Journal of Pediatric Perspectives
Year:2017 | Volume:5 | Issue:9 (45)|Papers Count:20

Background: Macrosomia is a risk factor for adverse maternal and neonatal outcomes and previous studies have reported different prevalence of macrosomia in Iran. We conducted a meta-analysis to estimate the overall prevalence of macrosomia in Iran. Materials and Methods: A systematic review and meta-analysis was conducted of all published literature pertaining to prevalence rates of macrosomia using international and national electronic databases ISI Web of Knowledge, PubMed, Scopus, SID, Magiran and Google Scholar from their inception until June 2017 with standard keywords. Egger test and Funnel plot were used to evaluate the publication bias and Cochran test and I2 statistics were used to examine the statistical heterogeneity. Pooled estimate of the prevalence of macrosomia were calculated using random effects meta-analysis. Results: A total of 40 studies were included in this meta-analysis. The publication bias assumption was rejected Egger test (P=0. 719) and Funnel plot. The results of Cochran test and I2 statistics revealed substantial heterogeneity (Q=1040. 5. 00, df = 39, P<0. 001 and I2=96. 3%). The overall prevalence of macrosomia using the random effect model in Iran was 5. 2% (95% confidence interval [CI]: 4. 4-5. 9). Moreover, the macrosomia prevalence in Tehran and other cities were 3. 9% (95% CI: 3. 2-4. 7) and 6. 0% (95% CI: 5. 0-7. 1), respectively. Conclusion: The macrosomia rate in Iran is high. There is a critical need to improve the education and the gestational care and identifying at risk neonates to reduce the macrosomia rate and its adverse outcomes.

Background Becoming a mother is one of the most important life changing events that a woman experience. The birth of very-low-birth-weight preterm infants imposes many challenges for the mothers. There is insufficient information regarding the mothers' experiences on the process of becoming a mother when their preterm infants are in neonatal intensive care units (NICU). The aim of this study was to investigate the barriers of parenting in mothers with a very low-birth-weight preterm infant, and their coping strategies. Materials and Methods This study was carried out in a major neonatal care center in Urmia located in North West of Iran based on qualitative approach and by focusing on content analysis. Eighteen mothers were observed and interviewed while their infants were in NICU. The interviews were recorded and printed out. The data were analyzed according to Graneheim and Lund man. MAXQDA2007 was applied to manage the data. Results The participants’ experience indicated that they experienced barriers in becoming a mother, so they use some strategies to cope with this situation. Merging the "barriers of parenting" and "applied strategies" resulted in extracting a category which was called "establishment of communication". Each category included subcategories. Conclusion It seems that there is an urgent need for healthcare professionals to be sensitive to the need of mothers regarding mothering process with consideration to culture as a bridge to facilitate the new role as a mother.

Background: Gastroesophageal reflux disease (GERD) is associated with a number of comorbidities in pediatrics. However, its association with attention deficit hyperactivity disorder (ADHD) has not been reported. The aim of the present study was to investigate the prevalence of ADHD in pediatric patients newly diagnosed with GERD. Materials and Methods: Sixty newly-diagnosed treatment naive GERD patients and sixty healthy controls aging between 5 to 12 years referring to the Children and Adolescent’ s medical center, Tehran, Iran were recruited in a case-control study during the year 2015. Then patients were evaluated for ADHD by a psychiatrist according to the DSM-IV criteria. The revised Conners' Parent Rating Scale (CPRS-R) was used for assessment of the symptoms of ADHD. To screen for psychiatry disorders other than ADHD, the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL) questionnaire was used. Logistic regression analysis was used for modeling the association between GERD and ADHD in the study sample. Results: The mean age of GERD patients was 5. 77± 2. 27 and for non-GERD controls was 6. 03± 2. 52 (P= 0. 543). Thirty-three out of 60 (55%) GERD patients and 37 out of 60(61. 66%) non-GERD controls were male (P: 0. 579). Prevalence of ADHD was 33. 60 (55%) in GERD patients and 10. 60 (16. 66%) in non-GERD (P<0. 001). Data analysis revealed that being diagnosed with GERD was associated with higher odds of ADHD diagnosis (P<0. 001; odds ratio [OR]: 6. 88, 95% confidence interval [CI]: 2. 8-16. 9). Conclusion: According to the results, diagnosis of GERD was associated with higher odds of being diagnosed with ADHD.

Background The early diagnosis of developmental disorders and timely interventions profoundly affect the health of children and their families; however, the detection rate of these disorders is much lower than the actual one. The present study aimed to explore effects of educating mothers about the national child development screening plan on detecting abnormal child development. Materials and Methods: This experimental study was a pretest-posttest intervention. Sample size was 100 mothers with a one-year-old child having attended healthcare centers in Najafabad (one of Isfahan’ s township, Iran). The Ages and Stages Questionnaire (ASQ) was used for gathering data. Three educational sessions (each one 45 minutes) were held for mothers of the experimental group. The questionnaires were completed both before and one month after the intervention. Data was analyzed using the SPSS program, version 20. 0 software. Results: There wasn’ t any significant difference in terms of child’ s gender, mother’ s occupation and educational status (P>0. 05). The mean score of child development from the mothers’ perspective in all domains in the experimental group after the intervention was significantly lower than that before the intervention (P < 0. 05). Thus, in the experimental group, after the intervention, the mothers could recognize their children’ s problem better. Conclusion In order that mothers could fill out the ASQ correctly and children with abnormal development could be detected, it is better to provide training in the importance of developmental screening and the early diagnosis of developmental disorders. Moreover, mothers with a one-year-old child should be educated about how to complete the questionnaire.

Background: Puberty is a period of psychological, physical, mental, emotional and social growth that stability and development of personality occurs in this period. This study aimed to determine the effect of planned behavior theory on improving pubertal health behavior in female first grade high school students. Materials and Methods: A quasi-experimental intervention was conducted in female high school in Khamir city, Iran in 2015. One of the schools were randomly assigned to the control group and other to the experimental group. Using the formula sample, 60 students were selected from each school. Samples were evaluated in two stages through pre-test and two months later via post-test by administered questionnaire including questions about demographic characteristics and structures of planned behavior theory. The content of training was presented through lecture group discussion with teaching aids such as booklet and pamphlet. The collected data were analyzed using SPSS version 22. Results: The intervention group mean age at first menstrual period was 12. 30 ± 0. 84 years old and for control group was 12. 25 ± 0. 79 years old. The results showed that two months after the intervention, health behaviors, subjective norms, behavioral intention, perceived behavioral control, and attitude, were significantly higher than pre-intervention (P<0. 05). Linear regression analysis showed that the behavioral intention has the greatest impact on pubertal health behaviors (P<0. 05, β = 0. 447). The distribution of information sources analysis revealed, the greatest source of information were: mother and family members, school health teachers, books, school friends, teachers, TV, pamphlets, websites, health workers, newspapers and magazines, school counselors and radio were next in ranking. Conclusion: According to the results, the theory of planned behavior-based training can improve pubertal health behaviors in students. Therefore, it is suggested the training programs should focus on these structures to improve pubertal health behaviors.

Background Child labor is one of the challenges among most big cities in the world. In recent years, substance abuse among working, and street children has become a common phenomenon. Thus, in the present study, the protective factors affecting the prevention of substance abuse among Iranian working children were identified by using the social-ecological approach. Materials and Methods The participants included seventeen 8-15-year-old children who were the members of Imam Ali and Ilia non-governmental organizations (NGOs). Semi-structured in-depth interviews were used for data collection. Purposive sampling began in December 2015 and continued till data saturation in June 2016. Data were analyzed based on qualitative content-oriented analysis. Results Different protective factors were identified and classified at five levels of the social-ecological model. Four themes (belief, knowledge, attitude, skill) at the personal level, two themes (family and relatives) at the interpersonal level, two themes (governmental organizations and non-governmental organizations) at the organizational level, the class of living environment at the community level, and two themes (supportive policies and restrictive policies) at the public policies level were considered. Conclusion The protective factors affecting the prevention of substance abuse are related to personal, household, social, organizational, and public policy factors. Thus, personal and social empowerment, social participation and capacity building seem necessary to strengthen the protective factors which play a significant role in the prevention of substance abuse among Iranian working children.

Background: Pregnancy induced hypertension is one of the most common causes of maternal and neonatal mortality and morbidity. New born delivered to mothers with hypertension are more liable for intrauterine growth retardation and may be delivered prematurely. We aimed to determine the effect of pregnancy-induced hypertension on complete blood count, gestational age and birth weight of newborn. Materials and Methods: This study includes 200 neonates, 100 neonates born to mothers diagnosed as having pregnancy induced hypertension this is considered as the study group and 100 neonates born in the same period to healthy mothers considered as the control group, the study conducted in the neonatal unit of the department of pediatrics and gynecological ward in AL-Imamein Al-Kadhimein Medical city, Iraq, from 1st August 2015 to 30th May 2016. Details of the baby including gender, Apgar score, birth weight and gestational age were recorded and hematological parameters (complete blood count) of both babies and mothers have been studied. Results: The study showed the significant difference between the two groups regarding mode of delivery, 94% of mothers in study group delivered by cesarean section while 60% of control group, delivered by cesarean section. There was the significant effect of gestational hypertension on gestational age, birth weight, need for resuscitation, Apgar score, mean WBC count and mean platelet count since (P< 0. 05). There were no significant differences between two groups regarding another element of complete blood count. Conclusion: At current study, gestational hypertension affects adversely growth parameter, wellbeing and both WBC and platelet count of a newborn.

Background Spina bifida (SB) is the most common abnormalities in neural tube defects in Iran. The aim of this study was to assess health-related quality of life in mothers of children with spina bifida and to compare their quality of life with mothers of children with cerebral palsy (CP). Materials and Methods Two-hundred and three mothers were recruited using the convenience sampling strategy in a crosssectional study. Quality of life (QOL) in mothers was assessed using a validated Persian version of 36-item Short Form Health Survey questionnaire according to the different levels of Hoffer criteria and types of Spina Bifida of their children. Also, the quality of life of mothers in this study was compared with data on Iranian healthy women and Iranian mothers of children with cerebral palsy. Results This study showed that the Sf-36 scores were significantly different between mothers having Spina Bifida children of different levels of Hoffer criteria and Spina Bifida types in terms of mean of physical component summary and mental component summary scores of SF-36 (P<0. 001). In mothers of children with Spina Bifida, the mean SF-36 scores were 27. 70 + 35. 25 that reduced scores than those in the general population (66. 5+ 39. 1). There was no difference between QOL of mothers of children with SB and children with CP (P>0. 05). Conclusion This study indicated that mothers of children with Spina Bifida suffer from poor quality of life similar to mothers of children with cerebral palsy, and should create supportive strategies for the physical and psychological aspects of their quality of life.

Background Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune neurological disorder that usually occurs as a paraneoplastic syndrome and is particularly associated with ovarian teratoma. Standard therapy for severe cases is not established and the prognosis in patients who do not respond to first-line treatment is poor. Case Report An 11-year-old boy complained psychiatric symptoms and rapidly lost consciousness. CT scan revealed mediastinal teratoma and serum/spinal fluid was positive for anti-NMDAR antibody. He kept comatose and his brain stem function was profoundly disturbed. His symptoms were refractory to first-line therapy, which involved tumor resection, methylprednisolone (mPSL) pulse, Intravenous immunoglobulin (IVIG), and plasma exchange. We administered a combination therapy of rituximab and cyclophosphamide as second-line therapy and achieved complete recovery without adverse effects related to treatment. Conclusion We consider early intensive treatment with a combination of rituximab and cyclophosphamide to be a safe and effective option for severe cases of anti-NMDAR encephalitis.

Background: Dilated cardiomyopathy (DCM) is revealed with the left ventricular dilatation and systolic dysfunction. This study was performed to determine the level of Calcitonin Gene Related Peptide (CGRP) and Brain Natriuretic Peptide (BNP) in children with dilated cardiomyopathy and controls and comparison of these two biomarkers in patients. Materials and Methods: This case-control study was performed from April 2014 to March 2015 on patients with DCM. The levels of BNP and CGRP were measured by ELISA and final amounts of biomarkers were compared with echocardiographic finding. 37 DCM patients compared with 30 healthy children selected randomly from those who referred to the hospital for routine checkup. Results: In this study the mean age was 10. 567± 5. 50 and 12. 135 ± 4. 626 years for controls and cases, respectively (P=0. 321). The majority of echocardiography indices in the left and right heart had different means in case and controls (P<0. 05). Means of BNP were 213. 814 ± 309. 601 and 2. 76 ± 1. 013 for case and control groups, respectively (P< 0. 001). Means of CGRP were 2. 278± 1. 586 and 1. 488± 0. 501 for case and control groups, respectively (P = 0. 001). In the dilated cardiomyopathy children however, no significant relationship was observed between CGRP level and Ross classification, but observed a significant association between Ross classification and BNP (Chi square = 15. 85 and P=0. 001). Conclusion: The present research was performed on DCM patients and showed that most echocardiographic parameters, mean of CGRP and mean of BNP increased in patients compared to healthy children. The severity of illness based on the Ross classification showed significant and positive correlation with BNP level but not with CGRP. Probably could be concluded that, BNP would be a better biomarker in DCM patients.

Idiopathic colon perforation is rare in children. It is more common at the extremes of age. Splenic flextures, ileocecal and lower sigmoid regions are the most common sites of perforation. Delay in proper management of this condition is associated with high mortality and morbidity rate. We report on the case of a 2. 5 years old girl who presented with fever, diarrhea, nausea and vomiting and progressive abdominal distention. Finally, she underwent an exploratory laparotomy for suspected peritonitis because of the patient's worsening condition. An area of perforation was found in the sigmoid colon that segmental resection and an end double barrel colostomy was done.

Background Urinary tract infection (UTI) is one of the most common bacterial infections in children, if not diagnosed leads to serious complications such as hypertension, chronic renal failure and renal scar. Constipation is one of the main risk factors for recurrent UTI. The aim of present study was to investigate the relationship between chronic constipation and urinary tract infection in children. Materials and Methods In this case-control study 105 patients with functional chronic constipation as case group, compared with 104 children without chronic constipation as control. The control group was matched according to gender and age. The prevalence of UTI in children with and without constipation as well as their improvement was compared after treatment. Results The prevalence of UTI in case and control groups was 13. 3% and 6. 7%, respectively (P=0. 17). The prevalence of UTI in case group decreased to 3. 8% after treatment of constipation. Escherichia coli (E coli) was the most commonly isolated organism in both groups. Conclusion Results of present study showed that despite of no significant urinary tract infection incidence between children with constipation and those without constipation, the constipation should still be considered as a predisposing risk factor for the UTI occurrence.

Dear Editor-in-chief, One of the most important threats to global public health, especially in developing countries is parasitic infections. These infections are very common in children and young people especially those who kept in kindergarten and primary schools. Because of the high population density and sometimes by the lack of adequate hygiene, these places are prone to parasitic infections. Infestation causes by ectoparasites like pediculosis, water-borne protozoan infections like giardiasis and the last but not less important, helminth infection like as Oxyuris are a permanent threat for children in this places. Prevalence of children parasitic infections in developing countries are meaningfully higher than other countries; so that from Yemen, Cuba and Egypt; 64. 5%, 71. 1% and 38% of these infections have been reported, respectively (1-3). More or less, Iran has a similar situation like these countries. Iranikhah et al. (2017) studied a total of 2, 140 students from several primary schools in Qom that 12. 86% of them were infected by intestinal parasites (IP) (4). In another survey was done by Haji Aliani et al. (2014), 904 children from 34 day-care Center in Karaj were studied that 172 (19%) of them were harboring at least one parasite (5). Alavi Naeeni et al. (1999) too surveyed the prevalence of (IP) in under 5 years’ old children in Saveh, Iran. In this study in rural and urban areas from a total of 1, 043 and 436 children, surprisingly 637 (61. 2%) and 228 (52. 3%) of them were infected, respectively (6). The prevalence of any parasitic infection in other parts of country unfortunately was significantly high. For example; from Sirjan, Shahrood, Kashan and Semnan, prevalence rate were 58. 3%, 43. 10%, 34% and 10. 20%, respectively (4). Placing children in a poor hygiene day-care center or school remarkably increase possibility of parasitic infections. Children spent a large part of day in close contact with each other. Since these infections sometimes have not special symptoms, then they more easily spread by asymptomatic infected children. Using the common toys and had frequent contact between objects and mouth by children cause increasing the possibility of infections transmission. For example one of the most common children parasitic diseases in kindergartens and primary schools that are extremely related to personal hygiene is Oxyuris. Infected child with scratching the contamination site and touching various toys, vehicles and their friends easily spread the parasite’ s eggs between their homes and kindergartens.

Background Vitamin D (Vit D) deficiency is one of the major nutritional deficiencies in children. Obesity has inverse association with vitamin D levels. The aim of this study was to determine the differences in response to conventional treatment for Vit D deficiency and insufficiency in obese and normal weight children and adolescents. Materials and Methods: This nested case control study was conducted in 69 obese children and 133 normal weight matched control suffering from Vit D insufficiency or deficiency. Vit D deficiency was defined as serum 25(OH) D3 <10 ng/mL and Vit D insufficiency was defined as 11< 25(OH) D3 <30 ng/mL. Conventional treatment with 300, 000-600, 000 IU of vitamin D3 was administered intramuscularly over one day for both groups. The participants were followed up after three month. 25 (OH) D3 was measured at baseline and after the follow up period. Data were analyzed using SPSS version 22. 0. Results: At baseline, mean Vit D level was 13. 5 ng/mL in obese and 14. 5 ng/mL in normal weight children (P>0. 05). After follow up, mean Vit D level became 29. 6 ng/mL in obese and 33 ng/mL in normal weight children (P<0. 05). 39. 8% of normal weight group still had Vit D insufficiency, while 50. 7% of obese group had Vit D insufficiency or deficiency and the difference was borderline significant (P= 0. 064). Conclusion Therapeutic response in obese children was less than normal weight children. It seems that treatment with higher doses of Vit D or longer period is necessary in obese children of the present study.

Background The impact of concomitant vitamin D deficiency and maternal hypocalcemia on fetal growth has is not clear. The aim of this study was to determine the effect of treatment with vitamin D on maternal and neonatal indices in pregnant women with hypocalcemia. Materials and Methods This clinical trial was conducted on 110 pregnant women (22-26 weeks of gestational age) with simultaneous mild hypocalcemia (8 < serum calcium< 8. 5 mg/dL) and vitamin D deficiency (25 (OH) D< 75 nmol/L). The study subjects were randomly allocated to intervention (n=55) and control (n=55) groups. In the control group, the subjects were given daily prenatal capsule until delivery. In the intervention group, the subjects were given 50, 000 Units vitamin D weekly for eight weeks in addition to prenatal capsules until delivery similar to the control group. At delivery, maternal calcium and 25 (OH) D level and neonatal indices (weight, height, and head circumference) were measured and compared between the groups. Results At delivery, mean maternal vitamin D level was 97. 5± 23. 4 nmol/L in the intervention group and 48. 9± 17. 2 nmol/L in the control group, respectively (P<0. 001). Mean maternal calcium level in the intervention group was higher than the control group (9. 0± 0. 6 mg/dl vs. 8. 8± 0. 5 mg/dl) but the difference was not statistically significant (P>0. 05). Mean neonatal weight, height, and head circumference were not significantly different between the two groups (P>0. 05). Conclusion In pregnant women with mild hypocalcemia, treatment with vitamin D would not have effect on mean serum calcium and neonatal indices.

Background: The present study is aimed to develop a nutritional model for the prevention and treatment of malnutrition in children and its effectiveness in patients admitted to Mofid children's hospital. Materials and Methods: This study was conducted as an interventional controlled clinical effectiveness trial with control group. The study population included children aged more than 1 year and under 10 years old who were admitted to the Mofid Children's Hospital in 2013-2014. The children were divided into 3 control group (n=100), nutrition counseling group (n=100), and Formula 100 (F-100) solution-fed group (n=100). At the start of the hospitalization, growth monitoring was performed on all children, and nutritional counseling was given to the both groups (nutrition counseling group and F100 group), based on malnutrition and calorie intake rate. Also in F-100 group, solution recipe was given to parents and nutrition nutritional orders were done during the hospitalization. After discharge, patients referred to the clinic at week 4 and week 8, and the growth monitor was performed by height, weight, and circumference. Results: In our study, boys and girls accounted for 50% and 50% of 300 children with malnutrition who were hospitalized for various reasons. All three groups were homogenous in terms of growth index. After the use of the F-100 solution, the growth index was improved and malnutrition severity, moderate malnutrition and mild malnutrition were improved by about 78%, 64% and 32%, respectively. In the nutrition counseling group, which had food orders and calorie intake, malnutrition severity was improved about 11%, 39% still had severe malnutrition and 60% had moderate malnutrition. There was a statistically significant relationship between the consumption of F100 solution and improvement of growth indices and serum albumin levels (P<0. 05). Conclusion: Children who are admitted to hospital for various reasons should be evaluated in terms of growth index so that their malnutrition is not exacerbated in the hospital. According to the present study, the use of the F-100 solution that can easily be provided by families is an acceptable and accessible supplement for malnourished and underage children.

Ceftriaxone is a versatile and useful "third-generation" cephalosporin that needs to be administered once-daily. Ceftriaxone is a β-lactamase-resistant cephalosporin. It is active against important gram-positive and most gram-negative bacteria. The MIC90s of ceftriaxone are 0. 1 μ g/ml for Escherichia coli, 0. 1 μ g/ml for Klebsiella species, 0. 2 μ g/ml for Proteus species, 0. 3 μ g/ml for Enterobacter species, 0. 4 μ g/ml for Serratia species, 0. 06 μ g/ml for Streptococcus agalactiae, and 2 μ g/ml for Staphylococcus aureus (β-lactamase producers). Ceftriaxone, like other cephalosporins, kills bacteria by interfering with the synthesis of cell walls. Ceftriaxone has a good penetration into the cerebrospinal fluid and is useful in the treatment of meningitis sustained by susceptible bacteria. The dose of ceftriaxone is 50 mg/kg per day in neonates and 100 mg/kg per day in older infants. Ceftriaxone has a longer half-life than other cephalosporins; the plasma half-life of ceftriaxone is 15 hours at birth and 7 hours over 2-4 weeks. The mean distribution volume of ceftriaxone ranges from 0. 497 to 0. 608 l/kg, and is not different in neonates and infants. In neonates, the total body clearance is 0. 28 ml/min/kg after single administration and 0. 41 to 0. 54 ml/min/kg after multiple ceftriaxone administrations. After single intramuscular administration of ceftriaxone, the time to reach the peak plasma concentration is 1. 8 hours. This antibiotic displaces bilirubin from albumin binding sites, thereby increasing the amount of free bilirubin in plasma. Ceftriaxone should not be administered to infants with hyperbilirubinemia. The aim of this study is to review the effects and pharmacokinetics of ceftriaxone in neonates.

Background The purpose of this study was to determine how to do parenting role's tasks as parents of healthy and disabled children younger than 7 years old in Iran (Arak). Materials and Methods In this cross-sectional study, the parenting role tasks questionnaire was completed for 120 parents of healthy children and 120 parents of disabled children with at least one child with disability and the parents were selected by convenience sampling method. T-test, Mann-Whitney test and analysis of variances was used to compare the scores between parents of healthy and disabled children based on studied variables including child age, parent age, child gender, parent education, family economic status, history of trauma and seizure in children was applied to perform the role of parents. Results: There was a significant difference of parent role in both groups of parents. There was observed a significant relationship between role of healthy children's parents and age of child (r=0. 21, P=0. 016), but not observed in disabled children's parents. In healthy children, there was no significant correlation between parent's role and maternal age. In contrast, in disabled children, there was found a significant difference (P= 0. 04) with correlation coefficient of-0. 18 representing the inverse relationship. Moreover, no relationship was found between history of seizure and performance of parenting role's tasks in the group of disabled children (P>0. 05). Conclusion The performance of tasks of parenting role in two groups of parents of healthy children and disabled ones in four areas of primary care, education, leisure and improving cognitive level had significant difference. This difference in the area of improving the cognitive level was higher. Due to complications of disability, parents of these children pay more attention to other areas of care except of improving cognitive level. Therefore presence of disabled child has negative effect on the balance of the performance of tasks of parenting role in various areas.

Background In recent years, with the advancement of medical science, rhinoplasty techniques have grown rapidly and now rhinoplasty is one of the most common types of surgeries in the world. On the other hand, the prevalence of body dysmorphic disorder (BDD) among the patients referred for cosmetic surgery is a disorder which, if not detected by a doctor, can lead to irreparable injuries to the physician and patient. Materials and Methods The present research was carried out with pre-test and post-test design and convenience sampling method. The research population consisted of all rhinoplasty applicants who referred to the Ear, Nose, and Throat (ENT) Clinic in Loghman Hospital in Tehran-Iran, during the years 2013-2015 and were treated by a team of surgeons. The study was conducted in two stages. In the first stage, the level of body image concern (using the body image concern inventory [BICI]) was evaluated in rhinoplasty applicants, and in the second stage, in a 3-month follow-up, the body image concern level was reassessed in patients undergoing cosmetic surgery and compared with preoperative stage. Results There was a significant difference in body image concern in rhinoplasty candidates before and after the surgery and after the cosmetic surgery, this body physical concern was increased (P<0. 05). Gender, education level and marital status were not effective in this regard (P>0. 05). Conclusion Psychological factors seem to play a role in the demands of both cosmetic surgery and its outcome. Therefore, the pre-rhinoplasty study of psychological components (including the level of body image concern) is necessary to provide a timely diagnosis and appropriate treatment in case of disorder.

Background Occult hepatitis B infection (OBI) is considered a risk factor for progression of liver disease in patients with hepatitis B virus (HBV) infection. This disease progression is reported to be more significant in those with concomitant HIV infection. We aimed to determine the prevalence rate of OBI in a sample of HIV-positive patients. Materials and Methods: Sixty-six HIV-infected patients with positive Hepatitis B core antigen (HBcAb) and negative Hepatitis B surface antigen HBsAg were included. HBV DNA was measured by real time polymerase chain reaction PCR method. Those with positive HBV viral load were considered as seropositive OBI. Then, the patients were studied regarding age, gender, intravenous drug use (IVDU), CD4 count, and concomitant infection by hepatitis C virus (HCV), available in their medical records. Results: Seventy-seven patients (38. 5%) had positive HBc antibody (HBcAb). Of 66 patients who were positive for both HIV and HBc antibody, eight patients (12. 12%) had OBI. About 3. 7% in age group younger than 40 years and 5. 3% in age group older than 40 years, OBI was detected. Forty-four patients (54. 5%) were male. OBI rate was 22. 2% in males and zero in females (P< 0. 05). In patients who received ART (anti-retroviral therapy) 11. 3% and in those who did not receive ART, 12. 4% had OBI. In patients with CD4 count of less than 350/mL, 20. 1% and in those with CD4 count > 350/mL, 4. 1% had OBI. In those who were IV drug user, 17. 94% and in those who were not IV drug user, 3. 57% gad OBI. Conclusion The prevalence of OBI in the studied sample of HIV-infected patients is considerable. As we did not find any significant association between OBI and studied factors except for gender, we think that screening for OBI would be useful for HIV-infected patients, especially male patients.