International Journal of Pediatrics
Volume:7 Issue: 68, Agu 2019

Background Epilepsy is one of the most common neurological diseases. Over the last decades the hypothesis of cardiovascular effects from sudden seizure has been raised, and cardiac rhythm and ECG changes in these patients have been highlighted. The study aimed to evaluate the electrocardiography findings in children with epilepsy compared with healthy children. Materials and Methods In this case-control study, 90 patients aged between 6 months and 18 years who were matched with equal number of healthy children who referred to pediatric ward the of 'Ali Ebne Abi Talib' hospital in Zahedan, Iran. The study was performed in multicenter of Neurology and Cardiology centers. In the patients, the epilepsy was confirmed by a unique pediatric neurologist based on the definition of having at least two unprovoked seizures in 24 hours. ECG was captured from all participants by a pediatric cardiologist. Results In patients, 45.6% (n= 41) were females and in healthy 51.1% (n= 46) were females. Mean age of participants was similar in patients and healthy children (p=0.060). ECG findings such as QT min (p=0.001), R-R interval (p<0.001), Heart rate (p<0.001), S in V1 (p=0.002), R in aVL (p<0.001), S in V3 (p=0.003), QTd (p<0.001), QTcd (p<0.001), QTc max (p<0.001), and LV mass (p=0.007) were different in patients compared to controls.  In patients, from ECG parameters, R in V5 was higher in male patients (p=0.043).   Conclusion Based on the results, QTc, QTd, QTcd were prolonged in patients with epilepsy and, R in V5 was higher in male patients. To prevent abnormality rhythm in epilepsy, it is needed to evaluate QT to recognize the autonomic changes.

Introduction Appendicocecal intussusception is an uncommon condition which must be differentiated from other types of invagination due to different therapeutic approaches and its ultrasound findings are outspread and imperfectly presented in literature. We present a case with specific sonographic signs as well as review of related articles. Case Presentation A 3.5 year-old girl with intermittent crampy abdominal pain from one month ago that was recently exaggerated was associated with nausea and vomiting. She had specific sign of appendicocecal intussusception. Due to unsuccessful hydrostatic reduction, surgical intervention and appendectomy was performed. Conclusion The absence of clinical symptoms and ultrasound findings of small intestine obstruction and invagination target (transverse diameter less than 20 mm) adjacent to terminal ileum loop containing hypoechoic Peyer's patches can help differentiate appendicocecal invagination from the other types of invagination.

Biliary tract injury is a major complication of laparoscopic cholecystectomywhich can be very challenging. But, the important part is to know the accurate anatomy of the ducts and site of the injury before any surgical attempt for ligation or repair. In this case a disaster might happen if we do not consider biliary anatomical abnormality as the main issue.   Case Report   In this case, there was an additional duct originating from the right hepatic lobe and inserting directly to the common bile duct (CBD) along with the right hepatic duct. The injury to this branch led to biloma secretion from two tearing sites, one proximal to the branch and another distal of the branch adjacent to CBD, during laparoscopic cholecystectomy.   Conclusion   There are numerous anatomic variations in the biliary tract, so according to this case we highly recommend to assay the exact anatomy before any intervention by means of Magnetic resonance cholangiopancreatography (MRCP) or intraoperative cholangiography.

Background The respiratory distress syndrome (RDS) is one of the most common respiratory disorders in premature newborns. The aim of this study was to determine the effect of surfactant accompanied by Ventolin on the RDS in premature newborns. Materials and Methods The study was a double-blind randomized controlled trial that was conducted on 80 premature newborns with RDS in Imam Reza Hospital of Kermanshah, Iran, in 2018. The eligible newborns, using a random number table, were divided into two groups of surfactant with Ventolin as intervention group (n=40) and surfactant with normal saline as control group (n=40). The data collection tool was a checklist, including the demographic characteristics (gender, birth weight, gestational age, etc.) and clinical variables (length of hospitalization, pneumothorax, need of Continuous Positive Airway Pressure (CPAP), mechanical ventilation, tachypnea duration, RDS score, etc.). Data were analyzed using SPSS software (version 24.0). Results The results of the study showed that the two groups of intervention and control have significant statistical difference in terms of RDS score, tachypnea duration, duration of taking oxygen, start time of oral feeding, length of hospitalization, partial pressures of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), need of mechanical ventilation and pneumothorax, respiratory rate, heart rate, oxygen saturation and FIO2 after intervention (P<0.05). However, there were no significant statistical differences between the two groups in terms of need of CPAP and outcome (P>0.05). Conclusion The results of this study showed that administration surfactant accompanied by Ventolin can lead to decrease in RDS score, improve the respiration status, reduce start time of oral feeding and also reduce length of hospitalization.

Background Mortality is one of the indicators of community health and reflects the social, economic and environmental status of the residence of people. In this regard, countries in the Eastern Mediterranean Region (EMR) have many problems. Therefore, this study was conducted to investigate the factors affecting on mortality in the region. Materials and Methods This study was conducted in the 22 EMR countries. Required data on mortality were collected from WHO online database and Weather, Geneva, Switzerland. The data were analyzed by ArcGIS 10.6.1 software, graphic statistical methods, SPSS software version 23.0, descriptive statistical tests, ANOVA, and regression correlation coefficient. Results The results showed that in the 22 EMR countries, mortality in children under five, neonatal mortality rate, mortality rate attributed to household and ambient air pollution, mortality rate attributed to exposure to unsafe WASH services and mortality rate attributed to unintentional poisoning were 52 per 1000 live births, 26.6 per 1000 live births, 58.8 per 100,000 population, 13.1 per 100,000 population and 1.4 per 100,000 population, respectively. The results showed that the countries of Somalia, Yemen, Iraq, Afghanistan, Pakistan, Sudan, and Djibouti were in a very poor situation and there was an inequality in health in the countries of the region. Conclusion Based on the results, the main factors affecting mortality rate included: 1) Average precipitation, 2) Latitude, 3) Above sea level, 4) Food safety, and 5) Births attended by skilled health personnel.

Cutaneous leishmaniasis (CL) is a main public health problem in Iran with a high incidence rate among children. According to numerous studies in Iranian society, the most commonly affected age group is 1–4 years. At present, we aimed to investigate the pediatric CL among children in Golestan Province in North of Iran. A cross-sectional study was run on data existed for 3,371 cases with pediatric cutaneous leishmaniasis based on routinely collected data from the Health System of Golestan Province, Iran, between 2010 and 2017. Data of the study were gathered using two checklists about CL and demographic status from District Health Network. Data were analyzed using SPSS software (version 18.0). In general, 3371cases were investigated. The majority of cases were male 1495 (50.9%), lived in the rural area, while the least CL were female 155 (38.7 %), and lived in the urban area.  Pediatric cutaneous leishmaniasis had the highest 883 (26.3%), and lowest 186 (5.5%) frequency in 2010 and 2013 years, accordingly. CL was increased from July and reached to maximum in October, then decreased considerably in January. In final, a significant relationship was found between CL cases and years of the survey (p= 0.001). The most CL cases were found among males and aged 0-5 years. As indicated by different studies, CL in the endemic area of the country (Golestan Province) occurs more often in children, while it commonly happens among adolescents in the central area of the country. Thus, it points to the role of mothers in protecting children through dressing up and sleeping habits in the outdoor environments.

Adolescence is one of the most important periods of life for all people. This is a transition period from childhood to adulthood, through which individuals should learn to make the right decisions and apply the life skills. This study aimed to explain the life skills' experiences of 12-14 year-old female adolescents. In this qualitative content analysis study, adolescent girls aged 12-14 years were selected by the purposeful sampling method. The data were collected using individual interviews and focus group discussions. The recorded audio files were transcribed. Then, the information was compared and merged with the available literature in the field. A classification matrix was created according to the constructs of the social cognitive theory (SCT). Categories were derived from the constructs of SCT and themes were extracted from the analysis and interpretation of data. The main extracted themes consisted of the environmental, behavioral, and personal factors. The theme of environmental factors included two categories of interpersonal relationships and influential role models as well as access to resources and facilities. The theme of behavioral factors included the categories of skills and the personal factors' theme contained the categories of personality traits, attitudes, perceived self-efficacy, knowledge, and outcome expectations. The use of life skills by adolescents is influenced by personal, environmental, and behavioral factors. Therefore, appropriate conditions should be provided for the adolescents to use the life skills. These conditions include acquisition of knowledge and skills, perception of positive outcome expectancies, existence of influential role models, existence of supportive systems, access to facilities, and positive attitudes.

Fear of dental care prevents dental cleaning behavior and increases the prevalence of dental caries. This study was conducted to determine the effect of Trans-Theoretical Model constructs and fear of dental care on the dental cleaning behavior of students. This cross-sectional study was carried out in Sanandaj city, Iran, in 2017. Using multi-stage sampling, 1,344 male and female students were included in the study. They completed a self-report questionnaire, including demographic information, Trans-Theoretical Model constructs and fear of dental care. Data were analyzed using SPSS software (version 22.0). A total of 1,344 male and female students with a mean age of 15.22±2.64 years participated in the study; from the perspective of students, dental caries (88.4%) was the most frequent illness and tongue inflammation (0.6%) was the least frequent disease.Overall, 32.9% of the students used no tools for cleaning their teeth. Fear of dental care and perceived barriers were reduced significantly during the stages of dental cleaning behavior (p<0.05) and perceived self-efficacy and perceived benefits were significantly increased (p<0.001). The odds of dental cleaning behavior increased with self-efficacy (OR=1.34, 95%CI=1.22-1.48, p<0.05), and decreased with fear of dental care (OR=0.90, 95%CI=0.80-0.98, p<0.01). The findings showed dental cleaning behavior among students was at a low level and various factors such as perceived self-efficacy, benefits and barriers and fear of dental care influenced its performance.

The administration of pediatric medicines in an accurate manner for successful therapy is imperative. This study aimed to investigate the Iran Medicine List for the appropriateness of the six pharmacological formulations for children populations to the success of accurate dose delivery. This is a cross-sectional study to evaluate oral delivery of the pediatric medicines that belong to six pharmacologic categories including anti-infective, anti-asthma, non-steroidal anti-inflammatory drugs, corticosteroid, cardiovascular and oral-rehydration-therapy in Iran. WHO pediatric model list has been assigned as the pattern of evaluation. The compatibility of the pediatric liquid formulations for oral route of administration, in Iran Medicine List, has been assessed. To evaluate the efficiency of oral liquid formulations for delivering the appropriate dosage and determining the amount of medication waste, minimum and maximum therapeutic range of each medicine for defined diseases was calculated according to six-year old child’s weight. Also, to obtain the minimum amount that could easily deliver the appropriate dose, as well as availability of selected medicines at the pharmacy level, an in-house questionnaire was prepared, validated, and was filled by 40 pediatricians and pharmacists. The results of comparison between the two lists showed that, among 106 medicines of WHO model list, only 37 medicines had liquid oral formulation and 13 medicines have not been registered in Iran Medicine List. Results obtained from questionnaire indicated that between these 37 oral liquid formulations, just 20 formulations are available in pharmacies. Based on the results, almost half of the medicines defined in the WHO model list are either not listed in Iran Medicine List or are not in appropriated formulation for pediatric use.

Child abuse is a serious global problem and can be in the form of physical, sexual, emotional or neglect by not providing for the child's needs. Functional constipation (FC) is a common functional gastrointestinal (GI) disorder in children. This study was aimed to assess the relationship between child abuse and functional constipation in children. Materials and Methods In this age frequency-matched case-control study, 100 children with FC were compared with 100 healthy children as control. The diagnosis of FC was based on history and physical examination. Child abuse in three sub-groups (physical, emotional and neglect) were assessed by ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C). The data were analyzed by Stata software (version 13.0). The results of this study revealed that the frequency of any kind of child abuse in case (children with functional constipation), and control group (children without functional constipation) is 93% and 84%, respectively, OR: 2.53 (95% CI: 1.00-6.45), P=0.052. The most frequent abuse in both groups was emotional abuse (91% vs. 81%) followed by physical (61% vs. 47%), and neglect (19% vs. 8%). There was a significant association between frequency of emotional (OR: 2.37, P=0.046), physical (OR: 1.76, P=0.048) and neglect abuse (OR: 2.70, P=0.027) among case and control groups. However, after controlling the confounding variables, the association between child abuse and FC remained clinically important but was not statistically significant (P>0.05). Conclusion Notwithstanding emotional abuse, physical abuse and child neglect rate were more frequent among children with FC, this study demonstrates that child abuse is not associated with FC occurrence.

The aim of the present study was to evaluate the effect of growth hormone on growth parameters such as Z scores for height, weight, and body mass index (BMI), and height velocity in two groups of children with chronic renal failure (CRF) treated with and without growth hormone. This longitudinal study was conducted on all children aged 6 months to 16 years with a short suture who had chronic kidney disease and indication of the growth hormone (GH) replacement therapy during the years 2016 to 2018 at Sheikh Nephrology Clinic. In our study, growth parameters including Z scores for height, weight, and BMI were measured in each patient at the beginning and at the end of follow-up. To assess the effect of growth hormone, growth parameters were compared between the two groups at the beginning and at the end of follow-up. Also, height velocity was compared in the growth hormone treated and untreated groups. Results showed that a significant difference between the two groups in terms of height velocity in the first year (P=0.013) and the whole period (P = 0.003). Also, there was no significant difference between two groups in terms of height Z score at the start of follow-up (P = 0.101), but it was significant at the end of the follow-up (P = 0.044). Results of comparing weight Z scores, BMI values and laboratory parameters in two groups at the beginning and at the end of the follow-up showed no significant differences.

Systemic lupus erythematous (SLE) is a multisystemic and autoimmune inflammatory disease characterized by production of autoantibodies against different cellular components. We aimed to investigate children with SLE in terms of clinical symptoms and laboratory findings who referred to Lupus clinic. In this cross-sectional study, 36 children with SLE referring to lupus clinic of Dr. Sheikh hospital, Mashhad-Iran, were enrolled for one year. Clinical symptoms and involvement of different organs were completely checked and recorded at the time of diagnosis of lupus disease based on questionnaire information. The patients with nephritic manifestations of lupus underwent needle biopsies of kidneys, with the samples being examined by light microscope and immunofluorescence to investigate the extent of renal involvement. The main course of treatment included steroid- cyclophosphamide (injection and oral), hydroxychloroquine - mycophenolate (Cellcept) and Azathioprine. Then, response or lack of treatment response as well as the extent and severity of relapse were recorded based on questionnaire. In this study, out of 36 lupus patients, 30 were female (83.3%). The mean age was 9.15±4.28 years. Lupus nephritis, musculoskeletal manifestations, hematological manifestations, cutaneous manifestations, and neurological manifestations existed in 20 (55.6%), 11 (30.6%), 9 (25.0%), 7 (19.4%), and 4 (11.1%), respectively. There was no significant relationship between the age plus gender and lupus clinical manifestations. However, there was a significant relationship between relapse of disease and lupus nephritis (p

Background Corpus callosum is the largest commissure in human brain. It consists of tightly packed white matter tracts connecting the two cerebral hemispheres.  In this study we aimed to evaluate role of fiber tractography (FT), and diffusion tensor imaging (DTI) in pediatric patients with corpus callosum anomalies and correlate findings with clinical presentation. Materials and Methods This prospective study included 115 children with clinical presentations and CT findings suggested corpus callosum anomalies. Their ages ranged between 2 and 12 year-old. They referred from Pediatric Neurology unit to Radiology Department in Minia University hospital for children, Minia (Egypt) from April 2018 till December 2018. They underwent MRI fiber tractography and diffusion tensor imaging after approval of ethical committee of our institution and informed consent form patients’ parents. Results Our study included 42 (36.5 %) males and 73 (63.5 %) females. They were reviewed for corpus callosum anomalies according to Hanna classification, the commonest was hypoplasia without dysplasia 37/115 (32 %). Using DTI and FT, corpus callosum fiber defects were classified into fronto-rostral, caudal and whole body defect. Significant statistical correlation was found between ADHD, autism and loss of fronto-rostral fibers. Epilepsy and developmental delay were correlated to whole body defect and caudal fiber tract defects. Conclusion Based on the results, Fiber tractography and diffusion tensor imaging are newly developed promising techniques. They proved high accuracy in localization of exact affected corpus callosum white matter tract. They help to predict prognosis of patients that could not be explained by morphological changes seen in conventional MRI.

The aim of the present study was to report a case series involving the treatment of primary congenital lymphedema using the Godoy method. Eight children (seven girls and one boy) with primary congenital lymphedema of the upper limbs treated at the Godoy Clinic. A retrospective clinical trial was conducted to evaluate treatment for primary congenital lymphedema of the upper limbs in children using the Godoy & Godoy lymphatic therapy method. The first treatment option for all children was cervical lymphatic therapy. The mothers were trained in the technique under the supervision of the team and, after demonstrating the ability to perform the therapy, were then free to continue cervical stimulation on their children at home. A reduction in edema was found in all children throughout treatment, ranging from two months to two years.

Background The first step in assessing thoracic lesions is chest X-ray, but the optional imaging procedure for the final diagnosis is controversial. We aimed to examine the diagnostic accuracy of imaging modalities in pediatric thoracic masses. Materials and Methods This prospective cross-sectional study was conducted from 2017 to 2018 in Dr. Sheikh hospital, Mashhad, Iran. A total of 130 patients with a confirmed pathology report of thoracic masses were recruited in this study. A pediatric radiologist independently evaluated the existing chest X-ray (CXR), ultrasound (US) and CT and reported the probable diagnosis. Imaging reports of CXR, US, and CT were compared with the pathology results. Results 83 (63.8%) of the patients were boys with the mean age of 72.15 + 46 months. The most prevalent site of the thoracic masses was the lung parenchyma with the frequency of 81 (62.3%), and the most frequent mass was hydatid cyst with the frequency of 57 (43.8%). Thoracic CT had the overall sensitivity of 100% for mass localization and 78.2% for nature determination; while US had the sensitivity of (95.4%) for mass localization and 90.9% for the diagnosis of mass nature. The sensitivity of CXR for thoracic mass localization was 89.4 and for mass nature determination was 35.5%. Conclusion Based on the results, CXR and US had a similar appropriate sensitivity in localization of thoracic masses. Although CT had the highest overall sensitivity for mass localization, in comparison with US, it was less diagnostic to define mass nature and US had the highest sensitivity for mass nature determination. Hence, US may potentially obviate further imaging such as CT in most of the cases.

Feedback is a conscious, unbiased, and objective evaluation of performance in order to improve clinical skills, not to assess students' personal talents and values. This study aims to compare the views of pediatric residents and general medical students at Mashhad University of Medical Sciences regarding method of providing feedback in clinical education. This cross-sectional study was conducted in the pediatric ward of hospitals affiliated to Mashhad University of Medical Sciences in 2018. The census method was used to select 35 pediatric residents and simple random sampling method was used to select 35 general medical students who had completed internship and apprenticeship. Data collection was carried out using a standard 21-item feedback questionnaire. Pediatric residents and general medical students were asked to identify the importance of feedback received during their clinical education using a 4-point Likert scale. The majority of residents believe that feedback was only sometimes expected (27.1%), clearly and explicitly outlined (17.1%), fair (21.4%), and useful in correcting their attitude (18.6%), performance (17.1%), and behavior (27.1%). Majority of general medical students believed that clear, explicit (24.3%) feedback was related with their future career (14.3%) and most of them received positive feedbacks (20). Apart from propositions items 20, 18, and 17, most medical students and residents have selected the Often and Sometimes options, respectively to respond to items. Pediatric residents were less satisfied with the feedback received during the clinical education as compared to the general medical students.

Breastfeeding self-efficacy is a psychological effective factor on initiation and duration of breastfeeding, which according to Bandura's theory, is affected by four sources including performance accomplishments, vicarious experiences, verbal persuasion, and the emotional/physiological responses. We aimed to systematically review the effect of interventions using Bandura's self-efficacy theory on breastfeeding self-efficacy in Iranian mothers. In this systematic review, all interventional studies from 1990 to May 2019, were searched in Web of Science, Scopus, EMBASE, Cochrane library and Medline databases as International databases and SID, Magiran and Irondoc as National databases by using English and Persian related keywords. Two reviewers studied the full text of the articles and their main findings were extracted and categorized. Quality assessment of studies was checked and verified by two authors independently based on the Effective Public Health Practice Project (EPHPP) tool. Finally, 21 articles (2,661 samples) which met inclusion criteria were investigated and reviewed in 5-domain that include performance accomplishments, vicarious experiences, verbal persuasion, and the emotional/physiological responses as well as interventions by using a combination of the 4 sources. The results of our review showed that mothers in intervention groups had significantly higher breastfeeding self-efficacy score compared to the control group. In addition, interventions by using verbal persuasion (52%, n=1660) are the most common and effective. The results showed that intervention with the use of Bandura's self-efficacy theory improves the breastfeeding self-efficacy. Due to the impact of these interventions on the initiation and duration of breastfeeding, simple and cost-effective, the implementation of theory-based interventions to improve breastfeeding self-efficacy in hospitals and health centers seems to be necessary.

Compared to intrathecal methotrexate (IT MTX), triple intrathecal therapy (TIT) has shown promising results in decreasing central nervous system (CNS) relapse in children with acute lymphoblastic leukemia (ALL). We aimed to compare these two IT regimens in terms of CNS relapse, survival, and IQ in Iranian non-high risk ALL children. In a two phases clinical trial study, 203 children with non-high risk ALL, aged 1-10 years at diagnosis, who were previously treated with the same systemic protocol but with two different IT regimens, based on IT regimen allocated to IT MTX (n = 109) and TIT (n = 84) groups were studied. In phase 1, isolated CNS relapses (i-CNS) and five-year survival of the two groups was compared, and in phase 2, IQ score of survivors of two groups was measured and compared. The overall rate of i-CNS relapse was 13.8% and the incidence of i-CNS relapse in contrast to other areas in the IT MTX group, was higher than in the TIT group (17.4% vs. 9.6%; P= 0.03). Most i-CNS relapses were asymptomatic and "early" and there was no significant relation between IT formulation and secondary relapse and mortality rate in patients with i-CNS relapse (P> 0.05). The 5-year survival of TIT group was more than the IT MTX group (80.9% vs.70.6%; P=0.04), but the mean scores of full-scale, verbal, and performance IQ (except cubes) were not significantly different in the two groups. Based on the results, TIT regimen compared to IT MTX reduced i-CNS relapse and increased 5-year survival in Iranian children with ALL but had no significant differences in total IQ score.