فهرست مطالب

  • Volume:7 Issue: 61, 2018
  • تاریخ انتشار: 1397/07/01
  • تعداد عناوین: 16
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  • Ginenus Fekadu *, Ebisa Turi, Dinka Dugassa Pages 8779-8786
    Background
    Antipyretic therapy administration to patients who develop fever due to infection is controversial and its impact on clinical outcomes has yielded mixed results. We aimed to assess the prescription pattern and rational use of antipyretics for infection induced fever among hospitalized pediatric patients.
    Materials And Methods
    A retrospective cross-sectional study design was conducted to describe the use of antipyretics in hospitalized fever develop infectious patients from 2015 to 2016. A total of 290 patients were included in the study using random sampling method. Data was collected from the patients’ cards from February to March, 2016 at Nedjo general hospital, Ethiopia.
    Results
    Of the 290 patients, 164(56.6%) were males while 126 (43.4%) were females. The mean age of the patients was 3.41.65 years with mean temperature of 37.21C0. The average hospital stay of patients was 4.65.82 days and a total of 201 antipyretics were prescribed. Among the patients’ cases, pneumonia accounts 96 (33.1%) of morbidity and 8 (42.1% of all mortality while neonatal sepsis accounts 79(27.24%) of morbidity and 7(36.8%) of all cause of mortality. During the study period there were 19(6.6%) in hospital mortality was recorded. The antipyretics ordered were Paracetamol, Diclofenac and Ibuprofen. From these, Paracetamol was the most frequent ordered drug, (96.5%) and 98.5% of the antipyretics were ordered as required basis (PRN).
    Conclusion
    The pattern of antipyretic prescription during the study depends on the diagnosis of the infection identified. Further studies are needed to demonstrate the effect of antipyretics on clinically relevant outcomes in fever developed hospitalized infectious patients.
    Keywords: Antipyretics, Ethiopia, Infection, Prescription pattern, Pediatrics
  • Mohammad Ghasem Hanafi *, Afshin Shiri Pages 8787-8793
    Background
    Acute appendicitis is the most common medical condition requiring immediate abdominal surgery. Medical ultrasound is a non-intrusive, non-expensive and available diagnostic method. In this study, the accuracy of ultrasound in diagnosis of acute appendicitis in hospital emergency was evaluated.
    Materials And Methods
    This retrospective cohort study was performed at Ahvaz Imam Khomeini hospital (Ahvaz city, Iran). The records of outpatient and inpatient of this hospital were studied to extract demographic information about the patients and radiological reports indicating the occurrence or exclusion of acute appendicitis and post-appendectomy report to allow for results comparison. Patient from 5-70 years included, with clinical suspicious to acute appendicitis, pathologic report also reviewed as gold standard of diagnosis.
    Results
    A total of 163 study subjects met the inclusion criteria, the age of the subjects ranged from 6 to 63 years. The accuracy, sensitivity and specificity were 98.1, 96 and 100%, respectively. The positive predictive value was 100%, while the negative predictive value was 82.35%. Diagnostic accuracy was 100% for the under-15 age group and 94.06% for the above 15 years age group.
    Conclusion
    The results showed that the medical ultrasound reports could be considered more credible in diagnosing acute appendicitis in under-15 male subjects which paves the way for more accurate planning of treatment and presenting patients with abdominal pains for surgery.
    Keywords: Accuracy, Appendicitis, Diagnosis, Ultrasound
  • Sheren Esam Maher *, Rasha A. Abdel-Magid Pages 8795-8803
    Background
    Many pediatric rheumatic diseases persist into adulthood, with negative squeal from the disease or its treatment. We aimed to assess health related quality of life in a group of children with rheumatic diseases and its relation to disease activity and functional disability.
    Materials And Methods
    Fifty one patients were divided into three groups: Group 1 includes 27 patients diagnosed as juvenile idiopathic arthritis (JIA), Group 2 includes 15 patients diagnosed as juvenile onset systemic lupus erythematosus (SLE) and Group 3 includes nine patients; three diagnosed as Juvenile Dermatomyositis, three diagnosed as Familial Mediterranean Fever and three female’s patients diagnosed as Juvenile Scleroderma. Childhood Health Assessment Questionnaire (CHAQ), Pediatric Quality of Life generic core scale version 4.0, Visual analogue scale for pain and Visual analogue scale (VAS) for global assessment were recorded. The activity index was assessed in each patient according to the nature of the disease.
    Results
    In JIA patients, the mean PedsQL score was 73.6 15.4, the mean CHAQ score was 0.7 0.7, the mean DAS28 was 3.5 0.9, with a significant negative correlation between PedsQL and CHAQ (p=0.48), VAS pain (p=0.001), and DAS 28 activity index (p=0.017). In SLE patients, the mean PedsQL was 66.4 20.3, mean CHAQ score was 0.7 0.67 and mean SLEDAI-2K was 24.2 14.6 with no significant correlation between functional disability and SLEDAI-2K (p=0.539). PedsQL showed a significant negative correlation with SLEDAI-2k (p=0.001), and positive correlation between CHAQ (p=0.022).
    Conclusion
    Health related quality of life in patients with juvenile rheumatic diseases is correlated with disease activity and functional disability and should be assessed in regular basis.
    Keywords: Children, Egypt, Juvenile idiopathic arthritis, Health related quality of life
  • Hamid Farhangi, Elham Bakhtiari, Nafiseh Pourbadakhshan * Pages 8805-8813
    Background
    Children with cancer are in risk of malnutrition. Nutritional risk assessment is more importance in developing countries. The aim of present study was to investigate the nutritional risk in admitted children with cancer.
    Materials And Methods
    One hundred admitted children newly diagnosed with cancer were studied at the time of admission, after 3 and 6 months. Demographic characteristics and anthropometrics indexes were recorded via standard and calibrated tools. Nutritional risk assessed according to modified Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP). Statistical analysis was performed using SPSS software (version 16.0).
    Results
    Of the 100 children 55 patients (55%) were female. The average age was 3.46±3.3 years. Hematologic tumors constituted 73.5% of patient. All patients were in nutritional risk. There was no patient with low nutritional risk during study; 17 patients (17%), 53 patients (56.4%), and 41 patients (43.6%) diagnosed with medium nutritional risk at the time of admission, after 3 and 6 months, respectively; 83 patients (83%), 41 patients (43.6%), and 40 patients (43%) diagnosed with high nutritional risk at the time of admission, after 3 and 6 months, respectively. Difference was significant (p
    Conclusion
    According to modified STAMP results, all studied patients were in the nutritional risk. Nutritional risk decreased during study. The nutritional risk decreased after 6 months in children newly diagnosed with cancer compared with the time of admission.
    Keywords: Cancer, Child, Neoplasm, Nutritional risk
  • Mohsen Mohebi, Hassan Mottaghi Moghaddam *, Mohsen Horri Pages 8815-8820
    Background
    Dextrocardia is a malposition of the heart defined as the right-sided development of the heart. It can increase the likelihood of congenital heart defects or diseases (CHD) and the risk of related morbidities and mortalities. We aimed to determine the frequency of CHDs among Dextrocardia patients.
    Materials And Methods
    In a retrospective cross-sectional study the records of patients with Dextrocardia who referred to Imam Reza Hospital (tertiary referral center) of Mashhad between 2006 and 2016 were studied. Data were analyzed using SPSS software version 16.0.
    Results
    In total 163 patients, 85 of whom (54%) were males were studied. Their mean age was 11.41 0.326 years. The frequency of major Dextrocardia subtypes were: Situs inversus in 77 (47%), Situs Solitus in 59 (36%), and Situs ambiguous in 28 (17%) patients. The frequency of associated complex congenital heart defects (CHD) was 55% in Situs inversus, 77% in Situs solitus and 100% in Situs ambiguous. Isolated associated CHD had a greater frequency in the Situs inversus and Situs solitus groups. The most common isolated associated CHD was septal defects.
    Conclusion
    More than 90% of all patients with Dextrocardia, had CHD whereas all patients with Dextrocardia and Situs ambiguous had complex CHD
    Keywords: Children, Congenital Heart Defects, Cardiac Malposition, Dextrocardia, Visceral situs
  • Masaudeh Babakhanian, Soraya Sayar, Faezeh Sadat Akrami, Masumeh Ghazanfarpour *, Leila Kargarfard, Fatemeh Rajab Dizavandi, Talat Khadivzadeh Pages 8821-8829
    Background
    Due to the low rate of breastfeeding among working mothers and support of interventions to increase the duration of breastfeeding, this systematic review conducted to evaluate psychometric properties of instruments measured mother’s perception of Breastfeeding Support.
    Materials And Methods
    The search was carried in English language databases including Medline (via PubMed), Scopus, Cochran library and Web of Science since inception to March 2018 regarding published studies evaluating the psychometric properties of the Breastfeeding Self-Efficacy. The COSMIN checklist was used to assess the quality of related studies.
    Results
    Authors of Perceived Breastfeeding Support Assessment Tool’ (PBSAT) suggested that instrument seem to should be two factors "workplace environmental support for breast-feeding working mother" and "the available social environmental support for working mothers". Total Cronbach's alpha was 0.85. In exclusive breastfeeding social support (EBFSS) instrument, based on exploratory factor analysis, 16 items grouped into three factors "instrumental", "emotional" and "informational factors" accounted 66% of total variance. EFA were followed by confirmatory factors analysis showed Modified model was partially fitted to the data. In the Workplace Breastfeeding Support Scale (WBSS), EFA identified four dimensions of breastfeeding support at workplace. These four factors labeled "technical support", "breastfeeding-friendly environment", "facility support" and "peer support". Cronbach’s alpha was 0.77 and split-half reliability was r=0.86. In Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q), data scaled by the Multidimensional Random Coefficients Multinomial Logit Model. A two-dimensional model (company polices/work culture and manager and her co-workers) were emerged. Cronbach’s alpha was excellent (almost 0.90).
    Conclusion
    Four instruments found to assess breastfeeding was valid and reliable to measure breast feeding in social and workplaces.
    Keywords: Adolescents, Aggression, Children, Life Satisfaction, Self, rated Health
  • Marzieh Saei Ghare Naz, Vida Ghasemi, Zahra Kiani, Farzaneh Rashidi Fakari, Giti Ozgoli * Pages 8831-8843
    Background
    During lactation, metabolic changes in the bone in different areas of the body may affect the amount of bone mineral density. The aim of this study was to determine the relationship between breastfeeding and bone mineral density in women.
    Materials And Methods
    In this study, articles were searched at Cochran, Medline (via PubMed), Scopus, and Web of Science databases until June 2018. The search procedure was conducted with keywords related to breastfeeding and bone mineral density. The mean (SD) of bone mineral density was extracted in the lumbar spine and femoral neck. Funnel plot and Egger's test was used for publication bias assessing and I2 index were used for heterogeneity.
    Results
    In this study, 10 articles involving 3,613 healthy women included for Meta analyze. We observed the decreasing trend in mean bone mineral density (BMD) of lumbar spine, femur neck in non-breastfeeding subgroup to 24 months or more breastfeeding subgroup. BMD of lumbar spine in non-breastfeeding women were [M: 0.96, 95%confidence interval [CI]; 0.89-1.02, P=0.000], in subgroup with more than 24 months breastfeeding the BMD were [M: 0.87, 95%CI; 0.79-0.95, P=0.000]. The femoral neck BMD in non-breastfeeding were [M: 0.80 95%CI; 0.73-0.87, P=0.000], and in subgroup with more than 24 months breastfeeding the BMD were [M: 0.76, 95%CI; 0.71-0.81, P=0.000]. In subgroup analyze, the mean BMD in Asian and postmenopausal sub-group was lower than others.
    Conclusion
    The results of this study showed that breastfeeding have reduced effect on bone mineral density in the lumbar spine and femoral neck of women, but there were high heterogeneity in sub-group analyze, so we recommended another studies in homogenous group of women.
    Keywords: Breastfeeding, Bone mineral density, Children, Meta, analysis
  • Edao Sado Genamo *, Habte Gebeyehu Bayisa, Redi Ditamo D Pages 8845-8851
    Background
    Drugs including antibiotics are among the important components of heath care systems. However, they are not used appropriately to their maximum potential. The aim of this study was to assess extent of antibiotics use among hospitalized pediatric patients in Butajira general hospital, Ethiopia.
    Materials And Methods
    A cross sectional study was conducted on the 120 hospitalized pediatric patients’ medical cards using data abstraction format. A patient’s medical card was selected by simple random sampling after cards were arranged in chronological order. Data were analyzed by using statistical package for social science for windows version 20.0.
    Results
    The results revealed that almost three quarter 74.7% (248/332) of pediatric patients were prescribed with antibiotics with an average of 2.07 antibiotics per a patient. Two thirds 66.9% (166/248) of antibiotics treatments were supported by laboratory investigations; and more than three quarters 83.9% (208/248) of them were administered through parenteral routes. Ceftriaxone 20.9% (52/248) and gentamicin 21.7% (54/248) were the most commonly used antibiotics; and acute gastroenteritis 14.2% (17/120) and pneumonia 48.3% (58/120) were the most common causes of hospitalization among the pediatric patients.
    Conclusion
    This study has demonstrated that there was high prevalence of antibiotics use and poly pharmacy practices among hospitalized pediatric patients. There was also prescribing of antibiotics without laboratory investigations.
    Keywords: Antibiotics, Children, Ethiopia, Pediatric
  • Farid Imanzadeh, Batool Emadi *, Pejman Rohani, Amirhossein Hosseini, Katayoun Khatami, Naghi Dara, Beheshteh Olang, Aliakbar Sayyari Pages 8853-8861
    Background
    Given the important role of amino acids in regulating many metabolic pathways of the body and considering the scarcity of markers for the diagnosis of inflammatory bowel disease (IBD) and its differentiation, we aimed to investigate the status of serum amino acids chromatography in children with IBD.
    Materials And Methods
    This case-control study was conducted among children with primary diagnosis of IBD who referred to Mofid Children's hospital in Tehran, Iran. Children with a definite diagnosis of chronic IBD on the basis of endoscopy and biopsy were enrolled. In addition, 100 children without any history of predisposing, chronic, or inflammatory disease who referred to the same hospital during the period of the study were also selected. All samples underwent serum amino acids chromatography via HPLC method.
    Results
    Of all the patients in the IBD group, 18 patients (18%) suffered from Crohn's disease and 82 patients (82%) had ulcerative colitis; the disease was active in 54 patients (54%). The results of serum amino acids chromatography showed that several amino acids were significantly higher in patients with IBD. Considering the normal serum levels of amino acids, only the levels of two amino acids of histidine and tryptophan were significantly different in the IBD group compared the control group. In total, of all the subjects, 30 children (15%) had abnormal amino acid serum chromatography; hence, its prevalence was significantly higher in the IBD group (P=0.048).
    Conclusion
    The current study showed that serum amino acid chromatography in children with IBD were different from that in healthy children. More specifically, the decrease in tryptophan level was more observed in patients with active disease.
    Keywords: Inflammatory bowel disease, Children, Chromatography, Serum amino acids
  • Mohamed Zouari *, Ahmed Khalil Ben Abdallah, Mahdiben Dhaou, Riadh Mhiri Pages 8863-8865
    Our study aimed to clarify the relationship between obesity and the risk of postoperative morbidity following LESS appendectomy. We performed a retrospective review of all patients who underwent LESS appendectomy from January 2013 to December 2016. LESS appendectomy was performed in 109 patients during the study period. Among these patients, 17 (15.6%) were obese. There were no significant differences in operative time, postoperative length of stay, surgical site infections, emergency department visits, or readmissions among nonobese and obese groups. In conclusion, obesity did not have any impact on the intraoperative course or short-term postoperative complications after LESS appendectomy.
    Keywords: Appendectomy, Children, LESS, Obesity, Tunisia
  • Roxana Mansour Ghanaie, Abdollah Karimi, Seyed Mohsen Zahraei, Sussan Mahmoudi, Patrick Louis.F. Zuber, Ahmad Reza Shamshiri, Seyedeh Mahsan Hoseini-Alfatemi * Pages 8867-8875
    Background
    The BCG vaccine, used since 1921 to prevent tuberculosis (TB), considered the world's most widely used vaccine. This study aimed to investigate the frequency and the type of complications associated with Bacillus Calmette-Guérin (BCG) vaccination in Iranian children.
    Materials And Methods
    This cross-sectional study conducted for 6months among children aged up to 18 months who presented to primary health care centers in Tehran (under supervision of all three Medical Universities of Tehran) for their routine vaccinations. All children had received BCG vaccination at birth. We investigated the occurrence of BCG complications through history taking from the parents and physical examination by the study physician. Complications categorized into four major groups: local, regional, remote, and generalized and the rate of occurrence compared between the two genders.
    Results
    Finally, 14,095 children enrolled during the study period; 574 patients (4%) had experienced at least one complication following BCG vaccination. The most common complications were local side effects observed in 304 children (2.1%); followed by lymph node involvement detected in 270 children (1.9%). Lymph node involvement was more common in males (P
    Conclusion
    We found local adverse reactions as the most common complication following BCG vaccination and age was an independent predictor for the time of presentation of post vaccination lymph node involvement. Disseminated BCG and Osteitis not observed among vaccinated children.
    Keywords: Bacillus Calmette, Guérin, Children, Complication, Iran, Vaccine
  • Narges Afzali, Abdolreza Malek *, Niloofar Abasi Pages 8877-8880
    Background
    Gastrointestinal (GI) obstruction is one of the most important surgical emergencies in neonates. Surgeons should select between conservative and invasive strategies. Imaging modalities are important in proper diagnosis. This study evaluates the sensitivity of abdominal radiographies (with or without contrast) in detection of neonatal GI obstruction.
    Materials And Methods
    A cross-sectional study was performed on 62 neonates admitted in NICU of 22 Bahman and Dr. Sheikh Hospitals (Mashhad, Iran) from June 2013 for two years. Radiographic findings were recorded in questionnaires and compared with surgical results in patients who underwent surgery. Statistical analysis was used for determining the sensitivity of radiologic investigations in diagnosis of neonatal gastrointestinal obstruction.
    Results
    From 62 neonates with GI obstruction, 46.8% of cases were female and the others were male. According to surgery results, the frequency of colon obstruction was 51.6% and small bowel obstruction, gastric outlet obstruction and esophageal obstruction were seen in 27.4%, 9.7% and 17.7% of cases, respectively. The sensitivity of radiographies (with or without contrast) in detection of upper GI obstruction was 100% and in lower GI obstruction was 95.2%.
    Conclusion
    Generally, sensitivity of radiologic studies (radiographies with and without contrast) in neonatal GI obstruction was 96.5%, so it is a valuable noninvasive diagnostic method in these diseases.
    Keywords: Intestinal obstruction, Neonate, Plain radiography, Radiography
  • Masoumeh Ghasempour, Nemat Bilan *, Mohammadamin Rezazadehsaatlou Pages 8881-8888
    Background
    Pulmonary involvement is the main cause of mortality in cystic fibrosis (CF). Airway clearance techniques are non-pharmacological complement options for CF patients. The aim of this study was to evaluate the short-term outcome of airway cleaning treatment in patients with cystic fibrosis in a children's hospital.
    Materials And Methods
    This clinical trial study conducted on 40 CF patients referring to the specialized lung clinic of Tabriz Pediatric Center in Tabriz, Iran from April 2016 to April 2017. Patients were randomly divided into two equal case (PEP), and control (conventional) groups. The basic spirometry parameters were measured on the European Respiratory Society criteria. After therapeutic intervention, the patients were followed for the next six months and the number of hospital admissions were recorded.
    Results
    The mean of FEV1, FEV1/FVC and FEF25%-75% in the control group after treatment were 62.60±20.39, 86.70±19.39 and 55.20±32.78, respectively. Comparison of the control group means of FEV1, FEV1/FVC, and FEF25%-75% in the case group after intervention (57.52±14.62, 76.80±21.83 and 59.8±28.71, respectively) showed significant differences (p
    Conclusion
    The patients undergoing treatment (PEP and control groups) showed better spirometry results. In the PEP group, the number of re-hospitalizations was significantly lower than the control group.
    Keywords: Cystic fibrosis, Lung injury, Pediatrics, Positive expiratory pressure
  • Noor Mohammad Noori, Alireza Teimouri *, Turan Shahraki Pages 8889-8905
    Background
    Celiac disease (CD) is an autoimmune mediated gluten sensitive enteropathy and a chronic inflammatory condition caused by immune pathology in the small intestines in genetically susceptible individuals. This study aimed to determine the efficacy of gluten free diet on cardiac functions using conventional and Doppler tissue echocardiography (DTE) in children with CD compared to controls.
    Materials And Methods
    This case-control study was conducted on 107 children with CD and 45 healthy children. The study was performed in the Ali Ebne Abi Talib hospital, affiliated to Zahedan University of Medical Sciences, Zahedan (ZaUMS), Iran. After considering exclusion criteria, participants underwent echocardiography. Data were analyzed through SPSS software version 20.0.
    Results
    Results showed that tTG-IgA was different in participants. Left MPI was different in control-positive (p
    Conclusion
    It was concluded in patients with positive response to gluten free diet that some heart functions were similar to the controls and in patients with negative response, some were similar to newly diagnosed patients. Diastolic and systolic dysfunctions are important findings in CD children and TDE is a better method to identify cardiac involvements in subclinical patients with CD.
    Keywords: Cardiac Involvements, Celiac, Children, Gluten
  • Zahra Alebrahim, Ali Reza Moayedi *, Abdolmajid Nazemi, Abdolhossein Madani, Maryam Montaseri Pages 8907-8913
    Background
    Although the development of effective and safe treatments for prophylaxis of migraine headaches represents an important public health concern, only a few medications have been approved by the specific treatment of patients with migraine. We aimed to compare the efficacy of cinnarizine with propranolol in the prophylaxis of pediatric migraine headache.
    Materials And Methods
    In a Randomized Clinical Trial, children aged 6-14 years were selected from the patients with migraine admitted to the neurology clinic of Bandar Abbas pediatric Hospital, affiliated to Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Eligible patients (n, 56) were randomly divided into two groups, each comprising 28 patients: the first group administered cinnarizine (37.5 mg/day in children aged 6–12 years and 50 mg/day in children aged 12–17 years), and the second group received propranolol (1-mg/kg/day). The frequency, severity of headaches over the trial period were assessed.
    Results
    After two months of treatment, both groups had significant reduction in headache frequency in comparison with baseline period (p= 0.047), although this difference between groups was not statistically significant. In addition, the mean severe migraine attacks at the end of the second month was significantly lower in the cinnarizine group compared with the propranolol group (p=0.048). At the end of the study 64% (n=18) of patients who had received the cinnarizine and 57% (n=16) of patients who had administered the propranolol, the drugs appeared to have a preventative effect on their headaches.
    Conclusion
    According to the results, Cinnarizine appeared as effective as propranolol for the prophylactic treatment of childhood migraine.
    Keywords: Children, Cinnarizine, Headache, Migraine, Propranolol
  • Ramadan A. Mahmoud * Pages 8915-8924
    Background
    Non-invasive ventilation is increased used in preterm infants. We aimed to compare the effectiveness of nasal intermittent positive pressure ventilation (nIPPV) versus nasal continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS) after less invasive surfactant administration (LISA).
    Materials And Methods
    In this clinical trial, eighty two preterm infants admitted in neonatal intensive care unit, Sohag University Hospital, Egypt with a gestational age of 28–34 weeks, mean ± standard deviation birth weight (1259.44±377.22 grams), suffering from RDS but not requiring intubation in the delivery room were included in the study. Forty one received nIPPV as an initial respiratory support (RS). If nIPPV failed, surfactant administration was given with the LISA approach and patients continued on nIPPV. This group was compared with a historical cohort group of 41 infants managed with nCPAP as an initial RS, and if nCPAP failed, the surfactant was given by LISA.
    Results
    There was no significant difference between the case and control group regarding the mean ± SD gestational age or birth weight. When nIPPV was used as the primary RS in preterm infants with RDS compared to nCPAP, it had a significantly less nIPPV failure (31.71% versus 53.66%, P = 0.04), had significantly fewer infants who needed invasive ventilation within the first seven days of life (12.20% versus 34.14%, P = 0.03), and the total days of supplemental oxygen was less (9 (3–18) days versus 12 (6–34) days, P = 0.02).
    Conclusion
    In infants born at 28–34 weeks gestation, nIPPV, when used as the primary RS, reduced the need for invasive ventilation and the surfactant requirement within the LISA technique.
    Keywords: Infants, Non, invasive Ventilation, Premature, Surfactant