Journal of Pediatric Perspectives
Year:2017 | Volume:5 | Issue:11 (47)|Papers Count:20

Background: Identifying and investigating the factors influencing self-efficacy and eventually health related quality of life (HRQoL) can be an important step toward the prevention and treatment of the obesity. The aim of the study was to compare weight self-efficacy and HRQoL among normal-weight, overweight and obese Iranian adolescents. Materials and Methods In this case-control study, 118 obese and overweight adolescents (case group) and 118 adolescents with normal weight (control group) were recruited. Adolescent's anthropometric characteristics were measured. The Weight Efficacy Lifestyle Questionnaire (WEL), pediatric quality of life inventory (PedsQLTM 4. 0) and self-reported physical activity were completed by the adolescents. Results: Multivariate logistic regression adjusting for various confounders indicated that overweight and obese adolescents were less likely to be physically active (adjusted odds ratio, AOR= 0. 66; 95% confidence interval [CI], 0. 48 to 0. 911), had lower ability to cope with social pressure (AOR= 0. 54; 95% CI, 0. 32 to 0. 93), involved in less positive activities (AOR= 0. 53; 95% CI, 0. 37 to 0. 75), and felt more negative emotions (AOR= 0. 23; 95% CI, 0. 14 to 0. 36) than their normal-weight counterparts. Moreover, obese and overweight adolescents were more likely to report deteriorated quality of life in all PedsQL subscales than those with normal weight P<0. 05). The results of the mediation analysis indicated that negative emotions mediated the relationship between adolescents’ weight status and HRQoL (Z =-5. 79, P<0. 001). Conclusion: Weight management programs should focus on increasing adolescent’ s control on situations related to negative emotions to improve their HRQoL.

Background The present study aimed to explore effects of companionship in training sessions on primiparous women’ s knowledge, attitude and performance toward breastfeeding. Materials and Methods: In this case-control interventional study, 105 primiparous women in the 30th to 34th weeks of pregnancy were selected and assigned to three groups, namely the intervention group without a companion (n=35), the intervention group with a companion (n=35), and the comparison group (n=35). Data gathering tools was a questionnaire and breastfeeding observational checklist. The control group received routine training in the hospital, but the other groups were trained by the researcher in four 90-minute sessions. Data were collected before and after the education, immediately after childbirth, and four and eight weeks after childbirth and analyzed using SPSS(version 20. 0) software and appropriate statistical tests. Results: No significant difference was observed in terms of demographic variables such as: maternal and paternal educational level and occupation status between control and intervention groups (P>0. 05). There was a significant difference between the mean scores of knowledge and attitude toward breastfeeding in the two intervention groups before and after the educational intervention, right after child birth, 4 weeks and 8 weeks after child birth (P < 0. 001). There was also a significant difference between the three groups in the mean score of performance of breastfeeding right after, 4, and 8 weeks after childbirth (P < 0. 001). Conclusion: According to results of this study, education during pregnancy and support from the accompanying person, before and after childbirth expand knowledge of breastfeeding, reinforce attitude toward it, and boost its performance.

Background Resistant Shiga toxigenic Escherichia coli (STEC), is the most prevalent source of diarrhea in pediatrics. This study was conducted to investigate the antimicrobial resistance properties of STEC strains of diabetic and non-diabetic pediatrics with diarrhea. Materials and Methods: This was a case-control study conducted from December 2014 to September 2015 in an educational hospital, Jiroft city, Iran. Diarrheic stool samples were collected from diabetic (n= 385) and non-diabetic (n= 300) pediatrics. The samples were cultured and the STEC strains were tested by disk diffusion and polymerase chain reaction (PCR) amplification were applied for detecting antibiotic resistance genes. Results Sampling was performed from 685 patients (51. 8% male). Total prevalence of STEC strains in diabetic and non-diabetic pediatrics were 6. 5% and 3. 0%, respectively (P = 0. 007). Prevalence of the gens that encode resistance against ampicillin (CITM), fluoroquinolone (qnr), trimethoprim (dfrA1), tetracycline (tetA), gentamicin [aac(3)-IV] and sulfonamide (sul1) were 97. 1%, 64. 7%, 61. 8%, 58. 8%, 58. 3% and 52. 9%, respectively. Non-diabetic pediatrics harbored the lower prevalence of antibiotic resistance genes (P = 0. 034). Conclusion High numbers of STEC, especially O157 strains, showed a multidrug-resistance against ampicillin, ciprofloxacin, gentamycin, sulfamethoxazole, and tetracycline. CITM, qnr, dfrA1, tetA, [aac(3)-IV] and sul1 antibiotic resistance genes were identified in the STEC strains of diarrheic samples of diabetic and non-diabetic pediatric patients.

Background Bacterial colonization during and shortly after birth are common in newborn infants. The aim of this study was to determine the umbilical cord bacterial colonization in newborn infants rooming in with mothers and neonates admitted to neonatal intensive care unit (NICU). Materials and Methods In a cross-sectional study, 180 newborn infants were studied in three groups including: newborn infants born via normal delivery and stayed with their mothers (n=60), newborn infants born by cesarean section and stayed with their mothers (n=60), and newborn infants admitted in NICU (n=60). Umbilical cord care was done as natural drying without use of any disinfectant or local antibiotic for all newborn infants. Bacterial culture was performed on the second day in three groups and in days of 5-7 only among the infants admitted in NICU. Results Among the subjects, 50% (n=90) were boy and 50% (n=90) were the first-time mothers. Normal gestational age (38 to 42 weeks) was seen in 67. 2% (n=121) of subjects. Three groups had no significant differences in terms of gender (p=0. 247), and first-time mothers (p=0. 344), but had a significant difference in terms of gestational age (p=0. 001). Staphylococcus aureus was the most common bacteria responsible for the colonization in the first culture (n=31, 17. 22%), and second culture (n=17, 13. 5%). Bacterial colonization was more common in newborn infants who were born by cesarean section and stayed with their mothers compared to the other groups (p<0. 001). Conclusion According to the study, bacterial colonization was common in newborn infants who were born by cesarean section and stayed with their mothers and Staphylococcus aureus had an important role in this colonization. Future study is recommended to confirm our results.

Background: Osteoporosis is the most common metabolic bone disease. Prevention of osteoporosis during childhood and adolescence is an important issue in World Health Organization. The purpose of this study was to investigate application of health belief model in prevention of osteoporosis among primary school girl students, in Fasa city, Fars Province, Iran. Materials and Methods: In this quasi-experimental study, 140 primary school girl students who were randomly divided into groups, experimental (n=70) and control (n=70) in Fasa city, Fars Province, Iran, were selected in 2015. A questionnaire consisting of demographic information, Health Belief Model (HBM) constructs was used to measure nutrition and walking performance for prevention of osteoporosis before, immediately after intervention and four months later. Data were analyzed using SPSS version 19. 0 software. Results: The mean age of students was 11. 45± 1. 13 and 11. 25± 1. 60 years old in the Experimental and the control group, respectively. Immediately and Four months after the intervention, the mean scores of the HBM components (Perceived susceptibility, Perceived severity, Perceived benefits, Perceived barriers, Self-efficacy, Internal cues to action), and nutritional and walking performance in experimental group was better than the control group (P<0. 001). Conclusion: The findings of the present study confirmed the practicability and effectiveness of the Health Belief Model based educational program in promoting behaviors about prevention of osteoporosis. Hence, these models can act as a framework for designing and implementing educational interventions for the osteoporosis prevention.

Background: Imaging modalities such as voiding cystourethrography (VCUG), direct radionuclide cystography (DRNC), and renal cortical scintigraphy (RCS) with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA), are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR). However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC. Materials and Methods: Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI) who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed. Results: Analyses showed a sensitivity and specificity of 95. 65% and 14. 72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3. 5-fold greater risk of having VUR than those with a normal scans (odds ratio=3. 5; 95% confidence interval [CI]: 1. 4-8. 58; p=0. 007). In addition, the risk of VUR is up to 7. 0-fold greater in children with moderate renal involvement (odds ratio=7. 0; 95% CI: 2. 6-13. 2; p<0. 0001) and up to 9. 2-fold greater in children with severe renal involvement (odds ratio=9. 2; 95% CI: 3. 2-17. 3; p=0. 007) in the Tc-99mDMSA scans compared to those with a normal scans. Conclusion: According to the results, Tc-99mDMSA scan can be used as a screening test in prediction of VUR in infants and children with first-time febrile UTI.

We present a 13. 5 years old boy with chronic intussusception that was misdiagnosed as Crohn disease and received treatment for the wrong diagnosis. Because his condition didn’ t improve, more work-up were performed and the radiologic work-ups revealed the diagnosis of a missed intussusception with fistula. We suggest that prolonged intussusception should be considered in the list of differential diagnosis for the refractory abdominal pain and distention, bloody diarrhea, and radiologist consultancy should be requested, as Crohn disease, infectious gastroenteritis, abdominal malignancies and prolonged intussusception should be carefully investigated and considered in such situations.

Dear Editor-in-chief, Infant health care should be one of the first and most important tasks of every nation and one of the main programs of any government, because children, as a vulnerable group, have a special place in health services (1); and the rate of neonatal mortality is one of the important indicators of development and health in the countries (2). Approximately, out of 130 million children born each year, about 4 million had died in the first 28 days of life worldwide, around 75% of death occurs in the first seven days of life, and 25% occurs in the first 24 hours of life (3). It is necessary to identify the causes of mortality in each country or regions of a country in order to minimize the problems of these plans (4-6). Hormozgan province is located in the southern Iran (5) (Figure. 1). This descriptive cross-sectional study was conducted by census method, and in this study, all cases of neonatal deaths and births were evaluated based on the vital horoscope in health centers in Hormozgan province between 2014 and 2015. The required information was manually extracted and collected from the vital horoscope and was analyzed using percentages and rates. Based on the findings, the number of live births in 2014 and 2015 was 39, 627 and 41, 575, respectively. The number of neonatal deaths in 2014 was 12. 5%, while it was 10. 5% in 2015. According to the neonatal mortality rate, from 437 neonatal deaths in 2015, the highest neonatal mortality rate occurred in urban population (49. 7%), and main rural (39. 8%); also the most deaths occurred in the hospital (93. 8%), which was about 4% less than neonatal deaths out of the hospital.

Thyroid ectopia is a dysgenesis of thyroid gland and Lingual position represents the most frequent ectopic location accounting up to 90% of ectopic cases. Hypothyroidism is commonly present because of absence of a normal thyroid gland in most instances. Primary hypothyroidism in juvenile population generally leads to retardation of linear growth and delay or even arrested puberty. We present a 20 years old female with typical and profound presentation of hypothyroidism due to lingual thyroid.

Background: Obesity is regarded as the epidemic of diseases correlated with an unhealthy lifestyle. The avoidance of inactivity could prevent obesity and its relevant issues. The present study aimed to explore the effectiveness of the theory of planned behavior (TPB) to improve obesity-preventive lifestyle among Iranian students. Materials and Methods: The current study was a quasi-experimental study. Using multistage sampling, 100 Junior High-school students in Khoy, Iran in 2016 were selected and assigned to two groups, namely intervention (n=50) and control (n=50). To collect the study data, researchers utilized a researcher-made questionnaire including items about demographic information and TPB constructs such as attitudes, subjective norms, perceived behavioral control (PBC), behavioral intention, and behaviors related to physical activities, television watching, and computer-game playing. The data were analyzed using SPSS software version 20. 0. Results: The mean age of the intervention group was 13. 88 ± 0. 79 and that of the control group was 14. 12 ± 0. 77 years. Prior to the intervention, there was no significant difference between the two groups in the mean of the scores of both the TPB constructs and their health performances. However, three months after the intervention, the mean score of attitudes, subjective norms, perceived behavioral control and behavior of students changed, and all these changes were statistically significant between two groups (p<0. 05). Conclusion: The results of the study showed that the TPB could be an appropriate theoretical basis for designing and evaluating interventions to encourage people to avoid a sedentary lifestyle and inactivity.

Background INtubate-SURfactant-Extubate (INSURE) method is one of the effective methods in treatment of infants with respiratory distress syndrome (RDS). This study was performed to predict risk factors for the failure of INSURE method in treatment of RDS in preterm infants. Materials and Methods: In this cross-sectional study, 192 infants who born between July 2011 and April 2016 at women and children's hospital of Amiralmoemenin in Semnan, Iran, were included to the study. Inclusion criteria were infants with moderate to severe RDS, 26 to 38 gestational weeks and weighted 500 to 3, 500 grams. All patients were treated with INSURE method, then were divided to success and failure INSURE. Severity of RDS was determined by RDS scoring system. The collected data including gender status, gestational age (GA), birth weight (BW), maternal diabetes mellitus, delivery type and neonatal morbidity (including intraventricular haemorrhage (IVH), Necrotizing enterocolitis (NEC) stage 1, sepsis, chronic lung disease (CLD), pneumothorax, and pulmonary bleeding. Statistical analysis was done using SPSS software, version 22. 0. Results: Of the 192 patients, 82 (42. 7%) infants were females. The mean GA and BW were 30. 25 ± 1. 85 weeks and 1950 ± 270 grams, respectively. Of all the patients, 156 infants (81. 25%) were born via cesarean section. INSURE failure was observed in 79 infants (41. 1 %) and INSURE success was observed in 113 (58. 9%). Among the factors, INSURE method failure had a significant relationship with GA, BW, RDS severity and increased probability of IVH, CLD, pneumothorax and pulmonary bleeding (p<0. 05). Based on logistic regression analysis, there was a significant relationship between the failure of INSURE method and RDS severity (odds ratio [OR]= 6. 31, 95% 95%CI [CI]= 2. 07-19. 19, P=0. 001), and GA OR=0. 78, 95% CI= 0. 67-0. 91, P=0. 001). Conclusion: According to the finding, among the risk factors, only higher severity of RDS and GA were able to predict INSURE method failure in treatment of RDS in preterm infants. Additional studies are recommended in this regard.

Background N-terminal pro– B-type natriuretic peptide (NT-proBNP) is a marker to evaluate the cardiac involvement in thalassemia. We aimed to evaluate conventional and tissue Doppler echocardiography findings and its relation to plasma NT-pro BNP, Ferritin and Iron levels in beta-thalassemia patients. Materials and Methods This study performed on 164 participants equal of major beta-thalassemia patients (n=82), and controls (82 healthy children with normal cardiovascular status). The patients collected from outpatients after applied exclusion criteria. Blood samples were taken from participants in fasting to measure NT-pro BNP, Ferritin and Iron serum. Participants were under echocardiography by Pediatric cardiologist. The level of error considered as 0. 05 for data analysis by SPSS version 20. 0. Results NT-pro BNP, Iron, Ferritin, left S', left A', right A', EF, FS, left and right A/A'; right and left MPI were significantly different in patients group (P<0. 05). FS and EF were higher in younger’ s and left and right MPI were lower. In higher level of NT-pro BNP right S' had converse trends compared with the Iron, its level was higher in patients > 10 years, and FS had different values significantly in lower levels. In lower level of left E/E' resulted that FS was significantly higher in the age group < 10 years. Right peak E velocity was significantly higher in younger’ s in higher level of left E/E'. Right E/E' was significantly higher in elders in lower level of left E/E' (P<0. 05). Conclusion The study confirmed that NT-pro BNP increases in thalassemia and association with age and LV diastolic dysfunction. NT-pro BNP with E/E' and S' were shown diastolic and systolic dysfunction in thalassemia. Therefore, an increased level of ferritin and NT-pro BNP can be used as a marker for the intensification of iron chelation therapy, which reverses iron-induced cardiomyopathy.

Background Down syndrome is the most common chromosomal anomaly. Dysmorphic features can occur in several organs in this syndrome. Cardiac anomalies with a prevalence of 50% are the most common anomalies responsible for death during the first two years of life. We aimed to determine the prevalence of cardiac anomalies among Down syndrome patients admitted to two tertiary hospitals in Kermanshah, Iran from 2002 to 2016. Materials and Methods In this descriptive study, the medical records of all patients with Down syndrome admitted to two university hospitals namely Imam Ali and Imam Reza, Kermanshah city located in Western part of Iran in the study period were reviewed. All patients had received Echocardiography two-dimensional (2D). The required data including cardiac anomaly type, consanguinity of parents, maternal age, surgical interventions, and survival were collected into a checklist. Results: During the study period, 166 patients with Down syndrome had received diagnostic and therapeutic services in the studied hospitals. There were 70 males (42. 2%) and 96 females (57. 8%). Familial consanguinity was documented in 95 patients (57. 2%). Mean ± standard deviation (SD) maternal age at delivery was 26. 33 (± 4. 7) years (range, 15 to 45 years). Of 166 studied patients, 123 (74. 1%) had cardiac anomaly. Ventricular septal defect (VSD) was the most prevalent single defect seen in 32 (26%) patients, followed by atrial septal defect (ASD) detected in in 22 (17. 8%) patients. Seventy patients (42. 1%) required surgical interventions. A total of 74 patients experienced relative improvement of the symptoms. Also, seven patients (10. 2%) died including five females and two males. Conclusion: The frequency of cardiac anomalies in the studied population of Down syndrome patients was higher than former reported figures. The pattern of the anomalies is compatible with some former reports, but contradicts other reports.

Background Currently, almost all patients with probable abdominal injury undergo urinalysis in emergency department (ED). The present survey was conducted with the aim of assessing the diagnostic values of urinalysis compare with abdominal computed tomography (CT) scan with contrast for predicting possible intra-abdominal injuries in children affected by blunt trauma. Materials and Methods: The present diagnostic accuracy study was accomplished on patients' < 16-year-old with blunt abdominal trauma who were admitted to emergency department (ED) and underwent both urinalysis and abdominal CT scan. Demographic and baseline characteristics data, and the results of urinalysis and abdominal CT scan were recorded. Thereafter, screening performance characteristics were calculated. Results Seventy eligible patients with the mean age of 7. 1 ± 4. 86 years were enrolled (68. 6% male). Screening performance characteristics including sensitivity, specificity and positive and negative predictive values of hematuria were 26. 7%, 92. 7%, 50. 0% and 82. 3%, respectively. Positive and negative likelihood ratios were calculated as 3. 67 and 0. 79, respectively. Conclusion It is likely that, presence of hematuria has acceptable specificity, but very low sensitivity in comparison with CT scan for prediction of abdominal organ injuries in children with blunt abdominal trauma. Therefore, urinalysis is not useful for screening the presence of organ injuries in this population.

Cefotaxime is a bactericidal "third generation" cephalosporin has a broad-spectrum activity against gram-positive microorganisms and exceptional activity against most gram-negative microorganisms. Cefotaxime is widely considered to be the antibiotic of choice for the management of neonatal meningitis and sepsis caused by gram-negative bacteria. Cefotaxime is active against Neisseria meningitis, Streptococcus pneumoniae, Haemophilus influenzae, Salmonella specimens, Staphylococcus, Enterobacter species, Haemophilus parainfluenzae, Pseudomonas aeruginosa, Escherichia coli, Citrobacter freundii, and Klebsiella pneumoniae. In neonates, the recommended dose of cefotaxime is 25 mg/kg every 6 hours by intravenous or intramuscular administration. Some authors administered cefotaxime at a daily dose of 150 or 300 mg/kg. After the intravenous administration of 50 mg/kg cefotaxime every 6 hours, the serum concentrations of this antibiotic are 56. 9+28. 7 μ g/ml at 1 hour and 3. 66+5. 65 μ g/ml at 6 hours after the administration. The cerebrospinal fluid concentration of cefotaxime, measured 1 hour after the intravenous administration of 50 mg/kg cefotaxime, is 3. 72+5. 57 μ g/ml. The MIC50 (μ g/ml), and the MBC50 (μ g/ml) are 0. 024+0. 026 and 0. 064+0. 054, respectively, for Haemophilus influenzae, 0. 062+0. 034, and 0. 240+0. 027, respectively, for Streptococcus pneumoniae and 0. 057+0. 088, and 0. 283+0. 44, respectively, for Neisseria meningitis. In neonates, the half-life of cefotaxime is 2 to 6 hours, it varies with gestational and postnatal ages, and the clearance and distribution volume are 0. 074+0. 03 l/h/kg, and 0. 461+0. 027 l/kg, respectively. Cefotaxime diffuses in tissues and penetrates into the cerebrospinal fluid. This antibiotic is safe and well tolerated in neonates. The aim of this study was to review the effects and pharmacokinetics of cefotaxime in neonates and infants.

Background Mobile phones and stethoscopes used in neonatology units could be colonized by potential bacteria pathogens. It can be a vector of severe nosocomial infections and multi-drug-resistant pathogens. The aim of this study was to evaluate the microbial contamination of mobile phones and stethoscopes, used by medical and paramedical staff. Materials and Methods The study was conducted in neonatal intensive care unit (NICU) of Mohamed VI University Hospital, Marrakech (Morocco) in April 2016. The bacteriological study was made on 17 mobile phones and 13 stethoscopes. Samples were taken from all surfaces of mobile phones and stethoscopes, with a sterile swab. These swabs were inoculated onto sheep blood agar plates and incubated for 3 days at 37° C. Results: Bacterial contamination rate of all mobile phones and stethoscopes was 100%. The cultures of bacteria isolated were polymorphic. Of the 17 mobile phones, 6 were contaminated with multidrug-resistant pathogens, with a contamination percentage of 35%. The isolated germs correspond to 4 (66. 6%) Klebsiella pneumoniae and 2(33. 3%) Escherichia coli both were expanded-spectrum betalactamase (ESBL). A strain of Klebsiella pneumoniae ESBL (7. 7%) was found on a stethoscope. Conclusion This study showed that mobile phones and stethoscopes could be involved in the transmission of severe nosocomial infections, with multidrug-resistance.

Dear Editor-in-chief, This letter is regarding the article by Daoudi et al. entitled "Study of bacterial contamination of mobile phones and stethoscopes in Neonatal Intensive Care Unit" published in International Journal of Pediatrics DOI: 10. 22038/IJP. 2017. 25504. 2170 (1). The authors have evaluated the microbial contamination of mobile phones and stethoscopes used by medical and paramedical staff. They reported that 100% of mobile phones and stethoscopes studied by their team showed bacterial contamination. Based on their findings, Daoudi et al. suggested that medical staff should wash their hands with care and use hydro-alcoholic solutions after using mobile phones and stethoscopes. Although the paper authored by Daoudi et al. addresses a challenging issue, it has at least one major shortcoming. The main shortcoming of this paper comes from this key point that the authors were unaware of the effects of electromagnetic fields generated by mobile phones on bacterial resistance against antibiotics which can strongly worsen the bacterial contamination of mobile phones and make it a life-threatening problem. Over the past decade, we have studied the health effects of exposure to different sources of electromagnetic fields such as mobile phones (2-6). While in some cases exposure to mechanical waves such as diagnostic ultrasound could make the antibiotic-resistant bacteria susceptible (7), we showed that bacteria can become more resistant to antibiotics after a pre-exposure to ionizing electromagnetic (8), or non-ionizing electromagnetic radiation (9). In this light, not only bacterial contamination of mobile phones of physicians and medical/paramedical personnel is of great importance, the increased resistance against antibiotics induced by exposure to mobile phone radiation strongly increases the risk of nosocomial infection.

Neuromyelitis optica (also known as Devic's disease or Devic's syndrome) is an uncommon disorder in pediatric age group, and is characterized by acute or subacute optic neuritis and transverse myelitis. Here we report an 11-year-old female child with relapsing Neuromyelitis optica (NMO) confirmed by positive NMO-IgG antibody and had clinical recovery with high dose methyl prednisolone therapy.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with multiple organ involvement and periods of relapse and remission that mainly affects young women of childbearing age. In this regard the reproductive health is an important issue. Although diagnosis, treatment and management of pregnancy in SLE women have been improved recently, but the main concern is effects of SLE on maternal, fetal and neonatal outcomes. This study aimed to investigate the maternal, fetal and neonatal outcomes in pregnant women with SLE. Materials and Methods: The databases of PubMed, Medline, Scopus and Web of Science as well as domestic database (Persian) such as SID, Magiran, Irandoc, and Google Scholar were searched with using keywords such as" Systemic lupus erythematosus"; "Pregnancy"; "Neonatal lupus"; "maternal, fetus or neonatal outcome"; and equivalent Persian words. Included were all Persian and English articles, published between 2000 and May 2017. Finally, a total of 77 studies were included. Results: Adverse perinatal outcomes increase in pregnancies with lupus. Outcomes include respiratory, cardiovascular, blood and skin disorders in mothers; stillbirth, spontaneous, and recurrent abortion in fetuses and neonatal lupus, prematurity, intrauterine growth restriction (IUGR), and small for gestational age (SGA) in neonates, respectively. Conclusion: Pregnant women with SLE are at high risk due to increased complications for both mother and fetus. It seems broad control of the women before fertilization, so that they be at full remission in the beginning of pregnancy and the disease activity be in complete control, it can help to improve outcomes of pregnancy and so better results can be expected.

Dear Editor-in-chief, The Republic of the Union of Myanmar – formerly known as Burma – is a small nation located in South East of Asia, on the border of Thailand, Laos, China and Bangladesh (Figure. 1). According to a 2014 census, the country has a population of over 51 million people. The country is officially a Buddhist state, but with 135 recognized ethnic minorities, it boasts a big religious diversity as well. Based on the 2014 census, over two million of Myanmar’ s residents identified as Muslims. Myanmar has a total area of 262, 000 square miles (678, 500 km2), and consists of 14 stets and regions (1-3). Many of Burma’ s indigenous Muslims live in Rakhine State, on the Western coast next to the border with Bangladesh. Rohingya are however considered to be stateless, because the Myanmar Government officially considers the ethnic minority to be illegal Bangladeshi immigrants. The persecution has forced nearly one million Rohingya to flee into Bangladesh since 1977, with many more seeking refuge in other countries. Other Muslim countries have opened their doors to the refugees, with some choosing to flee to India, Pakistan, Malaysia and Indonesia. The Rohingya face discrimination and barriers to health care (4, 5). According to a 2016 study published in the medical journal "The Lancet", Rohingya children in Myanmar face low birth weight, malnutrition, diarrhea, and barriers to reproduction on reaching adulthood (4). Rohingya have a child mortality rate of up to 224 deaths per 1000 live births, more than 4 times the rate for the rest of Myanmar (52 per 1000 live births), and 3 times rate of rest non-Rohingya areas of Rakhine state (77 per 1000 live births) (4, 5). The paper also found that 40% of Rohingya children suffer from diarrhea in internally displaced persons camp within Myanmar at a rate five times that of diarrheal illness among children in the rest of Rakhine (4).