Journal of Pediatric Perspectives
Year:2016 | Volume:4 | Issue:2 (26)|Papers Count:15

Background Recently the prevalence of obesity and its comorbidities has increased in children, in the worldwide. Some evidences show that there is a reverse relation between the serum level of 25-hydroxyvitamin D[25(OH)D] and Body mass index (BMI). The purpose of this study was scrutiny response to treatment vitamin D deficiency in obese/overweight children. Materials and Methods In a randomized clinical trial, cross sectional study 60 children aged 5-15 year-old with BMI≥ 85% were entered. After obtaining of informed consent the calcium, phosphorous, alkaline phosphatase, 25(OH) D and parathyroid hormone (PTH) levels were measured after 8 hours of fasting. According to intensity of vitamin D deficiency, intra muscularly vitamin D3, 300, 000 to 600, 000 unit was prescribed. All parameters were rechecked after 1 month. Data were analyzed with SPSS-20 software. Results Among total 60 subjects, 49 children (81. 7%) were overweight and 11 children (18. 3%) were obese. Also, all of subjects had vitamin D deficiency. After intervention only 35% got normal level of vitamin D. Mean level of vitamin D in girls were lower than boys. Average level of vitamin D rose significantly after intervention in both overweight and obese groups (P<0. 05). The mean PTH level was reduced significantly after intervention in overweight children (P<0. 05). Mean levels of calcium and phosphoruswere increased in two groups after intervention, but this is not significant (P>0. 05). Discussion With considering high prevalence of vitamin D deficiency in overweight/obese children, low response to treatment and multiple after math complications, we suggest more attention to vitamin D deficiency and renewal and early intervention in these children.

Background The X-linked cyclin-dependent kinase like 5 (CDKL5/STK9) gene has been shown to be responsible for a severe encephalopathy condition characterized by early onset of epilepsy and severe developmental delay. CDKL5 mutations have been shown to be more frequent among female patients. Results Here we report a 6-month male patient, second child of a healthy non consanguineous in the Iranian population. He has been affected by early onset epileptic refractory seizures and developmental delay. Whole-exome sequencing (WES) has revealed a base substitution c. 173T>A in CDKL5 gene, resulting in the formation of stop codon p. L58X. This mutation resides in the catalytic domain of the corresponding protein and is expected to result in premature RNA break down with no CDKL5 resulting protein. Conclusion The present report highlights the importance of CDKL5 mutation analysis in male patients affected with early onset refractory epilepsy.

Background Vascular ring is less than 1% of congenital heart disease. Double aortic arch (DAA) is the most common form of it. Its detecting is important because of the effects of pressure on the esophagus and trachea. Case Report In this study, three children suffering from double aortic arch with symptoms of dysphagia and recurrent aspiration, which in two cases had led to cardiac arrest, were introduced. In all of these studies, computed tomography angiography and chest X-ray were used to diagnose the compression effect of double aortic arch on the esophagus and the surgery provided for treatment of the children. After the surgery, all three patients were monitored in the intensive care unit (ICU) for five days without showing any symptoms. Conclusion Totally, we found that three computed tomography angiography, as a non invasive, high quality method, would be suitable for the diagnosis of this abnormality.

Background Asthma is one of the most important childhood diseases in developing countries. The prevalence, mortality, and economic burden of the disease have taken a rising trend since 1960, and this increase was more marked in children. The presents study aimed to assess the prevalence of asthma symptoms diagnosed by International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in Kurdistan province, Western Iran. Materials and Methods In a cross-sectional study, to collect the required data 4, 000 questionnaires were distributed among student aged 6-7 years and 13-14 years; and the response rate was 97 percent. An ISAAC questionnaire was used to collect data on socio-demographic variables, past health history, and respiratory health. Descriptive statistics, logistic regression and Chi-square test were use for analysis. Result. The prevalence of asthma diagnosed by physician was 3. 9%. The prevalence of wheezing was 26. 5% in the province in the past 12 months. There was a large difference between different cities in terms of the prevalence rates, so that it varied from 1. 7% in Dehgolan to 8% in Sarvabad; hence, the difference was statistically significant (P < 0. 05). Conclusion There was a relatively high prevalence of wheezing in the past 12 months and previous diagnosis of asthma among the students in Kurdistan province which was higher than that in other similar studies.

Background The feeding importance of child in first two years of life and mental damage caused by malnutrition during this period is obvious. However the mother's lifestyle and long-term effects on the health of the mother and infant during breastfeeding period should not be neglected. Therefore, this study aimed to determine the relationship between the demographic characteristics and lifestyle of breastfeeding mothers referring to health centers in Isfahan. Materials and Methods In this cross-sectional study, 190 breastfeeding mothers were selected by quota sampling from Isfahan-Iran. Demographic and lifestyle questionnaires were completed. Data were analyzed by descriptive and analytical statistical methods using of SPSS-16. Results The majority of mothers (88. 9%) in breast feeding period have an appropriate lifestyle. The most favorable conditions among different aspects of lifestyle related to spiritual health and the most unfavorable is related to sports and fitness. There was a direct and significant relationship between mother's education and prevention of accidents (r=0. 34, P<0. 05); father’ s education and social health (r=0. 281, P<0. 05) respectively. Results showed with increasing rank of birth, the avoiding of medications, drug and alcohol decreased; also with increasing duration of breastfeeding, prevention of accidents reduced (P<0. 05). Conclusion According of these findings, it seems that the pregnancy and postpartum period offers a percpective of opportunity to healthcare professionals to train and correct lifestyle and its different aspects of mothers in order to improve the health of the mother and infant.

Vitamin A is the generic name given to a group of fat-soluble compounds including retinol (the alcohol form), retinyl esters, retinaldehyde and retinol acid. Deficiency, first recognized in 1912, can damage the epithelial cells lining the respiratory tract. It can also affect immunocompetence, the reproductive function, growth and vision. The dose of vitamin A for neonates is 5, 000 IU given intramuscularly 3 times weekly for 4 weeks. Retinol concentrations < 0. 70 μ mol/l in serum and <1. 05 μ mol/l in milk are indicative of vitamin A deficiency. The supplementation of vitamin A to pregnant women with deficiency of vitamin A has protective effects against neonatal morbidity and mortality and has a positive impact on maternal vitamin A status. High cord vitamin A levels increase placenta weight and birth weight and length of the newborn. Vitamin A has been considered a therapeutic alternative in the reduction of the rate of bronchopulmonary dysplasia. The kidneys are target organs for vitamin A action. The vitamin A status of the mother profoundly affects the kidney organogenesis of the newborn. Retinoic acid regulates nephron mass. Intramuscular vitamin A (10, 000 IU) 3 times weekly improves retinal sensitivity in preterm neonates. Vitamin A increases the neonatal body size. A dose of ≤ 10, 000 IU vitamin A is not teratogenic.

Background Objective: To evaluate the utility of specific cut-off values for C-reactive protein (CRP) and immature-to-total neutrophil ratio (I/T) as screening tests for meningitis in culture negative early onset sepsis (EOS). Materials and Methods Retrospective chart review of 97 newborns with culture negative sepsis who had lumbar puncture performed as part of the sepsis evaluation in a level IIIB NICU at an academic medical center serving a predominantly minority population. Meningitis was defined as either a positive cerebrospinal fluid (CSF) culture or CSF WBC count ≥ 30/mm. The outcome measures were the sensitivity, specificity and predictive values of CRP >40 mg/L and I/T ratio >0. 3 for diagnosing meningitis in newborns with EOS. Results The sensitivity, specificity and positive predictive value of I/T ratio >0. 3, CRP >40 mg/L or a combination of these two either at 12 or 24 hours of life were very poor. However, CRP >40 mg/L alone or in combination with I/T ratio >0. 3 at both 12 and 24 hours of life had negative predictive values of 85-90%. Conclusion CRP >40 mg/L and/or I/T ratio >0. 3 have poor sensitivity, specificity and predictive values as screening tests for meningitis in culture negative early onset sepsis.

Background: Depression, a challenging disorder, affects 1– 6% of adolescents and early onset often predicts more serious manifestations in later life. Elevated Parathyroid hormone (PTH), parathormone levels have reported among adults with depression. In this study, the roles of 25(OH) D (vitamin D) and parathormone during adolescence, in which the frequency of depression is high, were studied. Materials and Methods: Patients who were followed-up jointly at both clinics and whose 25(OH) D and PTH levels were evaluated and questioned "Depression Scale for Children" for depression at the same time, were included in the study. Cases’ socio-demographic data, 25(OH) D and PTH levels and Depression Scale’ scores were recorded. Results: Depression was diagnosed in 35 (25. 3%) of the 138 patients. No differences were found between vitamin D and parathormone in terms of age and gender in groups either with or without depression. Negative correlation was found between the vitamin D levels and depression score in the group with depression (r=-0. 368; P=0. 03). A significant and positive correlation was found between the PTH levels and depression score (r=0. 399; P=0. 018). A significant and negative correlation was found between 25(OH) D and PTH levels. Conclusion: Even if clinical depression is absent, the frequency of depressive symptoms is increased with decreased vitamin D levels and increased PTH levels, independent of other factors. The prevention of depression, specifically in adolescents, is important to decrease possible suicidal and homicidal thoughts that might arise during adulthood, and substance abuse. Maintaining vitamin D support during adolescence, as with the first year of life, is necessary for both the prevention and treatment of depression.

Background In this study, given the importance of gastrointestinal anastomosis in surgical procedures, attempts have been made to compare the results of employing magnetic compression anastomosis and magnetic coils in intestinal anastomosis of rats. Materials and Methods This study was an experimental trial on 60 rats which had been randomly divided into two experiment (30) and control (30) groups. First, the rat intestine was cut off from a relatively fixed point and then magnet anastomosis was performed at the both ends of bowel in the control group and manual suture in the experiment group. Anastomosis was then examined 10 days after the surgery for possible complications with a histological analysis of the indices of tissue repair. Results The mean time required for performing anastomosis of the rat intestine was 735 and 366 seconds for the control and experiment groups, respectively. Also, the laparotomy performed 10 days after the first operation did not show any significant difference between two groups in terms of surgical complications such as infiltration factor of inflammatory cell and fibroblast activity (P>0. 05). The microscopic examination indicated that the tissue reaction in the anastomosis site was better in terms of tissue repair of neo-angiogenesis intestine and collagen deposition in the magnet group(P>0. 05). Conclusion Given the shorter duration of the anastomosis by magnets and more favorable histological results reported in the experiment group, as well as the lack of any significant difference in complications of the two techniques, magnetic compressive anastomosis can be used as a new technique for intestinal surgeries and pertaining anastomosis. Although, we recommend that study will be done with large sample size to obtain reliable results.

Background Annual four to five thousand babies are born with hearing loss in the Iran. Hearing impairment is a disability that affects the quality of life of people with this problem. These individuals need to support from family and friends because of their specific conditions that this received support has impact on their quality of life. This study was conducted to assess the status of perceived social support and quality of life of hearing-impaired adolescent. Material and Methods A cross-correlation study was performed with cluster and multi stage random sampling method on 83 students with hearing impairment who met the inclusion criteria of the study in Mashhad. The data collection tools included Pediatric quality of life inventory (adolescent form) and perceived social support inventory (from family and friends). The data obtained from the questionnaires were analyzed through SPSS software version 16. Results The results showed that the majority of the most of adolescents with hearing impairment were reported moderate total quality of life (%51. 8). But the majority of them reported perceived social support from family was moderate (%61. 5) and from friends was week (%45. 8). Also there was a significant relationship between category of total quality of life of adolescent viewpoint with perceived social support from family (P=0. 005). Conclusion Based on the obtained results, the majority of the most of adolescents with hearing impairment were reported moderate total quality of life. Disability and condition of these persons affects quality of life of them, so need for adequate support from family, friends and society. Nurses play an important role in identifying and introduce these needs and condition and how to deal with them.

Background Understanding environmental factors affecting the educational process and including them in educational planning will lead into increased outcome of education, mental health, reduced stress, and higher education performance. This study was conducted to investigate the impact of educational spaces coloring on learning and academic achievement of elementary school students in the academic year of 2015-2016 in Ahvaz. Materials and Methods At a Cross-sectional study, a total of 210 students were selected randomly as sample of study. Cluster sampling was done by appropriate allocation and questionnaires were randomly divided among students. Data collection tools included Hermance’ s achievement motivation questionnaire and researcher-constructed questionnaire (observation checklist to examine the physical parameters of learning environment coloring) and interviews with students. Data of study were analyzed in SPSS-21 software. Results The results showed that appropriate coloring of educational environment has impact on learning and academic achievement of elementary school students in Ahvaz (P<0. 05). Conclusion Our results suggest that educational managers of country must consider these factors in designing educational environments.

Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiovascular defect that occurs in approximately 1/300 000 live births or 0. 5% of children with congenital heart disease. There are two types of ALCAPA syndrome: the infant type and the adult type. The most infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the first year of life; also, without early surgical intervention they have a dismal prognosis. Materials and Methods We report 3-year experiences from January 2013 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital North East of Iran) that consist of all patients with ALCAPA syndrome. Results The Takeuchi procedure, were successfully performed in five children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). There was no death and significant mitral regurgitation postoperative (n=0) in this short study. All of patients (n=5) had evidence of improving ischemic myocardium status by increasing of ejection fraction and regional wall motion of left ventricular in follow up echocardiography. Conclusion The only cure treatment for ALCAPA syndrome is surgical intervention that needs to be performed immediately after diagnosis to prevent myocardial infarction and chronic heart failure. Today, establishing a system with two coronary arteries is the goal in definitive surgical repair. The Takeuchi procedure is a prefer method to establish a two-coronary repair for ALCAPA.

Background Abnormalities of external genitalia in male children nurseries and inguinal hernia are the most common congenital disorders in children. We aimed to determine prevalence rate of inguinal hernia and other genital among children nurseries, in Shahrood-Iran. Materials and Methods In this descriptive cross-sectional study, we examined 920 children nurseries boys. Physical examination of children was performed in presence of a parent in a warm room in supine and upright position with and without Valsalva maneuver. A written consent was obtained from parents before examination. Past medical history and history of surgery on inguinal and genital area was taken. Examination was performed 2 interns who were trained about genital system examination. Results A total of 920 children nurseries boys aged 3 to 6 years were examined which were detected in 88 children and prevalence rate of these abnormalities were 9. 6%. The prevalence of abnormalities in the children under study were as follows: Inguinal hernia (5. 1%), cryptorchidism (2. 1%), Hydrocele (1. 5%), hypospadias (0. 4%), Varicocele (0. 1%), micropenis (0. 4%). Conclusion Regarding to relatively high prevalence rate of these abnormalities and low level of people knowledge, seem screening systems for diagnosis and appropriate treatment of these abnormalities to be necessary.

Background: This study aimed to assess the relationship between meal frequency with mental distress and violent behavior among a nationally representative sample of Iranian children and adolescents. Materials and Methods: The participants of this national study were 14, 880 Iranian students with 6 to 18 years of age. They were selected from urban and rural regions of Iran by multi-stage cluster sampling method. The data were obtained about demographic information, mental distress, violent behaviors and meal frequency by the questionnaire of the World Health Organization-Global School-based Student Health Survey (WHO-GSHS). Results: The response rate was 90. 6%. The participants who were categorized as the group eating 3 meals per week significantly experienced less mental distress than those who were categorized as consuming 2 meals and one/no meal per week (P-value < 0. 05). The min rate of violent behaviors was observed among participants who were classified as consuming 3 meals group and the max rate in one/no meal group. Participants who were categorized as consuming one/ no meal and 2 meals per week had higher risk of mental distress and violent behaviors compared with those whom consumed 3 meals per week. Conclusions: Meal skipping was significantly associated with mental problems and violent behaviors among Iranian children and adolescents and this association was independent of known confounders.

Adolescence is a transitional stage of physical and psychological human development that generally occurs during the period from puberty to legal adulthood. There are approximately 1. 2 billion adolescents (10-19 years) globally, roughly 90% of whom live in low and middle-income countries. Most are healthy, but there is still significant death, illness and diseases among adolescents. Illnesses can hinder their ability to grow and develop to their full potential. Alcohol or tobacco use, lack of physical activity, unprotected sex and/or exposure to violence can jeopardize not only their current health, but often their health for years to come. The mortality rate decreased from 126 to 111 per 100 000 between 2000 and 2012. This modest decline of about 12% continues the trend of the past 50 years. Mortality rates dropped in all regions and for all age groups except 15– 19 year old males in the Eastern Mediterranean and the Americas regions. The leading causes of death among adolescents in recent years were: road injury, HIV, suicide, lower respiratory infections, and interpersonal violence. Promoting healthy practices during adolescence, and taking steps to better protect young people from health risks are critical for the prevention of health problems in adulthood, and for countries’ future health and social infrastructure.