This retrospective cohort study sought to determine the effects of maternal Ramadan fasting during pregnancy on neonatal birth weight as an important aspect of fetal health. It was carried out among healthy women who were admitted for their neonate delivery at two medical centers in Tehran from January to September 2000. Neonates of 284 mothers with a history of Ramadan fasting during pregnancy were compared with neonates of 255 mothers who did not have a history of fasting during their pregnancies. On univariate analysis, neonatal birth weight of the fasted group was 100 g more than those of the nonfasted group (p ¼ 0.009). However, body mass index (BMI) of the fasted mothers was greater than that of the nonfasted mothers. When controlling for maternal BMI on neonatal birth weight, multiple linear regression models showed that neonates of fasted women were 71 g heavier than those of the nonfasted group, which was not statistically significant (p ¼ 0.1). We conclude that maternal fasting during Ramadan did not have a significant effect on the neonatal birth weight. Other health effects that we did not observe could have occurred.

Congenital generalized lipodystrophy (CGL) is an autosomal recessive disorder with two major subtypes. Variants in AGPAT2 result in CGL type 1 with milder manifestations, whereas BSCL2 variants cause CGL type 2 with more severe features. Muscle hypertrophy caused by lack of adipose tissue is present early in life in CGL patients. Our aim was to investigate 10 CGL patients from 7 different countries and report genotype-phenotype relationships. Genetic analysis identified disease-causing variants in AGPAT2 (five patients) and in BSCL2 (five patients), including three novel variants; c.134C>A (p.Ser45*), c.216C>G (p.Tyr72*) in AGPAT2 and c.458C>A (p.Ser153*) in BSCL2. We also report possible novel clinical features such as anemia, breast enlargement, steatorrhea, intraventricular hemorrhage and nephrolithiasis in CGL patients. Generalized lipodystrophy and muscular hypertrophy were the only features in all of our patients. Hepatomegaly was the second common feature. Some manifestations were exclusively noticed in our CGL2 patients; hypertrichosis, high-pitched voice and umbilical hernia. Bone cysts and history of seizures were noticed only in CGL1 patients. The findings of this study expand our knowledge of genotype-phenotype correlations in CGL patients. These results have important clinical applications in diagnosis and management of the CGL patients as well as in genetic counseling in families at-risk.

Background: Recent studies on bacterial pathogens causing urinary tract infection (UTI) in children have shown high levels of antibiotic resistance in clinical settings. Objectives: We determined the common bacterial pathogens causing UTI and their antimicrobial resistance patterns in Iranian children. Patients and Methods:The study subjects were 114 children (female subjects, 58.8%) with culture-proven UTI categorized in the following 3 age groups: neonates (< 28 days, n = 45), infants (28 days to 2 years, n = 41), and children (> 2 years, n = 28). Sensitivity testing was performed using the disc diffusion technique. Results:The most frequently cultured pathogens included Escherichia coli (71.7%) and Enterobacter (28.9%). UTI caused by Enterobacter was more commonly detected in neonates (60.6%) than in infants (21.2%) and children (18.2%). Imipenem was the most active agent against E. coli isolates (susceptibility, 97.3%), followed by ciprofloxacin (90.4%) and amikacin (82.9%). Trimethoprim-sulfamethoxazole, cefalotine, and cephalexin were the least active agents, with 76.3%, 75.0%, and 73.7% of E. coli isolates exhibiting resistance, respectively. Imipenem and ceftizoxime were the most effective antimicrobial agents against Enterobacter, with sensitivity rates of 85.2% and 71.4%, respectively. Nitrofurantoin, ceftazidime, and cefalotine were the least active antimicrobial agents against Enterobacter, with resistance rates of 92.3%, 66.7%, and 62.5%, respectively. Conclusions: The low susceptibility of common UTI pathogens to cephalosporins may be because of their high rate of administration to children with UTI in our population. A change in empiric therapy should be considered, especially in neonates.

No abstract

Background:Neonatal sepsis is a worldwide problem that presents a management challenge to care groups for neonates and infants. Early diagnosis and management can considerably decrease the risk of sepsis, and improve the outcome.Aim:The aim of the present study was to determine the incidence, causative pathogens, and the antibiotic sensitivity pattern for neonatal sepsis in Iran.Materials and Methods:A historical cohort study was conducted on 84 patients with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) wards of Baqiyatallah and Najmieh University hospitals in Tehran, between 2003 and 2006. Clinical, demographic and laboratory data was collected from medical records.Results:Among all the comprised neonates, 44 patients were diagnosed with early-onset sepsis, 23 cases with late-onset sepsis and others with nosocomial sepsis. The most common isolated pathogen in all groups was Enterobacter, and was responsible for 31.4%, 47.8% and 41.2% of the episodes of sepsis, according to the sepsis type mentioned above, respectively. Susceptibility of common sepsis related pathogens to imipenem and gentamycin gradually reduced over the years between 2003 and 2006. Total mortality and morbidity rates due to neonatal sepsis were estimated at 27.4% and 89.3%, respectively. Mortality following sepsis was found more in boys (Odds Ratio (OR)=4.897, Conifdence Interval (CI)=95%, P=0.031), and those with low birth weight (OR=4.406, CI: 95%, P=0.011). Higher sepsis related co-morbidity was found in neonates following cesarean delivery (OR=6.280, CI: 95%, P=0.025).Conclusion:It seems that the mortality rate in this study was lower than similar studies in Iran and other developing countries. This difference between the mortality rates of the centers in our study and others could be due to the high occurrence of Enterobacter infections in the latter and also high resistance of these pathogens to commonly used antibiotics such as β-lactams and aminoglycosides reported in other studies.

BackgroundVitamin D is a vital lipid-soluble vitamin in the body, helping the growth and development of bones. Vitamin D deficiency in children has several adverse effects. The most important preventative factor is determining the deficiency at an early stage and prescribing vitamin D-containing supplements.ObjectivesTo investigate the vitamin D status of children younger and older than 2 years and determine the utility of prescribing vitamin D supplements.Patients and MethodsThree hundred healthy children who attended the pediatric clinic for routine assessments were enrolled in this study. Their parents were asked to complete a questionnaire, which included questions about demographics, nutrition, and supplements. Blood levels of vitamin D, calcium, and phosphorus were then measured.ResultsThe final study consisted of 286 children, 140 males and 146 females, with a mean age of 4.46 ± 2.82 yr. Of these, 218 (76.22%) children, with a mean age of 5.09 ± 2.82 yr, had vitamin D deficiency, and 76 children (23.78%), with a mean age of 2.58 ± 1.88 yr, had normal vitamin D levels (P = 0.001). The mean level of vitamin D was 29.71 ± 14.42 ng/mL in 88 (30.8%) patients up to 2 years and 17.11 ± 14.02 ng/mL in 198 (69.2%) patients older than 2 years (P = 0.0001).ConclusionsThe vitamin D levels of children aged more than 2 years are lower than those of children aged less than 2 years. Thus, prescribing vitamin D-containing supplements in children older than 2 years may be beneficial.

No abstract

BackgroundMustard gas, a known chemical weapon, was used during the Iran-Iraq war of 1980-1988. We aimed to determine if exposure to mustard gas among men was significantly associated with abnormalities and disorders among progenies.MethodsUsing a case-control design, we identified all progenies of Sardasht men (exposed group, n = 498), who were born at least nine months after the exposure, compared to age-matched controls in Rabat, a nearby city (non-exposed group, n = 689). We conducted a thorough medical history, physical examination, and appropriate paraclinical studies to detect any physical abnormality and/or disorder. Given the presence of correlated data, we applied Generalized Estimating Equation (GEE) multivariable models to determine associations.ResultsThe overall frequency of detected physical abnormalities and disorders was significantly higher in the exposed group (19% vs. 11%, Odds Ratio [OR] 1.93, 95% Confidence Interval [CI], 1.37-2.72, P = 0.0002). This was consistent across sexes. Congenital anomalies (OR 3.54, 95% CI, 1.58-7.93, P = 0.002) and asthma (OR, 3.12, 95% CI, 1.43-6.80, P = 0.004) were most commonly associated with exposure. No single abnormality was associated with paternal exposure to mustard gas.ConclusionOur study demonstrates a generational effect of exposure to mustard gas. The lasting effects of mustard gas exposure in parents effects fertility and may impact child health and development in the long-term.