negar yazdani

Subclinical hypothyroidism (SCH) is marked by elevated thyroid-stimulating hormone (TSH) levels while maintaining normal thyroxine levels. Although the link between insulin resistance (IR) and overt hypothyroidism is well-established, less is known about this relationship in children and adolescents with SCH.

This study aimed to explore the association between insulin resistance and SCH in individuals aged 4 to 18 years.

In this case-control study, 30 patients with SCH aged 4 - 18 from the Endocrinology Clinic at Imam Reza Hospital, Shiraz, Iran, were chosen as the case group through convenient sampling. Additionally, 30 healthy children and adolescents from the same clinic were randomly selected as controls. Exclusion criteria included positive Anti-TPO, goiter, previous thyroid disease, systemic diseases, chronic or acute diseases, diabetes, and a BMI ≥ 85%. Levels of TSH, insulin, fasting blood sugar (FBS), triglycerides, cholesterol, low-density lipoprotein, and high-density lipoprotein were compared between the groups. Data were analyzed using SPSS 25.

The study found that levels of FBS, insulin, and Homeostatic Model Assessment for IR (HOMA-IR) were significantly higher in the SCH group than in the control group. There was a significant correlation between TSH levels and both insulin levels and IR in the SCH group. Subclinical hypothyroidism was found to significantly increase the risk of developing IR among pediatric patients compared to healthy controls.

Overall, our findings indicate a positive correlation between TSH levels and IR in children with SCH. Additionally, HOMA-IR levels were significantly higher with elevated TSH in the SCH group compared to healthy children. It is recommended that IR be evaluated and treated timely in SCH patients to prevent future complications.

 There is a lack of conclusive evidence regarding thyroid function test (TFT) abnormalities in COVID-19, especially among children.

 This study aimed to investigate TFT abnormalities in COVID-19 pediatric patients compared to healthy children.

 This study was conducted on 37 COVID-19-positive children who were admitted to Namazi Hospital from January 21 to March 1, 2022, compared with 37 healthy children. Within 48 h of positive real-time polymerase chain reaction (PCR) results for severe acute respiratory syndrome coronavirus 2, a blood sample was taken to measure serum levels of thyroid-stimulating hormone (TSH) and total thyroxine (tT4) in the two groups. Additional tests, including free and total triiodothyronine, free T4, and thyroperoxidase antibodies, were also conducted on cases. The chi-square, Pearson correlation coefficient, and analysis of variance tests were used for data analysis.

 Twenty-five patients were male, and 49 were female, with a mean age of 7.99 ± 5.02. The abnormal TFT and TSH frequency was significantly higher in the case group than in the control group. Nevertheless, there was no significant difference between the case and control groups regarding tT4 abnormalities. We could not establish an association between the mean of TSH and tT4 and age groups in the two groups and between abnormalities of TFTs and COVID-19 severity.

 Although abnormalities of TFT were significantly more common among COVID-19 children, they were not associated with the disease severity. However, studies with larger sample sizes are recommended to evaluate thyroid abnormalities and their clinical course in COVID-19 children.

 Sepsis is a leading cause of morbidity and mortality in neonates.

 This study aimed to investigate the bacterial profile and antibiotic sensitivity in infants with sepsis.

 This cross-sectional study was conducted on 90 neonates with sepsis admitted to the neonatal intensive care unit of Namazi Hospital, a tertiary-level hospital, in Shiraz, Iran, from 2020 to 2021. Demographic and clinical data including gestational age, previous diseases, maternal infectious, underlying diseases, history and duration of premature rupture of the membrane and delivery, clinical symptoms (fever, reduced breastfeeding, and lethargy), laboratory results (complete blood cell and C-reactive protein), and results of blood and urine cultures were recorded and analyzed.

 Among 90 neonates with sepsis, the average age was 6.7 ± 7.6 days; 54 were male (60.0%), and 36 were female (40.0%). Fifty (55.5%) neonates had early sepsis. Gram-negative organisms were grown in 61% of positive blood cultures; the most common was Klebsiella. Among Gram-positive organisms, Staphylococcus epidermidis was the most common. Most organisms were sensitive to colistin, and most were resistant to cefotaxime. There was a significant relationship between the age of onset of sepsis symptoms and birth weight in infants with positive blood cultures (P = 0.004) (r = 0.3).

 Gram-negative bacteria are the most common causes of sepsis, mainly resistant to aminoglycosides and cefotaxime. Therefore, increasing awareness about the optimal use of antibiotics is necessary to curb the increase in resistance levels.

 Congenital hypothyroidism (CH) can influence neonates’ neurodevelopment. There are controversies on the cause of infantile hypothyroidism and its relationship with maternal hypothyroidism.

 This study aimed to investigate the relationship between maternal hypothyroidism and the incidence of CH.

 This cross-sectional study was conducted on 712 newborns with hypothyroidism born in Fars province, Iran, between 2018 and 2020, identified through the national screening program for genetic, metabolic, and endocrine congenital diseases recruited by the census sampling method. The information on infants’ files was recorded in a researcher-made checklist. Descriptive data were reported by mean ± SD and No. (%). The independent t-test, chi-square test, Pearson correlation, and Spearman’s rank correlation coefficient were used to evaluate relationships between variables.

 Of 179,448 infants screened, 712 (4 of 1,000 live births) had CH with a mean thyroid stimulating hormone (TSH) level of 22.34+24.8 mlU/L. Of these, 252 infants (35.4%) had a family history of hypothyroidism in the mother (OR = 4.951, P < 0.001). There was a significant relationship between CH and maternal hypothyroidism. Moreover, there was a significant difference in the mean TSH level between hypothyroid infants born to mothers with a history of hypothyroidism (19.10 ± 21.30 mlU/L) and those who had healthy mothers (24.23 ± 26.44 mlU/L, P = 0.027). The prevalence of CH in 2018, 2019, and 2020 were reported to be 0.34%, 0.4%, and 0.45%, respectively.

 Our results showed a significant relationship between maternal hypothyroidism and CH. Considering the importance of the prompt diagnosis of CH, especially in high-risk groups such as infants of hypothyroid mothers, it is recommended to conduct more studies to design more precise guidelines to screen infants who are at risk of CH.

Diabetes and its consequences increase the health system costs. Therefore, prevention and early diagnosis can reduce the cost and consequences. The studies have emphasized the role of education in treatment and people’s awareness of prevention and early diagnosis. Thus, the present study aimed to assess the awareness of people referring to Shiraz health centers with diabetes.

This cross-sectional study was conducted on 270 people aged 12-65 Y/O referred to Shiraz health centers in Iran in 2019. Participants completed an 18-item questionnaire with subscales of demographic data, general information about patients, causes and factors of diabetes, symptoms and diagnosis, prevention and treatment, and consequences and problems. Furthermore, other information, such as the presence of diabetic patients in the family and sources of information, was recorded. Data were analyzed using SPSS software-21.

The participants’ mean age was 33.96±10.05; 54.82% were female, and 45.18% were male. The main sources of information were friends and relatives. The mean score of awareness was calculated to be 15.18±5.03. Statistical tests revealed a significant relationship between job, educational levels, age, and source of information with the score of awareness (P<0.001), while this relationship with gender (P=0.068), marital status (P=0.196), and family history (P=0.060) was insignificant.

Overall, public awareness of diabetes in Shiraz was found to be moderate. Moreover, it is observed that men, married individuals, as well as older and less educated people exhibited lower levels of awareness. Hence, it is recommended that these factors be taken into account when designing health system programs aimed at educating all communities about diabetes.

 Peripherally inserted central catheters (PICCs) are an effective method for medication and nutrition infusion in preterm neonates. The present study aimed to identify the incidence of the most common complications of PICC implantation and evaluate the risk factors of each complication.

 This historical cohort study was conducted on 2500 neonates with birth weights (BWs)≥500 g and gestational age (GA)>24 weeks who had a history of PICC inserted in three NICUs between August 2015 and August 2018. Data were collected by reviewing medical records. Demographic data and indices of catheter placement, duration of catheter placement, and common complications were recorded. Data analysis was done using SPSS-21.

 The median cubital vein had the most PICC placement (43%). The most common complication was tip malposition (48.2%). The incidence rates (95% CI) of the main complications such as malposition, edema/occlusion, and PICC migration were 0.0356 (0.0337-0.0377), 0.0134 (0.0122-0.0147), and 0.0088 (0.0079-0.0099), respectively. PICC insertion position was the strongest predictor of malposition for the cephalic vein. Besides, the incidence of malformation in the cephalic vein was about six times higher than in the median cubital vein. Independent risk factors for non-technical complications included BW (OR=0.59, 95% CI 0.44-0.79), administration of hyperosmolar medications (OR=3.43, 95% CI 2.62-4.51), position (OR=2.43, 95% CI 1.92- 3.08), and duration of catheter presence (OR=1.02, 95% CI 1.01-1.03) (P<0.001).

 The most common complication was malposition related to catheter placement in an emergency. Moreover, BW, administration of hyperosmolar medications, and duration of catheter presence were the most critical risk factors for non-technical complications. Therefore, it is recommended to educate the PICC insertion team to reduce tip malposition and replace long-term catheters.

Diabetic ketoacidosis (DKA) can cause several complications. The myocardial damage in children with DKA was not evaluated clearly. This study aimed to investigate the troponin level as a biochemical marker of myocardial damage in children with DKA during the disease and after recovery.

This cross-sectional study was conducted in the pediatric endocrinology department of Namazi Hospital, Shiraz, Iran, from May to December 2019. Fifty diabetic children aged 1 to 18 years old with DKA by census sampling method. All patients were examed, and electrocardiography (ECG) was carried out. Troponin level was measured at admission and 48 hours after recovery. Finally, data were analysed using SPSS software 20.

At the time of admission, the mean troponin level was 11.56±5.35 ng/mL and it became 2.15±1.21 ng/mL after recovery. Although the initial troponin level during DKA in three patients was higher than the expected normal reference range, their echocardiography and ECG were normal. Moreover, there was no statistical relationship between troponin level with age, diabetes duration, and DKA severity.

The troponin level was remarkably different during DKA and after recovery. However, in merely 6% of DKA patients, the troponin level was higher than the expected value. We recommended that these patients be followed for future cardiovascular complications.

Because of the high daily mortality and quarantine procedures, coronavirus disease 2019 (COVID-19) can cause several psychological problems, especially in younger people.

Since most studies have mainly focused on physical problems of COVID-19 and they have neglected children in their analysis, this study aimed to evaluate the frequency and severity of stress symptoms and associated factors amongst children and adolescents aged 4 - 18 years during the COVID-19 outbreak.

Using a convenience sampling technique, this descriptive-analytic cross-sectional study was conducted in Shiraz, Iran, from March 2020 to June 2020. To collect data, the link of the online Children's Self-Reported Stress Symptoms Questionnaire was sent to eligible participants via SMS and WhatsApp. The data were analyzed using SPSS software version 21.

According to our results, 270, 77, and 16 cases had low, moderate, and severe stress, respectively. Age group, living with both parents, and birth rank had a significant relationship with the degree of stress. Furthermore, more than 50% of participants reported cognitive-emotional symptoms more than physical ones. There was a significant relationship between the age group and physical symptoms, the duration of quarantine with bad temper and sadness, and between no clear thoughts with mother’s workplace and father’s job.

Generally, almost 25% of participants reported moderate-to-severe stress. The most common symptoms of stress in children and adolescents were worrying, anger, and weakness. Furthermore, older children, those being the first child, and children living with both parents were more exposed to stress. Therefore, these items should be included in the healthcare team's training.

Celiac disease results from the interaction of gluten, the immune system, and genetic and environmental factors, which is diagnosed via clinical symptomsincludingweight loss, steatorrhea, and malnutrition. It is usually presented in children who have malnutrition and failure to thrive, but it has been recently reported in some obese children. Since nowadays screening of high-risk/susceptible groups has been emphasized, this study aimed to evaluate the frequency of serologic celiac disease in obese children.

This cross-sectional study was conducted on 104obese children who referred to the Endocrine Clinic of Shiraz University of Medical Sciences, Shiraz, Iran in 2016. Data were collected using a questionnaire through face to face interviews. To measure Anti TTG IgA and total IgA Ab, 5 ml blood sample was taken. Data analysis was done using SPSS version 18.

The mean age and BMI of the participants were 10.33±2.39 and 24.71±4.78, respectively, 65% of whom were girls. In this study, five patients (4.9%) had positive Anti TTG IgA, 80% of whom had reported positive gastrointestinal symptoms. The statistical tests suggested a positive and significant correlation between gastrointestinal symptoms and Anti TTG IgA.

Compared to 2% prevalence of serological TTG Anti in our community, a 5% prevalence Anti TTG IgA in obese children may indicate that there is an increased risk of potential celiac in obese children compared to the normal population. Therefore, it is recommended to screen obese children for celiac disease periodically and perform endoscopy and biopsy in the cases with persistence of anti-TTG.

Although selenium is one of the nutrients that has an important role in the metabolism of thyroid hormones, it has been investigated in rare studies. This study aimed to evaluate role of selenium deficiency in children and adolescents with acquired hypothyroidism.

This case and control study was conducted on 60 acquired hypothyroidism and 60 healthy children who had been referred to the pediatrics endocrine clinic in Shiraz, Iran, from November 2018 to April 2019. Some information such as age, gender, weight, height, duration of disease, and level of plasma selenium were recorded. Plasma selenium level was measured by atomic absorption spectrophotometer. Data were analyzed using SPSS software 21.0.

The mean of selenium level in the case and control groups were 93.77 ± 24.90 µg/dl and 85.96 ± 25.20 µg/dl, respectively. There was no significant difference between the two groups in the mean levels of selenium. Independent t‑test showed no significant difference in the mean levels of selenium in male and female samples in the case group, but this difference was significant in the control group.

Selenium deficiency may not have significant role as a cause of acquired hypothyroidism in pediatric and adolescent age group, in south of Iran. Thus, it does not seem necessary to routinely check the level of selenium for patients with thyroid dysfunction.

Since ventricular septal defect (VSD) is the most common congenital heart disease, this study aimed to investigate its prevalence, characteristics, and associated diseases in a referral children’s heart clinic in south of Iran.  

In this cross-sectional study that was conducted based on the databases of children with heart diseases, patients under 18 years of age referring to Imam Reza clinic were examined. All patients with at least one record of VSD in echocardiography during 2016-2017 were included. Demographic and echocardiographic characteristics including size of VSD, shunt gradient, pulmonary hypertension (PH), aortic regurgitation, and associated cyanotic and acyanotic defects were analyzed.  

The prevalence of VSD found in 7458 echocardiography records was 12%, the median age of patients was 9.3, and the male/female ratio was 1.08. The perimembranous VSDs were determined to be the most common types of VSD. The most common associated complication with VSD was detected to be PH followed by aortic regurgitation. Sub-pulmonic showed the highest association with aortic failure. Atrial septal defect and tetralogy of Fallot (TOF) were the most common acyanotic and cyanotic heart defects, respectively. Only 0.5% of the patients had Eisenmenger syndrome.  

Fortunately, the prevalence of the complication of VSD was not high in south of Iran, and the number of Eisenmenger syndrome was low. The types of VSD and the number of its complications identified in study population were similar to those in other populations.

Neonatal jaundice is an almost common problem among neonates that may cause complications such as kernicterus in severe cases. Since early diagnosis and proper treatment of neonatal jaundice is vital to prevent the related complications, it is necessary to check bilirubin before discharging the neonates. There are several evaluating and diagnostic methods to measure the level of bilirubin. Thus, this study aimed to compare the transcutaneous method versus measurement of serum bilirubin, using spectrophotometry for jaundice screening of full-term neonates before discharge from hospital.

This observational analytic study was conducted on six hundred neonates with birth weight more than 2000 grams and gestational age more than 35 weeks from September 2012 to March 2013 in Hafez hospital, Shiraz University of Medical Sciences. Parameters such as bilirubin level of neonates were measured and compared, using spectrophotometry and transcutaneous by Bili check with multi waves.

Six hundred neonates were enrolled in this study. The Pearson correlation test showed that there was a significant correlation between the two methods of the transcutaneous versus measurement of serum bilirubin, using spectrophotometry (r=0.63), (P>0.05). There was no significant difference between the mean of measured bilirubin, using each method in some demographic variables such as the different groups of gender (P=0.896), birth weight (P=0.419), and type of feeding in neonates (P=0.323), but it was significant in other demographic variables such as the different groups of gestational age and post-neonatal age (P<0.0001). Also, the results revealed that there was a significant correlation between two methods of the trans cutaneous versus measurement of serum bilirubin, using spectrophotometry based on demographic variables (P<0.0001).

In general, the bilirubin measurement using trans-cutaneous method may estimate bilirubin significantly less than the serum bilirubin measurement method, and this difference can be more obviously noticeable in infants with less gestational age and also less post-natal age.

Since diabetic type1 is a chronic and without definitive treatment disease, one of the main goals of health system is increasing of patients’ self-empowerment to control blood sugar and manage the disease. According to doing rare study in this age group, this study aimed to investigate the effect of team self-management training on blood sugar control in children and adolescents with type1 diabetes.

In this quasi-experimental study, 32 patients with type1 diabetes aged 6-18 years old were included. Initially, HbA1c was measured and self-management education was delivered by treatment team. Patients were asked to record the cause of increasing and decreasing of blood sugar and its’ level. This program lasted for three months in six sessions. Finally, HbA1c level, fluctuations in blood sugar, frequency of hypoglycemia and hospitalization, and daily insulin dose were compared pre and post of the study. Data were analyzed by SPSS18.

The mean age of participants was 12.59±0.5 years. Mean of HbA1c was 10.96±0.40 mg/dl and 9.85±0.35 mg/dl pre and post of the study, respectively that this mean difference was significant(P<0.05). After study, short-acting insulin dose had significantly decreased(P<0.05) and long-acting insulin dose had increased(P<0.05). The frequency of hospitalizations and hypoglycemia showed no significant difference between before and after the study (P>0.05).

Since self-management program had an effective role in decreasing of HbA1c and insulin dose, it is suggested to implement it in care programs of type1 diabetic patients in order to better control blood sugar and reduce insulin requirement.

 Morbid obesity negatively affects all aspects of quality of life (QOL); therefore, the assessment of QOL can be a useful criterion to evaluate obesity outcome.

 The present study aimed to design a QOL questionnaire in morbid obesity and assess its validation features.

 This sequential-exploratory mixed-methods study was conducted in both qualitative and quantitative stages. The qualitative stage was carried out through 20 semi-structured interviews with morbidly obese people. Furthermore, the initial items of the questionnaire were obtained by a review of related literature. In the next stage, face, content, and construct validity were assessed. The construct validity was examined by exploratory factor analysis with 319 people. Moreover, Cronbach’s alpha and test-retest correlation coefficient were calculated to evaluate the reliability of the questionnaire. Furthermore, confirmatory factor analysis was assessed.

 Based on the results of the quantitative stage, an 80-item pool was extracted. The exploratory factor analysis yielded six factors that explained 50.62% of the variance. The factors of one to six were as follows: self-dissatisfaction (15 items), functional disorders (7 items), spiro-mental experiences (11 items), perso-social isolation (7 items), physical changes (7 items), and financial pressure (3 items). The final Cronbach’s alpha coefficient of the 50-item questionnaire was calculated at 0.94. Moreover, the intra-class correlation coefficient between the test and retest scores was estimated at 0.97. All indicators of confirmatory factor analysis demonstrated that goodness of fit was acceptable for each factor. Furthermore, this questionnaire had appropriate interpretability, feasibility, and did not have any floor and ceiling effects.

 This valid and reliable questionnaire can be used as a suitable measurement tool for assessing the QOL of morbidly obese people in Iran and other countries with similar cultural features. This questionnaire can improve the quality of future clinical research on obesity. In addition, health care providers can perform a peculiar role in the provision of efficient services to patients to prevent obesity and its associated complications.

Umbilical vein catheterization is usually conducted for preterm neonates in neonatal intensive care units to administer medication, fluid and nutrition, and blood transfusion. However, catheter tip malposition can cause complications.

There are different methods to detect the accuracy of catheter’s position; hence, this study aimed to compare the diagnostic accuracy of radiography vs echocardiography to determine the accurate tip position of umbilical vein catheter.

This cross-sectional study was performed on all 104 neonates admitted to the neonatal intensive care units of hospitals affiliated to Shiraz University of Medical Sciences from March 2017 to January 2018. At first, the length of the catheter was estimated based on Dunn method. After catheterization, thoraco-abdominal radiography and echocardiography were performed by a pediatric radiologist who was blinded to the study objectives, and the data were recorded in two forms. Finally, data were analyzed by McNemar’s test, using SPSS 17 software.

The sensitivity, specificity, positive predictive value and negative predictive value by radiography and echocardiography for the catheter tip position in the inferior vena cava-right atrium junction was calculated 100%. Moreover, catheters were located in the ductus venous, inferior vena cava, inferior vena cava-right atrium junction, right and left atrium in echocardiography were in the radiograph equal to thoracic vertebrae of T9-T11, T9, T6-T10, T5-T8, and T4-T6, respectively.

Our study suggests that even though echocardiography is as reliable as radiography for early detection of the catheter tip position, it can also avoid complications of catheter malposition quicker than radiography

Since epidemiological information on type1 diabetes in children can help to control it, this study aimed to determine the frequency and characteristics of type1 diabetes patients during an 11-year period.

In this retrospective study, records of all 0-39 years old diabetic patients admitted to Nemazee hospital 2004-14 were reviewed. Since most new cases are admitted to this hospital, the patient’s data might be a good representative of all patients in Shiraz. Gender, date of birth, age of onset and associated diseases were recorded. Data were analyzed, using SPSS 22.0.   

In this study, 546 diabetes patients were admitted, of which 52.4% were females. Two peak age was observed (5-9 Y/O and 10-14 Y/O). The mortality rate was 23%. Most of them had no family history of diabetes. Majority of patients (86.3%( did not have any other medical condition. Moreover, there was a significant relationship between age of onset with positive family history and mode of presentation. The frequency of diabetic patients had a rising trend during this eleven-year period.

Incidence of type1 diabetes had a growing trend and peak age of presentation was similar to most previous studies. However, the percentage of diabetic ketoacidosis was more than that of developed countries. Therefore, people and physicians are recommended to have more information on type1 diabetes for early diagnosis to prevent further complications.

Morbid obesity is rising around the world. Surgery is a selective treatment intervention for it. Since most of the surgeons use weight loss for evaluating of the morbid obesity surgical outcomes and paying attention to the the quality of life (QOL) and body image evaluation are rare, this study aimed to assess the QOL and body image in pre‑ and postsurgery with other interventions.

This case–control study was done on 200 morbidly obese patients (n = 100 in each group) who referred to the obesity clinic in Shiraz. The data were collected by Body Image Concern Inventory and 12‑item Short Form Survey. The data were analyzed by t‑test, Pearson correlation coefficient test, analysis of variance, and regression analysis. P = 0.05 was considered as significant.

The paired t‑test showed a significant difference in mean scores of body image (P < 0.001) and all dimensions of the QOL (P < 0.001) in the case and control groups. In the case group, there was a significant difference between the mean scores of the QOL and the different categories of body mass index (BMI) in postsurgery (P < 0.05) and the different mean scores of body image and the different categories of BMI in pre‑ and postsurgery wasn’t significant (P > 0.05). Age was a predictor variable for the QOL of morbidly obese persons after surgery (P < 0.001). After surgery, men showed better QOL than women (P < 0.001).

Final results indicated that body image and QOL defects caused by obesity could be more improvement after surgery. This study can promote health‑care team’s knowledge about holistic supporting of all dimensions’ QOL of obese individuals. It is suggested that supporting interventions should be done as effective methods of maintenance for effects of weight loss methods such as surgery.