Dairy intake in association with asthma symptoms among a large sample of children and adolescents: a cross-sectional study

Background and objective

Dairy products may be associated with an increased risk of asthma, although there is little scientific evidence to support this association. The goal of this study was to explore the association between dairy consumption and asthma symptoms.

Materials and methods

This cross-sectional study was conducted on children and adolescents aged 6-8 and 13-14 years living in central Iran. Dietary food consumption was assessed using a multiple-choice questionnaire. Logistic regression was used to obtain odds ratios for the association between milk, other dairy products, and total dairy consumption with the risk of asthma symptoms.

Results

In total, 7,667 participants (3,414 boys and 4,253 girls) were included in the current study. Milk intake and total dairy consumption were not associated with the likelihood of wheezing, asthma confirmed by a doctor, current asthma, and asthma medication use. In addition, there was no association between other dairy product intake and the odds of wheezing in the past 12 months in the crude model. However, after adjusting for several confounders, those in the top category had lower odds of wheezing in the past 12 months than those in the bottom category (OR: 0.58; 95% CI: 0.40-0.85).

Conclusion

The consumption of dairy products other than milk, including cheese and yogurt, might reduce the likelihood of wheezing in children and adolescents.

Which Groups of Children Are at More Risk of Fatality during COVID-19 Pandemic? A Case-Control Study in Yazd, Iran

Introduction

The study aims to investigate the characteristics, comorbidities, laboratory findings, and clinical manifestations of under 18-year-old patients who died with the diagnosis of COVID-19 and determination of the most prevalent risk factors.

Method

This case-control study was performed at a referral hospital in Yazd from March 2020 to August 2021. All patients under 18 years who were diagnosed through real-time RT-PCR, chest computed tomography, and the World Health Organization definition were divided into deceased and survived groups. The characteristics (age and sex), disease severity, comorbidities, laboratory findings, and clinical manifestations of the two groups were compared and analyzed using SPSS, version 18 (SPSS Inc., Chicago, III., USA).

Results

A total of 24 patients in the deceased group and 167 patients in the survived group were compared. The highest mortality rate was observed in the age group of 1 month to 5 years, although no statistically significant relationship was found between age groups and the risk of mortality. Disease severity, dyspnea, low oxygen saturation on admission, length of hospital stays, and hospitalization history before the last admission were significantly correlated with mortality (P < 0.05). Lymphopenia increased the probability of mortality by more than two times (OR: 2.568; 95% CI (0.962-6.852)), but this was not the case for D-dimer and C-reactive protein. Furthermore, 27.5% of survived patients had normal chest CT scans, which was a statistically significant difference compared to the deceased patients (P: 0.031).

Conclusion

Based on the findings of this study, dyspnea, low oxygen saturation, and lymphopenia are critical indicators for identifying high-risk children with COVID-19 and triaging them for better care and treatment.

Association Between Pet Keeping and Current Asthma Among Adolescents Living in Yazd; Evidence from Global Asthma Network (GAN) 2020 Cross-sectional Study

BACKGROUND

The relationship between current pet keeping and allergic diseases, including bronchial asthma in adolescents, is controversial. This study was conducted to evaluate these associations among children aged 13-14 years in Yazd.

METHODS

This study is part of a multicenter cross-sectional study of the Global Asthma Network (GAN) in Yazd, Iran, in 2020, in which 5141adolescents enrolled. Information on respiratory symptoms and pet-keeping (dog/cat/birds) was obtained by a questionnaire derived from the GAN standard questionnaire.

RESULTS

Of 5141 participants who completed the study, 1800 (35%) children kept pets during the last year. Birds were the most common pet kept by adolescents (88%). Severe asthma was more common in bird and cat keepers (P=0.003 and P=0.034, respectively) than dog keepers. Furthermore, there was a statistically significant association between study-defined current asthma and cat keeping, but not bird or dog ownership (P=0.02). Moreover, we found that current any pet-keeping (birds, cats, dogs) was associated with a higher prevalence of asthma-related symptoms, including wheezing, night dry cough, and exercise-induced wheezing in the past year (P=0.002, P=0.000 and P=0.000 respectively).

CONCLUSION

Current any pet-keeping is associated with asthma-related symptoms. Additionally, cat keeping had a significant association with study-defined current asthma. The current keeping of birds, as the most common pet in our area, or cat keeping increases the risk of severe asthma in adolescents. Therefore, as an important health tip, this needs to be reminded to families by health care providers.

Association between Butter, Margarine, and Olive Oil Intake and Asthma Symptoms among School Children: Result from a Large-Scale Cross-Sectional Study

Background

There are conflicting results about the association between dietary fat intake and asthma symptoms. Since few studies in the Middle East have been explored the relation between dietary fat consumption and risk of asthma, the present study was conducted to investigate the association between the consumption of butter, margarine, and olive oil and asthma risk in school children living in central Iran.

Method

In this cross-sectional study, out of 10,240 participants, asthma and its symptoms and dietary intake of butter, margarine, and olive oil of 7,667 children and adolescents were assessed using a validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The relationship between fat subtypes and asthma was assessed using logistic regression.

Results

The prevalence of asthma confirmed by a doctor in the study population was 4.22%. An inverse association was found between butter and margarine consumption once or twice a week and odds of current asthma and wheezing in the past 12 months (OR = 0.52, 95% CI: 0.28-0.96; OR = 0.7, 95% CI: 0.55-0.88, respectively); however, those with higher consumption did not have a higher chance for developing wheezing or asthma.

Conclusion

We found that margarine and butter intake one or two times a week might have an inverse association with asthma and its symptoms among children. Prospective cohort studies are recommended to confirm these findings.

Survival and Mortality in Hospitalized Children with COVID-19: A Referral Center Experience in Yazd, Iran

Introduction

COVID-19 prognostic risk factors, therapeutic protocols, and clinical outcomes in pediatric cases are still under investigation.

Materials and Methods

This historical cohort study evaluated the survival time of hospitalized children (1 month-18 years old) with COVID-19 admitted from March 2020 to August 2021 to an educational hospital in Yazd, Iran. The follow-up of patients was performed at least one month after discharge.

Results

From 183 hospitalized cases, 24 children were deceased. The median age of patients was 5.41, and 54.2% were male. The survival rate after one-month follow-up was 0.88, and the most significant predictors associated with survival time were the male sex, positive history of hospitalization, lymphopenia, hypoxia, and length of stay more than two weeks using Bayesian Cox regression analysis.

Conclusion

Accurate estimation of the impact of predictors on poor outcomes may help healthcare providers use therapeutic protocols based on risk factors and healthcare requirements of each patient to improve their survival.

Dietary approaches to stop hypertension (DASH)-style diet in association with gastroesophageal reflux disease in adolescents

BACKGROUND

Dietary patterns and food items have been associated with gastroesophageal reflux disease (GERD) risk and they have led to conflicting findings. The aim of this study was to determine the association between a dietary approach to stop hypertension (DASH)-style diet with the risk of GERD and its symptoms in adolescents.

STUDY DESIGN

Cross-sectional.

METHODS

This study was performed on 5,141 adolescents aged between 13 and 14 years. Dietary intake was evaluated using a food frequency method. The diagnosis of GERD was done by using a six-item GERD questionnaire that asked about GERD symptoms. A binary logistic regression was used to assess the association between the DASH-style diet score and GERD and its symptoms in crude and multivariable-adjusted models.

RESULTS

Our findings revealed that after adjustment for all confounding variables, the adolescents with the highest adherence to the DASH-style diet had a lower chance of developing GERD [odds ratio (OR) = 0.50; 95%CI 0.33-0.75, P_trend< 0.001)], reflux (OR = 0.42; 95%CI 0.25-0.71, P_trend=0.001), nausea (OR = 0.59; 95% CI:0.32-1.08, P_trend=0.05) and stomach pain (OR = 0.69; 95%CI 0.49-0.98, P _trend=0.03) compared to those with the lowest adherence. Similar results were found for odds of GERD among boys, and the total population (OR = 0.37; 95%CI: 0.18-0.73, P_trend=0.002, OR = 0.51; 95%CI: 0.34-0.77, P _trend<0.0, respectively).

CONCLUSION

The current study revealed that adherence to a DASH-style diet might protect against GERD and its symptoms including, reflux, nausea, and stomach pain in adolescents. Further prospective research is needed to confirm these findings.

Psychological Impact of COVID-19 on Children and Adolescents: A Narrative Review

Background: With the global spread of COVID-19, many families have experienced the physical or psychological effects of the disease, which has had a profound impact on children. Objectives: Given that most studies have assessed the effects of COVID-19 on physical health, this study reviews the psychological and psychosomatic aspects of the disease and possible solutions to improve the condition of children and adolescents regardless of physical problems and complications of COVID-19. Methods: The data employed in our narrative review were searched for English documents published between 2019 and 2022 in EMBASE, Web of Science, Scopus, Google Scholar, and PubMed databases. Keywords included Mental health, Grief, Anxiety, depression, Children, and COVID-19. After screening the abstracts, the full text of 70 related studies was reviewed, and finally, 52 relevant surveys were selected. Results: Among the most important issues are the irreparable effects of losing a parent or the death of a loved one due to this disease (loss and grief) and a wide range of other disorders, such as feelings of fear, anxiety, depression, sleep problems, and post-traumatic stress disorder. However, the destructive effects of prolonged school closures and turning to social media without parental supervision and adequate infrastructure for children cannot be ignored. Conclusions: Children’s reactions to stress are different, such as overdependence, anxiety, withdrawal, anger, bedwetting, etc. Long-term quarantine and its consequences have increased anxiety and depression, sleep disorders, and nutritional problems in children and adolescents. Therefore, children need a safe and supportive environment, guidance, and help to express their fear and sadness.

Association of +1923C > T, -1112C > T and +2044A > G Polymorphisms in IL-13 Gene with Susceptibility to Pediatric Asthma: A Systematic Review and Meta-Analysis

BackgroundPrevious studies have provided conflicting evidence implicating the IL-13 polymorphism and pediatric asthma. Thus, we performed a meta-analysis to combine and analyze the available studies to provide more accurate conclusions. Methods: A comprehensive retrieval in PubMed, EMBASE, Web of Science, and CNKI was performed up to February 05, 2020. Results: A total of 39 case-control studies including 15 studies with 4,968 cases and 7,091 controls were on +1923 C > T, ten studies with 3,175 cases and 2,983 controls on -1112 C > T, and 14 studies with 4,476 cases and 5,121 controls on +2044 A > G were selected. Pooled data showed that the IL-13 + 1923 C > T, -1112 C > T and +2044 A > G polymorphisms were significantly associated with risk of pediatric asthma. The IL-13 + 1923 C > T (Asians and Africans), -1112 C > T (Caucasians) and +2044 A > G (Asians) polymorphisms were more frequently associated in these ethnic groups. Conclusions: Our pooled data indicated that IL-13 + 1923 C > T, -1112 C > T and +2044 A > G polymorphisms were correlated with risk of pediatric asthma.

Association of PAI-1 4G/5G and ACE I/D Polymorphisms with Susceptibility to Pediatric Sepsis: Evidence from a Meta-Analysis

BackgroundSeveral studies have investigated the role of PAI-1 4G/5G and ACE I/D polymorphisms in the etiology of pediatric sepsis, but the results are inconsistent. We performed a meta-analysis to assess for any associations. Methods: A comprehensive literature search on PubMed, web of science, and CNKI database was conducted up to April 15, 2020. Results: There were twelve case-control studies involving seven studies with 860 cases and 1144 controls on PA-1 4G/5G and five studies with 1602 cases and 1585 controls on ACE I/D. PAI-1 4G/5G and ACE I/D polymorphisms were associated with an increased risk of pediatric sepsis in the global population. Stratified analysis by ethnicity showed a significant association in the Caucasians children. Conclusions: The meta-analysis suggests that the PAI-1 4G/5G and ACE I/D polymorphisms may be risk factors for development of pediatric sepsis in the global population.

Association of IL-6 -174G > C Polymorphism with Susceptibility to Childhood Sepsis: A Systematic Review and Meta-Analysis

BackgroundThis meta-analysis evaluates the correlation between the IL-6 -174 G > C polymorphism and susceptibility of childhood sepsis. Methods: We searched PubMed, ISI Web of Knowledge, Scopus, CNKI, SID, SciELO databases until December 30, 2019 to identify all eligible studies. Results: A total of 17 studies with 1,287 cases and 2,482 controls were identified. Pooled data revealed that there was no significant association between the IL-6 -174 G > C polymorphism and risk childhood sepsis in the overall population. When stratified analysis was carried out by age group of cases, no associations were found in neonates and pediatrics. However, in ethnicity-based subgroups, a significant association was found in Caucasians and Africans. Conclusions: There was no significant association of the IL-6 -174G > C polymorphism with susceptibility to sepsis in childhood overall, but there was an association with the Caucasian and African ethnic subgroups.

Association of TNF-α rs1800629, CASP3 rs72689236 and FCGR2A rs1801274 Polymorphisms with Susceptibility to Kawasaki Disease: A Comprehensive Meta-Analysis

Kawasaki Disease (KD) is a multifactorial condition at the junction of infectious diseases, immunology, rheumatology, and cardiology. The aim of this study is to derive a more precise estimation of the association of TNF-α rs1800629, CASP3 rs72689236 and FCGR2A rs1801274 polymorphisms with risk of KD. Methods: PubMed, EMBASE, CNKI databases were searched to identify all relevant studies. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using CMA 2.2 software. Results: A total of 25 studies including eleven studies on TNF-α rs1800629, five studies on CASP3 rs72689236 and nine studies on FCGR2A rs1801274 were selected. Overall, pooled data revealed that CASP3 rs72689236 and FCGR2A rs1801274 polymorphisms were significantly associated with an increased risk of KD. However, there was no significant association between TNF-α rs1800629 and KD. Conclusions: This meta-analysis suggested that CASPS rs72689236 and FCGR2A rs1801274 polymorphisms may modulate individual susceptibility to KD.

Prevalence of Allergic Rhinitis and Eczema in Adolescents Living in Yazd City: Part of Global Asthma Network Survey

Allergic rhinitis and eczema are two common global diseases that can lead to impaired quality of life. Determining the prevalence of these allergic disorders can be useful in planning prevention and treatment. This study aimed to investigate the prevalence and severity of allergic rhinitis and eczema in adolescents living in Yazd city. Using an electronic questionnaire based on the Global Asthma Network (GAN) core questionnaire, 5141 adolescents aged 13-14 years were cross-sectionally surveyed. The prevalence of current symptoms of rhinitis turned out to be 36.3%, proving significantly higher in boys (p=0.009). Moreover, the prevalence of allergic rhinitis and rhinoconjunctivitis in the past year leveled at 12.4% and 10.5%, respectively; however, the former was significantly higher in females (p=0.014). Additionally, severe rhinoconjunctivitis was observed in 0.2% of the participants with no gender preference (p=0.09). Confirmed hay fever by a doctor was reported in 13.2% of adolescents, significantly higher in males (p<0.001). The prevalence of current itchy rash and current eczema was found to be 5.5%, and 2.9%, respectively, with no difference in terms of gender. Severe atopic eczema and eczema confirmed by a doctor were seen in 0.4% and 5% of the participants, no gender preference was identified. Concurrent prevalence of current rhinoconjunctivitis and eczema was detected in 1% of the participants. Despite the increasing trend of allergic diseases in most parts of the world, the prevalence of rhinoconjunctivitis and eczema in adolescents has not increased in Yazd in the last two decades, and this city is located in a low to moderate prevalence area.

Prevalence and Severity of Adolescent Asthma in Yazd, Iran: Based on the 2020 Global Asthma Network (GAN) Survey

Asthma, as the most common chronic disease in children, encompasses substantial health and socioeconomic burden worldwide. This study aimed to evaluate the prevalence, severity, and management of asthma in adolescents aged 13-14 years. This cross-sectional study, which was part of the Global Asthma Network (GAN) 2020 survey, was conducted in early 2020 in Yazd, Iran. A total of 48 schools in Yazd city were selected by cluster sampling. In this study, 5141 students, including 3069 (59.7%) females and 2072 (40.3%) males participated. Prevalence of ever and current wheezing was 19% and 9% respectively. The former was significantly higher in males than females (p<0.001). About 2% of the participants, which was 22.1% of students with current wheezing, had severe asthma. The prevalence of severe asthma was significantly higher in males (p=0.026). Our results showed that 4.8% of students had confirmed asthma by a doctor, significantly predominant in males (p<0.001). The prevalence of using inhaled medicines in the past 12 months was 3.8%, which was significantly higher in males than females (p<0.001). The prevalence of using short-acting β-agonists (SABA) and long-acting β-agonists (LABA) was 2.3% and 1.4% among the students, respectively, with a male predominance (p=0.019). About 1.2% and 0.8% of participants were using inhaled corticosteroids (ICS) and the combination of ICS and LABA, respectively, which was significantly higher in male participants (p<0.001). According to our findings and in comparison to the previous ISAAC study in Yazd, the prevalence of severe asthma has decreased which indicates better management of asthma during the past two decades.

Frequency Distribution of Antibiotic Therapy Intervention According to Lumbar Puncture Cerebrospinal Fluid Outcome in Hospitalized Children

Background: The aim of this study was to evaluate the frequency distribution of antibiotic therapy according to lumbar puncture outcome in hospitalized children. Methods:This study was conducted on 94 children undergoing lumbar puncture. All data were extracted from medical records. Administration of primary treatments and initial diagnosis including febrile convulsion, meningitis, and encephalitis in these patients were based on a physician's opinion. Results:The majority of subjects were diagnosed with febrile convulsion. Antibiotic treatment before lumbar puncture was taken by 58 children. After lumbar puncture, 35 children discontinued antibiotic therapy, two patients were switched to another antibiotic treatment and 21 subjects continued antibiotic medication. In addition, 36 children did not take antibiotics. Positive PCR was found in four cases from the encephalitis group. Conclusion: After lumbar puncture, antibiotic treatment was continued in 23 cases, whereas administration of antibiotics could be justified only in four cases based on positive PCR. Given that antibiotic treatment of our subjects was initiated prior to lumbar puncture but it was changed in two cases and continued in 21 cases after the medical procedure, conducting lumbar puncture seemed to be not very useful in these patients, assuming that laboratory signs or symptoms could justify an antibiotic treatment.

Antiepileptic Hypersensitivity Syndrome to Phenobarbital: A Case Report

Phenobarbital is still one of the most commonly used medical treatments for different types of seizures. It has numerous different side-effects. Antiepileptic hypersensitivity syndrome (AHS) is a rare and potentially life-threatening adverse reaction to aromatic anticonvulsants such as phenobarbital. Its characteristic features are fever, rash, and lymphadenopathy with different severity of hematologic abnormalities. This case report presents a 26-month-old girl that developed fever, disseminated maculopapular rash, petechiae and thrombocytopenia two weeks after the initiation of phenobarbital prescribed for febrile seizure prophylaxis. The patient was admitted in our center with the impression of hypersensitivity syndrome, so phenobarbital was discontinued and her treatment was resumed with methylprednisolone and intravenous immunoglobulin. After a few days, all symptoms improved and the platelet count was normalized. Thrombocytopenia is a rare complication of hypersensitivity syndrome to phenobarbital in children. Paying attention to this point can prevent the life-threatening adverse effects of this highly consumed medicine.

Study to evaluate two dosage regimens of vitamin D through an academic year in middle school girls: a randomized trial

Vitamin D is an essential hormone for growth and development of bones in children. There is a lot of evidence for deficiency of this vitamin in Middle East females. This study conduct to find a way to combat deficiency in girls during rapid growth phase of puberty in academic year. One hundred and two Middle School girls who had not consumed any vitamins supplement have been participated in this randomized clinical trial. They allocated randomly in two case groups who received 50,000 or 100,000 IU vitamin D3 in October and three months later in January or in control group who received vitamin E. At the end of winter blood samples for 25-hydroxyvitamin D were checked. The mean of 25-hydroxyvitamin D were 5.5±1.5 ng/ml, 15.2±6 ng/ml, 23.0±6.8 ng/ml in control, 50,000 and 100,000 IU vitamin D groups respectively (P<0.05). Neither dosage of vitamin D could raise 25-hydroxyvitamin D above 20 ng/ml in all cases. However, none of the students in 100,000 IU of vitamin D3 had severe deficiency in winter. Headache, dizziness, and weakness were the most common complain after vitamin D consumption, but no difference between groups detected (P>0.05). Urine calcium/creatinin ratio was equal in case and control groups (P>0.05). 100,000 IU of vitamin D3 every three months (equal to 800 IU/day) can raise 25-hydroxyvitamin D above 12 ng/ml in all cases but for area with high prevalence of sever deficiency, dosage more than 100,000 IU every three months or shorter interval recommended to achieve optimal level.

Water status of breastfed infants during weaning in Yazd, Iran

OBJECTIVE

To investigate the state of hydration in infants during the weaning period in dry and hot climates in the center of Iran.

METHODS

Using a refractometer, 162 urine specific gravity (USG) was measured from 400 infants, between 4 to 6 months old. They were chosen among infants who visited the primary clinics in the city of Yazd, Iran for routine vaccination during the summer and winter of 2005. A questionnaire was filled out on air conditioning system and diet from mothers. A USG >1.020 was accepted as dehydrated, and a USG <1.010 as well hydrated.

RESULTS

Thirty-one percent of the infants were dehydrated, and 34% were well hydrated, infants were more dehydrated in summer (p<0.05). Twenty-seven percent of them started solid food without water supplementation, and dehydration was significant in most of them (p<0.05). We could not determine which type of air conditioning devices now used at home affect water status, but there was a trend toward dehydration in those using both fan and cooler (p=0.096).

CONCLUSION

In the desert area in the center of Iran, during weaning, approximately one third of the infants are exposed to the danger of dehydration. Our primary health care provider should consider the priority of water during weaning when water supplementation is safe.