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Background: Bacteria induced sepsis is common in infants and children. Staphylococcus aureus produces numerous exotoxins, like staphylococcal Toxic shock syndrome toxin (TSST- 1), which stimulate the immune system by T cell activation and inflammation in various organs. Recent studies suggest that staphylococcal toxins, generally named super antigens (SAgs), may also have a significant role in the pathogenesis of some pediatric disorders especially in the clinical presentation of sepsis and septic shock. This study was carried out in order to compare staphylococcal TSST- 1 (SAgs) in children with sepsis symptoms (and septic shock) with negative blood culture versus a control group. Materials & Methods: This cross-sectional study was conducted during 2 years (2014 -2016) in two referral hospitals (Rasoul Akram and Bahrami hospitals) in Tehran, Iran. We selected 44 children) mean age of 4 years) who were admitted in pediatrics and PICUs wards with sepsis symptoms- /+septic shock. Forty-five children (mean age of 3.9 years) were selected as a control group. All cases with blood samples were examined for TSST-1 (SAgs) by polymerase chain reaction (PCR) method in both case and control groups and results were compared. Data were analyzed by SPSS-16software. Chi-square or Fisher test was used to compare the variables. P-value < 0.05 was considered as a valuable tool. Results: Positive blood cultures with other bacteria, Streptococcus pneumonia, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, were detected in 5 cases with negative TSST-1 in blood samples. S.aureus isolated from blood culture was detected in 2 cases with positive TSST- 1.Positive TSST-1 (SAgs) was detected in 6 cases (14%) with negative blood culture for S.aureus; it was significantly higher in cases (14% vs. 2%; P value = 0.05). Conclusion: This study indicates the probable role of TSST-1(SAgs) in the progression of sepsis (and septic shock) in toxic children with negative blood culture for S.aureus. Anti-staphylococcal treatment is immediately required, especially in toxic children with related clinical presentations, even in cases with negative blood cultures. Indeed, the clinical use against SAgs suppressants of downstream cell-destructive events might be helpful.

Aim: We investigated the genetic characterization of the respiratory syncytial virus (RSV) ON-1 genotypes and their different lineages based on the G gene among children

One of the causes of infants' hospitalizations is bronchiolitis, while different viral agents could be causative agents. As there is little information regarding the common agents of bronchiolitis in Iranian infants, we designed this study to determine which agents were responsible for hospitalization due to bronchiolitis among infants in an Iranian tertiary center. Two hundred and three infants with bronchiolitis who were hospitalized in Bahrami hospital were enrolled. Data regarding age, sex, duration of hospitalization, exposure to smoking, previous antibiotic usage and fever were collected for all enrolled cases. Throat sample by means of soap was collected and rapid test with immunochromatography (IC) test was performed. Rapid test was positive in 59 (29%) cases and three cases had concomitant infection with two viruses. The most common viral agent was RSV (Respiratory Syncytial Virus). Mean age was significantly lower in cases with RSV or RSV+ adenovirus infectious in comparison with other two groups (adenovirus or influenza only), while mean duration of hospitalization was significantly longer in RSV/RSV+ adenovirus group. RSV is the most common viral etiology of bronchiolitis in Iranian infants less than one year old, which is related with younger age and longer duration of hospitalization.

An accumulating body of evidence suggests that the endocannabinoid system plays a significant role in pathophysiological processes and impacts disease severity. Here we investigate the possible role of a cannabinoid receptor type 2 (CB2) functional variant in determining disease severity and the potential pharmacological therapeutic effects of CB2 activation in viral respiratory infection. The common missense variant (CAA/CGG; Q63R) of the gene-encoding CB2 receptor (CNR2) was evaluated in 90 inpatient and 90 outpatient children with acute respiratory tract infection (ARTI). The frequency distribution of respiratory syncytial virus (RSV)-the main cause of severe cases of bronchiolitis and pneumonia in children-was studied in all collected samples. The mechanism through which CB2 affects clinical outcomes in case of RSV infection was studied in Balb/c mice model using AM630 as a CB2 antagonist. The potential therapeutic effect of CB2 activation during RSV infection was studied using a selective agonist, JWH133. The CB2 Q63R variation was associated with increased risk of hospitalization in children with ARTI. Children carrying the QQ genotype were more prone to developing severe ARTI (OR = 3.275, 95% CI: 1.221–8.705; p = 0.019). Of all the children enrolled in the study, 83 patients (46.1%) were found positive for RSV infection. The associated risk of developing severe ARTI following RSV infection increased more than two-fold in children carrying the Q allele (OR = 2.148, 95% CI: 1.092–4.224; p = 0.026). In mice, the blockade of CB2 by AM630 during RSV infection enhanced the influx of BAL cells and production of cytokines/chemokines while exaggerating lung pathology. CB2 activation by JWH133 reduces the influx of BAL cells and production of cytokines/chemokines while alleviating lung pathology. Collectively, CB2 is associated with RSV severity during infancy and may serve as a therapeutic target in RSV infection through the alleviation of virus-associated immunopathology.

Background and Objective: Diarrhea (as one of the main manifestations of parasitic or microbial infections in gastrointestinal tract) is still a leading cause of mortality and morbidity in children younger than 5 years old in developing countries such as Iran. Objective: Identify and compare the relationship between serum levels of zinc, vitamin A and D in children with acute gastroenteritis (AGE) and the control group to demonstrate that those who need hospitalization due to infection have lower levels of said elements. Materials and Methods: This was a cross sectional study on 25 patients with AGE in pediatric ward of Rasul Akram hospital and Bahrami Hospital during a year (2011-2012), were compared to 40 other patients who were admitted to surgical wards for elective surgery. 72% of all the patients were male and 28% were female. All patients were older than 6 months years; mean age of cases was 2.17 years. Serum levels of vitamins A and D and zinc were measured using HPLC; Radioimmunoassay; atomic methods in 2 groups. Findings: Despite the lower levels of vitamins A in cases than controls, serum levels were not significantly different (p=0.5). Serum levels of zinc were considerably but not significantly lower in cases than the controls (p=0.06). However, serum levels of vitamin D were significantly lower in AGE cases (p=0.003). Conclusion: We found lower serum levels of vitamin D in AGE cases but no difference had found in serum levels of vitamin A and zinc between the two groups probably is the end result of various effects of vitamin A and zinc on diarrhea in different age groups and AGE. This trial emphasizes therapeutic effects of vitamin D supplementation on AGE in children especially in those with malnutrition and in developing countries. Therefore, other trials on a larger scale designed to investigate discriminating different etiologies for AGE and in different age groups is performed.

Recurrent bacterial meningitis is usually a complication of cranial anatomical defect or the result of impaired humoral immunity, notably, defects of the complement system and agammaglobulinemia. It could present a diverse range of symptoms. Meningitis as a presentation of intramedullary abscess is not common. Here we present a 7-year-old boy with recurrent meningitis as the first manifestation of an underlying upper cervical cord abscess.

Migraine involves 5-10% of children and adolescents. Thirty percent of children with severe migraine attacks have school absence and reduced quality of life that need preventive therapy. The purpose of this randomised control trial study is to compare the effectiveness, safety and the tolerability of pregabalin toward Propranolol in migraine prophylaxis of children. From May 2011 to October 2012, 99 children 3-15 years referred to the neurology clinic of Mofid Children's Hospital with a diagnosis of migraine enrolled the study. Patients randomly divided into two groups (A&B). We treated children of group A with capsule of pregabalin as children of group B with tablet of propranolol for at least 8 weeks. In this study, 99 patients were examined that 91 children reached the last stage. The group A consistsed of 46 patients, 12(26.1%) girls, 34 (73.9%) boys and the group B consisted of 45 patients, 14(31.1%) girls, 31 (68.9%) boys. Basis of age, gender, headache onset, headache frequency, migraine type, triggering and relieving factors there was no significant difference among these groups (P>0.05). After 4 and 8 weeks of Pregabalin usage monthly headache frequency decreased to 2.2±4.5 and 1.76±6.2 respectively. Propranolol reduced monthly headache frequency up to 3.73±6.11 and 3.34±5.95 later 4 and 8 weeks respectively. There was a significant difference between these two groups according to headache frequency reduction (P=0.04). Pregabalin efficacy in reducing the frequency and duration of pediatric migraine headache is considerable in comparison with propranolol.

Human rotavirus genotypes G1-G4, G9, P[4] and P[8] are major worldwide causes of acute gastroenteritis in children. Rotavirus genotype G1P[8] is predominant in many countries. In this study, the genotypic diversity of group A rotaviruses were detected in children5 years of age who were treated for dehydration and diarrhea in Tehran, Iran from October 2004 to September 2008.A total of 700 stool specimens were collected from children and assessed for the presence of rotaviruses by the dsRNA-PAGE technique. G and P typing of the positive samples were performed by semi-nested multiplex RT-PCR.Rotaviruses were isolated in 19% of samples. A total of 14 rotavirus dsRNA different electrophoretypes were detected. The predominant genotype was G1 (76.3%), followed by G4 (11.5%), G8 (0.8%), P[4] (9.2%) and P[8] (66.4%), respectively. In mixed type samples, the majority were of genotype G1P[8] (53.4%), followed by G1P[4] (9.2%) and G4P[8] (4.6%). Mixed types consisted of 3.1% of the total sample followed by G1G2/-P (1.5%), G1G4P[4] (0.8%) and G1G4P[8] (0.8%).In this study, a high prevalence of the G1P[8] genotype was determined to be the cause of childhood gastroenteritis in Tehran, Iran. The sequence of G and P genotypes showed high levels of similarity to strains from other Asian countries. Our data will be useful for future vaccine formulation in Iran.

Human rotavirus has now been established as the most important cause of childhood gastroenteritis worldwide. The RNA genomic electrophoretic diversity of group A rotavirus strains in Tehran, Iran, during April 2002 through March 2005, was investigated in 1250 stool specimens.Stool samples were obtained from young children with acute gastroenteritis. RNA electrophoretype of group A rotavirus strains was determined using RNA polyacrylamide gel electrophoresis in those samples found to be positive for rotavirus by enzyme immunoassay.The predominant RNA profile detected was the long electrophoretype (90%) followed by the short profile (8.8%). Four patients (1.1%) had patterns of mixed infection. Fourteen different electrophoretic RNA patterns, eight of long and six of short, were detected in the study area. A long RNA electrophoretype persisted during the years of the study with peak incidence in cool seasons. The long pattern occurred throughout the study period and in patients aged one to 60 months, but the short profile identified only in infants at varying intervals.Our data demonstrate epidemiologic differences between the incidence of long and short electrophoretypes. The long profiles appear to circulate continuously in the area, whereas the short patterns appear in an episodic fashion.

Objective: Nosocomial infections are one of the most important causes of mortality and morbidity in hospitals. These are major public health problems worldwide, but particularly in developing countries. These infections have the most common frequency in pediatric hospitals-especially in neonatal wards-second to burn hospitals. In the present study, neonatal nosocomial infections have been reviewed in Bahrami Children Hospital from fall of 1999 through fall of 2004.Methods: Nosocomial infected patients were defined as all patients who were neither infected not were in incubation period at the admission time and had positive culture after third day of admission. The incidence of nosocomial infections computed as infections per 100 hospital discharges and infections per 100 hospital days. Chi square test was used for comparison of rates.Results: Fifty-two patients had been diagnosed having nosocomial infections. NICU (Neonatal Intensive Care Unit) showed the highest portion of infections (40%) followed by neonatal surgery ward (35%) and neonates ward (25%). Frequencies of nosocomial infection by site were as follows: eyes (27%), septicemia, surgical wounds and location of drain or catheter (each one 21%), CSF (7%) and urinary (2%). The most common pathogenic organisms wereEnterobacter (27%),aurues Staphilococcus (21%),Klebsiella (18%),E.coli (14%) and epidermis Staphilococcus (9%). Total number of hospitalized patients was 5990 and total number of hospitalized days was 39,095 in the five years. Infections per 100 hospital discharges and 100 hospital days by service were as follows, respectively: NICU (2.9, 0.26), neonatal surgery (1.7, 0.18) and neonates (0.3, 0.06) The differences wera significantly meaningful (p value