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Background and Objective: Despite the self-limiting nature of bronchiolitis, its severe forms require hospitalization. Electrolyte imbalance during bronchiolitis is common, however, the relationship between bronchiolitis severity and serum sodium (Na) levels has not been well studied. The purpose of this study was to investigate the relationship between serum Na level and bronchiolitis severity. Methods: This cross-sectional study included hospitalized children with bronchiolitis at Amirkola Children's Hospital, Babol, Iran, from May 2020 to May 2021. Diarrhea, underlying disease, glucocorticoid intake, and intravenous fluid therapy before admission were considered exclusion criteria. The Bierman-Pierson scale was used to evaluate the severity of the disease, and hyponatremia was divided into mild, moderate, and severe groups. Variables were analyzed using Statistical Packages for Social Sciences (SPSS) 26. A value of P<0.05 was considered significant. Findings: Sixty-one children (55.7% male) with a mean age of 5.19 ± 4.36 months were enrolled in the study, with most (50.8%) belonging to the mild form of the disease. The mean serum Na levels based on the severity of bronchiolitis were 136.22 (SD: 2.99), 133.76 (SD: 3.88), and 130.50 (SD: 11.45) in the mild, moderate, and severe groups, respectively. There was a statistically significant relationship between serum sodium level and severity of bronchiolitis (P-value = 0.013). Conclusion: The results showed that higher severity of bronchiolitis was associated with an increased risk of hyponatremia. Therefore, periodic monitoring and correction of hyponatremia in children with bronchiolitis, especially at younger ages, is necessary to improve the outcome of the disease. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the transverse and vertical dimensions of the palate of children with allergic rhinitis (AR). There was no significant difference for intermolar and intercanine distances between two groups in primary and mixed dentitions. Palate depth in children with allergic rhinitis was statistically more than in children without any respiratory disease. Cross bite was more prevalent in study group. It seems that the main influence of alteration of breathing pattern from nasal to mouth occurs on the vertical plane.

Objective: Hereditary Angioedema (HAE) is a rare autosomal dominant disorder that is caused by improper quantitative level or C1-inhibitor function and these lead to the HAE type I and type II, respectively. C1-inhibitor is a serine protease inhibitor, which controls the activation of complement system and regulation of the fibrinolytic, contact and coagulation systems. C1-inhibitor gene (SERPING1) is located in the q12-q13.1 sub-region of chromosome 11 and consists of eight exons. The aim of this study is genetic diagnosis of HAE type I patients. Material and Methods: The patients who referred to Immunology, Asthma & Allergy Research institute (IAARI) between Jan 2006 to Jan 2014 with clinical phenotype of HAE (subcutaneous angioedema, abdominal pain, laryngeal edema), were entered this study. Twenty HAE type I patients were evaluated for genetic analysis of SERPING1 gene based on low levels of C4 and C1-inhibitor. Blood samples were obtained from these patients and after the DNA extraction from EDTA treated blood samples, polymerase chain reaction (PCR) was accomplished for coding exons (exon 2 to 8) of SERPING1 gene and PCR products were sequenced and the results were analyzed by Finch TV program. Results: Among twenty patients from 15 families with HAE type I, 9 mutations in SERPING1 gene were identified in 12 patients. All mutations were in heterozygous state except one new homozygous missense mutation (c.440T>A) in a patient. The others including one splicing defect (c.51+2T>C) in intron 2, three frame shift mutations in exon four (c.650delG) and exon 8 (c.1356_1357delTG, c.1264delT), three missense mutations in exon 2 (c.5C>T), and exon 8 (c.1477G>A, c.1442T>C), and one nonsense (c.1480C>T) mutation in exon 8 which are previously reported. Conclusion: HAE is a life-threatening disease, and if laryngeal edema occurs possibly leads to death. Therefore, early genetic diagnosis in the families who carries the mutation with symptomatic or asymptomatic phenotype of disease could be helpful for prevention of acute edema and proper treatment in HAE patients and other family members. [ABSTRACT FROM AUTHOR]

Background: Urticaria is a common dermatologic disease. About 20 per cent of the population experiences it in a life-time period. The aim of this study was to compare the various laboratory examinations of chronic urticaria patients and healthy individuals and to determine the necessity of laboratory tests in such patients. Materials and Methods: In this study 78 patients suffering from chronic urticaria and 67 healthy individuals (2-50 year-old) with analogous demographic features underwent ALT, AST, S/E, ESR, CBC, TSH, T4, C4, C3, CH50, ANA, anti-thyroglobulin, anti-peroxidase, and anti H. pylori antibodies testing. Results: Forty-one per cent of patients had increased IgE in comparison to 14.92% in normal subjects. Anti-thyroid antibodies were positive in 17.94% of cases while only 9% of normal individuals were positive (p<0.05). Anti H. pylori antibodies were positive in 69.23 % of patients (all above 18-year-old) and 61.19 per cent of normal population (p>0.05). No significant difference found in other variables. Conclusion: Urticaria is often diagnosed based on clinical grounds and no routine laboratory examination is required. [ABSTRACT FROM AUTHOR]

Objective: Hereditary Angioedema (HAE) is a rare autosomal dominant disorder caused by low serum levels (type I) or dysfunction (type II) of C1 Inhibitor (C1INH), which is characterized by subcutaneous and/ or submucosal edema attacks involving face, limbs, genitalia, gastrointestinal and respiratory system. HAE could give rise to fatal laryngeal edema, acute abdominal pain leading to unnecessary emergency surgeries, and reduced quality of life. Therefore, the aim of this study was to investigate and report the demographic, clinical and laboratory findings of patients registered in Iranian HAE registry (IHAER). Material and Methods: The patients referred (2006-2016) to Immunology, Asthma and Allergy Research Institute (IAARI) with symptoms suggestive of HAE were investigated (after signing informed consent form) using a questionnaire and laboratory tests. The patients with a definite diagnosis of HAE (type I, II) based on low serum levels of C4 and C1INH quantity/quality accompanying with suggestive clinical findings (after ruling out other possible etiologies) were enrolled into this study. Moreover, in some cases genetic analysis reconfirmed laboratory results. Results: Among 80 patients registered in IHAER with definite diagnosis of HAE (Type I, II; 48.8%, 51.3%) 30 patients belonged to children and adolescents group (aged ≤ 21). The median symptoms age-onset and median diagnostic delay were 11 (min, max; 1, 72) and seven (min, max; 0, 39) years, respectively. Physical trauma (69.7%) and emotional stress (57.6%) were found to be the most common triggers of attacks; however, 82% of patients reported spontaneous attacks as well. The most commonly involved sites were face and limbs. Moreover, laryngeal edema was reported in 56.1% of patients leading to death in three patients during this study. Conclusion: HAE is a life-threatening disease diagnosed with significant delay possibly due to mistaking it for other disorders causing similar symptoms such as acute face and limbs edema. On the other hand, complete avoidance of emotional and physical stress as common HAE triggers could not be easily achieved. Thus, the outcomes of IHEAR in the form of scientific papers/reports is meant to inform health care providers, and policy makers about this rare disease, which would in turns, help with an earlier diagnosis, and improvement in patient care and quality of life. [ABSTRACT FROM AUTHOR]

Objective: Chronic cough is one of the most common causes of absence from school, education and disturbances in ordinary works. According to its high prevalence in our population and lack of study (ies) about this in our country, this study has been performed to estimate chronic cough preformed, to estimate chronic cough prevalence and determinate its relations to variables such as age, sex, location, parent's education and smoking. Materials and methods: This descriptive analytic cross- sectional study has been performed on 3222 students of primary school during 1379-80. Date was acquired by interview, completion of questionaries' and sanitary service records. Then information became analyzed and tested by person chi-square test if needed. Results: Findings showed that the prevalence of chronic cough in our population was 3.6% (3.5% male and 3.8% female). Among 3222 students, 1748 (962 male and 786 female) subjects were from urban and 1474 (719 male and 755 female) rural population. 118 cases had chronic cough in urban population the prevalence was 4 percent (3.2% male and 4.7% female) and in rural population 3.2% (3.6% male and 2.9% female). Among 118 involved students, 60 cases had a smoker father (50.8%) and among 3104 others, 1438 cases had a non-smoker father (46.3%). Conclusion: Our finding showed that sex, age location smoking and parent's education had relation to chronic cough of students. So we decide that for reducing the chronic cough prevalence in our society especially primary school ones. Health and sanity education planned and distributed in a wide array to diagnostic modalities and appropriate therapeutic plans for reduction of chronic cough complication. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the recognition of asthmatic students by their elementary school teachers in Babol, Iran.

Background: Hereditary angioedema (HAE) is a rare autosomal dominant disorder characterized by Cl-INH (Cl esterase inhibitor), low serum levels (type I), dysfunction (type II) or normal serum levels and function (type III), which lead to subcutaneous and submucosal edema attacks. The aim of this study was to investigate the demographic, clinical and laboratory findings of Iranian patients with HAE. Methods: The patients with a history or symptoms of angioedema who were referred to Immunology, Asthma and Allergy Research Institute (IAARI) between Jan 2006 and Jan 2014, were assessed based on a specific questionnaire and laboratory evaluation. The patients with a definite diagnosis of HAE type I and type II were entered into this study. Results: Among 51 patients, 63.3% were diagnosed with HAE type I and 36.7% with HAE type II. Fifteen patients were under 18 years and 36 were adults. The mean age of symptoms onset and diagnosis were 12.33 ± 10.20 years and 24.48 ± 14.64 years, respectively. The mean delay of diagnosis was 11.02 ± 11.60 years. The most commonly involved locations of edema were hands, face and genitalia. Moreover, laryngeal edema was observed in 61.2% of patients, which led to death in two patients during this study. Conclusion: Hereditary angioedema is a life threatening disease with considerable morbidity and mortality. The outcomes of this study can be used to inform clinicians and health care providers about HAE, which can help earlier diagnosis and better management of the patients, specifically in life threatening attacks. [ABSTRACT FROM AUTHOR]

Background: The New coronavirus (SARS COV-2) can cause acute respiratory disease and also multiorgan dysfunction. There is insufficient data about kidney involvement in children. So, this study was done on children with COVID-19 to evaluate nephrological involvement., Methods: All children with confirmed or suspected COVID-19 who were admitted in Children Hospital .were enrolled. They were admitted in hospital from March 2020 to July 2020. Serum Blood Urea Nitrogen (BUN), creatinine, sodium, potassium, calcium and urinalysis were evaluated. Also, glomerular filtration rate (GFR) was calculated by Schertz's formula. All patients were evaluated by chest x-ray and/or computerized tomography scanning (CTS). The data were analyzed by SPSS software and P value less than 0.05 was determined as significant., Results: Forty-seven children with confirmed or suspected COVID-19 were enrolled to this study. At admission, 23.4% and 27.7% of children with COVID-19 infection had abnormal increase in serum BUN and creatinine, respectively. Also 78.8% and 25.5% of children had GFR less than 90 and 60 ml/min /1.732, respectively. Additionally, 13/47 (27.7%) of children had abnormal urine analysis (microscopic hematuria and/or proteinuria). There wasn't a significant relationship between pulmonary lesions and abnormal reduction of GFR (P<0/05)., Conclusion: In the study, the risk of AKI (acute kidney injury) and decrease of GFR and also abnormal urinalysis is high in children with COVID-19. So, more attention for detection of kidney involvement is necessary and more conservative management for prevention of AKI and decrease of GFR are recommended., Competing Interests: We declare no competing interests.

Patients with primary immunodeficiency disease (PID) are not only vulnerable to mycobacterial disease, but are also more likely to develop adverse events following BCG vaccination. These events can range from regional disease (BCGitis) to disseminated disease (BCGosis). Chronic granulomatous disease (CGD), which is characterized by impaired leukocyte phagocytic function, is one of the many inherited PIDs that increase the body's susceptibility to recurrent bacterial and fungal infections. Here, we report a 6-year-old boy with no significant past medical history who presented with progressive lymphadenopathy six years after BCG vaccination. He was later diagnosed with CGD on further evaluation., Competing Interests: The authors report no declarations of interest., (© 2020 Published by Elsevier Ltd.)

Background: Cardiac involvement was the major leading cause of death in patients with Kawasaki and IVIG administration reduces cardiac complications. The objective of this study was to determine the frequency of cardiovascular complications and duration of fever with regard to the time of intravenous immunoglobulin (IVIG) administration of patients with Kawasaki disease., Methods: This follow-up study was done on all patients with Kawasaki disease who were hospitalized at Amirkola Children's Hospital between 2006 and 2011. Diagnosis of Kawasaki was clinical and included fever more than 5 days with 4 of 5 signs containing mucosal changes, scaling and skin rash, bilateral nonexudative conjunctivitis, cervical lymph adenopathy and edema in lower extremities. After diagnosis of Kawasaki, all patients received standard treatment (intravenous immunoglobulins and aspirin) and undergoing cardiac echocardiography in 2 weeks, 2 months and 6 months. Information including age, sex, sign of diseases, laboratory findings, and cardiac complications in echocardiography were recorded., Results: This study was performed on 100 patients (61 boys and 39 girls) with Kawasaki disease. The mean age of children was 2.8±2.6 years. Cardiac complication rate was 47% at the onset of the disease and had reached to 7% at the end of the sixth month (P=0.000). Distribution of cardiovascular complications in the second week, the second month and the sixth month after treatment was not significantly different according to the start of time of treatment (p>0.05). Duration of fever in patients who received treatment before 10 th day (1.5±1.3) did not have significant difference (P=0.78) with patients who received after 10 th day (1.6±0.9)., Conclusion: Result shows that most of patients (99%) responded to the treatment with IVIG and ASA and cardiovascular complication ratio decreased. There was not significant relationship between duration of fever and time of IVIG treatment initiation.

Background: Systemic lupus erythematosus (SLE) has various presentations in children. Hematologic abnormalities is common in childhood onset of SLE, however, isolated thrombocytopenia is relatively rare. Thus, we present a child with isolated thrombocytopenia as a rare presentation of SLE., Case Presentation: A 12-year-old boy with chief complaints of loss of appetite, weight loss, decreased platelet count (8000/µL) and lymph node enlargement was referred to our hospital. Biopsy of lymph node showed reactive lymphadenopathy. Investigations regarding infectious disease was negative. Platelet count remained low after low dose steroidned therapy. Antinuclear antibody (ANA) and anti-double stranded DNA antibody screening tests were positive with titer of 1/62 and 1/54, respectively. Therefore, juvenile SLE was considered as the final diagnosis and raising the dose of prednisolone to 2mg/kg/day was associated with increasing platelet count to 40000/µL and a week later to 96000/µL., Conclusion: The findings of this study indicate that in cases with isolated thrombocytopenia refractory to conventional dose of steroids, SLE should be considered. This study justifies serum ANA and anti DNA assessment in children with thrombocytopenia.

Stevens-Johnson syndrome is an uncommon inflammatory skin disorder in which immune mechanisms, cytotoxic reactions, and delayed hypersensitivity seem to be involved. Herein, an unusual case with strange complaint of"bus allergy" is presented, suffering from severe generalized itching and skin lesions, followed by ulcers in his mouth and genitalia. The diagnosis of Stevens-Johnson syndrome was made and appropriate treatment was advised. However, detailed medical history revealed a completely different cause of his allergic reactions, as he had occasionally used dimenhydrinate because of motion sickness in his history. Therefore, adverse drug reaction to dimenhydrinate was considered as the main underlying cause of the disease. In conclusion, thorough medical history should be taken to make a definitive diagnosis and identify the underlying disease, since accurate diagnosis and appropriate treatment can prevent further complications.

Background: Allergic diseases including asthma, allergic rhinitis (AR) and eczema are common chronic diseases in children. The purpose of this study was to determine the prevalence of asthma, AR and eczema in Sari, Iran., Methods: This study was carried out on all elementary schools selected as a cluster from February 2010 to July 2010 in Sari, North of Iran. A questionnaire was provided according to International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Asthma, AR, eczema and their combinations were recorded., Results: Out of the 1818 cases, 646 (35%) subjects had allergic disorder; 223 (12%) had asthma, 318 (17%) had AR and 105 (6%) had eczema The prevalence of allergic disorder in boys (65%) was higher than the girls (40%) (p<0.05)., Conclusion: The results show that around one - third of the elementary school children have allergic disorders. The prevalence in males is higher than the females.

Severe allergic reactions during specific immunotherapy may occur in the treatment of hymenoptera sting allergy. The objective of the present study was to examine the characteristics of allergic reactions during specific immunotherapy in patients with allergy towards hymenoptera venom in the Iranian population. A prospective study was performed using the clinical reports of 27 patients with anaphylaxis to bee venom (Apis melifera, Geupes vespula and Geupes Polites). Ten patients treated with Cluster protocol during 2002 and 2006 After diagnosis of hymenoptera sting allergy according to history and intradermal tests, the patient were treated with Cluster protocol immunotherapy. The protocol lasted 6 weeks with an increase in the concentration of venom from 0.01 microg/ml to 100 microg/ml. None of the patient received premedication. All patients with hymenoptera venom allergy received 120 injections. Anaphylactic reactions were classified according to the Mueller-classification. The frequencies of systemic reactions during Cluster protocol were 8.33% and 5% for yellow jacket and honey bee venom respectively. No patient experienced severe systemic reaction. Cluster protocol for hymenoptera immunotherapy is a reliable method for the treatment of anaphylactic reactions to bee venom. It is safe with low cost and do not need hospitalization.

In the management and evaluation of asthma, simple instruments for measurements of peak expiratory flow rate (PEFR) are necessary. The aim of this study was to determine normal PEFR of the healthy children in Babol, Iran. This study was randomly done on 1050 students (primary and secondary schools) in Babol. Mini-Wright peak flow meter was used for measurement of PEFR. The range of age, weight and height were defined. Information was statistically analyzed by SPSS, T- Test and R2 and due to formula with regression. Mean age of 1050 students (525 male and 525 female) who participated in this study was 10.26 years. The mean of PEFR was 262.35+/-71.97 L/Min. Obtained PEFR with all anthropometrics variants indicate a high correlation. Correlation between PEFR and height was more significant and between PEFR and weight was lower, and according to importance of height and age, formulas suggested for prediction of PEFR in females {(agex4.8)+ (heightx0.6)-25)} and in males ({(agex1.7)+ (heightx2.1)-208)}. The results of this study can determine normal PEFR and it can be useful for treatment and monitoring of children with asthma who live in this region.

Common variable immunodeficiency (CVID) is a primary immunodeficiency disease characterized by hypogammaglobulinemia and recurrent bacterial infections. The records of 65 patients with CVID (37 males and 28 females) in the age range of 24 to 537 months were reviewed. By the year 2003, 11 patients had died and seven patients could not be located. The total follow-up period was 221 patient-years. The median diagnostic delay (time between onset and diagnosis) in our patient group was 60 months. At the time of diagnosis, the baseline serum immunoglobulin G (IgG), IgM, and IgA levels were below the level normal for the patients' age; the medians for this group were 120, 10, and 0 mg/dl, respectively. All of the patients presented with infectious diseases at the time of onset, the most common of which were otitis media, diarrhea, pneumonia, and sinusitis. Acute and recurrent infections were also found in almost all of the patients, particularly involving respiratory and gastrointestinal systems. The most common infections, before diagnosis and during follow-up, were pneumonia, acute diarrhea, acute sinusitis, and otitis media. CVID should be considered in any patient with a history of recurrent infections and decreased levels of all serum immunoglobulin isotypes.

In this study, we report a mutation in CYBB gene in a patient with X-CGD (diagnosed on the base of family history, NDT test, DHR 123 assay). Mutation in CYBB gene was detected using SSCP analysis (single-strand conformation polymorphism) followed by sequencing. During screening for mutations in the CYBB gene we observed 880 CT in exon 8. This mutation resulted in 290 ArgStop. We also observed a change (-270 CA) in the promoter region which needs further investigation.We would like to pursue this study by analyzing more X-CGD patients to find out the CYBB mutation spectrum in Iranian patients.