اطفال

Rectal prolapse, characterized by the extrusion of the rectal mucosa through the anal sphincter, is a relatively rare condition in children. This condition can be attributed to several anatomical and functional factors. This study aimed to investigate defecation habits in children with rectal prolapse.

This retrospective study was conducted from 2017 to 2021 in Akbar and Sheikh children's hospitals. The study population included 50 children under the age of 14 who were diagnosed with rectal prolapse and visited the hospitals. Data were collected using pre-prepared checklists and analyzed using SPSS version 24. Inclusion criteria were children under 14 years diagnosed with rectal prolapse, while exclusion criteria included incomplete data or other severe unrelated health conditions.

The results showed that 67.4% of the sample were boys, and the most affected age group was children under 2 years (38.8%). A total of 57.1% of the children had daily bowel movements, and 68.2% reported consistently hard stools. Additionally, 48% of the children experienced pain or burning during defecation.

The findings of this study indicate that children with rectal prolapse often face challenges related to stool consistency and defecation pain, despite having frequent bowel movements. These results emphasize the need for targeted interventions to improve stool consistency and manage pain to effectively prevent and treat rectal prolapse.

Diabetic neuropathy (DN) is one of the most common complications of diabetes which causes disability and mortality. Nearly half of patients with diabetes develop DN. A few studies have been conducted to evaluate the prevalence of DN in children. More than 90% of diabetic children have type 1 diabetes mellitus (T1DM). The most accurate way to diagnose neuropathy is NCV. Accordingly, the present study investigates the prevalence of DN in children with T1DM by clinical symptoms, neurological examinations, and NCV.

This cross-sectional study was conducted between 2021 and 2023 after approval. Patients (younger than 18 years old) with T1DM, diagnosed for at least 5 years, and not suffering from other diseases such as hypothyroidism and neuromuscular diseases were included. Children who were not willing to undergo NCV were excluded from the study. Demographic data of patients (age, gender, weight, height, body mass index (BMI), and duration of diabetes) were collected. Neurological symptoms were evaluated using the neuropathy symptom score (NSS). Patients were asked about tingling, burning, numbness, fatigue, cramping, and pain in the lower extremities. The clinical history of the patients, including HbA1c levels, blood pressure, retinopathy, lipodystrophy, nephropathy, history of diabetic ketoacidosis, and daily insulin dosage, was evaluated. The Achilles reflex was evaluated using the case reflex hammer and peripheral nerve function through 10g monofilament in patients. Patients who met the inclusion criteria of the study underwent NCV. NCV was performed by a specialist in physical medicine and rehabilitation. In NCV, peroneal, tibial, and sural sensory and motor nerves were performed in both lower limbs, and median and ulnar sensory and motor nerves in both upper limbs.

In the present study, 32 patients with T1DM met the study criteria. The mean age was (14.16±2.55 years), height (154.28±8.96 cm), weight (44.88±12.32 kg), and BMI (18.55±3.787) of the patients. The mean duration of diabetes in the studied patients was 7.1±2.428 years. The mean HbA1c was 9.54%±1.941. The mean NSS was 2.94±2.862. The NSS results showed that 18.75% (score: 3 or 4), 31.25% (score: 5 or 6), and 6.25% of patients had mild, moderate, and severe symptoms (score: 7 to 9), respectively. The blood pressure of the examined patients was in the normal range. The most common complications of type 1 diabetes mellitus in patients were lipodystrophy (21.87%), nephropathy (12.5%), and retinopathy (3.12%). The results of Achilles reflex evaluation revealed no disorder in any of the patients. Only one (3.12%) of the studied patients was diagnosed with peripheral nerve disorder in the evaluation by monofilament. However, the NCV results of this patient showed that the patient did not have peripheral neuropathy.

We found that the prevalence of DN in children and adolescents with T1DM is very low. Our results, similar to those of other studies, showed that a mere clinical evaluation and having DN symptoms are not sensitive enough to diagnose DN. Further investigation through a standard test (NCV) is needed in this regard. Based on the results of the present study, NCV is not recommended for T1DM patients under 18 years of age, whose 10g monofilament results were also negative. A limited number of patients were evaluated in the present study and it is necessary to conduct studies with a larger population.

Dear Editor,
With the global spread of the COVID-19 pandemic, symptoms such as fever, cough, myalgia, and fatigue, along with laboratory findings of leukocyte count abnormalities and chest radiographic evidence, have been reported as nonspecific symptoms in various variants. Fever was the most common symptom in all variants of the SARS-CoV-2 virus, although evidence suggest that children with the beta variant experienced less fever. Other manifestations, such as diarrhea, vomiting, abdominal pain, and dizziness, have been less common, but may sometimes be the only symptom. In a systematic review on the characteristics of infants with SARS-CoV-2 infection in England, it was reported that the main symptoms at presentation were heatstroke, poor feeding, vomiting, respiratory symptoms, crysis, and lethargy. The clinical symptoms of COVID-19 in children vary depending on the virus variant and correspond to the World Health Organization peak variants of concern. Therefore, clinical guidelines are recommended to perform protected deliveries and reduce the possibility of contracting Covid-19 during delivery and after delivery in infected pregnant women. Standardized testing protocol, avoiding mother-to-child transmission, and providing the best treatment for symptomatic infants are central issues in the management of infections in infants and children with suspected or suspected COVID-19. It is better to use breast milk in the form of expressed milk or powdered milk. PCR-positive neonates should be admitted to a negative pressure isolation room and provided with intubation or airway management services.

 Diabetes mellitus is a group of chronic metabolic diseases with increased blood sugar. In various studies, the association between diabetes and hematologic parameters has been investigated. Diabetes mellitus may lead to different hematologic abnormalities.

A complete blood cell count is more available than hemoglobin A1C, in this study we summarize the hematologic changes in type 1 diabetes. The reasons and association of different changes with the prognosis will be discussed. 

This study is a review article based on a search with the keywords in medical-scientific databases, including PubMed, Scopus, MEDLINE, and Google Scholar, from 2000 to 2023. All articles were evaluated, and 50 articles were selected as the primary study sources.

The mean of red blood cell count, hemoglobin, and hematocrit were less in the diabetic group in comparison to healthy patients. Recent studies show an association between anemia and with development of diabetic nephropathy. Diabetic patients have higher red cell distribution width compared to healthy individuals. Mean platelet volume and platelet distribution width are higher in children with type I diabetes compared to healthy children. Studies showed that patients who have recently been diagnosed with type 1 diabetes mellitus have higher leukocyte and neutrophil counts. Also, there is a positive correlation between increased leukocyte and hyperglycemia.

The occurrence of blood cell changes in children with type 1 diabetes is related to the prognosis of the disease. Since hematological tests (complete blood cell count) are available, the use of these tests is helpful for early detection of complications.

Periodontal inflammatory disease is one of the most common chronic inflammatory diseases that can affect individuals of any age. The results of some studies have shown that both type 1 (T1DM) and type 2 diabetes may be associated with an increased risk of periodontal inflammation. Inflammatory status and vitamin D deficiency create a suitable environment for the progression of chronic diseases such as diabetes and periodontitis in children. This study aimed to investigate the association between vitamin D levels and gingivitis in children with T1DM.

This case-control study was conducted in the city of Ilam to examine the association between 25-hydroxyvitamin D (25(OH)D) levels and gingivitis in 148 children with T1DM. The case-control group was randomly selected from all children aged 6 - 12 years. Participants were classified into two groups, healthy and T1DM, based on the presence of gingivitis. Fasting blood sugar, calcium, and serum 25(OH)D levels were assessed in this study.

The results of the Mann–Whitney showed that 25(OH)D levels were significantly lower in the group with gingivitis (20/72±12/77) compared to the group without gingivitis (29/57±10/72) (p<0.05). In addition, there was no statistically significant difference in the level of 25(OH)D according to gender between the group with gingivitis and the group without gingivitis (p=0.673 and p=0.350). Also, the results of the chi-square test showed that there was no significant difference between the two groups with gingivitis and those without gingivitis in terms of gender and age distribution. (p>0.05)

The results of this study show that vitamin D deficiency is an effective factor in high gingivitis in children with T1DM. Timely monitoring of the level of this vitamin in patients with gingivitis is essential.

Sleep disorders are the most common behavioral complaints in children. Signs and symptoms of inadequate sleep in children are different from those in adults and may manifest as mood swings, activities, and excessive attention span and neurological disorders. The aim of this study was to investigate sleep disorders in children referred to pediatric clinics and its relationship with maternal insomnia in Baharloo Hospital in 1397-98.

This is a cross-sectional study of analytical-descriptive type. The statistical population includes children aged 2 to 12 years referred to Baharloo Hospital who were included in the study as a sample by considering the inclusion criteria of 303 people. Data collection tools include; The BEARS questionnaire was used to assess sleep disorders in children and the ISI questionnaire was used to assess maternal insomnia. Data were analyzed using descriptive statistics and T-test.

The results showed that among children aged 2 to 12 years, 74 mothers had insomnia according to the sleep questionnaire. The mother had a daughter and 38 mothers had a son. But insomnia mothers were higher in percentage among mothers of female children (44.4%) (p <0.05). There was also a significant relationship between children who have trouble going to bed at night and who have an insomniac mother. Among sleepless mothers (n = 74), 27 children (36.5%) had difficulty going to bed at night, which was higher in terms of both number and percentage of children of mothers with normal sleep (p <0.05). .

Hypoglycemia is one of the most important possible side effects of fasting in children who need surgery, and its prevention is very important. This study was conducted in order to investigate and compare the oral administration of 5% dextrose and intravenous infusion of 1.3, 2.3 sugar-salt serum on the blood sugar levels of 6-2-year-old children who were candidates for minor surgery under general anesthesia.

In this randomized clinical trial study, 66 children aged 2-6 years who were candidates for minor surgery under general anesthesia at Hazrat Ali Asghar Hospital in Tehran were selected as available and randomly selected in one of two The group under oral administration of 5% dextrose (intervention group) at the rate of 10 cc/kg 2 hours before the operation or continuous intravenous injection of 1.3, 2.3 sugar saline serum (control group) according to the formula 4, 2, 1 direction Calculation of the volume of venous fluids were divided while fasting, and their blood sugar levels were measured and compared on two occasions (immediately after induction of anesthesia and then half an hour later).

In this study, the average blood sugar immediately after induction of anesthesia was 88.75 in the group receiving oral dextrose and 85.77 in the group receiving saline serum, and there was no significant difference between the two groups (P=0.554), but the average blood sugar half an hour later of induction of anesthesia was 79.75 in the group receiving oral dextrose and 64.84 in the group receiving intravenous sugar-salt serum, which was significantly higher (P=0.36).

 based on the results obtained in this study, it is concluded that the oral administration of 5% dextrose has an equivalent role to the intravenous infusion of sugar-saline serum in preventing the occurrence of hypoglycemia in 2-6 year old children who are candidates for surgery. It can be used as a suitable alternative to intravenous serum in children.

This study was aimed to investigate the radiological (deformity) and clinical outcomes following two types of medical or surgical treatment in children with spinal trauma.

This study was conducted as a retrospective cohort study containing patients of a 13 years period (2007-2019). Patients under 18 years of age who underwent medical or surgical treatment in one trauma center due to spine trauma in the thoracic and/or lumbar parts were evaluated and followed up. Demographic characteristics, mechanism of injury, clinical, radiological conditions and type of treatment were extracted from medical records. At the time of follow-up, after evaluating the neurological status and spine imaging, the primary and secondary characteristics of the patients were compared.

A total of 79 patients with an average age of 14.36 ± 3.5 years were included in this study and were followed up for an average of 36 months. The fracture was single level in 42 patients and the most common form was compression. Primary neurological deficit was present in 14% of patients, of which 2.6% had incomplete deficit and the rest had paraplegic manifestations. Thirty eight patients were treated surgically. More than one third of patients with neurological deficit at initial examination, finally had neurological improvement and were able to perform personal activities without dependence. Finally 2.53% of patients had scoliosis at the time of follow-up. Scoliosis was more common in patients who underwent surgery. Multiple level fractures was associated with lower amounts of thoracic kyphosis.

It seems that it would better to use Thoracolumbar Injury Classification and Severity Scale (TLICS) with a more surgical threshold for decision making.

Nephrogenic adenomas in children, similar to adults, are rare benign lesions that often occur in patients with a history of previous surgery or chronic irritation of the urinary tract. These lesions often appear with hematuria and appear as polypoid or papillary lesions in cystoscopy and may have a differential diagnosis with malignant lesions. Most of the patients have a history of bladder augmentation, recurrent urinary tract infections, and urinary stones. So far, no case of nephrogenic adenoma has been reported in children following vesicostomy site prolapse.

Case Report: 

We report a case of nephrogenic adenoma in the bladder of a 2-year-old boy with a history of vesicostomy and vesicostomy prolapse and repeated surgery on the bladder. Vesicostomy was performed due to bilateral vesicoureteral reflux and posterior vesicoureteral valve. After performing two surgeries to correct the vesicostomy site, the vesicostomy was closed at the age of 18 months following resection of the posterior urethral valve, and in the follow-up ultrasound at the age of 2 years, a 2 cm mass was seen in the posterior wall of the bladder, and in the pathology report of the resected mass Nephrogenic adenoma is reported.

Prolapse of the vesicostomy and continuous irritation of the bladder mucosa can cause nephrogenic adenoma in the child's bladder.

Early diagnosis of jaw lesions is of great importance, especially in children. The aim of the present study was to investigate the frequency of jaw lesions in panoramic radiography of children (5-12 years old) in north of Iran.

In this study, 1000 panoramic images of children attending oral radiology centers (2012-2019) in north of Iran were studied during one year. Information, including the age, gender, and presence or absence of any jaw lesion were extracted from the radiographic images of patients. Data analysis was carried out in SPSS V22 applying Chi-square.

Out of 1000 panoramic images, 188 (18.8%) were found with jaw lesions. The mean age of children with these lesions was 8.64±2 years. Radiolucent lesions (in 185 images) were more frequent than radiopaque lesions.

Radiolucent lesions were more of periapical lesions.

Non-pharmacological treatments are methods to control a child's pain during various therapeutic procedures. Many studies have suggested different methods for this purpose. However, a study has not yet examined what is appropriate for each age group.

The present systematic review study was conducted based on the PRISMA guideline for review studies. This study was conducted to review controlled clinical trial studies evaluating the effectiveness of any non-pharmacological intervention (during painful intervention) compared to routine care to improve children's experience of pain. A systematic search of the literature reviewed by two of the researchers in this study was conducted by 2020. The search was conducted on PubMed, the Cochrane Library, and the Web of Science, Scopus, and Science direct. The modified Jadd scale was used to evaluate the quality of the studies. Microsoft Excel was used to extract study details.

The results of a pilot study showed that there was a great deal of heterogeneity in the types of tools used as a non-pharmacological method of pain control and the tools used to evaluate the patient's experience; Therefore, the synthesis of the findings was not done quantitatively. In the present study, 24 studies with a total of 2653 participants were reviewed. In the case of preterm infants, 5 studies were performed with a total of 378 infants. The studies that examined term and infant infants were three studies with a total of 460 term or infant infants. A total of 16 studies were reviewed involving 1,815 children (toddlers, early childhood children, middle-aged children, and adolescents). More taste stimulation and sucking were appropriate for premature infants. Mother's arms were a good option for term babies. In higher age groups, different deviation methods showed good performance; But the results for music playback have been conflicting.

The present study showed that the use of different methods of pain control should be selected according to the age of the child and due to the existence of different options with appropriate performance and the absence of risk in the use of non-pharmacological methods, according to the circumstances. The child should use one or more appropriate distraction methods.

Trauma is one of the most important preventable causes of child mortality and morbidity around the world and in Iran. Given the vulnerability of children, knowledge of epidemiological information regarding trauma in this age group helps to carefully plan for preventing these events. Therefore, this study was performed to evaluate the epidemiology of trauma in children under 5 years of age referring to the emergency department of Imam Reza Hospital in Birjand.

This descriptive epidemiological study was performed on 415 children under 5 years old, who referred to the emergency department of Imam Reza Hospital in Birjand from March 2021 to March 2022 due to trauma. Using a checklist, the patients’ demographic information including: age, sex, number of children in the family, parents’ education level, parents' marital status, mother's job, mother's age, the presence of a disabled person in the family, and Type of home (apartment, house), as well as the cause, time, and place of the trauma, the pattern of trauma, and the anatomical site of the trauma were gathered in an interview with the child. Finally, the outcome of trauma at the time of patient’s discharge was evaluated and then, SPSS Software version 20 was used to perform descriptive analysis on the obtained data.

Data of 415 children were gathered. 249 cases (60%) were boys, 164 cases (39.5%) were at the age of 5 years, 332 (80%) had siblings, 220 (53%) were injured between 4 pm and midnight, in 223 cases (53.7%) trauma had occurred at home, 238 (57.3%) traumas were due to falling, 364 cases (87.7%) had blunt traumas, 186 cases (44.8%) had sustained head and face injuries. Parents of 394 cases (94.9%) were still married, 132 mothers (31.8%) and 128 fathers (30.8%) had education higher than high school diploma, 361 mothers (78%) were housewives, and 242 mothers (58.3%) were more than 35 years old. In 404 families (97.3%), there was no disabled person and 241 cases (58.1%) lived in houses that had a yard. 344 cases (82.9%) were discharged from the hospital with complete recovery.

Since the traumas had most commonly taken place at home and due to falling, dangers for children can be prevented by safeguarding houses and improving the awareness of parents.

Complex partial seizures are known as focal seizures with impaired awareness. Excluding the first year of life, complex partial seizures are the most frequent type of seizures in patients with epilepsy. A detailed history of the patient and family members is a vital element in diagnosing seizures. Although rare, psychotic and anxiety symptoms in individuals may be the result of the seizure. A 7-year-old boy referred to our hospital emergency room complaining of fear, crying, screaming, and the imminent death sensation and decreased consciousness. The patient's symptoms started two years ago. He was treated with Risperidone and with the impression of ADHD and anxiety disorder. The patient's laboratory tests were unremarkable. A brain MRI was performed with a seizure protocol, with no pathological findings. EEG was then performed for the patient, which confirmed focal seizures with impaired awareness. The patient was prescribed carbamazepine and phenytoin, and Risperidone was stopped.

Hemodialysis can have adverse effects, such as increased blood phosphorus in these patients. Considering the fact that hemodialysis does not affect the blood phosphorus in dialysis patients and in order to improve the quality of life in these patients, this study was conducted to determine the incidence of hyperphosphatemia and its reduction strategies in children undergoing hemodialysis.

This descriptive cross-sectional study was performed on 30 children undergoing hemodialysis in Sheikh's Children's Hospital in Mashhad. The incidence of hyperphosphatemia was measured by blood test of the patients. Data were collected using a questionnaire and analyzed by SPSS software.

In this study, 30 children were studied; 36.7% were girls and 63.3% were boys. 86.7% were hemodialysis for 3 sessions per week. The mean serum concentration of phosphorus in the first three months of the year was 6.8 mg / dl and the second quarter of 97 was 35 mg / dL.

According to the results of the second quarter of 1997, the mean serum concentration of phosphorus in children undergoing hemodialysis increased by 28.2 mg / dl compared to the same period of the first month of the year. This is while the calcium and phosphorus product, which is more important, has been reduced by 3.4 mg / dl after corrective action; therefore, this diet can be partially offset by increasing the amount of phosphorus in the blood.

The principle of individualization of punishments is considered as one of the basic principles of criminal law systems that are very closely related to fundamental human rights. The purpose of this study is to investigate the principle of individualization in relation to the criminal process related to children and adolescents.

This research is theoretical type; the research method is descriptive-analytical and the method of data collection is library, which was done by referring to documents, books and articles. Ethical Considerations: In this research, while observing the authenticity of the texts, honesty and fidelity have been observed.

The findings of the present study show that non-binding UN documents, due to their high flexibility and inspiration from international human rights norms and principles, are highly consistent with the structures and norms of domestic systems in terms of content.

Non-binding UN documents relating to children and adolescents in prison generally seek to prevent violations of the law by them. They also improve the treatment of children and adolescents accused or suspected of violating the law. Finally, by supporting children and adolescents deprived of their liberty, strengthening of the aggression and delinquency of them has been prevented, so that children can be reformed and return to their community and family.

Not only do parents become anxious when their child is admitted, but this feeling may continue after the child is discharged from the hospital. The aim of this study was to evaluate and compare the anxiety of parents of children before surgery.

This descriptive cross-sectional study was performed in 2019. In this study, 66 parents (parents) of children were randomly enrolled in the study before surgery. Data collection tools were a researcher-made demographic questionnaire and Spielberger State-Trait Anxiety Inventory, which was completed by participants the night before the operation.

The mean age of mothers was 32±6.6 years and their fathers were 36.3±7.8 years. The majority of children were girls (59.1%) and were in preschool (57.6%). In terms of hospitalization history, most of the studied units had no previous history. There is no significant difference in the mean score of anxiety between mothers and their spouses at all levels except the level of very severe anxiety. And only 4.5% of fathers had severe anxiety. Also, there was no significant difference between parents in terms of hospitalization history (P> 0.05).

Group or individual training of parents with children the night before surgery, the presence of parents in the operating room before induction of anesthesia and after surgery in the recovery room will have a significant effect on reducing parent-child anxiety

Endoscopy is an invasive and painful procedure. The use of sedatives, especially in children, is expanding. The aim of this study was to compare the sedative effects of ketofol and the combination of midazolam-ketamine in upper endoscopy in children aged 1 to 14 years who referred to Taleghani Hospital in Gorgan.

In this study, 55 children entered the study 1 to 14 years after obtaining parental consent. They were then divided into two groups, ketamine-propofol (KP) and ketamine-midazolam (KM), by simple randomization. At all stages of the work, patients underwent cardiac and respiratory monitoring. All hemodynamic parameters and ramsy sedation score (RSS) were recorded for all participants in the 5 time periods before, during and after endoscopy. ANOVA test and bonferroni tracking test were used in spss software to analyze and compare data.

54.5% were male patients. The ANOVA test showed that the scores of the two groups at the time of the study had a statistically significant difference (p=0.02). In the KM group, the mean blood pressure and heart rate of patients increased at all times compared to before the intervention (p=0.005). Blood pressure in the KP group had a steady trend over time (p<0.001).

There was a statistically significant difference between the scores of the two groups and the group (KM) had higher scores, but the use of two drug regimens Propofol-Ketamine and Ketamine-Midazolam caused a good sedation in pediatric endoscopy. The propofol-ketamine compound resulted in greater hemodynamic stability in cardiovascular parameters during and after endoscopy