kambiz eftekhari

Hypotonia in children is an important and common clinical symptom that can manifest in various neurological disorders. It often poses a serious diagnostic challenge for physicians, frequently leading to inaccurate evaluations and unnecessary investigations. The purpose of this study was to investigate the causes of hypotonia, various diagnostic methods, and the final outcomes of these patients. 

Children with hypotonia who were hospitalized in the pediatric intensive care unit (PICU) of Bahrami Children's Hospital and Children's Medical Center during a two-year period (2017-2018) were enrolled. All relevant information, including key points from their medical history, clinical examinations, and paraclinical data that could lead to diagnosis, were recorded. The patients was followed up for two years after hospitalization through phone calls or visits to the neurology clinic. 

Out of 65 children examined, 28 patients (43.07%) had peripheral nervous system involvement, 20 (30.76%) had central nervous system involvement, and 4 (6.17%) had both central and peripheral nervous system involvement. The most common causes for peripheral and central involvement were spinal muscular atrophy (SMA) and syndromic causes, respectively. In 20% of cases however an,  specific underlying cause  was  found. The most common diagnoses were SMA (16.9%) and Guillain-Barre syndrome (13.8%). Finally, 15 children (23.1%) recovered, 31 (47.7%) had neurological sequelae, and 19 (29.2%) died. 

Understanding the underlying causes and outcomes of patients hospitalized with hypotonia in the PICU enhances physicians’ diagnostic skills. It is also useful for selecting effective treatment strategies and avoiding the complications associated with delayed diagnosis.

Allergic rhinitis is a common childhood disease. Although various drugs have been used to treat allergic rhinitis, including nasal corticosteroids, antileukotrienes, and antihistamines, there is still controversy about the optimal dose and the best combination with the highest efficacy. Higher doses of antihistamines are recommended for better control of urticaria, but there is insufficient evidence regarding the efficacy of increased doses of antihistamines in allergic rhinitis. The aim of the study was to evaluate the effectiveness of different drug combinations in the treatment of children with allergic rhinitis. Sixty-four children with persistent moderate to severe allergic rhinitis were enrolled and randomly divided into 4 groups. All children received mometasone furoate nasal spray once daily. In addition to mometasone, each group received one of the following drugs or drug combinations: daily desloratadine, twice daily desloratadine, montelukast, or a combination of desloratadine and montelukast. The severity of symptoms before and after the intervention was evaluated based on the total nasal symptoms score, including sneezing, nasal congestion, nasal itching, and rhinorrhea. Sixty patients completed the study. The reduction of nasal congestion score and total nasal symptoms score in the groups receiving desloratadine twice a day and desloratadine plus montelukast was superior to the daily desloratadine group and daily montelukast groups. According to this work, the treatment of allergic rhinitis with mometasone nasal spray with desloratadine twice a day or with the combination of desloratadine and montelukast was more effective than other treatment regimens.

 The Lung Clearance Index (LCI) serves as a non-uniform ventilation index utilized for monitoring pulmonary function in patients with cystic fibrosis (CF). Lung Clearance Index exhibits higher sensitivity compared to forced expiratory volume in 1 second (FEV1) for early detection of lung disease and does not necessitate active patient cooperation, as required for FEV1 measured through spirometry. Presently, FEV1 is the standard parameter employed for monitoring lung function in CF patients.

 The objective of this study was to assess the correlation between LCI and FEV1 in patients with cystic fibrosis.

 This cross-sectional study enrolled children aged 6 to 18 years with confirmed CF diagnosis, who were referred to the CF clinic at Children's Medical Center Hospital (Tehran, Iran). Participants completed consent forms and subsequently underwent pulmonary function tests. Lung Clearance Index was calculated using the exhaling-D device via the Multiple Breath Washout (MBW) method, followed by FEV1 assessment through spirometry.

 The study included 52 patients with an average age of 12 years, among whom 52% were males. The mean ± standard deviation of FEV1 and LCI were 80.2% ± 25.3 and 8.9 ± 2.8, respectively. A significant inverse relationship was observed between these two parameters in the study (r = -0.49, P = 0.001).

 These findings further underscore the potential utility of LCI, which offers ease of administration and demonstrates high reliability and accuracy compared to FEV1 for monitoring pulmonary function in CF patients.

 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.

Cystic Fibrosis (CF) is a life-threatening autosomal recessive disease. The purpose of this study was to evaluate the value of Polymerase Chain Reaction (PCR) in CF patients with Nontuberculous Mycobacteria (NTM) negative sputum culture.  

This is a descriptive cross-sectional study. The population included all children with CF, aged between 5 - 18 years old, with an NTM negative sputum culture. The patient's sputum samples were sent for smear and culture of NTM, RFLP PCR, and PCR sequence.  

In total, 57 CF patients with negative NTM sputum culture were enrolled. Nine patients (15.78%) had positive sputum PCR for NTM. Among these strains, Mycobacterium simiae was the most common one with 5 cases (8.77% of total positive cases).  

PCR can be used as an alternative diagnostic method for NTM in CF patients with negative NTM sputum culture, always under clinical suspicion of the disease.

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.

Cancer is one of the most common causes of death in children. The aim of this study was to evaluate the effect of parents’ education on the prevention of leukemia in children.

This study was a survey performed in Mahak and Bahrami hospitals in 2019. Checklists were completed in two groups of parents, those who had a child with leukemia and those who had a healthy child. Data were analyzed by SPSS statistical software.

In this study, 365 individuals in the healthy group and 81 in the cancer group participated. More than sixty percent (62.3%) were females. The highest frequency of age in both groups was 31 - 40 years. The highest frequency of parents’ education in the healthy group was associate degree and bachelor (about 51%) and in the cancer group, lowers than associate degree (about 73%). There was a significant relationship between parents’ education and the prevalence of leukemia in children (P < 0.05).

Based on the study, parents’ higher education can be effective in preventing the development of leukemia in children.

There is a possible association between celiac disease (CD) and juvenile idiopathic arthritis (JIA). Our aim was to evaluate the serological incidence of CD in patients with JIA. Children under 16 years of age with JIA who did not respond adequately to routine treatment, who referred to the pediatric centers of Tehran University of Medical Sciences (2017–2019), were enrolled in this study. Manifestations of CD were also evaluated. CD-related serological screening tests were measured. Seventy- eight patients were enrolled in the study. Their mean age was 7.9 ± 3.9 (1.6–16) years. Three patients with oligoarticular JIA had Anti-TTG-Ab levels above normal (prevalence = 3.8%). None of them had symptoms of CD. There were no significant statistical differences in terms of growth disorders, sex distribution, and different subtypes of JIA (P value ˃ 0.05) between the groups (sero- positive vs. sero-negative). In one case, CD was confirmed by pathology and the gluten-free diet was recommended. The absence of CD symptoms in patients with JIA does not rule out concomitant CD.

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.

Bilious vomiting is highly suggestive of an acute and emergent condition among neonates. The aim of this study was to investigate the non-surgical causes of bilious vomiting in neonates admitted to a tertiary center and to compare them with the surgical causes.

This cross-sectional study was performed on 80 infants with bilious vomiting who were admitted at the neonatal intensive care unit of a pediatric tertiary center over 2 years. The demographic characteristics, clinical symptoms and signs, diagnostic assessments and therapeutic approaches were recorded.

The mean age of neonates was 9.07 ± 8.84 days and 55% of them were males. The most common final diagnosis was: Necrotizing Enterocolitis (NEC), duodenal atresia, Hirschsprung’s disease, gastroesophageal reflux disease (GERD), volvulus, sepsis, meconium plug, isolated mal-rotation, metabolic abnormalities, imperforate anus, and Ladd’s bands, respectively. Abnormal findings in ultrasound and X-rays were detected in 35% and 46.3%, respectively. About half of the affected neonates were treated non-surgically. Overall, 17.5% of the patients died.  Most deaths were seen in infants with NEC. Using multivariable logistic regression analysis, the presence of NEC as an underlying etiology was the only predictor of neonatal death in neonates with bilious vomiting (OR = 12.455, 95%CI: 1.365 – 113.618, P = 0.025).

The most common cause of bilious vomiting was NEC followed by duodenal atresia. Half of the neonates with bilious vomiting were treated medically without operation

 In the contemporary century, the media has played a significant role in educating communities.

 The purpose of this research is to investigate the role of national media programs in the prevention of childhood cancer.

 Participants in this research study included ordinary people, parents of children with cancer, and pediatric oncologists. The study was performed for six months (2017) in Bahrami and Mahak hospitals. Participants were asked questions about the role of the media in the prevention of childhood cancer, and their answers were recorded in a questionnaire.

 The results showed that, while ordinary people evaluate the role of national media programs, their simplicity and comprehensibility in the prevention of childhood cancer as desirable, parents of children with cancer consider this program’s comprehensibility as low. Physicians also considered the influence of the contents of radio and television programs as low but their simplicity as desirable.

 Our study confirmed the effectiveness of national media programs in the prevention of childhood cancer. The level of education of parents was effective in understanding media education in the prevention of childhood cancer.
 

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.

Benign esophageal strictures are not rare. Over the past two decades, endoscopic balloon dilatation (EBD) has been used to treat them.

The purpose of this study was to identify the most common causes of benign esophageal stricture in children determine the success rate of endoscopic balloon dilatation.

Children younger than 16 years with benign esophageal strictures referred to the endoscopy department during one year (2016 - 2017) were enrolled. After obtaining written consent from parents, endoscopy balloon dilatation was performed with two types of balloon catheters. Response to treatment was evaluated based on clinical symptoms and was classified according to the Vantrappen table score.

In this study, thirty-one (31) children participated including 19 (61%) boys and 12 (39%) girls. The mean age was 5.1 ± 3.9 years. The most common causes of esophageal stricture were: achalasia (45%), esophageal atresia (19%), stenosis due to the caustic ingestion (19%), another congenital stenosis (16%). Overall, 27 children (87.1%) had a good response to treatment. In children with stenosis due to caustic ingestion, the inappropriate response was higher than the rest (33%). However, only in 4 (12.9%) patients, balloon dilatation failed. No complications were observed.

Achalasia, esophageal atresia, and caustic ingestion are the most common cause of benign esophageal stricture in the children. EBD is an effective and safe treatment in these children, even in cases of previous surgery and recurrence. If this procedure is performed by an expert using appropriate balloon catheters, no complications will be created.

Excessive and irrational use of antibiotics in the treatment of acute diarrhea has caused increased resistance to these medications. It is well defined that most cases of diarrhea in children do not require the use of antibiotics. This study was aimed to determine the status of antibiotic administration for treatment of acute diarrhea in children younger than five years. All who admitted at the pediatric ward of Besat Hospital in Sanandaj.

First, the study was approved by the ethics committee of Kurdistan University of Medical Sciences. The archived files of all children under 5 years with a positive history acute diarrhea who were admitted in Besat Hospital of Sanandaj during the period of 1 years, from May 2016 to May 2016 were reviewed. Demographic information such as age, gender, type of diarrhea, type of nutrition, type of the prescribed antibiotic, results of the stool and blood samples were collected and recorded in the questionnaire.In Stool samples the contained a large number of WBCs and RBCs along with high fever, Shigellosis were considered. The results were analyzed by SPSS software, version 23 (SPSS Inc., Chicago, IL, USA).

A total of 1,029 cases were reviewed. 60% were boys. The highest incidence of diarrhea (75.5%) was observed at 12-24 months and the lowest rate of diarrhea was under 6 months (11.5%). The frequency of diarrhea was lower in winter than in other seasons. Only 31.49% of children received proper and rational treatment with antibiotics. The most commonly used antibiotics in hospitalized patients were ceftriaxone (94.5%) and before hospitalization was cefixime (39.5%). Based on the results of this study, it was found that 66.13% of children younger than 5 years with acute diarrhea had appropriate treatment. 31.94% of patients had inappropriate antibiotic therapy.

In most cases of acute diarrhea in children, no evidence of bacterial or parasitic infection was found. However, a high percentage of patients received antibiotics without laboratory evidence (stool testing).

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.

Celiac disease is an immune-mediated systemic disease, in which gluten ingestion causes different symptoms. HLADQ2 is positive in 90% - 95% of celiac patients. HLA has been considered to inhibit antibody production against the hepatitis B virus vaccine. Considering that celiac disease affects about 1% of the population, this phenomenon could be a significant factor in immunization programs. On the other hand, HLA-DQ2 positive patients not only are at the risk of HBV infection themselves but also have the potential to be an important source of HBV dissemination in the world.

This study was carried out to evaluate the responsiveness of celiac-affected children to HBV vaccination in Iran.

This case-control prospective study was performed on 62 Iranian children (31 children with confirmed celiac disease before introducing a gluten-free diet and 31 healthy children). HBS Ab (antibody against hepatitis B virus surface antigen) titer was checked in the patients and compared between the two groups.

It was shown that 67.7% of cases and 64.5% of controls had HBS Ab titer above 10 mIU/mL, but the difference was not significant statistically. After matching for the time interval from the last HBV vaccination, it was observed that although non-significantly, celiac disease can decrease the chance for anti-HBS production up to 30%.

This study did not confirm non-responsiveness against the HBV vaccine in celiac disease in children. This may be due to genetic factors or type of vaccine. Moreover, in our study, responsiveness was assessed qualitatively in the two groups (HBS Ab > 10 mIU/mL was considered as a responder).

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.

Escherichia coli (E. coli) is considered to be the most common cause of urinary tract infections (UTIs) worldwide. Due to the recent rise in bacterial resistance to antibiotics and the appearance of multidrug-resistant E. coli, treatment options have been significantly limited, thus increasing the cost of treatment as well as morbidity and mortality rates, especially in developing countries. This study aimed to identify the antibiotic susceptibility patterns of E. coli for use in early empirical treatments and cultures of negative UTIs caused by previous antibiotic usage.

In the present study, 704 urine samples with a positive culture of E. coli were evaluated in terms of susceptibility to gentamycin, nitrofurantoin, ceftazidime, cefixime, meropenem, cefepime, azithromycin, ceftriaxone and ciprofloxacin using the Kirby-Bauer disc diffusion method. Data were collected based on age, sex, and hospitalization or ambulatory patient status. Data were analyzed using SPSS 22.0.

E. coli showed the lowest resistance to nitrofurantoin (4.5%) and the highest resistance to cefixime (34.9). There was a statistically significant relationship between antibiotic resistance and age, gender, and hospitalization status

Because of the high resistance rate of E. coli to cefixime, precautions should be taken before using cefixime to treat UTIs.