Journal of Pediatric Perspectives
Year:2019 | Volume:7 | Issue:9 (69)|Papers Count:16

Background: There is little information about the survival rate of pediatric peritoneal dialysis (PD) patients and its risk factors. Therefore, the aim of the present study was to assess survival rate and its risk factors in Iranian children undergoing PD. Materials and Methods: Demographic and laboratory data of 407 Iranian children (up to 19 years old) undergoing PD, from 20 centers in Iran were included. The outcome of interest in our study was survival rate and determination of its risk factors in PD children. The joint models of longitudinal and time-to-event data analysis was used. Results: The median duration of follow-up was 537 (interquartile range: 146 to 1, 177) days. Finally, 72 (17. 7%) patients died during a period of 23 years. Our results showed that one-year survival rate of PD patients was 93. 6% and five-year survival rate was 76. 9%. In addition, the most important risk factors for the PD all-cause mortality were age (HR=0. 9301; 95% CI: 0. 9031 to 0. 9587), serum creatinine (HR=0. 8907; 95% CI: 0. 8138 to 0. 9750), platelet count (HR=0. 9999; 95% CI: 0. 99995 to 0. 99999), aspartate aminotransferase level (HR=1. 0001; 95% CI: 0. 9999, 1. 0002), alkaline phosphatase (HR=0. 9989; 95% CI: 0. 9982 to 0. 9997), renal solute clearance rate (HR=0. 9839; 95% CI: 0. 9700 to 0. 9981), and normalized protein catabolic rate (HR=0. 4031; 95% CI: 0. 1879, 0. 8648). Conclusion: The survival rate of Iranian pediatric PD patients is similar to other countries. It is suggested that laboratory assessment be continually evaluated in PD patients to reduce the risk of death.

Background The change in venous oxygen saturation occurs earlier, and even its reduction is faster than arterial oxygen saturation. The aim of this study was to validate SvO2 and PvO2 for O2 content measurement in children hospitalized with respiratory distress. Materials and Methods In this cross-sectional study, 80 children who were admitted with respiratory distress were included in the study according to the study inclusion and exclusion criteria. Baseline characteristics such as age and gender were recorded in the data collection form, designed by the researcher. In order to determine the amount of SaO2 and PaO2 the arterial blood sample was prepared, venous blood sample was prepared to determine the amount of hemoglobin, SvO2 and PvO2. The gold standard for the determination of O2 content was the arterial blood sample. All samples were examined by a blood gas analyzer and then calculated using the formula of O2 content values. For SvO2 and PvO2 validation, we used diagnostic analysis methods including sensitivity, specificity, positive and negative predictive values. Cut-point value for SvO2 and PvO2 were 76. 50 and 44. 30, respectively. Results In this study, the patients’ mean age was 5. 15 ± 4. 20 years. 62. 5% (n=50) were male and 38. 5% (n=30) were female. The values of arterial and venous O2 content were 14. 13 ± 3. 05 and 11. 95 ± 3. 04 from a total of 80 patients. SvO2 and PvO2 for measuring O2 content had a sensitivity of 80. 5 and 71. 80%, respectively, and specificity of 80. 5 and 78%, respectively. Conclusion SvO2 and PvO2 have good validity for evaluating O2 content in patients admitted to PICU. So that SvO2 had a sensitivity and specificity of over 80%, and PvO2 had a sensitivity and specificity of over 70%.

Background Many neonates admitted to Neonatal Intensive Care Unit (NICU) need mechanical ventilation for recovery. This study was designed to evaluate the short-term outcome of mechanically ventilated neonates admitted to NICU. Materials and Methods In this descriptive cross-sectional study, all the neonates in need of mechanical ventilation in NICU of Besat Hospital, Hamadan, Iran, were enrolled for one year from September 2017 to September 2018. The selected data were of neonatal age at admission time, birth weight, gender, gestational age, indications of mechanical ventilation, lab results, length of hospital stay and the outcome of the disease were extracted from the medical file and analyzed using SPSS software (version 22. 0). Results Of 141 mechanically ventilated neonates, 55. 3% (n=78) were males. The mean of neonatal age, mean gestational age and mean birth weight were, 4. 67 ± 6. 58 days, 35. 51 ± 3. 88 weeks, and 2779. 37 ± 827. 06 g, respectively. RDS (58. 9%) was the most common indication for mechanical ventilation. The overall rate of neonatal recovery was 51. 8%. The results of unilabiate analysis showed a significant relationship between indications of mechanical ventilation, gestational age, neonatal birth weight, acidosis (pH <7. 1), duration of mechanical ventilation, duration of hospitalization and the disease outcomes (P<0. 05). Conclusion The results of this study showed that respiratory distress syndrome, low gestational age and birth weight, acidosis and duration of mechanical ventilation would lead to increased death in mechanically ventilated neonates.

Background Calprotectin is a cytosolic protein that belongs to the S-100 protein group with immunomodulatory and antiproliferative actions. The level of this protein increases in infection, inflammation, and malignancy. The aim of this study was to evaluate the level of calprotectin in asthmatic children as indicator of asthma severity. Materials and Methods This is a prospective study that included forty-five children with bronchial asthma and admitted to pediatric department, Minia University Children’ s Hospital, Egypt, they were (15 intermittent asthma, 15 mild persistent asthma and 15 moderate persistent asthma), and 20 apparently healthy children were included in the study and subjected to thorough history taking, full clinical examination, lung function test, CBC, Immunoglobulin E and measurement of serum levels of calprotectin using ELISA. Results The study revealed a statistically significant increase in the level of calprotectin in asthmatic children compared to that of the control group (p<0. 000). Also, there was a significant increased level of calprotectin in children with persistent asthma compared to those with mild intermittent asthma and control group (p<0. 001). In addition, there was a positive correlation between serum level of calprotectin and eosinophil count (r=0. 83, p=0. 001), and negative correlation with lung functions (FEV1 and PEEF) (r=-0. 89 and r=-0. 88, respectively, p<0. 05). Conclusion Increased levels of calprotectin in asthmatic children suggest that it may play a role in asthma, also it was associated with poor lung functions suggesting that there is a close relation between calprotectin level and the severity of childhood asthma.

Dear Editor-in-Chief, Obesity in children and young people is a significant public health issue. It can be associated with adverse health, economic and social implications. It is argued that preventing obesity needs adaptation to a healthy lifestyle, which includes behavioral modification, reduction in sedentary behavior, changes in nutrition, managing stress and increased physical activity. Families, healthcare professionals, school nurses, policy makers, researchers, and the community share responsibilities to prevent and manage obesity in children and young people.

Background There are contradictory results regarding association between maternal HIV infection and neonatal adverse outcomes. Therefore, in this study the neonates born from HIV-positive mothers compared with HIV-negative mothers were assessed in Tehran, Iran. Materials and Methods This retrospective case-control study was conducted on 50 infants born to an HIV-positive mother compared with 53 infants born to an HIV-negative mother as control group, during 8 years of a period from 2006-2015, admitted in Valiasr Hospital of Tehran. Data were gathered from medical records of patients. Results All children (n=53, 100%) in the case group were born through cesarean section; while 20. 75% of the control group children were born by natural delivery (P=0. 001). There was statistically significant difference between neonates born from HIV-positive mothers compared to HIV-negative mothers with respect to delivery method and gender (P<0. 05). The mean weights (gr) were higher in the controls than the cases (3052. 830± 380. 71 vs. 2731. 80± 575. 90) (P=0. 001). Also, a significantly increased Hemoglobin was observed in the controls (15. 87± 1. 97 g/dL) compared to the cases (13. 42± 1. 69 g/dL) (P=0. 001). Liver functions test (LFTs) was significantly higher in case groups (P=0. 005). Conclusion Based on the results, the mean weight and hemoglobin were lower in infants born from HIV-positive women compared with HIV-negative women. Also, LFT Disorder was higher in infants born from HIV-positive women compared with HIV-negative women.

Background Cardiovascular complications are continuing to be a major cause of morbidity and mortality in diabetes mellitus type I (DMTI). The study aimed to evaluate the rate of changes in ECG parameters in children with DMTI compared with healthy children. Materials and Methods This case-control study was performed on 140 participants which consisted of 70 patients with DMTI (case group) matched in sex and age with 70 healthy ones (control group) in two centers in collaboration with Ali Asghar Hospital, Zahedan, Iran, between March 2017 and April 2018. Electrocardiography was performed in all participants (patients and healthy), and heart rate, QT (start of the Q wave and the end of the T wave) QTc interval (QT/ √ RR), QTd (dispersion between maximum and minimum of QT), and QTcd (dispersion between maximum and minimum of QTc) were measured. Duration of diabetic and level of HbA1c were obtained for patients and the effects of these parameters on ECGs were investigated. Results Height, weight and heart rate were higher in the patients (P<0. 001) when S in V1 was higher in case (6. 16± 3. 23) compared to the control group (4. 33± 2. 22) (P<0. 001). QT (356. 71± 27. 28 compared to 347. 00± 23. 55), QTd (49. 00± 14. 66 compared to 41. 21± 8. 32), and QTcd (60. 47± 17. 32 compared to 49. 93± 10. 44) were higher in case group (p<0. 05). Hemoglobin A1C (p=0. 043) was higher in boys and heart rate was higher in girls (p<0. 001). Diabetic time duration and HbA1c normality states did not change the length of these parameters in diabetic patients. Conclusion Based on the results, QT, QTd, QTc and QTcd were higher in patients with DMTI. Diabetic time duration and HbA1c states did not change the ECG parameters in diabetic patients.

Background For decades, child labor has been an important global issue associated with inadequate educational opportunities, poverty and gender inequality. In order to make effective policies to reduce child labor it is important to understand the specific factors that affect it. We aimed to investigate the main factors affecting child labor n Iran. Materials and Methods There are authoritative websites on the topic of working children in Iran, including the WHO, UNFPA, UNDP, Web of Science, ProQuest, Medline, Scopus, and CINAHL databases for reviewing studies conducted in Iran. Articles from internal dissertations and Google's databases, SID, Magiran, and Iran Doc during the period 1985 to June 2019 were included. Quality of studies was reviewed by the STROBE checklist. Information was extracted by two blind researchers. Results A total of 9 studies were identified (including 17, 219 on child labor), the majority of which were cross-sectional. Affecting factors on child labor and Street children were grouped into four categories such as "Family problems", "Urbanization", "Social and Cultural", and "Personality". Conclusion In the contemporary Iranian society, many children, for some reasons including personal, family, social and cultural, and urbanization problems, are involved with important social damages such a child labor. These factors make children vulnerable and endanger the health of the community.

Background In addition to their widespread applications in various fields, cellular phones have some inappropriate social consequences, including psychosocial addiction, degradation of values, reduced social interactions, early maturity and endangering the psychological well-being of users. Therefore, the present study aimed to investigate detrimental effects of Mobile phones on the psychological well-being of second grade students. Materials and Methods In this cross-sectional study, the sample population included 269 second grade students (107 boys and 162 girls) in Kermanshah, Iran in 2018 and being in the 10-18 age-range who were selected using cluster sampling. As for data collection, the Jenaro’ s Cell-Phone Over-Use scale and Ryff’ s psychological well-being scale were utilized, which were filled out by the students themselves. Results The results of the present study demonstrated that the means of the deleterious use of mobile phones and psychological well-being measured 44. 71± 16. 45 (total score=126), and 63. 86± 14. 43 (total score=84), respectively. The results also indicated that the observed F (F=10. 12) was significant at p<0. 005, and the predictor variables together explained 0. 33 of the variance of psychological well-being. Moreover, it was shown that the deleterious use of mobile phones and psychological well-being significantly and negatively correlated at p<0. 005, r=0. 49. Conclusion According to this study, it was revealed that the deleterious overuse of mobile phones and psychological well-being were significantly and negatively correlated; which means that the higher the use of mobile phones, the more vulnerable the psychological well-being becomes.

Background Fever is the most important and common symptom of pediatric diseases. Fever can be a sign or symptom or complication of disease. Considering the development of complementary and alternative medicine worldwide and the prevalence of this symptom in children, we aimed to investigate their application based on Persian medical textbooks by searching herbs used in pediatric fever. Materials and Methods In this review study, materials were extracted by searching in reliable Persian medical textbooks of the10th-20th century using related Persian medicine keywords. Then the documentations for herbs extracted were searched in the databases based on the conventional medicine. The interpretation was made based on the results. Results Based on the Persian medical textbooks, seventeen herbs have been prescribed for decreasing pediatric fever. Among them, 16 herbs have proven mechanisms of action for treatment of fever, classified into five categories (diaphoretic, anti-inflammatory, anti-septic, immunomodulatory, anti-oxidant) based on literature review. On the other hand, according to Persian medicine, there were thirteen cold temperament herbs and only four hot temperament ones. They were administrated using various oral and topical methods. The maternal and neonatal treatment was emphasized. Conclusion According to this study and documentations of conventional medicine, many of these herbs can be effective in the treatment of pediatric fever, so further clinical studies are recommended for evaluating their efficacy.

Background Based on vast usage of teucrium polium (TP) in alternative medicine of developing countries for treatment of ailments in children and adults, this study is designed to examine acute hydro alcoholic extract of TP effects in different doses on rat liver and kidney functions and tissue structures. Materials and Methods Animals were given daily intraperitoneal (i. p. ) injection of TP at 3, 10, 30, 100, and 200 mg/kg or equal volume of normal saline for a week. One-hour postprandial blood glucose at day 1 and day 7, liver enzymes, serum creatinine (Cr), blood urea nitrogen (BUN) and hepatorenal tissues were examined at the end of the study. Animal body weights were also measured on a daily basis. Results TP at 3, 10, 30 and 100 mg/kg body weight didnot affect functional and structural characteristics in rat liver and kidney tissues compared with control animals. However, at high 200 mg/kg dose, it provoked liver and kidney tissue damages together with significant rise in aspartate aminotransferase (p<0. 001), alanine aminotransferase (p=0. 001), Cr (p=0. 001), and BUN (p=0. 001). Animal body weight in each group under TP pretreatment protocol unchanged during the study except at high 200 mg/kg which showed a significant weight loss (p<0. 001). Conclusion TP detrimental health effects especially on liver and kidney tissues are frequently overemphasized, but in a dose-dependent manner. However, we also believe TP has potential medical benefits and can find a way to the medical arena if thorough conducted researches can determine its toxic components and isolate appropriate derivatives for ensuing use.

Background One of the most common causes of severe physical disability in childhood is cerebral palsy (CP). Mobility is one of the most important functions to fulfill the activities of daily living. We aimed to determine the effectiveness of cold application to improve the ambulation in spastic diplegic CP children. Materials and Methods In this clinical trial study, 40 subjects were included for the study. They were divided into two groups, namely experimental (n=20), and conventional group (n=20). Study was carried out in Holy Cross College, Department of Rehabilitation Science, Tiruchirappalli, India. Conventional group was given regular conventional training and experimental group was given cold therapy, passive stretching in both legs before training. Both groups received training for 45 minutes, 3 times a week for a duration of 6 weeks. Modified Ashworth scales were used to measure spasticity step length, stride length and Cadences were used to measure the gait parameters, and Timed Up and Go test (TUG) was used to measure the functional activity. Results Significant effect was observed in decrease in spasticity, there was increase in gait parameters and timed up and go test in two studied groups. The post-test mean values of all the variables of cold therapy, passive stretching in experimental group are improved compared with that of conventional group. The experiment improved with stride length, step length, cadence, timed up and go test and Modified Ashworth scale (p<0. 05). Conclusion Based on the derived results, there was decreased tone in spastic muscles and improvement in gait parameters and functional ability in children with diplegic CP after application of cold therapy and passive stretching.

Introduction Gyrate atrophy of the choroid and retina is a metabolic disorder, which is inherited in an autosomal recessive pattern. Although gyrate atrophy is rare, it is concerning as it results in blindness. It is characterized by hyperornithinemia, retinal atrophy, leads to progressive myopia and tunnel vision, and Posterior Subcapsular Cataracts. Patients have lower amounts of ornithine aminotransferase. Case Report In this study, we report a 17-year-old boy referred to our hospital by an ophthalmologist, with progressive visual loss from 7 years of age. The eye examinations manifested chorioretinal degeneration and high myopia. In lab data, plasma ornithine amount was elevated 10-fold higher than normal. By this finding, he was diagnosed as having Gyrate Atrophy. Conclusion Treatment with pyridoxine and low arginine diet can reduce the ornithine plasma level in Gyrate Atrophy. Our report is to describe the first case of gyrate atrophy in pediatric endocrinology department in Iran diagnosed by biochemistry and treated with pyridoxine and low arginine diet.

Background: Today, an increasing trend to methadone as an alternative maintenance treatment for opiate dependence in adults is observed; children for both intentional and accidental reasons are exposed to serious and fetal effects of methadone. We aimed to investigate effects of methadone on children and sexual functioning among adults in Iranian population. Materials and Methods: An extensive search was done in databases of Medline, EMBASE, Scopus, Cochrane, and Web of Science until August 2018. Two independent researchers screened articles, and categorized them based on the evaluated outcomes and overall effect size was presented. After excluding the duplicated, irrelevant and low-quality articles, eligible ones were enrolled in the meta-analysis. Finally, pooled effect size was presented as standardized mean difference (SMD) or pooled prevalence with 95% confidence interval (95% CI). Results: Methadone was found to be more effective than morphine on neonatal abstinence syndrome. The first four most common symptoms of methadone poisoning were loss of consciousness (81%), sleepiness (72%), meiotic pupils (76%), vomiting (56%), and Apnea (48%). The overall prevalence rate of sexual disorders and erectile dysfunction was 66. 3% and 77. 5%, respectively. The subjects in methadone group were over 2. 5-fold more likely to use condom during intercourse (p<0. 001). The methadone therapy could lead to a significant reduction in orgasm functioning (p<0. 001), and a significant improvement in libido (p=0. 001). The methadone maintenance treatment (MMT) significantly resulted in decreased orgasm function and improved libido in males. Conclusion: Evidence suggests a positive impact of methadone maintenance treatment on risky sexual behaviors. Regarding the methadone poisoning effect on children, people should be informed by health care providers about serious and fetal effects on children.

Background Medication errors are known as a preventable cause of idiopathic damage in pediatrics. These errors could entail serious direct and indirect outcomes that often lead to disruptions in the health care system. The present study aimed to determine the relationship between medication errors with job satisfaction of nurses in pediatric ward. Materials and Methods This cross-sectional, descriptive-analytical study was conducted on 80 nurses working in pediatric wards in hospitals affiliated with Ahwaz University of Medical Sciences, Iran that were selected by census. The questionnaires of medication administration error and nurses' job satisfaction (Minnesota job satisfaction) by purposive sampling were used for gathering data. Validity and reliability were checked for internal consistency and stability. Results Mean nurses’ medication errors in pediatric wards for every nurse over a 3-month period was 11. 41+ 11. 79 cases, and mean error reporting was 1. 97+ 3. 92 cases. Nurse’ s age (P≤ 0. 01) and education level (P≤ 0. 03) were statistically significantly related with medication errors. The findings of job satisfaction of nurses showed that 44. 07% of nurses were dissatisfied. However, there was no significant relationship between incidence of medication errors and nurses’ job satisfaction (r=-0. 167, P= 0. 138). Conclusion Compared to the other studies, the incidence of nurses’ medication errors was somewhat higher in this study; however, the report rate was low. It is suggested that, by periodic measuring of job satisfaction and identifying factors that have impact on job satisfaction of nurses and also using strategies to resolve existing problems and dissatisfactions.

Background: Primary dysmenorrhea is painful bleeding in the absence of any confirmed pelvic disorder, which is often accompanied by nausea, vomiting, and headache. The tendency of patients to use herbal and alternative medicine is more than the past. Regarding the fact that no meta-analytical study has been done to evaluate aromatherapy with Iranian herbal medicines, this study was conducted to evaluate the effect of aromatherapy with different herbs on premenstrual syndrome and primary dysmenorrhea. Materials and Methods: English and Persian electronic databases were systematically searched without any time limit until May 5, 2019. The references of review articles and clinical trials were also reviewed. Two authors independently reviewed the titles and abstracts, if the subject of the article was relevant, the full article was extracted and criticized. Comprehensive Meta-Analysis software was used to conduct meta-analysis. Results: Finally, 14 studies were entered into a meta-analysis. The mean standard difference between two groups of aromatherapy with different plants and control group was-1. 06 (95%CI:-1. 33 to-0. 848; p<0. 001). Aromatherapy with roses (SMD=-1. 35; 95%CI=-0. 01 to-2. 69; p=0. 048), and aromatherapy with lavender (SMD=-1. 08; 95% CI:-0. 73 to-1. 43; p<0. 001) compared to the control group had better effect in reduction of pain severity. According to three studies, aromatherapy with Geranium 2% essential oil, Citrus aurantium blossom essential oil, and Rosa damascena were more effective than control group regarding mental and physical signs. Conclusion This meta-analysis showed that aromatherapy with different Iranian herbs such as lavender and rose could significantly reduce primary dysmenorrhea and premenstrual syndrome. This treatment can be used specifically in patients who cannot tolerate conventional treatments.