from the study. Hepatic cholestasis was diagnosed based on the infant's medical history and confirmed by a pediatric gastroenterologist. All infants underwent diagnostic evaluation tests and abdominal ultrasound. Liver biopsy was performed when necessary to assess liver pathology. Short-term outcomes of hepatic cholestasis, including length of hospitalization, frequency of hospitalization, need for special care, liver transplantation, and mortality, were evaluated. Demographic information, along with the causes and outcomes of cholestasis, were reported using measures of central tendency (mean) and dispersion (standard deviation), or as frequencies and percentages.

During the study period (2012-2022), 3,650 infants under 2 years of age were admitted to Amir Kola Children's Hospital. The frequency of cholestasis among hospitalized children was 54 (1.47%). The most common symptom of cholestasis was hepatomegaly, observed in 35 (64%) infants. The leading causes of cholestasis included biliary atresia in 21 (38.8%) infants, idiopathic hepatitis in 17 (31.4%) infants, and congenital metabolic disorders in 7 (12.96%) infants. Of the children in the study, 23 (42%) were hospitalized at least once, and 10 (18.5%) were hospitalized twice. Liver biopsy was performed in 32 (60.4%) of the 54 children; 11 had neonatal cholestasis, 7 had normal ultrasound results, and 13 had giant cell hepatitis and neonatal hepatitis (10 with normal ultrasound results), with 2 showing normal pathology reports. Additionally, 20 (37%) of these children died, 24 (44%) recovered, and 9 required liver transplantation.

According to the results of this study, more than one-third of children with cholestasis died, with biliary atresia and idiopathic hepatitis identified as the most common causes. Biliary atresia was also the most frequent indication for liver transplantation. These findings highlight the need for timely diagnostic examinations, testing, and specialized evaluations to support early diagnosis and treatment in infancy.

Colonoscopy serves as a diagnostic and therapeutic tool for children. However, the process of bowel preparation presents a considerable challenge. This study aimed to compare the effectiveness of a clear liquid diet (CLD) versus a low-residue diet (LRD) in bowel preparation for colonoscopy among children aged 2-14 years.

In this single-blind clinical trial, a total of 110 children aged 2-14 years undergoing colonoscopy were randomly assigned to two groups: the CLD group and the LRD group. Along with their assigned diets, all participants received 2 g/kg of polyethylene glycol in two or three divided doses, as well as a single dose of 5-mg bisacodyl prior to colonoscopy. The primary outcome was the adequacy of bowel cleansing for colonoscopy, evaluated using the Boston Bowel Preparation Scale (BBPS) in both groups. The secondary outcomes included the tolerability of bowel preparation diets and adverse effects.

According to the physician’s assessment, the CLD group had favorable BBPS scores (BBPS ≥5) in 96.5% (55/57) of cases, while the LRD group had favorable scores in 98.1% (52/53) of cases. There were no significant differences between the two groups in terms of the mean BBPS score, regimen tolerability, and adverse effects. 

This study demonstrated that both CLD and LRD regimens were effective in bowel preparation and were well-tolerated by children aged 2-14 years.

Foreign body ingestion is one of the most common problems and reasons for emergency endoscopy in children. The aim of this study was to determine the type and location of entrapped objects and endoscopic observations in children with foreign body ingestion.

This cross-sectional study was conducted on all children with complaints of foreign body ingestion who underwent upper endoscopy at Amirkola Children's Hospital, north of Iran during 2014-2021. Demographic information, type of foreign body, clinical symptoms, and examinations during hospitalization, endoscopic findings, and short- and long-term outcomes were recorded. A value of P<0.05 was considered significant.

The mean age of 84 children in the study was 47.98±31.51 months and 56% of them were boys. The most commonly ingested foreign bodies were food (26.2%) and coins (25.0%). The most common location of the foreign body was the upper part of the esophagus (41.7%) and 29.7% of children were without clinical symptoms, and among those with clinical symptoms, vomiting (38.1%) was the most common symptom. The most common endoscopic findings were esophageal ulcer (11.9%). No significant relationship was found between gender and type of ingested foreign bodies (p=0.528).

The results of the study showed that the most common foreign bodies were food and coins and that the most common site of injury was in the esophagus, and the incidence of dangerous complications in children was low, with no deaths. Therefore, monitoring of children and providing appropriate treatment based on existing guidelines are helpful.

Cancer is as the second leading cause of death among children in the United States. The mortality rate for cancer has witnessed a decline, dropping from 6.5 per 100,000 in 1970 to 2.3 per 100,000 in 2016. Second malignant neoplasms (SMNs) represent novel primary malignancies emerging after the initial cancer diagnosis, particularly prominent as late effects of cancer therapy in children. The incidence of SMNs sees a substantial increase over time, reaching nearly 10% even a decade after the initial diagnosis. A comparative analysis between the general population and child cancer survivors reveals a six-fold higher risk of developing SMNs among the latter. Various factors contribute to the elevated risk of second cancers, with age, lifestyle, environmental influences, primary cancer treatment, and genetic predisposition playing pivotal roles. Noteworthy risk factors for SMNs in children encompass radiation therapy, chemotherapeutic agents, topoisomerase inhibitors, genetic factors, hematopoietic stem cell transplantation, and ionizing radiation, as elucidated in the present study. Despite these findings, further research is imperative to accurately quantify the risks associated with etiological factors, enabling the identification of individuals at a heightened risk for second cancers and facilitating proactive screening and preventive measures.

 Some dietary patterns like Dietary Approaches to Stopping Hypertension (DASH) and/or Mediterranean Diet (MED) are often recommended to prevent Cardio Vascular Diseases (CVDs) based on their effects on lipid profile. Thus, we aimed to investigate the relationship between the DASH diet score and Mediterranean diet score with lipid profile in healthy individuals aged 20-50 years in Shiraz, Iran. 

  In this cross-sectional study, 236 participants were selected from Shiraz (Iran) medical centers through random cluster sampling. Information about food intake was collected using a 168-item Food Frequency Questionnaire (FFQ), then DASH score and MED diet score were calculated. Logistic regression was used to evaluate the relation between DASH and MED score adherence and lipid profile.

 Individuals in the highest tertile of MED and DASH pattern adherence had significantly lower Low-Density Lipoprotein (LDL) compared with those in the first tertile (p<0.05). In both crude and adjusted model, higher adherence to the MED pattern was associated with reduced odds of Total Cholesterol (TC) (OR: 0.30; 95% CI: 0.13–0.66 and OR: 0.27; 95% CI: 0.12–0.61) and LDL (OR: 0.36; 95% CI: 0.17–0.77 and OR: 0.32; 95% CI: 0.15–0.70). Moreover, higher adherence to the DASH pattern was associated with reduced OR of LDL in crude (OR: 0.43; 95% CI: 0.19–0.94) and TC in adjusted model (OR: 0.44; 95% CI: 0.20–0.96). 

 The study illustrated a negative association between the MED diet and serum levels of TC and LDL. Also, a higher DASH score was associated with lower TC. Future studies are necessary to confirm these findings.

Appendicitis is one of the reasons for abdominal pain and the most common cause of referral to pediatric emergency departments. There are different results on the frequency and complications of appendicitis during COVID-19 pandemic. This study aims to compare the frequency and complications of acute appendicitis in children who underwent laparotomy before and during the COVID-19 pandemic in Babol Children's Hospital, north of Iran.

This retrospective study was conducted in 172 children with acute appendicitis who underwent laparotomy. Children were divided into two groups according to the time of referral; before the COVID-19 pandemic (between December 2018 and November 2019) and during the pandemic (between March 2019 and February 2020).  Surgeon’s observations in laparotomy and also the complications (perforation, abscess, gangrene, and peritonitis) were recorded. Data analysis was carried out using Chi-score and paired t-test.

The children studied included 94 before the COVID-19 pandemic and 78 during the pandemic. The average age was 7.76±2.89 years. Findings showed that 165 (95.9%) and 7 (4.1%) children had confirmed and unconfirmed appendicitis, respectively, indicating no significant difference between the two groups (P=0.45). The complications of appendicitis (perforation, gangrene, abscess, and peritonitis) were 8.25% before the pandemic and 34.2% during the pandemic (P=0.24). There was no significant difference between the two groups in average time interval between the onset of pain and attending the hospital (P=0.38).

In this study, the COVID-19 pandemic did not affect the frequency of acute appendicitis in children. These results probably indicate the proper performance of the treatment staff and the parents' rapid response to their child’s acute abdominal symptoms during the pandemic.

Gastroduodenal perforation (GDP) is a rare cause of acute abdominal pain in children.

A 12-year-old boy presented with abdominal pain around the periumbilical and epigastric region on 7previous days. His familial history was significant for sickle cell anemia in the mother and minor thalassemia in the father. He had been diagnosed with sickle cell anemia at the age of 4 years and had received blood transfusion and hydroxyurea every month. At physical examination, a distended abdomen and decreased intestinal sounds were seen. Also, he had a history of cholecystectomy (for cholelithiasis). Fecal occult blood was detected, while no Helicobacter pylori antigen was present. Abdominal ultrasound examination revealed splenomegaly and evidence of free fluid. Surgical results showed bile discharge in the abdominal cavity, and perforation of duodenum and pylorus.

Since the symptoms of GDP in children are non-specific, especially in children with sickle cell anemia, it should be considered in these patients with abdominal pain.

Bezoar is a mass or indigestible substance that accumulates in the gastrointestinal tract, especially in the stomach. The formation of gastric bezoars (especially phytobezoars) is rare in children; however, when they are formed, they present a therapeutic challenge due to their hard composition and consistency as well as their large size.
Case Report: A 7-year-old boy with an abdominal mass was investigated in this case report. The patient had eaten a lot of persimmons and pomegranates in the past. Gastroduodenoscopy revealed a large phytobezoar in the stomach, which was removed and treated using a gastroduodenoscope.

The gastroduodenoscopic technique is cost-effective in the treatment of gastrointestinal bezoars and has fewer complications for the patient than the surgery.

Ingestion of corrosive substances in children is associated with complications and costs to the health care system. The aim of this study was to determine the incidence and complications of ingesting corrosive substances in children.

This cross-sectional study was conducted on children aged 6 months to 14 years who underwent upper endoscopy at Amirkola Children's Hospital during 2014-2021 for complaints of corrosive ingestion. Information studied included demographic information, type of corrosive substances, clinical symptoms, endoscopic findings, complications, and laboratory results.

In the 79 children (mean age of 31.33±20.38 months), 65.8% were boys, the most common type of ingested substance was alkaline (86.1%) and the most common ingested substance was bleach (69.6%). Totally, 70.1% of children had symptoms. The most common clinical symptoms were vomiting (68.4%) and oral lesions (39.2%). The esophagus (59.5%) was more affected than the stomach, and the most common esophageal endoscopic finding was grade 1 esophagitis (45.6%). No significant relationship was found between clinical symptoms, the incidence of esophageal-gastric involvement, or the severity of esophageal involvement. Leukocytosis (p=0.009), the increase in C-reactive protein (CRP) (p=0.001), erythrocyte sedimentation rate (ESR) (p=0.007), and blood sugar (BS) (p=0.019) were significantly related to the severity of esophageal involvement.

The results of the study showed that the rate of dangerous side effects caused by ingestion of corrosive substances was not high in children, but often caused by the use of alkaline drain openers, so attention and appropriate diagnostic measures are recommended, as well as preventive measures.

The World Health Organization (WHO), as the international authority on public health and water quality, directs and monitors global efforts to prevent the transmission of waterborne diseases and advises governments on the development of health-based goals and regulations. 

This review study aims to investigate the management methods, including control, prevention, and treatment of gastrointestinal (GI) diseases in children in the Middle East caused by contaminated water through WHO.

For this purpose, Scopus, Google scholar, PubMed, SID, Irandoc, and up-to-date databases were searched without time limitation. Keywords included contaminated water, pediatric, GI diseases, and WHO. In this study, the full text of various articles in Persian and English was used. After removing duplicate articles and articles that did not fit the topic of the study, 54 articles were finally selected.

Based on the findings, the WHO has reported that diarrhea, polio, hepatitis A, and cholera are the most common GI infectious diseases caused by contaminated water in children in the Middle East. The present reports of waterborne disease represent only a small proportion of the total number of cases of this disease in the population. In some areas, it has been shown that investments in water and wastewater supply by responsible institutions can provide a net economic gain by reducing negative health impacts and healthcare costs.

The results of this study indicate that most of the diseases caused by contaminated water affect children, due to low ability to observe personal hygiene and the state of the child’s immune system, which often leads to the death of children. The lack of diagnosis and insufficient prevalence of these diseases in some Middle Eastern countries, followed by the lack of attention to the prevention and control of waterborne diseases, threatens the health policies of these countries. International organizations, especially the WHO and the united nations children’s fund, play a vital role in addressing and controlling this problem.

 One of the most common functional problems in children is functional abdominal pain (FAP), and dysmotility is one of the possible causes of FAP. Domperidone is a prokinetic drug that increases gastrointestinal motility.

 The aim of this study was to evaluate the effect of domperidone on the treatment of FAP in children.

 In this double-blind clinical trial study, FAP was diagnosed in 80 children aged 5 - 14 years, who were referred to Amirkola Children's Hospital in Babol for one year based on the criteria of the Rome IV. Then, they were randomly divided into two groups of 40 patients. Group A received domperidone tablets (0.25 mg/kg, three-time/day) for two months, and group B received a placebo. The primary outcome was at least a 50% reduction in both frequency and severity of pain, and the secondary outcome was a significant reduction in the duration, frequency, and intensity of pain according to the Wong-Baker scale compared to baseline.

 A total of 80 children completed the trial (40 with domperidone). The recovery rate was higher in the domperidone group than in the placebo group after eight weeks (71.8% vs. 28.2%; P < 0.0001), and domperidone had significant superiority over the placebo in reducing the duration (4.58 ± 7.71 vs. 24.5 ± 41.45, min/day, P < 0.001), frequency (3.35 ± 3.99 vs. 10.63 ± 10.55, episode/week, P < 0.001), and intensity (2.20 ± 2.16 vs. 5.05 ± 2.37, P < 0.001) of the pain.

 Based on the results, domperidone can be useful in the treatment of FAP in children.

DNA microarray is a useful technology that simultaneously assesses the expression of thousands of genes. It can be utilized for the detection of cancer types and cancer biomarkers. This study aimed to predict blood cancer using leukemia gene expression data and a robust ℓ2,p-norm sparsity-based gene selection method.

In this descriptive study, the microarray gene expression data of 72 patients with acute myeloid leukemia (AML) and lymphoblastic leukemia (ALL) was used. To remove the redundant genes and identify the most important genes in the prediction of AML and ALL, a robust ℓ2,p-norm (0 < p ≤1) sparsity-based gene selection method was applied, in which the parameter p method was implemented from 1/4, 1/2, 3/4 and 1. Then, the most important genes were used by the random forest (RF) and support vector machine (SVM) classifiers for prediction of AML and ALL.

The RF and SVM classifiers correctly classified all AML and ALL samples. The RF classifier obtained the performance of 100% using 10 genes selected by the ℓ2,1/2-norm and ℓ2,1-norm sparsity-based gene selection methods. Moreover, the SVM classifier obtained a performance of 100% using 10 genes selected by the ℓ2,1/2-norm method. Seven common genes were identified by all four values of parameter p in the ℓ2,p-norm method as the most important genes in the classification of AML and ALL, and the gene with the description “PRTN3 Proteinase 3 (serine proteinase, neutrophil, Wegener granulomatosis autoantigen” was identified as the most important gene.

The results obtained in this study indicated that the prediction of blood cancer from leukemia microarray gene expression data can be carried out using the robust ℓ2,p-norm sparsity-based gene selection method and classification algorithms. It can be useful to examine the expression level of the genes identified by this study to predict leukemia.

Inflammation plays a critical role in the progression of cancer in children. On the other hand, children with cancer experience abnormal activation of the inflammatory system. Moreover, it is known that these patients have a predisposition to depression. According to studies, moderate to severe depression was observed in about 63% of children with cancer and acute illness. Therefore, identifying inflammation-related biomarkers and targets in this regard is essential. The inflammation changes are related to cytokine deregulation, which in turn may influence the expression of depressive symptoms. Studies have reported that the deregulation of serum inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α may influence depressive disorder in pediatric cancer patients.  In addition, determining the risk of severe bacterial infection complications in pediatric cancer is essential to reduce the cost of therapy and hospitalization. However, the role of cytokines as an infection marker in these children is still a debate. Determining these plasma cytokine levels may have diagnostic value in assessing febrile neutropenia, although their crucial role in systemic inflammation is known. Given that evidence regarding the role of pro-inflammatory cytokine levels and relation to clinical parameters, including depression and infection in pediatric cancer patients is limited, we assessed the role of cytokine and its relation to depression and infection complications in pediatric cancer.

To the best of our knowledge, limited studies explored gastrointestinal (GI) symptoms and hepatopancreatic involvement in children with coronavirus disease 2019 (COVID- 19) infection. 

This review study aimed to evaluate the GI symptoms and abnormal liver and pancreas function in children with COVID-19 infection.

In this review study, databases of Scopus, PubMed, Google Scholar, and Web of Science were searched using the relevant keywords of “COVID-19,” “children,” “gastrointestinal,” “liver,” and “pancreas.” Descriptive and cross-sectional studies were reviewed in the current study, with the main focus on GI symptoms and elevated liver enzymes in children with COVID-19 infection. 

Overall, 27 studies from countries of Iran, Spain, Turkey, Italy, and the United States were selected. Although the prevalence of GI symptoms varied in different studies, our review showed that most children with COVID-19 infection experienced GI symptoms. In addition to GI symptoms, there is the possibility of elevated liver enzymes, such as alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine phosphokinase in children with COVID-19 infection. 

COVID-19 infection may present various GI, hepatic, and pancreatic manifestations in children. The difference in the prevalence of these symptoms can probably be attributed to the geographical region of the study and the history of the disease.

Infertility has been a significant problem for couples in recent decades, and the issue can often lie with the male rather than the female.

This study aimed to investigate the effects of fats and minerals intake on semen parameters in infertile men.

This cross-sectional study was performed on 260 infertile men referred to Isfahan Infertility Clinic, Isfahan, Iran in the summer of 2018. Semen parameters regarding sperm concentration, total motility, normal morphology, and sperm volume were considered. To assess dietary intakes, a validated food frequency questionnaire was used.

In the adjusted model, the prevalence of abnormal concentration was 5.23 times higher in the top quartile of calcium intake, compared with the bottom quartile (p = 0.03). Also, the prevalence of abnormal morphology was 68% lower in the third quartile of calcium intake (p = 0.03). Additionally, the prevalence of abnormal concentration was 84% lower in the top quartile of folate intake in comparison to the bottom quartile (p = 0.01) and the prevalence of abnormal morphology was 70% lower in the top quartile of folate intake (p = 0.03). Additionally, the prevalence of abnormal concentration was 72% lower in the top quartile of selenium intake in comparison to the bottom quartile (p = 0.04). Furthermore, in the crude model, the prevalence of abnormal volume was 64% lower in the second quartile of linoleic acid intake rather than the first quartile (p = 0.01).

In conclusion, diets containing higher amounts of folate and selenium, and lower amounts of cholesterol, saturated fatty acid and calcium were associated with more favorable semen quality parameters.

World Health Organization (WHO) declared COVID -19 infection a global pandemic. Children have milder disease than adults but different aspects of disease in children are not fully understood.

We describe 5 pediatric patients with COVID-19 that referred to Amirkola Children’s Hospital, Babol, Iran. The youngest patient was 4 years old and the oldest was 12 years old. Three patients were males. None of the patients had a history of contacts with symptomatic patients with COVID -19. The most common symptoms included fever, cough, anorexia, weakness and diarrhea. One patient had gastrointestinal symptoms without respiratory symptoms. All patients had elevated ESR and CRP. Three of them had lymphopenia. RT-PCR was positive in all patients. Management included supportive care, antibiotics, antiviral treatment and hydroxychloroquine. All patients were discharged with good condition.

Children may have a variety of symptoms including respiratory or gastrointestinal symptoms. Mortality is rare in children and prognosis is better than the adults

The New coronavirus (SARS COV-2) can cause acute respiratory disease and also multiorgan dysfunction. There is insufficient data about kidney involvement in children. So, this study was done on children with COVID-19 to evaluate nephrological involvement.

All children with confirmed or suspected COVID-19 who were admitted in Children Hospital .were enrolled. They were admitted in hospital from March 2020 to July 2020. Serum Blood Urea Nitrogen (BUN), creatinine, sodium, potassium, calcium and urinalysis were evaluated. Also, glomerular filtration rate (GFR) was calculated by Schertz's formula. All patients were evaluated by chest x-ray and/or computerized tomography scanning (CTS). The data were analyzed by SPSS software and P value less than 0.05 was determined as significant.

Forty-seven children with confirmed or suspected COVID-19 were enrolled to this study. At admission, 23.4% and 27.7% of children with COVID-19 infection had abnormal increase in serum BUN and creatinine, respectively. Also 78.8% and 25.5% of children had GFR less than 90 and 60 ml/min /1.732, respectively. Additionally, 13/47 (27.7%) of children had abnormal urine analysis (microscopic hematuria and/or proteinuria). There wasn’t a significant relationship between pulmonary lesions and abnormal reduction of GFR (P<0/05).

In the study, the risk of AKI (acute kidney injury) and decrease of GFR and also abnormal urinalysis is high in children with COVID-19. So, more attention for detection of kidney involvement is necessary and more conservative management for prevention of AKI and decrease of GFR are recommended.

Hypomagnesemia can lead to bronchial smooth muscle contraction and is associated with wheezeing, airway hyperactivity and impairment of lung function. The aim of this study was to compare serum magnesium levels between asthmatic and healthy children.

This case-control study was performed from September 2018 to February 2019. Totally, 125 children (78 asthmatic and 47 healthy non-asthmatic children) aged 3-14 years referred to Amirkola Childrenchr('39')s Hospital in Iran were entered to the study. Sampling was done using the available method based on inclusion criteria. Serum magnesium levels were measured in all children in the laboratory of Amirkola Childrenchr('39')s Hospital. P<0.05 was considered a significant level.

The mean age of children was 81.21±35.45 months, among them, 77 (61.6%) and 48 (38.4%) were male and female, respectively. The mean serum magnesium level of children was 2.08 and 2.04 mg/dl in the control and asthma groups, respectively and there was no statistically significant difference between the two groups (p=0.49).

Based on the findings of this study, there is no significant difference between serum magnesium levels in asthmatic patients and the control group and it is not necessary to routinely measure magnesium levels in these patients.

There is some evidence of a relationship between attention-deficit/hyperactivity disorder (ADHD) and functional defecation disorders (FDDs), both of which are common in childhood. The aim of the study was to investigate the frequency of ADHD in children with fecal incontinence (FI) and functional constipation (FC).

This cross-sectional study was conducted on 99 children aged 4-14 years who met the Rome IV criteria to diagnose pediatric chronic FC with FI from January to May 2020. The ADHD was then assessed by the child and adolescent psychiatrist via clinical visits, DSM-5 and Conners Rating Scale (CRS). Pearson’s Chi-Square test and Mann-Whitney’s test were used to compare children with and without ADHD. A P value <0.05 was considered statistically significant.

According to DM-V and clinical visits, about 24 (24.2%) children with FC and FI were diagnosed with ADHD. Moreover, six and one of their relatives had anxiety/depression and schizophrenia, respectively. Children with ADHD were significantly male (83%, p= 0.009), older (p= 0.003), heavier (p= 0.005), first born (79%, P < 0.001) and premature (37%, P=0.01) with older mothers (p=0.01).

This study showed that there was a high prevalence of ADHD in children with FC and FI. Therefore, screening of suspected children is recommended.

Diarrhea with salmonella and shigella infections is one of the main causes of mortality in children less than 5 years. Determining the antibiotic resistance of these bacteria is one of the most important methods in the treatment of diarrhea. This study was performed to evaluate antibiotic resistance of Salmonella and Shigella pathogenic bacteria in children with acute diarrhea referred to Amirkola Children  Hospital.

This cross-sectional study was performed on 252 stool samples collected from children aged 6 months to 5 years with acute diarrhea referred to Amirkola Hospital in 2018. Samples were cultured and the bacteria were isolated by routine methods and the identified strains were evaluated for antibiotic resistance and abundance of class I, II and III integron genes.

Out of 252 samples, 15(5.9%) were positive for Shigella spp and 13 (5.1%) were positive for Salmonella. Antibiotic resistance of Shigella and Salmonella for nalidixic acid(100%) and(54%),trimethoprim sulfamethoxazole(93%) and (0%), azithromycin (87%) and (23%), ampicillin, respectively. Ampicillin(73%) and (8%), cefotaxime (60%) and (46.1%) were observed. Of the 15 Shigella strains, all were ESBL positive (beta-lactamase positive). In Salmonella, 7 strains (53.9%) were ESBL positive. PCR results showed that 11 (73.3%), 14 (93%) and 10 (66.7%) of Shigella isolates carried intl I,II and both intlI/intlII genes. Class III integron not detected. PCR results revealed that 23% (3/13) of Salmonella isolates carried intl I, no class II,III integrons were detected.

The results showed that the frequency of Shigella infection and also their antibiotic resistance is higher than Salmonella.

The prevalence of Helicobacter pylori infection is reported variously in different studies in Iran. These study aimed to determine the prevalence of Helicobacter pylori infection in children in Iran.

In this systematic review and meta-analysis, we searched Medline, Scopus, EMBASE, Web of Science, and Google scholar systematically from Jan 1990 to up to December 2020. "Helicobacter pylori", "Child", "H. pylori", "Campylobacter pylori" and "Iran" were used for search. All English-language articles associated with the prevalence of H. pylori performed in Iran were evaluated, and after passing the qualification assessment (Newcastle –Ottawa Quality Assessment Scale), these were entered into the analysis. The prevalence of H. pylori in children at a 95% confidence interval was estimated using a random-effect model.

The search initially identified a total of 778 publications, and finally, 43 studies involving 16,939 children were included. The pooled prevalence of H. pylori infection in Iranian children is estimated as 43% (I2=98.1, p=0.001). Based on the diagnostic methods, the pooled prevalence in the group with stool antigen evaluation was 44% (I2=99%, p=0.001), the pooled prevalence in the serology evaluation group was 40% (I2=96%, p=0.001), in the biopsy group, 50%, in Rapid urease test/ urea breath test 40%, and in combined diagnostic tests group 56% (I2=84.5%, p=0.001), and in the not determined group the pooled estimate was 26%. The heterogeneity between groups was significant (p <0.001).

The pooled prevalence of H. pylori infection in children in Iran is estimated as 43%, which has been higher than the global prevalence. Also, a higher prevalence rate was reported in studies in which the diagnostic test was a biopsy.

COVID-19 can cause various symptoms in children. The aim of the study was evaluation of multi-organ presentation of children with COVID-19 infection in Amirkola Children’s Hospital in Babol, Iran.

This study was conducted retrospectively and data were extracted from medical records. All children with suspected COVID-19 infection who were referred to Amirkola Children’s Hospital in Babol (north of Iran) from March 4, 2020 to May 30, 2020 were enrolled. Clinical features of the respiratory and digestive system and Multisystem Inflammatory Syndrome in Children (MIS-c) were assessed. In all children WBC, RBC, Hb, MCV, Lymphocyte, CRP, ESR, ALT, AST, PT, PTT and platelets were also evaluated. Data analysis was conducted with SPSS software version 16.0.

Totally 37 children were recruited to the study. The most common clinical symptoms in children were fever (86.5%), weakness (75.7%) anorexia (73%)abdominal pain (48.6.9%), diarrhea (45.9%) nausea and vomiting (37.8%), cough (32.4%). About 60% and 8% of children had Hb and MCV less than normal levels respectively,So that 80% and 60% of children had abnormal elevations in CRP and ESR, respectively. Also, 32% and 35% of them had an increase in ALT and AST levels respectively and about 40% of them hadhypoalbuminemia. Additionally, 7 of 37 (18.9%) children had MIS-c. The result of the study demonstrated that 10/37 (32.4%) of children had pulmonary involvement.

In this study gastrointestinal symptoms were more common than respiratory symptoms in children with COVID-19 infection. Also, about one- fifth of children with COVID-19 had MIS-c. Attention to manifestations of organs other than respiratory system in children with COVID-19 infection is necessary.

One of the common functional gastrointestinal disorders in children is functional abdominal pain (FAP). The aim of the present study was to determine whether the administration of a synbiotic composed of fructo-oligosaccharides (FOS) and the seven types of beneficial bacteria is useful in FAP of childhood.

In this placebo-controlled, double-blind trial, 4-15-year-old children who met the Rome III criteria for FAP were randomly divided to receive either synbiotic or placebo twice daily for 4 weeks. Primary outcome was at least 50% reduction in the number of pain episodes, and secondary outcomes were a decline of at least two scales in the pain duration and intensity based on Wong-Baker scale. Response to therapy was decrease of pain frequency/intensity.

A total of 67 children completed the trial (35 with synbiotic). Response rate was higher with synbiotic than placebo after four weeks (53.1 vs 11.4%; p<0.001), and synbiotic had significant superiority to placebo to relieve the duration (4.56±9.12 vs12±18.59, min/day, P=0.04), frequency (0.31±0.53vs 1.17±0.7, episode/Wk., P<.001) and intensity (2.38±2.29 vs 5.49±1.83, p<0.001) of abdominal pain.

Synbiotic compared to placebo significantly decreased the intensity, frequency and duration of FAP in children.

Microarray experiments can simultaneously determine the expression of thousands of genes. Identification of potential genes from microarray data for diagnosis of cancer is important. This study aimed to identify genes for the diagnosis of acute myeloid and lymphoblastic leukemia using a sparse feature selection method.

In this descriptive study, the expression of 7129 genes of 25 patients with acute myeloid leukemia (AML), and 47 patients with lymphoblastic leukemia (ALL) achieved by the microarray technology were used in this study. Then, the important genes were identified using a sparse feature selection method to diagnose AML and ALL tissues based on the machine learning methods such as support vector machine (SVM), Gaussian kernel density estimation based classifier (GKDEC), k-nearest neighbor (KNN), and linear discriminant classifier (LDC).

Diagnosis of ALL and AML was done with the accuracy of 100% using 8 genes of microarray data selected by the sparse feature selection method, GKDEC, and LDC. Moreover, the KNN classifier using 6 genes and the SVM classifier using 7 genes diagnosed AML and ALL with the accuracy of 91.18% and 94.12%, respectively. The gene with the description “Paired-box protein PAX2 (PAX2) gene, exon 11 and complete CDs” was determined as the most important gene in the diagnosis of ALL and AML.

The experimental results of the current study showed that AML and ALL can be diagnosed with high accuracy using sparse feature selection and machine learning methods. It seems that the investigation of the expression of selected genes in this study can be helpful in the diagnosis of ALL and AML.

Cow’s milk intolerance can lead to chronic constipation in children. The present study seeks to determine the effect of cow’s milk-free diet (CMFD) on chronic constipation in children who are not responding to laxatives.

Seventy children suffering from chronic constipation (described as the Rome III criteria) were enrolled in an open-label randomized clinical study. Each group included 35 children aged 4-14 years treated with laxatives for at least three months with no improvements. The intervention group received CMFD plus calcium supplements for four weeks and the control group did not have any restrictions in consuming cow’s milk and dairy products. Also, both groups received polyethylene glycol (PEG; 1 gr/kg/day) and high-fiber foods (at least 10 gr/day) for four weeks. Responsiveness was described as a reduction in symptoms and signs according to the Rome III criteria after four weeks.

After four weeks, 25 (71.4%) children in the CMFD group responded to the treatment compared to four (11.4%) children in the control group (P<0.001). Significant differences were found between the CMFD and control groups in terms of the seven Rome III criteria post-intervention; history of large stools (25% vs. 53.6%), large fecal mass in the rectum during examination (17.1% vs. 50%), history of painful defecation (18.2% vs. 55.6%), history of retentive posturing (10% vs. 46%), ≥1 episode/week of incontinence (25 % vs. 50%, P=0.001), ≤ 2 defecations/week (17.4% vs. 52.3%) and history of thick stool with toilet obstruction (22.2% vs. 52.3%)

This study showed that children with functional constipation with no response to laxatives could benefit from a cow’s milk-free and dairy-free diet.