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Intestinal Malakoplakia in Children
Fatemeh Farahmand,Hassan Karamy,Fatemeh Mahjoub
Iranian Journal of Pediatrics , 2008,
Abstract: Objective: Malakoplakia is a rare inflammatory disease, related to enterobacterial infection in the context of a disorder of cell-mediated immunity. Malakoplakia is exceptional in children and usually involves the gastrointestinal tract. The diagnosis is exclusively based on histological analysis.Cases Presentation: In this paper we have reported 3 children with intestinal malakoplakia which were enrolled during a period of 6 years between 2001 to 2006 at Childrens Medical Center. Two were male, and one female. The main clinical manifestations were: chronic bloody and mucosal diarrhea, abdominal pain and polypoid masses detected by diagnostic colonoscopy. Histological diagnosis proved to be definite in these cases. The response to drug treatment with trimethoprim-sulfamthoxazole in all three patients was good. Conclusion: The presence of intestinal malakoplakia must be ruled out in every child having chronic bloody mucosal diarrhea.
Breastfeeding and Helicobacter Pylori Infection in Children with Digestive Symptoms
Maryam Monajemzadeh,Fatemeh Farahmand,Fatemeh Vakilian,Fatemeh Mahjoub
Iranian Journal of Pediatrics , 2010,
Abstract: Objective:This study aims to evaluate the role of breastfeeding in the acquisition of Helicobacter pylori (H. pylori) infection in Iran and to compare the histopathologic changes occurring in children feeding on breast milk with those in infants feeding on formula. Methods:In a case-control study parents of children with and without H. pylori infection who had undergone endoscopic survey and gastric biopsy in the Childrens Medical Center, Tehran, were asked about their feeding practices during the first 6 months after birth, the duration of breastfeeding period, the symptoms, and the duration of symptoms and concomitant diseases. Findings:A total of 154 children were included in this study. From this sample, 77 children formed the case group and 77 children formed the control group. A significant difference was found between H. pylori infection and feeding with formula (P=0.045). In case group, a significant difference was found between breastfeeding and age of the infected child (P=0.034), shorter duration of symptoms (P=0.016), and finally degree of H. pylori colonization (P=0.021). Conclusion:It appears that breastfeeding in the first 6 months after birth can decrease the degree of H. pylori colonization, postpone infection until older age, shorten the duration of symptoms, and be concomitant with milder gastritis.
The Role of Abdominal Ultrasonograghy in Predicting Pediatric Gastritis and Helicobacter Pylori Infection
Fatemeh Khanali,Mehrzad Mehdizade,Fatemeh Farahmand,Fatemeh Mahjoub
Iranian Journal of Radiology , 2009,
Abstract: "nIntroduction: There are not any reports on the relationship between the thickness of gastric layers assessed by ultrasonography and histologic diagnosis of gastritis and Helicobacter pylori (Hp) infection. The aim of our study was to assess the diagnostic accuracy of abdominal ultrasonography (AUS) in the diagnosis of gastritis and HP infection in children. "nMaterials and Methods: A total of 100 children, 1 to 15 years old with abdominal pain and a history of peptic disease who had to undergo endoscopic evaluation and biopsy were included in this study. The thickness of gastric antral layers was measured by AUS before endoscopy. Histologic assessment was performed including the presence and type of gastric inflammation and the density of mast cells. All specimens were also assessed for HP. SPSS was used for statistical analysis. "nResults: A statistically significant increase in the thickness of the first two layers of the antral wall (but not the whole layers) was seen in HP affected children.(P =0.03). The children who suffered from gastritis without HP infection did not show any significant changes in the gastric layer thickness in comparison with the unaffected group. "nConclusion: AUS is a useful noninvasive procedure which could evaluate the thickness of the gastric antral layers in children. It helps us to predict infection with HP if the thickness of the first two layers of the gastric antrum is increased. "nKeywords: Abdominal Ultrasonograghy, Helicobacter Pylori Infection, Gastritis, Mast Cell Density, Thickness of Gastric Wall Layer.
Intestinal Neuronal Dysplasia with Intermittent Diarrhea and Pseudo Obstruction
Mandana Rafeey,Afshin Dezhakam,Fatemeh Mahjoub
Research Journal of Biological Sciences , 2012,
Abstract: Intestinal Neuronal Dysplasia (IND) is a bowel motility disorder, consisting two distinct clinicopathologic subtypes one manifesting itself as intermittent diarrhea and the other as chronic constipation. We report a patient with intermittent diarrhea and failure to thrive who have a pseudo-obstruction which finally led to the diagnosis of a Intestinal neuronal dysplasia. A review of literature is presented to elucidate the differential diagnosis of the neuronal intestinal dysplasia and pseudo obstruction.
Sirenomelia; A Case Report and Review Article
Fatemeh Mahjoub,Ali-Asghar Aliehpour
Iranian Journal of Pediatrics , 2007,
Abstract: Objective: Sirenomelia or Mermaid syndrome is characterized by complete or incomplete fusion of lower extremities with an incidence of 1.5 to 4.2 in 100000 live births. It occurs in gastrulation period (beginning of third gestational week) because of insufficient mesoderm formation in caudal region. Various theories have been postulated to explain the etiology of sirenomelia such as pressure theory which denotes that some intra-uterine force, probably amniotic, acts on the tail of embryo. The aim of this study was to present a rare congenital malformation. In addition we reviewed the pertinent literature in this regard.Case Presentation: We report a case of sirenomelia with multiple interesting anomalies including bilateral renal agenesis, absent external genitalia, gall bladder agenesis, colorectal agenesis from mid ascending colon, ileosacral dysgenesis, meningocele, caudal tapering of abdominal aorta and single umbilical artery. History, detailed autopsy findings and review of literature are presented in this report. Conclusion: Sirenomelia is a rare congenital malformation leading to stillbirth or early death after birth due to multiple anomalies, so promp intra-uterine diagnosis and therapeutic abortion is of utmost importance.
Intestinal Neuronal Dysplasia with Intermittent Diarrhea and Pseudo Obstruction
Mandana Rafeey,Afshin Dezhakam,Fatemeh Mahjoub
Research Journal of Biological Sciences , 2008,
Abstract: Intestinal Neuronal Dysplasia (IND) is a bowel motility disorder, consisting two distinct clinicopathologic subtypes one manifesting itself as intermittent diarrhea and the other as chronic constipation. We report a patient with intermittent diarrhea and failure to thrive who have a pseudo-obstruction which finally led to the diagnosis of a Intestinal neuronal dysplasia. A review of literature is presented to elucidate the differential diagnosis of the neuronal intestinal dysplasia and pseudo obstruction.
Introducing a Rapid and Safe Method for Myeloperoxidase Staining  [PDF]
Fatemeh E. Mahjoub, Fahimeh Firouzjaie Karder, Issa Jahanzad, Saghi Vaziri, Ramezan Ali Sharifian, Zahra Farahani
Open Journal of Pathology (OJPathology) , 2015, DOI: 10.4236/ojpathology.2015.52006
Abstract: Background: Myeloperoxidase staining is used to differentiate leukemias since several decades. Despite implementation of flow cytometric, cytogenetic and molecular techniques for identification of leukemic blasts, histochemical stains such as myeloperoxidase stain are persistently used for better classification of leukemias. The myeloperoxidase staining is a time consuming and hazardous procedure. The present report describes a sensitive, rapid and easy method for assessment of peroxidase activity. Materials and Methods: Bone marrow aspiration slides were stained with Dako product: Code number: K3467 containing DAB chromogen (3,3-diaminobenzidine in chromogen solution) and substrate buffer (Imidasole-HCL buffer, PH 7.5 containing hydrogen peroxide and an anti microbial agent) in a rapid procedure taking only ten minutes time. The staining needs no material preparation steps. Neutrophils in the slide are taken as positive control or another normal smear was costained to be used as control. All cases were followed up with flow cytometry and cytogenetic studies. Result: The reaction product of this stain is brown and granular. Promyelocytes and myelocytes are the most strongly staining cells with positive (primary) granules. Lymphoblasts are negative. The result of classification of leukemias with this technique was in concordance with flow cytometric immunophenotyping. Discussion: Many practical techniques have been described using benzidine as an indicator for myeloperoxidase staining. Benzidine is a carcinogenic material and its usage is severely restricted in laboratory. Formerly we prepared requisite materials for myeloperoxidase staining by hazardous ways (boiling), but we decided to apply ready to use 3,3-diaminobenzidine (DAB), which is used in final step of immunohistochemistry stains. Conclusion: Use of 3,3-diaminobenzidine (DAB) is highly recommended for myeloperoxidase staining, while the result is extraordinary and fully compatible with flow cytometry and the method is safe and rapid.
Atomic Absorption Spectrometry in Wilson’s Disease and Its Comparison with Other Laboratory Tests and Paraclinical Findings
Fatemeh Mahjoub,Rana Fereiduni,Isa Jahanzad,Fatemeh Farahmand
Iranian Journal of Pediatrics , 2012,
Abstract: Objective: Wilson's disease (WD) is an autosomal recessive disease with genetic abnormality on chromosome 13 causing defect in copper metabolism and increased copper concentration in liver, central nervous system and other organs, which causes different clinical manifestations. The aim of this study was to determine the sensitivity of different clinical and paraclinical tests for diagnosis of Wilson’s disease.Methods: Paraffin blocks of liver biopsy from 41 children suspicious of WD were collected. Hepatic copper concentrations were examined with atomic absorption spectrophotometry (Australian GBC, model: PAL 3000). Fifteen specimens had hepatic copper concentration (dry weight) more than 250μg/g. Clinical and laboratory data and histologic slides of liver biopsies of these 15 children were reviewed retrospectively. Liver tissue was examined for staging and grading of hepatic involvement and also stained with rubeonic acid method for copper.Findings: Patients were 5-15 years old (mean age=9.3 years, standard deviation=2.6) with slight male predominance (9/15=60%). Five (33%) patients were 10 years old. Three (20%) of them were referred for icterus, 8 (54%) because of positive family history, 2 (13%) due to abdominal pain and 2 (13%) because of hepatosplenomegaly and ascites. Serum AST and ALT levels were elevated at the time of presentation in all patients. In liver biopsy, histological grade and stage was 0-8 and 0-6 respectively, 2 (13%) had cirrhosis, 1 (7%) had normal biopsy and 12 (80%) showed chronic hepatitis. Hepatic copper concentrations were between 250 and 1595 μg/g dry weight. The sensitivity of various tests were 85% for serum copper, 83% for serum ceruloplasmin, 53% for urinary copper excretion, 44% for presence of KF ring and 40% for rubeonic acid staining on liver biopsies.
Congenital Microvillous Atrophy, Report of Two Consecutive Siblings with Complete Histologic, Immunohistochemical and Detailed Electron Microscopic Studies, First Report from Iran  [PDF]
Fatemeh Elham Mahjoub, Seyedeh Nakisa Niknejad, Mahnaz Sadeghian, Afshin Abdirad, Mehri Najafi Sani, Issa Jahanzad, Elham Talachian
Open Journal of Pathology (OJPathology) , 2014, DOI: 10.4236/ojpathology.2014.42010
Abstract:

Introduction: Microvillous inclusion disease (MVD) or microvillous atrophy disorder is a congenital disorder of the small intestinal epithelial cells that presents with persistent and severe diarrhea and it is characterized by enterocytes abnormalities [1]. For these children, prognosis is generally poor due to metabolic acidosis with poor compensation. To our experiment, this disease is very rare in Iran and it is yet unreported, so we decided to report two consecutive siblings with the same disease from Iran. Report of Cases: Two siblings were born to healthy parents. Parents were cousins. Both siblings were hospitalized due to severe diarrhea starting shortly after breast feeding. The frequency of diarrhea in both cases was 10 to 17 times per day and their stools were loose and green. Histological studies of both siblings revealed duodenal mucosa with complete flattening of villi (total villous atrophy). Superficial lining cells showed atrophy. Crypts showed no hyperplasia, however it showed distortion and difference in size. By PAS staining and CD10 staining, a poorly developed brush border and typical inclusions were seen in apical boarder of enterocytes. Electron microscopy was performed for the second case and showed microvillous involution and inclusions in the apical part of the epithelial cells. Discussion: Microvillous congenital atrophy is a rare congenital disorder. Due to rareness of congenital microvillous atrophy (CMA), it is crucial to distinguish it from other diseases with persistent and severe diarrhea as soon as possible.

Congenital spinal tumor in a patient with encephalocele and hydrocephalus: a case report
Farid Radmanesh, Farideh Nejat, Fatemeh Mahjoub, Mostafa El Khashab
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-9
Abstract: We report the case of an Iranian girl with a history of encephalocele surgery, who, at the age of four years, developed an intramedullary spinal teratoma, and discuss the pathogenesis of this association.To the best of our knowledge, this is the first report of an association between encephalocele and spinal teratoma.Encephalocele refers to a group of rare congenital anomalies of the central nervous system (CNS), where brain tissue protrudes from a defect in the skull [1]. Its prevalence has been estimated to be 0.8 to four in every 10,000 live births [2].Teratomas are tumors derived from all three germ layers [3]. In children, teratomas are more commonly found in the sacrococcygeal region than in the spinal cord [4], which occurs in one of 38,500 viable births. Intramedullary spinal teratomas are rare tumors [5]. In 41.7% of teratomas, a concomitant anomaly of the vertebral canal is found, most commonly a diastematomyelia, [4]. However to the best of our knowledge, there is nor repot of an association with encephalocele in the English literature.We report a case of encephalocele and lumbar intramedullary teratoma and discuss the possible etiology.A four-year old Iranian girl was referred to the neurosurgical department with severe back pain and motor regression. She was the second child of nonconsanguineous parents, and was delivered by elective Cesarean section due to being repeat. She had a history of occipital encephalocele, which was treated surgically during the neonatal period and she later received a shunt to treat progressive hydrocephalus. She could sit at nine month of age and stand at two years, but was unable to walk. Six months before her referral, she had developed back pain, which was particularly severe at night, and after three months, she was unable to stand.On physical examination, our patient was found to be generally normal, with good mental performance, and normal results from a neurological examination of the arms. She had a head circumferenc
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