Medical Centers In Tehran Research Articles

Setting Sun Eye in Normal Healthy Infants

Background: The setting sun eye is a common sign associated with severe disorders signifying intracranial hypertension. Rarely it can be observed in a healthy infant. We conducted this study to evaluate and follow setting sun eye in normal infants without any obvious intracranial diseases. Methods: A cross-sectional study was conducted in the Children’s Hospital Medical Center in Tehran from June 2001 to 2006. The study included 15 healthy infants who were referred to the neurosurgery clinic for setting sun eye. All were evaluated with brain imaging, and laboratory tests including at least thyroid function tests, and serum calcium and phosphorus. The cases were followed by regular outpatient visits until the age of 2 years. Results: They were 3–8 months old at the time of referring to the outpatient clinic. Setting sun eye was observed by the mother in all cases and confirmed during their visit to the clinic. All had normal brain imaging and normal laboratory tests (thyroid function and electrolytes). Setting sun eye disappeared gradually during the follow-up period with a range of 2–8 months after detection by the mother. Conclusion: Despite the fact that setting sun eye is a grave sign, most commonly accompanied by other neurological signs and symptoms suggesting serious diseases, it might be observed as a sole finding in a totally normal infant with inconclusive brain imaging and laboratory tests. We found that this type of setting sun eye has a benign course and will disappear without any intervention several months after its detection (commonly before the age of 2 years without any intervention).

Relationship Between Uterine and Ovarian Arterial Blood Flow Measured by Doppler Sonography at Different Stages of Puberty

Measuring blood flow using a special form of color Doppler ultrasonography can help radiologists to identify the stages of development of organs, such as the uterus and ovary. The aim of this study was to determine the relationship between arterial blood flow to the uterus and ovaries at different stages of puberty. Sixty girls referred to the Children's Medical Center in Tehran for the evaluation of pubertal stages were included in the study. They were divided into three subgroups: girls without primary puberty signs ( n = 20); girls with these puberty signs but without the beginning of menstruation ( n = 20); and girls with signs of puberty and menstruation ( n = 20). Uterus and ovary volumes were measured with the use of a 3.5-MHz convex transducer (Logic 500 Pro; General Electric, Milwaukee, WI, USA) and Doppler flow measurements of the uterine vessels were performed transabdominally with a 3.5-MHz color Doppler system (AU4 Idea; Esaote Biomedica, Genoa, Italy). We found no significant differences between the groups in terms of either resistance index or pulsatility index of the right ovary, left ovary or uterus. However, there were relationships between the volume of the uterus and pubertal stages, and also between the volume of the ovaries and these stages. Uterine and ovarian arterial blood flow, measured by Doppler sonography, was not useful for the evaluation of pubertal stages. However, it should be investigated with a greater sample size.

Breastfeeding: a potential protective factor against ventriculoperitoneal shunt infection in young infants

Previous studies have shown nutritional benefits of breastfeeding for a child's health, especially for protection against infection. Protective factors in human milk locally and systemically prevent infections in the gastrointestinal as well as upper and lower respiratory tracts. It remains unclear whether breastfeeding protects infants against ventriculoperitoneal (VP) shunt infection. A cohort study was conducted from December 2003 to December 2006 at Children's Hospital Medical Center in Tehran, Iran. A total of 127 infants with hydrocephalus who were treated using a VP shunt in the first 6 months of life were enrolled. Each infant's breastfeeding method was classified as either exclusively breastfed (EBF), combination feedings of breast milk and formula (CFBF), or exclusively formula-fed (EFF). Infants were followed up to determine the occurrence of shunt infection within 6 months after operation. Statistical analysis was performed using survival methods. Infants ranged in age from 4 to 170 days at the time of shunt insertion (mean 69.6 days), and 57% were males. Regarding the breastfeeding categories, 57.5% were EBF, 25.2% were CFBF, and 17.3% were EFF. During the follow-up, shunt infection occurred in 16 patients, within 15 to 173 days after shunt surgery (median 49 days). The 6-month risk of shunt infection was 8.5% (95% confidence interval [CI] 4-18%) in the EBF group, 16.5% (95% CI 7-35%) in the CFBF group, and 26.0% (95% CI 12-52%) in the EFF group. There was no statistically significant difference between these 3 groups (p=0.11). The trend test showed a significant trend between the extent of breastfeeding and the risk of shunt infection (p=0.035), which persisted even after adjustment for potential confounding variables (hazard ratio=2.01, 95% CI 1.01-4). This study supports the protective effect of breastfeeding against shunt infection during the first 6 months of life and the presence of a dose-response relationship, such that the higher the proportion of an infant's feeding that comes from human milk, the lower the incidence of shunt infection. Encouraging mothers of infants with VP shunts to breastfeed exclusively in the first 6 months of life is recommended.

Predicting the risk of death in patients in intensive care unit.

The ability to identify critically ill patients who will not survive until hospital discharge may yield substantial cost savings. The aim of this study was to validate the mortality prediction model II (MPM II) in in-hospital mortality of critically ill patients for quality management and risk-adjusted monitoring. The data were collected prospectively from consecutive admissions to the Intensive Care Unit of Imam Hossein Medical Center in Tehran. A total of 274 admissions were analyzed using tests of discrimination and calibration of the logistic regression equation for mortality prediction model II at admission (MPM0 II) and at 24th hour (MPM24 II). The mortality prediction model II exhibited excellent discrimination (receiver operating characteristic curve area). Calibration curves and Hosmer-Lemeshow statistics demonstrated good calibration of both models on outcome. We recommend using mortality prediction model II in Iranian ICUs for routine audit requirements. Mortality prediction model II is not affected by the standards of treatment after admission to ICU. The information needed to calculate mortality prediction model II is easy to collect, and the model is applicable to all ICU admitted patients.

Teratoma inside a myelomeningocele

A myelomeningocele (MMC) can be associated with paraplegia, bladder and bowel incontinence, Chiari malformation Type II, and hydrocephalus. The coincidence of an MMC and a neoplasm is rare, and only limited reports on the concurrence of a teratoma within an MMC have been published. A retrospective study was performed using the records of 330 children who underwent operations to correct an MMC at the Children's Hospital Medical Center in Tehran between January 2001 and June 2005. The postoperative histopathological assessments in 15 (4.5%) of these patients revealed evidence of a teratoma inside the MMC. The age of these patients at admission ranged from 2 days to 2 years (median 30 days). Neurological findings were normal in all patients except for three with lower-extremity weakness or paralysis. Hydrocephalus was detected in six patients. Physical appearance of the teratoma in all cases included cystic or solid soft-tissue masses in the dorsal midline area, covered with abnormal rudimentary skin. Pedunculated skin tags, a primitive genitalia-like appendage, dermal sinus, a human tail, and cutaneous stigmata such as color changes, hemangioma, dysplastic skin, and tufts of hair around the mass were occasionally observed. The special feature of a protruding fingerlike appendage or intraoperative detection of a cystic portion of an MMC without direct connection to the spinal canal can be possible signs of teratoma concurrent with an MMC. Teratoma inside an MMC is a benign neoplasm, without any recurrence after standard surgery for an MMC.

Effect of shunt catheter on the systemic immune response: evaluation of neutrophil count, function, and rate of chemotaxis

The localized impairment of the host defense mechanism due to the presence of a shunt apparatus has been suggested as a risk factor for shunt infection. The purpose of this study was to evaluate the probable systemic effect of a shunt catheter on neutrophil phagocytosis and chemotaxis in vivo. Twenty-four children with hydrocephalus who were referred to the Children's Hospital Medical Center in Tehran for ventriculoperitoneal shunt placement were included in this study. Neutrophil count, chemotaxis, and nitroblue tetrazolium (NBT) tests were performed before and 2 months after the operation. In comparing the preoperative neutrophil count, NBT percentage, and chemotaxis (with and without the addition of a chemoattractant factor) with these same factors postoperatively, the authors found no statistically significant differences. In four children, shunt infections developed during the follow-up period. There were no significant differences between the aforementioned parameters in children with infected shunts and those with uninfected shunts. The results of this study do not support the idea of systemic impairment of neutrophils after shunt insertion. Further studies with more specific methods are required to elaborate on this issue.

Intelligence quotient in children with meningomyeloceles: a case–control study

Meningomyelocele (MMC) is a common central nervous system birth defect. As one of many problems facing patients with MMC, learning disabilities are often overlooked. The aim of this study was to evaluate IQs in a group of children with MMCs and determine if a correlation exists between intelligence level and the presence of an MMC and/or its complications. A case-control study was conducted at the Children's Hospital Medical Center in Tehran, Iran, from December 2004 through December 2005. The patient group included 50 children with MMC from 5 to 12 years of age who were referred to the authors' institution for treatment of complications or for follow up after surgery for MMC closure. The patient group was individually matched for age and sex with a control group of 50 children referred to the hospital for other reasons and who did not have MMC or other neurological abnormalities. The IQs in all children in this study were evaluated using the Ravens Progressive Matrices test. The children in both groups were similar in the socioeconomic status of the family (p = 0.347) and educational status of the father (p = 0.117) and mother (p = 0.439). Patient age at the time of surgery for MMC closure varied from 1 day to 96 months (mean 4.1 months). Only 20% of the patients with MMC could walk with a normal gait. Forty-six percent of the patients had undergone placement of a ventriculoperitoneal shunt, and half of these patients experienced shunt-related complications; 72% of the children in the patient group were completely incontinent for both urine and feces. The IQ results obtained in the patient group ranged from 73 to 134 with a mean (+/- standard deviation) of 96.62 +/- 13.01. In the control group the IQ range was 70 to 128, and the mean was 104.82 +/- 12.30. Compared with the control group there was a statistically significant correlation between having an MMC and having a lower IQ (p < 0.001, paired t-test). Although the average IQ in the patient group was significantly lower than that in the control group, it is important to note that all children in the patient group had an average or above-average IQ. In contrast with the results reported in other studies, earlier repair of the MMC, the presence of a shunt or shunt-related complications, walking difficulty, and the spinal level of the lesion did not correlate significantly with IQs. Therefore, the lower IQ and reduced cognitive levels noted in these patients result from the disease process itself and not from the associated complications.

The prenatal ultrasonographic detection of myelomeningocele in patients referred to Children's Hospital Medical Center: a cross sectional study

BackgroundTo find out about the prenatal diagnosis rate of myelomeningocele (MMC) by ultrasound scan in patients referred to the Children's Hospital Medical Center in Tehran, Iran from July 2004 to July 2005.MethodsWe included 140 children born with MMC and who were referred for management, surgery and treatment of complications associated with it. The ultrasound reports were examined. Data on sex, age, location of MMC, time of prenatal ultrasound and the trimester in which the diagnosis was made along with the results of the diagnosis (MMC, hydrocephalus, or both), were collected.ResultsAmong the studied patients, 136 (97.1%) cases had prenatal ultrasound, amongst those, 58 (42.6%) sonographic evaluations were diagnostic for hydrocephalus and/or MMC. The prenatal ultrasound was positive for MMC in 16 (11.8%), hydrocephalus in 25 (18.4%) and both MMC and hydrocephalus in 17 (12.5%) cases. Among all cases with prenatal diagnosis of MMC, 3.4% were detected in the first, 31% in the second and 65.5% in the third trimester. Thoracic/thoracolumbar lesions were found prenatally in 40% of cases, which is significantly higher than the detection rate of other locations including cervical/cervicothoracic and lumbar/lumbosacral/sacral regions diagnosed only in 0% and 21% of cases respectively.ConclusionThere is a large difference between the detection rate of our population (24.3%) compared to others (68%). Pregnant women should have an ultrasound at 20–22 week for detection of congenital anomalies including MMC.

Cervical Myelomeningocele

Cervical myelomeningocele (cMMC) is a rare disease. Only a few series have been published regarding cMMC. Different issues regarding the etiology, classification, clinical, surgical, and pathological aspects of cMMC are still a matter of conflict. Sixteen children operated on for cMMC between July 2000 and 2003 were followed by the neurosurgical service at Children's Hospital Medical Center in Tehran. The patients were followed up for 2 to 5 years (median, 3 yr). The studied patients were nine boys and seven girls, ages 1 day to 4 months. Neurological examination was normal in all but two patients. All children had a normal anal fold, could void spontaneously, and showed no evidence of gross orthopedic deformity. We found eight patients with hydrocephalus, four patients with Chiari II malformation, two patients with syringomyelia, one patient with diastematomyelia at the level of cervical hemimyelomeningocele, and one patient with associated sacral myeloschisis. A thorough urological evaluation was planned for 13 patients, which confirmed bladder dysfunction in 10 (71%) patients. All infants had midline lesions, which consisted of a protruding sac from the back of neck, covered with purplish rudimentary or dysplastic skin at the dome. All patients underwent surgical resection of the sac and intradural exploration to release any adhesion and to exclude other associated anomalies. Cervical myelomeningocele differs structurally and clinically from myelomeningocele in distal areas and has a more favorable outcome. We think that some trivial neurological deficits in cMMC are caused by the late and limited neurulation abnormality during its development. We advise thorough preoperative evaluation of the brain, spinal column, and urinary system. Intradural exploration to release any potential adhesion bands as well as correcting associated anomalies is recommended in all cMMC operations.

Distribution of hepatitis C virus genotypes among hemodialysis patients in Tehran—a multicenter study

Hepatitis C virus has substantial heterogeneity of genotypes throughout the world. The aim of this study was to determine the frequency of HCV genotypes, risk factors and clinical implications in cases of hemodialysis living in Tehran. A total of 155 patients treated by hemodialysis, who had been identified to be anti-HCV positive at 45 medical centers in Tehran, were enrolled. Genotyping was using restriction fragment length polymorphism (RFLP) on HCV-RNA positive samples. HCV-RNA was detected in 66 (42.6%) patients. Genotyping of HCV-RNA positive serum samples demonstrated that subtypes 3a and 1a were predominant accounting for 30.3 and 28.8%, respectively. The distribution of other HCV genotypes showed genotype 1b, 18.2%; genotype 4, 16.7%; mixed genotypes 1a and 1b, 3%; and genotype 3b, 3%. Genotype 2 was not detected in this study. Statistically significant differences were identified between HCV infected and non-HCV infected patients regarding history of hemodialysis unit changes more than two times (P = 0.01), and history of hemodialysis for more than 20 years (P = 0.02). However, blood transfusion, mean duration of hemodialysis therapy and the history of solid organ transplantation did not differ between these two groups. This study indicates that the dominant HCV genotypes among patients treated by hemodialysis living in Tehran were 3a and 1a, and considering previous reports from the general population, genotype 4 was strongly associated with hemodialysis. The duration of treatment by hemodialysis and, in turn, more hemodialysis unit changes will lead to more frequent HCV infections.

Evaluating expression and potential diagnostic and prognostic values of survivin in bladder tumors: a preliminary report.

Survivin, an inhibitor of apoptosis (IAP), has been reported to be capable of regulating both cellular proliferation and apoptotic cell death. Survivin expression has been described during embryonic development and in adult cancerous tissues, with greatly reduced expression in adult normal differentiated tissues, particularly if their proliferation index is low. In the present study, the expression and potential diagnostic and prognostic value of survivin in bladder tumors was evaluated. Primary and recurrent bladder tumor specimens were obtained from patients referred to the Shaheed Labbafinejad Medical Center in Tehran, Iran. Total RNA was isolated from frozen tissues, reverse transcribed and amplified by means of a nested polymerase chain reaction technique. Survivin was detected in 3 cases of primary tumors (42.8%) and 6 cases of recurrent tumors of bladder (60%). Survivin-DeltaEx3 expression was seen in 41.2% of the 17 cases with bladder cancer. Our findings suggest that the expression of survivin and survivin-DeltaEx3 is well associated with invasive and more-aggressive forms of bladder cancer. Our data also indicate that the presence of survivin-DeltaEx3 is better correlated with tumorigenesis of bladder cancer compared with survivin expression.

Maternal Ramadan fasting and neonatal health.

This retrospective cohort study sought to determine the effects of maternal Ramadan fasting during pregnancy on neonatal birth weight as an important aspect of fetal health. It was carried out among healthy women who were admitted for their neonate delivery at two medical centers in Tehran from January to September 2000. Neonates of 284 mothers with a history of Ramadan fasting during pregnancy were compared with neonates of 255 mothers who did not have a history of fasting during their pregnancies. On univariate analysis, neonatal birth weight of the fasted group was 100 g more than those of the nonfasted group (p=0.009). However, body mass index (BMI) of the fasted mothers was greater than that of the nonfasted mothers. When controlling for maternal BMI on neonatal birth weight, multiple linear regression models showed that neonates of fasted women were 71 g heavier than those of the nonfasted group, which was not statistically significant (p=0.1). We conclude that maternal fasting during Ramadan did not have a significant effect on the neonatal birth weight. Other health effects that we did not observe could have occurred.

Adverse reactions of prophylactic intravenous immunoglobulin infusions in Iranian patients with primary immunodeficiency

Although long-term intravenous immunoglobulin infusion is an effective treatment for children with antibody deficiencies, it can be complicated by systemic adverse reactions. To evaluate the adverse reactions of intravenous immunoglobulin therapy in patients with primary immunodeficiency. Seventy-one immunodeficient patients receiving intravenous immunoglobulin were evaluated during a 7-year period (1995-2002) at Children's Medical Center in Tehran, Iran. Immunological diagnoses were as follows: common variable immunodeficiency (31 patients), X-linked agammaglobulinemia (25 patients), IgG subclass deficiency (5 patients), hyper-IgM syndrome (2 patients), and ataxia-telangiectasia (8 patients). One hundred fifty-two cases (12.35%) of adverse reactions occurred following 1,231 infusions in 35 patients. The most frequent immediate adverse reactions were mild reactions (131 infusions), including chills, fever, flushing, muscle pains, nausea, headache, and anxiety. Moderate reactions, such as vomiting, chest pain, and wheezing, occurred in 19 infusions. Two patients experienced severe adverse reactions. The highest proportion (23.06%) of reaction to injection was in patients with common variable immunodeficiency. Intravenous immunoglobulin is a well tolerated medical agent for patients with antibody deficiency. However, to prevent occurrence of immediate adverse reactions during infusion in these patients, physicians should perform a detailed history and proper physical examination and check the titer of anti-IgA.

Pretransplant hepatitis C virus infection and its effect on the post-transplant course of living renal allograft recipients.

Hepatitis C virus infection (HCV) is a main health problem in end-stage renal disease (ESRD) patients. The effect of pretransplant HCV infection on survival among ESRD patients who have undergone renal transplantation is controversial. We report the results of a large monocenter study that evaluated the effect of hepatitis C on the patient, and on graft survival in renal-transplanted patients who received living donated allograft. A historical cohort study, we investigated all 1006 patients who received a living kidney transplant at Baghiatollah Medical Center in Tehran, Iran, between March 1995 and October 2001 (up to 85 months follow up). Patients' sera had been routinely assayed for anti-HCV antibodies and hepatitis B surface antigen (HBsAg) at the time of transplantation. The HBsAg-positive patients were excluded from the survival analysis. Survivals were examined using Kaplan-Meier analysis and compared using the log-rank test. Multivariate analysis was performed using Cox's model. Forty-five patients (4.5%) were anti-HCV-antibody positive. Anti-HCV-antibody-positive patients spent a longer time on dialysis and had a higher rate of retransplantation. There were no differences in recipients' sex and age and donors' age between the two groups. The 7-year patient survival rate was 89.9% in the anti-HCV-antibody-positive group and 95.5% in the HCV-negative group (P = 0.74). Seven-year graft survival was 82.0% and 75.0% in the anti-HCV-antibody-positive and HCV-negative groups, respectively (P = 0.39). In the multivariate analysis, age was the only significant parameter correlated with patient survival (P = 0.02). HCV infection does not seem to influence patient and graft survival within a medium-time follow up in living allograft recipients, and anti-HCV-antibody positive status (alone) is not a contraindication for renal transplantation. However, further studies are needed to better define the role of HCV infection in long-term prognosis.

Incidence of enteric adenovirus gastroenteritis in Iranian children.

Enteric adenoviruses, i.e. adenovirus 40 (Ad40) and adenovirus 41 (Ad41), have been shown to be a substantial cause of pediatric gastroenteritis in various parts of the world, but no data are available for Iran. The present study was performed to determine the incidence of enteric adenoviruses in children presenting to the Children's Medical Center with gastroenteritis in Iran. Stool specimens from 872 children less than 7 years of age attending the Children's Medical Center in Tehran, Iran, with gastroenteritis were tested for the presence of Ad40, Ad41, and adenovirus-genus by a monoclonal antibody-based enzyme immunoassay. 6.7% of stool specimens contained enteric adenoviruses (3.3% Ad40 and 3.4% Ad41) and 2.0% nonenteric adenoviruses. Mean ages of Ad40, Ad41 and NEAd-positive children were 21, 19 and 29 months, respectively. Among the adenovirus-positive patients, 53.9% were male and 46.1% female. Watery diarrhea was present in 86.4% of children infected by adenoviruses. In conclusion, for the first time, we demonstrated the presence of enteric and nonenteric adenoviruses in a considerable proportion of stool samples from Iranian children with gastroenteritis.