morteza alijanpour

This study aimed to determine the volumetric parameters of platelets including MPV (Mean Platelet Volume) and PDW (Platelet Distribution Width) in diabetic children with and without diabetic ketoacidosis (DKA) and to evaluate their relationship with the severity of DKA.

A case-control study was conducted on 112 children with type 1 diabetes mellitus (T1DM), with and without DKA, who referred to Amirkola Children's Hospital, Iran, in 2016-2021. Of them, 43 were boys, and 69 were girls. The diagnosis of diabetes was based on clinical symptoms and diagnostic criteria, and DKA was diagnosed through the analysis of arterial blood gas. The patients’ MPV and PDW were also evaluated, and the P values less than 0.05 were considered significant.

Out of 112 children with diabetes (with the mean age of 8.71 ± 3.22 years), 56 persons had DKA.  In terms of DKA severity, 17 patients (30.4%) had mild, 29 (51.8%) had moderate, and 10 (17.8%) had severe DKA. The children with DKA had the mean blood glucose of 490.98±46.11mg/dL, MPV of 10.02± 1.19fl), and PDW of 13.07± 1.18flwere significantly higher (P<0.001). It was found that, an increase in the severity of DKA would raise the mean MPV (P = 0.006) and PDW(P<0.001) significantly.

Based on the results of this study, as the severity of DKA increases in diabetic children, the mean levels of MPV and PDW increase significantly. Therefore, it is suggested that MPV and PDW be used to predict the severity of DKA in diabetic children.

Hypothyroidism can play an important role in the development of non-alcoholic fatty liver disease (NAFLD). This study compared the thyroid function tests in overweight and obese children and adolescents with and without NAFLD.

This case-control study was conducted on 100 children and adolescents aged 4-18 years who referred to the endocrinology clinic of Amirkola Children's Hospital, Babol, Iran in 2021. 42 obese and overweight children with NAFLD were considered as case group and 56 persons without NAFLD as control group. They were selected after physical examination and body mass index (BMI) assessment. Then, TSH, T4, FBS, lipid profile, 25(OH) vit D3 (VD), AST and ALT levels were measured. Abdominal ultrasound was performed to survey fatty liver. T-test and Chi-score were used for analysis and p< 0.05 was considered significant.

The mean age in both group was 11.63±2.55 and 10.07±2.61 years, respectively (P=0.004). Hypothyroidism was not seen in the groups. Two groups in terms of mean TSH (P=0.92), T4 (P=0.87), FBS (P=0.33), cholesterol (P=0.44), LDL (P=0.35), VD (P=0.07) had no significant difference. However, difference was found between the two groups in terms of the mean level of AST (P=0.003), ALT (P=0.001), TG (P=0.02), HDL (P=0.01) and BMI (P<0.001). 

This study showed that the mean level of thyroid hormones in both groups did not have significant difference and hypothyroidism was not seen. Other studies with larger sample size and longer periods of time are suggested.

Methylmalonic acidemia (MMA) is a rare autosomal recessive metabolic disorder resulting from a genetic defect in methylmalonyl-CoA mutase (MCM) or a defect in the biosynthesis of its cofactor, adenosyl-cobalamin (AdoCbl). The disease is caused by a mutation in six main genes (MUT, MMAA, MMAB, MMADHC, MMACHC, and MCEE). In this investigation, we estimate MMAdisease gene frequencies globally and report MMA-causative mutations in the Iranian population.

Human gene mutation database (HGMD) has been utilized to estimate MMA-disease gene frequencies. To compile MMA mutations in Iran, we systematically reviewed PubMed, Google Scholar, CIVILICA, Magiran, and SID databases to explore relevant articles in English and Persian.

The frequencies of causative genes among MMA patients at the global level were as follows: MUT (64.14%), MMACHC (17.74%), MMAA (13.48%), MMAB (7.1%), MMADHC (2.9%), and MCEE (0.85%). Until February 11, 2024, 24 MMA mutations had been compiled from the Iranian population; of which 11 mutations (45.8%) had been diagnosed only in Iran and had not been addressed in other populations yet.

Collection and recognition of MMA mutations in the Iranian population can be helpful for early diagnosis and treatment before the onset of neurological manifestations in neonates.

Zinc transporter autoantibody 8 (ZnT8A) was recently identified as a novel antibody antigen in type 1 diabetes mellitus, and its positivity is associated with early onset of the disease. So the present study was conducted to determine the prevalence of autoantibodies related to type 1 diabetes mellitus, especially ZnT8A as a newer antibody in children from 1 to 18 years of age referred to Amirkola Children's Hospital.

In this descriptive and analytical study, 80 children under 18 years of age with type 1 diabetes referred to Amirkola Children's Hospital, Babol, Iran during the years 2013 to 2021 were included in the study. Pediatric diabetes was diagnosed based on the criteria of the American Diabetes Association and with a visit to a pediatric endocrinologist. Antibodies related to type 1 diabetes including 65 glutamic decarboxylase (anti-GAD), protein tyrosine phosphatase (IA-2A), anti-islet cell autoantibodies (ICA), insulin autoantibodies (IAA), and zinc transporter 8 (ZnT8A) was measured from their blood samples at the time of disease diagnosis by ELISA method. Data were analyzed using t-test, chi-square, and Fisher's exact test. The significance level in this study was considered as p<0.05.

Samples were 80 children with an average age of 7.9±3.6 years (57% girls and 43% boys). The level of GADA in the studied samples was 65.2%, IA-2A 58.8%, ZnT8A 56.3%, ICA 47.5%, and IAA 6.3%.

93.8% of diabetic patients were autoantibody positive, which shows that by measuring the level of pancreatic antibodies, type 1 diabetes is confirmed in more than 90% of patients. Also, by measuring newer antibodies such as ZnT8A, the percentage of idiopathic type 1 diabetes cases also decreases.

Background and

The aim of the study was to determine the relationship between electrolyte disorders and disease severity in children with COVID-19 infection referred to Amirkola Children's Hospital.

We performed the cross-sectional study on children aged 1 month to 18 years with COVID-19 infection referred to Amirkola pediatrics hospital, Babol, Iran from March 2018 to July 2018. The level of serum of potassium, sodium, calcium, and fasting blood sugar were measured at the beginning of hospitalization in all study children. Severity of COVID-19 infection was evaluated with Pediatric Early Warning Score (PEWS). Data were analyzed using Chi-Square, ANOVA, and logistic regression tests. P-values of less than 0.05 were considered significant.

Out of 160 children referred to the hospital during the study, 122 were selected. The most common electrolyte disorders were hyponatremia (42.6%) and hypocalcaemia (16.4%). No significant relationship was found between calcium (P=0.30) and potassium (P=0.12) disorders and severity of COVID-19 infection. There was a significant relationship between the sodium disorder and severity of COVID-19 infection (P<0.001). Also, the results of the logistic test illustrated that after adjusting confounding variables (age and gender), children with hyponatremia experienced a higher chance of severe COVID-19 infection (OR: 6.31.00; CI: 2.61, 15.28; P<0.0001).

Hypernatremia and hypocalcaemia are the most common electrolyte disorders in children with COVID-19 infection. Hypernatremia was associated with increased chance of severe COVID-19 infection.

Hyperbilirubinemia is a common problem in neonates that causes hospitalization. The aim of this study was to investigate the effects of concentrated pomegranate juice (CPJ) consumption by breastfeeding mothers on neonatal hyperbilirubinemia.

In this open?labeled, add?on, randomized clinical trial, 86 breastfeeding mothers and their neonates were allocated into two groups. In the control group, neonates received phototherapy.Besides neonates’ phototherapy in the intervention group, their mothers received CPJ (1 tablespoon [15 g] three times a day) up to discharge. The bilirubin level was the primary outcome. The duration of phototherapy, the duration of hospital stay, and the need for exchange transfusions were secondary outcomes.

CPJ reduced the bilirubin level of hospitalized neonates within 48 h after consumption (P = 0.048, standard mean difference = 0.648). It also resulted in reduced duration of hospital stay and faster discharge of the neonates. Furthermore, in 48 h after discharge, bilirubin was significantly lower in the CPJ group (P = 0.003, partial eta squared = 0.123).

Compared to the control group, consumption of CPJ by lactating mothers whose infants underwent phototherapy resulted in lower bilirubin levels, shorter hospital stay, and faster discharge.

The growth and development of children affect biochemical variables. This population-based study was designed to evaluate the reference interval for alkaline phosphatase (ALP) routinely measured in the clinical laboratory.

For this examination, 873 cases were selected among the healthy children and adolescents aged 1-18 years who referred to the endocrinology clinic of Amirkola Children's Hospital for growth evaluation. After overnight fasting, early morning blood samples were obtained to measure the ALP level and other biochemical parameters using an automatic biochemical analyzer. Subjects were categorized by age, sex, and body mass index (BMI) values. The age groups were categorized as follows: 1-4 years, 5-8 years, 9-13 years, and 14-18 years.

There was a significant difference among the age and sex categories; on the contrary, there was no meaningful variation between the two groups categorized by BMI. The reference range for ALP was 474.14-517.71 U/L for children aged 1-4 years, 273.47-871.44 U/L for 5-8 years, 215.04-893.69 U/L for 9-13 years, and 228.9-739.22 U/L for 14-18 years. Also, significant positive correlation was found between ALP with length (P=0.000, r=0.134), weight (=0.04, r=0.073), phosphorus (P) (P=0.001, r=0.122), and alanine aminotransferase (SGPT) (P=0.000, r=0.142) respectively.

This project's data established a reference interval for ALP in healthy children and adolescents, which will prepare a basis for diagnosis and monitoring liver- or bone-related disorders.

Type 1 diabetes mellitus (T1DM) is a chronic disease with multiple long-term complications that could trigger depression. This study was performed to determine the relationship between HbA1C levels and depression in children and adolescents with T1DM.

This cross-sectional study was conducted in all children and adolescents with T1DM attending an endocrine clinic affiliated with Amirkola Children's Hospital, Iran 2018-2019. The patients aged 7-18 years old and at least 1.5 years had passed since the onset of their diabetes. Average of three HbA1c values (every six months) were considered and depression was measured using the Marques Children Depression Inventory.

Out of 100 patients with T1DM based on age-appropriate HbA1c, good, poor, and severe control of diabities were seen in 22%, 74%, and 4%, respectively. The risk of of depression in patients with poor control of diabities was 1.75 times higher than those with a good control of the disease, but this was not statistically significant (P=0.29). The risk of depression in children with illness duration of more than 6 years was 3.74 times higher than that in children with less than 6 years duration of the disease (P= 0.005).

Better management of T1DM and HbA1c levels are needed to reduce the risk of depression in these patients.

The New coronavirus (SARS COV-2) can cause acute respiratory disease and also multiorgan dysfunction. There is insufficient data about kidney involvement in children. So, this study was done on children with COVID-19 to evaluate nephrological involvement.

All children with confirmed or suspected COVID-19 who were admitted in Children Hospital .were enrolled. They were admitted in hospital from March 2020 to July 2020. Serum Blood Urea Nitrogen (BUN), creatinine, sodium, potassium, calcium and urinalysis were evaluated. Also, glomerular filtration rate (GFR) was calculated by Schertz's formula. All patients were evaluated by chest x-ray and/or computerized tomography scanning (CTS). The data were analyzed by SPSS software and P value less than 0.05 was determined as significant.

Forty-seven children with confirmed or suspected COVID-19 were enrolled to this study. At admission, 23.4% and 27.7% of children with COVID-19 infection had abnormal increase in serum BUN and creatinine, respectively. Also 78.8% and 25.5% of children had GFR less than 90 and 60 ml/min /1.732, respectively. Additionally, 13/47 (27.7%) of children had abnormal urine analysis (microscopic hematuria and/or proteinuria). There wasn’t a significant relationship between pulmonary lesions and abnormal reduction of GFR (P<0/05).

In the study, the risk of AKI (acute kidney injury) and decrease of GFR and also abnormal urinalysis is high in children with COVID-19. So, more attention for detection of kidney involvement is necessary and more conservative management for prevention of AKI and decrease of GFR are recommended.

Hypomagnesemia can lead to bronchial smooth muscle contraction and is associated with wheezeing, airway hyperactivity and impairment of lung function. The aim of this study was to compare serum magnesium levels between asthmatic and healthy children.

This case-control study was performed from September 2018 to February 2019. Totally, 125 children (78 asthmatic and 47 healthy non-asthmatic children) aged 3-14 years referred to Amirkola Childrenchr('39')s Hospital in Iran were entered to the study. Sampling was done using the available method based on inclusion criteria. Serum magnesium levels were measured in all children in the laboratory of Amirkola Childrenchr('39')s Hospital. P<0.05 was considered a significant level.

The mean age of children was 81.21±35.45 months, among them, 77 (61.6%) and 48 (38.4%) were male and female, respectively. The mean serum magnesium level of children was 2.08 and 2.04 mg/dl in the control and asthma groups, respectively and there was no statistically significant difference between the two groups (p=0.49).

Based on the findings of this study, there is no significant difference between serum magnesium levels in asthmatic patients and the control group and it is not necessary to routinely measure magnesium levels in these patients.

Congenital hypothyroidism (CH) is one of the most common endocrine diseases and one of the major causes of mental retardation in children. So we aimed to evaluate the developmental outcome of children with CH.

This case-control study was performed on two 3-6-year-old groups of 100 patients. The case group was children with CH, referred to Endocrine Clinic of Amirkola Children's Hospital (2011-2017) and the control group was healthy children and normal from other states. The Denver developmental screening test-II (DDST_II) was used to assess the developmental factors and disorders in four areas of gross motor, fine motor, personalsocial and language. Data were analyzed by SPSS 21 using descriptive statistics, t-test and chi-square, and a p<0.05 was considered significant.

The mean age of 200 children in the case and control groups was 54.62±15.72 and 59.68±15.64 months, respectively. In the case group, 45% and 55% of them had transient and permanent CH, respectively. All four criteria of DDST_II in the control group as well as gross motor in the case group were normal, but fine motor, personal-social and language were reported normal in 94, 95 and 93% of the case group, respectively. All subjects with abnormal DDST_II, had a negative neonatal screening tests.

The results obtained from DDST_II indicated that 6% of children with CH had an abnormal development, all who had an onset of medical treatment over 30 days, which makes it important to screen the neonatal thyroid disease and diagnose this disease timely

Spontaneous pneumomediastinium (SPM) can be due to increased intrathoracic pressure. Pneumomediastinium (PM) with Diabetic Ketoacidosis (DKA) is a very rare complication that can be caused by severe vomiting or Kussmaul breathing.

Case Report:

 The patient is a 15-year-old girl with a history of type 1 diabetes mellitus (T1DM) who has been hospitalized due to nausea, severe vomiting, abdominal pain, chest pain and dyspnea. Based on physical examination and imaging (CXR and chest CT scan), PM was diagnosed. The patient underwent conservative treatment for PM and treatment for DKA and was discharged after 5 days in good general condition.

SPM with DKA is a rare complication with a benign process that usually has a good prognosis if diagnosed and treated timely.

Beta thalassemia major is one of the most common inherited blood diseases and patients with this condition require regular blood transfusions. The resulting iron overload deposition causes endocrine gland disorders, including growth hormone (GH) abnormality. In this study, we examined the effects of recombinant growth hormone (rGH) in these patients.

This retrospective study was performed in thalassemia major patients in Amirkola Thalassemia Center, using the medical records (2011-2018), to evaluate the therapeutic effects of rGH on  growth velocity of six short stature patients aged 7-15 years (four boys and two girls). On the basis of abnormal or normal response to GH provocation test, the patients were included in GH deficiency (GHD) group (n=3) and idiopathic short stature (ISS) group (n=3), respectively. The data were analyzed in SPSS-18.

The mean age of patients was 11.00 ± 2.75 years old. The mean values for growth velocity before and after the treatment were 4.00± 0.86 and 7.83 ± 1.25 cm/year in GHD group (P=0.057) and 4.06 ± 0.81 and 6.00 ± 1.50 cm/year in ISS group, respectively (P=0.023).

In this study, the positive therapeutic effects of rGh in improvement of growth velocity were seen in thalassemia major patients (both GHD and ISS groups).

Because of the importance of thyroid function and its effect on different organs, such as the heart, this study was aimed to evaluate the effect of levothyroxine on cardiac function in children with subclinical hypothyroidism.
This quasi-experimental study was performed on children aged 4-12 years old with diagnosis of subclinical hypothyroidism in Amirkola Children's Hospital during 2018-2019. Cardiac functional parameters, including ejection fraction (EF), fractional shortening (FS), ratio of early filling velocity to early diastolic mitral annulus velocity (E/E'), myocardial performance index (MPI), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD), were measured by echocardiography at baseline and 6 months after levothyroxine treatment.
Out of the 30 subjects, 19 (63.3%) were boys and 11 (36.7%) were girls. The mean age was 6.60±2.13 years old. The mean EF index was 63.13±3.01 percent before treatment, which increased to 69.07±4.50 percent after treatment (p<0.001). Also, the mean FS was 31.83±1.62 percent before treatment, which improved to 35.10±1.13 percent after treatment (p<0.001). The mean MPI was 0.28±0.02 before treatment, which increased to 0.33±0.03 after treatment (p<0.001). On the other hand, no significant difference was found in the mean E/E' before and after treatment. The mean LVEDD decreased from 3.47±0.46 cm before treatment to 3.05±0.40 cm after treatment (p<0.001), whereas LVESD non-significantly decreased after treatment versus before treatment.
The results showed that treatment with levothyroxine may improve cardiac functional parameters in children with subclinical hypothyroidism.

Hyperglycemia is one of the most complications of corticosteroid and asparaginase during induction phase of chemotherapy in children suffering from acute lymphoblastic leukemia (ALL). This study was carried out to evaluate the incidence of hyperglycemia and associated risk factors during chemotherapy induction phase at Amirkola Children's Hospital. In this cross-sectional (retrospective) study, 150 children (mean age: 79.16±42.68 months) with ALL were evaluated (2000- 2011). Hyperglycemia was described as random blood glucose level more than 200mg/dl in patients less than 2 years old. In patients older than 2 years, fasting blood glucose level more than 110-125 mg/dl was considered as impaired glucose level and fasting blood glucose level more than 126 mg/dl was defined as diabetes mellitus. The data were analyzed using SPSS (version 18) and running chi square test, pearson Ccorrelation, and logistic regression. P-values less than0.05 was considered statistically significant. Out of 150 children with ALL, 21 (14%) of them had hyperglycemia, but none of them had diabetic ketoacidosis. Hyperglycemia was significantly associated with gender (P=0.014) and age. (P=0.000) which was more likely in patients older than 10 years. The incidence of hyperglycemia was also related to BMI (P=0.000). Relapse rate for ALL was 14.7%, which was not significantly associated with hyperglycemia. Hyperglycemia was common and transient during induction phase of chemotherapy and it was correlated with age, sex, and weight.

Type I diabetes mellitus (T1DM) with growing frequency which is considered as a world health threatening problem is an autoimmune disease with insulinupenia. Considering the relationship between the incidence of T1DM and environmental factors, the aim of this study was to assess seasonal incidence of T1DM and its association with birth season. This cross-sectional study was conducted on 112 diabetic patients (66 males, 46 females) less than 18 years, referred to Pediatric Endocrine Clinic (Amirkola Children's Hospital) during 2011-2017. All the needed information was extracted from the patient's files and asking questions of their parents. Data were collected in a checklist. Comparison between different seasons and age groups was done by Pearson's chi-square test. Data were analyzed using SPSS 19 and p£0.05 was considered significant level. The mean age of the patients during diagnosis of T1DM was 7.34±3.70 years. The incidence of T1DM was significantly increased in the cold seasons (especially winter) (P<0.008). A more increased incidence was seen in cold seasons in the aged group of 5-9 years old compared to other groups. However, no significant difference was found in all groups in terms of birth season. The results of this study suggest the effects of season as an environmental factor on diabetes incidence. This seasonal diversity is more prominent in the age less than 10 years. So, attention to maintaining the public health and to preventing from viral infections in cold seasons is recommended.

Tacrolimus is a main drug for induction and maintenance immunosuppression for patients with kidney transplants in many centers. One of important side effect of drug is post-transplant diabetes mellitus .Of course; diabetes ketoacidosis (DKA) is rare. In this report, a 12-year-old girl with DKA was presented after 45 days of kidney transplantation.