Publications by authors named "Manijeh Kahbazi"

20 Publications

  • Page 1 of 1

Evaluation of hypercalciuria in patients receiving intravenous Cefotaxime.

J Family Med Prim Care 2019 May;8(5):1558-1561

Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran.

Introduction: Cefotaxime is one of the third generation cephalosporins, which is used against many infections. This drug has a urinary excretion and potentially may have nephrotoxic effects. Hypercalciuria can cause important complications, including the formation of kidney stones. In the recent study, we decided to evaluate hypercalciuria in children receiving cefotaxime.

Materials And Methods: This case-control study was conducted in Amirkabir hospital (Arak, Iran), where 30 children received intravenous cefotaxime were placed in the case group and 30 children without intravenous administration of cefotaxime were included in the control group. The ratio of calcium to creatinine was measured in both groups. Data were analyzed by SPSS software version 23.

Results: This study showed that the ratios of male and female children in both the groups were 19 (63.3%) and 11 (36.7%) respectively, the mean age of children in the case group was 2.36 years with a standard deviation of 0.71 and the mean age of the children in the control group was 5.18 years with a standard deviation of 3.31. The ratios of urine calcium to creatinine in the case and control groups were 0.90 with a standard deviation of 1.79 and 0.37 with a standard deviation of 0.44 ( value = 0.003).

Conclusion: According to the above results, it is concluded that receiving intravenous cefotaxime may increase calcium to creatinine ratio in children.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_33_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559067PMC
May 2019

Vitamin A supplementation is effective for improving the clinical symptoms of urinary tract infections and reducing renal scarring in girls with acute pyelonephritis: a randomized, double-blind placebo-controlled, clinical trial study.

Complement Ther Med 2019 Feb 12;42:429-437. Epub 2018 Dec 12.

Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran.

Introduction: It is believed that tubulointerstitial inflammation plays a role in the formation of renal scarring secondary to acute pyelonephritis (APN). Vitamin A is an anti-inflammatory agent that is involved in the re-epithelialization of damaged mucosal surfaces.

Objective: The aim of this study was to evaluate the efficacy of vitamin A supplementation in combination with antibiotics for improving urinary tract infections (UTIs) symptoms and preventing renal scarring in girls with APN.

Study Design: This randomized, double-blind, placebo-controlled clinical trial was conducted on 90 girls aged 2 to 12 years old between 2015 and 2017. Patients with UTIs and first episode of APN diagnosed based on 99 mTc-DMSA scintigraphy (uptake defect) were assessed for eligibility. Patients were randomly divided into two groups that either received 10 days of oral vitamin A (intervention group) or 10 days of placebo (control group) in addition to antibiotics during the acute phase of infection. The clinical response was considered as the primary outcome [duration (positive days) of UTI symptoms during trial treatment period] and secondary outcomes (no change, improving and or worsening of 99 mTc-DMSA scan results 6 months after treatment from baseline). P < 0.05 was considered to be statistically significant.

Results: Seventy-four patients (vitamin A group: 36 patients, placebo: 38 patients) were included in the analysis. The mean age was 5.25 ± 1 year old. Three patients (7.89%) in the placebo group and 2 patients (5.55%) in the vitamin A group had vesicoureteral reflux (VUR) (p = 0.114). Duration of fever (vitamin A group: 1.8 days, placebo: 3.1 days, p = 0.0026), urinary frequency (1.3 days vs. 2.8 days, p = 0.003) and poor feeding (2.3 days vs. 4.2 days, p = 0.005) were significantly lower in the vitamin A group. Following the second 99 mTc-DMSA scan, worsening of lesions was observed among 8 (22.2%) and 17 (44.7%) patients in the vitamin A and placebo groups, respectively (p = 0.003). 63.8% (23 patients) of the vitamin A group and 21% (8 patients) of placebo group showed lesion improving in the photopenic region. (P < 0.0001) There was no evidence of vitamin A intolerance.

Discussion: Our results show the efficacy of vitamin A supplementation on reducing renal scarring secondary to APN and on fever, urinary frequency and poor feeding duration in girls with APN.

Conclusion: Vitamin A supplementation is effective for improving the clinical symptoms of UTI and reducing renal injury and scarring following APN in girls with first APN. However, larger randomized clinical trials (RCTs) with longer follow up are needed to confirm these effects.
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http://dx.doi.org/10.1016/j.ctim.2018.12.007DOI Listing
February 2019

Enterobacter Meningitis Due To Dermoid Cyst Manipulation.

Iran J Child Neurol 2018 ;12(4):169-177

Department of Pediatrics, Bouali Children's Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

Gram-negative meningitis can occurssubsequent to dura-arachnoid barrier disruption because of trauma, surgery and rarely an infected dermoid cyst. Association of neurosurgical procedures with Gram-negative meningitis was described for the first time in 1940. Intracranial infections from gram-negative bacilli like are serious and difficult to treat as many antibiotics fail to achieve bactericidal concentrations in the cerebrospinal fluid. Here in, we report a rare case of pediatric meningitis in a patient with a dermoid cyst that had been manipulated. She was managed with antibiotic therapy plus surgical removal of the infected cyst.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160624PMC
January 2018

Novel Mutations in Gene of Pyrazinamide Resistant Clinical Isolates of .

Sci Pharm 2018 Apr 16;86(2). Epub 2018 Apr 16.

Infectious Diseases Research Center (IDRC), Arak University of Medical Sciences, Arak, 3819693345, I.R. of Iran.

In clinical isolates of (MTB), resistance to pyrazinamide occurs by mutations in any positions of the gene (NC_000962.3) especially in nucleotides 359 and 374. In this study we examined the gene sequence in clinical isolates of MTB. Genomic DNA of 33 clinical isolates of MTB was extracted by the Chelex100 method. The polymerase chain reactions (PCR) were performed using specific primers for amplification of 744 bp amplicon comprising the coding sequences (CDS) of the gene. PCR products were sequenced by an automated sequencing Bioscience system. Additionally, semi Nested-allele specific (sNASP) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods were carried out for verification of probable mutations in nucleotides 359 and 374. Sequencing results showed that from 33 MTB clinical isolates, nine pyrazinamide-resistant isolates have mutations. Furthermore, no mutation was detected in 24 susceptible strains in the entire 561 bp of the gene. Moreover, new mutations of G→A at position 3 of the gene were identified in some of the resistant isolates. Results showed that the sNASP method could detect mutations in nucleotide 359 and 374 of the gene, but the PCR-RFLP method by the SacII enzyme could not detect these mutations. In conclusion, the identification of new mutations in the gene confirmed the probable occurrence of mutations in any nucleotides of the gene sequence in resistant isolates of MTB.
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http://dx.doi.org/10.3390/scipharm86020015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6027673PMC
April 2018

Insights into Pyrazinamidase and DNA Gyrase Protein Structures in Resistant and Susceptible Clinical Isolates of .

Tanaffos 2016 ;15(3):147-153

Infectious Diseases Research Center (IDRC), Arak University of Medical Sciences, Arak, Iran.

Background: Mutations in and genes cause pyrazinamide (PZA) and fluroquinolone resistance in (). In the present study, structures of pyrazinamidase (PZase) and DNA gyrase proteins were studied in resistant and susceptible clinical isolates of

Materials And Methods: Sixty clinical isolates of were used in this study. Polymerase chain reaction (PCR) amplification of and genes was accomplished on purified DNA. Sequence of the fragments was determined by an Applied BiosystemsTM apparatus. Bioinformatic analysis was performed by online software and three-dimensional (3D) structures of proteins was predicted using Molegro Virtual Docker (MVD) Modeler software.

Results: Amplified 744 and 194 bp fragments of and genes, respectively were yielded suitable sequence results. Predicted 3D structures of proteins showed some differences between wild-type and mutant structures. Mutation in amino acid No.31 (T92C) caused an increase in distance from metal ion position to enzyme active site, but it was considered as a polymorphism. Docking results by MVD revealed a relationship in quinolone resistance-determining regions (QRDR) amino acids in interaction with antibiotic. T92C mutation in PZase from non-polar aliphatic amino acid Ile (ATC) to polar aliphatic amino acid threonine (ACC) was a polymorphism.

Conclusion: Structural changes in two important proteins related to drug resistance were proven in clinical isolates of .
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304958PMC
January 2016

Antimycobacterial activity assessment of three ethnobotanical plants against Mycobacterium Tuberculosis: An In Vitro study.

Int J Mycobacteriol 2016 Dec 27;5 Suppl 1:S108-S109. Epub 2016 Oct 27.

Infectious Diseases Research Center (IDRC), Arak University of Medical Sciences, Arak, Iran.

Objective/background: Resistances to herbal medicines are still not defined and finding natural remedies against drug resistant Mycobacterium tuberculosis (MTB) has research priority. The antimycobacterial susceptibility method for herbal extracts is unclearly defined and there is no standard method for assessment of the materials against bacteria. In the present study, time kill of three medicinal plants was determined against MTB.

Methods: The clinical isolate of MTB from a patient who harbored confirmed tuberculosis was used in the study. Aqueous extracts of Aloe vera leaves, mint, and Hypericum perforatum were prepared using reflux distillation. Disk diffusion methods were conducted in Petri dishes and McCartney bottles containing Löwenstein-Jensen medium to measure the sensitivity of plant extracts in serial concentrations of 0.25-8mg/mL. A pour plate method was performed by mixing 0.7mL of each concentration of extract in 5mL Löwenstein-Jensen medium followed by surface culturing of MTB fresh cells. The time kill method was conducted by bacterial suspension in equal amounts of the extract and viable evaluation in fresh culture at the beginning, and at 24-h, 48-h, 72-h, and 1-week intervals. All cultures were incubated at 37°C for 4weeks. Inoculum concentrations were considered as a variable.

Results: The zones of inhibition of A. vera, H. perforatum, and mint extracts in the disk diffusion method in McCartney bottles were 60mm, 41mm, and zero, respectively, but Petri dishes did not have repeatable results. In the pour plate method, an extract concentration up to 1mg/mL could inhibit cell growth. In mint extract, colony forming was four times more than the others at 0.5mg/mL. Time kill of 95% of cells occurred when exposed to extracts of A. vera and H. perforatum separately, but was 50% in 24 h and 20% in 10 min. The time kill for mint was 95% in 1week.

Conclusion: The results give some scientific basis to the use of plant extracts for growth control of MTB cells. Clinical trials are recommended for assessment of the extract as complementary medicine, as well as for antisepsis.
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http://dx.doi.org/10.1016/j.ijmyco.2016.10.025DOI Listing
December 2016

Efficacy of Synbiotics for Treatment of Bacillary Dysentery in Children: A Double-Blind, Randomized, Placebo-Controlled Study.

Adv Med 2016 30;2016:3194010. Epub 2016 Nov 30.

Infectious Diseases Research Centre (IDRC), Arak University of Medical Sciences, Arak, Iran.

Bacillary dysentery is a major cause of children's admission to hospitals. To assess the probiotic and prebiotic (synbiotics) effects in children with dysentery in a randomized clinical trial, 200 children with dysentery were studied in 2 groups: the synbiotic group received 1 tablet/day of synbiotic for 3-5 days and the placebo group received placebo tablets (identical tablet form like probiotics). The standard treatment was administered for all patients. Duration of hospitalization, dysentery, fever, and the weight loss were assessed in each group. It was concluded that there was no significant difference in both groups in the baseline characteristics. The mean duration of dysentery reduced ( < 0.05). The mean duration of fever has been significantly reduced in the synbiotic group (1.64 ± 0.87 days) in comparison to the placebo group (2.13 ± 0.94 days) ( < 0.001). Average amount of weight loss was significantly lower in the synbiotic group in comparison to that in the placebo group (129.5 ± 23.388 grams and 278 ± 28.385 grams, resp.; < 0.001). There was no significant difference in the mean duration of hospitalization in both groups ( > 0.05). The use of synbiotics as an adjuvant therapy to the standard treatment of dysentery significantly reduces the duration of dysentery, fever, and rate of weight losses. The trial is registered with IRCT201109267647N1.
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http://dx.doi.org/10.1155/2016/3194010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155077PMC
November 2016

The effect of short-term workshop on improving clinical reasoning skill of medical students.

Med J Islam Repub Iran 2016 12;30:396. Epub 2016 Jul 12.

MD, Student Research Committee, Emergency Medicine Department, Arak University of Medical Sciences, Arak, Iran.

Background: Clinical reasoning process leads clinician to get purposeful steps from signs and symptoms toward diagnosis and treatment. This research intends to investigate the effect of teaching clinical reasoning on problem-solving skills of medical students.

Methods: This research is a semi-experimental study. Nineteen Medical student of the pediatric ward as case group participated in a two-day workshop for training clinical reasoning. Before the workshop, they filled out Diagnostic Thinking Inventory (DTI) questionnaires. Fifteen days after the workshop the DTI questionnaire completed and "key feature" (KF) test and "clinical reasoning problem" (CRP) test was held. 23 Medical student as the control group, without passing the clinical reasoning workshop DTI questionnaire completed, and KF test and CRP test was held.

Results: The average score of the DTI questionnaire in the control group was 162.04 and in the case group before the workshop was 153.26 and after the workshop was 181.68. Compare the average score of the DTI questionnaire before and after the workshop there is a significant difference. The difference between average KF test scores in the control and the case group was not significant but between average CRP test scores was significant.

Conclusion: Clinical reasoning workshop is effectiveness in promoting problem-solving skills of students.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004529PMC
August 2016

Zinc Supplementation in Treatment of Children With Urinary Tract Infection.

Iran J Kidney Dis 2016 Jul;10(4):213-6

Department of Basic Sciences, Arak University of Medical Sciences, Arak, Iran.

Introduction: Urinary tract infection (UTI) is very common in children. Precocious diagnosis and appropriate treatment are important because of the permanent disease complications. Zinc increases the response to treatment in many infections. In this study, we explored the effect of zinc in treating UTI.

Materials And Methods: Two hundred children with UTI were divided into 2 groups of 100 who were comparable in terms of age, sex, urine laboratory profiles, and clinical signs and symptoms. The control group received a standard treatment protocol for UTI and the intervention group received oral zinc sulfate syrup plus routine treatment of UTI.

Results: A faster recovery was observed in the patients receiving zinc, but abdominal pain was exacerbated by zinc and lasted longer. Three months after the treatment, there was no significant difference between the two groups in the time of fever stop and negative urine culture.

Conclusions: In children with UTI, zinc supplementation has a positive effect in ameliorating severe dysuria and urinary frequency while the use of this medication is not recommended in the presence of abdominal pain.
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July 2016

Minor Contribution of inhA-15 Mutations to the Rapid Detection of Isoniazid Resistance in Mycobacterium Tuberculosis Isolates.

Iran J Med Sci 2016 Mar;41(2):161-3

Medical Laboratory Sciences and Research Center for TB and Pulmonary Diseases, Tabriz University of Medical Sciences, Tabriz, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764969PMC
March 2016

Surveillance of Antibiotic Consumption Point Prevalence Survey 2014: Antimicrobial Prescribing in Pediatrics Wards of 16 Iranian Hospitals.

Arch Iran Med 2016 Mar;19(3):204-9

Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran.

Background: Antibiotics are among the most commonly prescribed drugs in pediatrics. Due to lack of uniformity in pediatric antimicrobial prescribing and the emergence of antibiotic resistance, appropriate drug utilization studies have been found to be crucial to evaluate whether these drugs are properly used.

Methods: Data were collected between January 2014 and February 2014 in 16 Iranian pediatric hospitals using a standardized method. The point prevalence survey included all inpatient beds.

Results: Of 858 children, 571 (66.6%) received one or more antimicrobials. The indications were therapeutic in 60.6%. The parenteral route was used in 92.5% of therapeutic indications. Ceftriaxone was the most prescribed antimicrobials for therapeutic indications (32.4%) and combination-therapy was the most type of therapy in pediatric intelligent care unit (PICU).

Conclusion: According to results of this study, antibiotics' prescribing in pediatrics wards of Iranian hospitals is empirical. Therefore, for quality improvement of antimicrobial use in children continuous audit process and antibiotic prescriptions require further investigation.
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http://dx.doi.org/0161903/AIM.009DOI Listing
March 2016

Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study.

Fundam Clin Pharmacol 2016 Feb 12;30(1):70-5. Epub 2015 Nov 12.

Department of Pediatrics, Amirkabir Hospital, Rah Ahan Square, Shiroodi Blvd, Arak, Iran.

The objective of this study was to compare the effect of L-epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children. A randomized, double-blind clinical trial was implemented on 174 patients with croup, aged from 6 months to 6 years, and admitted to the Amir Kabir Pediatric Hospital (Arak, Iran). After randomized allocation, patients were administered dexamethasone, and then, they received either saline or L-epinephrine. Westley croup scores, heart rate, respiratory rate, and blood pressure were recorded every half an hour for a total of 120 min. There was a significant difference in mean of croup scores between two groups (P < 0.009). In addition, a significant difference was seen on mean of heart rate between two groups (P < 0.026). Our results showed a considerable difference in reduction of velocity of croup scores in patients who received nebulized L-epinephrine compared to patients who received placebo.
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http://dx.doi.org/10.1111/fcp.12158DOI Listing
February 2016

Arginine adjunctive therapy in active tuberculosis.

Tuberc Res Treat 2015 3;2015:205016. Epub 2015 Feb 3.

Tuberculosis and Pediatric Infectious Diseases Research Center, Arak University of Medical Sciences, Arak 38159 34798, Iran.

Background. Dietary supplementation has been used as a mechanism to augment the immune system. Adjunctive therapy with L-arginine has the potential to improve outcomes in active tuberculosis. Methods. In a randomized clinical trial 63 participants with smear-positive pulmonary tuberculosis in Markazi Province of Iran were given arginine or placebo for 4 weeks in addition to conventional chemotherapy. The final treatment success, sputum conversion, weight gain, and clinical symptoms after one and two months were considered as primary outcomes and secondary outcomes were ESR, CRP, and Hg. Data were collected and analyzed with SPSS software (ver. 18). Results. Arginine supplementation reduced constitutional symptoms (P = 0.032) in patients with smear-positive TB at the end of the first month of treatment. Arginine treated patients had significantly increased BMI at the end of the first and second months of treatment (P = 0.032 and P = 0.04) and a reduced CRP at the end of the first month of treatment (P = 0.03) versus placebo group. Conclusion. Arginine is useful as an adjunctive therapy in patients with active tuberculosis, in which the effects are more likely mediated by the increased production of nitric oxide and improved constitutional symptoms and weight gain. This trial is registered with Clinical Trials Registry of Iran: IRCT201211179855N2.
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http://dx.doi.org/10.1155/2015/205016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334935PMC
March 2015

Study of pyrazinamidase structural changes in pyrazinamide resistant and susceptible isolates of Mycobacterium tuberculosis.

Tuberk Toraks 2013 ;61(2):110-4

Tuberculosis and Pediatric Infectious Diseases Research Center, Faculty of Medicine, Arak University, Arak, Iran.

Introduction: Pyrazinamide is one of the first line four drugs for treatment of tuberculosis. It was proved that mutations in two nucleotides of 359 and 374 pnc genes are highly associated with resistance to pyrazinamide.

Materials And Methods: In this study, mutations in these two codones in 30 clinical isolates of Mycobacterium tuberculosis were detected by means of sequencing. Protein structures encoded by this gene with and without mutation were investigated in resistant and susceptible isolates to pyrazinamide, respectively.

Results: Mutation in the positions 359 and 374 altered some parameters like change in electronic charge, distance change of mutated amino acids to situation of active enzyme and metal connection situation. In these conditions, structure and function of pyrozinamidase enzyme were changed and antibiotic was ineffective and consequently caused resistance to pyrazinamide in M. tuberculosis.

Conclusion: This work was revealed protein changes in resistance to pyrazinamide in clinical isolates of M. tuberculosis.
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http://dx.doi.org/10.5578/tt.3888DOI Listing
December 2013

Determination of principal genotypic groups among susceptible, MDR and XDR clinical isolates of Mycobacterium tuberculosis in Belarus and Iran.

Tuberk Toraks 2012 ;60(2):153-9

Research Center of Molecular Medicine, Arak University of Medical Sciences, Arak, Iran.

Introduction: All members of the Mycobacterium tuberculosis complex were assigned to one of the three principle genetic groups based on KatG463/GyrA95 polymorphism.

Materials And Methods: A total of 202 isolates of M. tuberculosis consisting of 50 susceptible, 121 MDR (multidrug resistant) and 31 XDR (extensively drug resistant) isolated from culture-confirmed tuberculosis patients in different regions of Belarus and Iran (Tehran and Markazi province). Isolates were screened by sequencing and polymerase chain reaction restriction fragment length polymorphism (RFLP) assay, and were further divided into three principal genetic groups (PGG), based on Sreevatsan's pattern as polymorphisms in KatG463/GyrA95 codons.

Results: Among the 104 isolates, characterized as MDR from Belarus, 57 (54.8 ± 4.8%), 30 (28.8 ± 4.43%), 17 (16.3 ± 3.6), belonged to PGG 1, 2, and 3, respectively (p< 0.05). Thirty one XDR isolates from Belarus had a similar pattern as 15 (48.4%), 12 (38.7%), 4 (12.9%) PGG 1, 2, and 3, respectively. From Iranian samples, Markazi isolates (susceptible to drugs) had a pattern as 12 (36.5%), 15 (45.5%), 3 (6%), and Tehran samples were (selected MDR): 9 (53%), 6 (35.2%), 2 (11.8%) (PGG 1, 2, and 3, respectively). In a study of tuberculosis patients, who were in prison, no relation was found between PGG and resistance to isoniazid, but most of the identified isolates belonged to PGG 1 (45.5 ± 10.9%) (p< 0.05). Overall, the group 1 isolates showed more frequency in MDR and XDR rather than susceptible strains, and there aren't any relations to geographic region.
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http://dx.doi.org/10.5578/tt.3520DOI Listing
September 2012

Aetiology of upper respiratory tract infections in children in Arak city: a community based study.

Acta Microbiol Immunol Hung 2011 Dec;58(4):289-96

Arak University of Medical Sciences Tuberculosis and Pediatric Infections Research Center, Faculty of Medicine Arak Iran.

Viruses are frequent causes of upper respiratory tract infections in children. We investigated the viral aetiology of community-acquired upper respiratory tract infections (URIs) in young children treated as outpatients in community settings. During November 2008, nasal swab specimens were taken from children with recent onset of upper respiratory tract infections. The patients attended day care or primary schools; the specimens were randomly obtained by pediatricians from schools and childcare institutions and sent for identification by PCR method. A total of 300 specimens were collected. From all samples, 40.67% were positive for at least 1 virus, viz. adenovirus 11.76%, rhinovirus 9.8%, respiratory syncytial virus 6.08%, influenza virus 5.56%, parainfluenza virus 4.9%, enterovirus 2.94% and a combination of 2 viruses 2%. Clinical manifestations of the respiratory infections were as follows: 70.7% of the patients had coryza, 69.3% cough, 26% sneezing, 19.7% sore throat, 2.7% headache, 7.7% fever, 2.3% conjunctivitis, 1.3% abdominal pain and 1% hoarseness. The results of this study demonstrate that adenoviruses and rhinoviruses are the two most common viral agents isolated from pediatric outpatients with acute URIs in autumn in Arak City. Coryza and cough were the most common symptoms in children. Sore throat and hoarseness were more prevalent in infections caused by influenza virus, conjunctivitis in parainfluenza, and coryza in rhinovirus infections.
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http://dx.doi.org/10.1556/AMicr.58.2011.4.5DOI Listing
December 2011

A randomized, double-blind and placebo-controlled trial of modafinil in children and adolescents with attention deficit and hyperactivity disorder.

Psychiatry Res 2009 Aug 12;168(3):234-7. Epub 2009 May 12.

Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran.

Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder in childhood, with an estimated prevalence worldwide of 7%-17% among school-aged children. Modafinil is a centrally acting agent that is structurally and pharmacologically different from stimulants such as amphetamine and methylphenidate. It has been reported that modafinil is effective in diminishing the symptoms of ADHD. The aim of the present study was to further evaluate, under double-blind and placebo-controlled conditions, the efficacy of modafinil for ADHD in children and adolescents. Patients were 46 outpatients, children (35 boys and 11 girls) between the ages of 6 and 15 who clearly met the DSM-IV-TR diagnostic criteria for ADHD. All study subjects were randomly assigned to receive treatment with modafinil in a film-coated tablet, 200-300 mg/day, depending on weight (200 mg/day for <30 kg and 300 mg/day for >30 kg) (group 1) or placebo (group 2) for a 6-week double-blind, randomized clinical trial. The principal outcome measure was the Teacher and Parent ADHD Rating Scale-IV. Patients were assessed by a psychiatrist at baseline, 14, 28 and 42 days after the medication started. At 6 weeks, modafinil produced a significantly better outcome on the Parent and Teacher Rating Scale scores than placebo. Decreased appetite was observed more often in the modafinil group. The results of this study indicate that modafinil significantly improved symptoms of ADHD, was well tolerated, and may open a new window in the treatment of children with ADHD.
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http://dx.doi.org/10.1016/j.psychres.2008.06.024DOI Listing
August 2009

Modafinil as a treatment for Attention-Deficit/Hyperactivity Disorder in children and adolescents: a double blind, randomized clinical trial.

Prog Neuropsychopharmacol Biol Psychiatry 2008 Jan 8;32(1):145-9. Epub 2007 Aug 8.

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran 13337, Iran.

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most prevalent psychiatric disorder currently afflicting children and is among the most common chronic conditions affecting school-age children. Modafinil is structurally different from the psychostimulants that are typically used to treat ADHD and has been reported to be effective in improving the symptoms of ADHD. The aim of the present study was to further evaluate, under double blind and controlled conditions, the efficacy of modafinil for ADHD in children and adolescents as compared to methylphenidate. Patients included 60 outpatients, children (47 boys and 13 girls) between the ages of 6-15 who clearly met the DSM-IV-TR diagnostic criteria for ADHD. Subjects were recruited from an outpatient child and adolescent clinic for a 6 week double blind, randomized clinical trial. All study subjects were randomly assigned to receive either treatment with modafinil film coated tablet (in doses of 200-300 mg/day) depending on weight (200 mg/day for <30 kg and 300 mg/day for >30 kg) (group 1) or methylphenidate (in doses of 20-30 mg/day) depending on weight (20 mg/day for <30 kg and 30 mg/day for >30 kg) (group 2). The principal measure of outcome was the Teacher and Parent ADHD Rating Scale-IV. Patients were assessed at baseline and at 21 and 42 days after the medication started. No significant differences were observed between the two groups on the Parent and Teacher Rating Scale scores. Side effects of decreased appetite and difficulty falling asleep were observed more in the methylphenidate group. The results of this study indicate that modafinil significantly improved symptoms of ADHD and was well tolerated and it is beneficial in the treatment of children with ADHD.
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http://dx.doi.org/10.1016/j.pnpbp.2007.07.025DOI Listing
January 2008

Cumulative prevalence of risk factors for atherosclerotic cardiovascular diseases in Iranian adolescents: IHHP-HHPC.

J Pediatr (Rio J) 2005 Nov-Dec;81(6):447-53

Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Iran.

Objective: To evaluate the cumulative prevalence of atherosclerotic cardiovascular disease risk factors in a representative sample of Iranian adolescents.

Methods: The subjects of this cross-sectional study were 1,000 girls and 1,000 boys, ages 11-18 years, selected by multi stage-random cluster sampling from urban and rural areas of three cities in Iran.

Results: The prevalence of physical inactivity, dyslipidemia, smoking, high blood pressure and obesity (body mass index >95th percentile) were 66.6, 23.7, 8.7, 5.7 and 2.2%, respectively. Of subjects studied, 79.1% had at least one and 24.6% had two cardiovascular disease risk factors. The prevalence of physical inactivity was significantly lower in boys than girls [53.9 vs. 79.3%, respectively, OR 95%CI, 0.44 (0.39-0.51)]. The prevalence of smoking was higher in boys than girls [13.1 vs. 4.2%, respectively, OR 95%CI, 3.4 (2.4-4.9)].

Conclusion: Considering the high prevalence of cardiovascular disease risk factors in adolescents, age-appropriate and culturally sensitive interventions for lifestyle change are warranted, so that preventive measures can be taken in a timely manner.
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http://dx.doi.org/10.2223/JPED.1418DOI Listing
June 2006

Dietary fat intake and lipid profiles of Iranian adolescents: Isfahan Healthy Heart Program--Heart Health Promotion from Childhood.

Prev Med 2004 Oct;39(4):760-6

Preventive Pediatric Cardiology Department, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Iran.

Objectives: To assess the serum lipid profiles of Iranian adolescents and their correlation with dietary fat intake and to evaluate the knowledge, attitude, and practice (KAP) of students, parents, and school staff.

Methods: The subjects of this cross-sectional study were 2000 students (1000 girls and 1000 boys), ages 11-18 years, selected by multistage random sampling, and one of their parents (2000 subjects), as well as 500 school staff in urban and rural areas of two provinces in Iran (one for further interventions and the other for reference). The data were obtained by questionnaires, anthropometric measurements, 3-day food record form, and a 20-item food frequency questionnaire (FFQ). All serum lipids were determined in the same laboratory.

Results: Although the percentage of fat intake (21.2 +/- 0.4%) among the adolescents was within the recommended daily allowance (RDA < or = 30%), in most cases, the percentiles of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were significantly higher and the percentiles of high-density lipoprotein cholesterol (HDL-C) were lower than standard values according to Lipid Research Clinics (LRC) data; for example, the mean TC values for girls in the 11- to 14- and 15- to 18-year age groups were significantly higher than LRC standard values (169 and 172 vs. 160 and 159 mg/dl, respectively, P < 0.05). This difference was also significant in boys (167 and 168 vs. 160 and 153 mg/dl, respectively) at the P < 0.05 level. A significant linear association was shown between adolescents' dyslipidemia and the frequency of intake of hydrogenated fat, fast foods, cheese puffs, and potato chips (P < 0.05). Although the protein intake was lower than the RDA (13.4 +/- 0.9% vs. 15%, P < 0.05), because of the highly prevalent consumption of fatty lamb meat, the frequency of red meat intake had a direct association with dyslipidemia (P < 0.05).

Conclusion: The improper intake of high amounts of saturated fat and the observed serum lipid profile of Iranian adolescents are likely placing them at increased risk for cardiovascular disease (CVD) and necessitate developing guidelines and community-based interventions.
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http://dx.doi.org/10.1016/j.ypmed.2004.02.047DOI Listing
October 2004