Journal of Pediatric Perspectives
Year:2020 | Volume:8 | Issue:8 (80)|Papers Count:25

Background: Smoking is increasing among adolescents, and family is a factor influencing it. The present study aimed to examine the relationship between transition in smoking stages and parenting styles of parents of adolescents. Materials and Methods: This was a longitudinal study in which 3968 high school students in Tabriz, Iran, were examined from November 2017 to June 2018. Sampling was multi-stage, with proportional and random clusters. A questionnaire containing demographic information and potential confounders were filled in by students, and the Parenting Style Inventory was completed by parents only in the first stage. Moreover, students twice (in the beginning of the study and six months later) completed a valid algorithm of stages of cigarette smoking. Data were analyzed using univariate and multivariate logistic regression analysis. Results: After the six-month interval, 429 students (11. 7%) with a 95% Confidence Interval (CI) (10. 68-12. 76) progressed through the stages of smoking. By controlling potential confounding variables, the father's permissive parenting style compared to the authoritative style increases the odds of progress through the stages of smoking by almost five times (OR=5. 06, 95% CI: 2. 58-9. 93), and the father's authoritarian parenting style compared to the authoritative style increases the odds of progress through the stages of smoking by almost four times (OR=4. 01, 95% CI: 2. 17-7. 40). Conclusion: Inefficient parenting styles are an important risk factor for progress through the stages of cigarette smoking in adolescents. Desirable relationships between parents and children as well as parents' awareness of parenting styles may prevent smoking in adolescents.

Background: It is important to find a predictor for the course of Idiopathic Nephrotic Syndrome for better planning of treatment. Renal cortical echogenicity in ultrasonography has been postulated as a marker for the course of renal disease. The present study aimed at evaluating the relationship between renal cortical echogenicity and the course of Idiopathic Nephrotic Syndrome in children. Materials and Methods: In this cross-sectional study, the samples were consisted of 42 patients under 17 years old with Idiopathic Nephrotic Syndrome, who was admitted to Imam Reza Hospital, Kermanshah city, Iran, during 2015-2016. The echogenicity of renal cortex and liver was compared using the sonography scanning, and divided into three grades; grade (0): echogenicity of the renal cortex less than that of the liver, grade (1): echogenicity of the renal cortex is equal to that of the liver, and grade (2): The renal cortical echogenicity is greater than that of the liver. Results: Twenty-five patients (59. 5%) were male and 17 patients (40. 5%) were female. Twenty-seven patients (64. 2%) were steroid-responsive, 10 patients (23. 8%) were steroid-dependent and five patients (11. 9%) were steroid-resistant. There was no statistically significant relationship between genders and the steroid response (p=0. 81), but there was a statistically significant relationship between the course of the disease and the renal cortical echogenicity (p=0. 01). Conclusion: The results showed a relationship between steroid response and the course of the disease with renal cortex echogenicity, which means that higher renal cortical echogenicity may be a predictor of a more complicated course in Idiopathic Nephrotic Syndrome. Moreover, the small sample size, especially in the steroid-resistant group, was a limitation in the present study.

Background: The maintenance and health of children's milk teeth are important due to the high rate of caries and the fact that their health clearly affects the permanent teeth, the treatment of these caries and its complications leads to high costs for families and the society. This study aimed to determine the mother's knowledge and attitude regarding oral health among their preschool children. Materials and Methods: The maintenance and health of children's milk teeth are important due to the high rate of caries and the fact that their health clearly affects the permanent teeth, the treatment of these caries and its complications leads to high costs for families and the society. This study aimed to determine the mother's knowledge and attitude regarding oral health among their preschool children. Results: Based on the results of this study, and given the correct answers, the average score of mothers' knowledge is 14. 42 ± 2. 33 (out of 20). There was a significant relationship between the mother's age (the mean age of the mothers was 7. 07 + 4. 0 years), and their level of knowledge (p-value = 0. 029). The mean score of mothers knowledge was significantly different when compared with different levels of their education (p-value = 0. 032), and a significant relationship was observed between having multiple children and an increase in knowledge in mothers (p-value = 0. 043). Conclusion: This study revealed that only about 40% of mothers were not aware of simple facts regarding the usage of baby bottles and their children's oral hygiene, which could lead to an increased prevalence of Early Childhood Caries in their children. Hence it is concluded that maternal educational interventions are necessary for improving children's oral health habits.

Background: The prevalence of urolithiasis in both infants and children is increasing. The metabolic features contributing to urolithiasis formation in children may vary from those in adult patients. The purpose of this study is to determine the prevalence of urinary metabolic abnormalities and related factors in infants and children with urolithiasis in Kermanshah, West of Iran. Materials and Methods: In this cross-sectional study, 104 children and infants with urolithiasis who were admitted to the Pediatrics Nephrology Clinic of Imam Reza Hospital in Kermanshah, Iran in 2018 were investigated. Urinary metabolic abnormalities, including hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitraturia and cystinuria, were examined using random urine samples. Results: Of the 104 children (66 boys and 38 girls) examined, 64 (61. 5%) had at least one urinary metabolic abnormality. Hypercalciuria was the most common (31 patients, 29. 8%), followed by hyperuricosuria (27 patients, 26%), hyperoxaluria (20 patients, 19. 2%), hypocitraturia (13 patients, 12. 5%), and cystinuria (one patient, 0. 96%). Hyperuricosuria (88. 9%) and hypocitraturia (46. 2%) were more common in infants younger than 12 months old compared to those older. No statistically significant association was observed between the frequency of urinary metabolic abnormalities with gender and family history of urolithiasis, but a significant relationship was found between age and prevalence of urinary metabolic abnormalities. Conclusion: Hypercalciuria was the most common metabolic abnormality in the urine. Although detection of urinary metabolic abnormalities is important, the role of other variables, like nutritional and climatic factors in the development of childhood nephrolithiasis should be considered too, since no metabolic disorder have been found in more than a third of patients.

Background: Pulmonary complications following valvular heart surgery are common and contribute to increased duration of hospital stay, rate of morbidity, and mortality. The purpose of the present study was to investigate the response of maximum inspiratory pressure and functional capacity to Positive End-Expiratory Pressure device in patients who underwent valvular heart surgery. Materials and Methods: Thirty males and females who underwent valvular heart surgery aged from 12-18 years old and recruited from the National Heart Institute enrolled in this study. They were assigned into two matched groups: the intervention group consisted of 15 patients, received Positive End-Expiratory Pressure (PEEP) with the mouthpiece in addition to routine chest physiotherapy program; the control group consisted of 15 patients, received routine chest physiotherapy program only. The program continued for four weeks, then the results compared in two groups. Results: According to the results of data analysis, there was a statistically significant difference between pretreatment and post-treatment data in both groups regarding inspiratory muscle strength and functional capacity (p< 0. 001). There was no significant difference between groups regarding post-treatment data of Maximal Inspiratory Pressure (MIP), and VO2 max (p=0. 084, p=0. 325), respectively. Conclusion: According to the results, expiratory training using a PEEP device with mouthpiece improved inspiratory muscle strength and functional capacity after valvular heart surgery.

Background: Intellectual Disability (ID) is a heterogeneous disorder, in which at least 600 genes participate. The present study aimed to identify the effect of genetic counseling and consanguinity marriage in Iranian families with sporadic mental disability. Materials and Methods: In this retrospective cross-sectional study, we examined 151 families with a sporadic mental disability referred for genetic consultation to the Welfare Center of Sari city, North of Iran. Results: About 41. 05% (n=62) of the cases were consanguinity marriage. In this study, other diseases were also observed with ID. The following four types of consultations were also reviewed, most of which were Diagnostic Counseling (DC) (60%). According to the inheritance pattern analysis, the share of non-hereditary cases was higher compared to the share of hereditary and unknown cases. The results of the present study showed a significant difference between consanguinity marriages and potential genetic etiology ID (P=0. 012). Besides, there was no significant difference between other groups. Conclusion: In this study, we highlighted the importance of genetic counseling and found that consanguinity marriage was a key factor in the development of the disease in our society. Therefore, given the high cost of genetic tests and socio-economic problems, it is wise to include genetic counseling to prevent many diseases such as mental disability before birth.

Right ventricular non-compaction cardiomyopathy (RVNC) is a genetic heterogeneous cardiomyopathy. Despite the increasing number of RVNC cases, the classification and natural history of this disorder are not completely clear. Also, because the pathogenic non-compaction cannot be easily differentiated from normal trabeculations, it is usually hard to accurately measure the prevalence of RV involvement. In this review, we searched main databases including Medline, Web of Science, EMBASE, and Scopus. In addition, the Google Scholar was searched until December 2019. Owing to the disagreements over RVNC classification and lack of diagnostic tests, there is no reliable and accurate statistical data about the prevalence of RVNC in newborn and children populations. Hypothetically, it is propounded that the disorder is being over-diagnosed as the number of RVNC cases reported during recent years has significantly increased.

Background: This study was conducted to identify cardiac dysfunction and the relationship of hemoglobin A1c (HbA1c) levels and serum lipids to echocardiographic indices in children and adolescents with T1DM. Materials and Methods: This case-control study was conducted on 100 cases including 50 children and adolescents aged 3-19 years old suffering T1DM for at least two years and 50 age-and sexmatched healthy subjects with the patients. This study was conducted in Shahrekord, Iran. All participants underwent TDI echocardiography and the levels of HbA1C and serum lipid were measured in diabetic patients. Then echocardio function of two groups were compared and the relation between these findings and HbA1C and lipids was evaluated. Data was analyzed using SPSS software (version 23. 0). Results: MPI, E/A, E'/A', E wave, A wave, IVRT, ET, EDV, LVIDd and LVIDs were significantly different between diabetes and control groups (P<0. 05). However, EF, E/ E', IVCT, ESV and EF values showed no significant difference between diabetes and control groups (P>0. 05). A significant, positive correlation was observed between E/E' and TG (p=0. 007, r= 0. 37). E/A showed positive correlation with HDL (p=0. 046, r=0. 284) and negative correlation with TG (p = 0. 048, r=-0. 281), and LDL (P=0. 012, r=-0. 352). E'/A' showed positive correlation with HDL (p=0. 033, r=0. 302), and negative correlation with TG (p=0. 014, r=-0. 347) in diabetic patients. Conclusion: In diabetic patients, first, cardiac diastolic function decreases, resulting in a decrease in E /A and E/A ratios as well as a decrease in myocardial performance index, which indicates systolic and diastolic function, and is recommended to be taken into account in the initial examination of the heart of diabetics and not to wait for late-onset systolic function change.

The inspissated meconium pellets are a cause or effect of ileocolic obstructions. The present study aimed at explaining our experience of ultrasound-based approach for differentiation and treatment of the inspissated meconium pellets. This study was conducted at Mashhad University of Medical Sciences, Mashhad, Iran, from 2017-2020. Twenty-four neonates (less than 8 days) with inspissated meconium pellets were examined using ultrasound. Moreover, in cases with non-complicated inspissated meconium pellets, ultrasound-guided contrast enema was performed for confirmation of the diagnosis or probable treatment. In ultrasound, the inspissated meconium pellets were observed as uniform hypo-to hyper-echoic tubular or beaded intra-luminal material in ileocolic loops or rectosigmoid area. These pellets were in five states: simple meconium ileus, localized or generalized meconium, small bowel, meconium plug syndrome, and Hirschsprung's disease. During contrast enema in non-complicated meconium ileus, moving and floating of inspissated meconium pellets was observed during ultrasound scanning, while this issue was not observed in small bowel atresia. The success rates of the hypertonic contrast enema in patients with simple meconium ileus were 80%. The inspissated meconium pellets have an ultrasound appearance. They are mainly observed in patients with simple and complicated meconium obstructions and bowel atresia. Except in complicated meconium obstructions, the ultrasound-guided contrast enema was performed for their differentiation and probable treatment.

Background: Platelets have an important contribution in pathogenesis of different infectious and inflammatory disorders. This study was performed to identify the diagnostic value of platelet count (PLT), and platelet indices in children with acute pyelonephritis (APN). Materials and Methods: In a cross sectional case control study, a total of 91 children with APN and 90 healthy control children were investigated during 2018-2019. About 3 ml EDTA blood was drawn before antibiotic treatment and investigated for white blood count (WBC), Hemoglobin level, mean corpuscular volume (MCV), platelet counts, and platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (PLCR) in two groups. Then, the results were compared in two groups. Results: Mean age at diagnosis of patients was 34. 57± 30. 96 months. Children with APN had significantly higher PLT, along with lower MPV, PDW and PLCR, compared to the normal healthy group. Using the best cutoff points, PLT>452000, and MPV≤ 7. 7 had the highest sensitivity (96. 67%) and specificity (92. 22%) for diagnosis of APN, respectively. Based on AUC, PLT and platelet indices were accurate diagnostic markers of APN. Conclusion: Based on the results, PLT and platelet indices were fast and additional tests for diagnosis of children with acute febrile urinary tract infection.

Background: Breastfeeding and mother-infant physical contact play an essential role in the mother's emotional recovery and readjustment. The present study aimed to investigate the association between attitude toward breastfeeding and postpartum depression. Materials and Methods: The present descriptive cross-sectional and analytical study was conducted on 200 females with postpartum depression referred to rural and urban health centers, Kerman, Iran. The selection was carried out using the convenience sampling method. The mothers who met the inclusion criteria and had the willingness to participate were included in the study. They were called, and if they had inclusion criteria, they were asked to refer to health centers. Data were collected using a questionnaire about baseline characteristics and the Edinburgh Postnatal Depression Scale (EPDS). Results: This study showed that there was no special baseline effect on total attitude and aspect of depression. The results showed a significant negative relationship of total attitude with anxiety (r=0. 213, p=0. 003), depression (r=-0. 163, p=0. 022), and anhedonia (r=-0. 213, p=0. 003). There were the strongest and the weakest relationship between anhedonia and depression (r=0. 567, p<0. 001), and between total attitude and depression (r=-0. 163, p=0. 022), respectively. According to the results of the independent t-test, a significant relationship was observed between scores of depression and total attitude, which means that females with depression had a more negative attitude (p<0. 001). Conclusion: The results of this study documented the relationship between the attitude towards breastfeeding with postpartum depression and anxiety.

Background: Many factors can effect on children's abilities and development. This study was conducted to investigate the effect of some risk factors as maternal health on child development using path analysis. Materials and Methods: This cross-sectional study was conducted on a total number of 608 mothers and their children, multistage sampling method, in the city of Yasouj, Iran. The data collection instrument was questionnaire-based. The researcher-made questionnaire included a demographic characteristics information form for mothers and a child profile form. Other questionnaires included Ages and Stages Questionnaire (ASQ), Socioeconomic Inventory, Social Support Appraisals (SS-A) scale, Perceived Stress Questionnaire (PSS-14), Perceived Stress Scale (14 items), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI-II), and Enrich Marital Satisfaction Scale. Mothers completed the questionnaires in 4 days and after that handed them over to the researcher in the kindergartens. To analyze the data, the SPSS software version 20. 0 and LISREL 8. 8 and path analysis test were used. Results: Amount of developmental delay was 17. 4% and the minimum and maximum delays were reported in problem-solving, personal-social skills and communication domains. There was a significant correlation between developmental status of children and socio-economic status, depression, social support, anxiety and marital satisfaction but correlation between developmental status of children and perceived stress was not significant. The final path model fitted well (RMSEA= 0. 018, CFI= 1, NFI=1, IFI=1). Maternal anxiety had the most significant effect on child development (β Total =-0. 24722). Conclusion: Many factors including socio-economic status, maternal anxiety, perceived stress, social support, anxiety, and depression can affect on the developmental status of 3 to 5 year-old children.

Background: Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, which might increase the risk of joint dislocation. Hip dysplasia may occur at birth or develop in early life. The purpose of the present study was to assess the effect of treatment with Tubingen hip flexion splint for Developmental Dysplasia of the Hip (DDH), and its safety. Materials and Methods: The systematic search was carried out on the online databases (Medline, Cochrane library, EMBASe, and Scopus) to assess the effect of treatment with Tubingen hip flexion splint for developmental dysplasia of the hip. Articles indexed until 20 April 2020 were reviewed using keywords such as (Hip dislocation, Congenital, DDH, and Tubingen hip flexion splint). The study selection was carried out by two reviewers. Results: Six studies were included in systematic review and meta-analysis. The pooled successful rate of Tubingen hip flexion splint was 88% with a Confidence Interval [CI]; 87-97%; p<0. 001; heterogeneity; I2: 89%%, p<0. 001; six trials; random effect model. The heterogeneity level was high among the included studies. Due to high heterogeneity, the sensitivity analysis was conducted to assess the effect of each study on the result and the level of heterogeneity. The results of the sensitivity analysis showed that no studies influenced the outcome and the level of heterogeneity. However, the pieces of advice were not associated with serious side effects. Conclusion: According to the results, the success rate of this Tubingen brace was 88%. Moreover, the results must be interpreted with caution due to the small sample size and high heterogeneity. The effectiveness of this method in the long term is still debatable.

Background: Infants' discharge from neonatal intensive care unit (NICU) creates high level of anxiety for parents, especially mothers; therefore, some strategies are needed to reduce parental anxiety. The aim of this study was to investigate the effect of home-visit training program on the anxiety of mothers of preterm infants. Materials and Methods: In this clinical trial study, 70 mothers whose preterm infants were discharged from the NICU of Ayatollah Rouhani and Amirkola Children's Hospitals in 2018 were divided into intervention and control groups (n=35 in each) based on inclusion criteria. The premature infant care package was presented to the mothers in the intervention group using lectures, practical education, and pamphlets through four sessions held twice a week at their homes. The mothers of both groups completed the State-Trait Anxiety Inventory (STAI) after infants' discharge and one month after training sessions. Results: Mean age of mothers was 29. 17± 6. 05 and 29. 09± 6. 56 years in intervention and control groups, respectively. Mean gestational age was 33± 2. 27 and 32. 76± 2. 92 weeks in intervention and control groups, respectively. The mothers of the two groups did not differ in age and other demographic factors (P>0. 05). In the intervention group, the mean anxiety decreased from 88. 77± 15. 53 before the intervention to 64. 02 ± 11. 9 after the intervention, but in the control group, it enhanced from 80. 25± 20. 33 to 103. 05± 26. 69 the difference was significant (p > 0. 001). Conclusion It seems that home-visit training program decreases maternal anxiety of preterm infants; it can be used as a supportive care to decrease maternal anxiety.

Background: Malnutrition is one of the most common disorders among children with Cystic Fibrosis (CF). The present study aimed to investigate the effect of nutritional consultation on the type and severity of malnutrition in children with CF. Materials and Methods: This quasi-experimental study was conducted on 78 children with CF referred to Mofid Pediatric Hospital, Tehran, Iran, in 2017-2018. Their parents filled the demographic questionnaire. Participants with malnutrition were undergoing the assessment on growth indices, including weight, height, ideal body weight, mid-upper arm circumference, and Z-score. Moreover, the nutritional consultations were considered for them (30-45 minutes). Children and their parents were consulted and trained about total daily calorie acquirement, type, number of the meal, amount of food intake, drinks, and avoided eating of any low-calorie food like snacks, during the consultation. All patients were reassessed three months later for growth indices. The data were analyzed using SPSS software version 22. 0. Results: We assessed 78 children with CF, 21 (26%) of them had mild, 26 (34%) moderate malnutrition, and 31 (40%) severe malnutrition. The result showed that nutritional intervention was effective. Consequently, 1 (3. 8%) of the moderately malnourished child was improved to mild malnutrition and 5 (27. 8%) children under five years old were improved from severe to moderate malnutrition. Moreover, 1 (5. 6%) child were improved from severe to mild, and 2 (15. 4%) of children over five years old were improved from severe to moderate malnutrition. Conclusion: According to the results, the early growth assessment in hospitalized and outpatient, diagnosis of malnutrition and nutritional intervention will be useful in improving the severity of malnutrition and growth indices in children with CF.

Background: reeclampsia is one of the most common causes of maternal mortality. This complication has been attempted to prevent preeclampsia. Many drug treatments have also been tested, including aspirin, one of the drugs prescribed to prevent preeclampsia. Therefore, the present study was designed to summarize the findings and conclusions for the effect of aspirin on preeclampsia. Materials and Methods: In this systematic review, databases of Iran Doc, IRCT, SID, ProQuest, Medline, Scopus, and Cochrane were reviewed until October 2019. The keywords "Aspirin, Preeclampsia, hypertension, acetylsalicylic acid, ASA, Iran and clinical trials" were searched for references in the literature and their possible combinations in the title and abstract. Qualitative analysis of studies was performed according to the Evidence-Based Medicine Checklist for therapeutic studies. Results: Six clinical trials including 1, 765 pregnant women were studied. In four studies, aspirin had a significant effect on the prevention of preeclampsia. In two studies, calcium-D had a significant effect on reducing the incidence of preeclampsia. Results regarding the effect of aspirin on infant birth weight, preterm labor and intrauterine growth restriction are inconsistent. Conclusion: The results showed that aspirin (within the lowest daily dose of 75mg) has a positive effect on the prevention of preeclampsia (pregnant women at risk of preeclampsia) among most of the studies and positive results. Judging the definitive efficacy of aspirin in relation to other variables such as neonatal birth weight, preterm labor and intrauterine growth restriction requires more and more detailed studies with a sufficient sample size.

Background: Exposure to electro-magnetic fields is a risk factor for abortion. We aimed to review the relationship between exposure to magnetic fields during pregnancy and the risk of abortion. Materials and Methods: Two independent researchers screened the articles with related keywords including: "Radiofrequency", "RF", "RF-EMFs", "Phone", "Mobile phone", "Cell phone", "Electromagnetic field", "Electromagnetic waves", "EMF", " EMW", "Magnetic Field", "Abortion, and "Miscarriage". Following electronic databases: Scopus, EMBASE, Cochrane, Web of Science and Medline were searched without time and language restrictions from inception up to March, 2020. Results: In the first study, there was a significant difference in the magnitude of Extremely LowFrequency Electro-Magnetic Fields (ELF-EMF) between the two groups in the participants' houses. In the second study, the relationship between the miscarriage risks with high Magnetic Field exposure was evaluated among pregnant women by eliminating various confounding factors. In the third study, there was a relationship between miscarriage risk and prenatal exposure to the highest magnetic field, about 16 mG (95% CI: 1. 2-2. 7). In the fourth study, the research units exposed to higher MF levels were 2. 72 times more at risk of miscarriage compared to the women exposed to lower MF levels. In the fifth study, a significant difference was observed between the two groups regarding the magnitude of ELF-EMF in the participants' houses. A significant likelihood of miscarriage in women who exposed to a significant level of the electromagnetic wave was observed; however, this relationship was not confirmed by the Wald test. Conclusion: The effect of exposure on the risk of abortion depends on the distance from the source of radiation and the intensity of the frequency of the waves.

Background: Although the left ventricle is the major site of BNP secretion in response to cardiac pressure or volume overload, the myocytes of both atria and ventricles secrete B-type natriuretic peptide (BNP). This study aimed to assess and compare the plasma levels of BNP in common pediatric cardiac diseases to clarify its pathophysiological role and evaluate its possible diagnostic and prognostic utility in pediatric patients with congenital heart disease (CHD), and heart failure (HF). Materials and Methods: The study is a prospective, case-control research including 131 pediatric patients selected from Pediatric Department of South Valley University Hospitals in Qena, Egypt, with a variety of cardiac diseases and 70 healthy controls. The patients were categorized into 4 groups: 61 newly diagnosed pediatric patients with CHD, 30 patients with HF, 20 pediatric patients with cardiomyopathy (CM), and 20 children with rheumatic heart disease (RHD). Clinical and echocardiographic assessments for the pediatric patients were performed. Bioassays of plasma BNP using commercially available ELISA assay kits were performed to the study the participants. Results: The median plasma BNP levels were significantly higher in the CHD, HF and CM groups than the RHD and control groups, with p<0. 001 for all groups with non-significant differences between both RHD and control groups. BNP levels did not significantly differ in patients with PDA or multiple cardiac anomalies vs. the controls (p>0. 05). Conclusion: The validity of plasma BNP in diagnosing HF was significantly superior to its utility in predicting CHD among pediatric patients.

Background: Effective interventions on exclusive breastfeeding that are appropriate for the existing conditions can have significant benefits on maintenance, continuity, and promotion of breastfeeding in mothers. The aim of this study is to evaluate the effect of Fenugreek on breast milk sufficiency in nursing mothers. Materials and Methods: In this review, trials on the effect of Fenugreek on breast milk sufficiency were searched on the electronic databases of Scopus, EMBASE, Cochrane, Web of Science, and Medline, with no language or time restrictions before the end of December 2019, using the combination related keywords of Mesh. Study selection was done by two reviews. Results: Reviews of 9 eligible clinical trials indicated the positive effect of fenugreek on breast milk adequacy and increased breast milk supply markers in the research participants compared to the control group. Effects of Fenugreek on breastfeeding adequacy were demonstrated in increasing neonatal weight gain, breastfeeding frequency, and fecal excretion frequency, number of changing diapers, increased breast milk production, and increased maternal prolactin hormone levels. Conclusion: According to the results of reviewing previous studies, the use of fenugreek to improve breastfeeding adequacy and promote neonatal growth is recommended, considering its ease of access and use and rare adverse effects on the mother and infant.

Background: Childbirth is a fundamental physical and emotional struggle. This study is an attempt to investigate the psychological factors related to the first delivery, and its relationship with the preference of the type of subsequent deliveries in women. Materials and Methods: This is a descriptive-analytical study in which 380 pregnant mothers referred to Qamar Bani Hashem Hospital in Khoy, Iran, who were hospitalized for childbirth, were selected by simple random sampling. Participants were first asked about their preference for the next type of delivery. Afterwards, the Individual and Social Profile Questionnaire, the Edinburgh Depression Questionnaire, the overt and covert anxiety of Spielberger, and the Wake-Forest questionnaire in the interview method were completed. All data were analyzed using SPSS software version 22. 0. Results: There was no significant statistical relationship between psychological variables and the preferred type of delivery. Age, spouse's education level, and income were among the predictors of preference for delivery. These factors had a statistically significant relationship with confidence in the physician in participating women. Apart from income, there was a statistically significant relationship between other social factors with preference of the type of delivery. There was also another significant relationship between complications during childbirth and postpartum with a preference for the type of the next delivery (P<0. 05). Conclusion: Based on the results, there was a relationship between socio-individual factors and complications during and/or after childbirth with a preference for the next type of delivery in women. Further studies are needed.

Background: Neonatal sepsis is a critical condition caused by a generalized bacterial infection in the first month of life. The present study aimed to investigate the relationship between serum vitamin D levels and neonatal sepsis. Materials and Methods: A search of online databases (Medline, Cochrane Library, Web of Science, EMBASE-Ovid, and Scopus) were carried out for randomized control trials and non-randomized prospective or retrospective clinical studies published in English till April 2020. Two reviewers selected the studies. Results: In the first study, the level of 25-hydroxyvitamin D [25(OH)D] in the cord-blood sample of infants in the Early-Onset Neonatal Sepsis (EONS) group was significantly lower compared to the control group. 25(OH)D level (19 ng/ml) in the control group were significantly higher compared to the 25(OH) level (8. 6 ng/ml) in the sepsis group. In the third study, the serum 25(OH) level showed a significant decrease in the affected neonates (6. 4 nmol/L) compared to healthy neonates (42. 5 nmol/L). In the fourth study, the sepsis and control group had a significant difference in the level of 25(OH)D (69± 7. 5ng/ml and 35± 19ng/ml). According to the fifth study, the serum 25(OH)D level was insufficient in the case group and sufficient in the control group (p<0. 0001). In the sixth study, the odds of very-early-onset neonatal sepsis among the neonates who had the serum 25-hydroxyvitamin D deficiency were lower compared to the odds among neonates who did not have serum 25hydroxyvitamin D deficiency. Conclusion: The level of 25-hydroxyvitamin D in the blood sample of infants in the sepsis group was significantly lower compared to the control group; further studies required to confirm the results by considering more confounders.

Background: Tuberous Sclerosis Complex (TSC), and Spinal Muscular Atrophy (SMA) are two inherited disorders while they are genetically independent. TSC is characterized by the formation of multiple hamartomas in nearly all organs. SMA is a destructive neurological disorder leading to progressive muscular weakness and atrophy. Case Presentation: The patient was an Iranian (Urmia, East Azerbaijan Province, Iran) 11-year-old daughter of nonconsanguineous parents. She developed seizures as an infantile spasm at three months old. She had a delay in motor development. At 11 years old, the patient had proximal muscle weakness resulting in a characteristic waddling gait and Gowers' sign, which was suspected of SMA. The SMA was then confirmed using molecular analysis. Clinical examination of the patient revealed angiofibromas, shagreen patch, and hypopigmented spots on the skin; cortical tubers, subependymal nodules, and subependymal giant cell astrocytoma in the brain; angiomyolipomas in the kidneys; and retinal hamartoma, which fulfilled the diagnostic criteria of TSC. Conclusion: Although TSC and SMA are genetically independent disorders, they may rarely occur together in an individual, simultaneously. Further studies required to find the patterns of genetic inheritance of these diseases among the reported patient.

The ductus arteriosus (DA) is a vital structure in fetal circulation, carrying about two thirds of the right ventricular (RV) output to the aorta. During fetal life, ductal patency is actively preserved by several different factors, and pathologic ductal constriction causes right-sided pressure overload of the heart, leading to RV failure. There have been many reports of ductal constriction so far, most of which are linked to maternal use of non-steroidal anti-inflammatory drugs, but they are mainly reported in the third trimester. In the present study, we report the case of a 25-year-old gravid 2 woman with premature constriction of the DA following maternal treatment with dexamethasone and ibuprofen at the very early age of 18 weeks of gestation. She was referred to the radiology department for fetal echocardiography after a recent ingestion of ibuprofen for back pain. She was found to have had a constricted ductus arteriosus 3 days after being medicated at the gestational age of 18 weeks.

Background: Asthma is the most common chronic airway disease in children. We aimed to investigate the effect of vitamin C supplementation on improving the asthma symptoms in children. Materials and Methods: In a double-blind clinical trial: sixty 2-12-year-old children hospitalized with the diagnosis of asthma attack in the Ghaem and Dr. Sheikh hospitals, Mashhad, Iran were randomly assigned into two groups: intervention (receiving vitamin C tablets 500 mg every 12 hours, n=29), and control (receiving placebo, n=31). In each group, at the beginning and end of the hospitalization, one blood sample (3ml) was taken to evaluate the serum level of vitamin C and for other necessary tests. A pediatric resident recorded clinical symptoms at the beginning and every 6 hours until discharged including tachypnea, wheezing, retraction, and hypoxia every six hours until discharge from the hospital. Eventually, the data in the two groups were compared. Results: The mean age of the hospitalized patients was 33± 24 months. There was a significant difference between the intervention and control groups regarding the serum level of vitamin C at the beginning of hospitalization and at the time of discharge. A significant difference was found in tachypnea of the hospitalized patients of both groups at 24, and 36 hours post hospitalization. Existence of wheezing in the patients of the intervention and control groups had a significant difference at 18, 36, and 66 hours post-hospitalization (p<0. 05). Conclusion: According to the results, oral vitamin C prescription in patients with acute asthma symptoms leads to improved respiratory status (tachypnea and wheezing) in 2-12-year-old children. Also, it is effective in reducing the duration of hospitalization of these children.

Background: The aim of the present research was to compare the effectiveness of training cognitive behavioral therapy and Neuro-linguistic programming (NLP) strategies on mitigating anxiety, depression, and stress of students. Materials and Methods: The method of this semi-experimental research was pretest posttest with control group. The statistical population consisted of all female and male adolescents 15-18 year-old studying in the second grade of high school in Kerman, Iran. Forty-five students with the maximum score in anxiety, depression, and stress were chosen as the sample and were randomly assigned into three 15-student groups (15 in the control group, 15 in the experimental group I, and 15 in the experimental group II). Next, experimental group I received training in neurolinguistics programming strategies as therapeutic method, while experimental group II received cognitive behavioral therapy (CBT). The instrument used in this research was DASS-21 which was completed by all three groups before the study and after the therapeutic period. Results: The results indicated that training NLP strategies and cognitive behavioral therapy had a significant effect on reducing anxiety, depression, and stress of students (p<0. 05). The extent of impact of training NLP strategies and cognitive behavioral therapy had no significant effect on mitigating the students' anxiety, but it had a significant influence on reducing depression and stress; the extent of effectiveness of NLP strategies was greater than that of CBT for reducing depression and stress. Conclusion: Based on the results, training NLP strategies and cognitive behavioral therapy had a significant effect on reducing anxiety, depression, and stress of the students. The students who received treatment through NLP and CBT experienced diminished anxiety, stress, and depression.