BackgroundThe prevalence of food insecurity is an indicator of material well-being in an area of basic need. The U.S. Food Security Module has been adapted for use in a wide variety of cultural and linguistic settings around the world. We assessed the internal validity of the adapted U.S. Household Food Security Survey Module to measure adult and child food insecurity in Isfahan, Iran, using statistical methods based on the Rasch measurement model.MethodsThe U.S. Household Food Security Survey Module was translated into Farsi and after adaptation, administered to a representative sample. Data were provided by 2,004 randomly selected households from all sectors of the population of Isfahan, Iran, during 2005.Results53.1 percent reported that their food had run out at some time during the previous 12 months and they did not have money to buy more, while 26.7 percent reported that an adult had cut the size of a meal or skipped a meal because there was not enough money for food, and 7.2 percent reported that an adult did not eat for a whole day because there was not enough money for food. The severity of the items in the adult scale, estimated under Rasch-model assumptions, covered a range of 6.65 logistic units, and those in the child scale 11.68 logistic units. Most Item-infit statistics were near unity, and none exceeded 1.20.ConclusionThe range of severity of items provides measurement coverage across a wide range of severity of food insecurity for both adults and children. Both scales demonstrated acceptable levels of internal validity, although several items should be improved. The similarity of the response patterns in the Isfahan and the U.S. suggests that food insecurity is experienced, managed, and described similarly in the two countries.

We herein describe a case series of children with SARS-CoV-2 infection (COVID-19) complicated with acute intracardiac thrombosis. The diagnosis of COVID-19 was confirmed through the reverse transcription-polymerase chain reaction (RT-PCR). Transthoracic echocardiography of patients revealed large intracardiac mobile masses resected successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory state of the disease incurred by the SARS-CoV-2 virus.

Despite the general welcoming attitude of all groups of specialists, they had insufficient knowledge and inadequate use of EBM in their practice. Designing and conducting EBM training courses and its integration into the general practitioners' training curriculum should be considered.

Background Multi-system inflammatory syndrome in children (MIS-C) involves multiple organs and shows increased inflammatory markers. Since the onset of the COVID-19 pandemic, several studies have reported the association between severe COVID-19 and MIS-C. Reversible cerebral vasoconstriction syndrome (RCVS) presents with thunderclap headaches and multifocal reversible vasoconstriction on imaging. RCVS is very rare in children. This paper reports two cases of pediatric COVID-19 with severe MIS-C and clinical and imaging features indicative of RCVS. Methods Clinical, laboratory and imaging data of the patients were reviewed. The diagnosis of RCVS was confirmed based on clinical symptomatology and brain magnetic resonance imaging findings. Results Two pediatric patients with clinical findings compatible with severe MIS-C and hemodynamic compromise presented to the hospital. During their hospitalization course, they developed thunderclap headaches and neurological deficits. Both were receiving vasoactive agents, intravenous immune globulin (IVIG), and immunosuppressants. Imaging studies showed marked multifocal cerebral vasoconstriction in both cases and infarcts in one. The course and management of the patients will be presented. After controlling inflammation and elimination of triggers, both patients were ultimately symptom-free upon discharge. Cerebral vasoconstriction had completely resolved on follow-up imaging. Conclusions Although a variety of symptoms including headaches may be seen in pediatric COVID-19 patients with MIS-C, RCVS should be considered as a differential diagnosis in cases of thunderclap headache accompanied by neurologic signs in these patients. Imaging findings and follow-up are also key in establishing the diagnosis.

BackgroundHyperinsulinaemic hypoglycaemia (HH) is a group of clinically and genetically heterogeneous disorders characterized by unregulated insulin secretion. Abnormalities in nine different genes (ABCC8, KCNJ11, GLUD1, GCK, HADH, SLC16A1, HNF4A, UCP2 and HNF1A) have been reported in HH, the most common being ABCC8 and KCNJ11. We describe the genetic aetiology and phenotype of Iranian patients with HH.MethodsRetrospective clinical, biochemical and genetic information was collected on 23 patients with biochemically confirmed HH. Mutation analysis was carried out for the ATP-sensitive potassium (KATP) channel genes (ABCC8 and KCNJ11), GLUD1, GCK, HADH and HNF4A.Results78 % of the patients were identified to have a genetic cause for HH. 48 % of patients had mutation in HADH, whilst ABCC8/KCNJ11 mutations were identified in 30 % of patients. Among the diazoxide-responsive patients (18/23), mutations were identified in 72 %. These include two novel homozygous ABCC8 mutations. Of the five patients with diazoxide-unresponsive HH, three had homozygous ABCC8 mutation, one had heterozygous ABCC8 mutation inherited from an unaffected father and one had homozygous KCNJ11 mutation. 52 % of children in our cohort were born to consanguineous parents. Patients with ABCC8/KCNJ11 mutations were noted to be significantly heavier than those with HADH mutation (p = 0.002). Our results revealed neurodevelopmental deficits in 30 % and epilepsy in 52 % of all patients.ConclusionsTo the best of our knowledge, this is the first study of its kind in Iran. We found disease-causing mutations in 78 % of HH patients. The predominance of HADH mutation might be due to a high incidence of consanguineous marriage in this population. Further research involving a larger cohort of HH patients is required in Iranian population.