Tehran University Medical Journal

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Background: Meningitis is one of the serious and dangerous infections in the infancy and childhood and rapid diagnosis of meningococcal disease is important, especially in infants. C-reactive protein (CRP) is a protein found in blood and is an acute phase protein. CRP sensitive reactive that used for diagnosis of infection. This study conducted to assessment of the relationship between cerebrospinal fluid C-reactive protein, and neonatal meningitis, as well as diagnostic value of test. Methods: Forty nine hospitalized infant that suspected to meningitis were enrolled in this analytic cross sectional research via non probable accessible sampling. 28 patients (52.7%) of all the patients were male and 21 patients (42.8%) were female. The average age of the patients was 22.6±11.88 days. Data from clinical examinations and laboratory tests entered in a questionnaire and all of samples divided in two bacterial (septic) and non-bactria (aseptic) meningitis group. All data including cerebrospinal fluid CRP of newborns were statistically analyzed. Results: In total, the mean and standard deviation of age was 22.6±11.88 days. 57.2% of infants were male and 42.8% were female. In total, 40.82% of infants were diagnosed with septic meningitis. There was no significant difference between septic and aseptic groups in terms of sex (P= 1.00) also in terms of age (P= 0.1). The mean and standard deviation of CRP level in septic meningitis group was 0.95±0.68 mg/L and in aseptic group was 0.16±0.36 mg/L. The CRP level difference in septic meningitis group compare with aseptic group was statistically significant (P<0.000). The finding showed that cut off point for CRP level as a diagnostic test was 0.17 mg/L, sensitivity was 95% and specificity was 86%. Conclusion: In the present study, newborns with septic meningitis had higher cerebrospinal fluid CRP level than newborns with aseptic meningitis, and CSF-CRP can be used in rapid diagnosis of septic and aseptic meningitis. Although this result has been seen in many studies, but more research is needed.

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Background: Severity of respiratory infection in children is depended on various fac-tors such as causative organism and the host immunologic response to the organism. Vitamins and micronutrients play an important role in this response with supporting the immune system and therefore, the response to infections. Nutritional deprivations in children, especially vitamins and micronutrients such as zinc, vitamin A and vitamin D are very common in middle east and other countries in Asia, which is due to inappro-priate diet and nutrient loss in recurrent infections. This study aimed to evaluate the se-rum levels of vitamins A, D and zinc in hospitalized children aged six months to five years. Methods: This analytic cross-sectional study was performed in 65 children aged six months to five years who were hospitalized in pediatric and surgical wards of Rasul Akram Hospital and Bahrami Hospital in Tehran. All of samples were evaluated ac-cording to WHO cri-teria for acute respiratory infection, and underwent measurement of serum vitamin A, vitamin D and zinc levels by using Atomic, Elisa and spectropho-tometer methods. Results: Serum levels of vitamins A in patients with acute respiratory infection was 0.27±0.16 µg/ml and in children without infection was 0.41±0.2 µg/ml, that different wasn’t statistically significant (P=0.4). Serum levels of vitamins D in patients with acute respiratory infection was 35.37±34.68 ng/ml and in children without infection was 45.78±21.05 ng/ml, that different wasn’t statistically significant (P=0.1). Serum levels of zinc in patients with acute respiratory infection was 87.93±23.34 µg/dl and in chil-dren without infection was 106.95±23.70 µg/dl, the difference was statistically signifi-cant (P=0.002). Conclusion: According to finding in this trial, there is a correlation between lower levels of zinc in serum, and chance of respiratory tract infection in children. Future larger studies could provide the correlation between serum levels of vitamins A & D and chance of respiratory tract infection.

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Background: Toxic shock syndrome (TSS), a dangerous consequence of Toxic shock syndrome toxin-1 (TSST-1) caused by Staphylococcus aureus. The early detection for infections of Staphylococcus aureus in burned children is very important, also the pre-vention for consequences of TSST-1. Fever is one of the most noticeable sign in burned children. On the other hand, fever is one of the important consequences of TSST-1 pro-duction. Methods: This study aimed to assess the toxic shock syndrome toxin-1 level in the wound’s specimens of two groups febrile and afebrile in the hospitalized burned chil-dren in Motahari hospital Tehran, Iran in the year 2013. In this case-control study, 90 children who admitted to the burn unit, divided in two groups of 45 patients: febrile (cases group) and afebrile (control group). All of burned children under went wound biopsy, and then all of wound’s specimens were tested by PCR for specific primer of toxin producing genome. Finally all of data collected and statistically analyzed. This data include group febrile and afebrile, demographic characteristics, percentage of burned surface severity and result of PCR. Results: The positive result for PCR test, production of TSST-1 in febrile burned chil-dren (cases group) was 37.7% and in afebrile burned children (control group) was 11.1% that this different was statistically significant (P=0.003). The mean and stan-dard deviation for percentage of burned surface (severity) in samples with positive re-sult for PCR test was 30.9±16.93 and in samples with negative result for PCR test was 20.09±11.02 that this different was statistically significant (P=0.01). There was no dif-ference between positive PCR result and negative PCR result of age and sex. Conclusion: Direct association was approved between the production of TSST-1 and the occurrence of fever in burned children. Increased surface severity of burns also re-lated to the production of TSST-1. Further research is recommended.

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Background: Assessment of the serum lead’s concentration in the newborn immediately after birth can be effective for the detection of lead poisoning in the early stages and prevent of developmental disorders and neuropsychiatric behaviors. This study aimed to assess the serum lead levels of cord blood in some of the hospitalized newborns. Methods: This cross-sectional analytic study conducted in the newborns ward of two hospitals (Rasoul Akram and Akbar Abadi) From December 2011 to October 2012 in Tehran, Iran. After non-probability sampling, 60 newborns in the first days after birth, underwent the cord blood sampling and the cord blood lead levels were measured by atomic absorption spectrophotometer. Then all of data were collected and analyzed. The serum lead concentration greater than 5 μg/dl was considered valuable. Results: In total, 61.4% of samples were boys. The mean (±SD) of gestational age was 37.4±2.64 weeks and mean (±SD) of birth weight was 2701±642.8g. The mean (±SD) of maternal age was 29.20±6.73 years. 70% of mothers were urban. 13% of mothers had a history of drug use, and 5% were current smokers. The mean (±SD) of the serum lead level of cord blood was 2.97±2.24 μg/dl. This level was not associated with fetal gender, place of residence, drug history and current smoking. This level in the 16.7% of samples was greater than 5 μg/dl (high risk cases). High risk level was associated with maternal age, weight and fetal age (P=0.02, P=0.004, P=0.03), but this level was not associated with fetal gender, place of residence, drug history and current smoking. Conclusion: Serum lead level of cord blood was relatively higher than other studies, although the prevalence of the high risk newborns (serum blood lead levels greater than 5 μg/dl) was low. Further research has recommended assessing the serum lead level in other newborns in the different areas to identify risk factors of neuromotor outcome in infants to prevent.

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Background: Cerebrospinal Fluid (CSF) culture for distinction between aseptic and bacterial meningitis can be difficult and long-term, and other diagnostic methods are under studying. This study aimed to assess the diagnostic value for the levels of Interleukin 1 (IL-1), IL-6 and IL-8 of CSF in the children and adolescent with meningitis. Methods: Fifty-one patient with meningitis between one month and 18 year included in a Cross-Sectional Studies in the Rasul Hospital, Tehran, from 2012 to 2014. All of samples underwent aspiration of CSF. The routine tests performed that include culture coloring and biochemical of CSF. The concentrations of IL-1, IL-6 and IL-8 were determined by Enzyme-linked immunosorbant assay (ELISA) method and all of data were analyzed. Results: Frequency of bacterial and aseptic meningitis was equal (49%). 64.7% of samples were boys and gender had not different between two bacterial and aseptic group (P=0.7). Mean (±SD) of the age in total was 358.46±858.40, and bacterial group had a higher mean of age than aseptic group (P=0.047). The level of IL-1 was 10.87±37.04 pg/ml in bacterial and 0.55±1.64 pg/ml in aseptic group, that had not different (P=0.168). The level of IL-6 was 90.51±139.3 pg/ml in bacterial and 21.36±67.84 pg/ml in aseptic group, that had significant different (P=0.030). The level of IL-8 was 365.40±765.52 pg/ml in bacterial and 50.66±59.34 pg/ml in aseptic group, that had significant different (P=0.047). Diagnostic value of IL-1 was noted in the 80.77% of bacterial and 68.00% of aseptic group that had not different (P=0.349). Diagnostic value of IL-6 was noted in the 53.85% of bacterial and 64.00% of aseptic group that had not different (P=0.572). Diagnostic value of IL-8 was noted in the 80.77% of bacterial and 28.00% of aseptic group that had significant different (P=0.000). There was not different between two group of CSF variables include coloring degree, WBC and RBC index, glucose and protein. Conclusion: Although the concentration of IL-6 and IL-8 was higher in bacterial meningitis than in aseptic patients, only IL-8 had suitable diagnostic value for distinction between different types of meningitis.

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Background: Helicobacter pylori (H. pylori) cause various diseases especially gastrointestinal disorders. Clinical diagnosis of H. pylori infection can be done in different ways, and new diagnostic methods are under study .This study aimed to assess the levels of interleukin (IL) 6, 17 and 23 in the middle ear effusion of patients with otitis media, and the association between these levels with H. pylori infection. Methods: This cross-sectional study conducted in 40 patients who nominated for ventilation tube (VT) placement due to otitis media with effusion, and admitted to ear, nose, and throat (ENT) clinics of Tehran University of Medical Sciences from March 2012 to August 2013. All of patients underwent myringotomy with VT insertion, and then aspirated effusion sample was tested. H. pylori infection diagnosed by polymerase chain reaction (PCR) and bacterial culture. The concentration of IL-6, IL-17 and IL-23 measured by enzyme-linked immunosorbent assay (ELISA). The levels of each interleukins were compared between the two positive and negative PCR groups. Results: In all of samples, PCR test result was positive in 22.5%. The mean and standard deviation of IL-6 level was 10.11±2.95, IL-17 was 5.89±0.91 and IL-23 was 4.07±1.34. The mean±standard deviation (SD) of IL-6 level in patients with a positive PCR (H. pylori) was 22.29±6.40 and in patients with a negative PCR was 6.16±3.88 that difference was significant (P=0.01). The mean±SD of IL-17 level in patients with a positive PCR was 6.16±1.29 and in patients with a negative PCR was 5.81±1.13 that difference was not significant (P=0.42). The mean±SD of IL-23 level in patients with a positive PCR was 6.15±3.77 and in patients with a negative PCR was 3.42±1.33 that difference was not significant (P=0.27). Conclusion: According to finding, association between H. pylori infection and increased levels of IL-6 in the middle ear effusion was approved. It is recommended to conduct researches aimed to identify other cytokines as inflammatory markers.