Tehran University Medical Journal

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Background: Bacterial meningitis is one of the most serious infections in infants and children. Three organisms include S.PneumoN.meningH.Influ are the most common cause of meningitis in children between 2M-14y age.Etest is a new method for determination the MIC of some antimicrobial drugs in agarose .This method is useful for some organisms like as S .Pneumo N.mening H.Influsensitive Streptococcus and anaerobic aerobic gram negative.

Materials and Methods: In this descriptive cross sectional study In 57 suspected meningitis children organisms isolated from blood CSF or other sterile boy fluid after culturing and antibiogram. .MIC of someorganisms detected by Etest method.

Results: Streptococcuswas the most prevalent ( 70%) and S.pneumon( 90% of all Streptococcus) H.infl 2%N.mening 4%and L.monocyt 6%(more than expected)Gram negative (Ecoli Klebsiella entrobacter and psudomona) 18%. There was significant difference (P =0.01)in type of organisms between age groups. S.pneumonia was more frequent in children > 2 year N.meningitis in>4yr old .Site of isolation :blood CSF (35.8*28.3%)other sterile site 18.4%concomitant positive culture in two site:17%.Mean age in Streptococcus was significantly different with Listeria (p=0.05) N.meningitis (p=0.04)H.influ (p=0.04).but no difference with StaphylococcusKlebsiella and E.coli Two type of H.inf were sensitive to Ampici or chloram both of them were sensitive to ceftiaxon. GBS were sensitive to PNC or Ampici Strep.nonAnonBnon- Cotrimoxazol>32mic/ml /PNC >256mic/ml/ Vanco>256mic/ml Strep.D: Cotrimoxazol>0.062mg/ml/ /PNC >0.016mic/ml/Imipenem>0.032mic/ml. Strep Pneumonia: All fo them were sensitive except 3 cases /Cotrimoxazol>2ic/ml /PNC =0.01mic/ml/Vanco>0.125mic/ m Vanco>0. 25mic/ ml/.Cotrimoxazol>2ic/ml / PNC =0.01mg/ml Vanco>0.125mic/ ml / Cotrimoxazol>2mic/ml /MIC-PNC >0.016mic/ml Therefore high dose of PNC is adequate for S.pneu because of Interm resistance to PNC All 3 N.menin were sensitive to PNCChloraCeftria and vanco Resistant to all drugs and high MIC for cefotaximeCIPRO>32mic/ml. E coli: Pseudomona Aerogenosa:: Ceftriaxon>256mic/ml/ /Genta>0.038mg/ml Imipenem>32mic/ml. Klebsiella only Sensitive to Cipro Staph .Aureous:Sensitive to ClindaCiproChloraResistant toCeftPNCand Cotri

Conclusion: Most type of N.meningitidisH.inf and S.pneumonia were sensitive to many drugs. Only minority of them were resistant to Ampicillin but sensitive to chloramphenicol and vice versa. limited number of pneumococcal resistance to penicillin is medium resistance( MIC:0.1-1) .we can treat this resistant type by increasing of penicillin dosage .The others were sensitive to all drugs. Therefore ampicillin and chloramphenicol are the drug of choice in empiric treatment of bacterial meningitis after neonatal period.

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Background and Aim: Auditory and visual stimuli are the most important factors in communication. It seems during the brain maturation, decrease of visual inputs causes enhancement of somatosensory and auditory cortical responses. In this research latency and amplitude of auditory middle latency responses (AMLR) are studied in blinds and normally sighted subjects.

Materials and Methods: This descriptive-analytical study was performed on 40 congenitally blinds and 40 normally sighted subjects in the range of 14-20 years. All of cases had normal hearing sensitivity and acoustic reflexes without any middle ear disorders. The reason of this age range is the maturation of auditory middle latency responses. Sampling was randomized.

Results: There was significant difference between amplitude of Na, Pa & Nb waves and latency of Na while no significant difference between latency of Pa & Nb in blinds and normally sighted subjects.

Conclusion: Increase of amplitude and decrease of latency of AMLR in blind subjects were due to sensory compensation phenomenon, probably. It seems rate of processing and auditory perception in blinds is better than normally sighted subjects.

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Background: Infectious diseases are problematic in all around the world especially in the developing countries and early diagnosis of infections and one etiologic agents has a major role in the treatment of one patients. There are some culturing methods consist of conventional, semiautomatic and automatic. One of automatic methods is BACTEC system worked by fluorescent technology and Co2 production of organisms in culture media.
Methods: This study is based on observational-descriptive method with simple convenient sampling. We analyzed 262 samples of body sterile fluids of patients admitted in pediatric and internal wards of a university (Rasol- Acram) Hospital. They are consisting of 150 blood, 46 synovial, 32 CSF, 24 pleural, and 10 peritoneal samples.
Results: There were no differences between two sex in BACTEC and Conventional methods. Average age of patients with positive and negative culture in two methods had not differences. 72 (27.5%) samples were positive that 32 (12.2%) samples only in BACTEC method, 4 (1.5%) in conventional method and 36 (13.7%) in two methods had statistical differences (p=0.003). That means positive cultures are seeing in BACTEC more than Conventional method. Comparison of two methods in positive blood culture samples had statistical differences (p=0.02) but no statistical differences in other body fluids were seen. i. e. positive cultures were seen in BACTEC more than Conventional method. Positive culture in these two methods had statistical differences in antibiotic utilization (p<0.001). Positive culture in antibiotic utility were seen in BACTEC more than Conventional method. The average time of culture to become positive were 17.5+ 5.88 hours in BACTEC against 62.36+ 13.98 hours in Conventional method. Contamination was seeing in 4 samples in BACTEC and 2 in Conventional method that had no significant differences.
Conclusion: According to these data organism detection in BACTEC culture media from body sterile fluids overall and specially from blood is more successful than Conventional method. It is a better method in antibiotic utilization. BACTEC can isolate organism in shorter duration than Conventional method. BACTEC can facilitate early and accurate diagnosis of infectious etiology, shorten duration of hospital stay and decrease mortality and morbidity and cost.

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Background: In recent years, many ill cases with cytomegalovirus reactivation in non-immuno compromised persons reported. Goal of study: to determine the CMV infection in cerebrospinal fluid of aseptic meningoencephalitis children hospitalized in Rasul & Mofid hospital (2005-2007).

Methods: In a cross sectional study 132 cases selected with simple sampling. CMV-DNA in their Cerebro spinal fluids searched by qualitative PCR.

Results: The age range of the study patients was 5 month- 13 years, median age= 2±3.7 years 87(65.9%) male and 45(34.1%) was female. The presenting signs and symptoms were convulsion 77(69.4%) meningitis 25(18.8%), loss of consciousness 47(37%) neurologic defects 15.9%. DNA extrated in 11 cases. Mycoplasma- DNA in 2cases DNA-CMV detected 2(1.5%). Positive DNA HSV found in 7(15.3%) of patients. DNA- HSV type- 15.3% (7/132) cases. An infant 5 month age with developmental delay, microcephaly and recurrent convulsions. A 1 year girl with brain atrophy and progressive hydrocephaly with intracranial shunt

Conclusions: Differentiation between herpes meningoencephalitis and other encephalopathy based on clinical signs in children is too difficult. CMV (1.5%) has lower rate than herpes simplex type-1 (5.7%). In addition to CMV and HSV1 all of herpes family viruses (varicella, herpes 6, 7, Epstein barr virus) could have role in  children with meningoencephalitis. In recent years a sensitive, rapid, simple diagnostic  test "Single tube Multiplex PCR" in cerebro spinal fluid recommend. Rapid diagnosis and faster treatment is necessary for decreasing mortality and morbidity in all of herpes meningoencephalitis cases

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Background: M. pneumoniae infection in children is usual and diagnosis of its neurologic complications for rapid treatment is very important. To compare the CSF- M. pneumoniae antibody level between febrile children with acute neurologic signs (Menigoencephalitis, Guillan Barre Syndrome (GBS), Transverse myelitis, Ataxia and so on) with unaffected ones.

Methods: A cross sectional/ case control study in pediatric wards of Rasoul-e-Akram & Mofid hospitals (2007-2009) was done. The amount of Specific M. pneumoniae IgG (ELISA) antibody level determined in CSF of 55 cases and in 10 controls. Chi square values (CI 95%, p< 0.05) calculated for all categorical variables. Sensitivity specificity Positive Predictive Value (PPV) Negative Predictive Value (NPV) of CSF antibody level determined by using the Area under the ROC Curve.

Results: Cases (n= 55) aged between five month to 13 years with mean age of 3.84±3.43 years. Area Under Curve (AUC) in ROC was 0.876 (%95 CI, 0.78- 0.96 p< 0.0001). Cut off level for antibody was 0.0025 with 73% sensitivity 90% specificity 100% PPV 28.8% NPV. CSF antibody level had significant difference between cases and controls [0.08± 0.26 Versus 0.001± 0.001 p: 0.02] It had poor agreement between cases and controls (Kappa= 0.27). Lowest amount seen in cases with aseptic meningitis highest amount observed in cases with GBS and cases with focal neurologic signs.

Conclusion: The presence of very low amount (0.0025) of M. pneumoniae antibody in CSF of febrile children with acute neurologic signs had 70% sensitivity and 90% specificity 100% PPV but had low (28.8%) NPV. M. pneumoniae would be a rare cause in cases with aseptic meningitis. Finding the M. pneumoniae-DNAs in CSF are not so frequent (2%) but in high suspicious cases adding this test to determining the CSF antibody level might be helpful.

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Background: Streptococcus pneumoniae is a common cause of respiratory infection. Pneumococcal upper respiratory tract infection (URTI) in children is seldom bacteremic. Determination the prevalence of S.pneumoniae infections in children with URTI using rapid urinary antigen test (BINAX now) and titration of serum pneumolysin antibody (added to conventional culture) was the object of this study.
Methods: A cross sectional, case-control study done in ENT & pediatric departments of Rasoul Hospital in Tehran, Iran, (2008 -2010) upon 133 cases with upper respiratory tract infection (otitis media, sinusitis and tracheitis). The nosocomial infection omitted in first step. 60 remaining cases followed for S.pneumoniae infection by culture and rapid urinary antigen test (Binax Now). Serum pneumolysin antibody titers compared between 45 cases and 66 controls.
Results: Positive culture (S.pneumoniae, H.influenza) obtained in 4/60 URTI cases. Positive urinary S.pneumoniae antigen detected in 50% (30/60) of cases and 6% (4/66) of controls (p=0.01). The pneumolysin antibody level with cut-off level 525pg/ml was higher in URTI cases than controls (982±441 Vs. 525±42, p<0.0001). Area under the ROC curve for pneumolysin antibody was 0.923 (95%CI 0.86-0.97, p<0.0001) and had 87% sensitivity and 82% specificity for differentiation between cases and controls.
Conclusions: The high pneumolysin antibody level in cases with URTI strongly indicates the pneumococcal infection. Pneumolysin antibody level even in little amounts (525pg/ml) with 87% sensitivity and 82% specificity is a suitable test for diagnosis of pneumococcal infection in children with URTI, but this test should be added to conventional culture (gold standard) and rapid urinary antigen test.

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Background: Recently, many cases diagnosed as pediatric autoimmune neuropsy-chiatric disorders associated with group A beta hemolytic streptococcus infection (PANDAS) due to production of autoimmune antibodies. Object of this study was comparison the titer of antibodies against group A beta hemolytic streptococcus (ASOT, Anti-DNase B, and Anti streptokinase) between children with movement disorders (tic and tourett's disorders pediatric autoimmune psychiatric disorders) and healthy control.
Methods: A cross sectional/ cases control study in pediatric neuropsychology ward and clinics in two referral hospitals (Rasoul & Aliasghar) affiliated by IUMS had done in Tehran, Iran (2008-2010). We selected 53 children with tic disorder and 76 healthy controls (age matched children). The antibody titers (IU/ml) in their area were compared and analyzed statistically. The area under ROC, sensitivity, specificity and positive predictive value of tests calculated.
Results: Age of cases was between 4-16 years. All antibody titers had significant difference between two groups (p<0.0001 p=0.05 p=0.002 for ASOT, Anti-DNase and Antihyaloronidase respectively). ASOT (cut off level> 200IU/ml) had 75% sensitivity 84% specificity and 80% PPV Anti- streptokinase (cut off level> 332IU/ml) had 34% sensitivity 85% specificity, and 90% PPV Anti-DNase (cut off level> 140IU/ml) had 70% sensitivity 99% specificity and PPV 90%.
Conclusion: Patients with tic disorder had a significant high antibody titer against streptococcal infection in comparison with healthy children. It presents possible role for streptococcal infection in tic disorders. Treatment of streptococcal infection is achievable by using of long acting Penicillin in our country. Use of aggressive treatment like plasmaphresis etc needs future RCT studies.

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Background: Urinary tract infection 0 in children causes renal scarring and permanent damage to the organ. In this study, we compared the diagnostic value of magnetic resonance urogram for urinary tract anomalies with other conventional imaging methods in children with UTI. Methods: In this case-control study, 190 children (mean age 3.23±3.59 yrs) with UTI were recruited from the Pediatric Ward of Rasul-e-Akram Hospital during 2007-2009. The patients were divided into two groups based on the applied imaging technique: MRU (cases) and conventional imaging groups (controls). Results: Abnormal imaging detection rates for Ultrasonography were 32%, X-ray of kidneys, ureters and bladder (KUB) 9%, Intravenous Pyelogram (IVP) 26%, Voiding Cystoure therogram (VCUG) 54%, Dimercaptosuccinic Acid scan (DMSA) indicating non-obstructive (reflux) uropathy in 76% (mean age 3.5 yrs) and MRU 43% (mean age 1.6 yrs), respectively. A meaningful correlation was observed between MRU and DMSA scan with IVP results (Kappa=0.75). KUB and Ultrasonography had similar results in cases with abnormal MRU and DMSA scan (P=0.121). MRU had strong agreement with VCUG and IVP for the detection of obstructive uropathy and scar due to congenital malformation even during intrauterine life but not with sonography results. Conclusion: Sonography had poor results for the diagnosis of urinary tract anomalies in comparison with MRU. Use of dynamic MRU for the diagnosis of congenital anomalies (hydronephrosis, obstruction, pyelonephritis, renal scar) in children with UTI seems to be of better help, although higher costs and the need for sedation during MRU still are its disadvantages

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: In the last two decades, cryptococcosis has been gaining a distinct public health importance due to the growing number of AIDS cases. Considering the low sensitivity of direct examination with India ink and culture, use of sensitive techniques is crucial in the diagnosis of cryptococcal meningitis. Polymerase Chain Reaction (PCR) can be used to directly detect Cryptococcus neoformans in CSF samples to increase the diagnostic power in cases where conventional methods are unable to detect the organism.
Methods : In this cross-sectional study, CSF samples were obtained from 25 patients suspected of having neurocryptococcosis. The patients were referred to the Medical Mycology Laboratory of the School of Public Health affiliated to Tehran University of Medical Sciences from March 2009 to February 2010. Three different methods, direct India ink examination, culture and PCR were used to evaluate the CSF samples. Two 102 and 106 of Cryptococcus neoformans dilutions in 1ml of CSF were prepared and examined by the three methods. In PCR method, two primer pairs were selected to amplify the Cryptococcus neoformans URA5 gene. The sequences of primers were for A, B, C and D serotypes.
Results : Only in one case PCR, as well as direct examination and culture were positive. All the other samples were negative in PCR, direct examination or culture. Both CSF dilutions were positive in the three tests in the mentioned patient and the positive control.
Conclusion: PCR method can efficiently identify both control and positive samples of Cryptococcus neoformans.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Recent evidence suggest that group A ß-hemolytic streptococcal (GABHS) infection may increase the risk of pediatric autoimmune neuropsychiatric disorders (PANDAS) composed of the clinical signs of obsessive-compulsive and attention deficit hyperactivity disorders. The objective of this study was to compare the titer of antibodies against GABHS between children with PANDS and the controls.
Methods : This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran during 2008-2010. We compared serum antibodies streptolysin O, deoxyribonuclease B, and streptokinase against GABHS quantitatively in 79 cases with PANDAS and 39 age-matched controls. The area under ROC curve, sensitivity, specificity and positive predictive value (PPV) of tests were calculated.
Results : Most cases were studied in summer (57%) and spring (23%). The three aforesaid antibodies were higher in the cases (P=0.001). Antisterptolysin O (cut-off point 195) had a 90% sensitivity, 82% specificity and a 92% PPV, (CI=95%, 0.99-0.91). Anti streptokinase (cut-off point 223) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.934-0.735). Anti-DNase (cut-off point 140) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.99-0.91).
Conclusion: The study demonstrated a possible role for streptococcal infection in PANDAS. We found a significantly higher antibody titer against GABHS in OCD and ADHD cases in comparison with healthy children. Treatment of streptococcal infection is achievable by the use of long-acting penicillin. Use of aggressive treatment schedules like plasmaphresis, IVIG, etc needs further RCT studies.

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Background: Determining the etiologic causes of septic arthritis is of the most importance. Goal of this study was to investigate presence of staphylococcal enterotoxins A, B, C and Toxic Shock Staphylococcal toxin-1 in the synovial fluid of patients with arthritis.

Methods: This cross-sectional study was performed in the Pediatric and Orthopedic Wards of Hazrat Rasoul Hospital in Tehran, Iran during 2008- 2010. Gram stains, conventional cultures, direct detection of soluble bacterial antigens were used to detect H. influenza, S. pneumonia, group B streptococci, and N. meningitidis while Latex particle agglutination test was used for staphylococcal supper antigens (by enzyme immunoassays) upon synovial fluid tapping of 62 individuals (5 mo to 16 yrs, mean=113.8 yrs). P<0.05 was considered statistically significant.

Results: Positive SF cultures (n=11): 5 positive cases of S. aureus 5 S. pneumonia 1 H. influenza, and 1 Klebsiella. Positive gram stains: 10% and positive LPA: 4%. Staphylococcal arthritis was diagnosed in 7 (39%) cases upon positive culture or positive gram stain. The most common type was TSST-1 (47%) and the least common was enterotoxin B (18%). Isolation of S. aureus (positive culture) was correlated to presence of enterotoxin A in synovial fluid but not to enterotoxins B, C or TSST-1.

Conclusion: Staph. aureus had a prominent role in arthritis. 47% of cases with negative culture for S. aureus had at least one type of staphylococcal super antigens in the synovial fluid. Searching for antigens of usual organisms or staphylococcal supper antigens could be helpful for diagnosis and

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Background: Staphylococcus aureus secretes numerous superantigenes which trigger the inflammatory mechanisms of sinus mucosa and cause chronic rhino-sinusitis. This study was designed to evaluate the role of staphylococcus aureus superantigens in polyp tissues of patients with chronic rhino-sinusitis in comparison with a control group.
Methods: Polyp tissue samples of 28 patients and mucosal specimens of 19 healthy individuals were evaluated for staphylococcus aureus bacterium superantigens, exotoxins A, B, C and D and TSST-1 with RT-PCR and ELISA methods Rasoul Akram Hospital during 2 years.
Results: Polymerase chain reaction (PCR) results revealed that 88.2% of the patients and 45.5% of the controls had at least one type of superantigen (P=0.03). Evaluation of superantigens using ELISA method showed presence of at least one type of superantigen in the nasal samples of all patients and in 35.3% of the controls (P<0.001).
Conclusion: A relationship between staphylococcal superantigens and nasal polyps is concluded from this study which indicates the probable role of these superantigens in the pathogenesis of nasal polyposis.

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Background: Infection with group B streptococcus (GBS) can present with respiratory distress, Pneumonia, meningitis and Osteomyelitis in neonates. The aim of this study was to determine the prevalence of GBS colonization in trachea of intubated neonates.
Methods: This observational analytic study was performed upon 33 intubated neonates due to respiratory distress in neonatal intensive care unit (NICU) Rasoul Hospital in Tehran, Iran during 2010-2012. Tracheal secretions cultured upon TODD-HEWITT BROTH and sheep blood agar 5%., chi-square test was used for compare the qualitative variables. P<0.05 was considered meaningful.
Results: Three cases had positive streptococcal culture (9.1%) and four cases had posi-tive culture for non-streptococcal organisms. no meaningful relation observed between positive GBS culture and neonatal gender, kind of delivery, PROM.
Conclusion: Prevalence of GBS positive results (9%) in present study is very close to GBS colonization in pregnant women although the higher colonization rate of pregnant women are expected.

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Background: Staphylococcal superantigens (SAg&aposs) may have some role in otitis media with effusion (OME). The aim of this study was the search of staphylococcal SAg&aposs in middle ear effusion of children with OME. 
Methods: This cross sectional-analytic study was done in ENT & pediatric wards upon 64 children with otitis media with effusion (OME) between 1-15 years, (mean age=7.42+4 years) of Rasoul Akram University Hospital, Tehran, Iran in 2009-2011. Fifty six percent (36) of cases were male, 43.8% (28) were female. Staphylococcal SAg&aposs Toxic Shock Syndrome Toxin-1 (TSST-1), Staphylococcal enterotoxin A, B, C, D (Enzyme immune assay, AB Cam, USA) were detected in middle ear effusion samples after conventional culture.
Results: None type of SAg&aposs found in 39% of OME cases, enterotoxin B found in: 22% enterotoxin A: 17%, enterotoxin C: 15.6%, enterotoxin D: 12.5%, Toxic Shock Syndrome Toxin-1 (TSST-1): 7.8% Mean age of cases with positive TSST-1, enterotoxin A, B, C, and D was: 1, 5, 8.6, 9.6 and 9.6 years respectively. Positive TSST had no agreement with positive enterotoxin A and C but had weak agreement with type B and D. Mean age of cases with positive TSST was one years which had significant difference with (7.9 years) in cases with negative TSST test (P<0.0001).
Conclusion: At least one or more type of staphylococcal toxins had found in middle ear effusion of 70% of OME cases with negative culture for Staphylococcus aureus. Even in culture negative cases, staphylococcal toxins might have some immunologic role in middle ear effusion forming. Finding the SAg&aposs (at least one type) are important for treatment of immunosuppressive or corticosteroid in cases with resistant OME.

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Background: Tonsils and adenoid hypertrophy is a major respiratory symptom in children which is partly due to recruitment of inflammatory cells in upper airway lymph nodes as a result of the effects of synthesis and release of different inflammatory cytokines. It seems that infections play role in concert with these cytokines leading to tonsilar hypertrophy and other pathologic consequences. It is proposed that cellular infiltrate of tonsils and adenoids may secrete different quantities of these cytokines compared with peripheral blood mononuclear cells (PBMC) cultures.
Methods: Among patients who were admitted for adenotonsillectomy to the ENT ward, 37 patients, under 1-12 years old patients with fulfill criteria selected to include the study. Excised adenoid and tonsils cultured and inflammatory cytokines Interferon-γ (INF-γ), Interlukine-1 (IL-1), IL-6, IL-8 and tumor necrosis factor-α (TNF-α) measured in cellular culture supernatant. The same cytokines measured in PBMC cultures.
Results: The data shows that there is a significant difference between IFN-γ and IL-8 amounts in adenoid tissue culture supernatant and PBMC culture of our patients. Furth-ermore, the amounts of IFN-γ, IL-1 and IL-8 showed considerable difference between tonsilar tissue culture supernatant and PBMC culture of these patients. Although there is a significant correlation between IL-6 amounts in tissue culture supernatant and PBMC culture (P=0.02), the respective data for TNF is only almost significant.
Conclusion: Inflammatory cytokines may have significant role in the early provoke of inflammation occurred in hypertrophied tonsils and adenoid. The majority of these cyt-okines increase the expression of adhesion molecules on epithelial cells and influence the recruitment of leucocytes and inflamed tonsils. On the other hand lack of sufficient cytokine release may lead to persistent infections and may cause chronic inflammation and hypertrophied tissue.

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Background: Urinary tract infection (UTI) is one of the most common infections in infants and children, especially in their first decade of life. These patients are more susceptible to renal scars and other possible complications like growth retardation, arterial hypertension, proteinuria, isostenuria, and finally chronic renal failure. Trace elements like vitamins and minerals are essential for efficient metabolism and proper function of various body systems namely immune system. In this trial we compared the relation between serum levels of zinc, vitamins A and D in children inflicted with UTI and control group.
Methods: This was a cross-sectional study on 25 patients with UTI admitted to pediatric wards of Rasul Akram Hospital and Bahrami Hospital. They were compared to 40 other patients admitted in surgical wards for elective surgery. Serum levels of zinc, vitamins A and D were measured in both groups.
Results: Seventy two percent of the patients were male and 28% female. The average age was 2.17. Despite the lower levels of vitamins A and D in cases than controls, the difference was not significant (P=0.4 and P=0.9, respectively). However, serum levels of zinc were significantly lower in cases than controls (P<0.05).
Conclusion: Vitamins A and D may play some role in patients’ vulnerability to UTI, but this supposition needs more research on larger samples, considering differences among patients of various age groups and their nutritional status.
According to the study, lower levels of zinc were associated with susceptibility to UTI thence, its administration might be helpful.

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Background: The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma.Gondii infection and describe the clinical presentation from birth and follow up them. 
Methods: We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran (Rasoul akram & Akbar Abadi) during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged, transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T.Gondii- antibodies (IGG, IGM) evaluated by ELISA methods. Neonates with positive T.Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease.
Results: Gestational age of newborns was between 28-41 weeks. Positive T.Gondii -IGM and T.Gondii -IGG determined in 1.5%, 44.1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement (50%), and brain disorders (50%). Positive PCR had not found in cerebrospinal fluids of seropositive (IgM) cases.
Conclusion: One and a half percent of newborns were seropositive for T.Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests (IGM) to neonatal screening test is recommended strongly.

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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: 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.