International Journal of Pediatrics
Volume:4 Issue: 35, Nov 2016

Gonad shielding has been recommended during pelvic x-rays since the 1950s. The popular method of gonad shielding is placement a lead shield in the midline of the pelvis. The aim of this study was to evaluate the prevalence and utility of gonad shielding in pediatrics undergoing pelvic x-rays.
Following study approval, we retrospectively retrieved data from the digital image library of ten radiology depertments of Khuzestan provience-Iran to identify pediatric patients who underwent pelvic x-ray (anteriorposterior [AP] view). All the images were reviewed for the probable evidence of gonad shield. If there was evidence of shielding, the accuracy positioning of the shield was also investigated by a single assistant radiologist.
In all 1745 pelvic x-rays (942 girls and 803 boys) were identified of which the shield was present in 51 (5.41%) radiographs of girls and 132 (16.43%) radiographs of boys. When a shield was present; the shields has adequate positioning only in 8 (15.68%) radiographs in girls and 59 radiographs in boys. Inaccurate placement and absence of gonad shields were more common in girls than the boys. Due to the shield has concealed the anatomical criteria of the pelvis, retakes of the examination was required in 11 (21.56%) radiographs of girls and 14 (10.6%) radiographs of boys.
The current methods of gonad shielding in girls pelvic x-ray was not effective nor is justifiable. We no longer advocate of gonad shielding during girls pelvic x-ray. However in boys it is controversial and depends on the skill and effort of radiographers.

Diabetes type I (DTI) is one of the most common endocrine disorders during childhood and adolescents in which has strong impact on physical and emotional development of individuals with family members. We aimed to evaluate of stress, anxiety and depression in parents with DTI child compared with parents with healthy child.
In this case – control study, 60 parents of patients with type 1 diabetes, who had referred to the endocrine clinic of Ali Asghar hospital in Zahedan city and the same number of parents with healthy children, who had referred to the hospital for their children's routine checkup, as control group (n=60), were studied. Depression, anxiety and stress was measurement by Depression Anxiety Stress Scale 42 (DASS). Data were analyzed using SPSS-16.
Mean age of children was 6.3 ± 3.6 years. In this study, the score and rate of depression in parents of children with diabetes type I was 21.4 ± 13.8 and 75.4%, respectively. The scores of depression, anxiety and stress in parents of children with DTI were 21.4 13.8, 18.8 11.3 and 27.1 11.5 respectively. Also, the scores of depression, anxiety and stress in parents with healthy children were 14.8 ± 11.3, 8.7 ± 6.9 and 15.8 ± 9.3, respectively; and these scores was significantly lower in control group (P0.05).
Diabetes in children is a stressful event that can affect the public health of parents. Parents of children who diagnosed with DTI, are at risk for experiencing anxiety, depression and stress.

Enterobius vermicularis (formerly Oxyuriasis vermicularis), is a prevalent parasitic infection especially in preschool children worldwide. The present study aimed to explore the prevalence of Oxyuriasis and its influencing factors in kindergartens.
A cross-sectional study was conducted on 175 children using multi-stage sampling method in Ali Abad-e-Katoul city- Iran in 2015 year. Data were collected using a three-part demographic questionnaire including personal characteristics, predisposing factor of infection, and clinical symptoms. Possibility of infection was tested by Graham method. Data were also analyzed using SPSS software (version 18). Significant level was also considered significant as The mean age of students was 6.30 ± 0.46 years. In total, 175 samples including 96 (54.9%) female were explored, and 109 (62.3%) of samples were lived in the rural areas. Oxyuriasis prevalence was 34.9% in 61 children. Logistic regression model indicated that rural children had 2.62 times greater chance to infect by Oxyuriasis than children of the urban area (Odds Ratio [OR]: 2.62; Confidence Interval [CI]: 1.17 - 4.83, P Oxyuriasis vermicularis infection was more prevalent than most of studies conducted in the country (Iran) and in the rural children. Hence, appropriate interventions to reduce the infection especially among rural children through parents education and group treatment in the kindergartens seem likely lucrative.

To develop the culture of breastfeeding, it is needed to know the level of maternal knowledge. Hence, the aim of this study was to evaluate maternal knowledge and attitude toward exclusive breastfeeding in six months after birth in Shiraz, Iran.
This was a cross-sectional study carried out on mothers who referred to health centers. Four health centers were selected from four geographic areas of Shiraz city; finally, 201 mothers was selected and their demographic information and knowledge and attitude toward exclusive breastfeeding were gathered through a researcher made questionnaire. Data were analyzed using SPSS version 14.0.
201 mothers who were 18-45 years old were studied. 43% of them were 30-34 years old. 46% of maternal education level was bachelor andMaster of Science or more and 80% of them were housewives. Their level of knowledge was low (69.2%), moderate (11.4%) and high (19.4%) respectively. Regarding the level of attitude 11.4% of them were low, 15.4% of them were moderate and the others were high. There was a significant relationship between maternal knowledge with parents’ education and infants’ nutrition (breastfeeding) (PAlthough maternal attitude about exclusive breastfeeding was good, but maternal knowledge about breastfeeding was low. So, this problem leads them to initiate and continue breastfeeding with serious challenges. Therefore, health policy makers should train mothers to improve their knowledge for breastfeeding promotion.

Resistin is reported as an antagonistic hormone of insulin and in the literature. Nowadays, importance of resistin is being more highlighted in the metabolism of mother and fetus during pregnancy. This study aimed to assess the level of resistin in the umbilical cord and blood sugar at birth and evaluate the association of resistin and neonatal birth weight.
This case-control study included 80 term and 80 preterm neonates. 5ml blood sample for measurement of resistin and glucose was obtained from cord blood. Neonatal birth weight was measured by standard method. Association of resistin and neonatal birth weight was evaluated.
Cord blood resistin was 27.1 ± 32.2 and 21.9±9.8 ng/ml in preterm and term neonates, respectively. There was not a significant differences between Resistin and birth weight (P>0.05). Blood sugar was 78.1 ± 23.6 and 79.5±19.8 mg/dl in preterm and term neonates, respectively. Cord blood Resistin and blood sugar did not differ in term and preterm neonates (P =0.158 and P= 0.165, respectively).
The present study did not reveal any significant differences in resistin level between the term and preterm neonates. Blood glucose was nearly the same in both groups, and resistin did not show any significant correlation with birth weight.

Oral-dental diseases, especially tooth decay, are among the most common diseases in the world which usually begin in adolescence. Oral health during this period of life has a huge impact on the reduction of dental problems. This study aimed to determine motivating and inhibiting factors to oral-dental health behavior in adolescents.
This cross-sectional which had a descriptive and analytical design was conducted on 10-12th grade students in Kashan city, Iran. Using multi-stage sampling method and based on sampling size formula, a total of 290 of the students were randomly selected from the schools and were enrolled into the study. Then they received a research-made questionnaire containing questions about the knowledge and motivating and inhibiting factors to oral-dental health behavior. The collected data were analyzed using SPSS V.20 by independent t-test, ANOVA, and Pearson correlation coefficient.
Of all, 62.8% of students brushed their teeth at least once a day. Moreover, 11.7% used dental floss once a day and 6.6% visited a dentist every six months. Oral-dental health behavior had a significant relationship with gender (P0.05).
When designing educational plans and interventions for improving oral-dental health behavior in students, it is necessary to adopt measures to enhance motivating factors and eliminate inhibiting factors.

Tracking of blood pressure from early life to adulthood and the increasing prevalence of elevated blood pressure in the pediatric age group are considered as important health issues. Rapid lifestyle change and dietary habits are considered as important determinants of this problem. This study aimed to systematically review the studies on the association of dietary habits and blood pressure in the pediatric age group.
The search was conducted from November 2015 to August 2016 .Those papers were included that investigated the association of dietary habits on blood pressure in children and adolescents aged less than 18 years. The following medical subject headings and keywords were used to search all field (Diet OR nutrition OR nutrient OR food OR food habits OR food preferences) AND (Blood pressure OR hypertension OR high blood pressure OR systolic pressure OR diastolic pressure OR Systolic Blood Pressure [TIAB] OR Diastolic Blood Pressure [TIAB]) AND (child [Mesh] OR children [TIAB] OR adolescent [Mesh] [TIAB] OR pediatrics [Mesh] OR paediatric [TIAB])
A total of 549 studies were initially identified in the databases. After excluding duplicate studies, 270 articles were retrieved and we reviewed them based on their titles and abstracts; then 161 articles were selected for more detail review. Findings of multiple studies showed the beneficial effect of fruits, vegetables and dairy products on blood pressure in children.
Increasing evidences indicate that dietary habits, notably daily salt intake of children is directly related to their blood pressure level. Our findings serve as confirmatory evidence on the necessity of paying more attention to primordial and primary prevention of hypertension.

Major attention has been drawn to the prognostic value of plasma/serum neutrophil gelatinase-associated lipocalin (NGAL) in detection of acute kidney injury (AKI) in children, but still no consensus has been reached. Accordingly, the present study aimed to assess the diagnostic value of this biomarker in detection of acute kidney injury in children through a systematic review and meta-analysis.
Two independent reviewers carried out a comprehensive search in electronic databases up to the end of August, 2016. After summarization of studies, screening performance characteristics of plasma/serum NGAL were evaluated in detection of AKI. The area under the curve of receiver operating characteristics curve, sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio of NGAL were calculated using a mixed-effects binary regression model. A p-value less than 0.05 was considered as significance threshold in all analyses.
Data from 22 studies (2,213 non-AKI children and 1,109 AKI patients) were pooled and analyzed. Analyses revealed that the performance of plasma/seum NGAL is maximal when the level of this biomarker is measured in the first 12 hours after admission or surgery, considering a cut-off level of 100 mg/dL. In this setting the area under the curve, sensitivity, specificity and diagnostic odds ratio of plasma/serum NGAL were 0.94 (95% CI: 0.91-0.95), 0.87 (95% CI: 0.67-0.96), 0.88 (95% CI: 0.65-0.96) and 48.05 (95% CI: 9.20-251.04), respectively.
The high diagnostic value in the first few hours is one of the advantages of plasma/serum NGAL, emphasizing its usefulness in clinical evaluations.

Calcium is the most abundant mineral in the human body. This mineral is provided only by the consumption of foods containing calcium that it is recommended to use at least1300 mg daily for adults. This study is aimed to investigate the nutritional behavior of female high school students about Consumption of Calcium-Rich Foods.
At a descriptive-analytical study, the method of sampling was based on multi-stage random clustering that 168 students were selected from 3 school (each school 56 female students). The data were collected by a research-made questionnaire containing questions in 4 parts including: the demographic features, the knowledge and attitude of students about consumption of calcium-rich foods and the fourth part included semi-quantitative food frequency table (FFQ) that was taught to the subjects and the correct understanding of the education was evaluated. The data were analyzed by SPSS-17.
The mean age of girls participated was 16 0.738 years. There were significant relationship between all demographic variables such as job, education and monthly income and consumption of calcium-rich foods (P The current study indicated that in female students, the improvement of student's attitude and knowledge about consumption of calcium-rich foods can be achieved using focused group discussion and suitable education. According to the results of this study, students’ knowledge and attitude of students about consumption of calcium-rich foods are not acceptable.

Nutrition behaviors of adolescent girls is of serious health concerns. Although nutrition education interventions in Iran have met with some success, most of them could not promote nutrition behavioral changes. The aim of our study is to determine a school-based nutrition education intervention to improve adolescents’ nutrition behaviors and behavioral mediators based on the social cognitive theory (SCT).
This study is a single-blind randomized controlled trial. Eligible participants will be all student girls in grade 6 and 7, their parents and teachers in Isfahan governmental schools. This multi com­ponent school-based intervention include adolescents’ nutrition education package, parents’ nutrition massages, participatory homework, parents and teachers nutrition education package, supportive group, and collaboration with decision makers. Changing in nutrition behaviors including breakfast, fruit and vegetable, snack and fast food consumption will be examined, as primary outcome. Secondary outcome will be behavioral mediators such as knowledge, self-efficacy, intention, situation, self-regulation, social support, outcome expectations and expectancies, in adolescent girls. The outcomes will be assessed at baseline, and after 3 and 6-month follow-up.
This study evaluates a school-based, guided SCT intervention, designed to improve healthy dietary behaviors, nutrition knowledge of adolescent girls. Few behavioral interventions have targeted this high-risk population in Iran. The intervention seems to be promising and has the potential to bridge the gap of the limited program outcomes of nutrition education in Iranian adolescents.

Smoking among youths is a main public health concern, and detecting predictors of smoking is essential for designing preventive programs. Any interventional program should plan with highlighting on behavioral change models and based on operative interventional program. So, this study aimed to investigate school-based smoking prevention programs for middle school students in Nowshahr, Iran.
A quasi-experimental study was performed with 280 male students aged 15-17 years selected by multistage sampling. For this purpose, 6 middle schools were randomly recruited from male students in Nowshahr- Iran. Then, 140 students were randomly chosen for each the experimental and the control groups. After pretest, educational program based on Health Belief Model were performed in experimental group. Also, post-test was applied four months after interventional program in both experimental and control group.
Based on the results, the prevalence of smoking was higher at age 14 old in both experimental (38.7%) and control (30 %) groups. About 35% of participants in the experimental group and 33.6% in control group had smoker father. Additionally, 10% in experimental group and 7.8% in control group had smoker mother. Most main cause for smoking in 57.9% of the experimental group and 52.63% of the control group was reducing anxiety. Results also shown that there was a significant difference between students in the experimental and control groups after performing educational program in the mean scores of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and preventive behaviors of smoking (P By performing educational program, it was found that the prevalence of cigarette smoking was decreased in the intervention group. So, with a better understanding of factors affecting on this complex behavior (cigarette smoking), it can be a valuable phase to decrease rate of costs and improve adolescent's health outcomes.

Two questions about diagnostic value of urinary neutrophil gelatin associated lipocalin (uNGAL) in detection of acute kidney injury (AKI) in children have remained unanswered; first, which cut-off point of uNGAL has the highest value in detection of AKI; and second when is the best time for measuring this biomarker in a patient? Accordingly, the present study aimed to conduct a systematic review and meta-analysis to provide evidence on the diagnostic and prognostic value of uNGAL in detection of AKI in children.
An extensive search in the electronic databases up to the end of August 2016 was performed. Data were summarized and then the diagnostic performance characteristics of uNGAl in AKI were evaluated.
Data from 37 articles were summarized. Analyses based on area under the curve, sensitivity, specificity and diagnostic odds ratio revealed that uNGAL provides the optimum prognostic and diagnostic value in detection of AKI in children when measured during 0 to 6 hours after admission or surgery with a cut-off point of 50 mg/dL. In this setting, area under the curve, sensitivity, specificity and diagnostic odds ratio of uNGAL are 0.97 (95% CI: 0.95 to 0.98), 0.92 (95% CI: 0.84 to 0.97), 0.92 (95% CI: 0.83 to 0.97) and 148.14 (95% CI: 32.13 to 683.10), respectively.
Based on these results, measuring uNGAL during the first 6 hours after admission or surgery with a cut-off point of 50 mg/dL, provides the optimum diagnostic value in detection of AKI in children.

About 15 to 40% of children with seizures are refractory to standard anti-epileptic drugs and for such patients, other treatments such as surgery and the ketogenic diet can reduce seizure frequency. Melatonin is a natural pineal gland hormone. The use of melatonin for controlling pediatric seizures is still controversial. This study aimed to evaluate the effect of melatonin on seizures, parent's satisfaction, sleep, and behavior in children with drug-resistant epilepsy.
In a pilot crossover study, children with drug-resistant epilepsy, who referred to the epileptic clinic of Ghaem Hospital, were randomly assigned to receive treatment with melatonin or a placebo for 4 weeks followed by a one-day washout period. Then patients who started with melatonin were switched to the placebo. Melatonin was administered 30 minutes before bedtime at a dose of 10 mg /m2 in 3mg tablets.
Twenty patients, of which 11 (55%) were male, were enrolled into the study. The range and mean age of patients were 2 to 13 years and 7.28 ± 3.46 years, respectively. The mean number of diurnal seizures in the study group during placebo treatment was 11.05 and during melatonin treatment was 6.25, which was statistically significant (P=0.021). However, the reduction of the mean duration of diurnal seizures in the study groups was not statistically significant (P=0.386). There was no correlation between decreasing in number or duration of seizures with melatonin plasma levels. Drowsiness was the only side effect of melatonin, which occurred in three patients.
Melatonin has probable beneficial effects on some epileptic patients with unclear mechanisms. Physicians can use it in selected epileptic children to improve seizures.

Training programs and providing essential information such as preborn educational programs for women, unmarried girls are essential as the most important prevention methods for control and prevention of health outcomes and disability. The current study conducted to assess the training effectiveness of Prevention Disability Package in high school girls in a community trail.
A community trial executed among 1,339 high school girls in Qom, Iran. Subjects were the students that training in 10th and 11th years of education. All of students in each class from all majors were included in the study. According to sampling framework, 55 classes selected randomly assigned to lecture (1264 girls [94.4%]), 4 (3%) girls to CD-based group and 35 (2.6%) girls to control group. Data collection was conducted by a standard and valid questionnaire. Analysis of variance test was used to compare the mean of knowledge score among three groups. Analysis of covariance (ANCOVA) used to control the confounding variables.
There were significant differences among three groups according to the total score of awareness of disability. Therefore, the mean score of in handicap, musculoskeletal diseases, pregnancy dimensions, and total knowledge about disability causes was higher than in lecture group than CD-based and control groups (P Our analysis showed that Lecture and CD-based training are effective methods for increasing the knowledge of the high school girls about the control, prevention, and risk factors of disability. However, Lecture based and face-to-face training is better method for growthing the awareness of students than CD-based.

Critically ill children admitted to pediatric intensive care unit (PICU) are at increased risk of gastrointestinal bleeding due to stress related mucosal injury. Reducing gastric acid by acid suppressant medication is the accepted prophylaxis treatment, but there is not any definitive guideline for using prophylaxis in PICU patients. The present study aimed to assess the effect of Proton Pump Inhibitor (PPI) and H2 Blocker (H2B) prophylaxis on gastrointestinal bleeding in admitted patients of PICU, Mashhad- Iran.
In this study, 100 patients admitted in PICU divided into two equal groups on the first day of admission. They received ranitidine or pantoprazole as prophylaxis of stress ulcer. Those patients who had history of gastrointestinal bleeding or coagulation disorder were excluded. 100 PICU patients who had not received prophylaxis during last 6 months retrospectively evaluated as control of the study. Data were collected as demographic characteristics, admission reason, definitive diagnosis, receiving corticosteroid and mechanical ventilation in each patient. Gastrointestinal bleeding (hematemesis, coffee ground aspirate, and melena) and clinically significant gastrointestinal bleeding were daily monitored. Data analyzed through descriptive statistical tests, Chi-square, logistic regression, t-test and using SPSS-16 software.
Among 204 patients (control group=105 and case group=99), incidence of gastrointestinal bleeding (GB) was 13.2% in which 6.9% of cases presented with clinically significant gastrointestinal bleeding (CSGB). Loss of consciousness and respiratory distress were the main reason of admission. There was no significant differences between the incidence of (GB) and (CSGB) in experimental and control groups (P>0.05) as well as ranitidine and pantoprazole prophylaxis (P>0.05). Significant risk factors of (GB) were mechanical ventilation and loss of consciousness and corticosteroid therapy.
There is ambiguity about probable benefits of gastrointestinal bleeding prophylaxis in critically ill children. We proposed that prophylaxis should prescribe in patients with two or more risk factors of gastrointestinal bleeding.

Meropenem, a carbapenem antibiotic, has a broad-spectrum activity and is active against Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influencae, Moraxella catarrhalis, gram-negative enteric bacilli as Escherichia coli, Klebsiella, Enterobacter, Serratia and Pseudomonas aeruginosa. Meropenem has excellent penetration in body tissues and in cerebrospinal fluid (in the presence of inflammation). Meropenem is bactericidal, because it inhibits transpeptidases responsible for peptidoglycan synthesis involved in cell formation and repair.
Meropenem is approved for use in complicated intraabdominal infections, complicated skin and skin structure infections and bacterial meningitis in pediatric patients. The dose of meropenem is 20 mg/kg by slow intravenous infusion once every 12 hours in the first week of life and once every 8 hours for infants older than this. Meropenem is predominantly excreted by renal route. After an administration of 15 mg/kg meropenem twice-daily to premature infants, the mean total body clearance is 0.157 l/kg/h, the distribution volume is 0.74 l/kg, and the half-life is 3.4 hours. The %T>MIC is the percent time above minimum inhibitory concentration. After a dose of 20 mg/kg t.i.d., the target value of 50%T>MIC is achieved, indicating that 20 mg/kg is effective for susceptible bacteria. In contrast, for bacteria with higher MIC such as Pseudomonas aeruginosa (MIC ≥2 µg/ml), the probability of target attainment of 50%T>MIC is 60.7% at a dose of 40 mg/kg t.i.d. The limited amounts of meropenem that cross the placenta are insufficient to treat infection in fetuses. The aim of this study was to review the effects and pharmacokinetics of meropenem in neonates.

Asthma is the most chronic inflammatory disorder of the airways in children and asthmatic patients can experience cardiac dysfunction, pulmonary hypertension and finally cor pulmonale later in life. We aimed to investigate Right Ventricular (RV) functions in asthmatic children by conventional and tissue Doppler echocardiography (TDE).
Pulmonary function tests, conventional and TDE examinations were performed on 42 asthmatic and 42 age- and gender matched healthy controls subjects (n=42).
Compared with healthy children the RV wall was statistically thicker among asthmatic patients (P= 0.01). Conventional echocardiography had not significant difference between cases and controls, but TDE had significant difference between these two groups. Peak E’ velocity, A’ velocity, E’/A’ ratio and S’ in lateral and medial sites of tricuspid annulus valve, were significantly differ from control group in our patients (POur study showed that although the conventional echocardiography and clinical finding were apparently normal in asthmatic children, TDE could showed subclinical dysfunction of the right ventricle in these patients. Our findings signify the diagnostic value of tissue Doppler- echocardiography superior to conventional echocardiography for the early evaluation, detection and monitoring of ventricular dysfunction among asthmatic patients.

Sitting on inappropriate benches, as well as the poor posture (body position) during the years of growth, can lead to spinal disorders, fatigue and discomfort in students. This study aimed to investigate the relationship between features of desks and chairs and prevalence of some musculoskeletal disorders in primary school students in Abadan.
This cross-sectional study was conducted in 2015 in the city of Abadan- South West of Iran; for which, 383 primary school students were selected and studied through cluster sampling method. Data were collected by the checkered board and researcher-made questionnaire. Features and dimensions of desks and chairs of students were recorded and evaluated based on their condition (being standard or not). Statistical analysis was conducted using SPSS, version 22; and then, descriptive statistics and Chi-square test were conducted.
Study results showed that about 56.1% of the desks and chairs in under study schools were non-standard. It found that drooping shoulder (85.4%) and scoliosis (81.7%) were the more prevalent disorders and back straight (1.6%) was the least frequent disorder. There was a significant relationship between the variable of non-standard desks and chairs and prevalence of drooping shoulders (P=0.001), scoliosis (P= 0.04), kyphosis (P=0.007) and lordosis (P=0.002) disorders in students.
The non-standard-sized desks and chairs increase the prevalence of skeletal disorders in schoolchildren. Therefore, it is essential to pay attention to design and build standard classroom desks and chairs, which are best, adjust to students’ physics.