Journal of Pediatric Perspectives
Year:2018 | Volume:6 | Issue:2 (50)|Papers Count:25

Background: The world-wide prevalence of overweight and obesity among children and adolescents has reached an alarming level and become a major health problem in today’s world. The aim of this study was to identify the stages and processes of change as well as their relationship with weight control based on a Trans - theoretical Model (TTM) in overweight and obese Iranian adolescents. Materials and Methods: This cross-sectional study was conducted with participation of 250 overweight and obese adolescents selected through cluster sampling method from March to April, 2016. In order to collect data, a researcher-made questionnaire based on TTM? The obtained data were entered into SPSS version 19.0 software. Results: The majority of participants (80%) were in inactive stages (pre-contemplation, contemplation, and preparation) of change for weight control, while only 20% of them were in active stages (action and maintenance). Also, results showed that a significant difference between stages and processes of change so that individuals' progress across stages of change from pre-contemplation to maintenance increased cognitive and behavioral processes’ scores (p<0.05).Conclusion: The majority of participants (80%) were in inactive stages (pre-contemplation, contemplation, and preparation) of change for weight control, while only 20% of them were in active stages (action and maintenance). Also, results showed that a significant difference between stages and processes of change so that individuals' progress across stages of change from pre-contemplation to maintenance increased cognitive and behavioral processes’ scores (p<0.05).

Background: After substitution of Pentavalent vaccine with diphtheria, tetanus, pertussis (DTP) in the Iranian National Vaccination program with 3 Pentavalent (three times vaccination with Pentavalent vaccine at months 2, 4, and 6) in 2014 and the lack of published research in the field of immunogenicity of pertussis component of this vaccine, the efficacy of pertussis vaccine was studied 6 months after the last dose of Pentavalent vaccine in Iranian infants.Materials and Methods: Five hundred blood samples were collected from healthy one-year-old children who attended 18 health care centers of Karaj, Iran for routine vaccination selected by cluster sampling (2016). Sampling checklists contained demographic information and risk factors. The blood samples were sent to the laboratory for determination of Immunoglobulin G (IgG) and IgA anti-pertussis antibody titer by ELISA method. Data were analyzed by STATA software (version 14.0).Results: 82.7% (n=413) of children (95% confidence interval [CI]: 79.49-86.11) had IgG titer less than 16 IU/ml against pertussis (no immune response), and 17.3% (n=87) had equal or greater than 16 IU/ml IgG titer against pertussis (95% CI: 13.89-20.51). IgA titer against pertussis was less than 8U/ml in all cases. Anti-pertussis IgG geometric mean titer (GMT) was 15.80 U/ml (95% CI: 15.26-16.36), and IgA GMT was 6.26 U/ml (95% CI: 6.22-6.30). There was not a significant correlation between titer of pertussis antibody and demographic factors.Conclusion: Based on low IgG titer in vaccinated children, immunogenicity of pentavalent vaccine in Iranian children needs more investigation. In this study, 100 % of children had negative serologic response (IgA<8 U/ml); therefore, natural infection did not occur in the study cases.

Background: Autosomal recessive polycystic kidney disease (ARPKD; OMIM number 263200) is a severe early onset hereditary form of polycystic kidney and liver disease.Case Report In the current study, we present a consanguineous couple with a history of an affected son with polycystic kidney disease (PKD), hepatic failure and epileptic seizures who died at the age of 8 months. Both parents were heterozygote for a missense mutation inPKHD1 gene (NM_170724, c.9107T>G, p.V3036G).Conclusion: Unlike previous studies which showed the association between missense mutations ofPKHD1 gene and mild phenotype of ARPKD, we have demonstrated the presence of a certain heterozygote missense mutation in parents of a patient affected with lethal form of disorder. Such phenotypic variations should be considered in genetic counseling of families especially those seeking prenatal diagnosis.

Ovarian torsion (adnexal torsion) is an uncommon disorder in pediatrics and should be considered as a differential diagnosis of abdominal pain in preteen girls. Almost 70% of ovarian torsions are seen in young girls older than 20 years, but it could also occur in preteen girls. Sonography is one of the most useful methods to diagnose ovarian torsion. In pediatrics, ovarian torsion should be treated laparoscopically by detorsion.The case was a seven-year-old girl, who experienced ovarian torsion twice in one of her ovaries in the course of nine months. The main complaint of the patient was abdominal pain with vomiting. However, the fallopian tube was normal. Surgical procedure led only to detorsion of ovary.

Background: At least half the world’s population is colonized the stomach by Helicobacter pylori (H. pylori) which are a key constituent of the human microbiome. The aim of this study was to investigate the association of cardiometabolic risk factors with H. pylori infection in Iranian adolescents. Materials and Methods: The current study was conducted along with the third survey of a national school-based surveillance system in Iran, entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease" (CASPIAN) study. Detailed questionnaires on demographic, socioeconomic, dietary, and health-related information of the participants were filled by one of the parents under supervision of trained health-care workers. Trained healthcare professionals measured anthropometric indices, blood pressures according to standard protocols. Fasting venous blood was examined for fasting blood sugar and lipid profile.Results: Overall 882 serum samples were suitable for testing. H. pylori antibody was found in 643 serum samples (72.9%). Among cardiometabolic risk factors, only the mean weight of participants was different between two groups (44.6±11.8 in H. pylori positive and 42.8±11.3 in H. pylori negative group; p=0.04). Overall, 5.1% of adolescents with positive H. pylori tests were overweight or obese, while 1.7% of negative ones were so (p=0.02). In the multivariate regression model, H. pylori seropositivity increased the risk of overweight (OR, 3.3; 95%CI, 1.2-9.3; p=0.03). In the multivariate model, association of other cardiometabolic risk factors with H. pylori infection was not statistically significant (p>0.05).Conclusion: Results of present study showed that H. pylori infection was associated with excess weight in adolescents. H. pylori eradication may be decrease the risk of obesity.

Bacterial infections may cause disease and death. Infants and children are often subject to bacterial infections. Antimicrobials kill bacteria protecting the infected patients and reducing the risk of morbidity and mortality caused by bacteria. The antibiotics may lose their antibacterial activity when they become resistant to bacteria. The resistance to different antibiotics in bacteria is named multidrug-resistance. Gram-negative bacilli, especially Escherichia coli, Klebsiella, Enterobacter, Salmonella, Shigella, Pseudomonas, Streptococcus, and Haemophilus influenzae type b, may become resistant. Amikacin ampicillin, amoxicillin, amoxiclav, cefuroxime, cefotaxime, ceftazidime, cefoperazone tetracycline, chloramphenicol, ciprofloxacin, and gentamicin may cause bacterial-resistance. Resistance to bacteria for several pathogens makes complications in the treatment of infections caused by them. Salmonella strains may become resistant to ampicillin, cephalotin, ceftriaxone, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, and tetracycline. Shigella strains may become resistant to ampicillin, cotrimoxazole, chloramphenicol, and streptomycin. Multidrug-resistance of Streptococcus pneumoniae may be due to β-lactams, macrolides, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole.Multidrug-resistance of Pseudomonas aeruginosa may become resistant to β-lactams, chloramphenicol, trimethoprim-sulfamethoxazole, and tetracycline. The antibacterial activity against Haemophilus strains may occur with ampicillin, sulbactam-ampicillin, trimethoprim-sulfamethoxazole, gentamicin, chloramphenicol, and ciprofloxacin. Multidrug-resistance of the Klebsiella species may be due with ampicillin, cefotaxime, cefuroxime, co-amxilav, mezlocillin, chloramphenicol, gentamicin, and ceftazidime. Multidrug-resistance of Escherichia coli may be caused by ampicillin, cotrimoxazole, chloramphenicol, ceftriaxone, and ceftazidime. Vibrio cholera may become resistant to cotrimoxazole, chloramphenicol, ampicillin, with least resistance to erythromicin, tetracycline, and ciprofloxacin. The aim of this study is to review the published data on the resistance of different antimicrobials in infants and children.

Background: Different patterns of gender-based relationships between attitude toward smoking and self-esteem with smoking behavior have reported. However, such associations may be much more complex than a simply supposed linear relationship. We aimed to propose a method of providing hand details on the total and gender-based scenarios of the relationships between attitude toward smoking and self-esteem with smoking. Materials and Methods: A secondary analysis conducted on a data set obtained for a cross-sectional study among 4, 905 male and female high school students in Tabriz, Iran (2012). We randomly selected 196 classes in a clustering process and invited all the students in the classes to participate in the study; then, investigated the relationship between smoking with attitude and self-esteem, as explanatory variables. We also found the data to fit a nonlinear functional relationship and to be free from normal condition due to applying Bayesian nonparametric functional latent variable model.Results: Among all the students, attitude was found as the only variable with conceptual effect on smoking (p<0.05). Among boys, self-esteem showed no conceptual effect on smoking which was in contrast to those found among girls. Smoking among male students with low self-esteem was high, but it was gradually decreasing by rising self-esteem. Among girls, in contrast, smoking was descending by decreasing self-esteem.Conclusion: The relationships between self-esteem and attitude with smoking may not be necessarily linear. Being at the high levels of self-esteem among boys may lead to the reduced levels of smoking, and among girls may result in the increased level of the behavior.

Background: Type 1 diabetes mellitus (T1DM) is by far the most common metabolic disease in children. Asthma is the most common chronic disease in pediatric population, and its prevalence has increased in the last decades. In this study, the prevalence of asthma among these children with T1DM has been described and its association with the demographic and clinical characteristics of Iranian children has been evaluated.Materials and Methods: A cross sectional study was carried out on children with T1DM who referred to pediatric endocrinology clinics of Isfahan University of Medical Sciences. The participants were classified as a group with asthma and the second group as diabetic children without asthma. After selection and evaluation of the diabetic patients with asthma, their glycemic status was evaluated three times in the past year. All data were analyzed using the SPSS version 23.0 statistical software package.Results: A total of 419 patients (49.4% male and 50.6% female) diagnosed with T1DM were included in the study. The mean age of patients at the time of recruitment was 12.65 ± 3.9 years with a range from 3.8 to 18 years. The mean of disease duration was 5.3 ± 2.7 years. Among all participants, asthma was detected in 24 children with T1DM (5.7%). Glycemic control was significantly poorer among asthmatic patients with diabetes compared with diabetic patients without asthma.Conclusion: The study demonstrated a lower prevalence of asthma among T1DM children rather healthy than ones. Hence, diabetic child patients with asthma experience poorer glycemic control in comparison with T1DM patients without asthma.

Background: Obesity in adolescents leads to physical and mental complications. Exercise is one of the main components of weight control programs. This study aimed to evaluate the effect of physical activity programs on self-esteem and Body Mass Index of overweight adolescent girls.Materials and Methods: This study was a semi experimental study. The subjects were 140 second grade student girls from two high schools in 5th district of Isfahan. Data collection scales included: tape measure, carriage scale, questionnaire to collect background and personal information, designed questionnaire based on Health Belief Model, weekly physical self- reported and adolescent weekly food record form, parent’s nutritional performance questionnaire, teachers’ attitude on adolescents’ nutrition questionnaire and Cooper Smith's Standard Self-esteem questionnaire. Education based program on Health Belief Model for improving nutritional status consistent with model structures during six sessions each 60-minute was conducted with emphasis on diet to control weight in overweight and at-risk adolescents. Questionnaires were compared immediately after and two months after intervention.Results: Average score of model structures and self-esteem of students in both groups had no significant difference at baseline, but immediately after and 2 months after the intervention, the mean component scores were significantly higher in intervention group in comparison with the control group. There was a significant difference in component scores at different times in the experimental group. Significant difference in BMI scores was seen at different times in experimental group.Conclusion: Findings of this study showed that school based approach of physical activity training leads to increase in knowledge, sensitivity, severity and perceived benefits and eventually increase in self- esteem and physical activity in students.

Background Pregnant women and newborns are at risk of vitamin D deficiency. This study aimed to determine the vitamin D status in pregnant women and their newborns in Karaj, Iran.Materials and Methods This cross-sectional study was conducted from March 2014 to October 2015. A total of 151 pregnant women and 154 newborns (three twin cases) were included in the study. After obtaining 5 ml venous blood samples from mothers and 5 ml blood from the umbilical cord of newborns, 25-hydroxy vitamin D [25 (OH) D] was measured by ELISA method. Serum level of 25 (OH) D below 20 ng/ml was considered deficiency, 21-29 ng/ml wasconsidered insufficient and 30-100 ng/ml was considered sufficient. Data were analyzed using SPSS software version 20.0.Results The prevalence of vitamin D deficiency and its insufficiency was 93.5% and 6.5% for pregnant women, 94.2% and 3.9% for newborns, respectively. The mean 25 (OH) D concentration in pregnant women and newborns was estimated to be 10.649±5.967 ng/ml and 10.574±6.280 ng/ml, respectively. There was a significant correlation between the mean 25 (OH) D concentration in mothers and their newborns (r=0.913 and p<0.001); 92.9% of mothers and their newborns had vitamin D deficiency simultaneously.Conclusion The results of this study showed that overall prevalence of vitamin D deficiencies (levels<30 ng/ml) in pregnant women and their newborns was estimated to be 100% and 98.1%, respectively and mean concentration of 25 (OH) D for pregnant women and their newborns is very low. Therefore, vitamin D deficiency should be considered as a serious health priority.

Background: Mothering co-occupations in caring for children with cerebral palsy (CP) are very challenging for mothers but play an important role in the daily life of children with CP. This study aimed to explore the mothering co-occupations process in caring for children with CP at home in an Iranian context.Materials and Methods A grounded theory approach was recruited using semi-structured interviews. The participants were 14 caregivers, 3 children with CP, 5 occupational therapists, 1 physiotherapist and 3 managers of rehabilitation centers. Participants selected through purposeful sampling followed by theoretical sampling and was continued until saturation. Trustworthiness of the study was examined throughout credibility, transferability, conformability and dependency. The Data were analyzed base on the Corbin and Straus method (2008).Results: The results were grouped into seven main categories: motherly care, coping with unusual co-occupation, confusion with the roles being played, trying to meet special care needs, managing dynamic co-occupations, continuing care and an inefficient environment. "Coping with unusual co-occupation" was extracted as the core concept.Conclusion: Understanding the challenges of caring for a child with CP and the experiences of mothers when engaging in caring with their child can also help them to be empowered for achieving the proper management and effective care. The results of this research could provide a broader perspective to therapists; rehabilitation managers and policy makers for understanding the needs, meeting challenges and concerns of caregivers and children with CP, for a comprehensive plan for caring of children with CP.

Background: Premature neonates are hospitalized until they can get full mouth feeding and this often leads to increasing the hospitalization period. This study compared two neonatal care policies: early discharge of stable preterm infants with home gavage feeding and discharge when they reached to full oral feeding.Materials and Methods: By a case-control study, all stable premature neonates admitted in Alzahra teaching hospital, Tabriz, Iran, who were not able to feed orally, were divided into two groups. Study group included 48 neonates who achieved full oral feeding through oro- gastric tube and were discharged for outpatient follow-up. Control group included 50 neonates with the same feeding conditions who remained hospitalized and fed up by their mothers. Within one month, early clinical criteria were compared between both groups.Results: The mean gestational age for the control group was (30.6 ± 2.5 weeks), study group was (30.2 ± 1.8 weeks) and average admission weights for control and study groups were 1409.0 ± 363.6gr and 1352.7 ± 272.3gr, respectively. Infants at the early discharge program, spent less time to reach the full oral feeding (13 days vs.16 days) than the control group (p=0.025), and had lower risk of sepsis and feeding intolerance compared to those in the control group and their difference for feeding intolerance was significant (p=0.03).Conclusion: This study showed that after an appropriate education for parents the early discharge of stable preterm neonates with home gavage feeding not only revealed a positive impact on their feeding and sucking improvement but also did not show any complication or negative impact on their growth parameters.

Schimke immune-osseous dysplasia (SIOD) is a rare autosomal recessive disorder presented with specific facial features, skeletal dysplasia, steroid resistance nephrotic syndrome (SRNS) and cellular immune insufficiency. This is a SIOD case reported from Iran. He was 5 years old boy when evaluated for proteinuria and short stature. In appearance, we detected hyperpigmented macules, kyphoscoliosis, and warty lesions. He developed progressive renal failure and steroid resistant nephrotic syndrome, so kidney biopsy was performed and revealed focal and segmental glomerulosclerosis. He didn’t respond to prednisolone and Calcineurin inhibitors. He had recurrent lymphopenia with low CD4/CD8 ratio.However lymphopenia respond to granulocyte colony-stimulating factor (G-CSF), he died with pneumonia and sepsis. Nephrotic syndrome due to focal segmental glomerulosclerosis may be accompanied by syndromes. In Qazvin province, we see autosomal recessive disorders more, because of consanguineous marriages. To the best of our knowledge, this is the fourth case of SIOD to be reported from Iran.

Background: Blood sampling is a usual and painful procedure on preterm infant. Repeating painful procedures may affect the process of normal brain development and Pain management is important for nurses. This study was conducted to evaluate and compare pain score in two sites of blood sampling in preterm infants.Materials and Methods: Blood sampling is a usual and painful procedure on preterm infant. Repeating painful procedures may affect the process of normal brain development and Pain management is important for nurses. This study was conducted to evaluate and compare pain score in two sites of blood sampling in preterm infants.Results The pain score was significantly higher while sampling was conducted from hand veins compared to scalp veins (p=0.001).The pain score was significantly higher in preterm infants with lower gestational age (28-30 weeks) than the infants with 30-32 weeks of gestation (p=0.048).Conclusion: The pain score in preterm infants according to ALPS-Neo method was significantly higher while sampling was conducted from hand veins compared to scalp veins. Preterm infants with lower gestational age had also higher pain score.

Dear Editor-in-Chief, Pleural empyema is a serious complication of pneumonia, its morbidity and mortality is important in developing country where hospital resources are limited (1). While pediatric empyema is less serious compared to adults where mortality can approach 20%, it still poses a considerable burden on hospitals and families (2). Different treatment strategies continue to generate controversy (2). We reported our experience in diagnosis and management of pleural empyema in children in a pediatric department in a development country. This study retrospectively evaluated patients who had been diagnosed with pleural empyema in the department of pediatric emergency and reanimation y in Hedi Chaker hospital in Sfax, Tunisia between 2010 and 2016. Over 7- year period, we diagnosed and managed 28 children with pleural empyema. The mean age was 3 years 10 months (3months to 13 years 6 months); ten were female and 18 were male. In first, the most frequent symptoms were fever (82%) cough (53%) and dyspnea (50%). Sixty one percent of children were using antibiotics before admission. Chest X-ray was made for all patients; ultrasonography was performed in 75% of cases. Most pleural fluid samples did not culture any organisms (75%), but most positive cultures grew Streptococcus pneumoniae. Twenty five percent of patients need only antibiotics and surveillance. Treatment with chest tube drainage was successful in 41.5% of patients. Surgical intervention was necessary in only 3.5% of patients. Pleural empyema was treated successfully in all our patients. The hospital stay was 11 ± 2 days (range: 7-16 days). Five children maintained postoperative respiratory symptoms with a mean follow-up of 3 years. Pleural empyema is a life-threatening emergency (3). The incidence of pleural empyema is still remains a significant health problem in developing countries due to low socioeconomic status, malnutrition, and delay in diagnosis of pneumonia, delayed referral to higher center (3). Chest radiography is usually the first imaging modality in the work up of pleural empyema, but it cannot confirm the diagnosis (4). Ultrasonography is a safe and inexpensive mode of imaging and can be used to confirm the presence of pleural empyema it can be used to guide catheter insertion and percutaneous drainage (4). A CT-scan is not indicated for the initial diagnosis (4). In all our patients the chest X-ray was made and the confirmation of diagnosis was made with ultrasonography in the majority of our patients. In early stage of pleural empyema antibiotic with or without chest tube drainage remains main choice of treatment in children (3). The insertion of a chest tube should also be considered if a patient fails to respond despite 48 to 72 hours of antibiotic therapy, hypoxia, ypercapnia, large amounts of free-flowing pleural fluid and if there is evidence of fibrinopurulent effusions (pH<7.0, glucose<40 mg/dL (2.22 mmol/L), lactate dehydrogenase>1000 IU (16.67 kat/L) (5). In our study, chest tube drainage was successful in majority of our patients. The early adequate surgical treatment in children with pleural empyema results in low morbidity, shorter hospital stay and good long-term outcome.

Background: Visceral leishmaniasis (VL) is most commonly found among children under the age of 10 in some provinces of Iran including Ardabil. As such, this study set out to determine the relationship between some climatic factors and the prevalence of VL in Northwest of Iran.Materials and Methods In this descriptive-analytic study, data collection was done on some climatic factors including rainfall, temperature, and the number of sunny and snowy days from Apr.2001 to Sep.2017 from the weather station in Meshkinshahr County of Ardabil province, Iran, and the related information of the VL patients from the health center. Statistical analysis was done using Excel and SPSS version 23.0 software. Pearson correlation coefficient test was utilized for data analysis.Results: Over the course of 17 years, 226 cases of VL occurred in rural and urban areas of Meshkinshahr. The highest prevalence of VL disease was reported in February and March. Climatic factors of temperature and the number of sunny days showed a direct relationship with the prevalence of VL disease (P<0.05). However, rainfall and the number of snowy days had inverse correlation with the prevalence of VL (P>0.05).Conclusion: In spite of the rather cold and humid climate of Meshkinshahr County during much of the year, based on the findings of present study, there was a significantly direct relationship between VL disease and the hot temperature as well as sunny days.

Background: Providing a favorable health status is of high importance for educational buildings and in particular schools. The aim of this study was to evaluate the school health and its accordance with national school health regulations in Kermanshah city, Iran.Materials and Methods: This cross-sectional study, the researchers randomized 200 schools and gathered data using a checklist comprising 87 questions, 74 of them on environmental health status and 14 of them on safety status of schools. This checklist designed based on the school health guidelines (developed by the health and work environment center of the Ministry of health, treatment and medical education). In this study, the researchers used only the former and filled out the checklist through visiting schools and interviewing with their staff. The collected data were transferred to the statistics software SPSS version 16.0 and Excel version 2010 and the outputs were presented in tables.Results: Out of the 200 schools surveyed, 66.5% were old (structural dating of more than 10 years), and only 33.5% (67 schools) were new (structural dating of less than 10 years). Among these schools, 99.5% (199 schools) provide healthy tap water places, 98.5% (197 schools) healthy hand washing facilities and 100% (200 schools) healthy toilets. The average level of school buffets health was observed 58.5%. The health and optimization status of the studied schools was 92-100% in accordance with article 13 of the regulation.Conclusion: According to the results of this study, there were some problems that include the health status of school buffets, classrooms and toilets, as well as the safety status of the investigated schools, so that attention to the health of schools should be among the priorities of the government and the authorities.

Background Rhizomelic chondrodysplasia punctata (RCDP) type 1 is among of the rare autosomal recessive peroxisome biogenesis disorders caused by mutations in thePEX7 gene. RCDP patients with the classic form of RCDP1 do not live more than 10- year.Materials and Methods In the present study, a two-year-old girl with skeletal abnormalities and dysmorphic facial appearance is reported to be suffered from RCDP. The patient's parents were second cousins and healthy and there was no similar case in the parents’ family.PEX7 gene was sequenced in the patient and her parents.Results A homozygous mutation, G257A, was identifiedPEX7 in the genome of patient while the parents were compound heterozygous.Conclusion Taken together, clinical presentation and peroxisome profile of the patient suggested a missense mutation led to formation of a pathogenicPEX7, responsible for incidence of RCDP.

Background: Intracranial pressure (ICP) control is one of the anesthesiologist challenges in craniosynostosis repair surgery, especially in multiple sutures involvement. The aim of this study was comparing the effect of two anesthesia methods including inhalation with hyperventilation and total intravenous anesthesia (TIVA) on ICP control and surgeon satisfaction in pediatrics with craniosynostosis surgery.Materials and Methods: In this randomized clinical trial study, 40 pediatric patients with American society of anesthesiologists (ASA) І-ІІ, 6 months to 2 years old were included. All of the patients were scheduled for craniosynostosis repair at Mofid Children Hospital, Tehran, Iran, in May 2016 to January 2017. The patients were randomly divided into two groups. In hyperventilation group, patients received isoflurane for maintenance of anesthesia and hyperventilation (Paco2=25-30 mmHg) established during surgery. The total intravenous anesthesia (TIVA) group received propofol infusion for anesthesia maintenance and Paco2 was maintained 35 mmHg. Intra cranial pressure (ICP) was assessed by surgeon using a 4-point scale. Hemodynamic (mean arterial pressure and heart rate) changes and blood loss were compared between hyperventilation and TIVA groups.Results: The mean age of patients in hyperventilation group was 10.9±3.25 months and in TIVA group was 8.7 ± 2063 months (p=0.11). Fourteen (70%) patients in hyperventilation group and 6 (30%) patients in TIVA group were male (p=0.74). A significant difference was seen in ICP control and surgical condition between hyperventilation and TIVA groups (p=0.032). ICP was controlled better in hyperventilation group. There was no difference in hemodynamic parameters and blood loss between hyperventilation and TIVA groups (p>0.05).Conclusion: This study showed inhalation anesthesia with hyperventilation was more effective than TIVA on ICP control in craniosynostosis surgery.

Dear Editor-in-Chief, Interdisciplinary coordination of the director of crisis committee with emergency and other department's staff, financial support team, public relations, rehabilitation team, and police are required to successfully manage mass casualty incidents (MCIs). Prevention, staff training, equipment availability, clear-cut responsibilities and predicting all requirements are crucial aspects to be prepared (1). The task force for Mass Critical Care published guidance for adult MCI in 2008; For children, 17 experts of the Oak Ridge Institute for Science and Education developed recommendations for pediatric MCI (2). Certain guidelines have been suggested by the Centers for Disease Control and Prevention (CDC) and subsequently published in Pediatric Critical Care Medicine as a supplement as well as the more recent supplement in CHEST that updates the previous works (3, 4). Although the literature has provided sufficient evidence managing the situation, some major difficulties still exist in the stage of response to the crisis. Lack of equipment especially in international crises may lead to neglect moribund patients. This problem is more prominent for pediatric patients (5, 6). Personnel shortage mandates to accept the less-qualified staff contribution for pediatric care.Triage modifications: Several field and hospital triage models were developed according to age or height and evaluated for accuracy in pediatric MCIs and some still recommend reliance on expert opinion (1, 7). It was recommended by the National Committee on Management of Pediatric MCIs to be used in prehospital settings. However, the available evidence are against validity and/or inter-rater reliability of jump START, and some other pediatric MCI primary triage tools such as Smart Tape and Care Flight were claimed to be more sensitive, although none had more than 48% sensitivity (8, 9). Ethical Challenges: While trying to maintain basic standards of care, the legal and medical ethic aspects may have different definitions in crisis. Justice, autonomy, beneficence and non-maleficence are the major rules modified in these situations (10). Patient-centered care, respect and autonomy are all differed widely. Field and hospital triage in mass casualty incidents guide us not to resuscitate victims with no or trivial signs of life, or to perform only basic rescuing maneuvers to decide to tag the patient dead or to identify the need for emergent care. In other words, we may have to decide whose life can be saved when it is impossible to rescue all when failure to obey activity plan would cause higher mortality rate (1, 11). Following a recent systematic review by Leider et al, it is noted that the majority of studies discuss why ethics is needed in MCIs and beside noteworthy advancement in disaster planning, ethical frameworks have also been tried to improve. Therefore, lack of standard ethical rules is still present- which is clearly stated and justified- and a single and accepted instruction is yet not available (10). To manage the great number of patients, canceling elective care, opening unused wards and preparing alternative areas as critical care units with extra beds, equipment and staff may work (6). Alternate consenting and ethics policy updates should be considered in conjunction with clinical team response.Conclusion: Pediatric MCIs mandate more specific planning, team and equipment preparation and coordination between clinical and ethics committees.

Background Recent studies indicate increased serum amylase in children with acute appendicitis. The objective of the current study was to determine the diagnostic accuracy of raised serum amylase level in prediction of perforated appendicitis in children with acute appendicitis.Materials and Methods In this cross-sectional study, 61 children (aged 3 to 15 years) who underwent appendectomy surgery due to acute appendicitis at two university hospitals in Kermanshah, Iran, from 2015 to 2016 were included. The diagnosis of appendicitis was confirmed with histopathologic examination. Before surgery, venous samples were obtained and serum amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase were assayed. The patients were divided into two groups: perforated appendicitis (18 cases) and non-perforated appendicitis (43 cases). The laboratory tests were compared between the two groups.Results The mean (±standard deviation) serum amylase level was 69.2 (±28.9) mg/dL in perforated group and 29.9 (±11) mg/dL in non-perforated group (P<0.001). At serum level of 46 mg/dL, serum amylase had a sensitivity of 89% and its specificity was 100% in prediction of acute perforated appendicitis.Conclusion The serum amylase level in perforated appendicitis was significantly higher compared to patients with non-perforated appendicitis. Serum amylase has good diagnostic value in prediction of perforated appendicitis.

Background: Burn is one of the public health problems, especially in low-income and middle-income countries, and this problem is far more important for pregnant women and their fetus. There was no a systematic study to comprehensively review the epidemiology of Maternal and Fetal`s Burn in Iran, this study was conducted for this purpose.Materials and Methods: In this systematic review and meta-analysis study, all related studies (Published in 2017 and earlier) extracted by two independent groups from national and international databases (Magiran, SID, Web of Science, Medline, Scopus, etc.). Meta-analysis has been applied to obtain the overall outcomes of maternal and fetal mortality in pregnant women in Iran. Forest plot, t2, and I2 tests are applied to evaluate heterogeneity, significance and its percentage, respectively. The analysis of meta-regression is applied because of the existence of heterogeneity. Publication bias is investigated by Funnel plot and Egger test.Results: The range of maternal and fetal mortality was 29.2% to 66.67% and 38.5% to 72.8%, respectively. Also, 48.4% and 54.2% were the overall outcome of maternal and fetal mortality based on meta-analysis, respectively. The highest maternal mortality is reported for pregnant women with Total Body Surface Area (TBSA) over 50%, intentional burns, and acute respiratory failures. Finally, reduction of maternal mortality had a statistically significant relationship with passing time based on the univariate analysis.Conclusion: It can be inferred from our results that some hazards of burn in pregnant women are average age of 22-27 years, living in rural areas, low levels of socio-economic, low education level and being housewife. Also, according to meta-analysis results, about half of mothers and fetuses died in pregnant women as a result of burns in Iran.

Background: Given that the protection of children's health is of special importance due to their special age and physical conditions, the present study aimed to investigate the condition of children's Geographic access to health services (Health Centers and Clinical Laboratories) in Kermanshah city, Iran.Materials and Methods: In this applied study, the research approach was descriptive-analytic using quantitative models in Geographic information system (GIS) environment. The statistical population was the whole population of young girls aged 0-14 years old in Kermanshah, Iran. Moreover, to evaluate the spatial deployment pattern of health services and the correct and true access of this group to such services, all data and information were collected through the Iranian Statistics Center and evaluated using the Arc-GIS Software. The latest published population statistics on the Population and Housing Census in 2011 were considered the basis for the analyses.Results: The results of the present study demonstrated that more than 40% and 60% of the young girls aged 0-14 years old in Kermanshah were deprived of proper access to health centers and clinical laboratories, respectively. In terms of the status of children’s access in the Second Scenario (access to health services by vehicles) and during 5, 10, and 15 minutes, about 5.53%, 93.1% and 15.1% lacked access to health centers, respectively. In addition, in terms of the status of children’s access to clinical laboratories during 5, 10, and 15 minutes, 17.26%, 65.4% and 51% lacked access to clinical laboratories, respectively.Conclusion: The access of young girls aged 0-14 years old to health services in Kermanshah was undesirable in the access to health services through walking. Additionally, the access of this group to health services in the access to health services by vehicles was far better than the first one.

Background Death of a child with cancer is one of the most painful events that results in traumatic reactions of bereavement. Care should be taken into account during the bereavement period. The present study aimed to develop bereavement care in Iran and comparing it with Jordan, England, Australia and Canada, which have achieved the desired situation in the above area.Materials and Methods In this comparative study, the necessary data was made to databases of reputable and sovereign centers of the countries and palliative care programs. After accessing the pioneering patterns of world-wide palliative care, Iran's palliative care program, which came from children's service centers and access to the databases of those centers, was also examined.Results In the developed countries of Canada, England and Australia, a wide range of bereavement care is provided in care facilities. for example following the death of a child, in Canada family members are covered by all the bereavement care, in Australia formal caregivers increase their relationship with parents and are available to listen to feelings and in England all family members are supported. Jordan provides significant services in this regard such as visits at the bereavement ceremony, however, it is provided limitedly only in one center in Iran.Conclusion In the developed countries, pediatric palliative care is well developed. But in some developing countries, including Iran, there are only a few of these services for dying children and their families. As a result, the traumatic results emerge in social and family life activities.

Cervical thymic cyst is a rare entity of either congenital or inflammatory origin described infrequently in literature. The asymptomatic nature of the entity and the rarity of the lesion frequently lead to a diagnostic dilemma many times. We present a case of cervical thymic cyst that presented to us as an asymptomatic neck mass that was managed surgically. Cervical thymic cyst should be kept as a differential diagnosis of an asymptomatic neck swelling especially in children.