The Open Urology & Nephrology Journal




ISSN: 1874-303X ― Volume 12, 2019
RESEARCH ARTICLE

Does the Trace Element Deficiency (Vit A, D & Zinc) Have Any Role in Vulnerability to Urinary Tract Infection in Children: A Case-Control Study: Tehran, Iran



Samileh Noorbakhsh1, *, Shima J. Nia2, Zahra Movahedi3, Sarvenaz Ashouri4
1 Department of Pediatric Infectious Disease, Iran University of Medical Sciences, Tehran, Iran
2 Department of Pulmonary Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Pediatric Infectious Diseases, Hazrat Masoumeh Hospital, Qom University of Medical Sciences and Health Services, Qom, Iran
4 ENT and Head and Neck Research Center and Department, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background and Objective:

Urinary Tract Infection (UTI) is one of the most common causes of hospital admission in our young population. This prospective cohort study was carried out to assess the relation of serum levels of zinc, vitamins A and D with UTI in children with proven UTI.

Methods:

The serum levels of Zinc, vitamins A and D were compared between 25 proven UTI cases (admitted in 2 educational hospitals in Tehran) and 40 controls without infection (children who had undergone for elective surgery). The average age of children was 2.17 years. Atomic absorption Spectrophotometry, Radioimmunoassay, and HPLC methods were used for measuring the Zinc, Vit D and A, respectively.

Results:

Although the serum levels of zinc were significantly lower in UTI cases (P=0.05), no significant differences had observed between cases and controls for vitamins A and D in sera (P=0.4 and P=0.9).

Conclusion:

Due to established lower zinc level in UTI cases (p-value = 0.05), zinc deficiency might have a role in susceptibility to UTI in studied children. Administration of zinc could be helpful in preventing UTI. To establish the role of Vitamins A and D in vulnerability to UTI, further extensive research with larger samples is needed.

Conclusion:

Due to established lower zinc level in UTI cases (p-value = 0.05), zinc deficiency might have a role in susceptibility to UTI in studied children. Administration of zinc could be helpful in preventing UTI. To establish the role of Vitamins A and D in vulnerability to UTI, further extensive research with larger samples is needed.

Keywords: Urinary Tract Infection , Pyelonephritis , Children , Vitamin A , Vitamin D , Zinc .


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 12
First Page: 23
Last Page: 26
Publisher Id: TOUNJ-12-23
DOI: 10.2174/1874303X01912010023

Article History:

Received Date: 16/01/2019
Revision Received Date: 24/05/2019
Acceptance Date: 30/05/2019
Electronic publication date: 31/07/2019
Collection year: 2019

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 119
Abstract HTML Views: 122
PDF Downloads: 74
ePub Downloads: 78
Total Views/Downloads: 393

Unique Statistics:

Full-Text HTML Views: 84
Abstract HTML Views: 89
PDF Downloads: 54
ePub Downloads: 57
Total Views/Downloads: 284
Geographical View

© 2019 Noorbakhsh et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Departement of pediatric infectious diseases, 4th floor, Hazrat Rasul Hospital, Niayesh Street, Satarkhan Avenue, Tehran, 14455 Islamic Republic of Iran; Tel: +98-21-66525328;
Fax: +98-21-66525328; Email: samileh_noorbakhsh@yahoo.com





1. INTRODUCTION

Urinary Tract Infection (UTI) is considered as one of the most common causes of hospital admission with estimated incidences of 1.28 per 1000 in girls and 0.18 per 1000 in boys younger than 14 years and a prevalence of 5.3% in febrile infants [1Schweich PJ. Fever in young infants.Oski’s Pediatrics 4th ed. 2006; 4th ed.701-2.]. Symptoms of UTI include fever, anorexia, and vomiting, dysuria, frequent and flank pain. These patients are more susceptible to renal scars and other possible complications (growth retardation, hypertension, proteinuria, and chronic renal failure) [2Frankul FA, Tawaige ZH. AL-Janabi AA.Urinary tract infections in febrile children. J Fac Med Baghdad 2003; 45(3-4): 41-50.]. The recurrence of APN is independently associated with increased risk of renal scarring [1Schweich PJ. Fever in young infants.Oski’s Pediatrics 4th ed. 2006; 4th ed.701-2.]. Nutritional deprivations in children might have some role in recurrent infections [3Freedman AL. Urologic diseases in North America Project: Trends in resource utilization for urinary tract infections in children. J Urol 2005; 173(3): 949-54.[http://dx.doi.org/10.1097/01.ju.0000152092.03931.9a] [PMID: 1571 1347] , 4Cuevas LE, Koyanagi A. Zinc and infection: A review. Ann Trop Paediatr 2005; 25(3): 149-60.[http://dx.doi.org/10.1179/146532805X58076] [PMID: 16156979] ]. In addition to the studied factors; bacterial virulence, immunodeficiency and anatomic or functional abnormalities make children with UTI vulnerable to renal scarring [3Freedman AL. Urologic diseases in North America Project: Trends in resource utilization for urinary tract infections in children. J Urol 2005; 173(3): 949-54.[http://dx.doi.org/10.1097/01.ju.0000152092.03931.9a] [PMID: 1571 1347] , 4Cuevas LE, Koyanagi A. Zinc and infection: A review. Ann Trop Paediatr 2005; 25(3): 149-60.[http://dx.doi.org/10.1179/146532805X58076] [PMID: 16156979] ]. Other factors such as the route of antibiotics administration, the time elapsed before the onset of symptoms and initiation of therapy are important factors [5Castellani ML, Shaik-Dasthagirisaheb YB, Tripodi D, et al. Interrelationship between vitamins and cytokines in immunity. J Biol Regul Homeost Agents 2010; 24(4): 385-90.[PMID: 21122276] , 6van den Broek N, Dou L, Othman M, Neilson JP, Gates S, Gülmezoglu AM. Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst Rev 2010; 11(11) CD008666[PMID: 21069707] ]. Trace elements like vitamins and minerals are essential for efficient metabolism and proper functioning of various body systems, namely immune system [7Munday JS, McKinnon H, Aberdein D, Collett MG, Parton K, Thompson KG. Cystitis, pyelonephritis, and urolithiasis in rats accidentally fed a diet deficient in vitamin A. J Am Assoc Lab Anima Sci 2009; 48(6): 790-4.-9Youssef DA, Miller CW, El-Abbassi AM, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol 2011; 3(4): 220-9.[http://dx.doi.org/10.4161/derm.3.4.15027] [PMID: 22259647] ] Youssef et al., (2011) reported antimicrobial implications of vitamin D [9Youssef DA, Miller CW, El-Abbassi AM, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol 2011; 3(4): 220-9.[http://dx.doi.org/10.4161/derm.3.4.15027] [PMID: 22259647] ]. Aslan et al., (2012) presented vitamin D receptor gene polymorphism in children with urinary tract infection [10Aslan S, Akil I, Aslan G, Onay H, Ozyurt BC, Ozkinay F. Vitamin D receptor gene polymorphism in children with urinary tract infection. Pediatr Nephrol 2012; 27(3): 417-21.[http://dx.doi.org/10.1007/s00467-011-2000-0] [PMID: 21947233] ]. The study of Hertting et al., showed that Vitamin D induced antimicrobial Peptide cathelicidin in the urinary bladder [11Hertting O, Holm Å, Lüthje P, et al. Vitamin D induction of the human antimicrobial Peptide cathelicidin in the urinary bladder. PLoS One 2010; 5(12)e15580[http://dx.doi.org/10.1371/journal.pone.0015580] [PMID: 21179490] ].

UTI is considered as one of the most common causes of hospital admission in Iranian young children [12Noorbakhsh S, Farhadi M, Tabatabaei A. Determination of the MIC of antibiotics for gram negative microorganisms isolated from the sterile sites of children hospitalized in Rasool Akram hospital. Iran J Pediatr 2006; 16(4): 419-25.-18Otukesh H, Hoseini R, Behzadi AH, et al. Accuracy of cystosonography in the diagnosis of vesicourethral reflux in children. Saudi J Kidney Dis Transpl 2011; 22(3): 488-91.[PMID: 21566305] ]. According to a trial on UTI, a good correlation between Vitamin A level and progression of UTI in children had found in our country [19Sobouti B, Hooman N, Movahed M. The effect of vitamin E or vitamin A on the prevention of renal scarring in children with acute pyelonephritis. Pediatr Nephrol 2013; 28(2): 277-83.[http://dx.doi.org/10.1007/s00467-012-2308-4] [PMID: 23052650] ].The effect of vitamin A in the prevention of renal damage following APN in Iranian children was reported by Ayazi et al., [20Ayazi P, Moshiri SA, Mahyar A, Moradi M. The effect of vitamin A on renal damage following acute pyelonephritis in children. Eur J Pediatr 2011; 170(3): 347-50.[http://dx.doi.org/10.1007/s00431-010-1297-1] [PMID: 20853007] ]. Nutritional status of Iranian population might have some role in recurrent infections among Iranian children [21Yousefi P, Moghaddasi Z, Tabaei A. Therapeutic effects of zinc supplementation in children with urinary tract infection. Koomesh 2010; 12(2): 204-8. [Persian].-25Javadi-Nia S, Noorbakhsh S, Izadi A, Shokrollahi MR, Asgarian R, Tabatabaei A. Vitamin A, D and zinc serum levels in children with and without acute respiratory tract infection in two university hospitals Tehran. Univ Med J (TUMJ) 2014 March; 71(12): 794-9.].

This prospective cohort study was carried out to assess the relation of serum level of zinc, and Vitamins A and D with UTI in children with proven UTI.

2. MATERIALS AND METHODS

This prospective cohort study. was carried out on 25 children (< 5 years old) with hospitalized in 2 referral educational hospitals (Rasul Akraml and Bahrami hospital; 2011-2013) and 40 children without infection (controls). The trial was performed after being credited by the Ethics Committee of Pediatric Infectious Diseases Research Center of Iran University of Medical Sciences to be compatible with Helsinki Regulations. An informed consent was obtained from every patient. A questionnaire on personal information, patients` medical history and imaging results was filled out.

2.1. Subjects

The cases included 25 proven upper UTI cases admitted in 2 referral educational hospitals. Upper UTI was established in cases and documented, based on clinical and laboratory examinations (positive urine culture), and confirmed with imaging studies (ultrasonography with or without DMSA scan).

Exclusion criteria: excluded all cases with Failure To Thrive (FTT) growth problems (i.e. weight for age, height for age or weight for height <-2 z-score in WHO Multicenter Growth Reference Study growth curves), underlying diseases, immunodeficient cases known malignancies or malabsorption states.

2.2. Controls

The control group included 40 age-matched children who were admitted for elective general surgery in the surgery department (i.e. appendicitis, hernia, orthopedic etc.). They were visited by a pediatrician before surgery to be assessed free of infectious status, FTT or malnourishment. Only if they had no manifestation of the disease after appropriate physical exams, they were considered as controls. We used their extra blood (which was taken for their routine blood tests before their respective surgery) for lab tests.

2.3. Lab Tests

Five ml of blood was collected from all children .Blood was centrifuged and sera were separated by centrifugation at 3,000 rpm for 10 minutes and stored in -20°C. The zinc, vitamin A and 25-hydroxyvitamin D (25(OH) D) levels were measured in all samples. Doping was done from the kits’ information sheets. The amount for Zinc, vitamins A and D in sera was measured and reported according to the normal cut off points indicated on laboratory kits.

We used the atomic absorption spectrophotometer AVANTA (GBC Scientific Equipment Pty Ltd, Melbourne, Australia). Serum levels of zinc equal or higher than 65µg/dL were considered normal.

Vitamin A levels were measured by High Performance Liquid Chromatography (HPLC) (Craft technologies, Inc). The normal levels were expressed according to the age. In our study, vitamin A levels between 0.2 and 0.49 mg/mL were considered normal.

We measured 25(OH) D levels by a radioimmunoassay kit (Diasorin, Stillwater, MN, USA) and considered a 25(OH) D level ≤ 20 ng/mL (50 nmol/L) as deficient and a higher level of 25(OH) D up to 30 ng/mL (75 nmol/L) as insufficient.

Collected data and lab results were statistically analyzed by SPSS version 13.5. The data was presented using descriptive statistics. We used Chi square and student’s t-tests to compare the mean between two groups. All p values were calculated using a two-sided test and values lower than 0.05 were considered significant.

3. RESULTS

Subjects were between 6 months and 5 years old (Mean age=2.7 years); 72% of them were male and 28% female. The Male/female ratio was not different(p=1) between cases and controls(1.7 vs. 1.5) ; The BMI (kg/m2) was not different between 2 groups (1.7 vs. 1.5;p=0.1) ;

The results of serum levels of Vit A, Vit D and Zinc of both the groups are shown in Table 1.

Zinc levels were significantly lower in patients than in controls (P value = 0.05).

Vitamin A levels did not show any significant difference (P value = 0.4) between 2 groups. The same results were reported for vitamin D (P value = 0.9).

4. DISCUSSION

Here, we found lower serum levels for zinc (normal > 65 µg/dl) in UTI cases as compared to normal children (95.43 vs. 106.9 µg/dl; P=0.05); but vitamin A level (normal range=0.2 to 0.49 mg/ml) did not have any difference between cases and controls (mean =0.4 mg/ml in both groups; P=0.4). Similarly, Vitamin D levels (normal range=7.3 to 59.2 ng/ml) did have any difference between cases and controls (mean =45 ng/ml, P=0.9).

Table 1
Comparison of the micronutrient levels in UTI cases and controls.


In some previous studies, the relationship between trace elements and vitamins serum levels was studied. Cuevas et al., reviewed the relation between the Zinc level and infection [4Cuevas LE, Koyanagi A. Zinc and infection: A review. Ann Trop Paediatr 2005; 25(3): 149-60.[http://dx.doi.org/10.1179/146532805X58076] [PMID: 16156979] ]. Studies by Castellani et al., indicated an interrelationship between vitamins and cytokines in immunity [5Castellani ML, Shaik-Dasthagirisaheb YB, Tripodi D, et al. Interrelationship between vitamins and cytokines in immunity. J Biol Regul Homeost Agents 2010; 24(4): 385-90.[PMID: 21122276] -10Aslan S, Akil I, Aslan G, Onay H, Ozyurt BC, Ozkinay F. Vitamin D receptor gene polymorphism in children with urinary tract infection. Pediatr Nephrol 2012; 27(3): 417-21.[http://dx.doi.org/10.1007/s00467-011-2000-0] [PMID: 21947233] ] Youssef et al., (2011) reported the antimicrobial implications of vitamin D [9Youssef DA, Miller CW, El-Abbassi AM, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol 2011; 3(4): 220-9.[http://dx.doi.org/10.4161/derm.3.4.15027] [PMID: 22259647] ]. Aslan et al., presented the vitamin D receptor gene polymorphism in children with urinary tract infection [10Aslan S, Akil I, Aslan G, Onay H, Ozyurt BC, Ozkinay F. Vitamin D receptor gene polymorphism in children with urinary tract infection. Pediatr Nephrol 2012; 27(3): 417-21.[http://dx.doi.org/10.1007/s00467-011-2000-0] [PMID: 21947233] ]. Munday et al., showed increased Cystitis, pyelonephritis, and urolithiasis in rats accidentally fed a vitamin A deficient diet [7Munday JS, McKinnon H, Aberdein D, Collett MG, Parton K, Thompson KG. Cystitis, pyelonephritis, and urolithiasis in rats accidentally fed a diet deficient in vitamin A. J Am Assoc Lab Anima Sci 2009; 48(6): 790-4.].

Nutritional deprivations especially vitamins and micronutrients such as zinc, vitamin A and vitamin D in our country are common, it might due to inappropriate diet and nutrient loss, as compared to other parts of middle east [22Kashian S. Fathivand AA. Estimated daily intake of Fe, Cu, Ca and Zn through common cereals in Tehran, Iran. Food 2015; 1: 193-6.-25Javadi-Nia S, Noorbakhsh S, Izadi A, Shokrollahi MR, Asgarian R, Tabatabaei A. Vitamin A, D and zinc serum levels in children with and without acute respiratory tract infection in two university hospitals Tehran. Univ Med J (TUMJ) 2014 March; 71(12): 794-9.]. According to our results, Zinc levels were significantly lower in UTI patients than in controls (P value = 0.05).Low zinc level might have a role in susceptibility to UTI in studied children. Similar to Youssef et al., (2010) reported the therapeutic effects of zinc supplementation in children with UTI [21Yousefi P, Moghaddasi Z, Tabaei A. Therapeutic effects of zinc supplementation in children with urinary tract infection. Koomesh 2010; 12(2): 204-8. [Persian].]. Abbaspour et al., compared the zinc and iron status in a case study in the Isfahan Province, central part of Iran [23Abbaspour N, Wegmueller R, Kelishadi R, Schulin R, Hurrell RF. Zinc status as compared to zinc intake and iron status: A case study of iranian populations from isfahan province. Research 335-45.[http://dx.doi.org/10.1024/0300-9831/a000175] ] concluing that lower Iron level than Zinc level could be due to frequent consumption of tea and dairy products [23Abbaspour N, Wegmueller R, Kelishadi R, Schulin R, Hurrell RF. Zinc status as compared to zinc intake and iron status: A case study of iranian populations from isfahan province. Research 335-45.[http://dx.doi.org/10.1024/0300-9831/a000175] ] while Kashian et al., reported daily intake of Fe, Cu, Ca and Zn through common cereals in Tehran, Iran (2015) [22Kashian S. Fathivand AA. Estimated daily intake of Fe, Cu, Ca and Zn through common cereals in Tehran, Iran. Food 2015; 1: 193-6.]. Ghasemi et al., reported the prevalence of serum zinc deficiency and dietary zinc inadequacy to be lower in Iranians, compared to other populations [24Ghasemi A, Zahediasl S, Hosseini-Esfahani F, Azizi F. Reference values for serum zinc concentration and prevalence of zinc deficiency in adult Iranian subjects. Biol Trace Elem Res 2012; 149(3): 307-14.[http://dx.doi.org/10.1007/s12011-012-9445-2] [PMID: 22592845] ].

The effect of vitamin A on renal damage following Acute Pyelonephritis in Iranian children was studied by Ayazi et al., [20Ayazi P, Moshiri SA, Mahyar A, Moradi M. The effect of vitamin A on renal damage following acute pyelonephritis in children. Eur J Pediatr 2011; 170(3): 347-50.[http://dx.doi.org/10.1007/s00431-010-1297-1] [PMID: 20853007] ] In contrast to some Iranian studies, vitamins A was not different in UTI cases as compared to normal children [19Sobouti B, Hooman N, Movahed M. The effect of vitamin E or vitamin A on the prevention of renal scarring in children with acute pyelonephritis. Pediatr Nephrol 2013; 28(2): 277-83.[http://dx.doi.org/10.1007/s00467-012-2308-4] [PMID: 23052650] , 20Ayazi P, Moshiri SA, Mahyar A, Moradi M. The effect of vitamin A on renal damage following acute pyelonephritis in children. Eur J Pediatr 2011; 170(3): 347-50.[http://dx.doi.org/10.1007/s00431-010-1297-1] [PMID: 20853007] ].

5. LIMITATION THE STUDY

The trace elements level, especially of Vitamins A and D are different among patients of various age groups. Due to small sample size, exact matching had not been done. Further extensive research with larger samples is needed.

CONCLUSION

Due to established lower Zinc level in UTI cases (p-value = 0.05), zinc deficiency might have a role in susceptibility to UTI in studied children. Administration of zinc could be helpful for preventing UTI. For establishing the role of Vitamins A and D in vulnerability to UTI, further extensive research with larger samples is needed.

LIST OF ABBREVIATIONS

UTI = Urinary Tract Infection
HPLC = High Performance Liquid Chromatography
Vit = Vitamin
Zn = Zinc
Ca = Calcium
Fe = Iron
Cu = Copper
APN = Acute Pyelonephritis
DMSA = Dimercaptosuccinic Acid
RDA = Recommended Dietary Allowance

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The trial was performed after being credited by Ethics Committee of Pediatric Infectious Diseases Research Center of Iran University of Medical Sciences.

HUMAN AND ANIMAL RIGHTS

No Animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.

CONSENT FOR PUBLICATION

An informed consent was obtained from every patient.

FUNDING

This project was supported by Pediatric Infectious Diseases Research Center of Iran University of Medical Sciences with Grant No. 1264 mt.

AVAILABILITY OF DATA AND MATERIALS

Not applicable.

AUTHORS’ CONTRIBUTIONS

The authors’ responsibilities were as follows: data acquisition (SA), conception (SA, SN), statistical analysis (SJ), and drafting of manuscript (SJ, SA), critical review, editing, and interpretation of results (ZM). All authors read and approved the final manuscript.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

We would like to thank the patients who participated in the study. Pediatric Infectious Diseases Research Center of Iran University of Medical Sciences is acknowledged for assistance in coordinating the distribution of supplements and receipt of samples and sample processing.

REFERENCES

[1] Schweich PJ. Fever in young infants.Oski’s Pediatrics 4th ed. 2006; 4th ed.701-2.
[2] Frankul FA, Tawaige ZH. AL-Janabi AA.Urinary tract infections in febrile children. J Fac Med Baghdad 2003; 45(3-4): 41-50.
[3] Freedman AL. Urologic diseases in North America Project: Trends in resource utilization for urinary tract infections in children. J Urol 2005; 173(3): 949-54.[http://dx.doi.org/10.1097/01.ju.0000152092.03931.9a] [PMID: 1571 1347]
[4] Cuevas LE, Koyanagi A. Zinc and infection: A review. Ann Trop Paediatr 2005; 25(3): 149-60.[http://dx.doi.org/10.1179/146532805X58076] [PMID: 16156979]
[5] Castellani ML, Shaik-Dasthagirisaheb YB, Tripodi D, et al. Interrelationship between vitamins and cytokines in immunity. J Biol Regul Homeost Agents 2010; 24(4): 385-90.[PMID: 21122276]
[6] van den Broek N, Dou L, Othman M, Neilson JP, Gates S, Gülmezoglu AM. Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst Rev 2010; 11(11) CD008666[PMID: 21069707]
[7] Munday JS, McKinnon H, Aberdein D, Collett MG, Parton K, Thompson KG. Cystitis, pyelonephritis, and urolithiasis in rats accidentally fed a diet deficient in vitamin A. J Am Assoc Lab Anima Sci 2009; 48(6): 790-4.
[8] Williams G, Craig JC. Prevention of recurrent urinary tract infection in children. Curr Opin Infect Dis 2009; 22(1): 72-6.[http://dx.doi.org/10.1097/QCO.0b013e328320a885] [PMID: 19532 083]
[9] Youssef DA, Miller CW, El-Abbassi AM, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol 2011; 3(4): 220-9.[http://dx.doi.org/10.4161/derm.3.4.15027] [PMID: 22259647]
[10] Aslan S, Akil I, Aslan G, Onay H, Ozyurt BC, Ozkinay F. Vitamin D receptor gene polymorphism in children with urinary tract infection. Pediatr Nephrol 2012; 27(3): 417-21.[http://dx.doi.org/10.1007/s00467-011-2000-0] [PMID: 21947233]
[11] Hertting O, Holm Å, Lüthje P, et al. Vitamin D induction of the human antimicrobial Peptide cathelicidin in the urinary bladder. PLoS One 2010; 5(12)e15580[http://dx.doi.org/10.1371/journal.pone.0015580] [PMID: 21179490]
[12] Noorbakhsh S, Farhadi M, Tabatabaei A. Determination of the MIC of antibiotics for gram negative microorganisms isolated from the sterile sites of children hospitalized in Rasool Akram hospital. Iran J Pediatr 2006; 16(4): 419-25.
[13] Ehsanipour F, Gharouni M, Rafati AH, Ardalan M, Bodaghi N, Otoukesh H. Risk factors of renal scars in children with acute pyelonephritis. Braz J Infect Dis 2012; 16(1): 15-8.[http://dx.doi.org/10.1590/S1413-86702012000100003] [PMID: 2235 8350]
[14] Noorbakhsh S, Zarabi V. Urinary Tract Infections, Dr. Peter Tenke (Ed.), ISBN: 978-953-307-757-4. www.intechopen.com/books/urinary -tractinfections/uti-in-children
[15] Ataei N, Sayari-Fard F, Madani A, Esfahani ST, Khorasani M, Ataei F. Scintigraphic screening in the detection of renal scarring in siblings of children with primary reflux. Acta Med Iran 2007; 45(3): 219-26.
[16] Noorbakhsh S, Lari AR, Masjedian F, Mostafavi H, Alaghehbandan R. Comparison of intravenous aminoglycoside therapy with switch therapy to cefixime in urinary tract infections. Saudi Med J 2004; 25(10): 1513-5.[PMID: 15494842]
[17] Zarabi V, Noorbakhsh S, Rahim Zadeh N, Samimi K, Ghafori M, et al. Diagnostic value of dynamic Magnetic Resonance Urogram imaging in children with Urinary Tract Infection. TUMJ 2011; 69(2): 872-7.
[18] Otukesh H, Hoseini R, Behzadi AH, et al. Accuracy of cystosonography in the diagnosis of vesicourethral reflux in children. Saudi J Kidney Dis Transpl 2011; 22(3): 488-91.[PMID: 21566305]
[19] Sobouti B, Hooman N, Movahed M. The effect of vitamin E or vitamin A on the prevention of renal scarring in children with acute pyelonephritis. Pediatr Nephrol 2013; 28(2): 277-83.[http://dx.doi.org/10.1007/s00467-012-2308-4] [PMID: 23052650]
[20] Ayazi P, Moshiri SA, Mahyar A, Moradi M. The effect of vitamin A on renal damage following acute pyelonephritis in children. Eur J Pediatr 2011; 170(3): 347-50.[http://dx.doi.org/10.1007/s00431-010-1297-1] [PMID: 20853007]
[21] Yousefi P, Moghaddasi Z, Tabaei A. Therapeutic effects of zinc supplementation in children with urinary tract infection. Koomesh 2010; 12(2): 204-8. [Persian].
[22] Kashian S. Fathivand AA. Estimated daily intake of Fe, Cu, Ca and Zn through common cereals in Tehran, Iran. Food 2015; 1: 193-6.
[23] Abbaspour N, Wegmueller R, Kelishadi R, Schulin R, Hurrell RF. Zinc status as compared to zinc intake and iron status: A case study of iranian populations from isfahan province. Research 335-45.[http://dx.doi.org/10.1024/0300-9831/a000175]
[24] Ghasemi A, Zahediasl S, Hosseini-Esfahani F, Azizi F. Reference values for serum zinc concentration and prevalence of zinc deficiency in adult Iranian subjects. Biol Trace Elem Res 2012; 149(3): 307-14.[http://dx.doi.org/10.1007/s12011-012-9445-2] [PMID: 22592845]
[25] Javadi-Nia S, Noorbakhsh S, Izadi A, Shokrollahi MR, Asgarian R, Tabatabaei A. Vitamin A, D and zinc serum levels in children with and without acute respiratory tract infection in two university hospitals Tehran. Univ Med J (TUMJ) 2014 March; 71(12): 794-9.
Society Affiliation


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open