Journal of Pediatric Perspectives
Year:2017 | Volume:5 | Issue:12 (48)|Papers Count:51

Background Febrile neutropenia with childhood cancer alters the outcome significantly. To study the clinical and laboratory parameters, which predict the outcome among cancer patients with febrile neutropenia this study was undertaken. Materials and Methods The study included children less than 18 years with febrile neutropenia episodes. Clinical and hematological / laboratory parameters were recorded during each episode. Hemoglobin, total leucocyte count, platelet count, absolute neutrophil count, absolute monocyte count and serum Creactive protein (CRP) levels at the onset of febrile neutropenia episode were analyzed as predictors of outcome of febrile neutropenia. The outcome was measured in terms of mortality, duration of fever and need for Intensive care unit (ICU) stay. Results The study consisted of 88 episodes in 40 children with a median (IQR) age of 5. 9 (3. 79, 10) years. In 67. 5% of Children's Leukaemia was the underlying disease. Mean (± SD) hemoglobin concentration was 8. 8 ± 1. 71 g/dl. Profound neutropenia was seen in 32(36. 5%) episodes. Most common infection was lower respiratory infection (30. 7%). Absolute monocyte count < 100 cells/cu. mm was found to predict a duration of fever > 7 days (p=0. 030). Thrombocytopenia (< 50, 000) and CRP (>90 mg/L) were found to be significant predictors of mortality (p <0. 001 and 0. 017, respectively), and the need for prolonged ICU stay (p =0. 027 and p=0. 048, respectively). Conclusion Thrombocytopenia and elevated CRP are significant predictors of mortality and the need for prolonged ICU stay, whereas low hemoglobin level, leukopenia and low absolute neutrophil count (ANC) were not associated with of adverse outcome in febrile neutropenia episodes.

Background: Jaundice is a common problem in infants, particularly premature infants (60-80%). The most common treatment of neonatal jaundice is phototherapy; however, traditional and complementary medicine is preferred due to complications of phototherapy in newborns. This study evaluates the effect of Chicory extract bath on bilirubin levels of infants with jaundice hospitalized in educational hospitals in Isfahan, Iran. Materials and Methods This study was a double blind randomized clinical trial in which participants included 64 mature infants with neonatal jaundice admitted to the selected hospitals of Isfahan. The infants were randomly assigned to two groups receiving phototherapy (n=32), and phototherapy with bath with 500ml of chicory extract prepared by hydroalcoholic method and made in Iran (n=32). The infants were bathed by trained nurse with chicory extract before phototherapy as well as 24 and 48 hours after phototherapy; then, the infants received phototherapy. During treatment, serum bilirubin was measured and recorded every 24 hours continuously. Control infants only received phototherapy; during treatment, serum bilirubin was measured and recorded every 24 hours. Results The results showed no significant difference in mean bilirubin levels between the two groups on admission (P=0. 37); while mean bilirubin level of phototherapy infants was significantly higher than that of infants receiving phototherapy and chicory extract bath in 24 hours after (P=0. 014), and 48 hours after intervention (P=0. 011). Conclusion: The results showed that chicory extract bath with phototherapy can be effective in reducing neonatal jaundice.

Positive outcomes of breastfeeding on both mothers and neonates health are inevitable. Mother selfefficacy has a constructive role on initiating and continuing breastfeeding, in turn, it is influenced by several factors. The present study aimed to determine some risk factors associated with breastfeeding self-efficacy of mothers with hospitalized newborns. Materials and Methods This descriptive-correlational study was carried out on 150 eligible mothers who were selected from Motahhari Hospital of Urmia in 2016, using consecutive sampling. Data was collected using questionnaires such as Demographics, Paloutzian and Ellison the Spiritual Health Scale (PESHS), Cohen’ s Perceived Stress (PSS), and Dennis Breastfeeding Self-Efficacy Scale (BSEF). Descriptive (Mean and standard deviation) and inferential statistics (ANOVA, Independent t-test, Pearson’ s correlation coefficient and multiple regressions) were used to analyze the data in SPSS software under windows with version 16. Results: The results showed that the mean and standard deviation of breastfeeding self-efficacy score were 128. 95± 17. 84, respectively. The final multivariate regression model showed that the variables of spiritual health (p=0. 01, β =0. 208, t=2. 54), perceived stress (p=0. 03, β =-0. 173, t=-2. 18), and monthly income (p=0. 01, β =0. 214, t=2. 55), had statistically significant relationships with breastfeeding self-efficacy. No significant relationships were observed between self-efficacy and other demographic variables (p>0. 05). Conclusion The study suggests that breastfeeding self-efficacy of mothers was influenced by spiritual health, perceived stress, and economic status. Hence, it is recommended and emphasized that health care providers consider these factors in designing their health interventions regarding breastfeeding.

Background Recent reports have suggested that gastroesophageal reflux disease (GERD) is link with cow’ s milk (CM) sensitization in children. The aim of this study was to determine the frequency of CM sensitization in young children with GERD. Materials and Methods This cross-sectional study included 33 children (median age, 2. 93± 1. 90 years) with GERD according to a valid gastroesophageal reflux questionnaire, and 33 healthy children (median age, 3. 39± 1. 90 years). CMA was diagnosed by skin test, serum specific immunoglobulin E level and atopy patch test to milk in both patient and control groups. Results Twenty-four children with GERD were positive for at least one of the diagnostic tests for CM sensitization compared to 13 children in control group (odds ratio [OR] = 1. 78; 95% confidence interval [CI]: 1. 14 to 2. 80). Unlike the results of skin prick tests and specific Immunoglobulin E (IgE) levels to milk which showed no difference between children with GERD and healthy controls, there was a significant difference in the results of patch test (OR=2. 06; CI95%: 1. 46 to 2. 91). Conclusion Based on our results, CM sensitization is 1. 7 higher in children with GERD than non-GERD children. Patch testing preferably would better to perform for diagnosis of CM sensitization in those children with GERD.

Background: Optimal surgical management of the neonate with imperforate anus (IA) depends on determining accurate location of sphincter muscle complex, pouch of rectum and rectourinary fistula. We aimed to investigate a novel minimally invasive technique of anorectoplasty assisted by intraoperative sonography pull-through for repair of anorectal malformation and rectourinary fistula. Materials and Methods: Eight male patients with anorectal malformation and IA underwent formation of a diverting colostomy within 48 hours after birth. These patients had anorectoplasty about 6-8 weeks postoperatively. A urinary catheter was inserted per urethra into the bladder and sonography of perineum was carried out under general anesthesia. The neoanus was reconstructed by suturing the pulled-through anorectum to the anal sphincter muscle complex and the skin using absorbable 4/0 sutures. Results: In all cases, the distance of pouch of rectum to the skin was 15-18 mm and entrance of the guide wire to fistula was 6-7 mm. Of eight patients 6 had removal of urinary catheter after two days, and 2 patients after 10 days because the fistula was not closed. The median range of hospital stay was 2. 12 days and follow-up was 30 days. We calibrate all of patients with size 12F dilators. Patients were followed up at one week and one month postoperatively, and all had defecation frequency of 3-5 times a day. There were no complications. Conclusion Intra-operative sonography guided pulled-through anorectoplasty (ISPA) is a novel and safe technique for surgical treatment of IA and rectourethral fistula. ISPA is a minimally invasive approach, which preserves the external anal sphincter muscle complex with good functional outcome.

Dear Editor-in-chief, Beta-Thalassemia Major (β-TM) is a childhood illness characterized by a severe hemolytic anemia. Globally, β-TM is the most commonly inherited hemoglobinopathy with a high incidence rate in Southeast Asia, the Middle East and Mediterranean countries (1, 2). Iran is one of the high-prevalent areas of β-TM among the Eastern Mediterranean region. Beta-Thalassemia Major is an important public-health challenge in Iran. According to reports, there are nearly 3 million carriers and 25, 000 β-TM patients in Iran (2). Patients with β-TM are usually diagnosed within the first two years of life (3). Given the chronic nature of the disease, β-TM patients require lifelong adherence to their distressing treatment regimens, including regular blood transfusions and daily chelation therapy (4). Although, regular blood transfusion is a lifesaving therapy in these patients, it is a major source of iron overload. Occurrence of transfusion-related iron overload complications, such as heart failure and cardiomyopathy, liver fibrosis, impairment of the endocrine and exocrine functions and etc., are associated with higher morbidity, mortality risk and shorter survival (1, 5). Fear of developing transfusion-related iron overload complications is one of the greatest concerns in β-TM patients and their caregivers (5, 6). To prevent these complications, β-TM patients require regular iron chelation therapy (1, 4). Despite its clinical importance, poor adherence to chelation therapy remains a prevalent and persistent problem in β-TM patients (7). Also, to date, cost-effective interventions to improve adherence to this therapeutic regimen in these patients are yet unavailable (4, 7). Delayed occurrence of iron overload complications is a factor which may deteriorate the adherence to the prescribed treatment regimen in β-TM patients. Feeling healthy, despite lack of chelation therapy adherence, is a reason for refusing this treatment in β-TM patients (5, 8). Previous studies found that delay in the occurrence of complications regarding the interruption of treatment can potentially lead to discontinue or irregular following of prescribed regimens by the β-TM patients (5, 6). However, lack of immediate consequences of insufficient iron chelation therapy unavoidably escalates the risk of developing iron overload complications in future (9, 10). Healthcare providers can play a pivotal role in improving patients’ adherence to treatment (11). Despite this fact, it has been previously shown that most of the β-TM patients’ family members have disappointed for asking support and help from health professionals, because they are constantly busy (12). Although, heavy workload is a major barrier to patients’ education, counseling and supervision by healthcare providers (13), the positive effect of healthcare provider-led adherence promotion interventions on patients’ adherence to treatment has been demonstrated (11). We believe that healthcare providers are in a unique position to improve treatment adherence in β-TM patients. It is need that they continually emphasis the importance of regular chelation therapy and assessment of body iron to patients for improving their survival chance. Regular reminding about the potential serious complications of poor adherence to treatment to β-TM patients and their caregivers, as one of their major concerns, by health care providers is a practical and potentially useful strategy for improving treatment adherence in these patients; especially patients with lower socioeconomic status that seem to be at higher risk for poor adherence to their prescribed treatment.

Background Failure to thrive (FTT) is a condition of poor weight gain in early childhood. Low appetite which is associated with FTT interacts with increasing caloric intake as the main treatment for FTT. Phytochemicals in herbal remedies could alter appetite more than the expected effects of other nutrients. This review aimed to assess the effective and safe herbal appetizer for children with FTT according to Traditional Persian Medicine (TPM). Materials and Methods By searching through major pharmaceutical books of Persian medicine during 8th-18th centuries (A. D. ), herbal remedies as appetizer were determined. We searched the phytochemical and pharmacological activities of these herbs in PubMed, Scopus, Web of Sciences and Google scholar databases, from 1950 to 15 December 2016. Results Overall, 42 herbs were found. Among these herbs, only 11 herbs were prescription for children. Improvement of feed intake, growth performance, weight gain and gastroesophageal protection were the most reported activities. Conclusion Natural remedies prepared from these herbs may be useful for enhancing appetite especially for FTT in children. Additional well-designed studies are required to investigate the safety and efficacy of these herbs.

Background Apnea of prematurity (AOP) is a developmental disorder that affects the premature newborns frequently. One of the new non-drug methods for controlling apnea attacks is olfactory stimulation. The aim of this study was to determine the effect of olfactory stimulation by vanilla on the rate of apnea attacks in neonates with AOP. Materials and Methods: This study is a single-blind randomized clinical trial study. The study samples included a total of 40 premature neonates with AOP who were admitted to the neonatal Intensive care unit (NICU) of Shahid Sadoughi hospital in Yazd, Iran, in 2016 and were assigned randomly in experimental (n=20), and control (n=20) groups. The experimental group was exposed to cotton impregnated with 2ml of vanillin extract for 24 hours. The number of apnea attacks, heart rate, and arterial oxygen saturation (SaO2) level were measured before, during and after intervention for three consecutive days. Data analysis was performed using statistical analysis in SPSS version 22. 0 software. Results: The results showed that there was no significant difference between the two groups in terms of mean number of apnea attacks (p>0. 05). However, there was a significant difference between in the experimental group on the first day (2. 84 ± 1. 25), and second day (1. 63 ± 1. 01) in terms of the mean number of attacks. Also, there was a significant difference between the mean heart rate and SaO2 level in both the experimental and control groups (p<0. 05). Conclusion: At current study, olfactory stimulation by vanilla was not effective on reducing the number of apnea attacks in neonates with AOP.

Background: Motivation is an important factor in learning. Educational games increase the learning motivation and understanding of students by creating a sense of joy, satisfaction and involvement. However, it is necessary to incorporate learning elements into the games, differently. In this study, the researcher tried to provide a model for designing educational games and determining its relationship with learning motivation. Materials and Methods: Components of the model for designing educational games were first determined qualitatively. Then, the relationship between the educational games designed and students' learning motivation was determined. A self-made questionnaire, with elements of educational game designing along with another questionnaire was used to determine the learning motivation. The obtained data were analyzed using Pearson correlation coefficient and independent t-test. Results: The model, with 4 main components and 26 sub-components, was designed. That set of various elements, including: the rules, objectives, tools, results and feedbacks, accidents, challenges and interactions displayed in the context of the game, along with instructional design component such as analysis, design, development, utilization and evaluation were used. After implementation of the pattern and designing the "States of Matter" lesson in the science book for the third graders, the results showed that there is a significant correlation between the use of designed educational game and components of the students’ learning motivation (r= 0. 85 and P=0. 01). Conclusion: According to this study given the relationship between the use of educational games and motivation to learn, it can be concluded that the educational games designed according to scientific principles could lead to the improved students’ motivation and learning.

Background: Anemia is a major public health problem in India, affects all age groups but children and women in childbearing age group are the most vulnerable. However, data from hospital patients of Indian islands are not available. We aimed to study the prevalence of anemia among children aged 2-12 years of age attending a tertiary care hospital (India). Materials and Methods A total of 444 children aged 2-12 years were enrolled in the study over six months from August 2015 to Jan 2016. A complete blood count was obtained by taking 2ml of blood using fully automated MINDRAY Hemat analyser-BC5800. Anemia was diagnosed according to the World Health Organization (WHO) standard for the given age. The data was analyzed and interpreted using descriptive and inferential statistics. Results: Overall prevalence of anemia among the children 2-12 years of age was 32. 21%. Severity wise, mild Anemia was the commonest (56. 64%), while severe Anemia was rare. The prevalence of Anemia was slightly more among girls compared to boys although not statistically significant (p>0. 05). Both Anemia and mean Hemoglobin (Hb) was significantly associated with age (p<0. 05), however, they had no significant association with other demographic variables including gender or education of parents (p>0. 05). Conclusion At current study, Anemia is common among the children of Andaman Nicobar (India), and affects boys and girls equally. Although mild anemia is very common, it remains asymptomatic and therefore goes unnoticed and untreated.

Background Neonatal respiratory distress is one the most common problems in the first few day of neonatal life. The present study intended to determine the frequency of the causes and outcomes of respiratory distress in neonates hospitalized in the neonatal intensive care unit (NICU) in Hamadan city, Iran. Materials and Methods In this descriptive and cross-sectional study, all the neonates with respiratory distress (RD), who were hospitalized in the NICU of Be’ sat Hospital in Hamedan city, Iran, during 2014 to 2015, entered the study. The required demographic information was extracted from patients’ dossiers. The collected data were analyzed using SPSS version 16. 0. Results The mean neonatal age upon admission, mean gestational age and mean birth weight were 5. 22± 7. 18 days, 36. 58± 3. 54 weeks and 2743. 9± 727. 9 grams, respectively. According to the results, intercostal retraction (75. 3%), tachypnea (67. 7%), and grunting (61. 3%) were the most common symptoms of neonatal respiratory distress (NRD), while respiratory distress syndrome (RDS) (36. 6%), pneumonia (30. 1%), and transient tachypnea of the newborn (TTN) (%14), were the most common causes of respiratory distress. Furthermore, about 19. 3% of the neonates died of the disease. The results of logistic regression for the independent risk factors associated with RD outcomes showed that the death rate of neonates with RD had a significant correlation with respiratory failure requiring mechanical ventilation (odds ratio[OR]: 33. 49, 95% confidence interval [CI]: 6. 95-161. 38), and incidence of apnea (OR: 5. 87, 95% CI: 1. 072-32. 167). Conclusion It was found that RDS is the most common cause of respiratory distress in the hospitalized neonates. Moreover, infant mortality rate increased due to respiratory failure requiring mechanical ventilation and occurrence of apnea.

Inclusion-cell (I-cell) disease (mucolipidosis II) is a rare inherited metabolic disorder resulting from a defective phosphotransferase, characterized by coarse facial features, skeletal abnormalities and mental retardation. As clinical feature of this condition mimic that of Hurler disease mutation studies help in the diagnosis. We present a case of I-cell disease in a neonate with Nacetylglucosamine-1-phosphate transferase alpha and beta subunits (GNPTAB) gene mutation.

Background The occult neurological disorders are an important cause of constipation in children. This study aimed to evaluate the spinal canal and lumbosacral by ultrasound in pediatric constipation to better identifying neurological causes of constipation. Materials and Methods In this case-control study, 100 children with constipation (age range 1 to 14 years) without previously known chronic illness referred to the Radiology Department of the Mashhad Pediatric Dr. Sheikh Hospital were selected. After recording clinical data, the patients were undergone sacral and spinal cord ultrasound examinations and the results were compared with the control group (healthy children with transient illness (otherwise constipation or urinary disorders) who had referred to radiology department for sonographic examination). Results The mean age of patients was 6 ± 3. 3 years old. The tethered cord and occult intrasacral meningocele were observed in 2% of patients group. Spina bifida was found in 64% patients, and 31% control subjects with significant difference (P = 0. 009). About one third of cases with spina bifida were found in lumbar L5 vertebra, and another two third were in high sacral vertebrae (S1 or S2). Various degrees of caudal regression were observed in 8% patients suffering from constipation and in control group, 2% children had coccyx hypoplasia. No significant correlation was found between case and control groups regarding the location of spina bifida and non-formation of the posterior arch of the sacrum, the mean coccyx length, dural diameter and the ossification age of first vertebra of coccyx. Conclusion In pediatric age, lumbosacral spinal anomalies can easily evaluate with ultrasound. The prevalence of spina bifida and caudal regression in children with constipation was significantly higher compared with normal control group.

Background: Breastfeeding is one of the most effective behaviors in health promotion and one of factor affecting its success, is breastfeeding self-efficacy. Low breastfeeding self-efficacy entails consequences such as early cessation of breastfeeding, reduction of exclusive breastfeeding, negative effect on sensation and performance. Regarding this study aimed to investigate the breastfeeding selfefficacy and its related factors in pramiparous breastfeeding mothers. Materials and Methods: This descriptive cross-sectional study was conducted on 300 primiparous breastfeeding mothers with less than 6 months infants referring to healthcare centers of Mashhad, Iran. The study population was selected through multi-stage random sampling technique. Data collection was performed by demographic form and Breastfeeding Self-efficacy Scale developed by fax and Dennis (1999). Data were analyzed using descriptive and inferential statistics, through SPSS version 16. Results: In present study, majority of participants were housewife within the age range of 15-25 years with diploma education and had normal delivery. Majority (79. 33%) of mothers had high level of breastfeeding self-efficacy with a mean of 130. 89± 13. 60. According to the multiple regression model, employed mothers (B =5. 88, p=0. 040) with an appropriate income (B=3. 7, p=0. 42) had significantly higher breastfeeding self-efficacy, compared to those with low family income. On the other hand, mothers with rental houses had significantly lower breastfeeding self-efficacy than their peers with owned properties (B =-3. 48, p=0. 023). Conclusion: As findings indicated, breastfeeding self-efficacy of participants was at high level. This factor can help health care providers to predict length of breastfeeding, and success rate of exclusive nutrition in mothers, and thereby identify mothers, who are at risk of early breastfeeding stop.

Background: The present meta-analysis was designed to determine the value of Pediatric Emergency Care Applied Research Network (PECARN) rule in prediction of clinically important traumatic brain injury (ciTBI). Materials and Methods: Extensive search was conducted in the databases of Medline, Embase, Scopus, Web of Sciences, Cinahl up to the end of August 2017. The search records were screened and summarized by two independent reviewers, and eventually the findings were presented as summary of receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio with 95% confidence interval (95% CI). Results: Data from 10 studies were included in this meta-analysis. Area under the curve (AUC) of SROC for PECARN model in prediction of ciTBI in children younger than 2 years old was 0. 85 (95% CI: 0. 82-0. 88). Sensitivity, specificity and diagnostic odds ratio of this model were also calculated to be 0. 98 (95% CI: 0. 92-1. 0), 0. 56 (95% CI: 0. 48-0. 64) and 82. 53 (95% CI: 16. 23-419. 63), respectively. AUC of SROC for this model in prediction of ciTBI in children aged 2-18 years old was also found to be 0. 97 (95% CI: 0. 95-0. 98) with a sensitivity, specificity and diagnostic odds ratio of 0. 98 (95% CI: 0. 95-0. 99), 0. 60 (95% CI: 0. 53-0. 67) and 80. 73 (95% CI: 30. 59-213. 05). Conclusion: The findings of this study are indicative of a high screening value for PECARN model in prediction of ciTBI and classification of patients. So it is recommended that the decision rule be used in routine practice for children referring with mild traumatic brain injuries.

Background Head lice infestation (pediculosis) is a serious health problem that can cause a high level of anxiety and psychological frustration, especially in developing countries. Socio-demographic factors are important determinants of the occurrence of head lice infestation. This study aimed to determine the head lice infestations and the factors affecting the rate of infestation in primary school girls. Materials and Methods In this cross-sectional study, a total of 358 school girls from two urban and three rural primary school girls in Sirik County, Southern Iran, were randomly selected. For the diagnosis of head lice infestation, students were examined carefully by visual inspection of the scalp and hair for the presence of lice. Self-administered questionnaire was used to collect data on socio-demographic and associated factors of head lice infestation. SPSS version 21. 0 was used to analyze the data. Results The prevalence of head lice infestation among primary school girls was 56. 15%. There were significant associations between head lice infestation and age (p<0. 05), school grade (p= 0. 045), family size (p=0. 048), parents' literacy (p=0. 001), father’ s job (p<0. 05), residential environments (p=0. 014), and history of lice infestation in one family member (p=0. 001). Conclusion The head lice infestation is one of the major public health problems in primary school girls of Sirik County. It seems that improvement of socio-economic conditions and also health education programs about head lice infestation for primary school girls and their parents could significantly reduce the prevalence of head lice infestation in this area.

Background Various studies have been conducted so far regarding feeding infants exclusively with natural mother milk; various factors, which may influence feeding process, are occupation of mothers, sickness of infants or mother. This study aimed to assess the relationship between maternal general health and feeding pattern of infants. Materials and Methods This cross-sectional study was done in 2016. The society in this study was mothers with infants between 0-6 months referred to Imam Ali hospital (Sari, Iran). Using accessible sampling method, 250 mothers were selected. Then they were divided to two groups of dry-powder-milk (DPM, n = 125), and mother-milk (MM, n = 125). Subsequently, general health of mothers in both groups was assessed via General Health Questionnaire (GHQ). Then data were analyzed using the SPSS 16. 0 (SPSS Inc., Chicago, IL, USA) by descriptive and inferential statistics tests. Results Mean age of mothers in dry-powder-milk (DPM) group, and mother-milk (MM) group was 28. 53  5. 44 and 27. 7  5. 15 years old, respectively. In overall results, general health were not significant difference between the two groups (p = 0. 34), but only one dimension of general health (Social functioning) had significant differences between MM and DPM groups (p = 0. 02). Conclusion Based on results, only one dimension of general health (Social functioning) had significant differences between two groups. So only social functioning had significant relation with feeding pattern of infants. Also, number of children had significant relationship with total score of GHQ. More studies are recommended to earn more detailed results.

Background Although both methods of spontaneous respiration and controlled ventilation during anesthesia are safe and effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal. This study aimed to determine the outcomes of anesthetic techniques in pediatric rigid bronchoscopy for foreign body removal. Materials and Methods In this retrospective cross sectional study, all children underwent rigid bronchoscopy for managing foreign body aspiration at Mofid hospital, Tehran, Iran from 2009 to 2015 were enrolled. Data gathering was done by a surgical technologist and using a structured checklist. The measured variables included gender, age, weight, and duration of anesthesia, duration of bronchoscopy, hospitalization in intensive care unit (ICU), and recovery time, and possible major and minor complications. Results Totally, 159 patients were assessed of whom 10 (6. 5%) were maintained spontaneous respiration and 149 (99. 35%) were given muscle relaxant. The mean ± standard deviation (SD) age of subjects was 27. 21 ± 24. 40 months, and also 61% (n=97) were male. The two groups did not differ in terms of age, gender and weight (p>0. 05). Patients with controlled ventilation had a similar duration of anesthesia, duration of bronchoscopy, hospitalization in ICU, recovery time, and complications with the patients who had spontaneous respiration during bronchoscopy (p > 0. 05). Conclusion Patients with spontaneous respiration and controlled ventilation during rigid bronchoscopy have a same outcome during and after the procedure. However, we strongly recommend further study in this regard.

Background Cough variant Asthma (CVA) is defined as chronic cough without wheezing, and may be precursor of typical asthma. Thus, the diagnosis of CVA and early intervention can partly inhibit asthma progression. This study aimed to evaluate the role of spirometry in diagniosis of Cough variant Asthma in Iranian Children. Materials and Methods This descriptive observational study included a total of 73 patients, who were referred to the specialized lung clinic of Tabriz Pediatric Center, Tabriz city, Iran. Patients were divided into two groups with classic asthma (n=37) and cough variant asthma (n=36) and basic spirometry parameters such as FEV1, FVC, FEV1/FVC, FEF 25-75% and PEF were measured, and the spirometry findings of each individual were measured based on the European Respiratory Society (ERS) criteria. Results The mean of FEV1 and FVC in the classic asthma group were 83. 45 ± 20. 49% and 86. 45 ± 21. 57%, respectively; and in the cough variant asthma group were 87. 44 ± 13. 99% and 86. 8 ± 14. 71%, respectively. There was no significant difference between the two groups for the basic spirometry parameters of FEV1 and FVC (p=0. 343, P=0. 916; respectively). The average FEV1/FVC parameter in the cough variant asthma group was 89. 44± 13. 07, but it was 72. 35± 8. 47 in the classic asthma group, with a significant difference between the two groups (p<0. 05). Conclusion There was a significant difference in the FEV1 / FVC value between two groups of cough and classic asthma. Spirometry of patients with cough variant asthma showed the FEF values (25-75%) were lower than expected; we suggest using spirometry in the diagnosis of cough variant asthma considering small airways changes.

Background Pediatric liver transplant (PLT) is a complex surgical procedure. Pediatric liver transplantation has evolved over the last two decades into an effective and widely accepted therapy for infants and children. We aimed to review the short and long term complications after oediatric liver transplantation. Materials and Methods The literature research was conducted in EMBASE, PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar; were searched from January 1984 to January 2016. The following keywords were used: Liver transplantation, Pediatric Liver transplantation, Risk factors, Complication, and Mortality. Results The main complications after pediatric liver transplantation were: infections (51. 4%) and surgical complications including (biliary complications [41. 2%], and postoperative bleeding [27%]). In general, vascular complications were observed in 35% of studied children. Conclusion Infections and biliary complications were the most common outcome occurring in children after LT. Advances in post-transplant care and monitoring of the recipients, technical refinements enable the better results.

Background: The presence of a mentally retarded child is a stressful experience for the family, especially mothers. The present study aimed to determine the effect of resilience education by the teach-back method on the stress of mothers of educable mentally retarded children. Materials and Methods: In this field trial study, 70 mothers of educable mentally retarded children were selected as the sample using convenience sampling method and then assigned to the intervention (n=35) and control groups (n=35) based on block random allocation. Each mother in the intervention group participated in 8 sessions of resilience education by the teach-back method (each session lasted 30-45 minutes) in a period of 30 days. The Parenting Stress Index of Abidin and Connor-Davidson Resilience Scale were filled out by mothers of the intervention (teach-back) and control groups in pretest and posttest. The obtained data were analyzed using SPSS version 16. 0 software. Results: The mean score of maternal stress before the intervention was 127. 94 ± 22. 35 in the intervention group, and 129. 31± 21. 82 in the control group. These values after the intervention were 88. 6± 17. 98 and 135. 23± 23. 08 in the intervention and control groups, respectively. In addition, the mean score of resilience before the intervention was 29. 17± 11. 95 in the intervention group, and 25. 89± 10. 3 in the control group. These values after the intervention were obtained 58. 94± 9. 43 and 22. 2± 8. 17 in the intervention and control groups, respectively. There was a significant difference between the intervention and control groups in the mean score of stress and resilience one month after the completion of intervention (p<0. 05). Additionally, mothers in the intervention group, who received the teach-back method, had significantly less stress and more resiliency (p<0. 05). Conclusion: The study showed that resilience education through teach-back had a significant effect on reducing stress and increasing resiliency of mothers of educable mentally retarded children.

Background Cryptosporidiosis has a worldwide distribution, and is the commonest cause of diarrhea in children and immune compromised individuals. Since there is no data available on the prevalence of Cryptosporidium species (sp. ) in Zabol city, thus this study was carried out to assess the disease prevalence and related factors influencing the disease. Materials and Methods In this cross-sectional study, 200 fecal specimens were collected from children referred to the Central or hospital labs in Zabol city, South East of Iran, during April 2014 to August 2016. Fecal examination was performed by staining with Ziel-Neelsen acid-fast to find oocysts of the parasite. The children were grouped according to the age, gender, kind of water supplies, and diarrheic and non-diarrheic condition. Data were evaluated using SPSS version 13. 0 software. Results Among the children referred to the Central laboratory, 200 fecal samples from different age groups were collected. The prevalence of Cryptosporidium species was 9. 7% which was higher in children under 4 years. There was a significant relationship between sources of water supply and diarrheic children infected with Cryptosporidium (P<0. 05). Conclusion Cryptosporidiosis is the most infectious disease in Zabol city, especially in children. Healthy water supply significantly affects the disease prevalence.

Background: Vaccination is the most common painful procedure throughout infancy. Therefore, vaccination pain management in infants may prevent short-term and long-term physical and mental consequences in them. As a result, this study aimed to determine and investigate the effect of breastfeeding and sensorial saturation on physiological parameters of infants after administration of pentavalent vaccine at four and six months of age. Materials and Methods: This randomized controlled field trial was conducted on 171 four-month-old infants. The infants were randomized into three groups. The first group was breastfed for two minutes before vaccination (Breastfeeding group =55 infants). In the second group, the five senses of the infants were stimulated for two minutes before vaccination (Sensorial Saturation group =57 infants). The third group did not receive any intervention (Control group = 59 infants). In all groups, physiological parameters of the infants at four and six months of age were measured and recorded one minute after the vaccination. Data was analyzed using descriptive and inferential statistics in SPSS version 21. 0 software. Results: Results showed no significant difference was observed in demographic variables of research samples including gender and weight at four and six months of age, and statistically significant between groups difference in three physiological parameters (respiratory rate, heart rate, and peripheral oxygen saturation) of the infants at four and six months of age (p=0. 001). Although sensorial saturation was more effective than breastfeeding, this difference was not statistically significant; whereas, these interventions were significantly more effective than the control. Conclusion: Both breastfeeding and sensorial saturation practices resulted in the stability of physiological parameters of the infants after vaccination at four and six months of age; however, no significant within-group difference was observed after vaccination at four and six months of age in these two groups and both methods had identical effects.

Background Autistic spectrum disorder (ASD) refers to a syndrome associated with persistent impairments in communication skills, social interactions, and so forth. Given the approval of risperidone and naltrexone by U. S. Food and Drug Administration (FDA) for ASD cases and extant controversy concerning their pertained side effects, this double-blind, placebo-controlled, crossover clinical trial with 2-treatment, 2-sequence, 2-period design was intended to evaluate the behavioral effectiveness of individual risperidone and its combination with naltrexone in autistic children aged 4-12 years old. Materials and Methods A total of 30 autistic children were recruited in this study, and then equally assigned into groups A and B. The first group underwent co-treatment with risperidone and naltrexone, while group B was instructed to use placebo and risperidone for 8 weeks. After a washout period of two weeks, treatments were crossed over for another 8 weeks. The behavioral changes were assessed applying the childhood autism rating scale (CARS). Results There were five out of 30 cases at the risk of drop-out due to side effect in group A, while only three failed to complete the trial in group B. The effect size of the combined treatment was greater than the individual which was manifest in the total score of CARS, improved 4-week listening response, and 8-week general impressions. Conclusion According to the results, naltrexone can be a promising candidate for the management of behavioral symptoms in autism children.

Ampicillin is a bactericidal antibiotic, it penetrates into the bacterial wall better than penicillin G and is active against gram-negative bacteria that are resistant to penicillin G. Ampicillin has a broadspectrum antimicrobial activity and is the most widely used antibiotic for treating infections caused by Listeria, Beta-lactamase-negative Haemophilus, enterococci, Shigella, streptococci, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Neisseria gonorrhea, Neisseria meningitis and many coliform organisms. Ampicillin is excreted unchanged in the urine. In neonates with a gestational and postnatal ages of ≤ 34 weeks and ≤ 7 days, respectively, the half-life, the clearance and the distribution volume of ampicillin are 5. 0 hours, 0. 055 l/h/kg, and 0. 40 l/kg, respectively. The ampicillin half-life decreases and the clearance of ampicillin increases with the neonatal maturation whereas the distribution volume is not affected by the neonatal maturation. Ampicillin may be administered orally. Ampicillin penetrates into the cerebrospinal fluid, especially when the meninges are inflamed. The recommended dose of ampicillin is 50 mg/kg every 12 hours in the first week of life, every 8 hours in neonates 1-3 weeks old, and every 6 hours in neonates 4 or more weeks old. Bacteremia, caused by group B Streptococcus, is treated with 150 to 200 mg/kg/day ampicillin and meningitis is treated with 300 to 400 mg/kg/day ampicillin in divided doses. Some organisms are resistant to ampicillin and a combination of gentamicin and a third-generation cephalosporin is recommended. The aim of this study is to review the effects and pharmacokinetics of ampicillin in neonates and infants.

Background: Cyproheptadine hydrochloride is an antihistaminic drug. Appetite stimulation is one of its secondary effects that can be of advantage in some diseases. In this study we investigated the effect of Cyproheptadine hydrochloride on weight gain in underweight children with anorexia at age group 2 to10 years old. Materials and Methods: In this randomized clinical trial, we selected 2-10 year-old underweight children with anorexia who referred to Ayatollah Mousavi Hospital in Zanjan (Iran), during 2015. One hundred and thirty-six children were allocated at random in two groups. The Cyproheptadine-treated children group were given the drug orally; 0. 1 mg/kg/dose three times per day for 8 weeks, while patients in placebo group received placebo with the same dose. After two months, weight gain was compared with the previous values in both groups. Results: In this study, 86 patients (63. 2%) were female. The average increase in weight in the cyproheptadine-treated group was significantly higher than in the placebo group (1. 08 ± 0. 67 kg and 0. 22 ± 0. 46 kg, respectively) (p=0. 005). The average increase height in the Cyproheptadine-treated group was significantly higher than in the placebo group (1. 60 ± 0. 97 cm, and 0. 86 ± 0. 85 cm, respectively) (p=0. 005). According to the parents of both groups, anorexia in the Cyproheptadine-treated group improved in 100%, and in the placebo group in 52. 7%. This difference was statistically significant (p=0. 005). No any side effects of Cyproheptadine hydrochloride were observed. Conclusion: According to the finding of our study, there were no serious side effects of Cyproheptadine hydrochloride. Therefore considering the acceptable safety of Cyproheptadine hydrochloride for inducing growth in underweight children, we propose its administration with the aforementioned dose.

Background The prevalence of asthma has increased significantly in recent decades, especially in lower socioeconomic groups and in minority populations. Because of the increasing prevalence of asthma among children in worldwide and Iran, the importance of timely control of the disease after its diagnosis and few studies on the effect of education on asthma control in Iran, the aim of this study was to investigate the effect of education on asthma control in children. Materials and Methods In this quasi-experimental study, 104 Iranian children (6-14 years old) with asthma referred to asthma and allergy clinic of Children's Medical Center in Tehran, Iran, were studied via convenience sampling method. Recruitment was occurred between 2011 and 2015. Subjects randomly were divided into two equal groups of intervention and control. For intervention group, common education as well as special education in format of booklet, pamphlets, CD and group training sessions were applied every two weeks within the first two months of follow up and every two months then after; while the control group received usual care. Results The means of FEV1/ FVC change, frequency of admission to the ED, hospitalization and absence from school and use of steroids were significantly different before and after education in the intervention group; while changes among measured parameters in the control group were not significantly different (p>0. 05). Conclusion The results of this study showed that specific education has significant helpful effect on asthma attack control in children.

Background Cough variant asthma (CVA) is a chronic or recurrent cough without wheezing accompanied by bronchial hyper-responsiveness and eosinophilic inflammation of the airways. This study aimed to evaluate the validity of spirometry in the diagnosis of CVA, as well as determining the specificity and sensitivity of spirometry parameters in CVA. Materials and Methods This descriptive observational study was conducted from March 2015 to February 2016. The subjects were 73 patients 5 to 15 years of age who referred to the pulmonology clinics of Tabriz Pediatric Center, Tabriz city, Iran. The patients were divided into two groups of classic asthma (n=37), and CVA (n=36). Basic spirometry parameters such as FEV1/FVC and FEF25-75% were measured and the spirometry findings of each individual were measured based on European Respiratory Society (ERS) criteria. After intervention (β 2 (beta2) adrenergic receptor agonists as bronchodilator test), in two groups, spirometry was again performed. The FEV1/FVC and FEF 25-75% parameters were examined for intervention. Data analysis was performed using SPSS (version 16. 0). Results Cut-off points for the diagnosis of CVA and classic asthma were obtained using FEV1/FVC and FEF 25-75% spirometry. The cut-off point for FEV1/FVC for the diagnosis of CVA was calculated to be 80%. When the FEV1/FVC ratio was higher than 80%, diagnosis of CVA was possible with a specificity of 94. 59%, and sensitivity of 66. 67%. These findings suggest a specificity and sensitivity of 94. 59%, and 66. 67%, respectively, for the diagnosis of classic asthma (with an FEV1/FVC ratio of below 80%). Analysis showed a positive predictive value of 100% for CVA at FEF 25-75% with a negative predictive value of 55. 4%. Conclusion Spirometry can be a sensitive method for the diagnosis of CVA at a FEF 25-75% below 65%; however, it lacks the specificity for accurate diagnosis of CVA.

Background: One of the common side effects of gastroenteritis in children is seizure, which is one of the causes of fever, electrolyte disturbances, and meningitis. This study was aimed to investigate the determinant factors in seizure in children with gastroenteritis and seizure admitted in Tabriz Children's Hospital from 2001 to 2016. Materials and Methods: This is a descriptive study. The study population included all children admitted with diagnosis of gastroenteritis and seizure in Tabriz Children's Hospital during the years 2001 to 2016. The data of admitted patients including electrolyte disturbances, age, gender, bloodvenous analysis, Blood urine nitrogen (BUN), and creatinine tests were extracted from hospital records by a resident and intern of this hospital using a questionnaire designed for this research. Results: A total of 84 patients were included in the study. The patients included 44 males (52. 4%) and 40 females (47. 6%). The mean age of the patients was 9. 31 ± 7. 13 years. Forty-six (55. 42%) patients suffered from electrolyte impairment, 24 of which (52. 2%) were male and 22 (47. 8%) were female; and hyponatremia was the most common disorder (24. 10%). Accordingly, only BUN of has proven to be a strong predictor of the likelihood of seizure; also despite of non-significant p-value of PH, it had a potentially strong association with seizure. Conclusion According to the results of this study, electrolyte impairment is fairly common in children with acute gastroenteritis. Education about the management of children with seizure to is an important factor in this regard.

Background Although effectiveness of cranberry for preventing urinary tract infection (UTI) has been reported in Iranian traditional medicine and recent studies there is still controversy in this regard. Therefore, the present study was designed with a meta-analytic approach aiming to evaluate the effect of prophylaxis prescription of cranberry in prevention of UTI in children. Materials and Methods In this study, a thorough search was performed in Medline, Embase, Web of Sciences, Scopus and CINHAL databases by the end of August 2017. Using keywords related to urinary tract infection combined with words related to cranberry, search strategy was designed. The articles were summarized and finally, the role of cranberry extract consumption in decreasing the incidence of UTI was evaluated by reporting odds ratio (OR), and 95% confidence interval (95% CI). Results In the end, 10 studies were included (414 cases in control group and 380 in cranberry extract treatment group). Analyses showed that prescription of cranberry significantly reduced the odds of UTI manifestation in children compared to placebo (OR=0. 31; 95% CI: 0. 21 to 0. 46; p<0. 0001). On the other hand, it was determined that effectiveness of cranberry in decreasing UTI manifestation was similar to antibiotic treatment (OR=0. 75; 95% CI: 0. 34 to 1. 70; p=0. 495). Conclusion In the present study, it was determined that prophylaxis prescription of cranberry extract leads to prevention of UTI manifestation in children and its effectiveness is similar to that of antibiotics.

Familial Mediterranean fever, an autosomal recessive disorder, is a member of the periodic fever syndromes, and considered to be the most common cause of recurrent febrile episodes in children. It is important to understand the disorder as familial Mediterranean fever falls on a spectrum of various presentations; the recurrent episodes of familial Mediterranean fever may be so severe that the quality of life may be affected in such patients. Therefore, physicians should not delay the evaluation in such cases and promptly initiate treatment to not only improve quality of life but to also avoid complications, such as amyloidosis. This study reports two different cases of familial Mediterranean fever, with varying clinical presentations, and established diagnosis via genetic testing as well as cessation of symptoms with a trial of therapy. Furthermore, this study discusses the various manifestations of familial Mediterranean fever, laboratory findings, and current therapies available for management.

Background When a child’ s body temperature rises, most parents become very worried that high fever may harm the child; in this study, knowledge and performance of the parents at the time of fever in children and how they act when encountering children’ s fever were studied. Materials and Methods In this cross-sectional descriptive study, samples (300 parents of children under 10 years) were selected using the convenience sampling method among the children admitted to Children's Hospital of Tabriz, Iran, and these parents completed the research made questionnaire of parental knowledge and performance at the time of fever in children. Data were analyzed using SPSS version 20. 0. Results The most common complication of high fever from the parents’ views was febrile seizure in 141 cases (47%). The use of corticosteroids for the treatment of fever in this study was observed in 23 cases (7. 7%), and 40. 7% of mothers had received their information about fever and how to manage it in children from doctors and nurses. In this study 87 (29%) of mothers had used thermometer to check for the child’ s fever. In total, 53% of mothers knew the correct definition of standard fever temperature. Results showed that 161 (53. 7%) of mothers believed in feeding the child more fluids than usual, 21 (7%) believed in feeding the child less fluids than usual, and 118 (39. 3%) believed in feeding the child the same amount of fluids as before. In total, 25. 7% of mothers had used antibiotics to treat their child’ s fever. Conclusion "Fever phobia" continues to be common among parents. Parents have low level of awareness about children’ s fever. Such low awareness and parents’ wrong perception of fever and their excessive fear and anxiety cause them fail to act properly.

Background: Unhealthy nutrition at early years of life causes some diseases such as cardiovascular diseases, cancers, diabetes, gastrointestinal disorders, and bone and joint diseases during adulthood. In other words, many of wrong health behaviors are rooted in childhood experiences. This study was conducted to examine effect of interventional programs on knowledge, attitude and nutritional behavior of students at 5th grade of elementary schools. Materials and Methods: This is an experimental study in which, 168 elementary female students (in Paveh city, Iran) were assigned randomly to two experimental (n=84) and control (n=84) groups. A valid questionnaire was used as data collection tool. Pretest was done in both groups. According to results obtained from pretest, educational intervention was implemented in 2 sessions holding health food festival and classes for intervention group. Each session continued for 30-45 minutes. Two months after intervention, questionnaires were redistributed among two experimental and control groups to evaluate knowledge, attitude, and performance of participants. The obtained data were analyzed through SPSS 16. 0 software. Results: Results showed a significant increase between means of knowledge scores and attitude level of students toward snack in experimental and control groups (p=0. 008). Also, compared with control group, there was a significant improve between mean scores of snack-related behaviors in experimental group after educational intervention (p=0. 04). Conclusion: Since, this study confirmed effectiveness of snack-centered nutritional education on increasing knowledge, attitude, and nutritional behaviors of students, it is recommended to design and implement suitable interventional programs to improve nutritional awareness, attitudes, and behaviors of students.

Background: Children with congenital heart disease (CHD) are prone to malnutrition and growth retardation. This study aimed to compare growth status between children with CHD and healthy children. Materials and Methods: This case– control study included 310 children with CHD and 300 healthy children matched in age and gender. CHD patients grouped according to cardiac diagnosis: group 1 (n=5), cyanotic patients with pulmonary hypertension; group 2 (n=22), cyanotic patients without pulmonary hypertension; group 3 (n=43), Acyanotic patients with pulmonary hypertension; and group 4 (n=240), Acyanotic patients without pulmonary hypertension. Anthropometric measurements of weight (Kg), height (cm), and head circumference (cm) were measured and recorded for both case and control groups. Descriptive and analytical statistics were performed using the by SPSS version 21. 0. Results: Weight and head circumference were significantly lower in CHD children compared to healthy children (p<0. 05). Weight, Height and Head circumference was significantly lower in cyanotic patients without pulmonary hypertension, and Acyanotic patients with pulmonary hypertension compared the CHD children (p<0. 05). Weight in Acyanotic patients with pulmonary hypertension and Head circumference in cyanotic patients without pulmonary hypertension, and Acyanotic patients with pulmonary hypertension, was significantly lower compared to Acyanotic patients without pulmonary hypertension (p<0. 05). CHD patients without operation ingested fewer weight, height and head circumference compared to CHD patients with operation (p<0. 05). Conclusion Children with CHD experience early, simultaneous decrease in growth trajectory across weight, length, and head circumference. The results suggest that early surgical intervention and nutritional support can be fruitful in prevention of these complications.

Background: Nasal carriage of Staphylococcus aureus (S. aureus) has a key role in the epidemiology and pathogenesis of infection. In this study we aimed to investigate the occurrence of the methicillin resistant Staphylococcus aureus (MRSA) and mecA gene among healthy primary school boys in North of Iran. Materials and Methods: This cross-sectional study was conducted from January 2017 to July 2017 in Sari city located in the North of Iran. Nasal swabs were taken from 277 healthy primary school boys. S. aureus strains were identified according to the standard microbiological procedures and presence of spa gene. Agar screen method was used to determine MRSA. All MRSA isolates were examined for the existence of the mecA and spa gene by using Multiplex Polymerase chain reaction (PCR) method. Results: The prevalence of nasal carriage of MRSA was 29. 24%. The existence of the mecA gene among MRSA strains was 49. 38%. The rate of resistant isolated to cefoxitin, vancomycin, cefixime, cefalotin, clindamycin, , cefazolin, co-amoxiclav, amoxicillin, cotrimoxazole and cefalexin antibiotics were 48. 14%, 39. 50%, 98. 76%, 96. 29%, 54. 32%, 91. 35%, 97. 53%, 95. 06%, 7. 40%, and 100%, respectively. Conclusion: The high rate of Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), and presence of mecA gene, and resistance to critically antibiotics against MRSA is a therapeutic concern and needs to strategies to prevent community spread of S. aureus.

Dear Editor-in-Chief Ingestion of batteries by children became more frequent in recent years, due to the increasing accessibility of electronic toys and devices to children. Most of the cases befall in the pediatric age, mostly between 6 months and 6 years (1). We report a fatal evolution of battery ingestion in a 2-month-old boy. A 2-month-old boy presented to the pediatric emergency room 3 hours after the unintentional swallowing of a lithium battery. An X-ray revealed a radiopaque round object in the stomach (Figure. 1). The esophagoscopy showed a 3rd degree ulcerative esophagitis of the cervical esophagus. Spontaneous emission of the battery was noted in 24 hours. The general state and the clinical examination were normal and the initial biological exploration was normal. So the patient was placed under intravenous antibiotic therapy, antacids, and steroids. On day 8, the patient presented an alteration of the respiratory state with abdominal bloating so an intubation was made. A CT-scan was done and it was normal. After extubating an upper digestive tract gastrografin swallow showed an esophageal stenosis with caustic esophagitis. A new alteration of the respiratory state was noted and the patient was newly intubated with chest X-ray showed an inhalation pneumonitis (Figure. 2). The patient died within 24 hours. Batteries lodged in the esophagus can cause severe tissue damage in just 2 hours with delayed complications (2). The majority of cases, 75%, occur before 4 years of age (3) cases of battery ingestion at ages inferior to 6 months (2 months for our patient) are extremely rare and ingestion is done accidentally and often with intervention of another person, in our case it is the older brother who putted accidently the battery in the mouth of his little brother. The mechanisms of injury of esophageal battery impaction are various. A local toxic effect is due to mercuric oxide, which can be lethal (4). Despite this potential danger, complications in button battery ingestion case series are, fortunately, rare, and those that do occur mainly arise when the batteries fail to migrate beyond the esophagus because of the increased propensity for their course to arrest (5). In our case the time interval between ingestion and the spontaneous emission of the battery was between 24 and 36 hours. Lithium battery ingestion is a serious condition with high risk of life-threatening complications in childhood, and it can be fatal especially in extreme age, under 6 months. Urgent endoscopic removal is the best treatment to reduce the risk of morbidity and mortality.

Background Infantile colic (IC) is a common painful disorder within early months of life. There is no definitive therapeutics for IC. In present study aimed to assess pain-relieving potential of glucose administration in infantile colic. Materials and Methods This was a double blinded randomized clinical trial performed during May 2015-June 2017 in pediatric ward of Amir-Al-Momenin Hospital, Zabol city, Iran. Overall, 72 infants were randomly assigned to either glucose or simethicone groups (36 infants per group). Treatments were continued for 28 days with either 25% or 30% glucose solution and 2. 5 mg/kg simethicone. Outcomes were assessed at the end of the intervention (28 days). Statistical analysis was done in SPSS version 22. 0. Results Males and females constituted 20 (55. 5%), and 16 (45. 5%) in glucose administrated, and 23 (63. 8%) and 13 (36. 2%, P=0. 4) in simethicone group respectively. The mean age (days) was 19. 1± 3. 8 and 20. 2± 4. 9 for glucose and simethicone administrated groups, respectively (P=0. 2). The crying times per day significantly reduced in both groups (mean reduction in crying times of 3. 7± 2. 1, and 6. 3± 2. 1 hours in glucose and simethicone groups, respectively). Moreover, 25% and 44. 4% of infants in glucose and simethicone groups achieved ≥ 50% reduction in crying time, respectively (P=0. 06). According to the glucose dose, infants who received 30% glucose solution significantly revealed higher ratio of ≥ 50% reduction in crying time (47. 3%) than those received 25% glucose solution in which no cases fulfilled this outcome (P<0. 0001). Conclusion Glucose may be a useful candidate to be considered as a pain-relieving agent in infantile colic.

Dear Editor-in-Chief Pneumatocele is most often seen in children with bacterial pneumonia but also develops after blunt thoracic trauma, positive pressure ventilation, and caustic aspiration (1). These lesions frequently resolve spontaneously; and this is usually slow and not uncommonly may take months or longer after disappearance of the underlying pathology (2). We here describe a case of pulmonary pneumatocele in postpneumonic empyema in a child. A 4-year-old female was admitted with a 2-week history of cough and sputum production with fever. The chest X-ray objective pneumonia, so she was initially put under antibiotic as an outpatient. However, after 6 days we note the persistence of the fever a chest X-ray was made showing a left pulmonary empyema confirmed by a CT scan. So we decide a hospitalization with intravenous antibiotic treatment. After a favorable evolution in the one month control chest X-ray and CT scan objective a left basal pneumatocele (Figure. 1), and biology showed leukocyte count at 10, 740/mm3 and C-reactive protein at 28 mg/dL. So antibiotherapy has been started. After 4 weeks of antibiotic administration, improvement was detected on clinical finding, laboratory test, and radiologic image. At the 2-month follow-up, chest radiography and chest CT indicated regression of the pneumatocele (Figure. 2). Clinical and radiological progress was good. During follow-up, resolution of the pneumatocele lesion was observed after more than 5 months. Pulmonary pneumatoceles occur as a complication of acute pneumonia, but are almost always transient and generally resolve spontaneously and completely, without sequelae (3). The diagnosis was usually made with a simple chest x-ray, however, CT establishes a definitive diagnosis of pneumatocele and it is necessary for a good surveillance (4). As in our case it was the CT which confirmed the diagnosis of pneumatocele and it was used in surveillance during the first three months. In the treatment, there are some reports regarding image-guided catheter drainage or surgical excision besides cases with spontaneous resolution (4). But in the literature it has not been clearly indicated which clinical or radiological signs are indication for treatment choice; and some authors reported a series of spontaneous resolution without sequelae (2, 4). In our patient antibiotic was used because of biology result and spontaneous evolution was noted after 5 months of follow-up. Generally pneumatocele need not an interventional treatment and an excellent prognosis can be given with only surveillance and antibiotic if it has indication.

Background: Neonatal Jaundice is a common problem that occurs in most preterm and term neonates. This systematic review aimed to examine the evidence for the effects of oxytocin in labor on neonatal jaundice. Materials and Methods: In this systematic review study, English databases including PubMed, Google Scholar, Embase, Cochrane Library, Scopus, Web of Sciences, and Persian databases including SID, Magiran, and Barakat Knowledge Network System Were searched from Jan 1980 to Dec 2017. Persian and English human clinical trials were targeted. The review was limited to human clinical trials examining the effect of oxytocin in labor on neonatal jaundice. The searched MESH vocabulary was "neonatal hyperbilirubinemia" OR "jaundice" in combination with "oxytocin in labor" OR "induction of labor". Two authors examined the articles separately and the disagreements were resolved through discussion. Results: Out of 583 articles searched in the databases, 440 title, 83 abstracts, and 60 full texts were reviewed, of which 5 English language articles entered the study and 4 articles entered the metaanalysis. Meta-analysis results showed that oxytocin did not affect the serum bilirubin level of the umbilical cord (Mean difference: 1. 60; 95% confidence interval [CI]:-2. 50 to 5. 69; P=0. 44; I2=78%). Furthermore, administering oxytocin in labor did not significantly affect serum bilirubin level on days 1 (-0. 32;-1. 36 to 0. 71; P=0. 54; I2=72%), and day 3 (3. 75;-11. 76 to 18. 90; P=0. 65; I2=63%), while it significantly affected serum bilirubin level on day 2 (-1. 63;-2. 81 to-0. 45; P=0. 007; I2=0%). Conclusion: The result of meta-analysis showed that the administration of oxytocin during labor does not affect serum bilirubin level on days 1 and 3, while induction of labor with oxytocin causes serum bilirubin to increase on the second postnatal day. However, due to the high heterogeneity of the studies, better designed clinical trials are recommended to achieve better results.

Background Oral diseases are one of the most common diseases in the world, and prevention of them is nowadays one of the health priorities. The aim of this study was to determine the demographic characteristics associated with vulnerability of oral diseases among primary school students in south of Iran. Materials and Methods This cross-sectional study, conducted in Shadegan city, the South of Iran, a total of 300 primary school students aged 7 to 12 years old, were randomly selected to participate voluntarily in the study in 2016. Data were gathered by interviewing among participants based on standard questionnaire. Questionnaire including the demographic characteristics and vulnerability of oral diseases scale. Data were analyzed by SPSS version 16. 0 using Pearson correlation, t-test, and one-way ANOVA statistical tests at 95% significant level. Results Almost 30. 6% of the volunteers reported had daily tooth brushing. The mean perceived vulnerability of respondents was 27. 20 [95% CI: 26. 67, 27. 72], ranged from 7 to 35. There was a significant positive correlation between perceived vulnerability with participant's mother education level, mother age, father age, and daily tooth brushing (P<0. 05). However, there was no significant difference between gender and perceived vulnerability (P>0. 05). Conclusion Our findings indicated, mothers education levels had significant role on increasing vulnerability of oral diseases among primary school students, and may be usefulness of the results in order to promotion of oral health care behaviors among chillers.

Background: The results of existing studies regarding the use of neuromodulation in fecal incontinence (FI) are contradictory and therefore, a definitive conclusion cannot be made in this regard. Therefore, the aim of the present study was to evaluate the effectiveness of neuromodulation in controlling FI in children through a systematic review. . Materials and Methods: A decision was made to perform the search in electronic databases of Medline, Embase, Web of Science, CINAHL and Scopus until end of October 2017. In the second step, the abstracts of the extracted studies were evaluated by 2 researchers independently and recorded in the data extraction form. Finally, all studies were summarized and categorized based on the evaluated outcomes and overall effect size was presented. . Results: Five studies were included in the present meta-analysis (including 115 children and adolescent). Pooled analysis also showed that the odds of improvement in the group under treatment with nerve stimulation was up to 20 times higher (OR = 20. 29; 95% CI: 8. 67 to 47. 45; p<0. 0001). In addition, using nerve stimulation leads to a significant improvement in fecal incontinence score of patients (SMD = 2. 32; 95% CI: 1. 12 to 3. 52; p<0. 0001). Conclusion: It can be concluded that neuromodulation can seemingly be an effective measure in controlling FI in children. However, the lack of standard clinical trials in this field is highly felt and it is suggested to assess the effect of neuromodulation on FI by performing blinded randomized clinical trials in future studies.

Background: Currently, Glucantime is considered the first-line treatment of cutaneous Leishmaniasis. This study aimed to evaluation of intralesional Glucantime (IG) and Cryotherapy (Cryo) plus intralesional Glucantime (Cryo and IG) therapeutic efficacy on Zoonotic Cutaneous Leishmaniasis in Qom province, Iran. Materials and Methods: In this randomized controlled trial of 197 CL patients reported from Qom health centers, Iran during (2014-2017), 112 cases were entered to this study. According to the Iranian Ministry of Health therapeutic guide line of CL, 54 cases with 116 lesions received IG weekly, and 58 patients with 115 lesions received the IG once a week coupled with Cryo using liquid nitrogen once every two weeks. The average volume of injected solution per lesion was 0. 2 ml to 0. 5 ml into the border of the healthy skin and the onset of erythema in the lesions using insulin syringe needles. In second therapeutic method; cryotherapy with liquid nitrogen was performed by dipstick technique. At first, the lesion size and induration of lesions were recorded. After 7 and 12 weeks of treatment lesions healing rate was monitored. Healing was defined as complete re-epithelialization and disappearance of induration. Results: Out of 112 CL patients, 54 cases with 116 lesions received IG, and 58 patients with 115 lesions received Cryo and IG. At 7th week after the initiation of treatment, complete healing was observed in 56 out of 116 lesions (48. 1%) in the group which received weekly IG and 83 out of 115 lesions (72. 2%) in the group which received biweekly Cryo plus IG. At 12th week after the treatment, the cure rate was 91% and 100% in group which received weekly IG and group which received IG once a week coupled with cryotherapy (p=0. 001). Conclusion: Based on the findings, IG once a week coupled with cryotherapy was more effective compared with weekly IG and reduced the period of treatment.

Acute disseminated encephalomyelitis (ADEM) is a monophasic clinical syndrome, characterized by immune-mediated demyelination of central nervous system neurons, which yield extensive damage in the brain and spinal cord. It usually affects children and young adults following infections or immunization. Here we describe a 9-year-old Fars female presented with acute onset of psychotic disorder, one week after an upper respiratory infection. Magnetic resonance images (MRI) of the brain were consistent with the diagnosis of the acute disseminated encephalomyelitis (ADEM). ADEM is one of the differential diagnoses to be considered when an acute psychotic disorder arises during childhood especially as post vaccination or infection.

Background: Although numerous observational studies have investigated the association between gender and risk of congenital hypothyroidism, the role of gender as a risk factor for congenital hypothyroidism remains unknown. This meta-analysis was conducted to summarize the epidemiologic evidence of the effect of gender on the congenital hypothyroidism occurrence, and also to identify the sex ratio for congenital hypothyroidism. Materials and Methods: A comprehensive literature search of numerous electronic databases including Medline (via PubMed), Scopus, EMBASE, and Science Direct was performed until February 1st, 2017. All studies designed case-control (six studies with 3, 254 subjects) and crosssectional studies (eight studies with 8, 258, 745 subjects) addressing the association by odds ratio (OR) and 95% confidence interval (95% CI) were included. Moreover, eleven cross-sectional studies were also included providing a sex ratio for congenital hypothyroidism. Pooled Mantel-Haenszel OR (MH OR) with 95% CI was estimated using the random-effects method. Results The overall summary results showed that girl gender is associated with an increased risk of congenital hypothyroidism (pooled MH OR=1. 46; 95%CI: 1. 10, 1. 95). The pooled MH OR for case-control studies was 1. 69 (95%CI: 1. 35, 2. 13), whereas the pooled MH OR for cross-sectional studies was 1. 26 (95%CI: 1. 00, 1. 59). In addition, pooled female to male sex ratio of congenital hypothyroidism incidence was 1. 35 (95%CI: 0. 99, 1. 83). Conclusion: The results of this meta-analysis provide evidence for a higher risk in girl gender for developing congenital hypothyroidism. More epidemiological and clinical studies are needed to explore why girl gender is at increased risk of congenital hypothyroidism compared with boy.

Background Epilepsy is among the most common neurological disorders in childhood, prevalence of which is increasing. Unpredictable and chronic nature of the disease affects physical, social and mental functions of the children and their family. This study was aimed to compare behavioral problems in epileptic children group versus healthy control group. Materials and Methods This study is a case-control one conducted from January 2013 to June 2016 in Tehran, Iran. The epileptic children in age of 7-10 years old that were diagnosed by neurologist referred to the researcher for further process. Their parents were provided with Child Behavior Checklist (CBCL) to be completed. For matching by age and gender, the healthy group was sampled after the epilepsy group. Multivariate Analysis of Variance was used for statistical analysis. Results In this study 94 children with epilepsy and 83 healthy children in age of 7-10 years old were studied. The results indicated that there were significantly higher behavioral problems in the children with epilepsy than in control group in nine categories of seclusiveness, physical complaints, anxiety and depression, social problems, thought problems, attention problems, delinquent behaviors, aggressive behaviors, and other problems. Comparison of two generalized and partial epilepsy groups indicated that there was a significant difference only in attention problems (p = 0. 024). Conclusion The present study indicates that the children with epilepsy have more behavioral problems as compared to control group. Therefore, educational and psychological interventions are necessary for supporting desirable psychosocial growth and development of such children.

One of the goals of education can be considered the transfer of knowledge, skills, competencies, wisdom, norms and values between generations. Intergenerational learning program provide this goal and opportunities for lifelong learning and sharing knowledge and experience between generations. This review aimed to investigate the benefits of this program for the children and older adult and its application in health care systems. An extensive literature search was conducted in some online databases such as Magiran, SID, Scopus, EMBASE, and Medline via PubMed until July 2016 and Persian and English language publications studied that met inclusion criteria. The review concluded that this program can be provided wonderful resources for the social and emotional growth of the children and older adults and can be used for caring, education and follow-up in health care systems especially by nurses. Also, this review highlighted the need for research about this form of learning in Iran.

Background Health literacy is the capacity of individuals to acquire process and understand information and basic health services needed for proper health decision-making. Medical students, as health promoters and professional care providers, play a key role in promoting health. Therefore, the present study aimed to investigate the components of health literacy and their relationships with health-promoting behaviors in students at Kermanshah University of Medical Sciences in 2017. Materials and Methods In this descriptive, analytical and correlational study, the statistical population consisted of all students at four faculties of Nursing and Midwifery, Health, Paramedics and Medicine in 2017. Then, the sample size was determined using the Cochran's sample size formula (n=420), and cluster random sampling was the sampling method. For data collection, a researcher-made demographic questionnaire, the health literacy questionnaire (1) the standard questionnaire of health-promoting lifestyle profile II were utilized. Furthermore, for data analysis, the descriptive (frequency distribution, mean, and standard deviation) and inferential statistics (Pearson correlation coefficient) were employed in the SPSS Statistics Software Version 23. 0. Results The results of the present study demonstrated that the means of students’ health literacy and healthpromoting behaviors measured 4. 04± 0. 43 out of a score of 5and 2. 68± 0. 43 out of a score of 4, respectively. Also, the results indicated that the health literacy significantly and positively correlated with students’ health-promoting behaviors (p<0. 020 and r=0. 31). Conclusion Given the results of the present study, it is recommended that some planning be done towards training and developing the health-promoting behaviors in students and more attention be paid to health literacy in health promotion programs.

Background: In traditional medicine and recent years, nerve stimulation has been introduced as a replacement therapy for managing several disorders such as overactive bladder. However, there is still controversy in this regard. Therefore, the present meta-analysis aimed to assess the effectiveness of electrical nerve stimulation in treatment of overactive bladder. Materials and Methods: The present systematic review and meta-analysis attempted to gather the evidence existing in Medline, EMBASE, Scopus, Web of Sciences and CINHAL databases until the end of October 2017. Summarization of the articles was done by 2 independent researchers and finally, pooled effect size was reported as standardized mean difference (SMD) or overall odds ratio (OR) with 95% confidence interval (95%CI). In all analyses p<0. 05 was considered as level of significance. Results: Data of 13 articles were entered. Analyses showed that using electrical nerve stimulation results in a significant decrease in wet days per week (SMD=-0. 92; 95% CI:-1. 47 to-0. 37) and voiding frequency (SMD=-1. 09; 95% CI:-2. 15 to-0. 03), and increase in maximum voided volume (SMD= 0. 43; 95% CI: 0. 13 to 0. 73) and average voided volume (SMD= 0. 78; 95% CI: 0. 11 to 1. 45). Finally, the success rate in the electrical nerve stimulation group was up to 2 times higher than the placebo or routine treatment group (odds ratio=2. 11; 95% CI: 1. 10 to 4. 06; p=0. 009). Conclusion: Since the findings of the present study indicate the effectiveness of electrical nerve stimulation in improvement of overactive bladder symptoms in children, it is suggested to use it in routine practice.

Background: Maternal death is a key qualitative reliable index of a nation’ s economic development. The present research aims to investigate causes of maternal mortality in Iran. Materials and Methods: A systematic review of the following databases led us to find the target articles: Medline (via PubMed), Science Direct, CINAHL, CINAHL (EBSCO), Scopus, Web of Science, SID, ISC, Magiran, and Google Scholar. The key terms searched for were: pregnancy, childbirth, mother’ s mortality, pregnancy side effects, Iran. The search was done in two languages, English and Persian. The operators used were AND, NOT, OR which led us to find related articles. Results: A review of the 19 articles indicated that the main direct causes of mortality were respectively bleeding, eclampsia, sepsis and embolism. Among the indirect causes of mortality, background diseases ranked first and heart diseases ranked next. Overall, the foremost rate of mortality was induced by direct causes. Conclusion: According to the present findings, a number of suggestions are made to help to significantly reduce the rate of pregnant women’ s mortality in Iran: recognition of mothers at risk by the healthcare staff, preventive measures such as educating efficient and experienced forces, more equipment and facilities including blood products, monitoring care provision during pregnancy, during and after the childbirth, development of local healthcare centers and educating more midwives especially in rural areas, improvement of nursing hospitals in counties and timely referral of mothers to specialized centers.

Background Aortic Coarctation (CoA) is one of the congenital heart diseases with the rate of 5-8% of Coronary heart diseases (CHDs). Balloon angioplasty is now one of the effective way of treatment for CoA, native or Re-coarctation (Re-CoA). We aimed to assess the immediate and short term response to angioplasty and stenting, and also complications. Materials and Methods Balloon angioplasty with our without stenting was performed in 53 patients with native or Re-coarcatation angioplasty (39 balloon angioplasty alone, and 14 balloon and stenting). Pressure gradient across the CoA segment was measured initially by Echo and pre, and Post procedure. Echocardiography was also used for follow up assessment during 24 hours, one and 6 months afterward. Results: Among 53 patients, 52. 8% were male. There were 98. 2% native and 3. 8% Re-CoA. The mean age of patients was 8. 65 ± 8. 37 years, and the mean weight was 25. 82± 20. 73 kg. The mean pressure gradient across the CoA site before angioplasty was 24. 88± 12. 32, and post procedure gradient was 4. 77± 6. 42 (p<0. 001). One of the patients experienced aneurysm formation at CoA segment site post balloon angioplasty. Conclusion On the basis of these data balloon angioplasty is safe, and effective in the treatment of native or Re-CoA. These results suggest that CoA angioplasty could be an effective alternative to a surgical approach, and gives good immediate results, although follow up studies are necessary to evaluate complications, and the long term effect on blood pressure in comparison to surgical approach.

Dear Editor-in-Chief,Since the emergence of regenerative medicine choosing the best source for extracting stem cells has been one of the most important challenges. Discovering a cell type with the highest efficiency and the least side-effects is one of the priorities of scientists active in this field. Of all the cells, mesenchymal stem cells have been and still are of interest to the researchers for use in pre-clinical and clinical studies due to being easily accessible, pluripotency, secretion of numerous growth factors, low risk of immunological rejection, and not having ethical issues for clinical use. Of all mesenchymal cells, human adipose-derived stem/stromal cells (hADSCs) are more safely and easily accessible, produce more growth factors compared to other mesenchymal stem cells, have the ability to differentiate to various cell lines, secrete high levels of angiogenic factor and their feasibility, safety and efficacy have been confirmed. Therefore, in the last decade, it has received more attention from researchers, compared to other cell sources (1-3). Since distribution and function of adipose tissue is versatile and changes at any age during the lifetime (4), it is expected that at different ages, hADSCs also show different functions and abilities. Therefore, it is hypothesized that autologous implantation is not necessarily always the best choice. Autologous transplantation of hADSCs is only the best choice in ages that these cells have the optimum efficacy. If it is determined in what age these cells have the highest efficacy, choosing the type of implantation (autologous or allogeneic) will be an important factor in achieving the best response to treatment. This matter is even more important regarding pediatric diseases. The results of Guasti et al. study in 2012 showed that a smaller volume of lipoaspirate is needed for extracting hADSCs from children’ s adipose tissues compared to adults (20 to 30 times less). In addition, many growth factors required for tissue repair are secreted in children’ s hADSCs, but not in hADSCs of adults; and hADSCs of children carry more markers of differentiation to various cell lines compared to hADSCs of adults. Therefore, they concluded that hADSCs of children have higher plasticity to differentiate into multiple cell lineages compared to their adult type and are better choices for cell therapy of diseases in children (5). What is sure is that autologous use of children’ s hADSCs is the best choice for stem cell therapy. In addition, in a study Liao et al. aimed to evaluate autologous bone marrow mononuclear cells in treatment of children with traumatic brain injuries and showed that this treatment method leads to a reduction in the intensity of organ damage and neurointensive care duration significantly decreases (6). But can allogeneic use of children’ s hADSCs for adults be the best choice? This is a question that definitely cannot be answered without performing further preclinical and clinical studies in this field.