International Journal of Pediatrics
Volume:9 Issue: 89, May 2021

In newborns, jaundice is the most common ailment that necessitates medical treatment and hospital readmission. The aim of this study was to evaluate vitamin D3 status and investigate the role of phototherapy in the treatment of jaundice and the improvement of vitamin D3 status in neonates with physiological jaundice.

 This prospective research included 50 full-term neonates with physiological hyperbilirubinemia who were phototherapy candidates. They came from Egypt's Qena University Hospitals' Neonatal Intensive Care Units. Colorimetric assays of albumin and ionized calcium, as well as daily serum bilirubin and an ELISA assay of vitamin D3 were performed on the included cases before and 5 days after phototherapy, in addition to clinical assessments.

 The findings revealed a high prevalence of vitamin D3 deficiency (96.7%), and a lower frequency of optimal and insufficient vitamin D3 status (3.3%) with lack of optimal vitamin D3 status among cases. Post-phototherapy total, direct, and indirect bilirubin levels were significantly lower than pre-therapy levels, with substantial improvement in vitamin D3 status (p <0.05 for all). Furthermore, both serum total bilirubin (r=-0.703, p <0.001) and serum indirect bilirubin (r=-0.710, p <0.001) had significantly negative associations with vitamin D3 serum levels.

Without vitamin D3 supplementation, neonates with low vitamin D and physiological jaundice who were received phototherapy had considerably improved vitamin D status 5 days later.

The available sources indicate our insufficient knowledge about vitamin D levels in infants born in Iran. Therefore, the aim of this study was to investigate the vitamin D status and effective maternal factors on vitamin D levels in cord blood of neonates born in south-east of Iran.
This descriptive-cross sectional study was performed on neonates who were born in Ali-Ibn-Abitaleb Hospital (Zahedan, Iran), and their mothers from August 2020 to January 2021. To assess the maternal serum and umbilical cord level of vitamin D, 5 ml of whole blood (umbilical cord blood and maternal venous blood) was evaluated by enzyme-linked immunosorbent assay. The relationship between different levels of the infants’ vitamin D and some maternal vitamin D deficiency factors were evaluated.
A total of 190 pregnant women & 190 infants participated in this study. The mean serum level of vitamin D in newborns was 37.90 ngr/ml, of which 41(21.8%) were vitamin D deficient.  Vitamin D status of neonatal cord blood was significantly related to using vitamin D supplements by mother during pregnancy, parity, maternal literacy level, infant gender, maternal exposure to sunlight and maternal vitamin D status (p<0.05 for all).
Our study showed that using vitamin D supplements by mother during pregnancy, parity, maternal literacy level, infant gender, maternal exposure to sunlight and maternal vitamin D status are related to the infants’ vitamin D status. Further research is needed to determine the reason behind some established relationships in the present research including the relationship between parity and vitamin D in neonates.

Exposure to environmental risk factors are common events in pregnant women and it can affect several health outcomes adverse in the offspring. Many observational studies, systematic reviews and meta-analysis have documented the aforementioned association. This narrative review highlights the results of previous studies about different types of adverse health outcomes during infancy, childhood, adolescent and adults that are related to maternal exposure to leading environmental risk factors e.g. smoking, alcohol consumption, infection and air pollution. Also, the review outlines the potential biological plausibility of the association. Hope this review will help to highlights the bivariate association between maternal health during pregnancy and child health as well as further researches to ascertain the potential mechanisms.

Primary nocturnal enuresis (PNE), with a prevalence of 5-30%, is a common and important disease in children. We aimed to investigate the efficacy of fluvoxamine in the treatment of refractory PNE and to compare it with standard desmopressin-oxybutynin treatment. In this pilot clinical trial study,children with PNE referred to the Dr. Sheikh Hospital (Mashhad, Iran, 2019) who were resistant to the first line of behavioral and drug treatment and did not have any other psychological disorders were enrolled in the present pilot clinical trial. Patients were randomly divided into fluvoxamine (25 mg at bedtime for one month), combination therapy (desmopressin, 10μg intranasal), and oxybutynin (0.1 mg/kg for one month). The recovery status of patients in the two groups was investigated and compared based on the number of wet nights during one month. 30 patients with PNE were included in this study. Three patients of the treatment group were excluded from the study due to lack of referral and follow-up. At the end of follow-up in the fluvoxamine treatment group, full recovery was observed in 8 patients (66.7%), partial recovery in 2 patients (16.7%), and no recovery in 2 patients (16.7%). Also, the desmopressin-oxybutynin treatment resulted in full recovery in 7 patients (46.7%), partial recovery in 4 patients (26.7%), and no recovery in 4 patients (26.7%), but there was no significant difference between the two groups in terms of therapeutic results (P> 0.05). Based on the results, there was no difference between the two groups of fluvoxamine and desmopressin-oxybutynin combination in the treatment of nocturnal enuresis.

The findings of various studies have supported the analgesic effect of transcutaneous electrical nerve stimulation (TENS). Studies yielded contradictory findings on electronic dental anesthesia (EDA) as a non-invasive method. This review study aims to evaluate the EDA as a non-invasive method.

This review study was conducted by screening all clinical trials evaluating the EDA in children. An electronic search was performed in Scopus, EMBASE, Cochrane, Web of Science, and Medline with no language or time restrictions.

Six clinical trials were included in this study. The results of the first study showed that EDA was less effective than local anesthesia. Another study indicated no statistically significant difference between the two groups in terms of perception of pain intensity and comfort. The third study revealed no significant differences between the two methods in terms of the level of pain in the first deciduous molars, but a higher level of pain was reported in the second deciduous molar in the case of the injection method. A comparison of behavioral responses and changes in vital signs of children in local anesthesia and electronic anesthesia methods showed positive responses to the latter. A combination of music and electronic anesthesia was reported to be effective in the relief of pain in children under the treatment of two corresponding deciduous molars. Another study showed that the vibraject technique led to a statistically significant reduction in pain among children.

The findings of this review study emphasize the importance of analgesic techniques in pediatric dental procedures. The use of new techniques along with conventional methods of analgesia should be taken into consideration, especially in pediatric dentistry.

Spasmolytic drugs such as hyoscine have been proven to enhance cervical dilatation and accelerate the stages of labor. The aim of this study was to compare rectal and intramuscular hyoscine in shortening the first stage of labor in term primigravid women.
In this randomized clinical trial, 80 pregnant women were selected by convenience sampling. One group received two 10 mg rectal suppositories, whereas 2ml intramuscular (IM) hyoscine was administered for the other group, both at the onset of the active phase of labor. The two groups were compared in terms of labor stages, cervix dilatation rate, maternal blood and heart rate, Apgar score at birth and fetal heart rate. The collected data were analyzed using SPSS software (version 21.0).
The mean age of women in the rectal and intramuscular hyoscine groups was 24.5±3.2 and 24.65±4.45 years, respectively. The duration of first and second stages of labor was not significantly different between the two groups (P>0.05); whereas the third stage of labor in the rectal hyoscine group was significantly shorter than IM hyoscine group (P=0.001). The mean 1st and 5th min Apgar scores and the fetal heart rate after drug administration were significantly different between the two groups (P<0.05).
Hyoscine rectal suppository, which is faster absorbed and avoids gastric irritation, was significantly more effective in shortening the duration of labor in comparison to IM hyoscine, although the difference was only in the 3rd stage of labor. Therefore, it is recommended in all pregnancies for accelerating the process of labor.

Background:

 Turner syndrome patients are more likely to develop autoimmune diseases in contrast to the general population. Many research have had controversial results suggest a possible relation between the cytogenetic findings and development of autoimmune thyroid disease in Turner syndrome. Therefore, we aimed to evaluate the prevalence of thyroid disorders and the possible relationship between thyroid disorders with the cytogenetic findings in these patients.

The present retrospective study took place in pediatric endocrinology clinic of Imam Reza Hospital (Mashhad, Iran), and every pediatric patient who were younger than 18 years old with the clinical phenotype of Turner syndrome and had complete thyroid function tests enrolled. The medical records of these patients were evaluated and patients were recalled if any further information was needed. The study data including thyroid function tests as well as patients' age, height, weight, and karyotype findings were entered in a check list and the relationship between thyroid functions tests and karyotype findings were evaluated.

Among the 79 patients enrolled in the present study, the mean ± standard deviation of age was 10.82 ± 2.6 years. The most of the study population had negative anti-TPO results (62 patients, 78%). Among all patients, eight patients (10.1%) had autoimmune hypothyroidism There was not any significant relationship between thyroid function tests with different cytogenetic findings (P>0.05).

Conclusion :

Hypothyroidism (26.6%) was the most common thyroid disorder among Turner syndrome patients. Although there was not any significant relationship between thyroid function tets, Z-scores for hight and weight with cytogenetic findings; however, our findings highlights the need for more specific screening programs for evaluating the thyroid functions in turner patient.

We aimed to assess the relationship between fetal lateral ventricular width and biometric measurements with ultrasound examination. A prospective case-control study on 178 fetuses as the control group with lateral ventricle diameter 4-7.9 mm and 80 fetuses as the case group with lateral ventricle diameter 8-12 mm. The study was done at Shariati hospital (Tehran, Iran), from 2015 to 2019. All patients underwent a detailed ultrasound exam according to ISUOG guideline and biometric measurements, including head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, cerebellar diameter, cisterna magna width, average ultrasound gestational age, and estimated fetal weight were done. At least two follow-up ultrasound examinations at 26-28 weeks of gestational age and 32-34 weeks of gestational age were performed to evaluate ventricle size, and fetuses with lateral ventricle width above 12 mm were excluded. Then we compared fetal biometric measurements, mentioned above, in these groups. The mean maternal age, maternal past medical history, obstetrical history, mode of conception, fetal presentation, and fetal gender did not differ between the groups. We compared 187 patients as the control group with 80 patients as the case group at the same gestational age and gender. The mean ventricular width in the case group was 8.6 mm, and in the control group was 5.9mm. The study group had significantly larger head circumference, biparietal diameter, femur length, and estimated fetal weight compared with the control group (p <0.05). The lateral ventricular width is dependent on other biometric parameters such as head circumference, biparietal diameter, and generally fetal size, and larger ventricle width is associated with larger parameters.

Beta-thalassemia is a common hematological disorder. The aim of this study was to determine the effect of oral administration of Cichorium intybus on reduction of liver enzymes in patients with major thalassemia. This study was randomized clinical trial study that was conducted on 100 patients with age over 2 years and major thalassemia referred to Mohammad Kermanshahi Hospital of Kermanshah city (Iran) in 2019-2020. Eligible patients were randomly divided into two intervention (n=50), and control (n=50)groups.The intervention group received 0.028mg/kg/day Cichorium intybus as a medicinal supplement and control group received placebo for 3 months. All patients were evaluated and followed up for 6 months. The Liver enzymes levels (AST and ALT) were measured at four time periods (baseline, 1.5, 3 and 6 months after intervention). Ferritin was also measured at three time periods (baseline, 3, and 6 months after the intervention).The SPSS software version 24.0 was used to data analysis. The results of Repeated Measure ANOVA test showed that therewere significant statistical differencebetween the two groups of intervention and control in term of ALT and AST at different time periods, so that the means of ALT and AST after the interventionwere lower in intervention group than control group(p <0.05). However, there wasno significant statistical differencebetween the two groups of intervention and controlin term of ferritin at different time periods (P>0.05).  Oral administration of Cichorium intybus can reduce liver enzyme levels (ALT and AST) in patients with thalassemia major. Therefore, Chicory administration in patients with major thalassemia is suggested.

The aimof this studyis to determine the effect of speed-strength training on memory in schoolchildren aged 13-14 years, taking into account the strength of their nervous system.

This case control study was conducted in a secondary school in the city of Kirov in Russia for a period of 3 months (January 12 to March 20, 2020). 40 boys and girls were engaged in physical education 2 times a week for 40 minutes. 20 schoolchildren from the control group were engaged in physical education according to the usual program. 20 schoolchildren from the experimental group additionally performed exercises for the development of speed and strength abilities. The strength of the nervous system was determined using a tapping test. Memory indicators in children were measured using the «Method of Jacobs» test. Data were analyzed using SPSS software version 16.0.

40 children participant in this study. After the pedagogical experiment, the indicators in all subgroups changed. In the control group, memory indicators in children with a strong nervous system improved only by 5% (p>0,05), and in children with a weak nervous system from 5.5±0.5 to 5.7±0.5, this is only 4% (p>0.05). At the same time, in the experimental group of children with a strong nervous system, memory indicators improved by 21% (p <0.05), and in children with a weak nervous system from 5.1±0.7 to 6.0±0.9, this is 18% (p <0.05).

Memory performance in children aged 13-14 years will improve if we perform speed-strength exercises at each lesson in physical culture. The load for children with a strong and weak nervous system should be differentiated.

Clinical status of children admitted to the intensive care units (ICUs) is important. We aimed to investigate prevalence of hypomagnesaemia in children admitted to the pediatric intensive care unit (PICU), and its relation factors.

This cross-sectional study was conducted in Ali Ebne Abitalib Hospital Zahedan, Iran, in 2018. From total children who were admitted to the PICU, 150 individuals aged one month to 12 years that were entered to the study. Magnesium level was estimated by XYLIDYL BLUE method using Erba kits. Children were divided into two groups based on their serum magnesium concentration defined as normal and abnormal.  Data were analyzed using SPSS software version 18.0. 

From 150 admitted children to the PICU, 44.7% were hypomagnesaemia with longer hospital stay, higher levels of Na, K and Ca (p>0.05). During the first five day of hospitalization, 58 children died, most of them were hypomagnesaemia. About 39.6% of 101 children who consumed diuretic medicine were hypomagnesemia. This pattern was 43.8% and 40.00% from 130 and 85 patients who used digital or aminoglycoside medicines. About half of the children who had heart diseases were hypomagnesemia. These trends were 33.3% in kidney and sepsis; about 50.00% and 43.5% were hypomagnesaemia from those who had central nervous disorder and respiratory problems, respectively. The eldest children had 1.79 times higher odds (95% CI=0.76 to 8.30) to be hypomagnesaemia compared to the youngest, and girls had 1.01 times higher odds (95% CI=0.44 to 2.30) to be hypomagnesaemia.

Prevalence of hypomagnesaemia in children admitted to the PICU was high and it was associated with the major electrolytes of sodium, potassium, and calcium.

Respiratory involvement in cystic fibrosis (CF) is one of the most complaints in pulmonary disorders. Though symptomatic treatment of the patients with chemical medications is efficient in sign reduction, medications side effects and permitting the disease to become chronic are precarious for patients. Today, the World Health Organization considers traditional medicine. Iranian Traditional Medicine (ITM) makes a priority for disease prevention by suggesting some strategies. We intended to investigate the lifestyle effect on cystic fibrosis patients. In this review, we searched the most important ITM sources [such as Qanoon fi al-teb (The canon of medicine), Zakhire-Kharazmshahi ,and Exir-Azam), and scientific databases such as Data sources included (Pub Med and Google Scholar] in English and without time restriction from inception up to April 2020. According to ITM, the six essential principles must be observed in the management of patients with thick and sticky airway secretions that include nutritional pieces of advice about food and drink, exercise quality, evacuation and retention quantity, advising calmness, no prolonged and daytime sleep and avoidance from air pollution. Anunhealthy lifestyle can play an important role in these patients that confirmed by classical medicine. Therefore, further clinical trials should be performed to confirm the long-term efficacy of a healthy lifestyle in cystic fibrosis patients’ management.

Background:

 Radiofrequency ablation (RFA) is considered as an optional treatment method in complicated monochorionic (MC) twin pregnancies. The purpose of this study is to investigate the main factors of fetal death after such treatment procedure. The study also compares the perinatal outcomes among various groups of indication and gestational age (GA) at procedure.

This prospective cohort study considers 195 cases of MC multiple pregnancies including one twin with twin-twin transfusion syndrome, selective intrauterine growth restriction ,sever anomaly and twin reversed arterial perfusion sequence(TRAP) which underwent selected reduction using RFA from 2016 to 2018 at Yas Hospital, Tehran, Iran. The GA at RFA categorized as 16- 19+6 wks., 20-23+6 wks., and 24-28 wks. The analysis of risk factors of fetal death after RFA is based on multivariable logistic regression model.

The result of analysis reveals that the rate of co-twin anemia after RFA in anomaly indication was higher than the other indications significantly (p=0.038) while according to GA categories, it is significantly lower in 20-23+6 weeks. (p=0.016). Three independent significant factors contributing in fetal death after RFA were co-twin anemia after RFA, TRAP and anomaly indications of RFA and GA at RFA, respectively.

Conclusion:

 The co-twin anemia after RFA was found the most contributing factor of fetal death. As the results showed that the rate of co-twin anemia after RFA is significantly low in 20-23+6 weeks of GA, such GA is suggested for RFA procedure to reduce the fetal death.

Background :

Today few studies have focused on using calprotectin as an effective biomarker for monitoring the exacerbation of pulmonary complications in cystic fibrosis (CF). Thus, the present study aimed to assess the diagnostic value of the changes in the calprotectin level of patient's serum and sputum during responding to the therapy of exacerbated CF in children.

The cross-sectional study was conducted among 21 CF patients, which received required supportive and therapeutic procedures based on the protocol related to pulmonology ward in the Children Medical Research and Training Center of Tabriz University of Medical Sciences. The sputum and serum samples of all patients were collected to evaluate calprotectin level at 1-2 days after starting therapy with routine antibiotics such as cephalosporin and macrolides, and they were again gathered at the end of therapy process.

Assessing outcome in 21 patients under study represented complete and partial recovery in 12 (57.2%), and 9 (42.8%) ones, respectively. The mean decrease in calprotectin level in the serum and sputum of the patients was respectively obtained as 40.7289.08 μg/ml and 99.03225.94 μg/ml. The calprotectin decrease in serum with the cutoff point of 15.70 μg/ml possessed the sensitivity of 66.7% and specificity of 55.6% in predicting complete recovery outcome; while that of sputum with the cutoff point of 26.20 μg/ml had the sensitivity and specificity of 66.7 and 22.2%, respectively.

The mean age of participants were 8.61±4.19 years. It can be concluded that serum and sputum calprotectin decrease with cutoff point of 15.70 μg/ml and 26.20 μg/ml, respectively in have high sensitivity for determining response to treatment in cystic fibrosis exacerbation.

Sickle cell anemia (SCA) is an inherited red blood cell disorder which results from the replacement of a valine residue for glutamic acid at position 6 in the beta-subunit of haemoglobin. This can lead to tissue ischemia, microcirculation obstructions, infarction and acute stroke. While Bell’s palsy is a neuropathy which caused by traumatic, inflammatory, infective, or compressive conditions on the facial nerve. However, in patients with SCA, stroke may occur as an acute clinical syndrome presenting with hemiplegia with unilateral facial nerve. Till now, there is no case has been reported in the literature with unilateral facial nerve palsy in SCA patient. Here, we present a rare case of idiopathic unilateral Bell’s palsy in a SCA patient.

Hereditary hemorrhagic telangiectasia (HHT) is a vascular dysplasia which is inherited in an autosomal dominant manner and may involve skin, mucosa and internal organs. HHT can cause arteriovenous, arterioportal, and portovenous shunts in the liver, resulting in cirrhosis and portal hypertension. An 8-year-old male patient with a diagnosis of myelodysplastic syndrome for 2 years was admitted with melena.Portal doppler ultrasonography showed a heterogeneous appearance of the liver parenchyma and 14 cm splenomegaly with no portal hypertension. An extended etiological investigation for chronic liver disease was conducted. Afterliver biopsy, the patient’s general condition deteriorated, with abdominal distension and reduced hematocrit. The Doppler and hepatic angiography findings together with the history of recurrent episodes of epistaxis led us to the diagnosis of HHT. He was referred to the transplant center for liver transplantation due to the irreversible bleeding from the liver. Hepatic telangiectasias may be present in patients with uncontrollable bleeding after liver biopsy who do not have any hematologic disorders.

Background 

Ectopic eruption is a tooth eruption disorder in which the tooth does not erupt in its proper eruption path. The most common type of ectopic eruption is the mesial eruption of the maxillary first permanent molar, which results in the loss of the second deciduous molars, resulting in a reduction in arch length and loss of space. Therefore, this study aimed to investigate the prevalence of ectopic growth of this tooth in children.

This descriptive cross-sectional study was performed on panoramic radiographic images of children aged between 5-8 years. Census sampling method was used in this study. A general dentist under the supervision of an oral and maxillofacial radiologist assessed ectopic eruption according to a grading system described by Barberia et al., all radiographs. The data was analyzed using SPSS software version 16.0.

772 panoramic radiographs were examined in this study, panoramic radiographs of 79 patients were considered to have ectopic eruption, which 61% of cases were in girls and 39% in boys. 25.6% of the patients had a mild, 60.3% had a moderate, and 14.1% had a severe ectopic eruption. All patients (except one) had a mesial ectopic eruption, 19% of the ectopic eruptions occurred in the maxilla, 59.4% in the mandible, and 59.5% in both jaws. Ectopic eruption in the mandible was more frequent in the mandible than in the maxilla and this finding was statistically significant (P <0.05).

Conclusion :

The results of the present study showed that the frequency of ectopic eruption of the first permanent molars in Sari was 10.2%, which is higher than the values reported in studies in other regions of Iran.

Background:

 The concept of fraction is one of the most difficult concepts of math in all levels of education. We aimed to investigate the effect of Merrill’s component display theory in the learning of students in math.

In this case-control study, the number of students under investigation was 183 boys where 31 students were randomly selected as experimental group and 30 as control group. The concept of teaching was designed based on the teaching design pattern of Merrill’s Component Display Theory and based on which the students in experimental group was taught for 10 sessions of 45 minutes; control group also received the traditional teaching. After two months, students were post-tested for their performance by a 10-question exam taken from teacher’s guidebook. Then, after three more weeks, they were again post-tested to ascertin their retention of the topic. Data were analyzed using SPSS software version 16.0

The T-test results showed that the mean of students in experimental group increased about four grades and from 13.9 reached to the significant number of 18 for the performance post-test with the standard deviation of 0.63. In retention, the mean of students changed from 15.4 to 15 which is not a lot. It also means that there was no significant difference between mean scores of retention of Merrill’ group and the scores of post-test Merrill’s group. It means that education materials used Merrill’s design have been positively effective.  

 Conclusion:

 Considering the findings, it can be stated that the Merrill’s component display theory has been effective in both performance and the retention of the students.

Foreign body aspiration (FBA) is a life-threatening problem that can be lethal in some cases. It usually occurs in children between 1–3 years old. Bronchoscopy is the best way for recognition, treatment and management of this problem. We aimed to evaluate the use of fiberoptic bronchoscopy after rigid bronchoscopy in foreign body aspiration in pediatric population.
  275 pediatric patients with a history of choking were entered to this cross-sectional study, from August 2015 to September 2018. The study was done in a Dr. Sheikh hospital, Mashhad, Iran. The age and gender of the patients were recorded individually. Rigid bronchoscopy was done for all patients. After that, fiberoptic bronchoscopy was performed immediately or 72 hours after the first procedure based on the patients' symptoms, time and personnel conditions. Data were analyzed by the SPSS software version 16.0.
  Among 275 patients, 175 cases (63.6%) were male. The patients' age was 3 months to 15 years old. In rigid bronchoscopy, 85 cases had no foreign body and in 190 cases, foreign body was found. In 43 cases fiberoptic bronchoscopy found a residual organic material in spite of negative rigid bronchoscopy.The most residual organic material pertained to 0-3 year age group and the cases with residue in males were more than females. There was a significant difference between FBA and age and gender (p <0.001).
  FBA in airway branches may not be seen by rigid bronchoscope due to the limited access to the distal branches. We suggest fiberoptic bronchoscopy as a complementary management along with rigid bronchoscopy to investigate distal branches, especially if the foreign body is soft in material.

International economic law has a transformational role in developing the economy, where the transformation leads to economic prosperity and growth, including changing several aspects of progression, especially social and political progress.  One of the unknown aspects of development, specifically in developing societies, is the impact of international economic law on the political development of children's rights. Like other aspects of social law, children's rights have an economic-political aspect whose study needs comprehensive research. Implementing international economic law is linked with different aspects of domestic development, and the question is raised of what impact international economic law has on developing an area such as children's rights. On the other hand, can developments in international economic law in political development help strengthen children's rights? The article is written in a library research format and seeks to answer the question of the basis of the connection between international economic law and political development.  In addition, how does the connection help to realize children's rights? On the one hand, international economic law strengthens political law and contributes to children's rights in both legal and social aspects, and on the other hand, strengthening the free market may pose a threat for implementing children's rights and its use; therefore, supervision of international economic law on the commitment of the benefiting states is one of the advantages of this type of economic system and a guarantee for the rights of the vulnerable groups of society, such as children.