Tehran University Medical Journal

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Background: The NCEP step II diet produced a desirable lipoprotein response in hypercholesterolemia. A relation between plasma concentrations of small dense LDL and cardiovascular risk factors has also been mentioned in children. This study was conducted to determine the effects of the National Cholesterol Education Program (NCEP) step 2 diets on the low density and high density lipoprotein particle size in dyslipidemic adolescents.
Methods: Forty- four dyslipidemic adolescents, aged 10-18 years, participated in this case-control study. The control group was not given a diet prescription and was simply instructed to “eat as usual”. Their eating patterns reflected the consumption of macronutrients, fruit, vegetables and dairy products, typical of what many Tehranian eat. NCEP step 2 diets was a diet with 30% of calories as total fat, less than 7% saturated fat, less than 200 mg cholesterol, less than 15% of calories as monounsaturated fat and less than 10% as polyunsaturated fat per day. Lipoprotein particle size was the major outcome variables, which was measured after 3 months of intervention. Lipoprotein particle size was estimated by nondenaturing polyacrylamide gradient gel electrophoresis using Krauss and Burke methodtion.
Results: The mean body mass index was 26.3±4.2 kg/m2. Baseline characteristics of these adolescents did not differ significantly across the NCEP step 2 and control diet groups. The NCEP diet resulted in higher reduction in total cholesterol (-13±4 vs –2±0.3 mg/dl, p<0.001), LDL (-9±2 vs 3±0.6 mg/dl, p<0.01) and higher increase in size of the LDL (1.7±0.4 vs 0.1±0.4 mg/dl, p<0.001). HDL particle size did not change significantly. The prevalence of hypercholesterolemia decreased significantly (p<0.05) in NCEP step 2 group (68% in NCEP step 2 vs 100% in the control group) after 3 months.
Conclusion: NCEP step 2 diet not only reduces the serum LDL concentration of hypercholesterolemic adolescents but also has a favorable effect on the LDL particle size distribution. The related mechanism needs to be studied in future experimental designs.

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Background: The object of this study was to determine the epidemiological characteristics of deliberate self-poisoning in adolescents referred to the only poisoning center in Tehran.
Methods: In a cross-sectional study, all cases of acute poisoning at the Loghman Hakim Hospital from May to December 2003 were reviewed. Data for adolescents (13-19 years of age) were analyzed by SPSS for Windows, version 13 and STATA, version 8.
Results: From a total of 9203 cases of deliberate self-poisoning, 28.5% were adolescents (2626 cases). The male/female ratio was 1/2.2. Approximately 87% were unmarried and 56% were students, while a total of 4859 different drugs/agents were used for self-poisoning (an average of 1.85 for each case). The majority of patients was from urban areas and had no history of attempted suicide. There was no difference between males and females regarding history of psychiatric and somatic disorders, though there was a significant difference in the average of age between male and female adolescents.
Conclusions: Among adolescents, self-poisoning is more common in girls while the mean of age is younger in boys. Although the prevalence of psychiatric disorders in adolescents appears to be less than the general population, this may be related to differences in their situations or due to underestimation of their frequencies. Psychiatric care should be a necessary component of the care administered to adolescents who attempt suicide and must be based on the needs and basic assessment of the patient’s status. Research regarding the familial history of abuse, neglect, self-harm/ poi- soning should be undertaken so that such social issues can be prioritized and addressed.

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Background: Rapid tissue growth and development during puberty increases the need for energy and nutrients. On the other hand, the prevalence of obesity is accelerating among adolescents. Controversies exist regarding meal frequency, obesity and adequacy of nutrients in particular, a more frequent snacking pattern has been associated with overconsumption of calories in children and adolescents and also with greater body weight. We investigated the meal frequency of adolescents in relation to meeting nutrient requirements.
Methods: This cross-sectional study, in the framework of the Tehran Lipid and Glucose Study (TLGS), included 367 boys and girls aged 10-19 years that were randomly selected. Dietary recalls for 48 hours were gathered and participants divided to three groups according to meal frequency group 1, 2 and 3 with <4 meals, 4-6 meals and ≥ 7 meals, respectively. The nutrient intakes were compared with the dietary reference intake (DRI). ANCOVA, Bonferroni and partial correlation by adjusting total energy intake were used for statistical analyses.
Results: The mean age of these 169 boys and 198 girls was 14±3 years old. The weight of the first group was higher by one-third in boys (54±18 vs. 45±13 kilogram, p<0.05). There were no other significant differences in anthropometric indices of the studied subjects, nor was there any difference in the vegetable and meat intake between the groups. But the first group had lower intake of fruits and milk groups (p<0.01). Individuals in all three groups had inadequate intake of calcium, zinc, copper, magnesium, pyridoxine compared with the DRI, although the vitamin C and riboflavin intakes were adequate. Higher meal frequency was associated with sufficient intake of magnesium, vitamin C, riboflavin and pyridoxine.
Conclusion: Adolescents tend to have inadequate intakes of calcium, pyridoxine, zinc, copper, all of which are essential for health and proper growth. Increasing the number of meals per day, without increasing energy intake could help to boost the quality of the diet.

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Background: Depressive disorders in children and adolescents are chronic and highly morbid. Few studies are carried out on antidepressant drugs for depressed youths, especially specific noradrenergic agents. Reboxetine is a selective norepinephrine reuptake inhibitor. This study was designed to evaluate the effect of reboxetine in childhood and adolescent depression.

Methods: Twenty patients of both genders, aged 7-17 years old, with major depressive or dysthymic disorders, as classified by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), participated in an 8-week clinical trial before-after study of reboxetine. Clinical semistructured interviews, based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS), were carried out. Reboxtine was initiated at a dose of 1 mg/day and increased up to 6 mg/day. Patients were assessed for changes in: depressive symptoms using the Children's Depression Inventory (CDI) and global functioning by the Children's Global Assessment Scale (C-GAS). Side effect questionnaire was also administered.

Results: There was a significant decrease in the ineffectiveness subscale (C factor) of CDI (p=0.006). Although the CDI scores decreased by 32.69%, this change was not significant (p=0.39). No significant change in C-GAS (p=0.2) was observed. Adverse effects were relatively mild to moderate and transient. The most common adverse effects were decreased appetite and sedation.

Conclusions: Reboxetine is relatively well tolerated and improves feelings of ineffectiveness among depressed children and adolescents however it does not improve all depressive symptoms. Double-blind, placebo and active comparator controlled studies and larger sample sizes are indicated.

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Background: Scoliosis is one of the most common spinal deformities with subsequent decrease in pulmonary function. The effects of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis are controversial. The purpose of the present study was to compare the postoperative pulmonary function changes in different surgical approaches chosen for its correction.

Methods: Sixty-five patients with adolescent idiopathic scoliosis who had undergone corrective spinal surgery in Shafa Yahyaian Hospital since 1997 to 2007 and had documented preoperative pulmonary function test report, included in our study. The patients had documented preoperative pulmonary function tests and were divided into three groups based on their surgical approach. The first group was comprised of 25 patients who had undergone posterior spinal fusion (PSF), the second group included 29 patients who had anterior and posterior spinal fusion (ASF+PSF), and the third group consisted of 10 patients who had posterior spinal fusion and thoracoplasty (PSF+ thoracoplasty). The preoperative and the final follow-up values of absolute and percent predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were compared and their relations with the undertaken surgical approach were evaluated.

Results: There were no significant correlations between the surgical approaches and changes in the pulmonary function tests (P>0.05). FVC and FEV1 values were similar to preoperative values in all groups after a minimum follow-up of two years.

Conclusion: There were no significant differences between different surgical approaches for adolescent idiopathic scoliosis regarding the pulmonary function test results after at least two years of follow-up.

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Background: Several studies have suggested higher incidence of osteoporosis in patients with idiopathic scoliosis in comparison with the normal population. The aim of this study was to assess the prevalence of low bone mass among adolescent girls with idiopathic scoliosis.
Methods: In this cross-sectional study performed in shafa Hospital in Tehran, Iran during 2011-2012, we recruited fifty-seven 12- to-20-year old girls with idiopathic scoliosis and compared them with 100 age-matched healthy girls. The patients had no other diseases including neuromuscular disorders, congenital vertebral anomalies or a history of spinal surgery. Bone mineral densities (BMD) of the hip and spine were evaluated and compared in all 157 participants using dual X-ray absorptiometry (DXA). Standard BMD (sBMD) was also calculated at the lumbar spine.
Results: Analysis of the data revealed that hip BMD was significantly (P=0.004) lower in patients with idiopathic scoliosis versus the controls. Moreover, BMD and sBMD of the Spine were also significantly lower in the patients (respectively, P=0.030 and P=0.030). Curve location had no effect on the values of hip BMD, spine BMD or spine sBMD (respectively, P=0.061 and P=0.274 and P=0.208).
Finally, with more severe curves a lower bone mass was detected for sBMD and spine BMD (respectively, P=0.017 and P=0.016), but it was not significant for hip BMD (P=0.069).
Conclusion: Adolescent girls with idiopathic scoliosis had lower bone mass compared with their healthy peers. The lower bone mass was correlated with the severity of the curve but not its location. 

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Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.
Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.
Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.

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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: Metabolic syndromes are known as a set of risk factors for the development of cardio-vascular disease and diabetes in the individual. The association between concentration of uric acid and metabolic syndrome in adolescents has yet to be established thoroughly. The aim of this study was to investigate the relationship between uric acid and metabolic syndrome in a sample of adolescents. Methods: This cross-sectional study was conducted from September 23, 2009 to September 22, 2010 in Jundishapur University of Medical Sciences, Ahvaz, Iran. In this study, 240 individuals aged 10-19 years were randomly selected among participants of the Ahvaz MetS study (120 subjects normal and 120 subjects MetS). The serum levels of UA were measured by a colorimetric method. In the normal group, anyone with abdominal obesity, high systolic or diastolic blood pressure, High-density lipoprotein (HDL)&le40 mg/dl, TG&le110 mg/dl, fasting blood sugar (FBS)&le100 mg/dl or diabetes was excluded from the study. History of Anticonvulsive drugs or steroids use was the criteria for exclusion for both groups. Results: Of the 240 subjects aged a mean of 14.95±2.64 years, mean of uric acid in metabolic syndrome group was 4.8±1.4 mg/dl and in the control group was 4.18±1.01 mg/d (P=0.001). Participants were divided into three groups based on uric acid levels: &le4.9 mg/dl, 4.9-5.7 mg/dl and >5.7 mg/dl. The risk of metabolic syndrome was significantly higher in third group of uric acid than the second and first group (odds ratio [OR], 3.7 95% confidence interval [CI], 1.70 - 8.04) and (OR, 5.9 95% CI, 2.42-14.35, P<0.001). In addition, uric acid level was inversely associated with hyperglycemia. The ORs of hypertriglyceridemia for the second and third group of uric acid were 4.36 (95% CI, 2.01- 9.47) 5.75 (95% CI, 2.43-13.61) respectively, compared with lowest group of UA. Conclusion: The results showed that hyperuricemia was significantly linked with increased risk for hypertriglyceridemia, low high-density lipoprotein cholesterol level, high blood pressure and waist circumference. Among Ahvaz adolescents, serum concentrations of uric acid strongly associated with the prevalence of metabolic syndrome and several of its components.