Caspian Journal of Pediatrics
Volume:3 Issue: 2, Sep 2017

Obesity, especially central obesity is related to many endocrine abnormalities, such as thyroid dysfunctions. Elevated levels of thyroid stimulating hormone (TSH) is common in obese children, however, it is not clear if such condition is associated with increased cardiovascular risk factors. The study aimed to determine the association between levels of TSH in overweight and obese children with components of metabolic syndrome (Mets).
The study sample included 197 overweight/obese 6-7 year old children in Tehran, Iran. Anthropometric (weight, waist circumference and height), metabolic (high-density lipoprotein cholesterol, triglycerides and fasting blood glucose) and hormonal (TSH) variables, as well as blood pressure were measured. Mets was defined according to Cook definition.
Totally, 20.3% and 79.7% of children were overweight and obese, respectively. Elevated levels of TSH were diagnosed in 10 subjects (5.1%), while Mets was seen in 35.4%. The most frequent component of Mets was abdominal obesity (72.5%). A weak positive correlation between BMI for age, Z scores and TSH level (r =0.11, P value= 0.123) was observed only in girls (r=0.2, P value= 0.034). TSH was not associated with components of Mets.
Elevated TSH levels may be found in obese children; however, the association between TSH elevation and cardiovascular disease risk factors, including components of metabolic syndrome needs further investigation.

Asthma is the most common chronic respiratory disease and a leading cause of school absenteeism. Awareness, attitude, and knowledge of asthma can play an effective role in controlling this disease and its consequences. Accordingly, this study aimed to determine the level of asthma awareness among primary school teachers in Zanjan.
This descriptive cross-sectional study was conducted on 403 teachers of boys- and girls-only primary schools, who were selected using single-stage cluster sampling. Data were collected using a researcher-made questionnaire, in which higher scores indicated higher level of asthma awareness. Findings were analyzed using descriptive and analytical statistics in SPSS.
Data analysis showed that 58 (14.4%) and 345 (85.6%) out of 403 participants were male and female, respectively. The means of age and work experience of the participants were 45±5.53 and 22±5.92 years old, respectively. In addition, teachers’ mean score for asthma awareness was at a good level (12±2.2). Teachers’ mean level of asthma awareness had a significant relationship with gender and history of dealing with asthmatic children (p = 0.03, p = 0.04), while it had no significant relationship with age, work experience, and education level.
In this study, the mean level of asthma awareness among the primary school teachers was good. Due to the importance of the disease in children and effective role of teachers in helping them, effective measures must be taken to increase teachers’ awareness.

Children with vesicoureteral reflux (VUR) are at risk of recurrent pyelonephritis, kidney scars, hypertension, and renal failure. Currently, VUR complications can be diagnosed by different imaging methods such as sonography, intravenous pyelography and dimercaptosuccinic acid (DMSA) scan, having certain limitations. Urinary level of ceruloplasmin (Cp) might be an effective non-radiological method. The aim of this study was to compare the urinary level of Cp with DMSA scan in the diagnosis of VUR complications.
The present cross-sectional study was conducted in Pediatric Research Center of Qom University of Medical Sciences and Health Services, Iran. Subjects consisted of 61 children with VUR, diagnosed by voiding cystoureterography (VCUG) and undergone either DMSA scan or urine Cp measurement. VUR stages and complications of the cases were evaluated using serum and urinary renal parameters. Data were analyzed using SPSS 22.
Among them, 80.3% were girls with a mean age of 7.2±3.8 years. Mean Cp urine level was statistically different between VUR sides in DMSA scan (unilateral: 269.56 vs. bilateral: 450.42 µg/dL) (P=0.034, r =0.273), but was not statistically different among various VUR degrees (P=0.102, r=0.211), different ages and genders (P>0.05).
Urinary level of Cp was not statistically different among VUR degrees, but was higher in bilateral VUR cases, indicating Cp can be used as a safe, non-invasive, and cheap measurement tool for screening test. Further studies are required to confirm Cp as an effective method.

The aim of this study was to investigate the validity, reliability and factor structure of the child and parent's version of psychological inflexibility in pain scale (PIPS) in the population of children with chronic pain and their parents.
The sample consisted of 112 pairs of children and parents, selected through available sampling method from the Tehran Children's Hospitals. The PIPS questionnaire along with KIDScreen scale (to measure well-being), Child Behavior Checklist (CBCL) (the Youth Self-Report (YSR)) (to measure negative mood) and Visual Analogous Scale (VAS) (to measure pain severity) was implemented on them.
The reliability results of PIPS showed that the Cronbach's alpha for the child and parent versions was 0.66 and 0.82, respectively. In addition, the rerun correlation of child and parent versions was significant and acceptable, ranging from 0.47 to 0.78. Moreover, the highest correlation between PIPS dimensions in two versions of the child and parent was 0.89 and 0.92, respectively. The convergent and divergent validity of the PIPS showed that this questionnaire had a negative and significant correlation with the KID Screen scale and had a positive and significant correlation with the CBCL, YSR and VAS.
The results of the exploratory factor analysis of this questionnaire revealed new factors. The exploratory factor analysis of child version indicated four factors (the factors 1, 3 and 4 are related to avoidance, and factor 2 measures the fusion) and in the confirmation factor analysis, the good fitting of these new factors was confirmed.

Hyperbilirubinemia is one of the most important complications encountered in neonatal units. It has been proposed that phototherapy yields oxidative stress. Therefore, this study was undertaken to survey the levels of antioxidant and oxidative stress in the serum neonate before and after phototherapy.
This study was performed on thirty-five healthy, late preterm (> 35 weeks) and term newborn infants from 6-10 days of age who underwent phototherapy due to hyperbilirubinemia (> 240 μmol/L). Infants with a congenital malformation, birth asphyxia, sepsis, those with signs and symptoms suggestive of severe illness, and babies who had received phototherapy before recruitment to the study were excluded. Blood samples were taken to determine total serum bilirubin, the total antioxidant capacity of serum (TAC), malondialdehyde (MDA), advanced oxidation protein products (AOPP) as markers of the intensity of oxidative stress and inflammation with photometric methods, reduced and oxidized glutathione (GSH) by HPLC-UV as well as the ratio of them before and after phototherapy.
The TAC, GSH and, bilirubin levels were significantly lower after phototherapy than before it, although, reversely about levels of MDA, AOPP and oxidized GSH in addition to the ratio of reduced to oxidized GSH (p phototherapy induces oxidative stress and inflammation not only due to inducing of MDA and AOPP but also with reducing of TAS and GSH as well as the ratio of reduced to oxidized GSH. It is suggested that supplementation of antioxidants before phototherapy may reduce oxidative stress in neonatal jaundice. A high positive correlation between total bilirubin and TAC as well as GSH but reversely about MDA and AOPP presented that bilirubin may be an important effect on the total antioxidant activity and oxidative stress.

Scimitar syndrome (SS) or congenital pulmonary venolobar syndrome is a rare anomaly, most commonly including partial pulmonary venous drainage into the inferior vena cava, right lung hypoplasia, dextroposition of the heart, and anomalous systemic arterial supply from aorta or one of its branches to the right lung.
Case report: A 10-day-old female infant was referred to our hospital with systolic murmur and tachypnea. Initial chest x-ray suggested cardiomegaly and displacement of cardiac structures into the right hemithorax, and initial echocardiogram indicated patent ductus arteriosus, coarctation of aorta, atrial septal defect, ventricular septal defect in this infant who was diagnosed as having SS.
We can consider Scimitar syndrome for infants with tachypnea, cyanosis, intrauterine growth restriction (IUGR) and right lobe opacity in chest x-ray.

Epstein-Bar virus (EBV) causes infectious mononucleosis in more than 90% of children. Rarely, mononucleosis may lead to malignancy. The aim the current study was to introduce a child with mononucleosis and persistent adenopathy. A 4-year-old male patient presented with complaints of fever, shortness of breath and sore throat. He was treated with antibiotics and prednisolone. Normal flora was grown by pharynx and blood cultures. Due to the high clinical suspicion (persistent large lymph nodes), open biopsy of cervical lymph nodes was done after 3 weeks and Non-Hodgkin lymphoma disease was diagnosed in the biopsy. Atypical presentation should be considered for every child and biopsy is inevitable in larger and persistent lymphadenopathy after 2 weeks. Because of poor prognosis and high mortality rate, early detection of lymphoma is very important.