International Journal of Pediatrics
Volume:11 Issue: 119, Nov 2023

Obesity prevalence has increased alarmingly in recent decades as a result of lifestyle changes. Obesity can have adverse effects during childhood and adolescence, which often persist into adulthood. Some studies have shown that echocardiographic findings are associated with obesity, accompanied by an increase in the left ventricle's size, diameter, and weight. This study compared Tissue Doppler and Pulse Doppler echocardiographic changes between obese and normal weight children and adolescents. In 2021, this research was conducted on 66 children and adolescents aged 9 to 18 in Birjand. It included 33 individuals, comprising 25 boys and 8 girls, with a Body Mass Index (BMI) greater than 95, classified as the obese group, and 33 individuals, comprising 21 boys and 12 girls with a BMI between 10 and 85, ranked as the control group. The two groups' parameters were measured using Tissue Doppler Index (echocardiography), and the data was analyzed using SPSS version 16 at a significance level of less than 0.05. The obese and normal weight groups had average ages of 12.84±1.92 and 12.87±2.87, respectively. In the obese group, the average BMI was 28.52±4.3, while in the control group, it was 16.55±2.21. The average EF (Ejection Fraction) in the obese group was 247.13±32.44, and in the control group, it was 249.6±24.68.In the obese group, the mean values of the parameters S´, A', and A were 12.91±2.63, 12.61±2.75 and 74.83±16.75, while in the control group, they were 11.47±2.66, 10.28±2.72, and 63.21±15.41. The obese group had substantially higher values compared to the control group (P<0.05). The mean values of IVRT, IVCT, MPI, E', and E were more significant in the obese group than in the control group, whereas ET and E/A were more significant in the control group. These differences, however, were not statistically significant. The significant increase in diastolic dysfunction parameters, including A' and E'/A', in the obese group may indicate a severe type of LV Compliance Decrease.

Juvenile Idiopathic Arthritis (JIA) is a chronic rheumatic disorder commonly affecting children younger than 16. The incidence and prevalence of JIA can vary greatly depending on ethnicity, genetic background, and socioeconomic status within different populations. Epidemiological studies play an essential role in planning successful treatment for chronic diseases like JIA and providing appropriate care measures in specific geographic regions.

In this cross-sectional study, 149 children were referred to the pediatric rheumatology department of Akbar Hospital in Mashhad from 2016 to 2019. Data was collected from all children within the first six months of disease onset, including the number of affected joints, demographic characteristics, systemic symptoms, extra-articular manifestations, and medication regimens.

The most prevalent subtype of JIA is Oligoarticular, followed by Systemic JIA at 25.5%. Among children with enthesitis-related arthritis, more girls than boys were affected. Additionally, the most frequently affected joints in children were those of the lower limb. 5.4% of the total, had involvement of lumbosacral and sacroiliac joints. Serositis was observed in 2% of the patients. Uveitis was detected in 4 out of 154 patients (2.6%); 3 of these cases were chronic anterior uveitis, while one was acute anterior uveitis. 3 children (2%) were reported to have Macrophage Activation Syndrome (MAS).

Diagnosing juvenile idiopathic arthritis and other rheumatic diseases in children can often be delayed due to physicians’ lacking adequate clinical knowledge. To properly manage this chronic childhood illness, it is crucial to identify its symptoms and clinical course. This study represents the most comprehensive research conducted on children with JIA in the Northeast of Iran.

Childhood obesity is widely recognized as a prominent challenge in the 21st century. The family holds considerable potential in effectively managing this concern, by incorporating behavioral modifications into the child's dietary patterns and physical activity engagement. The aim of this study was to determine the effectiveness of a family-centered, behavioral modifications package in improving the eating behavior, BMI percentile, and abdominal circumference of obese school-age girls. A randomized clinical trial was conducted on a cohort of 80 obese female students aged 7-12 in Mashhad between 2020 and 2021. Data was collected using a demographic information Questionnaire and the Children's Eating Behavior Questionnaire (CEBQ). Following a 3D body scanning procedure, a seven-session intervention program was implemented. Six months later, a reassessment was carried out, encompassing the evaluation of BMI percentile, 3D body scanning, and re-administration of the questionnaires. Data was analyzed through SPSS version 24, utilizing paired t-tests, independent t-tests, and multivariate analysis of variance. Following the intervention, significant increases were observed in scores for enjoyment of food, satiety responsiveness, and slowness in eating. Conversely, scores for food responsiveness, emotional overeating, emotional undereating, and food fussiness displayed a decrease. However, the differences did not reach statistical significance following the intervention (p>0.05). Notably, changes in BMI percentile and abdominal circumference displayed a statistically significant difference between the two groups after the intervention (p<0.05). The family-centered behavioral modification program represents an appropriate approach for modifying child's eating behavior, resulting in a success rate exceeding 10% in weight reduction.

Iron Deficiency Anemia (IDA) is a massive health concern with a high frequency in Iran. Differentiating between IDA and other microcytic-hypochromic anemia like beta thalassemia minor requires demanding and money consuming tests. That is why this study aimed to assess well-suited and conclusive deferential indexes for IDA diagnosis among children aged between 1-15 years old

Blood samples were collected from outpatients aged between 1-15 years old. Consequently, Ferritin, Hemoglobin, Serum Iron, RBC count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), red cell volume distribution width (RDW), total iron binding capacity (TIBC) were determined. Furthermore, differential indexes including Mentzer, Shine and Lal and England-Frazer were measured and the data were analyzed using SPSS.

Out of 100 children, 72 individuals were healthy and 28 had IDA. The average age was 3.6±2.9 years. The prediction value of the RBC indexes for the differentiation IDA were as follows: MCV (99%), HB (96%), Ferritin (95%), HCT (87%), MCH (79%), Serum Iron (71%), RBC count (51%), RDW (27%), and TIBC (26%). The prediction values of the formulas were as follows: Shine and Lal (96%), Mentzer (80%), and England-Frazer (79%).

According to the findings, it is possible to diagnose IDA by Complete Blood Count (CBC) test accompanied by differential indexes. A simple selective index such as Shine and Lal might be very beneficial for screening of IDA. This index is also useful for the diagnosis of microcytic anemia.

Nephrotic Syndrome (NS), common in the pediatric population is typically treated with high-dose glucocorticoid (GC). Long-term GC treatment in refractory cases results in osteoporosis susceptibility. Immunosuppressants adjuvant to GC, used to induce remission in steroid-resistant NS, have shown controversial effects on bone density. This study aims to evaluate and compare bone density in children with NS undergoing GC therapy for ≥2 years with or without immunosuppression using DEXA.

Twenty-three NS patients were enrolled in the study and underwent DXA scan. Demographic data and years of disease, and electrolytes including calcium, phosphorus, and vitamin D levels, as well as creatinine, Glomerular Filtration Rate (GFR), and albumin were documented.

DEXA scan showed low bone density in 4 out of 23 participants (17.4%), two of whom had scores lower than -2, which is indicative of osteoporosis, 2 of whom received cyclosporine and one received tacrolimus adjuvant therapy. Disease chronicity was significantly higher in children with lower whole-body Z-scores. Lower than normal vitamin D levels were detected in 68% of cases.

Our observations revealed a 2:1 ratio of cyclosporine to tacrolimus use in patients in Z-score <-1. We suggest that pediatric patients undergoing ≥2 years of GC therapy, especially in high doses or adjuvant to immunosuppressants, be screened for bone loss using DEXA scan for timely diagnosis and management. Furthermore, clinicians should be aware of the beneficial effects of vitamin D supplements in long-term GC therapy and evaluate their patients for vitamin D and calcium deficiency.