فهرست مطالب

Pediatrics - Volume:7 Issue:72, 2019
  • Volume:7 Issue:72, 2019
  • تاریخ انتشار: 1398/09/10
  • تعداد عناوین: 27
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  • Batool Esmaeeli, Molood Bolourian, Iman Kashani, Mohaddeseh Badpeyma, Samaneh Norouziasl *, Neda Dehghani, Fatemeh Hafezipour, Hamed Jafarpour, Fahimeh Khorasani Pages 10405-10411
    Background
    Literature presented numerous methods to promote nutrition in premature newborns. The aim of the review is to promote nutrition in premature newborns using numerous methods which have been suggested by systematic review.
    Materials and Methods
    Online databases including Scopus, Medline, Web of Science, EMBASE, and Cochrane Library were systematically searched to perform the present review. In this search date of publication was not considered and articles from the beginning until February 10, 2019 were included. The keywords of choice were "aromatherapy OR smell OR olfactory" AND "infants OR baby OR preterm OR premature". To evaluate the quality of the studies obtained by searching, Jadad scoring was utilized.
    Results
    Finally, four studies were included for review. In the first study, babies in milk-odor group showed more bursts consisting of more than seven sucking attempts, longer sucking bouts and ingesting more volume of milk in comparison to the control group. According to observations in the second study, elevated number of sucks in the presence of breast milk odor was seen in six of 7 infants switched from tube feeding to full enteral feeds in less time. In the third study, olfactory stimulus shows gestational age-related variations in premature infants babies born prior to 31th week of gestation receiving mother's own milk stimulation were able to feed prior to the control group. In the fourth study, babies born after 31th week of gestation did not show significantly different in response to receiving MOM than control group.
    Conclusion
    Aromatherapy improved feeding behavior by more sucking attempt, longer sucking
    Keywords: Aromatherapy, Nutrition, Premature Infants, Review
  • Mojtaba Fazel, Sajjad Ahmadi, Mohammad Javad Hajighanbari, Alireza Baratloo, Kavous Shahsavarinia, Mostafa Hosseini *, Mahmoud Yousefifard Pages 10413-10422
    Background
    Value of Corticosteroid Randomisation after Significant Head Injury (CRASH) prognostic model has not been assessed in children with traumatic brain injury (TBI). This study is designed to examine the value of CRASH model in prediction of 14-day mortality and 6-month unfavourable outcome of pediatric TBI.
    Materials and Methods
    In a cross-sectional study, 738 children with TBI brought to the emergency ward of four hospitals were studied. For assessing the predictive value of the CRASH model discrimination power and calibration of CRASH basic model and CRASH CT model were examined.
    Results
    The areas under the curve (AUC) of CRASH basic and CRASH CT models in prediction of 14-day mortality were 0.89 and 0.91, respectively. AUCs of the CRASH basic and CRASH CT models in predicting unfavourable outcome were 0.93 and 0.94. The value of two models in prediction of 14-day mortality (p=0.20), and 6-month unfavourable outcome (p=0.22) were equal. Both models had proper calibrations in predicting 14-day mortality and 6-month unfavourable outcome.
    Conclusion
    As calculations of the basic model are easier than those of the CT model and it does not necessitate CT scanning, the CRASH basic model is suggested in the field of pediatrics.
    Keywords: Clinical, Emergency service, Sensitivity, Specificity, Pediatrics
  • Noormohammad Noori, Maryam Nakhaee Moghadam, Alireza Teimouri *, Hossein Bagheri Pages 10423-10439

    Background Diabetes mellitus type I (DMTI) is one of the most common endocrine and metabolic conditions in childhood. We aimed to assess the tissue Doppler imagining changes in children with DMTI compared to healthy children. Materials and Methods This case-control study was performed on 96 DMTI and 96 healthy children. The diabetes mellitus type I was confirmed by the clinical manifestation and laboratory measures. Both groups underwent echocardiography by tissue Doppler imaging by a pediatric cardiologist and their height and weight were measured using standard equipment and then BMI was calculated. Patients’ HbA1c, diabetic duration and lipid profiles of cholesterol, HDL, LDL, and triglyceride were measured.  Results Left ET’, left IRT’, left E’, right ET’, right ICT’, right IRT’, right S’, right E’, left MPI’, and right MPI’, left E/E’ were significantly different in diabetes patients compared to healthy children (P>0.05). In patients based on HbA1c, left ICT’ (P=0.010), right S’ (P=0.050) were higher in abnormal status of HbA1c and in the case of diabetes duration categorization the results revealed that all the TDI findings were similar. The patients with higher TG had lower value of left A/A’. Right S’, right E’, right A’, right E/E’, and LDL were different in patients that were grouped based on CHO (P<0.05). Right S’ and right E’E’ were different in patients with normal LDL (P<0.05). Right S’ had higher values in abnormal status of LDL. Conclusion It was concluded that DMTI had more tissue Doppler imaging involvement. No changes were observed in TDI except   right S’, left MPI’ and left ICT’ in HbA1c and right IRT’, left ET’ and right MPI’ in diabetic duration.

    Keywords: Children, Diabetes Mellitus, Hemoglobin A1C, Tissue Doppler Imaging
  • Farzaneh Rashidi Fakari, Hedyeh Riazi, Sepideh Hajian, Giti Ozgoli, Malihe Nasiri, Padideh Janatiataei, Zohre Sheikhan, Monireh Sadat Khoramabadi * Pages 10441-10448
    Background
    Adolescence is one of the most important and valuable times in every person's life. Therefore, creating a way to adopt and maintain healthy behaviors, education and health interventions seem to be necessary. The present study was aimed to investigate the effect of planned theory-based education on health promoting behaviors in adolescent girls aged 12-14 years in selected schools in Tehran, Iran.
    Materials and Methods
    A quasi-experimental study (n=80) was conducted on female students (first course of secondary education) in Tehran's schools in 2016. Sample size was estimated based on the mean comparison formula of the two groups. The data gathering tool included health promoting behaviors questionnaire and demographic questionnaire. In the intervention group (n=40), the training (three one-hour sessions) was conducted by the researcher through lecture, question and answer and group discussion. Before intervention and two months after the intervention, the intervention group and the control group (n=40) completed the questionnaires twice in a two-month interval.
    Results
    The results of independent t-test showed no significant difference in mean and standard deviation of scores of attitude, subjective norms, perceived behavior, behavioral intention and behavior before intervention in the two groups (p> 0.05). Independent t-test result showed a significant difference in mean and standard deviation of scores of attitudes, subjective norms and perceived behavior after the intervention (p<0.05).
    Conclusion
    The results showed that education based on the theory of planned behavior improved health promoting behaviors of adolescent girls. Therefore, it is recommended that schools use theory-based educational programs to increase the health promoting behaviors of adolescent girls.
    Keywords: Adolescent, Attitude, Girls, theory of planned behavior
  • Ali Ahmadzadeh Amiri, Payman Sadeghi, Mahdieh Mousavi Torshizi * Pages 10449-10454
    Introduction Macrophage activation syndrome (MAS) is a rare and life-threatening complication of Kawasaki Disease (KD) that is usually diagnosed at the same time or after KD. We report a case of MAS as the initial manifestation of KD. Case Report A previously healthy 3-year old girl was admitted to the pediatric infectious diseases ward of Bahrami Children’s Hospital, Tehran, Iran. She had a 3-day history of fever and lymphadenopathy which persisted despite antibiotic therapy. Patient's general condition gradually worsened and she developed loss of consciousness. After being diagnosed with MAS based on laboratory findings, she developed mucocutaneous manifestations of KD. She responded to methylprednisolone pulse therapy, intravenous immunoglobulin and dipyridamole. The follow-up at 2 weeks and 2 months showed no abnormal findings. Conclusion MAS may manifest even before the diagnosis of KD is made.  Early recognition of MAS associated with KD and prompt treatment with corticosteroids can improve the outcome.
    Keywords: Children, Iran, Macrophage activation syndrome, Kawasaki disease
  • Siavash Kafian Atary, Arvin Mirshahi, Ahmad Amouzeshi, Abbas Ali Ramazani, Zahra Soleimani Khomartash, Babak Bahman, Mahsa Hasanzadeh Tahery, Forod Salehi * Pages 10455-10463
    Background
    Congenital heart disease is the most common type of maternal abnormality and is the leading cause of mortality in the first year of life. The aim of this study was to determine the epidemiological and related factors of congenital heart disease (CHD) in children referred to the pediatric heart clinic of Vali-e-Asr Hospital of Birjand, Iran.
    Materials and Methods
    In this descriptive-analytical cross-sectional study, the study population included 300 patients with congenital heart disease who referred to the Vali-e-Asr Hospital, Birjand, Iran. A checklist form was used to complete the information contained in the patient records and contact their parents. The collected data were analyzed using SPSS software version 16.0 at a significance level of p≤0.05.
    Results
    The mean age of children with CHD at the time of diagnosis was 1.25 ± 2.92 years. 156 (52%) were male. The most common type of CHD included ventricular septal defect (28.7%), patent ductus arteriosus (18.2%), and atrial septal defect (14.6%). Down syndrome (3.8%) was the most common anomaly. In 57% of cases, there was a familial relationship between parents. There was a significant statistical difference between drug use in pregnancy, maternal age, age of patients, mother's education level, place of residency, and familial relationship of parents and CHD in the children p≤0.05.
    Conclusion
    Based on the results, the most common type of CHD included ventricular septal defect, patent ductus arteriosus, and atrial septal defect, respectively. There was a relationship between baseline and clinical characteristics (maternal age, patient age, familial relationship, and drug use in pregnancy), and CHD in the children.
    Keywords: Children, congenital heart disease, Epidemiology, Related Factors
  • Mohammad Kazem Sabzehei, Behnaz Basiri, Farzaneh Esna Ashari, Firozeh Hosseini * Pages 10465-10471

    Background Preterm birth significantly affects the neonates’ survival. It also increases the risk of neonatal complications, prolongs the hospitalization period, and imposes high costs on the public health system. This study is aimed to assess the risk factors of the preterm birth. Materials and Methods This case-control study was carried out at a maternal referral hospital in Hamadan. The participants consisted of 470 preterm infants born in less than 37 weeks of gestational age (case group), and 470 term infants with normal gestational age (control group). Several variables including the neonatal birth weight, gestational age, type of delivery, the maternal age, history of infertility, birth order and maternal disease were compared in both groups. The collected data was extracted from the medical file and recorded in a pre-designed checklist; they were then analyzed using SPSS software (version 16.0). Results Mean gestational age (34.4±3.34 vs. 39.1±1.09 weeks, p=0.001), and mean neonatal weight (2475.43±683.28 vs. 3122.64±409.89 gr, p=0.001) were lower in the case group compared to the control group. Multivariate logistic regression analysis showed a statistically significant association between the preterm birth and older maternal age (OR: 1.07), history of infertility (OR: 0.5), mother exposure to smoking (OR: 2.4), intrauterine growth restriction (IUGR) (OR: 0.99), C-section delivery (OR: 0.39) and maternal diseases (OR: 0.96). Conclusion This study showed that older maternal age, history of infertility, mother’s exposure to smoking, IUGR, C-section delivery, and maternal disease were independent risk factors for preterm birth. The identification of these factors is essential in reducing the risk of preterm birth.

    Keywords: Newborn, Preterm Birth, Risk Factor
  • Hadi Moulaei, Kokab Namakin *, Mohmmad Hasan Namaei, Zohreh Azarkar Pages 10473-10480
    Background Helicobacter pylori (H. pylori) is believed to be the most common bacterial infection worldwide. Herein, we aimed to investigate the effect of red rose extract on H. pylori eradication in 9 to 15 year-old children. Materials and Methods In this randomized controlled clinical trial,by the convenience sampling method 332 children were screened for H. pylori infection. Their stool samples were studied by the H. pylori Antigen Enzyme Immunoassay (EIA) Test Kit. Positive cases were divided into two groups and received either red rose extract or placebo for 14 days. The stool exam was repeated once again at treatment termination. Data were analyzed using SPSS software (version 21.0). Results In total 17.8% (n=59) of the 332 cases were positive for Helicobacter pylori stool antigen (HpSA), and 56 completed the study. The mean HpSA titer remained stable in the red rose extract treated group but it increased in the placebo group following intervention; however, the difference was statistically insignificant (p=0.57). Moreover, the intervention resulted in no difference in the eradication rate between the two groups (p=0.57). Conclusion Red rose extract did not reduce HpSA titer after intervention, so it cannot be solely considered as an alternative for H. pylori eradication. Further studies with a different dose and duration or with combined regimens are recommended.
    Keywords: Children, Helicobacter pylori, Red rose extract
  • Gholamreza Sarvari *, Fateme Ghane Sharbaf Pages 10481-10484
    Introduction One of the rare problems in newborns is ascites. Almost 30 percent of neonatal ascites is caused by urinary disease. The most common cause is urinary tract obstruction from posterior urethral valve. Case Report In this case report, we present a two-day boy with urinary ascites at Akbar hospital Mashhad, Iran, it was initially thought the ascites have liver origin. Conclusion In conclusion the causes of the ascites should be determined for treatment management. This can be achieved by analysis of the ascites fluid. Although urinary ascites is a very rare condition, it needs rapid management to gain a good outcome.
    Keywords: Hyperbilirubinemia, neonate, urinary ascites
  • Azizollah Yousefi, Mahsa Salehi Sadaghiani, Elahe Norouzi *, Farnaz Yousefi Pages 10485-10491
    Background Pediatric functional constipation (FC) is a common disease and may impair behavioral and psychological functioning and ultimately quality of life (QoL) in children. The aim of this study was to compare four aspects of emotional, social, physical and educational functioning of constipated children with their healthy peers by means of pediatrics health related quality of life questionnaires. Materials and Methods A total of 184 Iranian children aged 7-12 years, 92 with FC defined as ROME IV criteria referred to pediatric gastroenterology clinic of Rasoul-e-Akram Medical Center in Tehran, Iran, during Apr. 2016 to Dec. 2017 and 92 healthy children as control group, were enrolled in this case-control study. QoL in four aspects of physical, emotional, social and school functioning were assessed and compared in two groups of children with and without constipation. Results Mean age of children with and without functional constipation was 9.49 ± 1.76 and 9.49 ± 1.43 years, respectively. 61% (66.3) of constipated children, and 40% (43.5) of healthy ones were male (P=0.002). There were statistically significant differences in mean QoL scores, as well as all four detailed aspects of QoL between children with and without FC (P < 0.001). Conclusion FC in children aged 7-12 years may impair all four aspects of QoL, so early diagnosis and adequate medical treatment alongside behavioral therapy are necessary for successful outcome and promoting QoL in these patients.
    Keywords: Children, Constipation, Quality of life
  • Sadegh Vahabi Amlashi, Faezeh Taghavi, Naser Tayebi Meibodi, Maryam Mahdavi * Pages 10493-10497

    Introduction Orf disease is a viral disease of sheep and goats that can appear in humans too. The usual presentation is in sites that have direct contact. Clinical manifestation of Orf disease may be unusual in burn patients. Case Report In this case report, we described a rare presentation of Orf disease on a burn scar of a two-year girl. The patient had a history of animal contact and the presence of Orf virus was confirmed using pathologic studies and Polymerase Chain Reaction (PCR). Conclusion Few other reports of Orf disease on a burn scar are also available in scientific literature which propose the higher risk of these patients for development of Orf disease.

    Keywords: Burn, Child, Orf, scar
  • Alireza Ataei Nakhaei, Kaveh Mousavi Kani, Nazanin Hazrati, Bahram Askarpour, Ziba Mohsenpour, Fatemeh Hazrati, Neda Dehghani, Fatemeh Ahmadinezhad, Farnaz Kalani, Moghaddam * Pages 10499-10504
    Background
    Preeclampsia is a major global cause of maternal, neonatal and perinatal mortality. The aim of this review was to summarize all reviews on Acetylsalicylic Acid for the prevention of Intra-uterine Growth Restriction (IUGR) in women at risk for Preeclampsia.
    Materials and Methods
    In this overview we searched databases following Medline, Scopus, EMBASE, Central Records Central Register Cochrane and the Web of Science databases for finding related articles regarding Acetylsalicylic Acid on the prevention of IUGR in women at high risk for Preeclampsia. Search was conducted from 1996 to 5 April 2019 with English keywords. Any meta-analysis (published or unpublished), was eligible for inclusion. No language restriction was imposed.
    Results
    Finally eight meta-analysis were included in the review. Acetylsalicylic acid begun at 16≤weeks significantly reduced IUGR in women; but it was not effective in the subgroups of women who took acetylsalicylic acid when they had gestational age of more than 16 weeks. One meta-analysis showed that acetylsalicylic acid was superior to control group in decreasing of IUGR in East Asians (OR=0.36); while no significant effectiveness was observed in non-East Asians (OR = 0.85).  According to one meta-analysis, a dose-response effect of acetylsalicylic acid (p=0.04) on IUGR was observed if it was begun at 16≤ weeks. However, a dose-response effect (p= 0.95) was not seen if women started acetylsalicylic acid when they were in gestational age more than 16 weeks.
    Conclusion
    Acetylsalicylic acid has decreased the incidence of IUGR if administrated before or at 16 weeks. Acetylsalicylic acid was superior to control group in decreasing IUGR risk in East Asians but not in non-East Asians.
    Keywords: Acetylsalicylic acid, Intra-uterine Growth Restriction, Preeclampsia, Women
  • Mojdeh Banaei, Masoumeh Simbar *, Vida Ghasemi, Haniyeh Nazem Pages 10505-10522
    Background
    Adolescence is an important period in human life and the low-level access of adolescents to reproductive and sexual health services is a concern because preventive, diagnostic and therapeutic services are needed for healthy sexual and reproductive behaviors. This study was conducted with the aim of considering the barriers against adolescent access to reproductive and sexual health services in Iran.
    Materials and Methods
    All Iranian qualitative and quantitative studies which were published without time limit were entered in this systematic review article. The investigation was performed in the international databases such as Scopus, Medline, ProQuest, and Cochrane Library and national databases such as Magiran, SID, IranDoc, and Barakat Knowledge Network System. Keywords were selected based on the Mesh and include: "Youth", "Teenager", "Adolescent health service", and "Iran", combined with the Boolean OR and AND operators. Ultimately, two researchers reviewed articles for the quality appraisal (Newcastle-Ottawa tool for observational studies and JBI-QARI tool for qualitative studies), and extracted their main findings, independently.  
    Results
    Finally, 10 articles (with 1,933 population) that comprised including criteria were selected. Articles were quantitative (n=8), and qualitative (n=2) types and their year of publication varied from 2009 to 2018. Barriers against adolescent access to reproductive and sexual health services were classified into four main categories (individual barriers, structural barriers, social barriers, and policy barriers).
    Conclusion
    Based on the results, the barriers of adolescent access to reproductive and sexual health services include individual, structural, social, and policy barriers. Because the development of adolescents’ demands is crucial for all societies, through identification and removal of these barriers, we can promote the access of the youth to adolescent health services.
    Keywords: Adolescent, Barrier, Health Care Service, Iran
  • Farzaneh Akhound Noghani, Asiyeh Moteallemi, Hoseein Alidadi, Monavar Afzalaghaee, Zohreh Rahnama Bargard * Pages 10523-10532
    Background
    Providing health facilities and attention to the physical and mental health of students are very important and it can affect the amount of their learning. The purpose of this study was the investigation of the environmental health status and safety of public and non-public elementary schools of Mashhad-Iran.
    Method
    In this descriptive cross-sectional study, 100 public and non-public elementary schools were selected randomly in Mashhad, Iran, 2017. A validated checklist based on instruction from Ministry of Health and Medical Sciences was used for data collection. The checklists were completed in schools by the trained expert by interview and observation. Finally data were analyzed by SPSS software (version 19.0).
    Results
    The mean of the environmental and safety standards for public and non-public elementary schools obtained 66.47± 13.69 and 63.54 ± 9.59, respectively (total score: 100). That shows the public schools have a better health status than non-public schools. Based on the results of this study, 36.85 % of schools had favorable conditions, 33.9 % partly favorable and 24.45 % were undesirable. According to statistical tests, there was no significant difference between public and non- public schools in terms of environmental health status and safety (P>0.05).
    Conclusion
    Based on the results of this study, the environmental health status and safety in most schools were somewhat desirable. Thus, attention to issues such as the proportionality of the schools area with the number of students, the health status of the buffets and as well as the existence of an alarm with special signs in emergency situations seems necessary.
    Keywords: Environmental health, Elementary school, Iran, Safety, School
  • Fatemeh Shoaee, Ziba Mohsenpour, Mohammad Reza Najarzadegan, Soudabeh Nekouhi, Parisa Razmjouei, Masoudeh Babakhanian, Masumeh Ghazanfarpour *, Fatemeh Rajab Dizavandi, Hossein Kareshki Pages 10533-10540
    Background
    There are few psychometric studies addressing sensitivity and specificity of the Persian version of the Edinburgh Postnatal Depression Scale (EPDS). Therefore, there is a need for future studies to identify the best cut-off point for EPDS score. The present study is aimed at assessing the validity of the EPDS among Iranian mothers.
    Materials and Methods
    The study is a secondary analysis on a descriptive correlational design to evaluate the sensitivity and the specificity of the Persian version of EPDS. The study was conducted in Mashhad, Iran, among 200 postpartum women attending routine post-natal care at six health service centers selected through stratified sampling method, and mothers completed the EPDS tool. Statistical analyses were performed using SPSS software version 16.0. The sensitivity and specificity of the EPDS were assessed against the DSM-IV criteria for depression with Receiver operating characteristic (ROC) curves using MedCalc statistical software (version 13.0).
    Results
    30% of mothers were depressed based on the Edinburgh scale. The best cut-off point to discriminate mothers with depression (a combination major and minor depression) from normal women in postpartum period was >10 with sensitivity 87.95% and specificity 93.86%. The highest area under the receiver operating characteristic curve (ROC= 0.959). For women with major depression, the best cut-off point was 16 with sensitivity 94.12% and specificity 94.54% (ROC= 0.98).
    Conclusion
    In conclusion, the finding of this psychometric study showed the Persian version of  EPDS can be used  as a valid tool at a cut-off score of >10 to screen mothers with a combination major and minor depression  and  at cut-off score of >16 for screening those with major depression  in postpartum period in health care center.
    Keywords: Edinburgh Postnatal Depression Scale, sensitivity, specificity, Postpartum women
  • Fatemeh Najafi Sharjabad *, Sahar Haghighatjoo Pages 10541-10551

    Background Despite recommendations from the World Health Organization in most Asian countries, young people’s sexual and reproductive health (SRH) needs are poorly provided and understood. The aim of this review paper is identifying barriers as well as improving strategies to access SRH information and services among Asian youth. Materials and Methods We conducted a review study and the databases used to search for articles include: Web of Science, Scopus, Medline, EMBASE, and the Cochrane Library, WHO, UNFPA, and UNESCO. The search terms "sexual health", "reproductive health", "reproductive health service", "information", "knowledge", "sex education", "barrier", "challenge", "strategy", "promotion" were used and combined with "Asian", "adolescent", "teenager", "youth" and "young people". In this study we sought both qualitative and quantitative articles published between Jan 2008 and Jan 2019. Results Limited knowledge on SRH among youth, lack of youth friendly services, socio-cultural, legal, policy, leadership and political factors were the main obstacles of Asian youth to access SRH information and services. Culturally sensitive community based intervention, involving religious and social leaders, reforming health services and policies, considering integration of refugee youth’s SRH needs into policy of local governments in Asian critical areas and use of new media for distribution of information were identified as effective strategies for improving youth SRH. Conclusion Socio-cultural and structural barriers are the most important challenge of Asian youth to access health services. Restructuring health system and polices, culturally appropriate sex education are required to improve youth access to SRH services.

    Keywords: Asian Youth, Barriers, Sexual Reproductive Health, Information
  • Fatemeh Hadian, Mojtaba Varshochi *, Zohre Feyzabadi, Arman Zargaran, Mehdi Besharat, Mojtaba Mousavi Bazaz Pages 10553-10563
    Background
    Pediatric fever is the common cause of consultation in primary care services. Antibiotics that are prescribed widely, are not indicated in most patients. Using non-drug approaches in these situations can be helpful. We aimed to assess the information existing in Persian medical textbook for relieving pediatric fever and search their efficacies based on Conventional Medicine.
    Materials and Methods
    In this study, data was extracted by searching a recent reliable Persian Medical Encyclopedia, "Exir-e A’zam" that is taught in Persian medical schools, and is the only reference that has a pediatric fever specific chapter. Then related information was searched and extracted from English (Medline, EMBASE and Web of Science, Scopus), and Persian (SID) online databases, based on both Persian and Conventional Medicine. Then investigation and analysis were done on findings.The period of research was between 2000 and 2019.
    Results
    Based on Persian opinion, management of every disease had principles that called "health preservation management" (Tadbir-e-hefz al-sehheh) that was applied in addition to the main treatment. Management that was prescribed for pediatric fever include: evacuation and retention, sleep and wakefulness, manual interventions and nutritional orders. These methods have ingredients that were applied as oral or topical or in life style. In conventional medicine some physical modalities which are used include: ice packs, cooling blankets and sponging. Some medicinal herbs are suggested for relieving fever, after finding the reason for the fever and administering the main treatment.
    Conclusion
    According to this study, Persian medicine has several complementary and alternative methods that can reduce body temperature. Many of them can be effective based up on recent articles and conventional medicine. Further clinical studies are recommended to investigatetheir effectiveness.
    Keywords: Children, Fever, Complementary Medicine, Persian Medicine
  • Kamyar Kamrani, Kambiz Eftekhari, Armen Malekiantaghi, Mahbod Kaveh, Effat Hosseinali Beigi * Pages 10565-10572
    Background The esophageal atresia (EA) is the most common esophageal congenital anomaly. The aim of this study was to evaluate the predictive factors in the survival of newborns with esophageal atresia. Materials and Methods This was a descriptive-analytic cross-sectional study performed on newborns with esophageal atresia who were admitted at Bahrami children’s hospital, Tehran-Iran, during 7 years (2009-2015). The patient’s information was collected from their medical records and recorded in a checklist. The variables of the checklist included: age, sex, gestational age, birth weight, congenital anomalies, duration of mechanical ventilation, duration of hospitalization, respiratory distress syndrome (RDS), and age at surgery, complications, and cause of death. Then, the relationship between different variables was evaluated with mortality and morbidity and the factors that had the greatest impact on patients' prognosis were identified.
    Results
    The study included 95 neonates with EA. Fifty-three (55.8%) were male. The most common anomalies were cardiac (38.9%), renal (15.8%), and skeletal (9.5%). The most common postoperative complication was pneumothorax (31.6%), pneumonia (25%), and stenosis at the site of anastomosis (21.1%). In this study, 15 children died (mortality rate 15.7%), and the most common cause was sepsis. There was a significant relationship between birth weight and death, pneumothorax (P=0.008, and P=0.037, respectively). There was no significant relationship between gestational age and mortality (P>0.05). There was a significant relationship between major cardiac anomalies and duration of mechanical ventilation and mortality (P= 0.043, and P<0.001, respectively). Conclusion This study showed that neonates with esophageal atresia, low birth weight, major cardiac anomalies and the need for prolonged mechanical ventilation are poor prognosis predictor factors.
    Keywords: Cardiac anomalies, Esophageal atresia, Low birth weight, Newborn
  • Akbar Molaei, Azizollah Khomahani, Mahnaz Sadeghi Shabestari, Shamsi Ghaffari, Seyyed Reza Sadat Ebrahimi * Pages 10573-10582
    Background

    Kawasaki disease (KD) is one of the most prevalent vasculitis diseases in children and can bring about serious cardiovascular complications. Early detection of cardiac involvement in KD can play an essential role in managing and preventing the cardiac sequels. We aimed to evaluate the applicability and diagnostic accuracy of cardiac biomarkers including cardiac troponin I (cTnI), and N-terminal pro-brain natriuretic (NT-proBNP) for early detection of cardiac involvement in children with KD. Materials and Methods In this cross sectional study, 32 children with KD who were admitted to the Children's Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, in a three-year period, were consecutively included. Transthoracic echocardiography was performed to evaluate cardiac involvement. Also, the serum levels of NT-proBNP and cTnI were measured to evaluate their diagnostic accuracy. ROC curve analysis was conducted to evaluate the discriminatory power of NT-ProBNP for the diagnosis of cardiac involvement in KD and to determine the best cut-off point at which the sensitivity and specificity were optimal.

    Results

    Of 32 enrolled patients, 4 (12.5%) had cardiac involvement including 3 patients with perivascular brightness of coronary arteries and one patient with small aneurysm of the coronary arteries. In all study patients, the cTnI levels were lower than 0.35 ng/ml and the NT-proBNP mesurment revealed an average of 678.5 pg/ml. Children with cardiac involvement had significantly higher NT-proBNP (p= 0.001). Both sensitivity and specificity of NT-proBNP at the optimum cut-off point of 1354 pg/ml were 100 percent (AUC=1.000, p=0.001).

    Conclusion

    Unlike the cTnI, our results support the applicability of NT-proBNP as an excellent objective test for early detection of cardiac involvement in children with KD.

    Keywords: Cardiac Biomarkers, Children, Kawasaki disease
  • Akram Rahimi, Mehrali Rahimi, Abdolreza Norouzy, Habibollah Esmaily, Peyman Eshraghi, Seyed Amir Reza Mohajeri, Mohsen Nematy * Pages 10583-10593
    Background
    The average age at menarche (AAM) has declined around the world, which is widely attributed to improvements in nutrition. This study was conducted to investigate the association between dietary patterns and early menarche (
    Materials and Methods
    This case-control study was carried out on 400 elementary school girls (200 early menarche and 200 premenarche) who were aged 12 years old and over, in Kermanshah, Iran, 2015. The participants were selected by cluster sampling from three areas of Kermanshah city. Body mass index (BMI) was calculated, and information on dietary intake was investigated by using a semi-quantitative food frequency questionnaire, which consists of 160 items and were filled by students’ parents. Logistic regression was performed to find a relationship between dietary patterns and risk of early menarche.
    Results
    The means age for the case and control groups (n=200, n=200) were 12.06±0.1 5 years and 12.0 6±0. 10 years, respectively. Four major dietary patterns of meat, western, vegetarian, and traditional were identified. After adjusting for the confounding factors, vegetarian (OR: 0.01; 95%CI: 0.003-0.02; P<0.001), and traditional (OR: 0.13; 95%CI: 0.06-0.26; P<0.001), dietary patterns were found to be negatively associated with early menarche whereas the highest tertile of meat dietary pattern (OR:1.21; 95%CI: 0.64-2.29; P<0.009), and BMI (OR: 3.36; 95%CI: 1.72-6.54) were positively associated with early menarche. Western diet showed no relationship with early age at menarche (P>0.05).
    Conclusion
    Based on the results, dietary patterns and body size were found to be related to early menarche among elementary school girls.
    Keywords: Early menarche, Dietary patterns, Food frequency questionnaire, Factor Analysis
  • Mohammad Ali Zamani, Hajar Sorani, Ali Asghar Rabiei *, Mehdi Ghatreh Samani, Soleiman Kheiri, Nika Khoshdel, Abolfazl Khoshdel Pages 10595-10603
    Background

    Lymphadenitis is the most common complication of BCG vaccination in children. Interferon-gamma (IFN-γ) plays a key role in immune response to Mycobacterial infections. In this study, the relationship of serum levels of IFN-γ and its receptor (CD119) to development of Bacillus Calmette Guerin (BCG) axillary lymphadenopathy was investigated.

    Materials and Methods

    In this case-control study, 45 children with axillary lymphadenopathy and 45 healthy children matched by age and sex were included. Two ml peripheral blood was collected in tubes containing anticoagulants. Then, level of IFN-γ was measured by ELISA and the level of CD119 expression in the peripheral blood mononuclear cell (PBMC) was measured by flow cytometry. Data were analyzed using SPSS software version 22.0.

    Results

    Totally, 90 children were enrolled in this study, which consisted of 30 girls and 60 boys. The mean age of participants was 14.5±6.5 months in case group and 15.2±7.1 months in control group, respectively (p=0.61). The level of IFN-γ was significantly lower in case group than in control group (p<0.001), but no significant difference was observed in PBMC percentage between the two groups (p>0.05). There was no significant relationship of age and sex to BCG (INF and PBMC) lymphadenopathy (p>0.05).

    Conclusion

    Based on the results, IFN-γ level was significantly lower in the BCG lymphadenopathy group than in the control group. Levels of IFN-γR (CD119 cellular level in PBMC) in two groups did not show a significant relationship.

    Keywords: Bacillus Calmette Guerin, CD119, Children, Interferon gamma, Lymphadenopathy
  • Mohammad Mahdavi, Feisal Rahimpour *, Mahmood Hosseinzadeh Maleki Pages 10605-10609
    There are few studies about post-cardiac surgery fungal infections especially by Aspergillus fumigatus. In this paper we report a case of Aspergillus fumigatus endocarditis after tetralogy of Fallot total correction (TFTC), and permanent pacemaker (PPM) implantation. A five-year-old female patient with current history of total correction of tetralogy of fallot was admitted in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, with unexplained prolonged fever. The fungal endocarditis was suspected. After three weeks’ antifungal regimen, the fever was suppressed gradually and general condition was good. Current paper revealed the importance of clinical suspicion by physicians in pediatric cases with current history of cardiothoracic surgeries for prompt diagnosis and successful treatment of Aspergillus fumigatus endocarditis.
    Keywords: Aspergillus fumigatus, Endocarditis, galactomannan, Tetralogy of Fallot
  • Yazdan Ghandi *, Alireza Farsi Pages 10611-10620
    Scimitar syndrome is characterized by partial or total anomalous pulmonary venous return from the right lung along with pulmonary hypoplasia.Wesearched the mail databases such as Medline (via PubMed), Scopus and EMBASE and Google Scholar. Diagnosing infantile scimitar syndrome requires meticulous attention and high suspicion of the early referral and management. The association of the syndrome with pulmonary hypertension leads to recurrent and prolonged hospitalization. Scimitar syndrome can be initially suspected from a chest X-ray, but it is typically confirmed via Computed Tomography (CT) angiography. The clinical spectrum of Scimitar syndrome ranges from severely ill infants to asymptomatic adults, which may present  respiratory or cardiac failure, hemoptysis and pulmonary hypertension, tachypnea, chest infection, and failure to thrive. The diagnosis can be made by transthoracic or transesophageal echocardiography, angiography, or by CT or MR angiography.Considering the wide clinical spectrum of scimitar syndrome, the medical intervention depends on the severity of presentation and the amount of blood flowing to the Inferior Vena Cava (IVC) from completely or partially anomalous pulmonary veins. In the presence of significant left to right shunting and pulmonary hypertension, surgical intervention should be considered.
    Keywords: Congenital anomaly, Pulmonary hypertension, Scimitar Syndrome
  • Mona Najaf Najafi, Elham Kargozar, Mahdi Mottaghi, Neda Dehghani, Parisa Razmjouei, Zeinab Sadat Hoseini, Masumeh Ghazanfarpour * Pages 10621-10633
    Background
    A religious belief and spirituality training of women can have a significant impact on various dimensions of individual and family health, including mental health and quality of life. The aim of this study was to review and summarize the results of trials conducted on the effect of religious beliefs on marital satisfaction spirituality training on mother’s health with ill children.
    Materials and Methods
     In this systematic review and meta-analysis, at first, English databases such as Medline, Scopus, ISI Web of Science, Cochrane Library, EMBASE, and Persian databases such as SID and Magiran were systematically searched without any time limitation up to May, 2019.The search keywords including: "spirituality, spiritual, children religious, religion, religiousness, religiosity, marital satisfaction, marital status and marital relationship" were used in order to find related studies. Study selection was done by two reviews.
    Results
    Totally 19 related articles were found. Meta-analysis of the combination of the results showed that religious education is the factor increasing the marital satisfaction among those who had received this education system in comparison with ones who had not. The value of effects obtained from the mentioned studies was 1.38 (95% CI: 1.11 to 1.66: heterogeneity;  = 0%, p=0.634), which is statistically significant (p <0.001). Spirituality training on mothers of mothers or caregivers with ill children resulted in a significant improvement in distress level, depressive symptoms, social functioning and some of components of spiritual resiliency such as patience, contentment, reliance and thanksgiving.
    Conclusion
    Religious belief teaching is effective on marital satisfaction. Spirituality training can significantly improve mental health of mothers with ill children.
    Keywords: Family, health, Marital satisfaction, Religious beliefs, Spirituality
  • Farzaneh Barkhordari Ahmadi, Ghasem Sobhani *, Alireza Abdulahzade Baghaee, Ahmad Ali Jalalinezhad, Bita Mirzaie Feiz Abadi Pages 10635-10642
    Many children who undergo surgery experience significant perioperative anxiety. Preoperative anxiety can prolong induction of anesthesia and postoperative recovery, increase the risk of postoperative delirium, increase pain, and increase analgesic use. Researchers are looking for ways to treat or prevent preoperative anxiety in children and possibly reduce its negative effects after surgery, such interventions include non-pharmacological and premedication interventions with sedation drug prior to surgery. Pretreatment, however, is often performed for children but it is not clear what the best medicine is and how it is prescribed. Among the ways to reduce children's anxiety, the anesthesiologist can use a combination of methods to achieve the best results.
    Keywords: Anesthesia, Effect, Non-pharmacological, Pediatric, Premedication
  • Abolfazl Fattah, Mehdi Mameneh, Zahra Sahraie, Azadeh Seyd Mohammadkhani, Soraya Sayar, Fatemeh Vafi Sani, Khadijeh Mamashli, Setareh Yousefi, Masumeh Ghazanfarpour, Jaleh Salari Nasab Pages 10643-10650
    Background

    The education system and society has endured a huge cost as a result of cheating. It is important to address the cheating since such persons doing cheating often transfer this inappropriate behavior into working environments after graduation. On the other hand, motivation to perform activities decreases in an honest person. We aimed to investigate factors affecting students' cheating behaviors in schools and universities.

    Materials and Methods

    English electronic databases, including Medline, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched systematically until May 10, 2019. Search words were a combination of: (Cheating OR Plagiarism OR Dishonesty) AND (College OR Student OR School OR Exam OR University) AND (Iran OR Iranian).

    Results

    Finally, nine studies were included in the review. Affecting factors on students’ cheating behaviors in schools and universities were grouped into four categories including: "personality factors", "educational system factors", "psychological factor", and "cultural, religious, and economic factors". Conclusion Considering affecting factors on  students' cheating behavior, there is a need to adopt appropriate and preventive measures by researchers, faculty members, managers and policy makers to prevent the occurrence of it as much as possible.

    Keywords: Cheating Behavior, Factors, School, University, Students
  • Somayeh Moeindarbary, Maryam Abbasi dalooei, Sara Ghahremani, Rana Tafrishi, Masumeh Ghazanfarpour, Farzaneh Fazeli *, Leila Mohammadabadi Pages 10651-10657

    Guillain-Barre syndrome is a neurological disorder that begins with weakness of the limbs and can cause respiratory and cardiac involvement. The subject of this report is a 30-year-old woman who was diagnosed with Cushing’s syndrome following recurrent bone fractures and receiving treatment for the Cushing’s syndrome. The patient was referred to a hospital during pregnancy because of generalized pain and weakness in the extremities. Abdominal ultrasound showed a mass in the left adrenal gland and so surgery was performed to remove the mass.
    However, the patient's symptoms did not improve after surgery. The patient was asked to consult a neurologist who made a diagnosis of Guillain-Barre syndrome after cerebrospinal fluid was examined. Patient was discharged with personal consent. Four months later, the baby was born with a normal Apgar score, and the general condition of mother and child were evaluated as good. This case demonstrates a rare coincidence of Cushing's disease and Guillain-Barre syndrome. Due to the increase in corticosteroids due to Cushing's syndrome, it is expected that symptoms of Guillain-Barre syndrome would not occur. This case could indicate that there are several mechanisms for development of Guillain-Barre syndrome and that animal models can be helpful in this context.

    Keywords: Cushing's syndrome, Guillain-Barre syndrome, Pregnant woman