Medical Journal of The Islamic Republic of Iran (MJIRI)

 ABSTRACT

 Background: To determine daily calcium, Vitamin D intake and serum biochemical findings of rickets in adolescent girls.

 Methods: A total of 414 healthy adolescent student girls aged 11-15 years were evaluated from various areas of Tehran, Iran with different socioeconomic status. A randomized, cross-sectional, prospective and descriptive study was undertaken for calculation of daily calcium, phosphorus intake and vitamin D acquirement by sunlight exposure by seven day recall record questionnaire. Serum 25-hydroxyvitamin D, parathyroid hormone, calcium, phosphorus and alkaline-phosphatase levels were measured. The serum abnormal biochemical findings of girls were divided as follows: normal or low calcium with raised alkaline phosphatase, group I normal or low calcium with raised alkaline phosphatase, normal or raised parathyroid hormone, low 25- hydroxyvitamin D, group II and low phosphorus and 25-hydroxyvitarnin D with raised parathyroid hormone, group III.

 Results: A total of 44 ( 10.62%) girls of 414 had abnormal biochemical findings, of these 29 (7%) were in group I, 9 (2.17%) in group II, and 6( 1.45%) in group III. The mean daily calcium intake and vitamin D acquirement by sunlight exposure and dietary intake were 360.85±350.50mg and 119.2±52.9 IU respectively. All girls had inadequate dietary calcium and vitamin D intake. All had less than 40 minutes sun exposure per day.

 Conclusion: This survey demonstrated that abnormal biochemical findings of rickets can occur even in sunny climates and are is caused by two factors, inadequate calcium intake as the major factor and vitamin D deficiency as a minor factor.

  Abstract

  Background: Diarrhea has been recognised as a major public health problem worldwide. Aprospective study was performed to determine the etiology, seasonal and age prevalence, relevant laboratory investigations, sensitivity of isolated microorganisms to current medication, and practical approaches to the diagnosis and management of diarrhea in Iran, as a developing country.

  Methods: All infants and children under age five (n=825, mean age 18.9) admitted to

  Tehran Children’s Hospital, Tehran, with diarrheal symptoms during the period of April

  2005 to March 2006 were included in the study 371 approximately age-matched controls (mean age 19.1 months) from the same hospital but not having diarrhea formed the control group.

  Results: The most frequent isolated pathogen was Escherichia coli (18.9%), followed

  by Shigella spp (0.7%), and Salmonella spp (0.4%). Prevalence of diarrheic children with

  either isolated or non-isolated pathogens were 66.5% in the colder seasons and 54.4% in warm seasons. E. coli was more prevalent in children younger than two years old while Sigella spp and Salmonella spp were common to all ages. Fecal leukocytes were associated with 100% of isolated Escherichia coli, 19.4% of non-isolated organisms, 2.5% of Shigella spp, 0.5% of Salmonella spp and none in controls. Escherichia coli was also associated with fecal red blood cells (29.4%), as were Shigella spp (83%) and Salmonella spp (33.3%). White blood cell counts, polymorphonuclear cells, band cells, erythrocyte sedimentation rate and C-reactive protein measurements had no diagnostic value. Amikacin was the global choice of antimicrobial treatment for Shigella spp in (99%) of cases and for Escherichia coli in (91%) of isolated cases. Only 70% of patients infected by Salmonella showed sensitivity to Gentamycin.

  Conclusion: Diarrheal diseases in either isolated or non-isolated pathogens were more

  prevalent in the colder seasons and in children younger than two years of age. For differentiation of bacterial from non-bacterial etiology, we had to wait for laboratory reports and then decide for antibiotic administration. The antibiotic most sensitive to Echerichia coli and Shigella was Amikacin, and Gentamycin was the most sensitive drug for Salmonella.