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Niknam R, Salehi A, Molavi Vardanjani H, Fattahi MR, Dehghani SM, Honar N, Haghighat M, Imanieh MH. Different Clinical Features of Celiac Disease in Children, Adolescents, and Adults; a Cross-sectional Study. Middle East J Dig Dis 2021; 13:121-130. [PMID: 34712450 PMCID: PMC8531929 DOI: 10.34172/mejdd.2021.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/20/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Celiac disease is a common disorder but there are few studies comparing the clinical features of the disease in adults, adolescents and children. METHODS Demographic and clinical characteristics of all patients with celiac disease referred to the Celiac Clinic were evaluated and compared in different age groups. RESULTS Of 3416 participants, 473 patients were included. 302 (63.8%) were women and 171 (36.2%) were men. Overall, 325 (68.7%) and 411 (86.9%) patients had gastrointestinal (GI) and non-GI manifestations, respectively. The most common symptom in adults was psychiatric problems (66.5%), while abdominal discomfort was the most common symptom in adolescents (45.2%) and children (53.8%). According to age groups, GI manifestations were seen in 79 (66.4%), 119 (59.8%), and 127 (81.9%) children, adolescents, and adults, respectively. Adults had significantly more GI manifestations than the other groups (PR 1.167; 95% CI: 1.094- 1.244; p < 0.001). Non-GI manifestations were seen in 90 (75.6%), 174 (87.4%), and 147 (94.8%) children, adolescents, and adults, respectively. Adults had significantly more non-GI manifestations than the other groups (PR 1.112; 95% CI: 1.060-1.168; p < 0.001). CONCLUSION Our study showed that there were significant differences in the clinical features of celiac disease between the different age groups. Considering these results may help plan for future studies.
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Affiliation(s)
- Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Salehi
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed-Mohsen Dehghani
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasser Honar
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Haghighat
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Hadi Imanieh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Amoozgar H, Ermis R, Honar N, Malek-Hosseini SA. Myocardial Performance after Successful Liver Transplantation. Int J Organ Transplant Med 2016; 7:77-83. [PMID: 28435639 PMCID: PMC5396053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Myocardial performance index (MPI) or Tei index is a Doppler-derived index of combined systolic and diastolic myocardial function, calculated as the sum of isovolumetric relaxation time (IRT) and isovolumetric contraction time (ICT) divided by the ejection time (ET). OBJECTIVE To evaluate the right and left ventricular systolic and diastolic function using MPI in children before and after liver transplantation. METHODS A cross-sectional study was conducted on 30 children with liver cirrhosis before liver transplantation, 30 age-matched comparison group at least 6 months after liver transplantation, and 30 aged-matched children without history of heart disease in Nemazi Liver Transplant Center, Shiraz, Iran, from April 2012 to April 2014. Echocardiographic evaluation was carried out with a GE Vivid 3 echocardiographic machine, using a 3-MHz probe with tissue Doppler imaging (TDI) software using conventional and TDI method. RESULTS The mean±SD left ventricle Tei index in patients was 0.33±0.02 before liver transplantation, 0.34±0.02 after liver transplantation, and 0.33±003 in the comparison group (p=0.36). The mean±SD right ventricular Tei index was 0.35±0.04 in patients before transplantation, 0.36±0.46 after liver transplantation, and 0.28±0.04 in the comparison group (p<0.001). In addition, when TDI was used, the mean±SD left ventricular Tei index was 0.39±0.50 in patients before transplantation, 0.37±0.42 after liver transplantation, and 0.38±006 in the comparison group (p=0.32). The tissue Doppler-derived Tei index for the right ventricle was 0.37±0.04 in patients before transplantation, 0.37±0.04 after liver transplantation, and 0.33±0.05 in the comparison group (p=0.031). The left ventricular Doppler-derived Tei index had a significant (p=0.03) correlation with Child-Turcotte-Pugh (CTP) score (r=0.57). CONCLUSION Left ventricular MPI with Doppler echocardiography was correlated with CTP score. Right ventricular MPI was significantly increased in patients with cirrhosis and did not improve 6 months after transplantation.
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Affiliation(s)
- H. Amoozgar
- Neonatology and Cardiac Research Center, Shiraz, Iran
| | - R. Ermis
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N. Honar
- Pediatric Gastroenterology and Hepatology Ward, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Naser Honar, MD, Department of Pediatrics, Namazi Hospital, PO Box: 7193711351, Shiraz, Iran, Fax: +98-71-3647-4298 , E-mail:
| | - S. A. Malek-Hosseini
- Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Honar N, Kamali S, Karimi M. Frequency of Celiac Disease in Children with Beta Thalassemia major. Iran J Ped Hematol Oncol 2014; 4:48-52. [PMID: 25002924 PMCID: PMC4083199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/14/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aimed to investigate the frequency of celiac disease in children with β-thalassemia major (B-TM) in Shiraz, southern Iran. MATERIALS AND METHODS In this study, the prevalence of celiac disease in children with B-TM was evaluated. Children with B-TM were screened for celiac disease by ant-tissue transglutaminase (anti-tTG) IgA antibody, IgA level and anti-tTG IgG. A total of 1500 school healthy children in Shiraz with age/sex matched were selected as control group. RESULTS A total of 215 B-TM patients with mean age of 12.7 ± 4.4 years, were included into the study (52.1% was male). None of the patients were positive for anti-tTG IgA. Eight cases were IgA deficient in whom anti-tTG IgG was investigated but none of them were positive for anti-tTG IgG. The finding in control group has a seroprevalence of 2% and biopsy proven disease of 0.6%. CONCLUSION Many patients with thalassemia major have multiple non specific symptom that are not justifiable with underlying disease and might be due to atypical celiac disease. We didn't find any case of celiac disease among more than 200 children with β-thalassemia major in Shiraz, southern Iran. So it seems reasonable to screen only those who have features, even not classical, of celiac disease.
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Affiliation(s)
- N Honar
- Assistant Professor of pediatric gastroenterologist, Department of gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Kamali
- Resident of Pediatrics, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Karimi
- Professor of pediatric hematology oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,Corresponding author: Karimi M , Professor of Pediatrics Hematology and Oncology Hematology Research Center, Nemazee HospitalShiraz University of Medical Sciences, Shiraz, Iran.
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Dehghani SM, Haghighat M, Imanieh MH, Honar N, Negarestani AM, Malekpour A, Hakimzadeh M, Dara N. Autoimmune hepatitis in children: experiences in a tertiary center. Iran J Pediatr 2013; 23:302-8. [PMID: 23795253 PMCID: PMC3684475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 03/29/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Autoimmune hepatitis (AIH) is a necroinflammatory liver disease of unknown etiology that occurs in the children of all ages. The present study aimed to evaluate the clinical and paraclinical presentations, including pattern of autoantibodies, response to treatment, mortality, and liver transplantation outcome in the Iranian children with AIH. METHODS The medical records of 87 children (56 girls and 31 boy) diagnosed with AIH between 2001 and 2010 were retrospectively analyzed for clinical and paraclinical profiles and also treatment outcome. FINDINGS The mean age of the patients was 10.1±4.5 years (64.4% females). The most common clinical findings were jaundice (70.1%), splenomegaly (67.8%), and hepatomegaly (51.7%). Antinuclear, anti-smooth muscle, and anti LKM antibodies were positive in 14/62, 22/53 and 6/40 patients, respectively (36 patients had type 1 AIH, 6 patients had type 2 AIH, 26 patients were seronegative, and autoantibodies were not available in 19 cases). The most common histological finding in the liver biopsies was chronic hepatitis with interface activity that was seen in 65 (74.7%) patients. The complete response was seen in 52 (59.8%) patients and 24 (27.6%) patients underwent liver transplantation. One-year and five-year survival rates were 87.5% and 80% in the transplanted patients. CONCLUSION AIH should be kept in mind in the differential diagnosis of both acute and chronic liver diseases in the children and treatment with combination of corticosteroids and azathioprine is a good treatment option. In the patients with end stage liver cirrhosis that did not respond to medical therapy, liver transplantation is the treatment of choice.
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Affiliation(s)
- Seyed-Mohsen Dehghani
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Shiraz Transplant Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author:Address: Gastroenterohepatology Research Center, Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran. E-mail:
| | - Mahmood Haghighat
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Hadi Imanieh
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Shiraz Transplant Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasser Honar
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir-Masoud Negarestani
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdorrasoul Malekpour
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Hakimzadeh
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naghi Dara
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Honar N, Imanieh MH, Haghighat M, Dehghani SM, Zahmatkeshan M, Geramizadeh B, Badiee P, Nikeghbalian S, Kazemi K, Bahador A, Salahi H, Malek-Hosseini SA. Evaluation of Candida infection after six months of transplantation in pediatric liver recipients in iran. Int J Organ Transplant Med 2011; 2:105-7. [PMID: 25013602 PMCID: PMC4089262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is the standard treatment of end-stage liver diseases (ESLD). Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. OBJECTIVE To determine the incidence of late-onset (after 6 months of LT) Candida infection in recipients. METHODS A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. RESULTS One recipient (2%) developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder (PTLD). CONCLUSIONS The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications.
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Affiliation(s)
- N. Honar
- Gastroenterohepatology Research Center,
| | - M. H. Imanieh
- Gastroenterohepatology Research Center,,Shiraz Transplant Research Center
| | | | - S. M. Dehghani
- Gastroenterohepatology Research Center,,Shiraz Transplant Research Center,Correspondence: Seyed Mohsen Dehghani, MD, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
E-mail:
| | | | | | - P. Badiee
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Honar N, Imanieh MH, Dehghani SM, Haghighat M, Geramizadeh B, Yaghobi R, Alborzi A, Ziaeian M, Kazemi K, Nikeghbalian S, Bahador A, Salahi H, Malek Hosseini SA. Evaluation of cytomegalovirus infection after six months of liver transplantation in children in shiraz, southern iran. Int J Organ Transplant Med 2011; 2:20-4. [PMID: 25013590 PMCID: PMC4089245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is a life-saving treatment for end-stage liver diseases (ESLD). Cytomegalovirus (CMV) infection is one of the important causes of morbidity after LT. OBJECTIVE To evaluate the incidence of late-onset (after 6 months of LT) CMV infection in pediatric recipients. METHODS A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. RESULTS Three recipients (6%) developed late-onset CMV infection. These patients finally responded to ganciclovir. CONCLUSION CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children.
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Affiliation(s)
- N. Honar
- Gastroenterohepatology Research Center,
| | - M. H. Imanieh
- Gastroenterohepatology Research Center, ,Shiraz Transplant Research Center,
| | - S. M. Dehghani
- Gastroenterohepatology Research Center, ,Shiraz Transplant Research Center, ,Correspondence: Seyed Mohsen Dehghani, MD,
Associate Professor of Pediatric Gastroenterology,
Shiraz Transplant Research Center, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences,
Shiraz, 71937-11351, Iran. Tel: +98 711 626 1775 Fax: +98 711 647 4298 E-mail:
| | | | | | | | - A. Alborzi
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Ziaeian
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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