International Journal of Pediatrics
Volume:5 Issue: 41, May 2017

Ceftazidime is a valuable third-generation bactericidal cephalosporin. Ceftazidime inhibits the biosynthesis of bacterial cell peptidoglycan, causing inhibition of bacterial growth or cell lyses and death. Common nosocomial gram-negative organisms susceptible to ceftazidime include Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Neisseria, Moraxella catarrhalis, Proteus mirabilis, Proteus vulgaris, and Providencia stuartii. Good activity remains against other gram-negative species including Salmonella, Shigella, and Neisseria species. Ceftazidime is widely distributed in most body tissues and fluids including respiratory secretion, ascitic fluid and cerebrospinal fluid. Ceftazidime is administered parenterally, is completely absorbed after intramuscular injection, and peak drug concentrations generally occur within 3 hours of intramuscular injection. Ceftazidime is not absorbed when taken by mouth.
Ceftazidime half-life is 4 to 10 hours at birth, but half this in infants more than a week old. In premature infants, the distribution volume and the clearance of ceftazidime range from 292 to 366흽 ml/kg and from 27.8.8 to 60.8.3 ml/h/kg, respectively. Ceftazidime binds to plasma proteins at 10% to 17%. No ceftazidime metabolites have been identified and this drug is excreted by renal elimination. The dose of ceftazidime is 25 mg/kg once-daily in the first week of life. Ceftazidime crosses the placenta freely, but there is no evidence of teratogenicity. As empirical ceftazidime monotherapy may not be appropriate for the treatment of neonatal sepsis, the addition of ampicillin, to cover against enterococci and Listeria monocytogenes, seems prudent in these neonatal patients. The aim of this study is to review the effects of ceftazidime in neonates.

Unfortunately, gestational diabetes with its demanding health cares and increasing economic costs is globally prevailing. Therefore, preventive measures against this difficulty are highly significant. The aim of the present study was to evaluate the effects of training interventions on behaviors of pregnant women for prevention of gestational diabetes.
This quasi-experimental study was conducted on 91 pregnant women (n=45 in intervention group, n=46 in control group), whom were chosen through multi-stage random sampling, and three training sessions with weekly intervals were offered for the intervention group. The data was collected in two stages including before the intervention and three months after intervention through interview as well as filling in questionnaire forms. The collected data was analyzed through independent sample t-test and paired t-test by considering 0.05 confidence level using SPSS software (version19.0).
The results of present study showed a direct and significant correlation between age and preventive behaviors (r=0.22, P Due to the fact that the results of the present study suggested the effectiveness of training interventions on enhancing the preventive behaviors against gestational diabetes through Health Belief Model and considering the significance of prevention of this disease, it is suggested to codify essential plans for performing training interventions.

Pediatric nephrolithiasis is a condition the prevalence of which varies geographically with multiple etiologies. The aim of this study was to determine possible concomitant anatomic and metabolic disturbances in children with nephrolithiasis and to answer the questions regarding the role of each metabolic and anatomic abnormality.
Between 2007 and 2015, 1,080 patients referred to our pediatric hospital of Hazrat Masumeh in Qom city, with the diagnosis of nephrolithiasis. Complete history from each eligible patient has taken using a prespecified data extraction form. Then, each child was referred for metabolic and anatomical evaluation using laboratory and imaging tests.
According to the extracted data, 92% of our patients had at least one concomitant metabolic disorder and 12.5% had an anatomic abnormality. Recorded metabolic disorders in our series were hypocitraturia (56.9%), hyperuricosuria (21.4%), hypercalciuria (19.3%), hyperoxaluria (14.7%), phosphaturia (11.4%), and cystinuria (1.4%). According to data analysis, 12.5% of patients had an anatomical abnormality of which the ureteropelvic junction obstruction and vesicoureteral reflux were the most common.
The current study showed that the most common abnormalities in association with nephrolithiasis were metabolic disturbances, which highlight the importance of further metabolic study, even in patients with anatomical abnormalities.

Youth' healthiness depends on their hygiene behaviors. Doing promoting behaviors of healthiness is one of best ways of health protect and control. This study aimed to investigate promoting behaviors of healthiness in two physical activity and nutrition statue domains in high school students.
The study was descriptive-analytic of cross-sectional type study which was done on 800 students of second level of high school in Sabzevar- Iran, during 2015-2016. Sampling method was as clustered and tool of collecting data was questionnaire include: first part demographic information and second part standard of healthiness promoting behaviors (HPLP). Data were entered into using Stata version 12.0 after collecting and were analyzed with statistical-descriptive and Chi-square tests.
Average of physical activity in boys and girls were 18.27 ± 5.38 and 13.8 ± 6.3, respectively. There was a significant relationship between rate of student's physical activity with level of parent's education and educational grades of students. Boys had more physical activity compared to girls in terms of gender (P0.05); while, there was significant relationship between favorable nutritional statue and their educational grade levels, educational field and parent's occupation in students (P In current study, female students had less physical activity and required programming to improve more physical activities among girls. Parents who had higher educational level, their children had more suitable pattern in terms of physical activity and nutrition statue.

Myasthenia gravis (MG) is an autoimmune disease resulting in destruction of the post-synaptic nicotinic receptors at the neuromuscular junction. Classically, the earliest symptoms of MG are ocular, including ptosis and diplopia. Other less common early symptoms include dysphagia and fatigable chewing. Our case report describes the unusual presentation of MG in a teenager patient and presented for an elective percutaneous endoscopic gastrostomy (PEG), tube placement due to persistent weight loss.
The patient underwent the procedure without any complications. At the time of tracheal extubation, she could not maintain spontaneous ventilation, so requiring mechanical ventilation. The patient was transferred from the recovery room to the pediatric intensive care unit (PICU). Subsequent investigations including a bedside electromyography (EMG), led to the diagnosis of MG. The patient was successfully extubated after treatment with intravenous immunoglobulin, oral prednisone 40 mg per day and pyridostigmine 60 mg every 8 hours.

Patent ductus arteriosus is an open channel between the aorta and pulmonary artery. The study aimed to evaluate the clinical course of patent ductus arteriosus after discharge and comparing in therapies technique.
This cross-sectional and inferential- descriptive study was performed in the hospitals of city of Zahedan-Iran in the period of one decade from 2005 to 2015. The study populations were all patients with patent ductus arteriosus (PDA) and these patients followed for at least one year after discharge from the hospitals due to the treatment with one of the Video-assisted thoracoscopic surgery (VATS), Amplatzer, surgery and medical techniques. 144 patients were assessed and the results of echocardiographic findings recorded in pre-determined data collection form and analyzed using SPSS version 15.0.
No residuals for VATS treatment after hospital discharge, but in the Amplatzer the rate of residual was 13.3% when the higher rate of 20% was for surgery. The highest rate of residual for PDA closure was 23.5% in medical treatment. In the treatment methods comparison analysis in respect to the size left atrium-to-aorta (LA / AO) changes from one month to one year observed a significant difference in the methods of VATS, Amplatzer and Surgery in which illustrate the left heart cavities that represent a great relief due to passing time occurred.
From the study concluded that in the methods of VATS, Amplatzer and surgery a closed PDA needs time to become normal left chambers by changes in LA / AO, but in the medical method, not observed any changes in LA / AO. The results showed any residual due to VATS method after discharge from hospital, but surgeryandAmplatzerhad very low rates.

At present of the limitation of the current case finding strategies and the global urgency to improve tuberculosis (TB) case finding, a renewed interest in active case finding (ACF) has risen. World Health Organization (WHO) calls for research on TB screening among low-income countries because of the limitation of the passive case finding strategies. We aimed to evaluated Active Case Finding strategy for TB among the slums population in North of Iran (Gorgan city) and comprise this procedure to Passive Case Finding.
We conducted a house-to-house survey from April 2016 to July 2016 by trained health volunteers for TB in ten urban slums of Gorgan. Individuals with TB symptoms were identified through targeted screening using a standardized questionnaire and investigated further for TB. Descriptive analyses were performed using Stata-12.
During study period, of 22,741 individuals screened for TB, 112 (0.49%) were identified as TB suspects; 95 suspects were evaluated for TB. TB was diagnosed in four individuals, representing 4.2% of those evaluated for TB as suspected cases. The incidence rate of tuberculosis was 17.5 in 100.000 people in slums population of Gorgan. Of the four detected cases, three individuals had pulmonary TB that among them two cases had new smear-positive TB.
ACF could supplement current strategies to yield additional TB cases, lead to early diagnosis and better treatment.

Autism as part of the category called Autism spectrum disorder (ASD), is caused by disorders in brain and nervous network and characterized by defect in social behavior, language and cognition. This study aimed to investigate receptive and expressive language performance and the severity of the disorder in 30 children with autism aged 2-8 years who speak in Persian language.
In this cross-sectional study 30 children with autism were selected using random sampling method. The study tools included "The Childhood Autism Rating Scale (CARS)", and "Newsha Developmental Scale (NDS)" for assessing the receptive - expressive language skills. In order to assess the level of language impairment in subjects, the participants were divided into 5 groups with 6 people (considering the speaking ability including sign language and speech), with equal number of boys and girls (3 girls and 3 boys) in each group. All of these children were evaluated by pediatric psychiatry, pediatric neurologist and pediatrician and were assessed according to the criteria for autism based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Eventually, the data were analyzed using descriptive and inferential statistics in SPSS version 16.0 software.
The results showed that there was a significant difference between the mean (standard deviation) and scores of receptive – expressive language skills in autistic subjects in each of the groups (P Altogether, it can be said that the HMTM treatment method (Hojjati Model) which is derived from Iranian traditional medicine and holistic philosophy, can be effective in the treatment of language disorder in children with autism.

Unfortunately just a few number of children and adolescents use sufficient amounts of fruit and vegetables. This study aimed to investigate the association between fruit and vegetables consumption and perceived self-efficacy, outcome expectations and outcome evaluation in adolescent girls in Shahrekord city.This is a descriptive analytic study conducted on 308 high school girls (first grade) who were selected by cluster sampling method in Shahrekord, Iran in 2013-2014. A researcher made questionnaire was used to collect the needed data like demographic variables, substructures of perceived self-efficacy, outcome expectations and outcome evaluation. In order to investigate the fruit and vegetables consumption status, the standard questionnaire of FFQ was used. The collected data was analyzed by SPSS 18 software, using descriptive and analytic tests such as one way variance analysis, Pearson and Spearman correlation. The mean scores of fruit and vegetables consumption and vegetables consumption were reported as 1.45±0.68 and 1.47±0.95 respectively as well. There was a direct significant association between adolescents’ perceived self-efficacy and outcome expectations. A direct significant association was also observed between fruit consumption and both outcome evaluation and perceived self-efficacy
Regarding the status of fruit and vegetables consumption and the mean scores of outcome evaluation, outcome expectations and perceived self-efficacy in adolescents which was low, and also the importance of promoting healthy diet in the critical period of adolescence, it seems necessary to use efficient patterns and theories of health education and promotion in which the roles of individuals, family and environment has been considered.

Breastfeeding is an only reliable nutritional source for infants. Many factors could affect breastfeeding such as delivery type. The aim of this study was to evaluate the relationship of delivery type and breastfeeding successful.
This was a descriptive-analytical study. Subjects of this study were 298 (148 subjects [49.7%] with cesarean and 150 subject [50.3%] with vaginal delivery) mothers who were referred to 4 health care centers in Urmia, Iran. The demographic data, type of delivery, breast feeding characteristics were collected by a researcher-made questionnaire. Statistical analysis was carried out using SPSS version 17.0 software.
The mean age of mothers was 28.2 ± 4.9 years old. Of a total 298 mothers, 148 subjects (49.7%) had experienced cesarean delivery and 150 subjects (50.3%) had experienced vaginal delivery. There was no statistically significant difference among mothers who had Vaginal delivery compared to mothers who had Caesarean delivery in terms of the first lactation duration (P = 0.406), from delivery to first breastfeeding duration (P = 0.125), mean duration of next breastfeeding (P = 0.750), mean number of lactation per day (P = 0.133), and mean number of lactation per night (P = 0.081), and age of onset of auxiliary nutrition (P = 0.784).
In this study there was no relationship between type of delivery and breastfeeding behaviors; while in the vaginal delivery group, the average distance to first lactation was shorter, so, cesarean delivery can be dangerous for mothers, but also can affect the breastfeeding pattern.

The appropriate moment for clamping the umbilical cord is controversial. Immediate cord clamping (ICC) is an item of active management of the third stage of labor (AMTSL). Unclamped umbilical cord may cause inconvenience in preterm neonates because they commonly need some levels of emergent services. Some studies revealed delayed cord clamping (DCC) of preterm neonates results in better health conditions like lower rates of respiratory distress syndrome (RDS), less morbidities in labor room and lower risk of postpartum hemorrhage. The aim of the present study was to determine the effect of delayed umbilical cord clamping on premature neonatal outcomes.
In this single‑center randomized control trial study, sixty premature neonates (gestational age ≤ 34 weeks) were randomly assigned to ICC (cord clamped at 5–10 seconds) or DCC (30–45 seconds) groups and followed up in neonatal intensive care unit (NICU). Primary outcomes were 1st and 5th minute Apgar score, average of level of hematocrit after birth, intra ventricle hemorrhage and need some levels of resuscitation.
Differences in demographic characteristics were not statistically significant. After birth, neonates who had delayed clamping had significantly higher mean hematocrit after at 4-hour of birth (49.58.15gr/dl vs. 46.58.40gr/dlin DCC vs. ICC groups, respectively) (P=0.031). Delayed cord clamping reduced the duration of need to nasal continues positive airway pressure (NCPAP) (86.7% and 60.0% in ICC and DCC groups, respectively, P= 0.039). Attractively, the results showed lower incidence of clinical sepsis in delayed cord clamping neonates (53.3% vs. 23.3% in ICC and DCC groups, respectively, P=0.033).
Prematurity complications might decrease by delay umbilical cord clamping which improve the hematocrit, duration of need to NCPAP and incidence of clinical sepsis. Furthermore, DCC may have no negative impact on neonatal resuscitation.

Ascending testis (AT) is one of the rare but serious complication that may occurs following inguinal hernia/hydrocele repair. We aimed to review our more than 7 years’ experience and discuss the possible mechanism through which the AT possibly occurs following inguinal hernia/hydrocele repair.
A retrospective analysis of 7,212 boys who had undergone inguinal hernia/hydrocele repair between March 2009 and April 2016 was conducted. Exclusion criteria were: undescended testis, misdiagnosed AT, and retractile testis. Two types of surgical procedures were performed based on the medical records: (1) transection of the hernia sac and processus vaginalisalone and (2) isolation of the vas deferens and testicular vessels and a global transection of the remaining structures. Subsequently, post-operative incidence of AT was compared across variables extracted from the medical records.
Sixteen (0.22%) patients were diagnosed with AT post operatively. AT incidence after inguinal hernia/hydrocele repair was reported in approximately 0.19% of the entire patient sample (in the 8491 hernia/hydrocele repairs). Comparison of AT incidence with the age at initial operation showed significant increase at the age of one year or less (P =0.017). In addition, AT incidence was significantly higher in the patients for whom only the sac/processus vaginalis was transected rather than the patients who underwent hernia/hydrocele repair with isolation of the vas deferens and testicular vessels (0.06% vs. 0.27%, respectively, P =0.023). Other subgroup analyses remained non-significant.
We conclude that transection of the cremaster muscle might decrease the incidence of ascending testis following inguinal hernia/ hydrocele repair.

Tobacco and hookah smoking is a worldwide problem among adolescents. The present study aimed to determine familial and social factors in predicting the tobacco and hookah smoking among high school students in Jahrom, South of Iran.
This cross-sectional study was conducted for assessing the factors affecting hookah and cigarette smoking among high school students during January to April 2015. The participants were 630 high school students (girls=315 and boys=315). The self-administered questionnaire containingstudents’ demographics, parent education, family sizes, tobacco using, tobacco using of the family, hookah smoking, and hookah smoking in the family was used. Multiple logistic regression (MLR) models using the Enter method were fitted to assess the factors that increased or decreased the risk of smoking.
The risk of cigarette smoking was increased with: cigarette smoking by sister (s) or brother (s) (36.8 [95% confidence interval(CI) (1.28-105)]; P=0.03), hookah smoking by mother (6.64 [95%CI (1.28-34.2)]; P=0.02), hookah smoking by father (OR: 5.33 [95%CI:1.88-15.07; P=0.02 ]), hookah smoking by mother (OR: 29.53 [95%CI:10.26-85.01, P In current study, the prevalence rate of hookah smoking is notable among bothmale (3.8%) and female (1.6%) sexes. Despite the protective role of family in the substance use studies, in the case of hookah smoking, the family provides an opportunity for adolescence to experience hookah smoking.

Social support and school play a pivotal role in the development of oral health-related behaviors among students. This study was conducted to determine the relationship between stages of dental cleaning behavior change based on Trans-theoretical model with school role and social support in Iranian students.
In a cross-sectional study, 525 male and female students were selected through cluster and simple random sampling. Demographic information, data related to trans-theoretical model constructs and social support and school role were collected via self-reports. The obtained data were analyzed using SPSS version 16.0 software.
The findings showed that 58% of students (32% boys and 26% girls) used none of the dental cleaning tools. Most of the students (42.5%) were found to be in the preparation stage of dental cleaning behavior. There was a significantly direct correlation between school role and self-efficiency and perceived benefits (P0.05).
The results indicated that the majority of students did not use of dental cleaning tools and did not receive sufficient social support in this regard. To perform dental cleaning behavior, student should increase perceived self-efficacy and benefits and decrease perceived barriers. Low performance of dental cleaning behavior among students is indicative of the necessity of performing intervention programs aiming to promote dental cleaning behavior.

Health status is an individual’s relative level of wellness and illness. Self-Perceived Health (SPH) is a single item considered as a health indicator for national and international survey. The aim of this study was to evaluate the SPH measure and its determinants in a National sample of Iranian children and adolescents.
This National study was performed as the fourth National survey of a school‑based surveillance program entitled the Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN‑IV) study. 14,880 students aged 6-18 years old selected from 30 provinces of Iran by a multistage Cluster and stratified sampling method. Two sets of valid and reliable questionnaires were completed for students and their parents.
Overall 13,846 participated in the present studywith 90.6 % participation. In this study, 80.5 % of boys and 79.4% of girls reported good SPH (95% confidence interval (CI), 79.3-81.6 versus 78.1-80.6, respectively). According to the living area, 79.5% from urban and 81.1% from rural area declared good SPH (95% CI, 78.6-80.5 versus 79.2-82.8, respectively). In the multivariate model, the subjects who had healthy weight compared with excess weight had significantly higher SPH (OR: 1.36; 95% CI, 1.17-1.59). Also, the subjects with high Socio-economic status (SES) had higher odds of SPH (odds ratio [OR], 1.23; 95% CI, 1.06-1.41).
Our results showed that SPH can be influenced by both demographic and life style related characteristics among study population. This association was stronger for SPH and academic success, talking with both parents and having normal body image respectively.

Aim: Urinary reflux is a probable reason of nephrolithiasis among children. This study aimed to assess the relationship between urinary reflux and other reason of stone formation in children.
This cross-sectional study was carried out with 199 children diagnosed with nephrolithiasis using ultrasonography. They were hospitalized in a referral children hospital in an urban area of in Iran. This study was conducted between 2014 and 2016. The presence of urinary reflux was assessed and graded by using the voiding cystourthrography modality.
Overall, 83.9% of the children had normal conditions regarding urinary reflux, while 1.5% had reflux grade I, 5.5% reflux grade II, 8.1% reflux grade III, and 1% reflux grade IV with the total urinary reflux rate of 16.1%. The most prevalent observed clinical manifestation was irritability (45.2%) followed by fever (45.2%), and dysuria (19.6%). Also, no relationship was reported between the size of stones in both kidneys and the presence of reflux and its reflux. Furthermore, the size of stones in left and right kidneys was not related to hematuria, pyuria, and urinary tract infection.
Vesicoureteral reflux and kidney stones in children may have interdependent identities. Therefore, the presence of reflux may not be a decisive reason for the diagnosis of nephrolithiasis.

The developmental delays of children, is one of the most important sources of information to detect the developmental delays of children. The aim of this study was to investigate the developmental delays and its relationship with anthropometric indices in Urmia city, Iran.
This is a descriptive analytical study that conducted on 422 children who had 6-12 months old and were selected randomly with cluster sampling from 10 Health Center. Anthropometric indices (weight, height and head circumstance) were collected from recorded files, and development of children was measured using developmental test of Ages and Stages Questionnaires (ASQ). The data were analyzed using SPSS version 18.0 software.
The results showed that the prevalence of the developmental delays of children was 18.8% and the highest and the lowest prevalence was related to the area of communication (7.1 %), and the area of gross motor (0.9 %), respectively. The developmental delays of children in boys, was more than girls (P 0.05).
Considering the significant number of the developmental delays of children and its relationship with birth weight in this study, it is recommended to consider appropriate interventions at pregnancy period for the prevention of low birth weight and the constant programs about the developmental delays.

Pulmonary arteriovenous malformations (PAVM) are abnormal communications between pulmonary arteries and pulmonary veins, and most commonly congenital in nature. Although rare, it is an important consideration in cyanotic patients of unknown cause. We report 3 cases with diffuse PAVM in children with different clinical manifestations and initial diagnosis was made by transthoracic contrast echocardiogram.
Transthoracic contrast echocardiography (TTCE) is valuable as initial diagnostic tools for diffuse PAVM. Pulmonary angiography should be reserved for therapeutic purposes for PAVM rather than diagnostic.

Menstruation cycle is a normal physiological process that is managed differently according to various social and cultural understandings. The aim of this study was to determine the relationship between attitude and knowledge of female students about menstruation cycle in Urmia city, Iran.
Methods and materials: In this descriptive cross-sectional study that conducted on 350 female students from second grade of high school girls in the Urmia city who were selected using multistage sampling of urban areas. The data collection instrument was a questionaire including personal and demographic information, knowledge and attitude questions about menstruation cycle that was completed by researcher. The data were analyzed using SPSS version 17.0 software.
The mean age of students and mean age of the first menstruation were 15.96± 0.86 and 12.29±1.04 years old, respectively. The results showed that there was a significant relationship between knowledge and attitude, negative feelings, living with menstruation, openness about menstruation and menstrual symptoms (P0.05).
The menstrual attitude of girl students can be improved by increasing the menstrual knowledge of them with the help of mothers and teachers.

Given that school-age students, as active road users, are more vulnerable to injury compared with other pedestrians, a large number of them, following an injury, may either fail to go to school at least for a short time or even suffer from disabilities for the rest of their lives. The aim of this study was to determine safe behavior in road crossing using the theory of planned behavior among middle school students.
The current study was cross-sectional, descriptive-analytical in design. The population included middle school students in Qom, Iran. A multistage sampling procedure was utilized with 364 students participated in the study. A questionnaire about theory of planned behavior underlying safe behavior in road crossing was employed. The collected data were analyzed using SPSS version 20.0 by independent-samples t-test, Chi-square, and Pearson correlation coefficient.
In the current study, the mean score of safe behavior in road crossing for female students was significantly higher than in male students (P As regards, safe behavior in road crossing is low among students, and their attitude and ability affected on behavior; therefore, using the theory of planned behavior can be increased safe behavior in road crossing.