Iranian Journal of Pediatrics
Volume:21 Issue: 3, 2011

Malnutrition is closely linked to chronic kidney disease (CKD) in adult patients with poor outcome. But data on pediatric patients is inadequate. The aim of this study was to describe the prevalence of growth failure and malnutrition in pediatric CKD patients and explore the relationship of these parameters to each other and to other clinical parameters. This study included 42 patients and 29 healthy children matched for age and gender. Patients were classified firstly in age group and secondly in therapy modalities. Nutritional evaluations were performed according to the Kidney Disease Outcomes Quality Initiative guidelines, and we performed adjustments using values from children with the same chronological age as reference. In pubertal group, the mean height SDS was lower than in pre-pubertal period while it was higher than in early childhood (P=0.4 and P=0.03 respectively). In all groups, 45% of patients had malnutrition: 20 patients on predialysis, 22 patients with end stage renal disease (14 on hemodialysis, and 8 on peritoneal dialysis). The mean weight SDS was lower in end stage renal disease groups (P<0.001). The height SDS was lower in end stage renal disease groups (P<0.001). Growth failure and malnutrition remain a significant clinical problem as age and therapy modalities are dependent in children with CKD.

Angiopoietins are involved in the pathogenesis of a variety of human diseases. We tried to evaluate the application of pleural and serum Angiopoietin-1 and 2 in categorizing pleural effusions (PEs) into exudates and transudates in children. Pleural fluid (PF) and serum Angiopoietin (Ang)-1 and Ang-2 were measured in 80 children with PEs (40 transudative and 40 exudative) by using enzyme-linked immunosorbent assay. PF Ang-2 levels were significantly higher in pleural exudates than in transudates (P 0.012). PF Ang-2 levels were significantly higher than serum Ang-2 levels in patients with pleural exudates and transudates (P<0.001). PF Ang-2 levels were higher in tuberculous than in non-tuberculous pneumonic PEs and empyema (P=0.01). PF Ang-2 levels correlate with serum Ang-2 levels (P<0.003). PF Ang-1 levels were significantly lower than serum Ang-1 levels both in patients with exudates and those with transudates (P<0.001). Cutoff points of serum and PF Ang-2, differentiating between transudative and exudative effusions were 3ng/ml and 8ng/ml respectively. Predictive potentials of serum and PF Ang-2 cutoff points were: Sensitivity 90% and 95% respectively, specificity 92.50% and 97.50% respectively, positive predictive value 92.30% and 97.40% respectively and negative predictive value 90.20% and 95.10% respectively. Ang-2 levels were elevated in exudative PEs and correlated with levels of markers of pleural inflammation and pleural vascular hyperpermeability. It could categorize PE to exudates and transudates with valuable discriminative properties. That was detected more obviously in pleural fluids than in serum.

This study aimed to determine the prevalence of increased alanine aminotransferase (ALT), defined by a gender-specific cutoff value, among normal weight and overweight children; and to assess the relationship of increasing ALT levels with cardiometabolic risk factors. This cross-sectional study was conducted among school students, aged 6-18 years in Isfahan, Iran. Based on the body mass index (BMI) percentiles, a group of normal-weight was compared with a group of overweight and obese students. Gender differences were considered for increased levels of ALT, i.e. 19U/L and 30U/L for girls and boys respectively. The study participants consisted of 1172 students (56.2% girls), with a mean (SD) age of 12.57 (3.3) years. Among overweight/obese students the mean triglycerides (TG) and diastolic blood pressure was significantly higher in those with increased ALT than in those with normal ALT levels. The logistic regression analysis showed that among overweight/obese boys, for each 1 unit increase in ALT, the odds ratio (OR) of TG, total cholesterol and systolic blood pressure increased significantly. After adjusting for age, these associations remained significant, and the OR of high density lipoprotein cholesterol (HDL-c) decreased significantly. In the model adjusting for age and BMI, the ORs of TG and HDL-c remained significant. After adjusting for age and waist circumference, HDL-c was the only parameter with significant OR. Among overweight/obese girls, in all models applied, the OR was significant for TG and total cholesterol. A significant independent association was documented for waist circumference and increase in ALT after adjustment for BMI. This study documented significant relationship of increased ALT levels, defined by a gender-specific cutoff point, with cardiometabolic risk factors and hypertriglyceridemic-waist phenotype in Iranian children and adolescents.

Exposure of DNA to sulfur mustard gas may increase the inheritance of asthma in chemical warfare victim's (CWV) offspring. The objective of this study was to determine the prevalence of asthma in children of CWV and compare it to asthmatic children in the general population. Four hundred and nine children from 130 CWV fathers and 440 children from 145 asthmatic parents from two cities in Iran participated in this study. The prevalence of asthma was determined by standard questionnaire released for epidemiological survey of asthma in children and compared between two groups. The prevalence of asthma in the CWV group was 15%; this was not significantly different from the control group (12.5%). The children of the CWV group reported a significantly greater incidence of wheezing (1.2±3.1 attacks) per year, but the control group reported more severe attacks leading to speech difficulties (3%) and coughing (7%). Regression analysis showed that with increasing family size in the control group, the number of subjects suffering from asthmatic symptoms decreases significantly (r=0.86, P=0.001). Chemical agents may increase the prevalence of asthma in the offspring of CWV.

Infections are the major cause of morbidity and mortality in febrile neutropenic patients with malignancy. Rapid diagnostic tests are needed for prompt diagnosis and early treatment which is crucial for optimal management. We assessed the utility of soluble triggering receptor expressed on myeloid cells (sTREM-1) in the diagnosis of bacteremia and fungemia in febrile neutropenic patients. Sixty-five febrile neutropenic children with malignancy hospitalized in Mofid Children's Hospital during a period of one year from January 2007 were recruited for this cross sectional study (mean age 66.2± 37 months; 35 females and 30 males). Thirty patients (46.2%) had acute lymphoblastic leukemia, 2 (3.1%) acute myeloid leukemia, one (1.5%) lymphoma and 32 (49.2%) were under treatment for solid tumors. Simultaneous blood samples were collected for measurement of serum sTREM-1 levels and for blood cultures which were grown in BACTEC media. Gold standard for the presence of infection was a positive BACTEC culture as a more sensitive method compared to current blood culture techniques. Blood cultures with BACTEC system were positive in 13(20%) patients (12 bacterial and one fungal culture). The mean serum sTREM-1 level in BACTEC positive patients was 948.2±592.9 pg/ml but in BACTEC negative cases it was 76.3±118.8 pg/ml (P<0.001). The optimal cut-off point of sTREM-1 for detecting patients with positive result of BACTEC was 525 pg/ml with sensitivity and specificity of 84.6% and 100%, respectively. Our study revealed a significant association between serum sTREM-1 level and bacteremia and fungemia in febrile neutropenic patients suffering malignancy with acceptable sensitivity and specificity.

Congenital heart disease (CHD) is the most common congenital anomaly in newborns. The aim of this longitudinal, hospital-based study was to evaluate the prevalence and pattern of CHD among Iranian newborns in Gorgan, Northern Iran. 11739 live births in Dezyani hospital in Gorgan were screened for CHD, 2007 through 2008. Clinical examination, echocardiography, color Doppler and cardio catheterization were used as diagnostic tools. Clinical and demographic factors, namely sex, type of CHD and associated anomalies of diagnosed cases were recorded in a pre-designed questionnaire for analysis. The overall prevalence rate of CHD was 8.6 per 1000 live births. This was 9.96 per 1000 male births and 7.34 per 1000 female births. It was 4.5 and 13.19 per 1000 in 2007 and 2008, respectively. ASD was the commonest lesion (2.64 per 1000), followed by VSD+ASD (1.28 per 1000) and PDA (1.28 per 1000). The rate of ASD in male and female was 3.02 and 2.26 per 1000 respectively. Parents of 40 (39.6%) babies were related. 39 (38.6%) couples were first cousins. This study showed that the prevalence of CHD among live births in Gorgan is lower than reported in the studies for Middle East and European countries.

In this study, we aim to demonstrate that measurement of the malondialdehyde (MDA) level in the umbilical cord blood of newborn infants born via cesarean section (C/S) and normal vaginal delivery (NVD) is indicative of oxidative stress during the perinatal period. The study was conducted at Bakirkoy Training and Research Hospital between January 2006 and April 2006 on 15 newborns born via elective C/S, 15 newborns born via emergency C/S, and 15 newborns born via normal vaginal delivery. Complete blood count, total bilirubin, glucose, creatinine phosphokinase (CPK), uric acid, iron, blood gas, and malondialdehyde levels were measured in the umbilical cord blood Malondialdehyde levels in the umbilical cord blood in the emergency C/S and NVD groups were found to be statistically and significantly higher than those in the elective C/S group. In the emergency C/S group, it was determined that the malondialdehyde level increased as the oxygen saturation of the umbilical cord blood increased. In the NVD group, a positive correlation was detected between the total bilirubin and malondialdehyde levels in the umbilical cord blood. In the emergency C/S group, the malondialdehyde level was recorded to be high in the infants with high level of uric acid in the umbilical cord blood. We concluded that the malondialdehyde level in umbilical cord blood could serve as an indication of perinatal oxidative stress and that it could thus help in preventing permanent damage.

Neonatal jaundice is a common clinical finding in newborns. The efficacy and safety of phototherapy for neonatal jaundice have been firmly established, but it has some side effects, thus herbal therapy has recently received special attention. Herein we investigated the efficacy of Zizyphus jujuba for treatment of jaundice in neonates compared to phototherapy. In this clinical-trial study, a total of 121 neonates aged 2-14 days hospitalized for jaundice, were randomly assigned into experimental group including 63 patients who received Zizyphus jujuba's fruit extract 1ml/Kg 3 times a day and phototherapy, and control group of 58 cases receiving phototherapy with distilled water. Bilirubin level during hospitalization in both groups was measured daily. Experimental group stayed in hospital for 3.47±0.3 days. None of the neonates in this group was hospitalized more than 7 days. In controls, hospitalization was 3.67±0.4 days. 2 cases stayed more than 7days. The bilirubin level had decreased in both groups. Decrease of serum bilirubin in experimental group after 12 hours was statistically significant compared to control group (P=0.026). In experimental group, after taking the herb for 1-2 days, 3 children developed slight diarrhea which resolved spontaneously. The results indicate that Zizyphus jujuba was effective for the treatment of neonatal jaundice in first 12 hours of treatment compared to controls which could be due to higher effect of Z. jujuba extract to reduce bilirubin concentration with different mechanisms.

Jaundice is the most common reason of newborn's admission to neonatal ward. Many Iranian families give traditional remedies like sugar water, camel's thorn and flixweed extracts to breast-fed babies for reducing jaundice. This study investigated the effect of traditional remedies on idiopathic neonatal jaundice. This prospective study has been performed on 336 babies with idiopathic jaundice in a four year period (2005-2009) at Ghaem hospital, Mashhad, Iran. The babies were divided into two groups. In case group (n=234) breast-fed babies received no remedy and in control group (n=102), traditional remedies were given additional to breast milk and the results recorded and compared. In the present study significant differences were observed between the two groups in age of admission (6.8±3.2 vs 9.2±3.7 day, P<0.001), serum bilirubin values (17.8 vs 21.3 mg/dl, P<0.001) and percent of weight loss (P<0.01). There were no significant differences between the two groups in birth weight, sex, gestational age and duration of hospitalization, age at jaundice remission, hematocrit value and maternal factors (age, gestational order, pregnancy and labor problems)(P>0.05). Traditional remedies (camel's thorn, flixweed and sugar water) cause more weight loss and delayed reexamination of newborns leading to increased hyperbilirubinemia. These remedies may raise pseudo confidence in parents, which postpones reexamination and follow up of the newborns.

The objective of this study was to determine the normative data and psychometric properties of the parent and teacher rating form of the child behavior checklist (CBCL) in an Iranian community sample. A sample of 6-12 year old students was randomly selected from ten elementary schools in Tehran, Iran. The parent's and teacher's versions of CBCL were accomplished. Clinical interview and the kiddie schedule for affective disorders and schizophrenia - present and lifetime version, Persian version (K-SADS-PL-PV) were used to evaluate the validity and the cut-off point of CBCL and the teacher rating form (TRF). Among 600 recruited students with mean age of 9.11 years (SD=1.45), 54.16% were girls (n=325). Girls had significantly lower scores in Attention Problems, Delinquent Behavior, Aggressive Behavior, Externalizing and Total Problems than boys (P<0.01). The relation was significant between the CBCL Internalizing and student's ages (β=0.124, P=0.002). The Internal consistency, the correlation among the CBCL and TRF scales, and the inter-rater correlations for CBCL/TRF scales were good to high for most indices and subscales. Based on the receiver operating characteristics (ROC) analysis the best convergences were between the CBCL Attention Problems subscale and attention deficit hyperactivity disorder (ADHD) diagnosis, the CBCL Total Problems and any disorders, the CBCL Externalizing and ADHD+ODD diagnosis. The sensitivities and specificities of the CBCL subscales were higher than the TRF except for Externalizing/ADHD+ oppositional defiant disorder (ODD) which was reverse. These results support the multicultural CBCL/TRF findings. CBCL is a useful instrument to consider ADHD and any disorders in community samples.

This research was designed to identify the validity and reliability of the Prescreening Developmental Questionnaire 2 (PDQ-II) in Tehran in comparison with the Denver Developmental Screening Test-II (DDST-II). After translation and back translation, the final Persian version of test was verified by three pediatricians and also by reviewing relevant literature for content validity. The test was performed on 237 children ranging from 0 to 6 years old, recruited by convenient sampling, from four health care clinics in Tehran city. They were also evaluated by DDST II simultaneously. Interrater methods and Cronbach's α were used to determine reliability of the test. The Kappa agreement coefficient between PDQ and DDST II was determined. The data was analyzed by SPSS software. All of the questions in PDQ had satisfactory content validity. The total Cronbach's α coefficient of 0-9 months, 9-24 months, 2-4 years and 4-6 years questionnaires were 0.951, 0.926, 0.950 and 0.876, respectively. The Kappa measure of agreement for interrater tests was 0.89. The estimated agreement coefficient between PDQ and DDST II was 0.383. Based on two different categorizing possibilities for questionable scores, that is, "Delayed" or "Normal", sensitivity and specificity of PDQ was determined to be 35.7-63% and 75.8-92.2%, respectively. PDQ has a good content validity and reliability and moderate sensitivity and specificity in comparison with the DDST-II, but by considering their relatively weak agreement coefficient, using it along with DDST-II for a two-stage developmental screening process, remains doubtful.

Treatment of hemangioma/vascular tumors emphasize minimal invasion which require sophisticated facilities. This study reports the role of surgery in the management of symptomatic, and hemangioma which failed to respond to other modalities of treatment in resource-limited subregion. A six-year (2004-2009) prospective study on the challenges and outcome of children referred for surgical management of hemangioma/vascular tumors was undertaken at the University of Benin Teaching Hospital, Nigeria. Sixty-three children aged between a day and six years (median 5 years) comprising 38 males and 25 females (ratio 1.5:1) were managed. Upper limbs involvement, 18 (28.6%), and face/neck, 12 (19.1%), were most common and were present at birth in 27 (42.9%) babies, appeared between 2-3 weeks in 32 (50.8%), and after six months in 4 (6.3%). Cavernous hemangioma in 19 (30.2%) children, mixed cavernous/strawberry in 31 (49.2%) and strawberry in 13 (20.6), were the major types that ranged from spot-like to extensive huge lesions measuring 12×15 cm in diameter. Failure of 46 (65.1%) cases to respond to non operative treatment, ulceration in 3 (4.8%), infection in 5 (7.9%) and hemorrhage in 2 (3.2%) were indications for surgical intervention. Surgical options included complete excision and primary wound closure in 34 (54%) children, immediate skin graft after complete excision in 10 (15.9%), injection sclerotherapy in 2 (3.2%), serial ligation of feeder vessels in 2 (3.2%), and conservative treatment in 5 (7.9%). Excision and primary wound closure gave better outcome compared with others (P<0.0001). No mortality was recorded on 1-6 years follow-up but ugly scar, 8 (12.7%) and limb deformity, 3 (4.8%) were problems. Surgical excision and primary wound closure gave good outcome which could be employed in complicated and hemangioma which failed to respond to other treatment in regions with limited resources.

Optimum diagnosis of glomerulopathies requires light microscopy, immunofluorescence and electron microcopy. In fact electron microscopy has a confirmatory role in glomerular diseases. It provides more information for patient management and can rule out other diseases. The goal of the present study is analysis the necessity of electron microscopy for the diagnosis of childhood glomerulopathies. 134 cases of renal biopsy with some clinical data retrospectively were reviewed. The contribution of electron microscopy to the final diagnosis was graded as necessary - diagnosis could not be reached without it, supportive - it increased the level of confidence in the final diagnosis and noncontributory - the diagnosis dont need electron microscopy for confirmation. The contribution of electron microscopy to the final diagnosis was necessary in 51 cases (38%), supportive in 40 cases (30%) and noncontributory in 43 cases (32%). In conclusion the results showed in about 68% of childhood glomerulopathies the ultrastructural study was necessary or supportive, so electron microscopy still remains an important tool in diagnosis of childhood glomerulopathies.

The prevalence, patient's age and sex and the site of the lesions are important factors for diagnosis and they may be different in various populations. The aim of this study was to determine the type and distribution of orofacial tumors among children and adolescents in an Iranian population In this retrospective, case series study, data about the type, age, sex and site of 142 tumors in patients ≤18 years afflicted with orofacial neoplasms referred 2005-2009 to two referral centers in Shiraz, Southern Iran, were collected and analyzed. There were 142 (2.8%) tumors among the subjects. The most common types of benign and malignant tumors were odontoma and lymphoma in children and pleomorphic adenoma and rhabdomyosarcoma in adolescents. Parotid and posterior parts of the mandible were the most common sites of soft tissue and intrabony tumors. In the oral cavity, the palate was the most common affected site. The tumors were found in boys with higher frequency (Male:Female ratio was 1.4:1). The observed differences in tumor type and distribution in comparison with previous studies may be attributed to genetic and geographic variations in the populations; however the design and methods of the studies are different, too.

The aim of this study was to evaluate the influence of sex on glycemic control, diabetes complications and associated abnormalities in patients with type one diabetes mellitus. In a cross-sectional study in 309 patients (156 females and 153 males within the age range of 3-16 years) with type one diabetes mellitus referred to endocrinology clinic in Children's Medical Center in Tehran from March 2005 to March 2007 gender differences in diabetes control were analyzed. Mean glycosylated hemoglobin (HbA1c), was significantly higher in females (9.25 vs. 8.01). Insulin dose per kilogram of body weight was significantly more in girls (0.91±0.31 vs. 0.74±0.37, P<0.001) self monitoring of blood glucose was performed significantly more in boys. Frequency of Diabetic ketoacidosis, height growth problems and dyslipidemia were significantly higher in girls. 1.20±0.86 vs. 0.93±0.55, P=0.004), (-0.05±1.20 vs. -0.41±1.17, P=0.015), (134.60±44.43 vs. 110.56±20.72, P=<0.001) respectively. Female sex is a risk factor in glycemic control and complications of diabetes type I and females should be managed more seriously regarding self monitoring of blood glucose, nutritional and psychological factors and puberty issues.

There are several problems associated to the management of patients with phenylketonuria (PKU). Social status could be one of the affecting factors on dietary adherence in these patients. The aim of this study was to evaluate family social status and dietary adherence of PKU patients in Iranian population. In a cross-sectional study, we studied 105 Iranian PKU patients (born 1984 to 2010), treated and followed at Mofid Children's Hospital, Tehran. Social status was defined by number of children in family, number of affected children in family, maternal and paternal education, marital and employment status of the parents. Age at diagnosis and duration of treatment were also recorded. Mean plasma phenylalanine level was considered as a sign of dietary adherence in PKU patients and was calculated considering the phenylalanine measurements throughout at least one year. Mean plasma phenylalanine concentration was 5.9±3.6 mg/dl in patients <12 years old and 13.1±3.9 mg/dl in patients >12 years old. Blood phenylalanine concentrations in 47.6% of patients were in normal age-related reference range. There was a significant association between divorced and unemployed parents, and higher levels of blood phenylalanine concentration (P=0.02 and P=0.03 respectively). There was a significant positive correlation between number of affected children in the family (r=0.43, P<0.001), age at diagnosis (r=0.2, P=0.03), treatment duration (r=0.7, P=<0.001) and blood phenylalanine concentrations. There was no significant relation between parental education, family size and dietary adherence. Social status affects dietary adherence to some extent. We suggest exploring care-givers dietary knowledge as the next step to improve dietary compliance in these patients.

Hydatid disease is still an important health hazard in the world. This disease is a parasitic infestation which is endemic in many sheep and cattle raising areas such as in Iran. The aim of this study was to evaluate the clinical appearance, diagnosis, and treatment of liver hydatid cyst in children. This retrospective study evaluated 100 patients who were referred to Mofid Children's Hospital with liver hydatid cyst from March 1996 to March 2010. Medical records of 1 to 14 year old patients who had definitive liver hydatid cyst were included and analysis of variables such as age, gender, symptoms, diagnostic investigation, operative technique, hospital stay, mortality, morbidity and outcome of treatment were evaluated. The patients consisted of 54 boys (54%) and 46 (46%) girls with an age range of 1-14 years (mean 11.8±4.6). The incidence rate increased by age. The patients had totally 110 cysts, right pulmonary lobe 81 (73%) cysts and left side had 29 (27%). Abdominal mass was the most common (50%) symptom. Abdominal sonography gave correct diagnosis in 94 (94%) patients. Conservative surgical treatment was carried out in 98 children. Two patients were treated medically as the cysts were small and calcified. The most common complication was wound infection in 3 cases. Mean length of hospitalization was 9 days. In 100% of our patients the type of parasite was Echinoccocus granulosus. The morbidity rate was 12% (prolonging external catheter drainage in 12 patients). There was only one (1%) mortality and 2 (2%) recurrences. Due to the less invasive and high accuracy of liver sonography in diagnosis of hydatid cyst, we recommend it as the method of choice for the diagnosis in endemic regions. Surgery is the method of choice for treatment.

Use of electrical instead of acoustical stimulation has made much objective electro­physiological evaluation possible. This is useful for management process of young children before and after the cochlear implant. These evaluations have been used for assessment of neuronal survival before cochlear implant and for monitoring of prosthesis function during and after the surgery. Electrically evoked compound action potential is one of these tests which makes a valid and reliable objective evaluation possible. The aim of this study was to evaluate the potential's amplitude changes three months after receiving the device in pediatric cochlear implant recipients. In this longitudinal study, changes of the potential's amplitude in four given electrodes in four sessions after receiving the device are evaluated by approximately one month intervals in children implanted in Amir Alam and Hazrat-e-Rasoul hospitals, Tehran in July to December 2007. The mean amplitude of the electrodes did not significantly change in different sessions, while there was significant difference between the first and the other electrode's responses in every session (P<0.05). Due to high reliability of the responses, the clinician can fit the speech processor for a long time. Better responses in apical electrodes may lead to develop an effective coding strategy.

Classic Pelizaeus-Merzbacher disease is a rare x-linked disorder of proteolipid protein expression first described clinically in 1885. This disease is characterized by abnormal eye movements, very slow motor development and involuntary movements. The causative gene is PLP1. A 1-year-old boy was referred to our clinic due to abnormal eye movements. He had horizontal and flickering eye oscillation, psychomotor retardation, hypotonia and head nodding. We found hypomyelination in brain MRI. The possibility of Pelizaeus-Merzbacher disease should be considered in boys with abnormal eye movements, psychomotor retardation and hypotonia.

McCune-Albright syndrome (MAS) is a rare non-inherited disorder characterized by the clinical triad of precocious puberty, cafe-au-lait skin lesions, and fibrous dysplasia of bone. We report a girl with MAS, presenting initially with vaginal bleeding at the age of 17 months. Ultrasonography revealed unilateral ovarian cysts and ureteral and ovarian enlargement. Considering the clinical and paraclinical findings, the patient diagnosed as a case of gonadotropin-independent precocious puberty was treated with medroxy-progestrone acetate (MPA) for three months. During the follow up, recurrent episodes of bleeding, ovarian activation and cyst formation, as well as breast size development were reported. At the age of 5.5 years, fibrous dysplasia was detected, which in coexistence with precocious puberty confirmed the diagnosis of MAS. The patient had no cafe-au-lait skin macles during follow up. Considering that clinical manifestations of MAS appear later in the course of recurrent periods of ovarian activation and cyst formation, a careful clinical observation and follow up of patients is necessary and the diagnosis of MAS must be kept in mind in cases with gonadotropin-independent precocious puberty.

The incidence of aberrant thymus in the posterior mediastinum is very uncommon. It is difficult to exclude malignancy before surgical procedure. In a six-month-old male coughing for two weeks prior to admission a posterior mediastinal mass was found incidentally by chest roentgenogram. Thoracotomy was performed. Histologic study revealed normal thymic tissue. When a mass located in the posterior mediastinum, ectopic thymus should be included in differential diagnosis. Imaging techniques may spare thoracotomy. Ectopic thymus has a benign clinical course, and surgical resection is not recommended

I read with great interest the article by Heydarian et al. The authors had conducted a clinical trial and found that zinc supplementation did not benefit clinical manifestations of acute bronchiolitis. The study is well described, but there are few points that need comment......

I thank Dr. Das for his comment on our article. I like to state that in our study bottles of drugs and placebo were similar in size and shape as well as in taste. This study was performed in two separate hospitals simultaneously and data was collected by different pediatric residents. No significant drug reaction was detected during study......