armen malekiantaghi

 Functional constipation (FC) is a common issue in pediatric healthcare, causing significant physical and emotional distress for patients and their families.

 This study aimed to investigate the prevalence of behavioral issues in children diagnosed with functional constipation, exploring their characteristics and relationship with various factors.

 We conducted a case-control study involving 107 children and adolescents (aged 2 to 18 years) with chronic functional constipation as the case group and 107 children without this condition as the control group. The Strengths and Difficulties Questionnaire (SDQ) was employed to evaluate different aspects of behavioral patterns.

 The comparison of various behavioral components assessed by the SDQ between the case and control groups revealed significantly higher average scores for emotional symptoms (0.85 ± 0.81 vs. 0.55 ± 1.03, P = 0.019), peer relationship problems (1.76 ± 2.23 vs. 0.76 ± 1.18, P = 0.001), and prosocial behavior (8.12 ± 1.87 vs. 7.42 ± 1.64, P = 0.002) in children with chronic functional constipation. Within the chronic constipation group, peer relationship issues were more common in boys, whereas girls exhibited more problems with prosocial behavior. Moreover, issues related to hyperactivity/inattention and prosocial behavior were more frequent in older children with chronic constipation.

 Chronic functional constipation in children is strongly associated with behavioral changes and problems, which are influenced by the demographic and anthropometric features of the patients.

Adenoid hypertrophy is a common childhood disease; its standard treatment is adenoidectomy. The desire for medical management is increasing due to fewer complications and more convenience. The present study investigated the effect of adding oral montelukast to mometasone nasal spray in treating adenoid hypertrophy.
This was a randomized, double-blind, placebo-controlled study conducted at a referral teaching hospital (Tehran, Iran) from September 2020 to September 2021. Children aged 2 to 14 years with clinical and radiological findings of adenoid hypertrophy were enrolled. Patients were randomly divided into two groups: mometasone nasal spray with oral montelukast (case group) or mometasone with placebo (control group). Then, the clinical scores were compared before and two months after the intervention.
Ninety-six patients completed the study [62.5% male (n=60)]. Of these, 51 were in the case and 45 in the control group. The clinical score in each group decreased significantly after the intervention (P<0.001), but the decrease in clinical score in the case group was not significantly different from the control (p=0.576).
The results showed that the combination therapy with mometasone and montelukast has the same efficacy as mometasone and placebo in treating adenoid hypertrophy. Adding montelukast to mometasone has no additional effect.

Oral Montelukast is recommended as maintenance therapy for persistent asthma, but there is controversy regarding its effectiveness in controlling asthma attacks. The present study was conducted to investigate the clinical efficacy of oral Montelukast for asthma attacks in children. This study was conducted as a double-blind placebo-controlled clinical trial on 80 children aged 1-14 years with asthma who were admitted to the emergency department of Bahrami Children's Hospital (Tehran, Iran) during one year. Patients were randomly divided into case and control groups. In addition to the standard asthma attack treatment, Montelukast was prescribed in the case group and placebo in the control group for one week. Patients were evaluated in terms of asthma attack severity score and oxygen saturation percentage (SpO2) in room air as primary outcomes 1, 4, 8, 24 and 48 hours after admission. In the first 48 hours, there was no significant difference in the score of asthma attack severity and SpO2 between the case and control groups. There was no significant difference between the groups in terms of length of hospitalization or number of admissions to the intensive care unit. None of the patients were re-hospitalized after discharge. The results of this study showed that the use of Montelukast along with the standard treatment of asthma attacks in children has no added benefit.

Gastrointestinal bleeding (GIB) associated with stress is an important complication in critically ill children admitted to the Intensive care unit (ICU), which can lead to serious complications and in some cases death. Only a limited number of studies have been conducted on the risk factors of gastrointestinal bleeding in Pediatric Intensive care unit (PICU), most studies have been conducted in the adults and neonates, therefore, the aim of this study was to evaluate the frequency of risk factors related to gastrointestinal bleeding in children admitted to the PICU.

This was a cross-sectional study. In this study, in a period of three years from (March 2016 to March 2019), all patients admitted to the PICU of Tehran Bahrami Children's Hospital were examined. The sample size was calculated 380. Demographic information, diagnosis during hospitalization, underlying disease, and initial tests during the first 24 hours of hospitalization were recorded in the checklist. To evaluate the demographic findings between patients with and without UGIB, chi-square and Fisher tests were used. A p-value of less than 0.05 was considered significant.

462 patients were studied, of which about (58%) were male. The mean age of the samples was 48 months and the average length of hospital stay in PICU was ten days. In general, (21.21%) of patients had gastrointestinal bleeding on the first day and (12.12%) on the second day of hospitalization. Gastrointestinal bleeding occurred in 50 patients (10.82%). Use of ventilator, pulmonary diseases, coagulation and blood diseases were significantly more common in patients with gastrointestinal bleeding than in children without gastrointestinal bleeding. Cardiac, neurological, hepatic, and renal disease were not significantly different in patients with gastrointestinal bleeding compared to children without gastrointestinal bleeding.

The occurrence of gastrointestinal bleeding in critically ill patients admitted to the PICU is a serious risk. The most important risk factor for upper gastrointestinal bleeding is mechanical ventilation. Other risk factors of gastrointestinal bleeding are lung disease, coagulation diseases, hematologic and oncologic disease.

 Typical manifestations of Coronavirus disease 2019 (COVID-19) include respiratory involvement. Gastrointestinal (GI) symptoms have also been reported as early clinical manifestations. The GI involvement can represent with diarrhea, vomiting, and abdominal pain. The present research aimed to identify dysentery as one of the signs of GI involvement in the novel coronavirus infection in children.

 We report twelve patients with COVID-19 and dysentery. All these children had positive reverse transcription-polymerase chain reaction (RT-PCR) results. None had underlying illnesses or recent travel history. However, all children had contact with a first-degree relative affected by non-digestive COVID-19. In three patients, obvious dysentery was observed, and in the rest, red and white blood cells were evident in the stool exam. Stool exams were negative for bacterial infections, parasites, and the toxin of Clostridium difficile. Abdominal ultrasonography and echocardiographic evaluations to rule out multisystem inflammatory syndrome in children were normal. Supportive treatment, such as zinc supplementation and probiotics, was prescribed. They also received intravenous fluid therapy based on their dehydration percentage. In the end, they were discharged in good general condition without any complications. No GI complications were found in the follow-up series.

 Dysentery in children can be one of the GI manifestations of COVID-19, which is usually self-limiting. It does not require invasive diagnostic measures and antiviral treatments. This symptom is in contrast to other viral infections of the GI tract.

Morning reports were held virtual after the outbreak of the novel coronavirus (COVID-19) in the world and Iran. We used the Skyroom platform, which was not used previously. The novelty of this method caused us to evaluate the learners' opinions about the advantages and disadvantages of the virtual method compared to the classic face-to-face one. This was a descriptive-analytical cross-sectional study during 2021. The population included the interns and residents of Pediatrics. Their opinions were assessed through a questionnaire at Bahrami Children's Hospitals, Children’s Medical Center, and Valiasr Hospitals in Tehran regarding the two methods of holding the morning report. The questionnaires were distributed and completed in a period of 6 months in 2021. A total of one hundred and twelve interns and residents were included. According to them, the virtual method had a higher score in terms of increasing information technology skills and easier interpretation of the paraclinical results. The advantages of the virtual method were: no need for physical presence, availability, ease of use of the application, and time-saving as well as better prevention and protection of COVID-19. The only disadvantage of this method was the occasional low-quality of audio and video. Also, in the virtual method, there was less possibility of participating in the discussion. More than half of the participants wanted to hold face-to-face meetings with the possibility of virtual participation in future. Virtual training platforms have been able to eliminate some of the face-to-face training problems. Online morning reports can be a satisfactory complement to face-to-face ones.

The neonate's Cardiopulmonary resuscitation (CPR) is the most important and common emergency condition in the delivery room. Approximately 10% of newborns are unable to initiate effective breathing and require assistance. The aim of this study was to evaluate the frequency of CPR levels of the neonates delivered during a year in Moheb Yas Hospital who were resuscitated.

This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.

There were 2,176 live births during the study. Of these infants , a total of 322 neonates (15.27%) underwent CPR. 51.8% were male. The mean gestational age was 36.08 weeks. The first minute Apgar was less than 5, between 5-7, and above 8 respectively in 10.5%, 33.4%, and 56% of neonates. About 42% of neonates needed initial resuscitation (warming, drying, and respiratory stimulation). 48% required respiratory ventilation with bag and mask, 5% endotracheal tube, 2.7% cardiac massage, and 1.3% needed medication. In 96.7% of cases, the CPR team was ready for resuscitation before delivery.

If resuscitation is performed in a timely and appropriate manner, very few of these infants will need advanced resuscitation. On the other hand, the high need for resuscitation by bags and masks can be secondary to the educational nature of this hospital.

Due to the chronic nature of diabetes, children with type 1 diabetes are prone to a number of long-term complications. One of the most important complications of this disease is cardiovascular involvement due to atherosclerosis, which is directly related to the control of blood lipids. The use of probiotics may be effective in the process of complications in these patients by affecting fat metabolism. The aim of this study was to evaluate the effect of oral probiotics on lipid profiles in children with type 1 diabetes.

This study was conducted at Bahrami Children's Hospital from May 2018 to May 2019. In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes (aged 2 to 16 years) were studied. We created two groups of 26 individuals. The inclusion criteria were determined as follows: Proof of T1DM by history and information of children’s medical record. Also, the Exclusion criteria were determined in this way: Patients consuming probiotics in the last 4 weeks, gastrointestinal infections in the last 2 weeks, and presence of chronic underlying intestinal diseases. The probiotic group received, in addition to insulin therapy, a daily probiotic capsule for 90 days. The control group received only routine insulin therapy. Blood samples were taken to measure lipid profiles at the beginning and end of the trial.

A total of 52 patients were included. The mean age of children was 9.3±2.9 (4 to 14 years). The mean age in the probiotic and control groups was 9.6±3.5 and 9.4±3.0 respectively. The results of this study showed that HDL-C was increased in the probiotic group compared to the control group, although it was not statistically significant (P>0.05). Also, changes in total cholesterol, LDL-C, and triglyceride were not statistically significant

In this study, the use of oral probiotics for 90 days in children with type 1 diabetes did not have a significant effect on blood lipid profiles compared to the control group.

Upper gastrointestinal bleeding is defined as bleeding occuring from a site proximal to the ligament of Trietz, which can present as hematemesis, melena, and hematochezia. Epidemiological studies on pediatric upper gastrointestinal bleeding were limited and its accurate incidence is not clear. This study deals with epidemiological investigation of upper gastrointestinal bleeding in hospitalized children.

This was a cross-sectional-descriptive retrospective study. Medical records of the children under 14 years of age who had been hospitalized in Besat Hospital in Sanandaj for upper gastrointestinal bleeding over the past seven years (2011-2017) were reviewed. Demographic data and endoscopic results obtained from the medical records were recorded in the questionnaires. Using SPSS 20 software, statistical analysis was performed.

Our study included 121 medical records. 64.5% of the patients were male. The mean age of the children was 5.66 years and the duration of hospitalization was 3.13 days. Among the patients, 77% were urban dwellers, 95% presented with hematemesis. 8.3% were treated with mechanical ventilation, and 5.8% had coagulation disorders. Endoscopic results showed that 45.5% of the children had prolapse gastropathy and 15.7% had Mallory Weiss syndrome.

According to our results, the most common manifestation of upper gastrointestinal bleeding in children was hematemesis and the most common cause of it was prolapse gastropathy.

Chronic constipation is one of the most common problems in children. It can cause anxiety and psychological problems in patients and parents. The purpose of this study was to investigate the relationship between obsessive-compulsive disorders (OCD) in children with chronic functional constipation. This is a case-control study performed at the gastroenterology clinic of Besat Hospital Sanandaj for one year. The children aged 7-14-year-old with chronic functional constipation were selected as a case group, and the healthy children were recruited as a control group, who referred for growth control. Then, the Maudsley questionnaire for obsessive-compulsive disorders was completed by a trained assistant. With this questionnaire, the presence or absence of OCD and its type can be determined. Forty-three children were selected as the case group and sixty-seven children as the control group. The mean age of the case and control group was 9.3±1.5 and 8.8±1.6 years, respectively. Based on the results, there was a significant difference between the groups in terms of checking, cleaning, slowness, doubting, and total obsessive score (P˂0.05). Therefore, all five types of obsessive-compulsive disorder in the case group were greater than the control group. Obsessive-compulsive disorders were more common in children with functional constipation, and the total obsessive score in these children than the healthy children was a significant difference.

Acute gastroenteritis is one of the most common diseases in children with a high rate of nausea and vomiting. Drugs such as ondansetron are used to treat vomiting.

The aim of the study was to compare the success rate of oral vs intramuscular ondansetron to reduce vomiting in children with acute gastroenteritis.

A single-blind randomized clinical trial study was conducted on 100 children with acute gastroenteritis. Two groups of patients were created; one group received an intramuscular injection of ondansetron and the other received oral ondansetron. The vomiting rate, hospitalization, and side effects were evaluated 30 minutes, 4, and 48 hours after drug administration.

Fifty-nine (59%) participants were boys. The mean age of the patients was 3.07 ± 2.20 years. There were no significant differences between the groups in terms of age, weight, and rate of vomiting before the treatment was launched. No significant difference between the drug administration route and the outcome of vomiting during the first half, 4, and 48 hours after receiving the drug was found either.

The study showed that the success rate of oral ondansetron did not vary significantly compared to intramuscular injection in terms of reducing the vomiting rate in children with acute gastroenteritis.

Ingested Foreign Bodies (FB) frequently occur in pediatric patients. The most commonly ingested foreign bodies are coins, magnets, batteries, small toys, jewelry, buttons, and bones in decreasing order of frequency. A three-year-old boy referred to the emergency room with incidental ingestion of an ampoule of epinephrine. The radiography data demonstrated the location of the ingested ampoule in the stomach. The upper endoscopy was performed; however, the object had already passed through the pylorus. The following day, he passed the ampoule without complications. Our case was pretty unique because the most commonly ingested FBs in the pediatric population include coins followed by magnets, batteries, and so on. Asymptomatic patients having no dangerous FB could be observed until either presenting something abnormal or uneventfully passing the FB.

Constipation and Urinary Tract Infection (UTI) are common problems in children. The gastrointestinal tract and the urinary system are related together anatomically and functionally. Constipation is one of the possible causes of UTI and its recurrence.

The purpose of this study was to evaluate the association between the duration of constipation and the frequency of upper and lower UTI in children in Sanandaj.

A descriptive-analytical study was performed on children with chronic constipation aged less than 12 years, referring to the Pediatric Gastroenterology Clinic of Besat Hospital in Sanandaj in 2018-2019. Urine analysis and culture were performed for all the patients. Data were recorded in separate questionnaires.

There were 220 children in this study. Most cases of constipation and UTI belonged to the group of 3-6 years. Constipation was more common in boys and UTI in girls. Lower UTI was more common than upper UTI. Besides, 45% of the patients had constipation for less than a year. There was no significant relationship between the duration of constipation and the prevalence and type of UTI (upper or lower) (P = 0.405, P = 0.911).

Urinary tract infection was common in children with chronic constipation. There was no relationship between the duration of constipation and the frequency and type of UTI.

The infantile colic is one of the most common complaints in the infancy; however, limited therapeutic approaches are described in the literature. Recently probiotics have been suggested as a potential strategy in the treatment of infantile colic. We conducted this study to investigate the efficacy of probiotics in relieving colic symptoms in Iranian infants. This double-blind clinical trial was performed among 70 infants aged 3 to 16 weeks with the presumed diagnosis of infantile colic according to Wessel criteria who were breastfed or formula fed. They were assigned at random to receive Pedilact® (Bifidobacterium infantis, Lactobacillus reuteri, and Lactobacillus rhamnosus) (N=33) or placebo (N=32). Demographic data were recorded in the questionnaires at the beginning of the study. The number of daily episodes of crying and fussiness, number of weekly crying days, and duration of crying were separately analyzed on 7, 21, and 30th  days of investigation. Baseline demographic data showed no statistically significant difference between intervention and placebo groups. Infants given Pedilact® showed a significant reduction in daily episodes of crying, duration of crying, and the weekly number of crying days at the end of the treatment period compared with those receiving placebo (P=0.000). On 21th day of the study, daily episodes of fuss and crying (P=0.032) and duration of crying reduced significantly in the intervention group in comparison to the placebo group (P=0.000). Administration of Pedilact® drop significantly improved colic symptoms by reducing crying and fussing times in breastfed or formula fed in Iranian infants with colic.

Background The esophageal atresia (EA) is the most common esophageal congenital anomaly. The aim of this study was to evaluate the predictive factors in the survival of newborns with esophageal atresia. Materials and Methods This was a descriptive-analytic cross-sectional study performed on newborns with esophageal atresia who were admitted at Bahrami children’s hospital, Tehran-Iran, during 7 years (2009-2015). The patient’s information was collected from their medical records and recorded in a checklist. The variables of the checklist included: age, sex, gestational age, birth weight, congenital anomalies, duration of mechanical ventilation, duration of hospitalization, respiratory distress syndrome (RDS), and age at surgery, complications, and cause of death. Then, the relationship between different variables was evaluated with mortality and morbidity and the factors that had the greatest impact on patients' prognosis were identified. The study included 95 neonates with EA. Fifty-three (55.8%) were male. The most common anomalies were cardiac (38.9%), renal (15.8%), and skeletal (9.5%). The most common postoperative complication was pneumothorax (31.6%), pneumonia (25%), and stenosis at the site of anastomosis (21.1%). In this study, 15 children died (mortality rate 15.7%), and the most common cause was sepsis. There was a significant relationship between birth weight and death, pneumothorax (P=0.008, and P=0.037, respectively). There was no significant relationship between gestational age and mortality (P>0.05). There was a significant relationship between major cardiac anomalies and duration of mechanical ventilation and mortality (P= 0.043, and P<0.001, respectively). Conclusion This study showed that neonates with esophageal atresia, low birth weight, major cardiac anomalies and the need for prolonged mechanical ventilation are poor prognosis predictor factors.

 Lead poisoning is a preventable environmental disease, able to produce many problems, including gastrointestinal disorders.

 The aim of this study was to evaluate blood lead levels (BLLs) in children with chronic non-organic abdominal pain, constipation and growth retardation and whether there is a connection between BLLs and these functional disorders.

 In this cross-sectional study, fifty-five children aged 2 - 14 years with non-organic chronic abdominal pain, constipation and growth retardation were selected as a case group. Fifty-five healthy children of the same age acted as a control group. The blood lead level in all children was measured. Lead poisoning was considered when the level was higher than 5μg/dL.

 The mean lead level in the case group (4.34 μg/dL) was higher than in the control group (1.19 μg/dL). There is a significant relationship between BLL and gastrointestinal symptoms. (P=0.0001). Constipation was the most common (38.2%) gastrointestinal disorder. Anemia and living in old housing were most commonly found in the case group (73.9% vs. 12.5%), (43.5% vs. 16.1%), which was statistically significant as well.

 In the study, BLL in children with these disorders was significantly higher than healthy children. In this study, 23 patients had BLLs above 5 μg/dL, all of whom were in the case group. None of the children in the control group had BLL higher than 5 μg/dL. There were significant differences between the groups with anemia and living in old housing. Our patients presented symptoms at lower lead levels (less than 5 μg/dL) than estimated as toxic.
 

Cleft sternum is a rare congenital malformation of the chest cavity. The failure of embryologic fusion of mescenchymal cells in the midline causes the amomaly, leaving the mediastinal viscera exposed to injuries. The defect is usually divided into partial or complete forms and is often accompanied by other anomalies. The etiology and incidence are not yet known. We present a case of bifid sternum with hemangioma of the face.

Non-Steroidal Anti-Inflammatory Drugs(NSAIDs) including Ibuprofen is one of the most currently used drugs in all age groups and finding the relation between upper gastrointestinal bleeding and Helicobacter pylori (H. pylori) in children who used Ibuprofen, is our topic of research.
During the two years of the study, ten children with upper GI bleeding after Ibuprofen were selected as case group and twenty children with upper GI bleeding without history of drug usage were the control group. Their histories were obtained and compared. Helicobacter pylori (H. pylori) infection prevalence and other factors were compared by means of SPSS software, T independent test and chi square, P value less than 0.05 was significant.
H. pylori was detected in 40% of case group and 8% of control group (P= 0.1) haemoglobin (mean ± standard deviation) in case group was lower than control group 10.5±2.1 vs 11.9 ±1.2 g/dl (P= 0.08). This level (Hb) in H pylori infected was 8.3±1.3 vs. 12 ±0.5 (P= 0.0001) in non- infected children.
Upper GI bleeding following Ibuprofen prescription is a complex matter in children. H pylori infection is more common in bleeding episodes following Ibuprofen users which show lower haemoglobin levels compared to non- infected patients.

Netherton syndrome is a rare autosomal recessive disorder consisting of ichthyosiform dermatosis, hair shaft abnormalities and an atopic diathesis that presents as widespread erythematous skin. The aim of these reports is emphasis on the importance of the examination of hair as a diagnose route.
Case 1: A 6 months old boy with respiratory distress and severe erythematous itchy scaling lesions. He had been under treatment of topical steroid without improvement. Case 2: A 28 days old boy admitted for failure to thrive with presentation of extensive dermatologic involvement, severe dehydration and respiratory distress.
Findings: Examination of hair under light microscopy revealed trichorrhexis invaginata, highly suggestive for Netherton syndrome.
In countries where access to genetic diagnostic tests is difficult, hair examination is the best and inexpensive definitive diagnostic method compared to the expensive genetic tests for diagnose of Netherton syndrome.