International Journal of Pediatrics
Volume:6 Issue: 60, Dec 2018

In recent years, ketamine has been the most used sedative in Emergency Department (ED) procedures for pain management. Therefore, this study evaluated ketamine associated vomiting (KAV) in children requiring sedation.
This is a prospective, randomized, and open trial study carried out on children of ages 3 months to 13 years requiring sedation for medical diagnostic or treatment procedures. The patients were randomized into 1 mg/kg IV, 2 mg/kg IV, 3 mg/kg IM and 5 mg/kg IM groups.
A total of 190 patients were enrolled for this study. In total, 17.37% of the children were reported to have vomited after ketamine administration. In the IV group, 21.69% of the children vomited, while in the IM group, 14.02% vomited (p= 0.18). In the 1 mg/kg IV group, 22.72% of the children vomited compared to 20.51% (p= 0.51) in the 2 mg/kg IV group. In the 3 mg/kg IM group, 14.54% of the children vomited as against 13.46% in the 5 mg/kg IM group (p= 0.54). There were no significant differences between sex and dose group on the incidence of vomiting (p= 0.40).
This study showed that the administration of ketamine via IV and IM in a standard dose is a safe method for sedating children. However, there is need to study the combination of ketamine with antivomiting agents in different injection routes, as well as to review the combination with tranquilizer to minimize the rate of vomiting in children requiring sedation in the ED.

The breastfeeding self-efficacy is one of the psychological factors affecting the duration of breastfeeding; the Breastfeeding self-efficacy measured by the breastfeeding self-efficacy scaleshort form (BSES-SF). It was validated and reliable in several studies. The current systematic review aimed to comprehensively review the validity and reliability of the BSES-SF in various versions to give comprehensive information for authorities in this field.
We searched English databases, including Medline (via PubMed), Scopus, Cochran library and Web of Science since inception to May 2018 to find all previously published reports the psychometric dimensions of the Breastfeeding Self-Efficacy. Two reviewers read independently extracted data assessed. The quality of the studies was carried out by the Consensusbased standards for the selection of health status Measurement instruments (COSMIN) checklist.
In this systematic review, reliability was measured using Cronbach’s alpha; inter coefficient of correlation (ICC) as well as an analysis of the item-total correlation. Cronbach’s alpha of breastfeeding self-efficacy for whole scale ranged from 0.76 to 0.95 considered moderate to excellent. Only two studies assessed test-retest reliability. One study reported correlation between two time intervals that was high (r=0.94) and another study measured test-retest reliability using ICC. It was ranged from 0.69 to 0.78 that consider suitable. Item-total correlation ranged from 0.23 to 0.85. Construct validity was tested using factor analysis. Original one- factor structure was confirmed in Spanish, Chinese, American, Canadian, Brazilian and Creation version. Some studies reported four and six –factor structure. Confirmatory factor analysis (CFA) confirmed one-factor structure.
Original one- factor structure was confirmed in Spanish, Chinese, American, Canadian, Swedish, and Japanese, creation, Turkish, Portuguese, Brazilian and Creation; version six and fourfactor need to further test in future studies. This study provides evidence also that the modified BSESSF may be a valid and reliable measure of breastfeeding self-efficacy.

Community acquired pneumonia (CAP) is a major infectious cause of mortality in preschool children especially in developing countries. Red Cell Distribution Width (RDW) has been associated with poor outcomes of CAP. We aimed to determine whether admission stress hyperglycemia and RDW can predict mortality in preschool children with CAP for early identification of patients at risk of mortality.
This is a prospective cohort analysis of a single-center study conducted in the pediatric department and Pediatric Intensive Care Unit (PICU) of Minia Children’s University hospital, El-Minia, Egypt during the period from September 2016 to February 2017. The patients were 1-59 months old children, with community acquired pneumonia. Measurement of admission serum glucose and RDW in addition to complete blood picture was done to all participating children. Assessment of the severity of CAP was done using Pediatric Respiratory Severity Score.
The male gender consumes a high percentage in the Non survivors group (72.7%). The hyperglycemias patients had a statistically significant risk of developing septic shock and respiratory failure than the other groups (23.8%, p17.4, sensitivity 90.9% and specificity 92.1%, followed by admission serum glucose at cutoff point >110 mg/dl, sensitivity 90.9%, and specificity 78.95 %.
According to the results, elevated RDW and admission hyperglycemia are reliable predictors of mortality in preschool children with community acquired pneumonia

Since several factors, rather than a single cause, contribute to developmental delay in children, identification of the condition's risk factors and their pathway of effects are critical to the design and implementation of appropriate intervention. This study aimed to determine the relation between social determinants of maternal health and child development in Iranian mothers and their children.
In this analytical cross-sectional study, the subjects were recruited from mother-child health clinics located at general hospitals affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran). A total of 950 mothers and their children were selected using cluster sampling. Based on the WHO conceptual framework of Social determinants of health (SDH) and review of literature, this model was proposed. The questionnaires used for data gathering were: Beck’s Depression Inventory II (BDI-II), Spiel Berger's State-Trait Anxiety Inventory (STAI), the 12- item MSPSS questionnaire for social support, Cohen’s measure of perceived stress, the Ages and Stages Questionnaires (ASQ) of infant developmental status, and socio-economic status questionnaire. The data and theoretical Path Model were analyzed using SPSS software version 19.0 and Lizrel 8.8 software.
The mean of Mother’s age was 28.05±4.22 years old. The percentage of children with suspected delay was 12.2%. The final path model fitted well (RMSEA=0.049 GFI=1). Maternal Socioeconomic status had the greatest direct, indirect, and total effects on child development (βTotal=0.35377), and maternal depression had the second most significant direct effects on child development (β= -0.17).
The proposed path model regarding the effects of maternal socioeconomic status, perceived social support, perceived stress, anxiety and depression, on the developmental status of 6 to 18 month-old children, fitted well.

Poor maternal sensitivity leads to insecure infant attachment, and has been associated with negative cognitive consequences later in life. Maternal sensitivity is an indicator of the interactions between mothers and infants characterized by mutual and concurrent interchanges. The aim of the study is to review and synthesize all published studies that examine the potential effect of breastfeeding on maternal sensitivity during the first year of life.
Searches were conducted using the following databases: Medline (via PubMed), CINAHL, and SCOPUS. Inclusion criteria were as follows: published in English, and no limitation on publication date. Articles were excluded if they did not focus on the main concepts of this review, maternal sensitivity, if they focused on the physiological aspects of breastfeeding or if they included children breastfed after one year of age.
Nineteen out of 60 articles met the inclusion criteria. All of the studies that were identified for this review were quantitative. Four categories emerged from these studies: Potential effects of breastfeeding on maternal sensitivity; Potential effects of breastfeeding-related environment on maternal sensitivity; Potential effects of infant’s health on maternal sensitivity, and No potential effect of breastfeeding on maternal sensitivity.
There is strong evidence that a relationship exists between breastfeeding and maternal sensitivity. However, that relationship is not well-defined .Identification of breastfeeding as a factor to enhance maternal sensitivity for newly and multi-children mothers will or may assist health care providers and social workers to help mothers improve their interactions with their infants to an optimal level.

Appearance of multi-drug resistance (MDR) Acinetobacter baumannii imposes
limitation on antibiotic therapy in patients. Detection of MDR A. baumannii can play a crucial role to prevent MDR strains spreading in hospitals. The aim of this study was determination the efflux pumps gene expression in tigecyclin resistance strains in collected isolates from selected training hospitals in Tehran, Iran.
In this cross sectional study, A. baumannii was collected from July to February 2014. Tigecycline susceptibility testing has been prepared according to CLSI guide- lines after identification. Active efflux pumps have been detected by Carbonyl cyanide m-chlorophenyl hydrazone (CCCP) as an efflux pumps inhibitor. Gene expressions of these efflux pumps have been determined by Real- Time PCR.
In this study 80 A. baumannii have been confirmed by conventional phenotypic methods. Tigecyclin resistant was confirmed according to antibiotic susceptibility testing results. The results of CCCP indicated that 22.5% of tigecycline resistant A. baumannii could include active efflux pumps. The results of Real- Time PCR indicated that abeM gene expression has been observed in the most of CCCP positive A. baumannii and adeB has been observed in the minimum number of strains.
According to the results of this study, Efflux pumps can play an important role in appearance of cross resistance and make MDR strains. Thus, the detection of antibiotic resistance related to active efflux pumps may be crucial to find a composition with efflux pump inhibitor effect by clinical usage.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are among the most severe dermatologic reactions to the drugs. Data about SJS and TEN among pediatric population especially in Iran is limited. This study aimed to investigate the clinical and para-clinical characteristics of pediatric patients with SJS/TEN.
From 2010 to 2016, all SJS and TEN children from three teaching hospitals in Mashhad-Iran with age less than 15 years were included in the study. Patients’ catechistic, history, physical examinations, progress notes, laboratory findings, medical consults, treatments taken and the final outcome were extracted from medical records by researcher. Data were further analyzed by SPSS (version 17.0).
Among 165 records, 48 children (58.3% male; mean age of 9.1 years) were among the SJS and TEN spectrum. Anticonvulsants (50%; including lamotrigine, phenobarbital, phenytoin, carbamazepine, valproate and clobazam) were the most common drugs followed by antibiotics (38.1%; including cefixime, penicillin, azithromycin, co-amoxiclav, cephalexin, co-trimoxazole and ceftriaxone), and analgesics (9.5%; including acetaminophen, ibuprofen and naproxen). Infectious agents were the possible cause of SJS/TEN in two patients. WBC counts, liver function tests, renal and electrolyte tests were significantly different in SJS and TEN groups.
The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%. The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%.

Helicobacter pylori (H. pylori), is the major known infectious cause of gastric diseases in children and adults. The rate of antibiotic resistance to H. pylori treatment regimens has rapidly increased. We aimed to determine the sensitivity of helicobacter pylori in gastric tissue samples of children and adolescents to various antibiotics in Isfahan, Center of Iran.
Data set included children and adolescents, aged 5 to 16 years, who have been referred to Imam Hossein Children Hospital in Isfahan, Iran, over 2015 to 2018 due to dyspepsia symptoms. Endoscopy was advised by Pediatric gastroenterologist. Then, Rapid Urease Test (RUT), and one biopsy specimen from antrum, body, andcardia were given and placed into the transfer medium. If RUT became positive, transfer media was transported to the laboratory and keep under 4oC temperature till adding to culture media (Colombia agar- Germany) under special conditions. After appearance of H. pylori on culture media, antibiogram was done. We used Epsilometer test (E-test) to determine H. pylori sensitivity and resistance to antibiotics as clarithromycin, amoxicillin, metronidazole, tetracyclin, ciprofloxacin and levofloxacin.
Out of 102 patients, E-test of H. pylori was positive in 47.1% (n=48) of patients. The highest susceptibility rate was 89.6 % for tetracycline, and 75% for levofloxacin, respectively. Metronidazole had the lowest susceptibility to H. pylori (14.6%). Also, the sensitivity of amoxicillin was low (43.8%).
In this study resistance to primary antibiotic therapy for H.pylori eradication (Amoxicillin, Metronidazole, and Clarithromicin) was relatively high in children and adolescents in Center of Iran. Thus, it seems updated treatment strategies based on susceptibility tests are required.

Wilson's disease (WD) is a genetic disorder with various clinical presentations due to excessive accumulation of copper in the liver and other organs. It can present as acute/chronic hepatitis, liver failure, extrahepatic and neuromuscular manifestations. Autoimmune hepatitis (AIH) is a necroinflammatory disease of the liver, which affects a lot of people particularly the children population. AIH has a broad clinical presentation that is similar to WD. Coexistence of WD with elevated creatinine phosphokinase (CPK) and AIH, may be a diagnostic dilemma.
Case Report: We presented a 6 years old boy with dysarthria, aggressive behavior, weak attention, concentration and weight loss with abnormal physical examination. Laboratory, histochemical, genomic studies, muscle/liver biopsy and atomic absorption test confirmed the diagnosis of both WD and AIH in the boy.
Although CPK and liver enzyme elevation is a rare presentation of chronic hepatitis with dominant feature of WD and AIH; however, simultaneous therapy with immunosuppressive drugs and Penicillamine may have superior benefit with a significant response.

One of the most common metabolic diseases is diabetes mellitus (DM), which its prevalence is growing trend. Early diagnose peripheral neuropathy (DPN) in early stages of patients with DM contributes to metabolic control and prevents severe complications. We aimed to determine the prevalence of peripheral neuropathy (PN) and its related factor in Diabetic children.
This cross-sectional study was performed among 60 children with diabetes (type 1) who referring the pediatric endocrinology clinic of Hakim Hospital, Neyshabur city, Iran, in 2016. The neurological symptom score was used for the assessment of neurological features. Neuropathy disability score (NDS) was obtained from the examination of vibration perception (by means of a 128-Hz tuning fork). Peripheral vascular examination was also carried out via evaluating dorsalis pedis and posterior tibial pulses by a neurologist.
The mean age of the children was 10.8±3.38 years. About 56.2% of the patients were female. Diabetic peripheral neuropathy (DPN) score was moderate in 6.7% of the children and it was mild in 38.3% of them. In general, 23% of the children with hemoglobin A1C (HbA1c) higher than the normal range had PN. Assessment of the degree of DPN based on duration of diabetes showed a significant difference among the participants (P=0.05). The study of HbA1C rate based on different degrees of DPN showed a significant difference (P=0.001). In addition, we found a significant difference in FBS score between the children with DPN and children without it (P=0.01).
According the results, more than 23% of children with diabetes had DPN, and the duration of diabetes was a related factor in PN. Therefore, neurological assessment including nerve conduction studies and meticulous physical examination should be performed for evaluating the function of large sensory and motor fibers.

Non-nutritive sucking is part of the initial development process in preterm infants that may speed up the transition from the tube to oral feeding. The aim of this study was to evaluate the effect of nonnutritive sucking on mother's finger on feeding tolerance and attainment of independent oral feeding in preterm infants.
This single blind clinical trial was conducted on 40 preterm infants admitted to the NICU of Imam Reza Hospital, Kermanshah in 2017. In the intervention group, non-nutritive sucking was performed on the mother's finger three times a day for 10 days during the first 10 minutes of gavage. Then, the gastric residual volume, time to achieve independent oral feeding, length of hospitalization, and weight at discharge were measured. The data was analyzed using SPSS software version 24.0.
According to the results, the mean of gastric residual volume was less in the intervention group (0.65±0.33) compared to the control group (2.30±0.71) (P0.05).
The results of the study showed that non-nutritive sucking on mother's finger can be effective in improving feeding tolerance and accelerating attainment of independent oral feeding in the preterm infants, resulting in early discharge from the hospital.

Making decision on asthma as an inflammatory disease is done mostly on the airways function and the patient symptoms which most of them are nonspecific and subjective. Also, the children are not able to express their signs and collaboration in examination of the lungs function. Evaluation of serum level inflammatory biomarkers can be useful in assessment of the response to treatment and severity of asthma. In this regard, we aimed to examine the changes of serum levels of biomarkers which may occur as a result of treatment in children with asthma.
This study was conducted in 2017 and 54 children who referring to the respiratory clinic of Tabriz University of Medical Sciences, Tabriz city (Iran), were studied by convenience sampling method. To evaluate the changes of biomarkers (Immunoglobulin E, Eosinophil, Periostin and Eosinophil Cationic Protein), 5ml peripheral blood samples were drawn before and after the treatment period of six-month. They were measured by ELISA method. The data were analyzed by SPSS software ver.16.0 using descriptive statistics and Paired Sample t test.
The mean age of the children was 6.27±2.25 years. There was a significant difference between the studied biomarkers before and after treatment (P>0.05) and the serum level of Immunoglobulin E, Eosinophil, Periostin and Eosinophil Cationic Protein was reduced after receiving the treatment.
The biomarkers serum levels in the children was reduced after the end of the treatment period. Thus, in this study, the role of selective biomarkers in asthma management was confirmed. The physicians could decide about the stop or continuation of the treatment by measuring their serum levels.

Attention-deficit/hyperactivity disorder (ADHD) as the most common behavioral disorder of childhood, can affect all aspects of a child’s life and their families. The aim of this study was to investigate the effectiveness of mother's emotion regulation strategies training on the symptoms of children with attention-deficit/hyperactivity disorder.
We conducted a quasi-study among mothers with ADHD children (ranged age between 4 and 12 years) in the pediatric clinic of Ibn-e-Sina psychiatric hospital, affiliated to the Mashhad University of Medical Sciences, Iran. Forty-four eligible mothers were randomly allocated to one of two parallel groups; the intervention group (n = 22) was trained for the emotion regulation (eight 90-minute sessions), and control group (n = 22). The Conner’s Parents Rating Scales-Revised Short version (CPRS-R: S) was administered to assess symptoms of ADHD children by mothers. The data were analyzed using SPSS software (version 16.0).
The mean value of mothers’ age was 34.7 ± 4.1 years in intervention group and 37.2 ± 6.4 years in control group. The results of independent t-test revealed no significant difference in mean of hyperactivity scores between the two groups before intervention (P>0.05), and a significant difference immediately and one month after the intervention (P Finding of this study showed that mother's emotion regulation strategies training can be effective in reducing hyperactivity scores in children with ADHD.

Dyslexia refers to children's disorder in reading. The most psychologists consider dyslexia merely as a sign of a special disorder in the process of reading instruction which is an important factor to lower the confidence of these children. We aimed to investigate the relationship between attachment styles and parenting styles with self-esteem in elementary dyslexic girl students.
At a cross-sectional study, the study samples included elementary dyslexic girl students in Kermanshah Center of Learning Disorders No.2, Kermanshah city (Iran); and 116 elementary dyslexic girl students selected by available sampling method. The tools used in this study included Cooper's Self-esteem questionnaire, Attachment Scale (RASS), and Parenting Styles Questionnaire. Children completed the self-esteem and attachment scale questionnaires and parents answered the parenting styles scale. Data were analyzed using SPSS software version 22.0
The mean of self-esteem in elementary dyslexic girl students was 28.84±13.06 (ranged 0-50), attachment styles were 27.87 ± 6.41(ranged 0-90), and parenting styles were 29.12 ± 8.67 (ranged 0-150). There was a significant positive correlation between self-esteem with ambivalent attachment style (r=0.28), and easy-going parenting styles (r=0.27), and rational authority parenting styles (r=0.21) at level p According to the results, there was a positive correlation between ambivalent attachment style, easy-going parenting styles and rational authority with self-esteem, and these variables have the ability to predict self-esteem in elementary dyslexic girl students.

Type-2 diabetes is a risk factor for progressive non-alcoholic fatty liver disease and the majority of diabetic patients have blood lipid disorders, so they take statin drugs. Statins have the adverse effects such as liver dysfunction and increase in liver enzymes. The purpose of this study was to compare the liver enzymes in type 2 diabetic patients who are user and non-user of statin.
In a case-control study, increased liver enzymes (ALT and AST > 40 U/L) were measured in blood samples of 200 type II diabetic patients (with and without statin consumption) who referred to Mashhad Diabetes Clinic in Mashhad city (Iran), during May to November 2017. Levels of liver enzymes and anthropometric indices were measured for both groups. Liver enzymes were assessed at the baseline of two groups. The SPSS 20th software was used for data analysis.
The mean of Body mass index in two groups of diabetic patients with and without statin consumption had a significant difference (p Based on the results, cholesterol level in diabetic patients with statin consumption was higher than non-consuming group.

Menstruation is a natural and physiologic process that is managed based on various socio-cultural habits and behaviors. Cultural beliefs about menstruation can improve or worsen menstrual health behavior. The present study aimed to explore the cultural beliefs about menstrual health in Bam city, Iran.
This is a qualitative study with Directed Content Analysis approach. The participants were a total of 34 individuals including; 14 girl students, 12 female parents, 8 school associates and health educators of 5 secondary schools in Bam city, Iran. The subjects were selected based on an objective-oriented approach which continued until data saturation. Data collection method was with the use of in-depth and semi-structured interview. Data were analyzed with Granehim and Lundman suggested steps.
The analysis of data identified 58 initial and conceptual codes, 15 sub- categories and 5 categories of beliefs related to menstruation including beliefs related to menstruation, beliefs related to health behaviours during menstruation, beliefs related to the effect of diet on menstruation, belief in the effect of some specific methods on menstruation and religious belief in menstruation.
The results of the study identified different cultural beliefs about menstruation among the subjects that should identify and modify these beliefs especially they are resulted negative attitude to menstruation, specific food restriction during menstruation and not regarding of personal health during menstruation.