فهرست مطالب

Pediatrics - Volume:8 Issue: 81, 2020
  • Volume:8 Issue: 81, 2020
  • تاریخ انتشار: 1399/06/19
  • تعداد عناوین: 25
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  • Rana Tafrishi, Shima Shekari, Mohammad Ajam, Elaheh Barati, Seyed Masoud Haghjoyan, Ali Rokni, Omolbanin Heydari, Farzane Ashrafinia, Samaneh Dabagh Fekri, Masumeh Ghazanfarpour, Maryam Abbasi Dalooei * Pages 11891-11899
    Background

    No systematic review study was found regarding the comprehensive examination of the effects of dates and fennel on breastfeeding adequacy of mothers. The present study aimed to examine the impact of dates and fennel on breastfeeding adequacy of mothers.

    Materials and Methods

    All clinical trials evaluating the effect of palm date and fennel on breastfeeding in lactating mothers were searched on the online databases of Scopus, EMBASE, Cochrane, and Web of Science and Medline with no language or time restrictions using the combination related keywords of Mesh.

    Results

    Five studies were included in this study. The results of the first research suggested the positive relationship between consuming fennel herbal tea and dates in enhancing milk production of mothers within the early days following birth. In the second study, the mother's satisfaction with the adequacy of milk showed the positive effect of dates consumption. The results of the third research showed that 80% of mothers in the intervention group had a smoothness score of breastmilk. The higher smoothness in the intervention group showed the positive impact of consumption of date on breastmilk. In the fourth study, a galactagogue drop containing fennel, Anise, dill, parsley, cumin, and fennel flower did not affect the volume of breastmilk and weight gaining of the infant. The fifth study showed the positive impact of the herbal tea of fenugreek seeds and fennel on improving the breastfeeding adequacy with positive changes in the anthropometric indicators, the number of wet diapers, and increased number of breastmilk drinking.

    Conclusion

    Considering the availability and inexpensiveness of fennel and dates, their usage by breastfeeding mothers is recommended for increasing breastmilk.

    Keywords: Breast-feeding, Dates, Fennel, Mother
  • Nabiollah Asadpour, MohammadReza Malek Ahmadi, Afsaneh Malekpour, Najmeh Bagheri * Pages 11901-11909
    Background

     The function of ductus arteriosus closes within a few minutes to a few days after birth in term neonates. In some cases, the duct remains open after birth, a condition which is called patent ductus arteriosus (PDA). PDA is associated with high rates of neonatal mortality and morbidity. The present study aims to evaluate the effect of oral ibuprofen on closure of PDA in term neonates.

    Materials and Methods

    In this clinical trial, 40 neonates (at the gestational age of 37 weeks and more) aged 5 to 30 days, with confirmed PDA through echocardiography, were randomly divided into two groups (n= 20). One group received ibuprofen syrup (10 mg/kg body weight) in the first 24 hours, followed by 5 mg/kg body weight for the next four days. The other group received placebo in the same manner. On the seventh day after the beginning of intervention, neonates underwent echocardiography for examination of PDA closure. Side effects of ibuprofen were evaluated. Symptoms of kidney failure, such as oliguria, edema, and proteinuria and increased creatinine, as well as gastrointestinal side effects such as gastrointestinal bleeding and recurrent vomiting, were assessed for one month. 

    Results

    According to the results, PDA diameter was not significantly different in ibuprofen compared to the placebo groups before (p>0.05) and after (p>0.05) intervention. Frequency of PDA closure was 13 (65%) in the ibuprofen group and 10 (50%) in the placebo group with no significant difference (p>0.05). There was no significant difference in the mean systolic and diastolic pressure gradient after intervention and in mean changes in pulmonary arterial hypertension between the two groups (p>0.05). No side effects were observed in any of the groups.

    Conclusion

    Based on the results, oral ibuprofen did not significantly affect PDA closure in term neonates.

    Keywords: Ibuprofen, Patent Ductus Arteriosus, term neonate
  • Asadolah Tanasan *, Ziba Hasani, Mehdi Moradi, Farzaneh Esna Ashari Pages 11911-11919
    Background

     Pulmonary hypertension (PH) in congenital heart disease affects the patient’s prognosis. Prolonged QRS and QTc intervals in ECG may intensify life-threatening dysrhythmia in patients. We aimed to investigate the correlation between QRS, QTc, and JTc intervals prolongation in ECG with PH in Congenital Heart Disease (CHD) patients.

    Materials and Methods

    This cross-sectional study was performed in the pediatric cardiology clinic of Be’sat Hospital in Hamadan, Iran, in 2016-2018. Patients with CHD and PH were compared with CHD patients without any evidence of PH as the control group. Afterward, QRS, QTc, and JTc intervals in ECG, RV MPI, and TAPSE echocardiography were compared between the case group (PH group) and the control group. We also compared the ECG and echocardiographic results between mild and severe PH patients in the case group.

    Results

    In this study, 40 patients in the case group (with CHD and PH) were compared to 40 patients in the control group (only CHD without PH). There was a significant difference in QRS (p=0.005) and QTc (p=0.036) intervals between the two groups, but no significant difference in the JTc interval was observed.  Of 40 patients with PH, 19 were in the mild PH subgroup, and 21 were in severe PH subgroup, in which 9 patients had irreversible PH or Eisenmenger syndrome (ES). QTc (p<0.001) and QRS (p=0.018) intervals in the severe PH subgroup with ES were significantly different from the mild PH subgroup, but the JTc interval was not significantly different.

    Conclusion

    Despite longer QRS and QTc intervals in the PH group of CHD, JTc interval did not show a significant prolongation.

    Keywords: Children, congenital heart disease, Pulmonary hypertension, QTC interval, JTC interval
  • Mozhgan Hashemieh * Pages 11921-11929

    Corona virus 2019 (COVID –19) is a public health emergency and according to the recent statistic of World Health Organization (WHO), this novel virus has infected all continents. During this outbreak, there is an urgent need for documentation of laboratory predictors to discriminate between mild and severe forms of this virus. In this pandemic, prompt identification of clinical and laboratory prognostic factors of progression towards critical and lethal forms of this disease is mandatory. During this new infection, lymphopenia, thrombocytopenia, sometimes neutrophilia, elevation of D-dimer, prolongation of prothrombin time (PT), and Partial Thromboplastin Time (PTT), and also increased level of fibrin degradation products (FDP) could occur. Moreover, elevation of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin, ferritin, Lactate dehydrogenase (LDH), and interleukin -6 (IL- 6) are other laboratory features. These parameters will enable risk stratification and favorable allocation of limited and technical resources particularly in under developed countries. In this review article, alteration of hematologic laboratory findings has been discussed.

    Keywords: COVID-19, Coagulation, Hematology, SARS-CoV-2, Thrombocytopenia
  • Gholamreza Mohammadi, Kobra Sheidaee, Saeed Dashti Dargahloo, Mohammad Tabarestani, Mohsen Hosseinzadegan, Farzane Ashrafinia, Masoudeh Babakhanian * Pages 11931-11937
    Background

    Coronavirus pandemic puts children in a more critical mental status compared to adults. Some symptoms of children’s mental disorders include extreme dependence, anxiety, fear, anger, and impatience. The present study aimed to review the studies, which have investigated the effects of coronavirus and its consequences on mental health, particularly the children, and provide some effective strategies to support them.

    Materials and Methods

    In this overview, two researchers carried out the present study after comprehensive research according to the latest articles in PubMed/Medline, Web of Science, and Google Scholar until March 27 2020.

    Results

    Ten studies examined were conducted on the children mental health status (the symptoms of depression (22.6%), anxiety (18.9%), and the prevalence of Post-Traumatic Stress Symptoms (PTSS) (30%)) as well as irritability, anger, emotional discharge and other symptoms, such as sleep disorders, nightmares, nocturnal enuresis, eating disorders, the sense of loneliness, the fear of illness and loss of parents or caregivers, understanding the physical signs of the disease in children under quarantine, news of outbreaks and school closures. This review reports that the symptoms of fear and anxiety in children of12-17 years old are higher compared to adults.

    Conclusion

    To reduce the negative psychological effects on the children arisen from coronavirus crisis, despite the recommendations of World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF), some strategies are significantly important including physiological counseling for parents and children, access to the mental health services, and paying more attention to the children exposed to risk.

    Keywords: Children, COVID-19, Mental health, Support
  • Gholamreza Soleimani, Elham Shafighi Shahri, Seyed Hosein Soleimanzadeh Mousavi * Pages 11939-11944
    Background

      Bronchiolitis, which is the most common infection of the lower respiratory tract among infants, is characterized by acute inflammation, edema, increased mucosal production, and bronchospasm. We aimed to investigate the effects of saline usage with different concentrations and salbutamol on the treatment.  

    Materials and Methods

    This double-blind, randomized clinical trial was performed on 180 pediatric patients with four weeks to 24 months old admitted to Ali-Ibn-Aboutaleb Hospital in Zahedan, Iran, during 2017-18 for possible diagnosis of acute bronchiolitis. Patients were divided into three groups of 60 patients using the permissive block method. The first group received 0.15 mg of Salbutamol Nebulizer and 5 ml of normal saline 0.9%, the second group received saline 3%, and the third group received saline 5% at the same dose as the first group. Clinical status, oxygen saturation, respiratory and heart rate, intercostal retraction, dyspnea, wheezing before treatment and every 20 minutes after treatment up to 3 times, and Clinical Bronchiolitis Severity Score (CBSS) were collected.  

    Results

    In all three groups, there was an increasing trend in oxygen saturation and a decrease in respiratory rate, heart rate, and CBSS. In the first and third groups, there was a significant difference in CBSS after treatment, but in the second group, it was significant only at 20 and 40 minutes after treatment. The mean days of admission for the second group were lower.  

    Conclusion

      It seems that due to its cost-effectiveness, lack of complication and earlier efficacy of 5% hypertonic saline in the treatment of bronchiolitis, hypertonic saline 5% instead of normal saline 0.9% is more effective and more cost-beneficial achieved in bronchiolitis remedy.

    Keywords: Bronchiolitis, Children, Salbutamol, Nebulizer
  • Tahia H. Saleem, Nagwan I. Rashwan, Mohammed H. Hassan *, Bahaa Hawary, Doha Abd-Elraheim Salama, Nahed A. Mohamed, Mohamed Elsayed Mohamed Ahmed, Eman Ahmed Abd Elmawgood Pages 11945-11957
    Background

    The diagnosis of inborn errors of metabolism is generally challenging. We aimed to explore various types of urea cycle disorders (UCDs), and their clinical presentations and biochemical findings among Egyptian pediatric patients.

    Materials and Methods

    This case-control study was conducted on 86 participants categorized into 43 pediatric patients suspected to have UCDs and 43 age- and sex-matched healthy controls, recruited from the Pediatric Outpatient Clinics, Inpatients Pediatric Departments, PICU and Neonatal Intensive Care Units of Qena, Assiut and Aswan University Hospitals, Egypt. In addition to the clinical assessments and routine laboratory investigations, colorimetric assays of blood lactate and ammonia, and plasma free amino acids assays using high performance liquid chromatography (HPLC), were performed for all included children. For patients with abnormal aminograms, the five enzymes of the urea cycle were measured in their liver tissue homogenates, using chemical methods.

    Results

    The results showed that 25 out of 43 suspected patients were confirmed to have UCDs. The most frequent type of UCDs was Ornithine transcarbamylase (OTC) deficiency (48%), followed by Argininosuccinate synthase (ASS) deficiency (36%) and the least frequent was arginase (ARG) deficiency (16%). The main clinical presentations were poor oral intake (100%), followed by lethargy (96%), hypotonia (68%), vomiting (64%), and hepatomegaly (48%). There were normal glucose and ABG values with significantly higher ammonia; lactate and the measured plasma free amino acids among patients with UCDs vs. the controls (p˂0.05).

    Conclusion

    The most frequent types of UCDs among pediatric patients in Upper Egypt were OTC and ASS deficiencies. In addition to clinical suspicion, assays of lactate, ABG, glucose, ammonia and aminogram may be helpful biochemical tests in diagnosing UCDs.

    Keywords: Argininosuccinate synthase, Hyperammonemia, Ornithine transcarbamylase, Arginase, Urea cycle disorders, Pediatric, Upper Egypt
  • Fariba Zabihi, Mina Mostafavi, Mohammad Esmaeili, Massoud Issapour Cheshani * Pages 11959-11966
    Background

     Urinary Tract Infection (UTI) is a common infectious disease among children. Deficiency in micronutrients such as zinc, is believed to play a role in predisposing children to UTI. However, rare studies have been conducted on this subject. The present study aimedto compare the serum zinc level between children with UTI and normal controls.

    Materials and Methods

    In this case-control study, which was conducted on children with UTI who referred to 17th Shahrivar and 22th Bahman hospitals, Mashhad- Iran, during 2016-2017, patients suspicious of UTI were assessed by urine culture. The urine sample of the patients who were not toilet-trained was collected using urinary bags, and those who were toilet trained were asked to collect the clean catch mid-stream urine. Demographic data, urinary symptoms, type of cultured microorganism, and colony count were recorded. Data were analyzed using SPSS V. 20.0.

    Results

    Overall, 104 children (52 cases and 52 controls) were included. The groups had significant differences regarding sex, age, and weight (P<0.05). Serum zinc level was 60.0± 17.1 µg/dl in the case group and 83.0±15.7 µg/dl in the control group (P=0.001). After being adjusted for demographic factors, the zinc deficiency proved to be a significant predictor of UTI (OR= 8.633, 95% confidence interval=3.084-24.171, P<0.001).

    Conclusion

    According to the results of our study, serum zinc level was markedly lower among patients with UTI. Zinc deficiency can put the children at an eight times higher risk for developing UTI, independent of age and gender.

    Keywords: Children, Micronutrients, Zinc Deficiency, Urinary tract infection
  • Mahsa Choroom Kheirabadi, Mahdieh Mousavi Torshizi *, Payman Sadeghi Pages 11967-11972
    Background

    Vitamin D supplementation has been suggested as a part of an interdisciplinary approach for the management of chronic musculoskeletal pain in children and adolescents. This study aimed to compare vitamin D serum levels in Iranian children with chronic musculoskeletal pain with and without hypermobility.

    Materials and Methods

    This cross-sectional study was performed on otherwise healthy children aged 16 years or younger with chronic musculoskeletal pain, who were admitted to the rheumatology clinic of Bahrami Children Hospital, Tehran, Iran, from January 2018 to January 2019. Chronic musculoskeletal pain was defined as recurrent episodes of musculoskeletal pain within the past month to the past week. The subjects were categorized into two groups, with or without hypermobility. Hypermobility was diagnosed using Modified Criteria of Carter and Wilkinson. Serum 25-hydroxy vitamin D (25-(OH)D) level and baseline characteristics were compared, and 25-(OH)D

    Results

    A total of 72 children (41 girls and 31 boys, with the mean age of 7.36 ± 2.42 years) were included. Most participants (73.6%) were 3 to 7 years old. Sixty-four patients (88.8%) were diagnosed with vitamin D deficiency (25(OH)D Conclusion Our study results suggested a high prevalence of vitamin D deficiency among children and adolescents with chronic musculoskeletal pain, but the difference in vitamin D deficiency between children with and without hypermobility was not statistically significant.

    Keywords: Children, chronic musculoskeletal pain, Joint Hypermobility, Vitamin D
  • Jamile Ahmadi, Mahbobeh Ahmadi Doulabi *, Firoozeh Sajedi, Malihe Nasiri Pages 11973-11986
    Background

    The initial years of life particularly the first two years are regarded as the most important brain development period. The development of children is an important determinant of health throughout the whole of life. We aimed to evaluate an educational program to improve the fine motor skills of 18-month-old children.

    Materials and Methods

    This randomized clinical trial was conducted in the city of Saqqez, Iran in 2015-2016. Seventy 18-month-old infants were randomly assigned to control (n=35), and intervention (n=35) groups. The training of fine motor skills was given to the mothers of the children of intervention group, including: painting, building a tower, stringing, tearing and crushing a piece of paper, targeting and dropping. Fine motor skills were measured before intervention and 4 and 8 weeks after the intervention using ASQ-II screening tool (Age and Stage Questionnaire, Second Edition). Data were analyzed using SPSS software version 20.0.

    Results

    In the intervention and control group, 51.5% (n=17) were male and 48.5% (n=16) were female. Statistical test of Chi-square showed that there was no statistically significant difference in terms of gender (p=0.59). According to independent t-test, there was no significant difference in the mean of fine motor score before intervention in the two groups with (p = 0.13). The repeated measurement test showed that 4 and 8 weeks after training, the scores of fine movements with (p = 0.04) became significant.

    Conclusion

    Based on the results, developmental skills training compared with control group improved the fine motor skills of 18-month-old children in this study.

    Keywords: Child, Development, intervention, fine motor
  • MohammedHashem Mahgoob *, Nageh Shehata Mohamed, Nagwa Ismail Okaily, Mohamed Ahmed Amin Pages 11987-11999
    Background

    The increase in the prevalence of obesity worldwide has led to non-alcoholic fatty liver disease (NAFLD) becoming one of the most common causes of chronic liver disease. Chemerin is a novel adipokine which regulates adipogenesis which is also a marker of systemic and vascular inflammation. Lipid accumulation product (LAP) is associated with the presence and severity of nonalcoholic fatty liver disease (NAFLD) in adults. We aimed to evaluate the clinical usefulness of both serum chemerin and LAP as predictors of NAFLD in children with simple obesity.

    Materials and Methods

    This was a prospective cross-sectional study including 65 obese children with age range of 6–18 years old from pediatric obesity and endocrine outpatient clinic, Children’s University Hospital, Minia University, Egypt, in addition to 30 healthy children, age and sex matched as control group. The included children were subjected to careful history taking, thorough clinical examination and laboratory investigations including liver enzymes, fasting blood glucose (FBG), fasting serum insulin, lipid profile and serum chemerin. Then LAP was calculated using waist circumference and serum triglyceride.

    Results

    Serum chemerin and LAP were significantly higher in obese children (p-<0.01). LAP  had 95.2% sensitivity and 70.5% specificity at a cut-off point > 41; while serum chemerin at a cut-off point of > 271.7 ng/dl showed an 85.4% sensitivity and 51.4%% specificity for prediction of liver steatosis  in our obese participants.

    Conclusion

    Based on the results, serum chemerin may be considered as an acceptable indicator of NAFLD in obese children but LAP is a more available, easy and inexpensive tool to predict NAFLD in those children.

    Keywords: Children, Chemerin, LAP, Non-alcoholic fatty liver disease, Obesity
  • MohammadMomen Gharibvand, MohammadGhasem Hanafi *, MohamadReza Fadaee Pages 12001-12009
    Background

     The metabolic enhancement resulted from hyperglycemia in gestational diabetes leads to macrosomia, which can affect the placenta. In gestational diabetes mellitus (GDM) pregnant women, the thickness of placenta and cord diameter can change at ages prior to treatment initiation. Therefore, this study was conducted to examine the thickness of placenta and umbilical cord in mothers with gestational diabetes, compared to the control group, in order to indirectly investigate the effects of hyperglycemia on fetus.

    Materials and Methods

    In this cross-sectional study, pregnant women in the gestational ages ranged 28-32 weeks, who underwent a 3-hour glucose test to detect gestational diabetes mellitus, were evaluated using ultrasound in terms of placenta thickness and umbilical cord area, compared to the control group.

    Results

    Out of 93 pregnant women in gestational ages of 28-32 weeks, 45 had gestational diabetes and 48 of them were selected as the control group. The mean age of the individuals was 26.33 years old with standard deviation of 4.88. There was a significant increase in the thickness of the placenta and the transverse diameter of the cord in the case group and there was a direct and significant relation (P<0.05). Also, there was a significant relationship between cord area and the thickness of placenta (P<0.05).

    Conclusion

    The thickness of placenta and consequently the cord area in mothers with gestational diabetes increases independently from changes caused by macrosomia and fetus weight.

    Keywords: cord diameter, Gestational diabetes, Placenta thickness
  • Ebissa Bayana *, Kidist Endale, Adugna Olani, Yonas Biratu, Kenenisa Tegenu Pages 12011-12021
    Background

     Neonatal sepsis is one of the major causes of neonatal morbidity and mortality globally. Its incidence varies from 1 to 4 cases per 1,000 live births in developed countries. The burden of the problem occurs in the developing world while most confirmation is derived from developed countries. This study is aimed to assess the prevalence of neonatal sepsis and associated factors among newborns admitted in neonatal intensive care units.

    Materials and Methods

    An institutional based cross-sectional study was conducted in two hospitals in Jimma town, Ethiopia, 2019. Sampling was taken consecutively to select the study participants. Face to face interview with the mothers and document review was used to collect data by using a structured questionnaire. The data was checked for completeness, coded, cleaned and entered into Epi-data version 3.1 and exported to SPSS version 23 for analysis. Binary and multivariable logistic regression was used to understand association between dependent and independent variables. P-value Results This study found that 52.6% of the neonates had neonatal sepsis during admission. Among these, 39.8% were early onset of neonatal sepsis and 12.8% were late onset of neonatal sepsis. Factors such as maternal Urinary tract infection, maternal fever, chorioamnionitis, and age of neonates (0-7 days), male sex and resuscitation at birth were significantly associated to neonatal sepsis.

    Conclusion

    This study identified that rate of neonatal sepsis was high and maternal related factors were significant predictors of neonatal sepsis. Therefore, health professionals should work on risk factors associated with sepsis to decrease its prevalence and other complications.

    Keywords: Ethiopia, Neonatal sepsis, Neonatal intensive care unit, Neonates
  • MohamadReza Golpayegany, MohamadReza Tohidi *, Sara Hookari, Bahareh Fouladi Pages 12023-12030
    Background

     The major treatment for thalassemia is a transfusion. The present study aimed to determine the frequency of erythrocyte alloantibodies and the relevant factors among the patients with thalassemia major in Kermanshah city, Iran.

    Materials and Methods

    Thiscross-sectional study was performed on 218 thalassemia major patients with 2-48 years old, referred to thalassemia boarding clinic at the Dr. Mohammad Kermanshahi Hospital in Kermanshah city, Iran. Blood samples from thalassemia patients (5 ml) were examined in terms of the presence of erythrocyte antibodies (using the screening antibody test), and additional information including age, blood Rh, spleen status was extracted from the patients’ profile. The information was finally analyzed using SPSS software version 20.0.

    Results

    A total of 74 patients (33.9%) had alloantibody, and 144 (67.1%) lacked antibody. The mean age of the subjects was 21.85±8.083 years. The oldest and youngest subjects were 48 and 2 years old, respectively. The sample population included 114 men (52.3%) and 104 women (47.7%).  35.8% of the patients underwent splenectomy. There was no significant relationship between blood Rh, spleen status, and incidence of alloantibodies (all P> 0.05).

    Conclusion

    The high prevalence of Alloimmunization in the present study requires a more detailed examination of donated blood for compatibility of main and sub blood groups.

    Keywords: alloantibody, Iran, Thalassemia, Prevalence
  • Sedighe Borna, Sedigheh Hantoushzadeh, Sodaboeh Kazemi *, Zahra Panahi, Razieh Akbari, Mamak Shariat Pages 12031-12037
    Background

     Predicting preterm delivery can help obstetricians and midwives for better management of pregnancy care. Therefore, we aimed to investigate the relationship between cervical length and uteroservical angle with the occurrence of preterm delivery.

    Materials and Methods

    The present cohort study was conducted on 100 pregnant women with singleton pregnancy referred for routine control to perinatology ward of Imam Khomeini Hospital in Tehran between Jan 2019-Apr, 2019. All included cases were undergoing transvaginal sonography to measure the anterior cervical angle and length. Maternal demographic and clinical data, as well as delivery data of pregnant women, were obtained from their medical records. Logistic regression was conducted to estimate the predictors of pre-term delivery. All analyses were performed using Stata 14.0.

    Results

    Among 100 pregnant women, 17 had preterm delivery. Pregnant women with bleeding during pregnancy were reported with a higher preterm delivery rate (23.53% vs. 4.82%) (P=0.01). The difference of mean cervical angle between pregnant women with the term and preterm delivery was statistically different (102.12° in women who delivered pre-term vs. 86.15° in term group, P<0.001).

    Conclusion

    According to the results, pregnant women with bleeding during pregnancy and those with a higher mean of cervical angle were more prone to pre-term delivery. Therefore, the anterior cervical angle and bleeding during pregnancy can be considered as predictors for preterm birth.

    Keywords: cervical length, cervical curvature, Preterm Birth, uterocervical angle
  • Majid Keivanfar, Nazanin Zibanejad, Hamid Rahimi, Sharareh Babaei, Monir Sadat Emadoleslami, Mohsen Reisi * Pages 12039-12051
    Background

     Choosing a unique empiric treatment for ventilator associated pneumonia (VAP) can be challenging. We aimed to determine the antimicrobial susceptibility pattern of Intensive Care Unit (ICU) of the only referral pediatric hospital in Isfahan in order to design the optimal empiric treatment protocol.

    Materials and Methods

    In this cross-sectional study 343 isolates were detected from 243 pediatric patients, from August 2017 to December 2018 in Imam Hossein Hospital, Isfahan, Iran. In suspicious cases of VAP, sampling was performed via non-Bronchoscopic Bronchoalveolar Lavage (NB-BAL). Microbial susceptibility and resistance were assessed. The treatment protocol of VAP was prepared based on existing guidelines.

    Results

    Out of 343 isolates 42 (12.2%) of the positive cultures were Candida albicans and 301 (87.8%) were bacterial isolates. Gram-negative bacteria were the most common organisms with the cumulative percentage of 62.9% of bacterial isolates. When tested with oxacillin, 61.5% of Staphylococcus aureus were MSSA and 38.5% were MRSA. The mentioned common gram-negative organisms had more than 25% resistance to at least one antibiotic from three or more antibiotic classes. However, P. aeruginosa showed below 20% resistance to majority of antibiotics. Twenty-seven (11.1%) of patients had VAP, 25 (92.6%) of whom were gram-negative infections.

    Conclusion

    The limited time period and sample size without any follow-up, made it impossible to define an effective treatment protocol. We defined our antibiogram in accordance with the existing standard guidelines and we designed a local protocol. An effective antibiotic against MRSA should be used in the empiric treatment of VAP. Also, in presence or absence of multidrug-resistant (MDR) pathogen risk-factors, it is necessary to use two effective antipseudomonal antibiotics from different antibiotic classes.

    Keywords: Microbial sensitivity Test, Pediatric, Pneumonia, Ventilator-Associated
  • Saeed Ghorbani *, Ahdiyeh Yadolahzadeh, Masoud Shakki, Saharnaz Noohpisheh Pages 12053-12060
    Background

     Genetic impacts on handwriting legibility and speed, especially in early childhood, are not well understood. The present study used a 2D:4D ratio as a biological marker to investigate the associations between genetic factors with quality and speed of handwriting among the elementary school children.

    Materials and Methods

    The present study used a comparative-correlational method. Participants included 109 boys and 114 girls attending second and third grades in regular elementary schools in 2019 in Golestan province, Iran. The Persian Handwriting Assessment Tool (Havaei et al. 2017), and photocopy method were used to measure handwriting performance and 2D:4D ratio, respectively. Legibility in copying and dictation, as well as the speed of handwriting, were assessed as dependent variables.

    Results

    The results showed that boys and girls had identical age and education. Moreover, it was revealed that boys had significantly lower 2D:4D ratio in both right and left hands compared to girls (P<.001). Furthermore, a negative association was observed between right 2D:4D ratio with word space in copying (r=-.23, P<.001) as well as a significant positive association between left 2D:4D ratio with word formation (r=.13, P=.04) in the dictation of boys. Additionally, the results indicated a significant negative association between right 2D:4D ratio with word alignment in the dictation of girls (r=-.20, P=.02). No other significant associations were observed between 2D:4D ratio and handwriting performance. Finally, no significant differences were observed between boys and girls in handwriting performance.

    Conclusion

    According to the results, the 2D:4D ratio does not positively affect handwriting quality and speed in elementary school children.

    Keywords: Digit ratio, handwriting, legibility, speed
  • Mohammadamin Ameri, Marzieh Reshadatian *, Mohammadhossein Haghighi Zadeh Pages 12061-12068
    Background

     Since adolescents do not frequently refer to pediatricians or even general practitioners, hospitals and clinical standard systems are not designed to meet their needs. Therefore, the present study aimed to identify adolescent’s views and feelings of the X-ray imaging process, suggest some age-appropriate facilities to respond to their needs to have a good experience of attending to radiology centers and appropriate interactions between middle adolescents and radiographers.

    Materials and Methods

    In this cross-sectional study, 60 adolescents (30 girls and 30 boys) from four secondary schools participated in the study. Their opinions and feelings regarding the waiting room, the imaging room, and their interactions with the radiographers were collected using the completed questionnaire. The questionnaire has been created by the Irish researcher (Davis), and its validity and reliability have been examined.

    Results

    The major complaints of adolescents (36.7%) was the lack of comfortable seats in the waiting room. They preferred watching TV in the waiting room to play music. None of the adolescent girls were nervous in the X-ray room, and 13.3% of boys stated that they were nervous. Twenty-two of the adolescents said the radiographer was quiet. 10% of girls stated that the radiographer was quite rough in dealing with them; however, none of the boys made such a statement.

    Conclusion

    Theresults showed that adolescents do not receive optimal care during X-ray imaging. It was suggested that age-appropriate educational posters to be installed on the wall, and television programs to be displayed in the radiology departments, as well as training courses on how to interact with adolescents for radiographers.

    Keywords: Adolescent, radiographer, x-ray imaging, waiting room
  • Angela Grace * Pages 12069-12074
    Background

    Cyclic Vomiting Syndrome (CVS) is a Functional Gastro-Intestinal Disorder (FGID) which remains under-recognized. In Indonesia, CVS has never been reported.

    Case Presentation

    A 10-year-old girl was frequently admitted due to her intense vomiting in a local, limited resource private hospital in Manggarai Regency, East Nusa Tenggara, Indonesia, and had always been diagnosed with Gastro-Esophageal Reflux Disease (GERD). Her episodes were characterized by vomiting every 30-60 minutes at first, gradually declining over 3-4 days, and recurring in about 6-7 days. All the available test results were unremarkable. Symptoms were resolved after the administration of amitriptyline. She was discharged with continuous amitriptyline for two weeks and went into remission.

    Conclusion

    CVS should always be considered in repeated vomiting among children regardless of the rarity in daily practice. Recognition of this disorder is important to establish the prompt diagnosis and timely intervention, thus improving the quality of life of the children.

    Keywords: Amitriptyline, Cyclic vomiting syndrome, Pediatrics, vomiting
  • Seyed Hhosein Soleimanzadeh Mousavi *, Zeinab Tavakolikia Pages 12075-12080

    This review study aimed to examine the relationship between Coronavirus (COVID-19) and its uses in renin-angiotensin-aldosterone system (RAAS) to infect the patient using the related studies in this regard. Finally, the logical method of using the related medicine, and the benefits and harms of using these Medications will be indicated in the treatment of novel coronavirus. It is hoped that a short step will be taken in the attitude of scientists to plan further studies on the pediatric treatment of upgrading COVID-19.

    Keywords: ACE2 enzyme, COVID-19, Pediatrics
  • Tahereh Galini Moghadam, Somayeh Moeindarbary, Fatemeh Vafi Sani, Alireza Salehi, Atefeh Ahmadi, Fahimeh Khorasani, Masumeh Ghazanfarpour * Pages 12081-12089
    Background

    The aim of this study is to evaluate the psychometric properties of the Persian versionof the Edinburgh Postnatal Depression(EPDS) among Iranian mothers in postpartum period.

    Materials and Methods

    This secondary analysis examines 200 Iranian mothers registered to receive prenatal care in health centers in Kerman, Iran. The subjects were selected using convenience sampling method. The reliability (Cronbach’s α coefficient), construct validity (confirmatory factor analysis (CFA), and exploratory factor analysis (EFA) were assessed. Model fit index (e.g., the root mean square error of approximation [RMSEA]), the Goodness of Fit Index (GFI), and the Comparative Fit Index (CFI) were calculated.

    Results

    The overall Cronbach’s α was estimated at 0.70 with subscales ranging from 0.70 to 0.88. EFA identified three factors with extractable eigenvalue >1.00, which accounted for 62% of the total variance. The eigenvalues of the first three factors were 4.11, 1.09, and 1.012. The first factor, labeled "anhedonia", contained items 1 and 2. The second factor, labeled "anxiety", consisted of items 3, 4, and 5, which explain 19.61 of variance. The last factor, labeled "depression", contained items 7, 8, 9, and 10. Item 8 loaded equally on anhedonia and depression factors. The screen plot also suggested three factors. In addition, CFA verified the model extracted from the EFA. The three-factor model displayed an acceptable fit (CFI = 0.94, TLI = 0.92, RMSEA = 0.06, p=0.001).

    Conclusion

    The results of EFA, CFA, and internal consistency revealed that the Persian version of 10-item EPDS instrument was valid and reliable, and can be used to screen and identify Iranian mothers with anxiety and depression in postpartum period.

    Keywords: EPDS, Persian, Postpartum Depression, Validation, Women
  • Saeideh Nasiri, Mahrokh Dolatian *, Fahimeh Ramezani Tehrani, Hamid Alavi Majd, Azam Bagheri, Pooneh Malekifar Pages 12091-12104
    Background

    Reduced age at menarche is an important health indicator for women and may be associated with complications such as an increased risk of asthma, breast cancer, ovarian cancer, type 2 diabetes. We aimed to examine the factors related to the age at menarche in Iran.

    Materials and Methods

    In this systematic review and meta-analysis, an advanced search with no time restriction was conducted in online databases such as the Web of Science, Embase, Medline, Scopus, and Persian databases of SID and Magiran, as well as the Google Scholar search engine, until the end of 2019. The publication heterogeneity and bias of the extracted studies were evaluated by the Q test and Begg’s test, respectively.

    Results

    In this study, 12 articles with a total sample size of 17672 were included. Based on the findings of these studies, the body mass index (BMI), the mother’s age at menarche, physical activity, nutrition, and socioeconomic status were correlated with the age at menarche for Iranian girls. A negative correlation was found between BMI (r=-0.07), and socioeconomic status (r=-0.57) with the age at menarche (P<0.05). A positive correlation existed between the girl's age at menarche and that of the mother (r=0.42, P<0.05). Moreover, correlation was weak and positive between the age at menarche and physical activity (r=0.14, P<0.05). The quantitative results of the studies were incomplete to establish a relationship between nutrition and age at menarche.

    Conclusion

    Due to the effects of numerous factors on the age at menarche, it is suggested that longitudinal studies be conducted to investigate the role of all the known factors, especially environmental factors, on the age at menarche.

    Keywords: AGE, Girls, Menarche, Meta-analysis, Related Factors
  • Bahareh Ali-Akbari Sichani, Tayebeh Darooneh, Farzaneh Rashidi Fakari, Fariborz Moattar, Malihe Nasiri, Samireh Delpak- Yeganeh, Somayeh Esmaeili, Giti Ozgoli * Pages 12105-12115
    Background
    Saffron is a perennial plant native to Iran which has been traditionally prescribed to facilitate labor. We aimed to investigate the effect of Crocus sativus (Saffron) on cervical ripening and progress of labor in a sample of primiparous term Iranian women.
    Materials and Methods
    This randomized double-blinded study, was conducted on 60 primiparous women whose gestational age was 40 weeks or longer and who had referred to Hazrat Zahra Marzieh hospital in Isfahan, Iran. Inclusion criteria were: singleton pregnancy, cephalic presentation of the fetus, lack of uterine contractions, intact amniotic sac and having a low-risk pregnancy. The intervention (n=30), and control groups (n=30) respectively received one saffron capsule (250 mg, the content of total flavonoid in each saffron capsule was calculated 0.13-0.18 mg), and one placebo capsule for 3 consecutive nights. Bishop scores of the samples were recorded before and after the intervention.
    Results
    The mean Bishop score before inclusion in the study did not show significant difference between two groups (P>0.05). However, on third day of study, this score in saffron group was higher than the placebo (Saffron: 3.93±1.10 vs. placebo: 2.52±1.57) (P=0.001). Further, the mean Bishop score in saffron group was higher on third day of study compared to before their inclusion in the study (before: 2.42±1.19 vs after: 3.93±1.10) (P=0.001). But the placebo group did not show a significant difference before and after inclusion in the study (P=0.16). The average length of first and second stages of labor in saffron group was shorter than in the placebo (P>0.05).
    Conclusion
    It seemsconsumption of oral saffron capsules, affects cervical softening and ripening, and progress of labor.
    Keywords: Cervical Ripening, obstetric labor, Saffron
  • Rogayyeh Sohrabi, Sedigheh AmirAli Akbari *, Mahbobeh Ahmadi Doulabi, Maliheh Nasiri Pages 12117-12129
    Background

    Developmental disorders are important in children, but there is not enough information regarding risk factors, and their effects on developmental disorders. We aimed to design a relational model and assess the relationship of mothers’ spiritual, social, and mental health and self-efficacy with child development.

    Materials and Methods

    The present analytical cross-sectional study enrolled 285 mothers with 18-month-old children through multistage sampling in health centers in Tehran, Iran. Mothers completed the following questionnaires in four months to collect the data: a demographic questionnaire, Paloutzian and Ellison’s Spiritual Health Scale, Keyes’ Social Health Scale, Goldberg’s mental health scale, Sherer’s Self-Efficacy Scale (SES), and the Ages and Stages Questionnaires (ASQ).The data and theoretical Path Model were analyzed using SPSS software version 19.0 and LISREL software version 8.8.

    Results

    Developmental delay was observed in 21.8% (n=62) of children. Maternal spiritual health, both directly (β=0.35), and indirectly, had an increasing and positive effect on the children’s development through increasing social health, increasing self-efficacy and decreasing mental health score (β=0.206). Maternal social health, both directly (β=0.16), and indirectly, had an increasing and positive effect on the children’s development through increasing self-efficacy (β=0.0465). Maternal mental health had a direct and decreasing effect on the children’s development (β= -0.14), but mother’s self-efficacy had a direct and increasing effect on the children’s development (β= 0.31. The final path model was well-fitted (RMSEA=0.025, GFI=1, NFI=1).

    Conclusion

    Considering the results and the impact of factors such as spiritual, mental health, social health and self-efficacy on one another and the developmental delay in children, it appears necessary to screen for these factors for early diagnosis and intervention.

    Keywords: Child, Developmental delay, Spiritual health, Social health, Mental health
  • Rahim Baghban, Somayeh Rahmanian, MohammadAli Kiani, AmirHossein Molkizadeh* Pages 12131-12142

    Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. These technologies allow communications between patient and medical staff with convenience as well as the transmission of medical, imaging and health informatics data from one site to another. It is also used to save lives in critical care and emergency situations. Although telemedicine systems have many advantages, including the distribution of high quality medical services to remote areas, failure to comply with infrastructure will reduce the efficiency and quality of their services. Issues such as building the infrastructure of the medical information industry, including the legal infrastructure, and thus providing a suitable platform for the legal and ethical issues of Telemedicine, as well as obtaining the necessary permits and requirements, will play an important role in the successful implementation of a Telemedicine system. The purpose of this study was to become more familiar with the field of Telemedicine and its services, as well as to review some legal issues in the field of e-health. Telemedicine is not able to solve the problems of the health and social systems, but the problems of the health and social systems cannot be solved without Telemedicine.

    Keywords: health care, Legal, Law, Telemedicine