Journal of Pediatric Perspectives
Year:2016 | Volume:4 | Issue:10 (34)|Papers Count:16

Background Although osteoporosis is a disease of adulthood, it can start from childhood and adolescence. Lifestyle, especially physical activity, mobility, and proper nutrition during adolescence are among the important osteoporosis preventive factors. Therefore, this study aimed to determine related factors of physical activity preventive behavior of osteoporosis based on the Health Belief Model (HBM) among teen girls in Qom city, Iran. Materials and Methods This cross-sectional descriptive analytical study was conducted on 265 tenth to twelfth grade girl students in Qom city. The participants were selected via multistage sampling method. A researcher-made questionnaire based on Health Belief Model used for data collection. Data were analyzed using SPSS-20. Results The current study, knowledge and perceived self-efficacy had a significant and positive relationship with physical activity behavior (r=0. 13, P<0. 05 and r=0. 25, P<0. 05, respectively); while, perceived susceptibility and perceived barriers had a negative and significant relationship with physical activity behavior (r =-20, P<0. 05 and r=-0. 26, P<0. 05, respectively). Perceived severity and perceived benefits had no significant relationship with physical activity behavior (P>0. 05). Conclusion The results of the study showed that educational interventions and programs must focus on increasing knowledge and perceived self-efficacy to enhance physical activity behavior and reduce the perceived barriers associated with osteoporosis preventive physical activity.

Background The positive effect of breastfeeding on the health of the mother, child and community has been globally accepted, but the rate of breastfeeding is still not at an acceptable level. Breastfeeding support can greatly influence the continuity and success of breastfeeding. This qualitative study aimed to explain the Iranian women’ s experiences of breastfeeding support. Materials and Methods This study was designed as a qualitative content analysis. The participants were selected purposefully, and 33 semi-structured interviews were conducted with 18 mothers with breastfeeding experience, 5 key family members (3 grandmothers and 2 husbands) and 10 providers of breastfeeding services. Data were analyzed by using five-step method of Hsieh and Shannon content analysis, simultaneously with data collection. Results The results of the analysis of the participants’ description and experiences revealed four major categories: spousal support for breastfeeding, family support for breastfeeding, health professionals’ support for breastfeeding and community support for breastfeeding, which indicated the dimensions of breastfeeding support. Conclusion In participants’ experiences, spousal support and family support for breastfeeding had key role in the success of breastfeeding and made the mothers more encouraged to initiate and continue breastfeeding. Further, the participants attributed the success of breastfeeding to receiving adequate knowledge and skill for breastfeeding from the healthcare system. From their perspective, community support for breastfeeding, especially among the working women played a pivotal role in the continuity of breastfeeding.

Background: Vesicoureteral reflux (VUR) is a common condition among children. Although, subureteral injection is a minimally invasive new method for VUR treatment, ideal bulking agent in endoscopic treatment still remains controversial. We aimed to evaluate VANTRIS subureteral injection efficacy in VUR treatment in pediatric patients. Materials and Methods: All patients who referred to Imam Khomeini hospital in Urmia-Iran, Urology ward with VUR diagnosis that had indications for open surgery, enrolled study (during Mar 2013 to Mar 2015). Prior to intervention, VUR severity, urinary tract infection (UTI) and subsequent complications determined using urine analysis and imaging. Subsequently, single injection of the VANTRIS performed for all patients and patients underwent six-month follow up including several clinical and paraclinical evaluations. Results: 31 patients with VUR diagnosis participated; of 31 patients, 18 (58. 06%) children with primary UTI who had surgery indication enrolled study; of 18 patients, seven patients (38. 88%) were boy and eleven patients (61. 12%) were girl with mean age of 6. 88 ± 2. 61 years, and out of 29 refluxing rental units (RRU), 13 (44. 8%) were right and 16 (55. 2%) were left kidney. In current study, patients divided to two subgroups regarding their age older than five or younger than five years old and there was no significant difference between the resolution rates following VANTRIS injection in two groups (P>0. 05). Eleven (38. 88%) RRU detected in boy patients, nonetheless VUR resolved in all of them, postoperatively. On the other hand, of 18 RRU in female patients, complete VUR resolution observed in 16 kidneys (88. 8 %), but only 2 (11. 11%) kidneys had incomplete, but significant VUR resolution, where no significant difference observed. The prevalence of reflux in patients with UTI was 30% and in patients without UTI was 17%. Conclusion: The current study indicated that in all age groups of patients, the subureteral injection of the VANTRIS was an accurate and effective treatment modality for VUR.

Background Foreign body ingestion is a relatively common in children. Most ingested foreign bodies spontaneously pass out of the body via the gastrointestinal (GI) system but sharp materials may perforate the GI tract and need to surgical intervention. Case Presentation The patient was a 9-year-old girl with progressive abdominal pain for one month and admitted with acute abdomen impression. She underwent esogastroduodenoscopy (EGD) due to severe epigastric tenderness. Upper GI endoscopy revealed duodenal ulceration and perforation by a toothpick while she had no history of foreign body ingestion. Toothpick was removed by endoscopy. She was successfully managed conservatively and had no abdominal pain during the one month follow-up period. Conclusion We recommend the endoscopic approach as the preferable method for the extraction of duodenal foreign bodies in children, even in the case of intestinal perforation.

Background Since the studies about the diagnostic value of Brain Natriuretic Peptide (BNP) in determining ventricular dysfunction in patients with Congenital Heart Diseases (CHD) is low and early detection of heart dysfunction from the mortality and morbidity rates decrease, this study aimed to assess BNP early diagnose of cardiac function in children with CHD. Materials and Methods This study was performed on children with CHD (n=100, case group) and healthy children (n=50, control group). Severity of heart failure modified Ross classification system was used for grouping patients in four classes. For all participants, height, weight and head circumference were measured. From all participants 3cc blood samples were taken and after separation, the plasma placed at temperature of-80° C. After collecting all samples they were in testing using an ELISA, BNP kit. For control group, statistical methods used to generate right venrticle (RV) and pulmonary artery (PA) pressure randomly. The data were analyzed using SPSS-15 with 0. 05 for the level of significant. Results The results of the study showed that among cyanotic patients 68. 19% were boys when these proportions were 51. 28% and 60% in cyanotic patients and control respectively. Also, RV, HB and O2 saturation (O2Sat) had different mean significantly accordance with the severity of disease. BNP had correlation with PA (P<0. 05 and r=021) and PA had correlation with pulmonary-to-systemic blood flow ratio (Qp/Qs) ratio (P<0. 05 and r=0. 45), resistance (Rp/Rs) ratio (P<0. 05 and r=0. 59), RV (P<0. 001 and r=0. 28) and O2Sat (P<0. 05 and r=0. 36) respectively. Conclusion The results of the present study showed that the BNP levels in children with CHD compared with healthy children increased; and the positive correlation was observed between the pulmonary hypertension and BNP level.

Background: Aggressive behaviors are common in the pediatric age and counseling with parents should be one of the main preventive and therapeutic starategies. This study aimed to assess the relationship between the frequency of aggressive behaviors, life satisfaction (LS) and self-rated health (SRH) and counseling with family members and friends in a representative sample of Iranian children and adolescents. Materials and Methods: In this nationwide study, 14, 880 school students, aged 6-18 years, were selected by cluster and stratified multi-stage sampling method from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire(WHO-GSHS) was used. Mental disorders were assessed through the WHO-GSHS questionnaire that consisted of worthless, angriness, anxiety, insomnia, confusion, depression, and worried. Results: Overall, 13, 486 students (49. 2% girls) with mean (standard deviation[SD]) age of 12. 47(3. 36) years participated the study. The prevalence of physical fight, victim, and bully was lower in children and adolescents who consulted with their father compared those who did not consult (P< 0. 05). Physical fight and bully were less prevalent in children and adolescents who consulted with their mother and friends compared those who did not consult (P< 0. 001). Also, the prevalence of LS and SRH “ good” was also lower in children and adolescents who share their problem with their father or mother compared with those who did not consult (P< 0. 001). Conclusion: Counseling with family members was associated with low physical fight, low bully, good sexual and reproductive health (SRH) and LS. So, children and adolescents should be encouraged to consult with their parents about their problems.

Dear Editor-in-Chief: Promote and support breastfeeding is an essential element for the health and development of infants so that, it introduced as most cost-effective intervention to reduce infant mortality in developing countries (1). Breastfeeding has an important role to ensure food security for maintain a healthy and productive life for a large proportion of babies in the world, in addition, it is associated with improves intelligence quotient (IQ), school attendance and higher income in adult life (2). World Health Organization (WHO) indicated exclusive breastfeeding for the first six months of life with starting in the first half hour after delivery for optimal growth and development (3). Early initiation of breastfeeding (first hour after birth) has positive effects on biological and emotional health for mother and child and reduces child mortality (4). It is estimated that if breastfeeding in children aged at 0-23 months have been considered optimally, among children under 5 years old globally over 800, 000 life could be saved every year (2). In other hand, protect effects of breastfeeding for mothers against breast and ovarian cancer, osteoporosis have been identified (5). Low rates and early cessation of breastfeeding can be along with important adverse effects on health. In this letter, we aimed to describe the profile of breastfeeding in Iran compared with other regions of the world, and to express some solutions for promotion of breastfeeding in regard to published studies about this matter.

Background Robinow syndrome is a rare congenital disorder with phenotypically heterogeneous abnormalities. Two modes of inheritances are known for this syndrome namely autosomal recessive and autosomal dominant. Case Report We describe here an eighteen-month-old child who had mesomelic short stature, abnormal facial features, clinodactyly, micropenis and vertebral changes which were further supported radiologically. The case was the first of his kind, which came to our hospital. The diagnosis was challenging and ascertained only after confirmation with multiple specialties and various interdepartmental discussions. Conclusion The syndrome is rare and hence is less known among health care workers. Also, the prenatal testing which is available for the entity needs to be explained to the suspected mothers.

Background: Preterm birth is one of the most remarkable reasons for neonatal and infant mortality and morbidity across the world. This study aimed to determine risk factors of premature infants in the rural area of Azadshahr city, Iran. Materials and Methods: A case-control study was conducted on all premature and low birth neonates (less than 37 weeks and weight less than 2500 grams). Data were collected by records in 30 health houses located in the rural areas of Azadshahr city durring 2013 to 2016. Two groups (case and control) were matched by gender and health houses. A trained midwife was collected data by using of a researcher-made checklist. To describe mean and standard deviation of the demographic characteristics, descriptive methods were used. To analyze, inferential statistic tests such as Chi-square, and independent t-test were implemented through SPSS (version, 16). Significant level was also taken <0. 05. Results: In total, 112 girl infant and 101 boy infant were explored. The mean age of mother in the case and control groups was 26. 14+ 8. 4 and 25. 67+ 9. 1 years old respectively. There was a significant difference between the two groups in terms of prenatal care and pregnancy complications. In addition, a remarkable relations was found between polytocous and delivery time (P<0. 05). Conclusion: Providing mothers with necessary information in terms of interval between births, and the importance of prenatal cares in the pregnancy period to prevent complication seems to be likely useful.

Background Measles is a contagious illness with symptoms including fever, cough and rash. Although after the start of vaccination, its mortality rate has decreased significantly, but in some countries, the disease still leads to dangerous complications. Since infectious diseases such as measles has long been of interest to practitioners, in this study the perspective of Traditional Iranian Medicine (TIM) scholars, especially Razi (Rhazes) about measles was examined. Materials and Methods In the present study, we reviewed Rhazes’ viewpoint about symptoms and treatment of measles in the book entitled "Al jodari-Al hasbah", and other TIM books. In addition, using scientific online databases, the latest studies in this regard are investigated. Results Rhazes was the first physician who described measles scientifically in a separate book called "Al jodari-Al hasbah". In addition to the disease symptoms, its complications and treatment strategies that includes three areas of general recommendations, nutritional measures and topical treatments such as laxatives, foods, fruits, vegetables and herbs with cold nature (based on TIM), he also explained the prognosis of the measles according to the division of skin rashes. Some other Iranian medicine scholars such as Avicenna in addition to the mentioning other therapeutic strategies also pointed out the contagious nature of measles. Conclusion Given that some of the diagnostic, therapeutic and preventive perspectives in TIM textbooks, especially Rhazes’ "Al jodari-Al hasbah" have been supported by evidence of new studies, it seems that the opinion of these scientists in the field of infectious and contagious diseases such as measles can be helpful.

Teicoplanin is a glycoside antibiotic which consists of five closely related glycopeptide antibiotics with similar antibacterial properties to vancomycin that were first isolated in 1976. Teicoplanin is active against many gram-positive anaerobe microorganisms and is particularly potent against clostridium species. It is also active against most Listeria, enterococci and staphylococci including methicillin-resistant strains. Nonviridans and viridans streptococci, Streptococcus pneumoniae, and enterococci are inhibited by teicoplanin. Teicoplanin has been used to treat a wide variety of infections, including osteomyelitis and endocarditis caused by methicillin-resistant and methicillin-susceptible staphylococci, streptococci, and enterococci. Teicoplanin has a spectrum of antimicrobial action similar to vancomycin, but teicoplanin has some advantages in that it only needs to be given once a day, does not need to be given as slowly as vancomycin and can be given by intramuscular injection. Teicoplanin cannot be given by mouth. Teicoplanin is excreted unchanged in the urine. The half-life of teicoplanin is 100 hours in adults and 21/2 days in children. Teicoplanin has a large distribution volume and long half-life and a loading dose is recommended. In infants, the loading dose of teicoplanin is 16 mg/kg administered intravenously followed by 8 mg/kg once daily. The target trough concentration of teicoplanin ranges from 15 to 30 μ g/ml. The incidence of hepatic dysfunction, renal impairment and thrombocytopenia is 14. 8%, 20%, and 14%, respectively, when the serum teicoplanin concentrations range from < 20 μ g/ml and ≥ 20 μ g/ml. The aim of this study is to review the effects and the pharmacokinetics of teicoplanin in neonates.

Background: Weight loss and decreasing the Body fat percentage (BF%) is motivated to optimize performance. In order to achieve these, many supplements are used by athletes, however the possible negative or synergic effects have not been fully described in the literature, specifically in humans. The present study was conducted to investigate the co-administration effects of two common used supplements in body weight and BF% management to recommend athletes for safe weight and BF% reduction. Materials and Methods: In the present double-blind, randomized, parallel, placebo-controlled study, the effect of six-week co-administration of caffeine and carnitine was determined on changes in body weight (BW), BF%, serum leptin concentration and lipid profile (triglyceride, HDL Cholesterol, LDL Cholesterol and Total Cholesterol), fasting blood glucose (FBG), and free fatty acid (FFA) changes. Twenty eight male teen soccer players from Ahvaz-Iran, were divided in three groups (group CafPlc, caffeine (6 mg/kg/day) + dextrose; group CafCar, caffeine (6 mg/kg/day) + carnitine (2g); and group Plc, dextrose). Results: Caffeine-carnitine had a lowering effect on BW (P=0. 02) and BF% (P=0. 03), compared to caffeine alone and placebo in male teen soccer players (mean age of 16. 92 ± 0. 76 years). TG was significantly decreased in CafCar (P=0. 04). FFA levels were increased in CafCar (P=0. 04) and there was significant differences between CafCar and Plc groups (P=0. 01). FBG was increased in both CafPlc and CafCar (P=0. 01 and P=0. 02, respectively), with no significant differences between groups. Conclusion: The synergistic effect of caffeine-carnitine might be suggested to decrease the BF% and BW, besides it may prevent the increment of FFA levels; however it should be prescribed cautiously since it increased FBG levels.

Background: The life style is formed and stabilized in adolescence. Since consumption of fruits and vegetables may affect the risk of chronic diseases, their low consumption during adolescence is very important. Knowledge and skill is considered as one of the main determinants of this behavior. This study aimed to investigate the Knowledge and skill of proper consumption of fruit and vegetables among adolescent girls in Shahrekord, Iran. Materials and Methods: This study was a descriptive-analytic investigation conducted on high school girls in Shahrekord city during 2013 to 2014. 308 female students were selected randomly from 8 high schools and a researcher made questionnaire was used to collect the demographic, Knowledge and skill related data. Validity and reliability of the questionnaire was evaluated by internal consistency method (Cronbach's alpha = 0. 70, Cronbach's alpha= 0. 76), respectively. The collected data was analyzed by SPSS-21 software. Results: The mean age of students was 13. 86 ± 1. 3 years. There was no statistically significant association between consumption of fruit and vegetables and fathers’ education level, mothers’ job and parents’ age. However, there was a significant association between fathers’ job and adolescents’ skill of fruit and vegetables consumption (P< 0. 05). In addition, a significant association between mothers’ education level and adolescents’ knowledge and skill of fruit and vegetables consumption was observed (P<0. 05). There was a significant direct association between knowledge and skill (P=0. 01 and r=082), so that adolescents with more knowledge, had a better skill as well. Conclusion: Considering the adolescents’ low knowledge and skill in proper consumption of fruit and vegetables and also the direct association between knowledge and skill, it seems necessary to implement educational programs according to the health education and promotion theories and models, with contribution of parents and school personnel, to improve the knowledge and skill and empower adolescent girls in consumption of fruit and vegetables.

Background Metabolic syndrome (MES) consists of central obesity, hypertension, reduced high density lipoprotein (HDL), elevated serum triglycerides and high Fasting blood sugar (FBS). They are susceptible to cardio-vascular disease, and insulin resistance. The goal of present research was to assess any relation between the composition of the body in Type 1 Diabetes Mellitus (T1DM) children and having components of metabolic syndrome. Materials and Methods This cross sectional study included all T1DM children who were referred to the pediatric clinic of diabetes, affiliated to the Shiraz University of Medical Sciences, Iran during Jul 2013 to Aug 2014. Anthropometric data, blood pressure, fasting blood glucose, lipids and body mass indices like android and gynoid fat mass was done by one physician with standard scale and techniques. The obtained data were analyzed using SPSS-18. Results Overall 87cases with definite diagnosis of T1DM were admitted in this duration (2013-2014). There was a positive correlation appeared between hypertriglyceridemia and Android fat mass (r=0. 1 and P =0. 046). Otherwise, there wasn’ t any relation between body composition criteria and the reduced HDL level, high blood pressure, Abdominal obesity and elevated FBS (P>0. 05). Conclusion It was revealed that hypertriglyceridemia was associated with Android fat mass. However, more pathophysiological research is needed to reveal the association of MES components and body-composition in T1DM children.

Background Test anxiety is a special case of a general anxiety which is of particular importance in students, because students will be the future of the country and the society activists. On the other hand, sleep quality and sleep disorders, have correlation with ailments, poor performance, decreased quality of life and increase of associated costs; This study aimed to determine the quality of sleep and its relationship with test anxiety among students in Qom city, Iran. Materials and Methods This study was a cross-sectional study, which was performed among 250 students who were going to pass the exam preparation classes. In order to collect data Pittsburgh Sleep Quality Index (PSQI) questionnaires and Test Anxiety Inventory (TAI) questionnaire were used. Data were analyzed using SPSS-16 with descriptive statistics and statistical methods, independent t-test, ANOVA and Pearson correlation coefficient. Results In this study, 50% of participants were boys (n=125) and 50 percent were girls (n=125). 81. 4% of subjects had poor sleep quality and 69. 6% had average to high score for test anxiety. Based on the results of anxiety test and sleep quality index there was a significant correlation between anxiety and sleep quality with gender (P=0. 003, r=0. 447). Conclusion School children had poor sleep quality and high test anxiety, and due to their direct and significant correlation, attention to this category of students, especially for girls, is important. Therefore, anxiety and promoting sleep quality control programs are recommended in this group.

Background This prospective study was designed to examine the role of fibrosis staging on selection and success of treatment options for autoimmune hepatitis (AIH). Materials and Methods The project was conducted on 110 selected AIH patients who, based on the results of liver biopsy, had been assigned into one of the three groups (mild, stages 1 and 2, moderate, stages 3 and 4, and severe, stages 5 and 6 fibrosis). The patients received prednisolone alone or in combination with azathioprine and the response to the treatment were assessed. Results The number of patients who were identified to have mild, moderate and severe fibrosis were 34 (31%), 35 (32%), and 41 (37%), respectively. Of 110 patients, 56 patients (51%) received prednisolone alone and 54 patients (49%) received combined drugs protocol. In total, 77 patients (70%) showed response to the treatment. The response rate for both modalities was much lower in the third group (P<0. 05). However, compared to the prednisolone single therapy, the response rate of combination therapy was higher in this group. Conclusion Our results clearly showed that response to treatment in AIH patients is decreased as hepatic fibrosis becomes more severe. Our findings indicate that pathological staging could navigate the selection of appropriate therapy, i. e. prednisolone alone is used for mild and moderate fibrosis while combination therapy is reserved for severe cases.