Journal of Pediatric Perspectives
Year:2019 | Volume:7 | Issue:10 (70)|Papers Count:14

Background: Influenza is an acute respiratory illness that can cause hospitalization, and confers a high mortality rate, especially in high-risk groups. Influenza vaccination for hospital staff can play an effective role in controlling nosocomial flu infections. The purpose of this study was to investigate causes of non-vaccination of influenza in healthcare workers at Zanjan educational hospitals. Materials and Methods: This was a cross-sectional study conducted during three months at two Zanjan educational hospitals, Iran. Two hundred and ten workers belonging to the hospital staff were randomly selected. The reasons for not receiving the vaccine and the demographic information of the staff were recorded in a special questionnaire. The questionnaire included demographic information such as: age, gender, occupation, work place, history of Influenza vaccination last year, and reason for non-vaccination of Influenza. Results: Two hundred individuals were enrolled, which included 58% of physicians and 42% of nurses. In the past year, 51% of the subjects have received influenza vaccine. Of these, 45. 7% were physicians and 58. 3% were nurses. The most common reasons for non-vaccination were: the belief that healthy people do not have the chance of getting the infection (28. 6%), forgetfulness (24. 5%), lack of adequate information and fear of complications from the vaccine (14. 3%). Conclusion: The status of influenza vaccination in the staff of these hospitals was relatively acceptable (51% of the subjects were vaccinated); however, it has not yet reached the ideal. According to the results, the most common reasons for non-vaccination were: wrong thinking about getting the infection, forgetfulness, and fear of complications.

Background Mobile phone has played an increasingly important role in people’ s lives; however, there is a global concern that it may cause adverse effects on health. This study aimed to assess the effect of educational intervention based on Health Belief Model (HBM) to decrease and prevent mobile phone addiction among female high school students. Materials and Methods This quasi-experimental study was done on high school students in Esfahan city in 2018-2019. During a period of 6 months, 112 female high school students were selected and randomly assigned to control and intervention groups. The educational intervention was implemented only in the intervention group (6 sessions of ninety minutes). Health Belief Model constructs were measured by self-report questionnaires and mobile phone addiction was measured by Persian version of mobile phone addiction scale before and two months after the intervention. Results: 112 students (56 in control group and 56 in intervention group) participated in the study. There was no statistically significant difference between the baseline characteristics of students in both groups as well as HBM constructs and mobile phone addiction. Two months after the intervention, the mean score of mobile phone addiction among the students of intervention group students was decreased and in control group students, the score of mobile phone addiction was increased (P ≤ 0. 05). Constructs of the HBM except perceived barriers for reducing mobile phone use and perceived benefits of mobile phone use significantly increased in the intervention group compared to the control group (P <0. 05). Conclusion According to the results, Educational intervention based on the HBM can prevent and decrease the mobile phone addiction in female students.

Background: Problematic use of new communication technologies, such as smartphone, declines social relationships and increases loneliness. The purpose of the study was to determine the relationship between smartphone addiction and loneliness, the motivation to progress and other relevant variables among high school students. Materials and Methods: The present cross-sectional study was conducted in Sari, Iran, in 2016. Using stratified cluster random sampling, 348 high school girls and boys (first year of high school) were selected as the study sample. Informed consent, demographic information, Loneliness Scale-Version, motivation to progress questionnaire, and smartphone addiction scale (SAS) were obtained from all students at the baseline. Data were analyzed using SPSS software version 22. 0. Results: The study sample consisted 396 students, including 208 (52. 2%) females. According to findings, Telegram application is widely used among the students. Parental educational level, loneliness and motivation to progress are negatively correlated to smartphone addiction. Additionally, factors such as the gender (p<0. 001), the type of communication software (Telegram) (p=0. 04), and the father’ s educational level (p=0. 04) significantly predicted smartphone addiction among students. Conclusion: The parental educational level especially father, gender of student, has a negative relationship with smartphone addiction, loneliness, and motivation to progress. Based on the results, the first year high school students are exposed to the risks and consequences of communication technologies. Therefore, it is imperative for Ministry of Education of Iran to consider the teaching programs about the proper usage of social network-related applications for students.

Background Beta thalassemia (β-thalassemia) is one of the most common genetic disorders that reduces the amount of specific chain production in hemoglobin. The aim of this study was to compare the efficacy and safety of Desfonak with Desferal in patients with β-thalassemia major in Iran. Materials and Methods The study was a two-treatment and two-period crossover Randomized clinical trial design that was carried out on 100 thalassemic patients referred to Mohammad Kermanshahi hospital of Kermanshah city, Iran in 2018-19. Eligible patients were divided into two groups using a random number table (Group A, n=50; Group B, n=50). The group A received Desferal then Desfonak vs. (30 mg/kg in 8 h and 6 days in a week). The group B received Desfonak then Desferal. The data collection tool was a checklist, including variables of age, sex, AST, ALT, ferritin, urea, creatinine and different complications of gastrointestinal, articular, skin, respiratory system and hearing problems. The data were analyzed by STATA software (version 14. 0). Results The results of the study showed that there are no significant statistical differences between Desferal and Desfonakin terms of different complications of GI, articular, skin, respiratory and hearing systems (P>0. 05). Also, the results showed that there was no significant statistical difference between Desferal and Desfonak in terms of variables of AST, ALT, ferritin, urea and creatinine at two time periods (P>0. 05). Conclusion The results of this study highlighted that Desfonak and Desferal have similar efficacy and safety in patients with thalassemia major.

Background: Cystic Fibrosis (CF) is a systemic disease affecting extra pulmonary dysfunction as a result of CF-related lung disease. Because of lack of enough studies in this field and utilization of TDE in this field, we aimed to evaluate the cardiac involvement in children with CF and compare it with healthy children. Materials and Methods: In this cross sectional study, children diagnosed with cystic fibrosis aged less than 15 years who referred to Emam Hossein Children’ s Hospital, affiliated to Isfahan University of Medical Sciences, Iran, during 2018, were enrolled. Participants were 2 groups: case and control. In this study 27 children with mild cystic fibrosis lung disease and 27 healthy children were evaluated. Case groups were consisted of children with CF, and control group were healthy children. FEV1, FVC, and FEV1 / FVC of all participants were recorded based on their spirometry findings. Cardiac function tests including electrocardiogram and Doppler echocardiography were evaluated by an expert pediatric cardiologist. Spirometry and Doppler echocardiography findings in two studied groups were compared. Results: Lateral wall tissue Doppler echocardiographic evaluation, annular peak velocity during systole and E’ /A’ ratio was significantly higher in children with CF than healthy children (P<0. 05). In the right ventricle (septal wall) tissue Doppler echocardiographic evaluation peak velocity during early diastole, peak velocity during late diastole and annular peak velocity during systole was significantly higher in healthy children than those with CF (P<0. 01). E’ /A’ ratio in the right ventricle (septal wall) tissue Doppler echocardiographic evaluation was significantly higher in children with CF than healthy children (P<0. 01). Conclusion Based on the results, it is recommended to consider tissue Doppler echocardiography in the earlier period of CF patients’ follow-up program.

Background: Preterm birth and subsequent admission of the infant to neonatal intensive care unit (NICU) can be distressing for parents and lead to their anxiety. The aim of this study was to evaluate maternal anxiety in mothers of infants admitted to the NICU and determine the characteristics associated with maternal anxiety. Materials and Methods: This study is a descriptive, cross-sectional study with participation of 100 mothers with infant that was born premature and hospitalized in NICU (mothers were selected through convenient sampling method) of Al-Zahra hospital, affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. Data collection tools included baseline characteristics (21 items), and Spielberger State-Trait Anxiety Inventory (STAI). Data were analyzed using SPSS software (version 23. 0). Results: The results of study showed that 62% (n=100) of mothers had moderate level of state anxiety and (54% (n=100) had moderate level of trait anxiety, mean (SD) state anxiety score was 48. 62(6. 00) and mean (SD) trait anxiety was 32. 45(3. 63. There was statistically significant difference regarding state anxiety mean scores and number of delivery, education level, gestational age at birth weeks and child order (P<0. 05). Conclusion: Based on the results, mother of premature infants had moderate level of state anxiety. Having university degree, the mothers whose premature infants were at 33 weeks gestational age and mothers who had third or more delivery number and their child order was third and over had experienced state anxiety.

Background Neonatal sepsis contributes substantially to neonatal morbidity and mortality, and is an ongoing major global public health challenge. We aimed to evaluate the effects of enteral feeding supplementation of low dose lactulose on the incidence of late onset sepsis in very premature infants. Materials and Methods In this randomized placebo-controlled trial preterm neonates with very low birth weight (VLBW) randomly received enteral supplementation of 1% lactulose (1 g per 100 mL feeds) (n=27) or distilled water (placebo, n=25) simultaneous with increasing volumes of milk. Incidence of late onset sepsis was considered as primary outcome. Feeding intolerance, time to reach full enteral feeding and duration of hospitalization in the course of the study were considered as secondary outcomes. Results Differences in baseline characteristics were not statistically important. The incidence of late onset sepsis was significantly lower in lactulose group compared to placebo (14. 8% vs. 40%, p=0. 04). The mean time to reach full enteral feeding was 12. 85± 3. 33 and 15. 20± 5. 24 in the lactulose vs. placebo group (p=0. 03). Duration of hospitalization, occurrence of necrotizing enterocolitis and body weight on the 30th day of life were not significantly different between the two groups. Conclusion Enteral feeding supplementation with low dose lactulose in very premature infants for prebiotic purposes was deemed to be safe and reduced the incidence of late onset sepsis in our study.

Background Attention-deficit/hyperactivity disorder (ADHD) is usually accompanied with other comorbidities that make treatment suboptimal and results in inadequate outcomes. Investigating the factors having an effect on improvement of ADHD can lead to better outcomes and a higher adherence to medication. Materials and Methods This historical cohort study was carried out on records of 6 to 13 year old patients with ADHD during the years 2008 to 2015 in the Children's Medical Center in Tehran, Iran. Baseline characteristics of patients such as gender, birth weight, the age of the first diagnosis, weight, severity of ADHD at the baseline, time duration of receiving the Methylphenidate, types of comorbidity, and dosage of Methylphenidate were extracted from hospital records. The Generalized Estimating Equation (GEE) was used to develop a multivariable model. This model is based on a stepwise procedure. Results One hundred and thirty-nine children (75. 5% boys, mean age of 97. 8± 26. 8 months) were assessed. Time duration of receiving Methylphenidate (OR=1. 06; p< 0. 001), severity of ADHD at the baseline (OR=0. 94; p< 0. 001), and dosage of Methylphenidate (OR=2. 34; p< 0. 001) had a significant relationship with improvement. In this study any relationship between improvement of ADHD and other factors was not found. Conclusion In this study, the clinical severity of ADHD at baseline, logarithm of dosage of Methylphenidate, and time duration of receiving the Methylphenidate were associated with improvement of ADHD.

Background: Explaining the risk factors of waterpipe smoking (WS) is very necessary in prevention programs. The aim of this study was determining the risk factors and the prevalence of WS in adolescents based on the social cognitive theory (SCT). Materials and Methods: This cross-sectional study was conducted among urban adolescents in two provinces located in the South East of Iran. We recruited 1, 218 adolescents (girls=595 and boys=623) through multistage sampling during the period October 2017 to February 2018. The data collection tool was a self-administered standardized questionnaire that included basic baseline characteristics, SCT constructs items and questions about WS behavior in the participants. The data were analysed using SPSS software version 22. 0. Results The ever use prevalence of WS in boys was 43. 8% (n= 264), and in girls 27% (n=160). WS in family member (OR=1. 87, CI: 1. 32-2. 63; p<0. 001) and intimate friends (OR=2. 34, CI: 1. 70-2. 26; p<0. 001) were the most important risk factors for adolescents. In the relation of WS with constructs of SCT: outcome expectations (OR=0. 64, 95% CI: 0. 50-0. 84; p<0. 001), outcome expectancy, (OR=0. 65, 95% CI: 0. 55-0. 85; p=0. 002) self-efficacy, (OR=0. 30, 95% CI: 0. 23-0. 41; p<0. 001), and situational perception (OR=0. 63, 95% CI: 0. 47-0. 84: p=0. 002) were the most important and related factors of WS. Boys were 1. 92 times (OR: 1. 06 – 2. 43; p<0. 001) more exposed to water-pipe smoking than girls. Conclusion The prevalence of WS was notable in students especially in boys. Peer group and family are important risk factors for tendency toward WS in adolescence. Also, lower score in SCT constructs such as knowledge, self-efficacy and situational perception in adolescents are important risk factors for WS in participants.

Background In respect to abnormalities in thalassemia patients and the effects of TNF_α , IL_6, and NT-pro-BNP on echocardiography findings the study aimed to investigate TNF_α , NT-pro-BNP and IL_6 correlations with Doppler tissue imaging findings in major thalassemia. Materials and Methods: This case-control study was performed on 112 healthy children and 112 patients with thalassemia in Ali Asghar hospital, Zahedan, Iran, in 2017. Healthy children were selected from those that referred to the pediatric clinics for routine check-up. Fasting blood samples were taken to measure TNF-α , NT-pro-BNP and IL_6 serums. Those thalassemia patients who had regular transfusions of hemoglobin higher than 10 g/dl and 48-72 h after packed red blood cell transfusion and those who were asymptomatic were entered to the study. Participants underwent echocardiography by pediatric cardiologist in Doppler method. Results: NT-pro-BNP, TNF_α and IL_6 were lower in controls (P<0. 001). Height, weight and BMI were higher in controls (P<0. 001). Right ET, left ET, IVSD, PWD, PWS, EF, FS, left ET', left ICT', left IRT', right ET', right IRT', right S', right Peak A', VE', VA', left and right MPI', LVMI were different in case and control (P<0. 05). Right Peak A (P=0. 049), PWD (P=0. 032), Left MPI' (P=0. 02) and LVMI (P=0. 005) were correlated with IL_6. IVSD (P=0. 01), LVDS (P=0. 01), EF and FS (P<0. 001), left ET' (P=0. 02), left ICT' (P<0. 001), right ET' (P=0. 001), right S' (P=0. 002), left MPI’ (P<0. 010) were correlated with NT-pro-BNP. Conclusion NT-pro-BNP, TNF_α , IL_6 were higher in thalassemia patients and NT-pro-BNP was correlated with some of the echocardiography findings. This suggests that NT-pro-BNP would be the best biomarker for evaluation of cardiac functions in thalassemia patients.

Background: Malnutrition is a great challenge for the public health system. Therefore, this study aimed to study the spatial pattern malnutrition using GIS in the world's countries. Materials and Methods: In this cross-sectional study, secondary child malnutrition data analysis was conducted using World Health Organization data from 2005 to 2016. The data were analyzed by Arc/GIS 10. 6 software. The prevalence rates of malnutrition were exported into Arc/GIS10. 6 to visualize key estimations, and the excess risk of malnutrition of each country was calculated. In this regard, the spatial patterns of variables of the prevalence of stunting in children under 5 (%), prevalence of wasting in children under 5 (%), and prevalence of overweight in children under 5 (%) were evaluated by GIS. Results: Our findings showed that the prevalence of stunting, wasting and overweight in children under 5 was not accidental and has emerged in the cluster form based on a regular occurrence in countries around the world. Furthermore, the results of our research indicated that the mean center and standard deviation of stunting and wasting included most of the African and Asian countries especially in the Middle East, but the mean center and standard deviation of overweight included more areas of the world. Overweight has included many parts of the world and its spatial distribution is more than stunting and wasting. Overweight was observed the African, Asian and European countries. Conclusion: The spatial pattern of malnutrition was clustered in the world. The results of this study could be the starting point for the development of appropriate malnutrition interventions and policies globally.

The Hutchinson-Gilford syndrome or progeria is a laminopathy generated by mutations that affect LMNA gene. This produces an abnormal protein named progerine which alters the formation of the cellular membrane inducing premature aging of all cells. In the present review aspects related to the pathophysiology and clinical characteristics of this syndrome are shown.

Background Autosomal recessive polycystic kidney disease (ARPKD) is caused by mutations in the PKHD1 gene. In the present study, we describe a severe case of ARPKD carrying a point mutation and a novel four-exon deletion of PKHD1 gene. Materials and Methods The PKHD1, PKD1 and PKD2 genes were analyzed using next-generation sequencing, whereas the PKHD1 gene exon deletions/duplications were screened using multiplex ligation-dependent probe amplification. Results The c. 2279G>A (p. Arg760His) mutation and a deletion encompassing exons 24-27 of PKHD1 gene were detected in compound heterozygosity in the affected neonate. The complete documentation of the genetic basis of the disease offered the possibility of a targeted prenatal diagnosis in the following pregnancy of the couple. Conclusion Given that the molecular analysis of ARPKD is mainly based on sequencing techniques, the PKHD1 gene exon deletion/duplication screening should be performed as a complementary assay in patients suspected to have ARPKD in the absence of two pathogenic mutations.

Background Sudden cardiac death is an important problem, because the patients have no opportunity to receive medical service. Recently some electrocardiogram (ECG) parameters are used for predicting arrhythmias, including P wave duration for predicting atrial arrhythmias and corrected QT and T wave peak to end interval (Tp-e), for predicting ventricular arrhythmias. Iron deficiency is the most prevalent nutrient disorder worldwide in which iron loads in different tissues including myocardium are decreased. We aimed to investigate the relationship between iron deficiency and arrhythmogenic ECG parameters. Then we compared electrocardiographic parameters of iron deficient patients before and after iron replacement therapy. Materials and Methods In the first phase of study, ECG and blood samples were taken from 9-18 years old healthy adolescents for CBC and ferritin tests. They were divided into three groups according to serum ferritin: group 1 (ferritin below 15), group 2 (ferritin 15-30), and group 3 (ferritin above 30) ng/ml. In phase two, group 1 were given standard iron replacement therapy. We compared ECG parameters in three groups and then in group 1 before and after treatment. Results The number of individuals in three groups was 120 (group 1= 25, group 2= 26 and group 3= 69). The results showed that all parameters were significantly higher in group one and the lowest in group three. Also, there was a significant decrease in these parameters after treatment in group one (P<0. 05). Conclusion Based on the results, Iron deficiency through decreased myocardial iron load can prolong ECG parameters and elevate risk of arrhythmia. Also, iron replacement therapy can reduce this risk.