It can be concluded that both enzyme-inducing AEDs and non enzyme-inducing AEDs decrease bone mineral density (BMD). Also alkaline phosphatase (ALP) is affected in ambulatory epileptic children on enzyme-inducing AEDs. Nevertheless, valproic acid (a non-enzyme-inducing agent) does not have the mentioned side effects.

Background: Vitamin D deficiency is common among children and adolescents and can be affected by several factors such as puberty and obesity. Objective: The aim of this study was to evaluate vitamin D status in children and adolescents and to analyse the influence of puberty and obesity on its level. Method: A cross-sectional study was carried-out, in which clinical and biochemical data were gathered from 384 healthy children and adolescents between May 2019 to May 2020. Results: 220 females and 164 males were enrolled (aged 7-16 years; mean ± SD: 11 ± 2.5). Vitamin D deficiency was found in 49% of the total cases and was significantly more prevalent in females than males (33.1% in female; 15.9% in male, P < .001). Mean vitamin D level was lower in obese children compared with non-obese ( P < .001). Non-obese group had significantly higher levels of vitamin D in Tanner stage IV of puberty than obese individuals (20.1 ± 17.0 vs 5.4 ± 2.0) ( P = .03). Vitamin D levels were significantly lower in females than males only in Tanner stage II (12.3 ± 9.0 vs 19.6 ± 16.6) ( P = .005). The lowest level of Vitamin D was in Tanner stage Ⅳ-Ⅴ in boys and in Tanner stage Ⅱ-Ⅲ in girls ( P < .001). Conclusion: Puberty is an additional risk factor for vitamin D deficiency especially in girls and obese children. This increased risk, together with the fact that most important time for building a proper skeleton is during childhood and adolescent, makes it essential to monitor vitamin D in these age groups.

Background: Hydatid disease (HD) is still an important health hazard in the world. This disease is a parasitic infestation endemic in many sheep-and cattle-raising areas such as Iran. Objectives: This study aimed to review the clinical manifestations, laboratory aspects, imaging findings, and management of HD. Patients and Methods: Data were collected from the medical records of patients diagnosed with HD in eight referral hospitals in different provinces of Iran from 2001 to 2014. Results: Overall, 161 children at a mean age of 9.25 ± 3.37 years (age range = 1 -15 years old) hospitalized with a definite diagnosis of the hydatid cyst between 2001 and 2014 were studied. The male-to-female ratio was 1.6:1. The most commonly involved organ was the lung (67.1%), followed by the liver (44.1%) and a combined liver and lung involvement was found in 15.5% of the patients. The cysts were found more frequently in the right lobe of the liver and lung than in the left lobe. The most frequent complaints were fever (35.4%) and abdominal pain (31.7%), and the most frequent sign was an abdominal mass in the liver involvement and cough in the lung involvement. There was a high eosinophil count (> 500/micL) in 41% of our cases. A high erythrocyte sedimentation rate (> 30) or positive C-reactive protein (based on the qualitative method) was found in 18.6% of the patients and leukocytosis > 15000/micL in 29.2% of the children. Ultrasonography was the main imaging test, with an accuracy rate of 96%, and chest X-ray was helpful in 88.6% of the cases. Surgery was performed in 89% of the patients, and selective patients underwent percutaneous aspiration-injection-reaspiration drainage or medical treatment. Conclusions: The lung was the most commonly involved organ in the children recruited in the present study. Given the high probability of multiple organ involvement, we recommend that patients with HD be assessed via ultrasonography and chest X-ray. In endemic regions, unexplained eosinophilia should be considered as a parasitic disease like HD and its complications.

Background: Early detection of pulmonary contamination in children with cystic fibrosis (CF) is essential since these children are vulnerable to Pseudomonas aeruginosa (P. aeruginosa) colonization. In Iran, home nebulization of antibiotics is a widespread practice in treatment for patients with CF and, to the best our knowledge, no bacteriological surveys have been conducted till date in this regard. Method: This observational, cross sectional study was conducted on 61 children with CF at Mofid Children's Hospital, Tehran, from September 2017 to march 2018. The swab sampling was performed from 61 home nebulizers used by children diagnosed with CF. Contemporaneous sputum sample or deep nasopharyngeal swab was taken from each patient for bacterial and fungal testing. Medical records of the patients were reviewed and the number of exacerbations were recorded over the last 12 months prior to the study enrollment. Results: The results of study showed that, 43 (70.5%) nebulizers were contaminated; 31 (50.8%) mouthpieces, 21 (34.4%) reservoirs, and 11 (18%) connecting tubes. The most common organism to be isolated was P. aeruginosa and was recovered from 19 (31%) nebulizers, 16 of them belonged to patients chronically colonized with P. aeruginosa. The remaining three had at least one positive sputum culture for P. aeruginosa in the past 1 year before the study. There was a significant increase in the number of CF exacerbations with an average number of exacerbation being 1.5 ± 1(SD) over last 12 months in children who had pathogenic organisms recovered from their home nebulizers compared with 0.4 ± 0.7(SD) exacerbations per year in whom non-pathogenic organisms were isolated from their nebulizers (P < 0.001). Conclusion: The majority of domiciliary nebulizers used by children with CF were contaminated with microorganisms indicating that the nebulizers may serve as potential reservoirs of pathogens for the patients' lung. Perpetuating colonization is a possible concern in the ones recently colonized with P. aeruginosa and, therefore, decontamination of nebulizer requires more attention to prevent ongoing infection. The negative impact of contamination of nebulizer on CF exacerbation requires serious attention and further investigations.

Background: Benign joint hypermobility syndrome (BJHS) is one of the most common hereditary connective tissue disorders in children in which autonomic nervous system involvement has been reported. This study aimed to evaluate the frequency of primary focal hyperhidrosis in children with BJHS. Methods: This observational-analytical study was conducted in a case-control setting on children aged 3 to 15 years in 2018 at Mofid Children's Hospital, Tehran, Iran. Benign joint hypermobility syndrome was diagnosed according to the Brighton criteria; then, the patients referred to a dermatologist for evaluation of hyperhidrosis. Results: In total, 130 eligible patients with confirmed BJHS and 160 age-and sex-matched healthy subjects were enrolled in this study. Primary focal hyperhidrosis (PFH) was seen in 56.2 and 16.3% of the cases and controls, respectively, indicating a significant difference (P < 0.05). The severity of hyperhidrosis did not differ between the two groups. Conclusion: Although the results of the study showed a significant correlation between BJHS and PFH, more comprehensive studies are needed to confirm these findings.

Deferasirox proved as an efficient and safe chelating agent in our patients, specifically in mild to moderate iron overloaded patients.

Introduction: To facilitate rapid and effective diagnosis of COVID-19, effective screening can alleviate the challenges facing healthcare systems. We aimed to develop a machine learning-based prediction of COVID-19 diagnosis and design a graphical user interface (GUI) to diagnose COVID-19 cases by recording their symptoms and demographic features. Methods: We imple-mented different classification models including support vector machine (SVM), Decision tree (DT), Naïve Bayes (NB) and K-nearest neighbor (KNN) to predict the result of COVID-19 test for individ-uals. We trained these models by data of 16973 individuals (90% of all individuals included in data gathering) and tested by 1885 individuals (10% of all individuals). Maximum relevance minimum redundancy (MRMR) algorithms used to score features for prediction of result of COVID-19 test. A user-friendly GUI was designed to predict COVID-19 test results in individuals. Results: Study re-sults revealed that coughing had the highest positive correlation with the positive results of COVID-19 test followed by the duration of having COVID-19 signs and symptoms, exposure to infected individuals, age, muscle pain, recent infection by COVID-19 virus, fever, respiratory distress, loss of smell or taste, nausea, anorexia, headache, vertigo, CT symptoms in lung scans, diabetes and hyper-tension. The values of accuracy, precision, recall, F1-score, specificity and area under receiver oper-ating curve (AUROC) of different classification models computed in different setting of features scored by MRMR algorithm. Finally, our designed GUI by receiving each of the 42 features and symptoms from the users and through selecting one of the SVM, KNN, Naïve Bayes and decision tree models, predict the result of COVID-19 test. The accuracy, AUROC and F1-score of SVM model as the best model for diagnosis of COVID-19 test were 0.7048 (95% CI: 0.6998, 0.7094), 0.7045 (95% CI: 0.7003, 0.7104) and 0.7157 (95% CI: 0.7043, 0.7194), respectively. Conclusion: In this study we implemented a machine learning approach to facilitate early clinical decision making during COVID-19 outbreak and provide a predictive model of COVID-19 diagnosis capable of categorizing populations in to infected and non-infected individuals the same as an efficient screening tool.

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