Social Development and Revolution in Iran

The scholarship about the consequences of social revolutions contends that social revolutions boost state capacity and strengthen the state’s developmental projects. Social justice and addressing the needs of ordinary citizens also were central themes in the discourse of the Iranian revolution and the Islamic Republic that emerged as the post-revolutionary regime with the fall of the monarchy in Iran. In this essay, I assess the performance of the post-revolutionary state in Iran according to different development indicators. Specifically, I compare the record of the post-revolutionary regime with the pre-revolutionary regime. My examination of various indicators relating to health, education, poverty, income inequality, and housing presents more of a mixed result than the overall improvement that previous scholarship anticipated and that the post-revolutionary regime had promised. Furthermore, the evidence points to declines in some important areas of development and welfare provision. Based on this analysis, I propose directions for future research about the developmental outcome of revolutions.

Update on Neonatal Isolated Hyperthyrotropinemia: A Systematic Review

The purpose of this paper was to systematically summarize the published literature on neonatal isolated hyperthyrotropinemia (HTT), with a focus on prevalence, L-T4 management, re-evaluation of thyroid function during infancy or childhood, etiology including genetic variation, thyroid imaging tests, and developmental outcome. Electronic and manual searches were conducted for relevant publications, and a total of 46 articles were included in this systematic review. The overall prevalence of neonatal HTT was estimated at 0.06%. The occurrence of abnormal imaging tests was found to be higher in the persistent than in the transient condition. A continuous spectrum of thyroid impairment severity can occur because of genetic factors, environmental factors, or a combination of the two. Excessive or insufficient iodine levels were found in 46% and 16% of infants, respectively. Thirty-five different genetic variants have been found in three genes in 37 patients with neonatal HTT of different ethnic backgrounds extracted from studies with variable design. In general, genetic variants reported in the TSHR gene, the most auspicious candidate gene for HTT, may explain the phenotype of the patients. Many practitioners elect to treat infants with HTT to prevent any possible adverse developmental effects. Most patients with thyroid abnormalities and/or carrying monoallelic or biallelic genetic variants have received L-T4 treatment. For all those neonates on treatment with L-T4, it is essential to ensure follow-up until 2 or 3 years of age and to conduct medically supervised trial-off therapy when warranted. TSH levels were found to be elevated following cessation of therapy in 44% of children. Withdrawal of treatment was judged as unsuccessful, and medication was restarted, in 78% of cases. Finally, data extracted from nine studies showed that none of the 94 included patients proved to have a poor developmental outcome (0/94). Among subjects presenting with normal cognitive performance, 82% of cases have received L-T4 therapy. Until now, the precise neurodevelopmental risks posed by mild disease remain uncertain.

Evaluation and Cardiac Rehabilitation on a patient with a congenital heart disease

Funding Acknowledgements Type of funding sources: None. Introduction Severe congenital heart disease (CHD) requiring surgical intervention occurs in 6 of 1000 live-born infants. Substantial improvements in surgical treatment and perioperative care have led to excellent long-term cardiac outcomes for most of these patients and, consequentially, to a significant increase in survival rates. Formal evaluations of preschool, school-aged children and adolescents born with complex CHD demonstrate a pattern of neurodevelopmental sequelae, which may appear alone, or in combination. Purpose F. is a 21 years-old patient with repaired complex transposition of the great arteries with ventricular septal defect, who have already undergone three surgeries: a) an initial palliative surgery (pulmonary artery banding and ductus arteriosus ligation) at the neonatal period; b) a corrective surgery (arterial switch and VSD closure) at the end of the first year of life and c) Pulmonary artery plasty for residual pulmonary stenosis at the age of 16 years-old. Now, he was admitted to our department for urgent wide-complex tachycardia treatment. His initial assessment documented a subjectively impaired motor development, and subsequently, a formal assessment was performed. Methods The Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2) is an individually administrated test that resorts to a series of engaging, goal-directed activities to measure a wide array of motor skills in individuals ages 4 through 21. The BOT-2 uses a subtest and composite structure that highlights motor performance in the broad functional areas of stability, mobility, strength, coordination, and object manipulation. Results Patient"s performance in the four main motor skill areas will be report, namely: Fine Manual Control, Manual Coordination, Body Coordination, and Strength and Agility. Because Fabio completed all four parts of the BOT-2, a comprehensive score from all four areas, the Total Motor Composite, will also be reported. Fabio"s scores were compared to the ones of a control group of age and gender-matched individuals. This Patient started sessions of Cardiac Rehabilitation. The rehabilitation sessions are conducting for 1 hour three times a week for 1 year. This program still in progress, but we speculate that the will improve his motor abilities and developmental skills. Conclusion The risk of a poor developmental outcome varies according to the specific cardiac effect. In addition, there is significant interindividual variation in developmental outcome even among children with the same cardiac defect. Other factors may contribute to neurologic dysfunctions. These factors can be divided into three main categories and time-frames: prenatal, perioperative and post-discharge.

Neuro-developmental status of children with congenital hypothyroidism: experience in a tertiary hospital of Bangladesh

Background: Congenital hypothyroidism is one of the most common preventable causes of mental retardation. Early diagnosis and initiation of treatment is fundamental for optimal neuro-developmental outcome in children with congenital hypothyroidism. Thyroid hormones play crucial role in early neuro-development especially in the first 2-3 years of life. If left untreated or delayed initiation of treatment in congenital hypothyroidism results in neurological and psychological deficits. Aim of this study was to assess neuro-developmental status of children with congenital hypothyroidism who were on treatment (levo-thyroxine) started at different ages. Methods: This cross-sectional study was done at paediatric endocrine outpatient department (OPD) and child development centre (CDC), BIRDEM General Hospital. Children with congenital hypothyroidism presenting at different ages who were followed up at pediatric endocrine OPD between January 2014 and January 2015 were included in the study.Their functional status in different domains were studied by rapid neuro-developmental assessment (RNDA) in CDC. Children with Down syndrome and perinatal asphyxia were excluded. Results: Neuro-developmental assessment was done in 34 children (male 21, female 13). Mean age during assessment was 36 months (standard deviation 18.56). Eighteen patients (53%) were diagnosed in BIRDEM General Hospital and rest 16 (47%) were diagnosed outside BIRDEM General Hospital. Patients were grouped into 4 on the basis of age of diagnosis and start of treatment: group I (age 0-1 month), n=6 (18%); group II (age >1-3 months), n=7 (21%); group III (age >3-12 months), n=9 (26%); group IV (age >12months), n=12 (35%). In group I, five (84%) had normal development and one had mild delay in cognition. In group II, three (43%) had normal development. Cognition and behavior was delayed in 3 patients (43% each), followed by delay in speech in 2 (29%). All patients (100%) in group III and IV had developmental delay, predominant domains affected were speech, cognition and behavior. Conclusion: We have found developmental delay especially in the domain of speech, cognition and behavior in children with congenital hypothyroidism who have started levo-thyroxin late. Early diagnosis and initiation of treatment is fundamental for optimal neuro-developmental outcome in children with congenital hypothyroidism. Birdem Med J 2021; 11(1): 63-66