دکتر هومان هاشمیان

Background Pneumonia is one of the severe infections in children, and empyema is one of its essential complications which causes more risk in affected children. Therefore, its early diagnosis is of great importance.
Objective This study aims to compare the value of two inflammatory markers including mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) in children with pneumonia associated with and without pleural empyema.
Methods This study was conducted on the data of 128 children aged 3 months to 14 years with bacterial pneumonia associated with pleural empyema and 128 children without pleural empyema. The MPV and NLR values and the patients’ demographic and clinical characteristics were analyzed in SPSS software version 18 software. The confidence interval for the area under the ROC curve was calculated using binomial exact method. The significance level was set at 0.05.
Results Of 256 children, 42.2% were girls, and most of children had ages <3 years (35.2%). Children with empyema had significantly higher NLR, platelet count, and MPV than children without empyema (P=0.040, 0.005, and 0.021, respectively). The MPV (P=0.020) and NLR (P=0.039) were significant predictors of empyema.
Conclusion The use of NLR and MPV may be useful in the early diagnosis of empyema in children with pneumonia.

Acute encephalopathy is a condition in which brain function deteriorates rapidly and usually presents with loss of consciousness with or without focal neurologic symptoms. Some of its causes are infections, trauma, toxicities, and metabolic disorders and so on
evaluat etiology, epidemiologic, clinical and para-clinical characteristics and outcome in children with acute febrile encephalopathy during 2013-2014 in educational and remedial 17-Shahrivar hospital, Rasht.
This is a case series and cross sectional study performed during 2013-2014 in 17-Shahrivar hospital, Rasht. All of children between 2 month and 14 years old with acute febrile encephalopathy enrolled in the study. Children with head trauma history or history of underlying metabolic or neurologic disease were excluded. Exact history was taken and clinical examination of neurologic system was done; Then laboratory examinations and related evaluation such as: Cell count and cerebro-spinal fluid, imaging and so on were performed. All of information was fulfilled in a checklist and data was entered in SPSS Ver 19 and analyzed with descriptive tests and Fisher Exact Test.
towenty seven children including 63% male and 37% female were entered in the study which most of them were more than 36 month old. 6.25% of them had headache and 51.9% of them had history of fever for more than 3 days of fever. 74.1% of them had white blood cell changes. Blood, cell count and Cerebro Spinal Fluide(CSF) culture and CSF smear were not positive in any children. 37% of results were enterovirus in viral culture. Towenty two patients had seizure, 4/7% of the children had improved with permanent side effect and none of them were died. Persistent complication of them was spastic cerebral palsy. There was no significant relation between treatment outcome and age group, season, gender and laboratory result of CSF (P>0.05).
Our results showed that in our population one of important cause of acute febrile encephalopathy can be associated with enterovirus factors

Infectious mononucleosis is a clinical syndrome, particularly in children, adolescents and young adults. Since the clinical and laboratory characteristics of infectious mononucleosis are different according to geographical regions and age groups, studies in different regions can be crucial in improving the diagnosis and treatment of patients with infectious mononucleosis.
This study aimed to investigate the frequency of demographic, clinical and laboratory characteristics of patients with infectious mononucleosis admitted to 17th shahrivar Hospital of Rasht since 2009 to 2013.
In this descreptive retrospective study, medical records of all patients with a diagnosis of infectious mononucleosis admitted to 17th Shahrivar Hospital of Rasht between 2009 and 2013 were examined. Patents’ demographic, clinical and laboratory findings were collected and analyzed by descriptive statistics using SPSS software version 18.
In this study, 99 patients with infectious mononucleosis with an average age of 6.19 ± 3.03 were assessed of which 55% were boys. The most common season was summer (35%), followed by spring (30%). The most common chief complaints were fever (88.8%), and pharyngitis (63.3%). The mean duration of disease was 6.19 ± 3.41days. The most common clinical signs were tonsillopharyngitis (98.9%), cervical lymphadenopathy and fever (9/93%).. Leukocytosis was seen in 73.7% of patients and also, lymphocytosis in 62.6%, atypical lymphocytosis in 29.3%, anemia in 13.1% and thrombocytopenia in 6.1%. The high ESR, increased liver enzymes, positive monotest and positive IgM-VCA test were detected in 54.1 %, 46.5 %, 11.1 % and 9/92 % of subjects, respectively. The most common complication was respiratory distress in 5 patients. One patient died with respiratory distress and bleeding.
The most common chief complaints were fever and sore throat; and cervical lymphadenopathy, fever and tonsillopharyngitis were most common signs. It is recommended that differences in the clinical manifestations and their prevalence in our region, be considered in the diagnosis.

Immunization against common infectious diseases is of great value in preventing early death in low aged children and is very effective and cost benefit worldwide. Health care officials and parents’ awareness of children vaccination program can be very effective in directing health service planning. To evaluate the level of knowledge of mothers about vaccination as directed by civil vaccination program in Rasht. This is a cross sectional- analytical study performed on mothers referred to health centers of Rasht from October, 2013 to June, 2014. Tool of research was questionnaire including parents and family demographic data, source of knowledge about vaccination and questions about knowledge of mothers. Sampling method was cluster based and 392 mothers were interviewed in health centers of Rasht. After data entry in SPSS version 18 software, descriptive statistics and T-test and ANOVA test were used for analysis Most mothers were between 25-29 years old (41.1%), and most of them vaccinated their children for the first time (62.2%). Most of them had diploma degree (48.2%), and were housewife (87%). We found that most of them had moderate knowledge and 15.6% had little knowledge and only 8.7% had good knowledge about vaccination. There was a significant relationship between knowledge of mothers and their education (P=0.032), their jobs (P=0.008), educational level of their husbands (P=0.014) and source of information (P=0.021). Knowledge of mothers about vaccination in this study was moderate in most cases. Therefore, consulting programs on vaccination for mothers is suggested in our country. In doing so, optimizing health and educational grounds, besides training and promoting parents’ level of knowledge are recommended.

Retinopathy of Prematurity (ROP) potentially leads to blindness and low vision in small but significant percentage of infants. Timely referral of the high risk infants is critical to diagnose and treat advanced stages of the disease. Evaluation of practice of Guilan province pediatricians about screening criteria for ROP. In this cross sectional study, Guilan province pediatricians practice about screening criteria for ROP have been evaluated by face to face method (using a questionnaire). 78 Cases (78.8%)of the pediatricians participated in this study. 40 Cases (51.3%) considered prematurity alone as the sufficient criterion to refer infant for ROP screening. 38 pediatricians (48.7%) declared one or more risk factors to refer infant for ROP screening. About the appropriate time for screening,7 pediatricians (9%) voted for immediately after birth, 15(19.2%) immediately after hospital discharge, 34 (44.6%) end of 4 weeks of birth,7 (9%) at the end of second months of age, and 8 (10.3%) after 2 months of age. only 21 (26.9%) pediatricians referred infants to the pediatric ophthalmologists or fellow of retina. 69 (88.5%) pediatricians requested for written reports of eye examination of which 47 cases (68.1%) recorded the written reports in medical records of the patients. Data analyzed by using chi-square and fisher exact test. it seems that upgrading of pediatricians practice helps for early diagnosis and treatment of infants at risk of ROP.

Abstract Identifying the exact causes of infant mortality in developing countries is very important. Infants’ mortality rate is a useful indicator for assessing the quality of health care in community. To detect the relative frequency of neonates and children’s mortality causes in 17 Shahrivar Training Hospital of Rasht, from Jun 2009 to Sep 2010 This was a cross sectional – descriptive study. The only exclusion criterion of the study was incomplete required information in the records. We designed a questionnaire which consisted of questions on age, gender, weight, living place, past medical history, the time between disease and hospitalization, diagnosis, positive culture and the cause of death. Having gathered the data, we used SPSS 16 software and chi-square test to analyze and compare the major causes of mortality and morbidity in the above-mentioned hospital. Data on 216 died patients were enrolled in the study. Their mean age was 3 years (minimum 1 month and maximum 7 years) and 133 (61.6%) of the cases were male and 83 (38.4%) were female. The main causes of mortality in this study were: pneumonia, respiratory distress syndrome, sepsis and liver failure. The causes of death among different age groups showed a significant difference (Chi-Square test, P.value<0.01). The leading causes of death in infants were respiratory distress syndrome (30.1%), pneumonia (20.3%), sepsis (14%) and prematurity (9.1%), and in children were pneumonia (26.3%), liver failure (17.7%), malignancy (12.5%) and sepsis (8.8%). With increase in our knowledge about prevalence and causes of death of diseases and related risk factors, we can have better planning to improve the quality of health and decrease mortality rate in our country.

Foreign body aspiration (FBA)، as a life-threatening emergency، is a common problem in children especially in 1-3 year old age group. FBA is one of the leading causes of death in the 7% of children under 4 years. The purpose of this study was to evaluate the clinical and radiographic findings of foreign body aspiration in children admitted to 17- Shahrivar hospital in Rash. In this study، the required data were collected from the medical records of all children with FBA hospitalized in 17- Shahrivar hospital (Rasht، Iran). Fifty-one percent of the children were 1-3 years and the most common complaints of patients were cough (34%) and respiratory distress (34%). In patients'' history records، initial suspicion to aspiration was 78%، respiratory distress، 65% and choking، 63%. Common physical examination findings were unilateral decreased pulmonary sound (65%) and rales (45%). The most common findings in CXR were consolidation (34%) and unilateral air trapping (32%). The most frequent foreign body was sunflower seed (34. 5%). The ratio of foreign body in the right and left bronchi was equal in children under 1 year old (40%) and was more in right bronchi in older children. Considering the high prevalence of aspiration and choking، initial suspicion to them and history records can be helpful in diagnosis.

One of essential issues that was discussed in word Health organization (WHO) is continuous learning and promoting knowledge and healthy skills related to public health. So، continuous education program as one of practical solution to identify achievement of educational goal should be considered. This study has been done to evaluate continuous medical education from viewpoints of eligible physicians. this is a cross- sectional descriptive study. data were collected by a questionnaire designed by ministery of health and medical education to assess continuing medical education program، offered to 132 eligible general physicians contributed in three- separate programs. Validity and reliability confirmed by content validity and alpha krobakh (0. 92) respectively. data were analysed by SPSS software and descriptive statistic. From the viewpoints of eligible physicians، 43% evaluated continuous medical education program as fair with regard to confirm information also، other subjects including: Presenting new scientific topics، proportion with occupational needs; logical sequences of the lecture، conditions and facilities were considered as moderate. They indicated ''gain points and updating information'' the most important factors for participating in CME programs. They found group discussion، case- presentation and lecturing as the best educational methods and self- teaching، seminar، codified program and E- learning the most suitable performance of continuous medical education programs. according to the current and similar research findings، and necessity to perform continuous medical education programs in order to updating information and promoting related skills، It seems that using of suitable educational methods، determining priorities in educational needs of eligible physicians، selecting subjects based on educational needs، providing suitable condition and atmosphere and educational equipments can promote impressiveness and efficiency of programs.

Abstract Neonatal Intensive Care Unit (NICU) is considered a major problem regarding nosocomial infection control. Considerig the importance of this subject and this point which this study has never performed in this province is necessity of performe of this research. To determine Nosocomial infections and accompanied factors in neonatal intensive care unit (NICU) at 17-Shahrivar hospital of Rasht, 2008-9. This study was a descriptive research and data were collected prospectively through a questionnaire and a checklist. Questionnaire was included demographic characteristic and treatmental factors. Structural and personnal factors were assisted by the checklist. In this study, samples were the same as study population and all neonates who had the characteristics of the research samples were included. Inclusion criterions consist of all of neonates that aged up to 30 days, suffering from prematurity, low weighting, hyaline membrane disease (HMD), respiratory distress syndrome(RDS), congenital anomalies and also neonates who required surgical treatment that manifested clinical infection signs after 48 hours of admission. All neonates that had clinical infection signs on admision time and suffering sepsis, meningities, pneumonia, urinary tract infection and other infections or the ones who were in incubation period were excluded from research. Nosocomial infection was diagnosed by focal point physician based on the National Nosocomial Infection Surveillance system (NNIS). Data was analysed by using SPSS and by means of frequency distribution tabels and graphs. During the study period, 270 neonates were hospitalized, among them 44 cases (16.29%) had nosocomial infection. Most of them (70.5%) were male, weight of them was under 2Kg and age of them was between 1-3days. Also most of them (73%) were preterm and were born by cesarean section method. Assessment of the research based on treatmental factors showed that majority of patients were premature and had respiratory distress. The most common isolated pathogens were entrobacter(57%), klebsiella (9%) and E-coli (2%). Assessment of Structural factors showed that there are physical space problems in spite of adequate equipment and instruments. Regarding personality situations, it is clear that educational programs have been provided for prevention of infection. It is recommended to pay more atention in personal heigenic, especially hand washing and using stril gloves and sterilization rules regarding in IV cathetering. Also it is advised to control and prevent infections with suitable destribution of staffing, providings standared rules in physical structures and promoting knowledge in physicians and NICU personels.

Urinary Tract Infection (UTI) is one of the major etiological factors of permanent kidney impairment, resulting in renal scarring and severe and pernicious side effects, such as arterial hypertension and renal failure. The purpose of this study was to clarify the impression of renal parenchyma involvement by first UTI (on the basis of acute DMSA scan) and vesicoureteral reflux (VUR-on the basis of VCUG/ RNC) on the renal scar formation (on the basis of late DMSA scan). Children diagnosed with their first UTI at the Children's Hospital Medical Center, Tehran, Iran, were evaluated. For each patient, we recorded age, sex, results of VCUG/RNCs and acute DMSA scan, as well as those of a late DMSA scan