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Background: Hypothyroidism can play an important role in the development of non-alcoholic fatty liver disease (NAFLD). This study compared the thyroid function tests in overweight and obese children and adolescents with and without NAFLD. Methods: This case-control study was conducted on 100 children and adolescents aged 4-18 years who referred to the endocrinology clinic of Amirkola Children's Hospital, Babol, Iran in 2021. 42 obese and overweight children with NAFLD were considered as case group and 56 persons without NAFLD as control group. They were selected after physical examination and body mass index (BMI) assessment. Then, TSH, T4, FBS, lipid profile, 25(OH) vit D3 (VD), AST and ALT levels were measured. Abdominal ultrasound was performed to survey fatty liver. T-test and Chi-score were used for analysis and p< 0.05 was considered significant. Results: The mean age in both group was 11.63±2.55 and 10.07±2.61 years, respectively (P=0.004). Hypothyroidism was not seen in the groups. Two groups in terms of mean TSH (P=0.92), T4 (P=0.87), FBS (P=0.33), cholesterol (P=0.44), LDL (P=0.35), VD (P=0.07) had no significant difference. However, difference was found between the two groups in terms of the mean level of AST (P=0.003), ALT (P=0.001), TG (P=0.02), HDL (P=0.01) and BMI (P

Background and purpose: Zinc transporter autoantibody 8 (ZnT8A) was recently identified as a novel antibody antigen in type 1 diabetes mellitus, and its positivity is associated with early onset of the disease. So the present study was conducted to determine the prevalence of autoantibodies related to type 1 diabetes mellitus, especially ZnT8A as a newer antibody in children from 1 to 18 years of age referred to Amirkola Children's Hospital. Materials and methods: In this descriptive and analytical study, 80 children under 18 years of age with type 1 diabetes referred to Amirkola Children's Hospital, Babol, Iran during the years 2013 to 2021 were included in the study. Pediatric diabetes was diagnosed based on the criteria of the American Diabetes Association and with a visit to a pediatric endocrinologist. Antibodies related to type 1 diabetes including 65 glutamic decarboxylase (anti-GAD), protein tyrosine phosphatase (IA-2A), anti-islet cell autoantibodies (ICA), insulin autoantibodies (IAA), and zinc transporter 8 (ZnT8A) was measured from their blood samples at the time of disease diagnosis by ELISA method. Data were analyzed using t-test, chi-square, and Fisher's exact test. The significance level in this study was considered as p

Background and purpose: The aim of the study was to determine the relationship between electrolyte disorders and disease severity in children with COVID-19 infection referred to Amirkola Children's Hospital. Materials and methods: We performed the cross-sectional study on children aged 1 month to 18 years with COVID-19 infection referred to Amirkola pediatrics hospital, Babol, Iran from March 2018 to July 2018. The level of serum of potassium, sodium, calcium, and fasting blood sugar were measured at the beginning of hospitalization in all study children. Severity of COVID-19 infection was evaluated with Pediatric Early Warning Score (PEWS). Data were analyzed using Chi-Square, ANOVA, and logistic regression tests. P-values of less than 0.05 were considered significant. Results: Out of 160 children referred to the hospital during the study, 122 were selected. The most common electrolyte disorders were hyponatremia (42.6%) and hypocalcaemia (16.4%). No significant relationship was found between calcium (P=0.30) and potassium (P=0.12) disorders and severity of COVID-19 infection. There was a significant relationship between the sodium disorder and severity of COVID-19 infection (P

Objective. This study aim to evaluate the level of vitamin D with the incidence of febrile seizure. Method. This case-control study was conducted on 90 febrile children referred to Amirkola Children’s Hospital from 19 February to 21 August 2021. Febrile children with and without seizures were considered as case and control groups, respectively. Vitamin D, calcium, phosphorus, and alkaline phosphatase were evaluated. Results. The mean level of vitamin D was not significant between the 2 groups ( P = .62), but the mean level of alkaline phosphatase was higher in the case group, statistically ( P = .04). 46.75% and 15.6% of case group, 28.9% and 26.7% of control group had deficiency and insufficiency levels of vitamin D, respectively ( P = .17). Conclusion. In this study the mean level and deficiency of Vitamin D were not significant between the 2 groups. No correlation was also found between Vitamin D levels and the incidence of Febrile Seizure.

Abstract Background This study aimed to evaluate the effect of Neuromuscular Electrical Stimulation (NMES) on serum glucose level in children and adolescents with type-1 diabetes. Methods This before-after, single-group, clinical trial was conducted on 29 patients with type-1 diabetes mellitus with the age range of 7–18 years. The patients underwent NMES in two 20-minute phases on the quadriceps and hamstrings muscles, three sessions per week for a period of 8 weeks. Fasting Blood Sugar (FBS), measured in two ways, by glucometer and laboratory testing, was considered as the primary outcome and the glycated hemoglobin (HbA1c) and the total daily dose (TDD) of insulin were measured as the secondary outcomes. The laboratory FBS and HbA1c were measured 1 day before the intervention (as a baseline value) and then 2 and 6 weeks after the last session of intervention. FBS by glucometer and total daily dose of insulin were recorded daily from 2 weeks before the intervention to the last day of the intervention and consequently, the weekly average of these variables was calculated and used for statistical analysis. Results The serum level of FBS (measured by glucometer) and the total daily dose of insulin reduced significantly 2 weeks after beginning of intervention. The laboratory serum level of FBS decreased significantly in the second week after the end of intervention compared to the baseline values. Although the HbA1c level decreased at follow-up period (2 and 6 weeks after the intervention), it was not significant. Conclusion It seems that 8 weeks of NMES has beneficial effects on the reduction of FBS and TDD of insulin therefore, it could be suggested as the contributory treatment in management of children and adolescents with type-1 diabetes. Trial registration The study was registered at https://fa.irct.ir/user/trial/51739/view (IRCT20100523003998N1) in date of 25/10/2020.

Background: The growth and development of children affect biochemical variables. This population-based study was designed to evaluate the reference interval for alkaline phosphatase (ALP) routinely measured in the clinical laboratory. Methods: For this examination, 873 cases were selected among the healthy children and adolescents aged 1-18 years who referred to the endocrinology clinic of Amirkola Children's Hospital for growth evaluation. After overnight fasting, early morning blood samples were obtained to measure the ALP level and other biochemical parameters using an automatic biochemical analyzer. Subjects were categorized by age, sex, and body mass index (BMI) values. The age groups were categorized as follows: 1-4 years, 5-8 years, 9-13 years, and 14-18 years. Results: There was a significant difference among the age and sex categories; on the contrary, there was no meaningful variation between the two groups categorized by BMI. The reference range for ALP was 474.14-517.71 U/L for children aged 1-4 years, 273.47-871.44 U/L for 5-8 years, 215.04-893.69 U/L for 9-13 years, and 228.9-739.22 U/L for 14-18 years. Also, significant positive correlation was found between ALP with length (P=0.000, r=0.134), weight (=0.04, r=0.073), phosphorus (P) (P=0.001, r=0.122), and alanine aminotransferase (SGPT) (P=0.000, r=0.142) respectively. Conclusion: This project's data established a reference interval for ALP in healthy children and adolescents, which will prepare a basis for diagnosis and monitoring liver- or bone-related disorders.

Background and purpose: Type 1 diabetes mellitus (T1DM) is a chronic disease with multiple long-term complications that could trigger depression. This study was performed to determine the relationship between HbA1C levels and depression in children and adolescents with T1DM. Materials and methods: This cross-sectional study was conducted in all children and adolescents with T1DM attending an endocrine clinic affiliated with Amirkola Children's Hospital, Iran 2018-2019. The patients aged 7-18 years old and at least 1.5 years had passed since the onset of their diabetes. Average of three HbA1c values (every six months) were considered and depression was measured using the Marques Children Depression Inventory. Results: Out of 100 patients with T1DM based on age-appropriate HbA1c, good, poor, and severe control of diabities were seen in 22%, 74%, and 4%, respectively. The risk of of depression in patients with poor control of diabities was 1.75 times higher than those with a good control of the disease, but this was not statistically significant (P=0.29). The risk of depression in children with illness duration of more than 6 years was 3.74 times higher than that in children with less than 6 years duration of the disease (P= 0.005). Conclusion: Better management of T1DM and HbA1c levels are needed to reduce the risk of depression in these patients.

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 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

Statement of the Problem: Alteration in salivary composition and its effect on the oral cavity in diabetic child patients remains equivocal. Purpose: This study was performed to assess the relationship between salivary factors and gingival status in children with type-1 diabetes mellitus (DM). Materials and Method: In this cross-sectional study, 120 subjects aged 6-16 years (60 well-controlled and poorly-controlled diabetics and 60 healthy individuals) were examined to determine the gingival index (GI) and plaque index (PI). The unstimulated saliva samples were collected to measure the salivary triglyceride, cholesterol, albumin, α-amylase, total protein levels by the laboratory kits. Total antioxidant capacity and the free radicals scavenger index were measured by the Ferric Reducing Ability Of Plasma (FRAP) and 1,1-Diphenyl-2-picryl-hydrazyl (DPPH) assays, respectively. Data were analyzed by parametric and non-parametric, Pearson correlation, and t tests at a 5% error level. Results: GI of diabetics was significantly higher than that of healthy individuals (1.51± 0.71 and 0.9±0.81, respectively, p< 0.001). No significant difference was found between the PI of diabetics compared to healthy volunteers (1.59±0.69, 1.63±0.74, respectively). The levels of salivary triglyceride and cholesterol, albumin and total proteins in healthy subjects were significantly higher than that in people with DM (p< 0.001). A significantly more salivary α-amylase activity was found in diabetics compared to non-diabetics (p< 0.001). No significant differences were found between diabetic and non-diabetic subjects in terms of DPPH (95.5, 95.9%, respectively) and FRAP (9.77±0.13, 9.78±0.12 (µmol/mL), respectively). Conclusion: More gingival inflammation and salivary α-amylase activity and lower level of salivary lipids, albumin, and total proteins were found in diabetic patients, but there was no association between the level of lipids, proteins, and the total antioxidant capacity of saliva with periodontal health indicators in patients with DM and healthy individuals.

Background: Congenital hypothyroidism (CH) is one of the most common endocrine diseases and one of the major causes of mental retardation in children. So we aimed to evaluate the developmental outcome of children with CH. Methods: This case-control study was performed on two 3-6-year-old groups of 100 patients. The case group was children with CH, referred to Endocrine Clinic of Amirkola Childrenchr('39')s Hospital (2011-2017) and the control group was healthy children and normal from other states. The Denver developmental screening test-II (DDST_II) was used to assess the developmental factors and disorders in four areas of gross motor, fine motor, personal-social and language. Data were analyzed by SPSS 21 using descriptive statistics, t-test and chi-square, and a p

Background and purpose: Beta thalassemia major is one of the most common inherited blood diseases and patients with this condition require regular blood transfusions. The resulting iron overload deposition causes endocrine gland disorders, including growth hormone (GH) abnormality. In this study, we examined the effects of recombinant growth hormone (rGH) in these patients. Materials and methods: This retrospective study was performed in thalassemia major patients in Amirkola Thalassemia Center, using the medical records (2011-2018), to evaluate the therapeutic effects of rGH on growth velocity of six short stature patients aged 7-15 years (four boys and two girls). On the basis of abnormal or normal response to GH provocation test, the patients were included in GH deficiency (GHD) group (n=3) and idiopathic short stature (ISS) group (n=3), respectively. The data were analyzed in SPSS-18. Results: The mean age of patients was 11.00 ± 2.75 years old. The mean values for growth velocity before and after the treatment were 4.00± 0.86 and 7.83 ± 1.25 cm/year in GHD group (P=0.057) and 4.06 ± 0.81 and 6.00 ± 1.50 cm/year in ISS group, respectively (P=0.023). Conclusion: In this study, the positive therapeutic effects of rGh in improvement of growth velocity were seen in thalassemia major patients (both GHD and ISS groups).

Background: Hyperbilirubinemia is a common problem in neonates that causes hospitalization. The aim of this study was to investigate the effects of concentrated pomegranate juice (CPJ) consumption by breastfeeding mothers on neonatal hyperbilirubinemia. Materials and Methods: In this open-labeled, add-on, randomized clinical trial, 86 breastfeeding mothers and their neonates were allocated into two groups. In the control group, neonates received phototherapy. Besides neonates' phototherapy in the intervention group, their mothers received CPJ (1 tablespoon [15 g] three times a day) up to discharge. The bilirubin level was the primary outcome. The duration of phototherapy, the duration of hospital stay, and the need for exchange transfusions were secondary outcomes. Results: CPJ reduced the bilirubin level of hospitalized neonates within 48 h after consumption (P = 0.048, standard mean difference = 0.648). It also resulted in reduced duration of hospital stay and faster discharge of the neonates. Furthermore, in 48 h after discharge, bilirubin was significantly lower in the CPJ group (P = 0.003, partial eta squared = 0.123). Conclusion: Compared to the control group, consumption of CPJ by lactating mothers whose infants underwent phototherapy resulted in lower bilirubin levels, shorter hospital stay, and faster discharge.

Background: Because of the importance of thyroid function and its effect on different organs, such as the heart, this study was aimed to evaluate the effect of levothyroxine on cardiac function in children with subclinical hypothyroidism. Methods: This quasi-experimental study was performed on children aged 4-12 years old with diagnosis of subclinical hypothyroidism in Amirkola Children's Hospital during 2018-2019. Cardiac functional parameters, including ejection fraction (EF), fractional shortening (FS), ratio of early filling velocity to early diastolic mitral annulus velocity (E/E'), myocardial performance index (MPI), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD), were measured by echocardiography at baseline and 6 months after levothyroxine treatment. Results: Out of the 30 subjects, 19 (63.3%) were boys and 11 (36.7%) were girls. The mean age was 6.60±2.13 years old. The mean EF index was 63.13±3.01 percent before treatment, which increased to 69.07±4.50 percent after treatment (p

Background: Methylmalonate-semialdehyde Dehydrogenase Deficiency (MMSDHD) is an uncommon autosomal recessive disorder. MMSDH is an enzyme encoded by the protein coding gene ALDH6A1 in humans. Case Presentation: We present a 4-year-old boy with elevated liver enzymes, 3-hydroxyisobutyric aciduria (MMSDHD) and cardiac symptoms. He had a mutated ALDH6A1 gene, c.184c>G (p.Pro62Ala). Conclusions: This is one of the rare case reports in the world and the first one in Iran that reports MMSDHD with cardiac disease.

Background: Type I diabetes mellitus (T1DM) with growing frequency which is considered as a world health threatening problem is an autoimmune disease with insulinupenia. Considering the relationship between the incidence of T1DM and environmental factors, the aim of this study was to assess seasonal incidence of T1DM and its association with birth season. Methods: This cross-sectional study was conducted on 112 diabetic patients (66 males, 46 females) less than 18 years, referred to Pediatric Endocrine Clinic (Amirkola Children's Hospital) during 2011-2017. All the needed information was extracted from the patient's files and asking questions of their parents. Data were collected in a checklist. Comparison between different seasons and age groups was done by Pearson's chi-square test. Data were analyzed using SPSS 19 and p£0.05 was considered significant level. Results: The mean age of the patients during diagnosis of T1DM was 7.34±3.70 years. The incidence of T1DM was significantly increased in the cold seasons (especially winter) (P

Background: Type 1 diabetes mellitus (T1DM) as an autoimmune disorder is associated with other autoimmune diseases such as autoimmune thyroid (AIT) disease. The aim of this study was to determine the prevalence of AIT in children who were referred to Amirkola Endocrine Clinic (north of Iran). Methods: This cross-sectional study was carried out on 100 diabetic children aged 1-15 years during 2008-2013, who were referred to the pediatric endocrine clinic. Serum levels of anti-thyroid peroxidase (Anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies and Thyrotropin Stimulating Hormone (TSH) were measured by Immune Chemiluminescence assay, and demographic information was obtained from patients'medical records. The collected data were analyzed using SPSS 18. Results: AIT was found in 13% of patients (8% female and 5% male). Significant levels were found for Anti-TPO (3%), anti-Tg (2%), and both antibodies (8%) in patients with AIT. Thyroid dysfunction was observed in 8 of 13 patients with AIT versus 2 of 87 patients without AIT (P

Tacrolimus is a main drug for induction and maintenance immunosuppression for patients with kidney transplants in many centers. One of important side effect of drug is post-transplant diabetes mellitus. Of course, diabetes ketoacidosis (DKA) is rare. In this report, a 12-year-old girl with DKA was presented after 45 days of kidney transplantation.

Background: Diabetic ketoacidosis (DKA) is the final consequence and life-threatening complication of severe insulin deficiency in type 1 diabetes with occurrence of 20-40%. The aim of this study was to investigate the incidence and predisposing factors of DKA and its consequences. Methods: This retrospective study was performed on 128 diabetic patients in Amirkola Children’s Hospital in 2005-2013. Patients' data were recorded in a predetermined questionnaire. The data were analyzed using SPSS.18. Results: Of all 128 hospitalized diabetic patients, 103 patients (80.5%) were referred for the first time and 25 (19.5%) patients were previously treated with insulin. Of total 128 patients, 71 (55.5%) had some degree of ketoacidosis that severe ketoacidosis was the most common form (in 36 cases; 50.7%). Among patients with the diagnosis of ketoacidosis (71 patients), 54 patients (76%) presented with DKA as the first symptom of diabetes. Generally, the predisposing factors of ketoacidosis were seen in 39 (54.9%) patients, which were due to infections and insulin therapy discontinuation in 27 (69.23%) and 12 (30.76%) of them, respectively. In patients with previous diagnosis of diabetes mellitus and history of admission with diabetic ketoacidosis, 70.58% had previous treatment cessation. Conclusions: In the current study, the incidence of ketoacidosis was high (55.5%). This subject seems to be related to lack of information about diabetes mellitus among population who require the universal education. On the other hand, in respect to high incidence of DKA among patients with cessation of previous insulin treatment, rigorous and complete training of them is critical.

Background: Thalassemia major (TM) is one of the most common hereditary anemia with multiple endocrinopathies (especially hypogonadism). So, we evaluated the rate of delayed puberty (DP) and its relation with serum ferritin level in patients. Materials and Methods: This cross-sectional (descriptive-analytical) study was conducted on 100 patients with TM between 14-64 years old, admitted to Amirkola Thalassemia Center, Babol, Iran, in 2016. The pubertal status, (Marshall-Tanner scale), existance of DP, and its different types were evaluated. Mean serum ferritin level was measured and the data were classified to three groups of <1500, 1500-2500, and >2500 ng/ml. Data were analyzed using SPSS (version20). Results: Out of 100 patients, 64 (64%) and 36 (36%) were female and male, respectively. Considering age, 23, 77 patients (%) were under and over 20 years old, respectively. Totally, 69 (69%) of them had DP, of whom 64 (92.8%) ones had secondary (central) hypogonadotropic hypogonadism. Mean serum ferritin level (±SD) was 2707.94±1683.42 ng/ml. In addition, 26, 29, and 45 patients had ferritin level <1500, 1500-2500, and >2500 ng/ml, respectively. Thirty two patients with DP (46.4%) had ferritin level above 2500 ng/ml (p-value= 0.623). Conclusion: The results showed a high frequency of DP in TM patients, requiring careful examination and follow-up in terms of puberty for early diagnosis and proper treatment to improve their quality of life, and prevention of the complications like osteoporosis. We couldn't find any significant relationship between serum ferritin level and hypogonadism, even for cases who received enough iron chelators. [ABSTRACT FROM AUTHOR]

Background: Rickets is failure in mineralization of growing bone and cartilage due to extreme vitamin D deficiency (VDD). The study aimed to identify rickets among vitamin D deficient children and determine any relationship between clinical findings and paraclinical evidence. Methods: This study was conducted in two stages. In the first stage, blood was drawn from 406 children aged 30-72 months for measurement of 25(OH)D level. Of these children, 108 had 25(OH)D levels of <20 ng/dL and were evaluated physically for signs and symptoms scores (0-1) of VDD and rickets. Biochemical analysis and radiography of the child's left wrist and hand was performed. Results: Of the 119 children (29.67%) with 25(OH)D levels of <20 ng/dL, 42 (10.3%) had vitamin D levels of <15 ng/dL. There was no correlation between serum 25(OH)D level and levels of calcium (Ca) (r = -0.16), alkaline phosphatase (ALP) (r = -0.12), P (r = 0.13), and parathyroid hormone (PTH) (r = -0.15,) in children with VDD. The mean of signs and symptoms scores had no significant difference between children with (1.59 ± 0.8) and without (1.73 ± 1.01) VDD (P = 0.3). None of the children with VDD had radiographic evidence of rickets. Radiographic data showed that 69.2% (72), 10.6% (11), and 20.2% (21) of the children had delayed, normal, and advanced bone age, respectively. Conclusion: Abnormal radiological findings of rickets were not found on wrist X-rays. Thus, this investigation is not necessary within the range of vitamin D levels described in the current study. [ABSTRACT FROM AUTHOR]