International Journal of Pediatrics
Volume:9 Issue: 88, Apr 2021

Most children with learning disorders suffer from anxiety, depression, alienation, and social adjustment difficulties, which must be taken into account in the treatment process. This study compared group play therapy and painting therapy's effectiveness on social adjustment and alienation among Iranian children with specific learning disabilities.
The research method was quasi-experimental with a pre-test, post-test, follow-up design, and a control group. The statistical population included all the girl students with learning disabilities in Kermanshah, Iran, in 2019. The sample consisted of 45 children with specific learning disabilities selected by convenience sampling and divided into two experimental groups (group plays therapy & painting therapy, n = 15 per group), and a control group (n = 15). The research instruments included the Social Adjustment Scale and the Children's Loneliness Scale. The first experimental group underwent eight sessions (45-minute sessions per week) of group play therapy and the second experimental group underwent eight sessions (45-minute sessions per week) of painting therapy. The follow-up was performed after 45 days. Data analysis was done using SPSS software version 21.0.
The participants included 45 girl students with specific learning disabilities, aged 11.20 ± 1.22 years old. The results indicated that play therapy and painting therapy interventions alleviated alienation and improved social adjustment among students with learning disabilities (P=0.001). There was no significant difference between play therapy's effectiveness and that of painting therapy on social adjustment and alienation.
This intervention method can be employed to mitigate alienation and enhance social adjustment among children with learning disabilities.

Background:

 Evidence regarding the relation between fetal distress and development of autism spectrum disorders (ASD) among children is rare. Therefore, this systematic review and systematic review and meta-analysis was conducted to assess the relation between fetal distress and ASD among children with stronger evidence.

In this systematic review and meta-analysis, Medline, Scopus, Web of Science and Google Scholar were searched using the relevant keywords on observational studies from inception to October 2020 without any language restriction by two independent authors. The pooled odds ratios (OR), and 95% confidence intervals (CI (were calculated from eligible studies used as random effect estimates of association among included studies. The inconsistency across results of studies was quantified using I2 statistic. Data were analyzed using Stata software version 13.0.

From 341 identified studies, eight studies (684,262 individuals) were included in the meta- analysis. The pooled estimates of OR did not show a significant association between fetal distress and the risk of ASD among children, respectively (OR = 1.27, 95% CI = 0.88 to 1.67). There was medium heterogeneity among included studies (I2=50.4%, P=0.049).

Conclusion :

Our findings showed that fetal distress was not a risk factor for ASD among children. In a comparison to the previous meta-analysis, this study provides the most up-to-date evidence supporting a lack of significant association between fetal distress and ASD. Here, the association between fetal distress and ASD is still under discussion so that, further researches and umbrella reviews are needed.

The prevalence of Helicobacter pylori infection is reported variously in different studies in Iran. These study aimed to determine the prevalence of Helicobacter pylori infection in children in Iran.

In this systematic review and meta-analysis, we searched Medline, Scopus, EMBASE, Web of Science, and Google scholar systematically from Jan 1990 to up to December 2020. "Helicobacter pylori", "Child", "H. pylori", "Campylobacter pylori" and "Iran" were used for search. All English-language articles associated with the prevalence of H. pylori performed in Iran were evaluated, and after passing the qualification assessment (Newcastle –Ottawa Quality Assessment Scale), these were entered into the analysis. The prevalence of H. pylori in children at a 95% confidence interval was estimated using a random-effect model.

The search initially identified a total of 778 publications, and finally, 43 studies involving 16,939 children were included. The pooled prevalence of H. pylori infection in Iranian children is estimated as 43% (I2=98.1, p=0.001). Based on the diagnostic methods, the pooled prevalence in the group with stool antigen evaluation was 44% (I2=99%, p=0.001), the pooled prevalence in the serology evaluation group was 40% (I2=96%, p=0.001), in the biopsy group, 50%, in Rapid urease test/ urea breath test 40%, and in combined diagnostic tests group 56% (I2=84.5%, p=0.001), and in the not determined group the pooled estimate was 26%. The heterogeneity between groups was significant (p <0.001).

The pooled prevalence of H. pylori infection in children in Iran is estimated as 43%, which has been higher than the global prevalence. Also, a higher prevalence rate was reported in studies in which the diagnostic test was a biopsy.

Febrile Seizure is considered as one of the most common seizure disorders during childhood. The purpose of this study is to compare serum potassium levels in children with febrile seizures and febrile children without seizures.

In this case study, 320 children admitted to Ghaem Hospital (Mashhad, Iran) aged six to 60 months were selected. In the case group, there were 160 children with febrile seizures, and in the control group, there were 160 febrile children without seizures. Potassium serum levels at the time of hospitalization as well as age, gender, duration and cause of fever, duration of hospital stay, and family history of seizures in both groups were investigated and compared.

Potassium serum levels were significantly higher in children with seizures than in those without seizures (P=0.007). Among children with seizures, those with complex seizures had significantly higher potassium levels (P=0.024). The binary regression test showed that the level of potassium was a risk factor for febrile seizures (P = 0.025).

Based on the results, higher potassium serum levels can be a risk factor in febrile seizure.

Eye examination for retinopathy of prematurity (ROP) examinations is a screening test which is among the painful procedures in neonatal care unit. The aim of this study was to investigate the effect of multisensory stimuli and breast milk on intensity of pain in premature infants during eye examination.

This study is a randomized clinical trial. Ninety premature infants in Shahid Sadoughi hospital of Yazd, Iran, were randomly divided into 3 groups included: two intervention groups (1-multisensory stimulation (30 infants), 2-the recipient of the mother’s breast milk (30 infants), and control group (30 infants) who received the usual care of the ward. In this study, pain index score was recorded at 6 times based on Premature Infant Pain Profile (PIPP). Data were analyzed using SPSS software version 20.0.

The mean pain score during the eye examination in the control group was significantly higher than two intervention groups (p>0.05). Both sensory stimulation and breast milk intervention groups reduced the pain score, but the sensory stimulation group reached the baseline score earlier than the breast milk group, so that in 1.5 minutes after the second eye examination, there was a significant difference between the pain scores of the two intervention  groups (p <0.05). 

Conclusion:

According to the results of this study, multisensory stimulation and breast milk both can be used to reduce pain in preterm infants during ROP examinations. Although the effect of multisensory stimulation was slightly greater, breast milk could be a good alternative to a multisensory stimulation because it is a natural safe and effective analgesic at no cost.

Omental torsion (OT) is an infrequent cause of acute abdomen in children. OT is usually located in the right iliac fossa, and a left-sided localization is rare, primarily seen in adults. Herein, a left-sided OT in a pediatric patient is presented because of its unusual localization managed successfully with conservative treatment.

A nine-year-old boy was admitted with left upper quadrant abdominal pain, anorexia, and vomiting. His medical history was significant for an appendectomy which was performed two months before. The patient was diagnosed with an OT with clinical findings and imaging techniques; thus, conservative treatment was applied successfully. The case was treated in the University of Health Sciences, Kanuni Education and Research Hospital, Department of Pediatric Surgery, Trabzon, Turkey, in March 2020.

Usually, there is no underlying condition in the OTs, but previous abdominal surgery or inguinal hernia repair may be the predisposing factor. Conservative treatment may be possible if a prompt diagnosis could be established, and unnecessary surgery may be avoided with a close follow-up.

The study aimed to determine the effect of speed-strength training on the indicators of attention stability of children aged 13-14 years with different nervous system strengths.

This case-control study lasted for three months (January 12 to March 20, 2020). All physical education classes at school number 60 in Kirov, Russia, were held twice a week for 40 minutes. According to the standard program, 20 children from the control group were engaged in physical education. Schoolchildren from the experimental group, 20 boys and girls-additionally performed a set of exercises to develop speed and strength abilities. All schoolchildren performed two control standards: The tapping test (assessment of the nervous system's strength), Bourdon test (assessment of the stability of attention).

Results showed that after the pedagogical experiment, the attention stability in schoolchildren from the control group with a robust nervous system improved by 4% (p>0.05), and in children with a weak nervous system, the indicators became higher by 3% (p>0.05). In the experimental group, the attention stability improved in schoolchildren with a robust nervous system by 18% (p <0.05) and in children with a weak nervous system by 14% (p <0.05).

Based on the results, the indicators of speed and strength abilities and the indicators of the stability of children's attention will improve.

Adverse effects of problems caused by chronic diseases can be reduced by increasing patient empowerment. The aim of the present study was to assess psychometric properties of Gothenburg Young Persons Empowerment Scale (GYPES) among Iranian adolescents with type 1 diabetes.

This is an applied descriptive study with psychometric assessment and test validation design. The study population consisted of 150 patients with type 1 diabetes referred to medical centers in Isfahan, Iran. Samples were selected using convenience sampling and based on inclusion criteria. The Persian version of the scale was developed based on the model of the World Health Organization (WHO). The validity of the scale was assessed by calculating the content validity index, face validity, and factor analysis. The reliability of the scale was also assessed by test-retest and Cronbach's alpha test. The collected data were analyzed using SPSS version 21.0 in two descriptive and inferential levels.

The content validity index (CVI) was more than 0.8 for each item except Item 12. Based on the results of exploratory factor analysis (EFA), none of the common values ​​was less than 0.5. The results of Pearson correlation test also showed a positive and significant relationship between the two stages of the questionnaire (P = 0.001). Cronbach's alpha method was used to measure the internal consistency of the whole instrument (0.725), and its dimensions (0.62-0.83).

The 14-item GYPES among Iranian adolescents with type 1 diabetes was approved and has acceptable validity and reliability. Therefore, this scale can be used as a valid tool, in the field of care and research, to empower adolescents with type 1 diabetes.

Pathogens stimulate presepsin (P-SEP) shedding from immune cells such as macrophages, monocytes, and neutrophils.  Although its function is still unclear, P-SEP is believed to interact with B and T cells to modulate specific immune responses. We aimed to evaluate the accuracy of P-SEP as a novel biomarker for the diagnosis of bacterial infection and correlate its level with blood culture, C-reactive protein (CRP), and procalcitonin (PCT) levels.

This is a prospective comparative study conducted at Minia University Hospital, Egypt, including eighty neonates. They were divided into two groups: Group I: Twenty full term neonates; infants > 37 weeks. Group II: Sixty preterm neonates Group II A: 20 Low birth weight neonates: 1501- 2500 gr, Group IIB: 20 Very low birth weight neonates: 1001-1500 gr, Group II C: 20 Extremely low birth weight neonates: 500-1000 gr. Cord presepsin (presepsin 1) was measured at birth. CBC, CRP, Blood culture, Procalcitonin and presepsin 2 were measured after the onset of sepsis.

No significant difference in levels of P-SEP 1 was found between the two groups.P-SEP 2 levels were higher in sepsis group than in non-sepsis group. Presepsin showed more diagnostic accuracy than PCT in diagnosis of sepsis. The best cut-off value for Presepsin was 485 pg/ml, with 97.8% sensitivity, and 94.1% specificity.

Presepsin as a biomarker is not only suitable for early diagnosis of sepsis but it is also more accurate than both PCT and CRP.

Non-traumatic loss of consciousness is a nonspecific symptom resulting from a broad range of diseases in children, and its outcome depends on factors, including its primary etiologies, age, sex, and patient clinical condition at the time of admission. The purpose of this study was to evaluate the etiology and outcome of children's non-traumatic loss of consciousness and to determine predictive clinical and paraclinical features.

This retrospective cross-sectional study was conducted in Imam Hossein Hospital, Isfahan, Iran. Documents of 101 children aged one month to fifteen years old who were admitted with non-traumatic loss of consciousness from March 2016 to March 2017 were reviewed. Data regarding patient’s profile, signs and symptoms, para-clinical findings, progression, and outcome were collected and analyzed using SPSS software version 23.0.

Results showed that the most common cause was infections (40.6%), followed by seizure (23.8%) and intoxication (19.8%). Also, infection was the main cause of mortality. The mortality rate was 18.8% and it was significantly and directly correlated with duration of hospitalization, intensive care unit (ICU) admission, and emergency interventions such as intubation or cardiopulmonary resuscitation (CPR) at the time of admission, seizure status, dehydration, irritability, poor feeding, oliguria, hypotension, non-reactive pupils, low oxygen saturation, hyporeflexia, and hypotonia. Moreover, paraclinical factors such as thrombocytopenia, neutropenia, impaired liver and kidney function tests, and high coagulation test predicated poor outcomes.

The most common cause of non-traumatic loss of consciousness and the most common cause of mortality was infection. Longer duration of hospitalization, ICU admission and interventions were associated with poor outcomes. It seems physicians should pay more attention to these predictive factors.

The low level of pregnancy-associated plasma protein A (PAPP-A) has relationship with unfavorable outcomes in neonates. We aimed to evaluate the association between thickness and size of placenta in singleton pregnant women.

In this prospective cohort study, we investigated 102 women in 18-23 weeks and PAPP-A level at gestational age in 11 to 14 weeks with singleton pregnancy who referred to Al-Zahra Hospital, Rasht, Iran, between 2017 and 2018. Serum PAPP-A of pregnant women was measured in the first trimester of pregnancy. Patients who had PAPP-A ≤0.5 Multiple of the Median (MOM (were dedicated to exposed group and others to non-exposed group. Placental thickness and size were assessed during second trimester by ultrasound examination and described as abnormal high thickness if the thickness was > 4 cm or more than 50% of placental length and abnormally small size when the maximum length was < 10 cm. Then, placental thickness and size of the two groups were compared.

Sixty-eight patients had PAPP-A >0.5 and 34 patients had PAPP-A ≤0.5. Women with low levels of PAPP-A in the first trimester had an increased incidence of abnormal placental thickness in 13 cases, and small placental size in 7 cases, whereas this number in another group was 12 and 7 cases, respectively (P=0.023). The sensitivity and specificity of PAPP-A.

Based on the results, the size and thicknesses of placenta in women with a low level of PAPP-A (≤0.5) were abnormal.

Specialized and sub-specialized medical education, considering the special role of residents in the educational and medical system of universities, is of key importance in the higher education system of Iran. The aim of the present study was to investigate the factors affecting the quality of residency education from the perspective of professors and pediatric residents.

In this cross-sectional study, sample size consists of pediatric residents and faculty members who were working in the pediatric wards of training hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran in 2020. The individuals have been selected through convenience sampling. The samples then filled a researcher made questionnaire (about the quality of Resident Education in clinical fields), and the obtained data were analyzed using SPSS software version 16.0.

A total of 10 faculty members and 35 pediatric residents participated in this study. Findings showed that professors assigned higher mean scores to the effect of individual and environmental factors on the residency education as compared to pediatric residents (p <0.05). The results showed a significant difference between professors and residents in terms of the mean scores given to the educational quality in items 14 and 13 and items 18 to 23. In other words, professors had more positive attitude towards quality of clinical education than pediatric residents (P <0.05).

Faculty members and pediatric residents did not have the same views on the quality of residency education and professors had more positive assessment of the effect of individual and environmental factors on the clinical field as compared to pediatric residents.

COVID-19 can cause various symptoms in children. The aim of the study was evaluation of multi-organ presentation of children with COVID-19 infection in Amirkola Children’s Hospital in Babol, Iran.

This study was conducted retrospectively and data were extracted from medical records. All children with suspected COVID-19 infection who were referred to Amirkola Children’s Hospital in Babol (north of Iran) from March 4, 2020 to May 30, 2020 were enrolled. Clinical features of the respiratory and digestive system and Multisystem Inflammatory Syndrome in Children (MIS-c) were assessed. In all children WBC, RBC, Hb, MCV, Lymphocyte, CRP, ESR, ALT, AST, PT, PTT and platelets were also evaluated. Data analysis was conducted with SPSS software version 16.0.

Totally 37 children were recruited to the study. The most common clinical symptoms in children were fever (86.5%), weakness (75.7%) anorexia (73%)abdominal pain (48.6.9%), diarrhea (45.9%) nausea and vomiting (37.8%), cough (32.4%). About 60% and 8% of children had Hb and MCV less than normal levels respectively,So that 80% and 60% of children had abnormal elevations in CRP and ESR, respectively. Also, 32% and 35% of them had an increase in ALT and AST levels respectively and about 40% of them hadhypoalbuminemia. Additionally, 7 of 37 (18.9%) children had MIS-c. The result of the study demonstrated that 10/37 (32.4%) of children had pulmonary involvement.

In this study gastrointestinal symptoms were more common than respiratory symptoms in children with COVID-19 infection. Also, about one- fifth of children with COVID-19 had MIS-c. Attention to manifestations of organs other than respiratory system in children with COVID-19 infection is necessary.

During the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), fewer children were involved compared to adults, and fewer data about the chest computed tomography (CT) findings in children are available. The aim of this study was to review chest CT findings in children with COVID-19.

To perform this review study, the main databases of Medline (via PubMed), Scopus, EMBASE, and Google Scholar search engine were searched until May 2020 in English with keywords of "COVID-19, SARS CoV-2, Clinical Features, Children, Pediatrics, Chest CT, and Computed Tomography" were searched. The related studies were reviewed and selected by two reviewers. The kappa statistic between the two authors was 78% for selecting the articles.

Based on the 17 evaluated studies, the most frequent abnormalities were respectively patchy shadowing, ground-glass opacities (GGOs), consolidations mostly surrounded with halo sign, and interlobular septal thickening. The lesions were commonly multiple, patchy, nodular, and bilateral; however, they could be single, local, unilateral, and dense in some cases; and most of the lesions have been detected in the right lower lobe.

Compared to adults infected with SARS CoV-2, the symptoms were milder and the lungs chest CT imaging indicated smaller lung involvement in pediatrics; however, the patterns of imaging changes were almost similar.

The effects of using intrauterine human gonadotropin hormone (HCG) with different dose before embryo transfer cycles on pregnancy rate in infertile women had controversy results. Therefore, the present study was conducted to evaluate the effect of infusion 500 units of HCG 15 minutes before embryo transfer cycles on pregnancy outcome in infertile women.

The present randomized clinical trial study was conducted on 196 infertile women referred to Yas Infertility Center, Tehran, Iran, from June to November 2019. The patients randomly allocated to the groups by balanced block randomization (99 patients in each group). The intervention group received 500 IU of HCG 15 minutes before embryo transfer by intrauterine infusion and in the control group no intervention was performed before embryo transfer. The in-vitro fertilization (IVF) cycle outcomes between two groups was assessed 15 days after embryo transfer and compared with chi square test.

The main causes of infertility in both groups were male factors and mixed factors. The chemical pregnancy rate in the HCG group was significantly higher than those of in the control group (30.92% vs. 18.18%, p =0.004). However, no significant difference was found in terms of clinical pregnancy, early miscarriage rate, ectopic pregnancy rate and twin pregnancy rate (p >0.05).

The infusion of 500 IU of HCG 15 minutes before embryo transfer improved the chemical pregnancy rate. However, due to conflicting result in other previous studies, further evidence with high sample size studies is needed to confirm the findings of this study.

The computed tomography (CT) scan is a valuable tool in the diagnosis of various diseases, but the absorbed dose causes concern, especially for children. The present study aimed to evaluate the absorbed dose of volume CT dose index (CTDIvol) and dose length product (DLP) in routine CT scan protocols in children under 15 years of age admitted to Imam Khomeini Hospital of Ahvaz, Iran.

The present descriptive-analytical epidemiological study was carried out on children under 15 years of age admitted to Imam Khomeini Hospital of Ahvaz during the first 6 months of 2019. CTDIvol and DLP values ​​were measured using a pencil ionization chamber. Universal dosimeter fire ware 2, 20, and single scan standard phantoms were done on children in a single scan for several routine CT scan protocols. Data were analyzed using SPSS software version 16.0.

Significantly different (P < 0.05) CTDIvol values were obtained for head, chest, and pelvis (2.14 ± 0.93, 0.93 ± 0.07, and 1.20 ± 0.53, respectively). The obtained DLP values for head, chest, and pelvis (28.46 ± 0.93, 23.91 ± 2.26, and 38.14 ±2.52, respectively) were significantly different (P <0.05). Mean CTDIvol and DLP values calculated for head, chest, and pelvic protocols were significantly different by month.

The mean CTDIvol and DLP values for the head, chest, and pelvic protocols, which are within the allowable range and will not be associated with the risks mentioned in this test on children, are less than the values ​​suggested by various guidelines and other studies.