فهرست مطالب

Pediatrics - Volume:8 Issue: 83, Nov 2020

International Journal of Pediatrics
Volume:8 Issue: 83, Nov 2020

  • تاریخ انتشار: 1399/08/20
  • تعداد عناوین: 20
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  • Sajedeh Farhangnia, Ramazan Hassanzadeh *, Saeed Ghorbani Pages 12317-12326

    Background:

     Poor performance in motor skills is common among children with Attention Deficit Hyperactivity Disorder (ADHD). However, difficulties of children with ADHD in handwriting and its underlying mechanism have rarely been studied. We aimed to investigate the handwriting performance of children with ADHD by considering the role of Visual-Motor Integration (VMI) as a possible underlying mechanism.

    Materials and Methods

    The present study used a comparative-correlational method, which was carried out in 2019 in Gorgan, Iran. Twenty-four children with ADHD and 24 healthy children of primary-school-age performed the Persian Handwriting Assessment Tool (PHAT). Children copied words on a paper sheet in which words were printed on top of the paper, and they had to copy words as accurately as possible. In the dictation part, the experimenter read a text aloud, and children had to write words on a paper sheet as accurately as possible. Legibility (including word formation, size, space, alignment, and text slant), as well as the speed of handwriting, were evaluated in both copying and dictation parts. The Beery test was used to measure VMI. 

    Results

    Results showed that children with ADHD were weaker in word-formation compared to healthy children. However, they had the same performances as healthy children in terms of word size, space, alignment, and text slant. The speed of handwriting was not significantly different between healthy and ADHD groups. ADHD children showed significantly lower scores in VMI compared to healthy children (p = 0.004). 

    Conclusion: 

    Children with ADHD had weaker handwriting legibility compared to healthy children, which is mainly due to word-formation. Moreover, VMI might act as a possible underlying mechanism affecting poor handwriting in ADHD children.

    Keywords: Attention deficit hyperactivity disorder, handwriting, Visual-Motor Integration
  • Arjang Fereydooni, Alireza Heidari *, Zahra Eftekhar Saadi, Parvin Ehteshamzadeh, Reza Pasha Pages 12327-12337

    Background :

      Children's anxiety disorders not only lead to problems related to themselves but also cause problems and confusion in the family. The present study aimed to investigate the effectiveness of happiness and mindfulness training in promoting the parental self-efficacy in mothers of anxious preschool children.  

    Materials and Methods

    This is an experimental research in terms of method with a pretest-posttest-follow-up design and a control group. The study population included all mothers of preschool anxious children in Shahrekord, Iran in 2018. Using the multistage sampling method, a sample of 45 individuals were selected and assigned randomly to a control and two experimental groups (n=15 per group). The research tools included Spence Children's Anxiety Scale (SCAS), and Parenting Self-Agency Measure (PSAM). Mindfulness (eight 90-minute sessions), and happiness (ten 90-minute sessions) training were conducted on the experimental groups. The control group did not receive any intervention. SPSS (version 24) was further used for data analysis.  

    Results

    The mean age of the participants in the mindfulness training, happiness training and control groups were 34.36±2.59, 36.08±2.63 and 34.20±2.29, respectively. The results indicated that the mean of post-test and follow-up scores were significantly different in the experimental and control groups. Furthermore, the happiness training for the mothers of anxious children was effective in their parenting self-efficacy (P=0.000); and a one-month follow-up in the experimental group indicated that the therapeutic intervention could maintain its intervention effect over time (P=0.000). 

     Conclusion:  

    Based on the results, mindfulness and happiness training methods could have lasting effects on the parent-child relationship and change the anxious relationship between parent and child, leading to parental self-efficacy.

    Keywords: Anxiety, Children, Happiness, Self-efficacy, Mindfulness, Mother
  • Omer Nasim, Muhammad Shah Fahad, Muhammad Khizar Hayat *, Zeinab Hussain, Salman Khan, Kashif Ahmad Pages 12339-12348

    Background:

     The diseasetrends help in identifying the importance of the disease. The purpose of this study was to obtain trends of high morbid diseases in children admitted in the pediatric ward of a tertiary care hospital in Peshawar, Pakistan.

    Materials and Methods

    This is an observational cross-sectional study, conducted in the Pediatric Ward of Rehman Medical Institute (RMI), Peshawar, Pakistan, in 2017. Secondary (historical) data was collected from the Pediatric Ward of Rehman Medical Institute. Data were analyzed using SPSS V.23 and tabulated in excel sheets with percentages and rates to determine the trends. The data was then presented graphically.

    Results

    A total of 26,810 records were collected from the RMI database to determine the trends of high-frequency diseases in a pediatric ward. Therefore, Acute Gastro-Enteritis (AGE) [12.8%] had the highest number of cases, followed closely by Lower Respiratory Tract Infections (LRTI) [10.7%] and Neonatal Jaundice (NNJ) [10.0%]. Asthma [3.2%] and Hepatitis A [2.5%] were the least prevalent cases. 14% of the cases were excluded. Pneumonia, NNS, AGE, and sepsis showed an increasing trend while URTI and asthma showed a decreasing trend for nine years.

     Conclusion:

     Trends of Pneumonia, Neonatal Sepsis, and Sepsis, in general, show a dramatic rise, AGE, LRTIs, and Enteric Fever show a very gradual increase, a general downward trend is observed in Asthma and Upper Respiratory Tract Infections (URTIs); while NNJ, Hepatitis A, and Urinary Tract Infections (UTIs) show a static trend.

    Keywords: Pediatric trends, Neonatal sepsis, Neonatal Jaundice, Respiratory Tract Infections, Urinary tract infections
  • Mahni Rahkar Farshi, Javad Ahmadian Heris, Zakiyeh Ebadi, Babak Abdinia * Pages 12349-12356

    Background :

    Inadequate antibiotic usage in children might have severe side effects and lead to antibiotic-resistant pathogens. Iran is the second country in terms of the rate of antibioticuse globally, and approximately one-fourth of the population of this country is under 14- year- old. Therefore, the existing problems in this regard could be identified by evaluating the knowledge and practices of mothers concerning antibiotics. The present study aimed to investigate the knowledge and practice of mothers about antibiotics use among children.

    Materials and Methods:

     This descriptive cross-sectional study was carried out in the pediatric hospital of Tabriz, Iran. A total of 450 mothers of children under 12 years old participated in this convenience sampling. They completed questionnaires (13 questions) of knowledge and practices (8 questions) designed by researchers. The data were analyzed using the SPSS software version 20.0. 

    Results: 

    The mean scores of mothers’ knowledge (ranged 0-13), and practices (from 0-8) were 6.83±2.89 and 5.83±1.63, respectively. Moreover, the education level and occupation of mothers had a significant relationship with their knowledge and practices (p <0.05).

     Conclusion:

     Considering the low level of knowledge and practices of mothers and the elevated antibiotic resistance during recent decades, major policies are required for medication distribution and counseling systems for parents. Furthermore, some plans are needed for public health education.

    Keywords: Antibiotic, Children, Mother, Practice, Knowledge
  • Masoumeh Fallah Nodehi, Saeed Boroomandfar *, Sara Moussavi Pages 12357-12367

    Background:

     In recent years, an increasing number of studies have shownself-esteem and self-consciousness can be protective factors against smartphone addiction among adolescents. Our study aims to investigate the relationship between smartphone addiction and self-esteem and self-consciousness among girls in their first year of high school.

    Materials and Methods

    The samples of this cross-sectional included all the female first year students in Tehran, Iran, from 2019 to 20. The formula suggested by Krejcie and Morgan was used to measure the sample size (n=140), and stratified sampling was used for the collection of samples. The scale of smartphone addiction, the scale of Coopersmith self-esteem, and the self-consciousness scale (revised version) were used. Data were analyzed by SPSS software version 23.0.

    Results

    The total sample of the study included 140 girls with the mean age of 15.81 (0.63) years. The Mean students' self-esteem was (34.58± 11.81). The correlation analysis indicated that self-esteem and self-consciousness (MR = -0.423, p <0.05) had a significant negative correlation with smartphone addiction among student. The results also showed a significant negative correlation between self-esteem and self-consciousness with smartphone addiction (p <0.05). The correlation coefficient between self-esteem and smartphone addiction was (r = 0.394, p <0.05) and the correlation coefficient between self-consciousness and smartphone addiction was (r = -0.293, p <0.05).

    Conclusion:

     Based on the regression equation with the standard coefficients, self-esteem and self-consciousness had a positive effect on smartphone addiction in students. The findings also show that self-esteem predictors, compared to those of the self-consciousness, are better predictors for smartphone addiction.

    Keywords: Adolescents, Self-Esteem, self-consciousness, smartphone addiction
  • Mohamed F. Afify, Yomna Hamdy, Reem Abdel Aziz * Pages 12369-12379

    Background:

     Hypernatremia commonly occurs in ICUs, mostly developing soon after admission. It has been associated with prolonged ICU stay and has a mortality rate of 40–60%. The aim of our study is to estimate the values of serum anion gap (AG), corrected anion gap (CAG), and hypernatremia for an early prediction of mortality in pediatric intensive care units (PICUs).

     Materials and Methods: 

    This retrospective comparative study used data collected from the records of children admitted to the PICU at Minia University Hospital between June, 2017 and June, 2019.

    Results:

     Patients were from 1 month to 18 years old. ROC curve analysis for the prediction of mortality showed the cutoff point of Na >154 (64.04% sensitivity and 79.75% specificity) and of cAG > 42.1 (57.37% sensitivity and 70.25% specificity).

     Conclusion:

    Ventilation, respiratory failure, severe and moderate GCS, PH, CO2, anion gap, high cAG, hypernatremia, K, CL, CRP, PLT, and creatinine were significant predictors of mortality among children admitted to the PICU.

    Keywords: Anion gap, Corrected anion gap, Hypernatremia, Pediatric intensive care unit
  • Azam Eshaghian Dorcheh, Mitra Zandi *, Maryam Rasouli, Mamak Tahmasebi, Fatemeh Esmaielzadeh Pages 12381-12395

    Background:

     Due to the increased survival of children with chronic and complex diseases, transferring a part of care provision to home and harnessing the family’s potential with the aim of shortening the length of stay and returning the child to the safe and familiar atmosphere of the family can affect the health system and the family. This study aimed to evaluate the cost-effectiveness of home-based palliative care for children with complex health care needs based on the literature review.

    Materials and Methods

    After selecting the keywords related to the research question, by examining MeSH, EMTREE and the experts’ opinions mentioned in articles, searching the databases PubMed/Medline, EMBASE, Scopus and Web of Science was done through a combination of them.

    Results

    Finally, 11 studies met the inclusion criteria, which were investigated in three groups of methodological features, economic outcomes and indirect outcomes. The reviewed studies were of medium to high quality. Eight were cohort studies, one pre-post study, and 2 economic evaluation studies. Studiesshowed that the decrease in the costs of home-based palliative care for the children in need of special health care, although little, was the result of either reduced hospital stay or the decreased number of hospitalizations. 

    Conclusion:

     In order to set up pediatric palliative care services in Iran, considering the cultural atmosphere and the limited resources of the health system, attention should be paid to the cost effectiveness of care settings and the provided services, and measures should be taken in order to improve the situation of the children with special care needs, based on social conditions.

    Keywords: Children, chronic disease, Cost effectiveness, Home Care Services
  • Rahele Rahimi, Zari Dolatabadi, Somayeh Moeindarbary, Sara Behzadfar, Neda Fakhr Ghasemi, Rana Tafrishi, Malihe Kamali * Pages 12397-12407

    Background:

     There is not enough evidence to estimate the prevalence of depression and anxiety in pregnant women during the COVID-19 outbreak. This study aimed to investigate the prevalence of mental health disorders among pregnant women during the COVID-19 pandemic.

    Materials and Methods

    In the present systematic review, a search process was conducted to screen the databases of ProQuest, Scopus, EMBASE, Web of Science, and MEDLINE for the relevant articles published between 2019 and 2020. The quality of the articles was assessed by the STROBE checklist.

    Results

    From the relevant studies, 15 were selected for review. The results showed the prevalence of anxiety was between 3.8 to 17.5% in Asian countries, with the lowest in Iran (3.8%) and the highest in Sri Lanka (17.5 %). The prevalence of anxiety was from 23.9 to 72% in Western countries, with the lowest in the USA (23%) and the highest in Canada (72%). In two of the studies in China, the prevalence of anxiety was from 3.09 to 29.6% and of depression from 5.2 to 40%. The incidence rate of self-harm thoughts as a result of the epidemic was significantly high (RR=2.85, 95% CI= 1.70, 8.85, P=0.005).

     Conclusion:

     The prevalence of anxiety was from 3.8 to 17.5% in Asian countries and from 23.9 to 72% in Western countries. The prevalence of depression was from 5.2 to 40%. Moderate levels of anxiety and depression were reported in Western countries compared with Asian countries. Depression and anxiety should be regularly screened in obstetrics and gynecology wards following the current epidemic to ensure optimal mental health during pregnancy and infancy.

    Keywords: COVID-19, Mental health, Pregnant Women, Prevalence
  • Yazdan Ghandi *, Sarvenaz Mehrabi, Rohaman Nariman, Danial Habibi Pages 12409-12419

    Background:

     Chest pain is one of the common chief complaints in children which can be benign and/or life-threatening. In this retrospective study, the causes of chest pain, associated factors, and clinical characteristics in children have been evaluated in order to have a better diagnosis and clinical approach.

    Materials and Methods

    680 patients with chest pain were referred to the pediatric cardiology clinic from Jan 2017 to July 2019. All the information about past medical history, family history, chest pain characteristics, and associated symptoms were collected and all the body systems were examined. The patients who were suspected to have psychological problems were referred to psychiatrists for evaluation. The data were indicated as counts and percentages. Statistical analyses were performed using SPSS (version 20.0).

    Results

    The most frequently reported symptoms accompanied with chest pain were palpitation and exertional dyspnea. 111 patients had abnormal echocardiography and 32 of them had abnormalities in ECG. Dyslipidemia was detected in one of the obese children. The most common causes of chest pain were idiopathic (42.4%), cardiac origins (22.2%), musculoskeletal (13.8%), psychiatric problems (8.6%), gastrointestinal (6.6%), respiratory (5.6%), and gynecomastia (0.08%) respectively. Cardiac chest pain was the most common type among the children between 15 and 18 years old. 

    Conclusion:

     The causes of chest pain could be diagnosed by history-taking, physical exams, and cardiac auscultation. Further tests such as echocardiography, ECG, chest X-ray, and laboratory tests were not essential to diagnose cardiac pains as the first line evaluation.

    Keywords: Chest pain, Children, Etiology, Echocardiogram, Heart Diseases
  • Marzieh Bagherinia, Masoumeh Simbar *, Fereshteh Yazdani, Farzaneh Safajou, Leila Mohamadkhani Shahri Pages 12421-12430
    Background

    Adolescence is considered as a momentous period for initiating risky behaviors. Adolescents do not have an accurate understanding of the perilous consequences of their behavior due to being self-centered. They are likely to discover risky situations, which increases their capacity for danger. The purpose of this systematic review study is to evaluate the school-based educational interventions to increase self-efficacy in preventing smoking in Iranian adolescents.

    Materials and Methods

    In this systematic review, all experimental and quasi-experimental studies from January 2000 to April 2019 in Iran, were searched from Web of Science, Scopus, ProQuest, Cochrane Library, and Medline (via PubMed) as English databases and SID, IRCT, Magiran and Irondoc as Iranian databases. Keywords were selected based on the Mesh and include: "adolescent, teenager, student, smoking, cigarette, education and Iran" combined with the Boolean OR and AND operators. Two reviewers studied the full text of the articles and their main findings were extracted and categorized. Quality assessment of studies was checked and verified by two authors independently based on Cochrane tool.

    Results

    In this systematic review, 6 studies with 964 adolescents that met the inclusion criteria were included in the study; 5 of them were published in English and 1 in Persian. Different methods of school education, including lectures, film presentations, group discussions, question and answer sessions and role playing were used in these studies.

    Conclusion

    According to the results of this study, education of adolescents in the school environment is effective in increasing self-efficacy skills as a preventive measure of smoking in adolescents.

    Keywords: Adolescent, Education, Iran, Self- efficacy, Smoking
  • Ashraf Direkvand Moghadam, Safoura Taheri, Yousef Vaisani * Pages 12431-12438
    Background

    Preterm labor is a crucial factor in neonatal morbidity and mortality. The present study aims to investigate the effects of Socioeconomic Status (SES) on preterm birth and to decompose the main inequalities affecting preterm birth.

    Materials and Methods

    In a cohort study in 2017, 458 pregnant women in Ilam, Iran, were followed from the 20th gestational week up to the labor. All participants were followed up according to the Prenatal Care Schedule approved by the Ministry of Health of the Islamic Republic of Iran from the beginning to the end of the study. The results of participants' laboratory tests were collected based on the records from their pregnancy documents. A code was inserted in the prenatal care booklet of each participant for exchanging information between the researcher and participants. The Concentration Index (CI) was used to determine inequality. The Inequality Index was decomposed to find out the main sources of inequality in preterm infants. Distributive Analysis Stata Package was used for estimating CI.

    Results

    Of the total of 458 participants, 12% had preterm labor. The number of male newborns was 219 (47.8%). Also, the prevalence of preterm labor was more in mothers aged 20 to 31 years (p < 0.001), housewives (p=0.037), and women with lower socioeconomic status (p < 0.001). The socioeconomic contributors to inequality were the mother’s age (p=0.008), father’s age (p=0.005), father’s education (p=0.003), and father's job (p < 0.001). The main factors of inequality were mother’s age (8%), father’s age (3%), father’s education (5%), and father's job (25%).

    Conclusion

    Overall, 12% of our study population had preterm labor. Preterm birth was significantly more observed among mothers of lower socioeconomic status. Some SES, including the mother's age, father’s age, father’s education, and father’s job, were important factors in preterm inequality among Iranian mothers.

    Keywords: Concentration index, Inequality, Preterm, Socio-Demographic Status
  • Hoorieh Mmohammadi Kenari, Zahra Karimi, Mansureh Akhavan * Pages 12439-12441

    Gastroesophageal Reflux Disease (GERD) characterized by a backward movement of gastric contents from the lower esophageal sphincter (1). GERD is the exacerbated and pathologic form of Gastroesophageal Reflux (GER) accompanied by symptoms and complications of damage to the esophagus (2). Vomiting is the most common symptom of this disease, which occurs in 50% of children; it will peak in 4 months and decrease over a year (3). An infant's reflux often brings about regurgitation and symptoms of esophagitis (e.g. irritability, arching, choking, gagging and food refusal) and therefore causes delayed growth (4). Due to high prevalence of this disease and side effects of drugs in infants, it is necessary to find simple remedies for prevention and reduce the complications of GERD. Persian Medicine (PM) as a branch of complementary medicine has some recommendations to prevent infant's gastrointestinal disease. Although these recommendations are recorded hundred years ago, many of them has been approved in conventional medicine. In Persian literature, clinical symptoms such as (Joshā-e Hāmiz) regurgitation of sour material and (Horqat laz’) heartburn are similar to GERD (5). Iranian physicians have proposed the following recommendation:

    Keywords: Infants, lifestyle, Gastroesophageal reflux, Persian Medicine
  • Nayere Azam Hajikhani, Abbas Ebadi, Elham Khoori, Giti Ozgoli * Pages 12443-12454
    Background
    Pregnancy can be troublesome for parents. This study was conducted with the aim of development and psychometric evaluation of a Fathers’ Concerns Questionnaire regarding low risk pregnancy of their wives.
    Materials and Methods
    This study was an exploratory sequential mixed method research. The participants were men whose wives visited Healthcare centers of Gorgan (Iran) for pregnancy care. In the qualitative stage, the individual experiences of 20 fathers were inquired by direct content analysis using semi-structured interview and questionnaire items were compiled based on findings of the qualitative study. The validity of the tool was confirmed by face, content and construct validity methods using exploratory and confirmatory factor analysis. The reliability was investigated by internal consistency methods using Cronbach's alpha and stability was determined by intraclass correlation coefficient (ICC) test-retest with an interval of 2 weeks.
    Results
    In the qualitative study, 28 initial items of the questionnaire were compiled in three dimensions, including the process of pregnancy and delivery (10 items), mother and child health (4 items), and individual-family concerns (14 items). In the face and content validity stage, 2 items were removed. Barlett’s test was significant (p=0.000) and Kaiser-Meyer-Olkin was equal to 0.88. Based on factor analysis results, 2 other items were omitted. The extracted factors were investigated by confirmatory factor analysis. Total reliability was determined by Cronbach's alpha (0.93), and ICC (0.99).
    Conclusion
    Fathers’ concerns questionnaire for low risk pregnancy of wives is designed with 24 items and 3 dimensions, which has appropriate validity and reliability and can be used to determine the status of fathers' concerns and the effectiveness of counseling interventions to reduce concerns during low risk pregnancy of their wives.
    Keywords: Concern, Fathers, pregnancy, Psychometrics, Questionnaire
  • Mohadese Khakpour, Nasrin Moazzen *, Ali Khakshour, Samaneh Norouziasl, Saeedeh Talebi, Hamidreza Kianifar Pages 12455-12460

    Background :

      Cow’s milk allergy is one of most prevalent food allergies worldwide. Due to elimination diet it can impair growth in infants. In this study we evaluate growth disorders in Non-immunoglobulin E mediated cow’s milk allergy named allergic proctocolitis.  

    Materials and Methods

    Forty-nine patients were included in this longitudinal study. The study was launched from February 2018 to February 2019 in Akbar hospital, Mashhad-Iran. Cow’s milk allergy was diagnosed according to the clinical presentation and Challenge test. All participants were breastfed during the course of study. Mothers were received 1000 mg calcium and infants 400 IU Vitamin D daily, as routine. The cow’s milk was eliminated from the diet of both mother and infant. Infants were followed up for 9 months with 3 month intervals. Growth patterns were evaluated by measuring height, weight and head circumference z-scores every 3-months. Serum level of Calcium, Vitamin D, PTH and phosphorus were evaluated before and after the follow-up period.  

    Results

    The mean age of the study participants was 4.57±2.41 month. There was a statistical significant difference between weight and height Z score (p=0.028) (p=0.001), respectively, at baseline and 9 months after treatment. However, no significant difference was found in head circumference Z-score at baseline and 9 months after treatment (p=0.564). The increase in Vitamin D and PTH along with the decrease in calcium, phosphorus was significant during the study period (p <0.01). 

     Conclusion:

       It seems that elimination diet in infants with cow’s milk allergy would not suppress growth parameters and might even improve it, especially weight gain.

    Keywords: Allergy, Children, Cow’s Milk, Growth, Proctocolitis
  • Tayebeh Rakhshani, Seyyed Mansour Kashfi *, Leila Movahed Nezhad, Zahra Motlagh, Nooshin Kohan Pages 12461-12470

    Background :

    According to the importance of self-efficacy and the role of health-promoting behaviors in training of adolescents and in order to develop interventions, better understanding of adolescents' health behaviors is required in daily life in order to target activities related to the adolescent health. This study was conducted to investigate the effect of educational intervention on self-efficacy and health-promoting behaviors in Iranian female high-school students.

    Materials and Methods

    This quasi-experimental study was conducted on high-school girl students in Darab city, Iran in 2018. The sampling method was cluster and the way of assigning individuals to the experimental and control groups was simple random method (70 students for experimental group and 70 students for control group). The outcomes of the study were self-efficacy and health-promoting behaviors that were assessed before and two months after intervention in control and training groups. The data were analyzed using SPSS software version 20.0.

    Results

    Mean age of participants was 15.82± 0.48 years. Independent t-test results showed there was no significant difference between the components of health-promoting (P>0.05), and self-efficacy (P= 0.5) before the educational intervention between the experimental and control groups, while there was a significant difference between the components of health-promoting and self-efficacy after the educational intervention between the experimental and control groups (P <0.05).

    Conclusion:

     Among high-school girl students, training intervention used was effective in increasing health-promoting behaviors and self-efficacy.

    Keywords: Adolescents, Education, Health promotion behaviors, Self-efficacy
  • Farhad Heydarian, Mona Nasiri, AliReza Attaei Nakhaie, Hamid Ahanchian, Somayeh Ghahremani, Ali Haghbin, Sarah Ghahremani Pages 12471-12479
    Background

    Acute respiratory infections and especially pneumonia are considered as the most important infection-induced cause of child mortality in developing countries. We aimed to investigate the effect of prescribing zinc sulfate on improving the clinical symptoms of pneumonia in 2-59-month-old children.

    Materials and Methods

    This clinical trial study was performed on 108 children complaining of fever, coughs, and tachypnea referring to three educational hospitals of Mashhad (Ghaem, Imam Reza, and Dr. Sheikh). The patients were randomly assigned into control (n=54), and intervention (n=54). In the control group placebo was prescribed, while the intervention group received oral zinc sulfate 10 mg (1 ml/ kg in children younger than one year, and 20 mg/kg for children above one year every 12 hours. During hospitalization, every 12 hours the clinical symptoms of both groups including tachypnea, duration of fever, coughs, intercostal retraction, hypoxia, crackles-wheezing, and duration of hospitalization were recorded. At the beginning and end of the treatment, two blood samples were taken for determining the serum level of zinc.

    Results

    The findings indicated that the serum level of zinc sulfate after the intervention increased significantly in the intervention group (p <0.001). There was a significant difference in the duration of fever between the intervention and control groups 24 hours after hospitalization (p=0.014) and 36 hours post-hospitalization (p=0.02). Comparing the presence or absence of tachypnea in the intervention and control groups, there was a significant difference at 36 hours post-hospitalization (p=0.02).

    Conclusion

    Based on the results, zinc supplement was effective for patients with pneumonia in reducing the duration of fever and number of breaths, but it had no significant effect on the duration of coughs and hospitalization.

    Keywords: Children, Cyanosis-Tachypnea, Pneumonia, Zinc sulfate
  • Amirreza Dehghan Tarazjani, Mostafa Ghaffari Moghaddam Noghabi, Abdolmajid Eslahtalab, Mohsen Hosseinzadegan, Javad Poormousa, Ali Rokni, Zahra Chaichi * Pages 12481-12486
    Background

    The aim of this review was to compare the efficacy of acupuncture therapy in the treatment of nocturnal enuresis with placebo acupuncture or oral pharmacological treatment based on randomized controlled trials.

    Materials and Methods

    Two independent researchers screened the meta-analysis articles on the effect of treatment nocturnal enuresis in children. The databases included Scopus, EMBASE, Cochrane, Web of Science, and Medline, with no time and language restrictions from the beginning up to March 10, 2020.

    Results

    The first meta-analysis showed that therapy with the combination of desmopressin and anticholinergics (combination therapy) was significantly better than desmopressin monotherapy. The second meta-analysis showed that structured withdrawal from desmopressin treatment compared with the abrupt withdrawal results in a significantly better relapse-free rate (pooled RR: 1.38; 95% confidence interval [CI]: 1.17–1.63; P=0.0001). The third meta-analysis reported a 31% rate of successful treatment for rapid palatal expansion, which is promising compared to the spontaneous cure rate. In the fourth meta-analysis, the pooled data showed a significant difference between acupuncture and meclofenoxate therapy (OR=2.81). No significant difference was observed between acupuncture, desmopressin (OR = 1.57), imipramine hydrochloride (OR = 1.71), and oxybutynin (OR = 3.57). In the fifth meta-analysis, a statistically significant difference was observed between the frequency of enuresis per week (P < 0.001), the number of patients with clinical response . 

    Conclusion

    Therapy with the combination of desmopressin and anticholinergics (combination therapy) produced significantly better results than desmopressin monotherapy. The findings showed the positive effects of acupuncture therapy and rapid palatal expansion on nocturnal enuresis in children.

    Keywords: Children, Nocturnal Enuresis, Treatment, Overview
  • Bahareh Seyyedin, Arezoo Rezazadeh *, Nasrin Omidvar, Farid Zayeri, Sakineh Nouri Saeedlou Pages 12487-12501
    Background

    Obesity and overweight is a great concern in adolescence that would have impact on adulthood. This study was conducted to identify major dietary patterns and their relation with overweight/obesity of female adolescents living in Northwest of Iran.

    Materials and Methods

    The design of the study was cross-sectional conducted on 350 female students aged 16-18 years in Urmia city, Iran. Height and weight were measured using standard techniques and weight status was defined by World Health Organization (WHO) and Center for Disease Control (CDC) cut-offs. Dietary intake information was collected by a validated 169-item semi-quantitative food frequency questionnaire via face-to-face interview. Dietary patterns were identified through principle component analysis. Demographic and socio-economic confounding factors were obtained by a questionnaire. Logistic regression was used to assess the relationship between overweight/obesity and dietary patterns.

    Results

    About one third of participants (n=115, 32.9%) were overweight or obese. Three major dietary patterns were extracted: "high vegetable-high dairy", "high protein", and "traditional dishes". Parental educational level, house assets and household size were associated with dietary patterns. After adjusting for confounders, adolescents in upper quartile of "high vegetable-high dairy" pattern (OR=3.17, 95% CI=1.50-6.70; p trend=0.010), and "high protein" pattern (OR=2.01, 95% CI=0.96-4.19; p trend=0.006) had a greater risk of being overweight/obese. However, traditional dietary pattern was not related to overweight/obesity (p trend=0.70).

    Conclusion

    Findings suggest that the chance of overweight/obesity was increased in adolescents that had higher adherence to "high vegetable-high dairy" and "high protein" dietary patterns. On the other hand, the socioeconomic status of household was an important factor influencing tendency of adolescents to a special dietary pattern.

    Keywords: adolescence, Dietary pattern, Iran, Obesity
  • Parisa Siyarsarai, Kheirollah Gholami, Shekoufeh Nikfar, Shahideh Amini * Pages 12503-12515
    Background

    Health transformation planwas implemented in 2014 in Iran with the aim of reducing healthcare expenditures. Transformation plans always have a financial impact on healthcare expenditures because of potential to increase the utilization. Drug utilization review is one of the effective solutions to explore consumption and improve rational use. This study aimed to evaluate the medicine utilization after health transformation with implementation of an evidence-based protocol in a tertiary hospital.  

    Materials and Methods

    This is a before-after study which was conducted in a tertiary children’s hospital with 400 beds in Iran. At first, costly medications were identified by ABC analysis in drug and therapeutic committee meetings of the hospital. Increased use of these medications was measured after the implementation of the health transformation plan. Then, the pattern of prescription, its appropriateness and impact of protocol implementation on the health expenditures reduction and rational use was evaluated.  

    Results

    Initial estimation of the usage showed that before protocol implementation, in six-month, albumin, pantoprazole, and Apotel® increased by 31.9%, 22.6%, and 21.9%, respectively following the health transformation plan. Medical records of 6,554 patients were evaluated for target medications. The frequency of inappropriate prescription reduced significantly from the first to the second phase for albumin (65.5%-35.8%, P=0.001), pantoprazole (58.9%-22%, p <0.001), and Apotel® (66%-17%, p <0.001), respectively. Health expenditures also reduced significantly for albumin (P=0.003), pantoprazole (P=0.001) and acetaminophen (p <0.001), respectively. 

     Conclusion:

      Timely implementation of medication prescription protocols can provide health benefits to patients and cost savings to the health service provider that could lead the health transformation plan to reach the aim of reduction in health expenditures with rational use.

    Keywords: Cost reduction, Drug Utilization Review, Health Care Reform, protocol implementation
  • Ehsan Keykhosravi, Amin Tavallaii, Masood Pishjoo, Behzad Aminzadeh, Mona Maftouh, MohammadAli Abouei Mehrizi, Mohammadreza Shahmohammadi, Hamid Rezaee * Pages 12517-12522

    Myelomeningocele is a condition caused by the disjunction of neuroectoderm and ectoderm during embryogenesis. It can lead to neuronal structure disorders such as kyphosis and scoliosis, with scoliosis being more common. Kyphosis is found in 10-15% of these patients and can cause poor clinical consequences. The annual progression of Kyphosis is approximately 8 to 12 degrees.  Kyphosis is a limiting factor in rehabilitation due to the inability of the patients to sit in wheelchairs and in the apex of the kyphotic region. This study aims to report a similar condition in a 14-year-old Iranian boy who underwent surgery for posterior kyphectomy. In the majority of cases with kyphosis, anterior wedging occurs in the vertebral body where the apex of the deformity is located. In the studied patient, the deformity had a round curve with no definite apex to mark out. These deformities need special surgical approaches and postoperative care.

    Keywords: Child, Iran, Myelomeningocele, Kyphosis, kyphectomy