International Journal of Pediatrics
Volume:10 Issue: 103, Jul 2022

Since there is insufficient data to compare the relative efficacy of commonly prescribed opioids (morphine and buprenorphine), the present study aimed to compare the effect of morphine and buprenorphine on term and near-term neonates with neonatal abstinence syndrome. This double-blind randomized clinical trial was performed on 60 neonates whose mothers were addicted to drugs (opium and its derivatives) and the neonate had symptoms of withdrawal syndrome. They were all. Admitted to Valiasr Hospital in Birjand. Neonatal assessment was based on Finnegan score. The neonates were randomly assigned in two groups of buprenorphine (n = 30) and morphine (n = 30). The Chi square test, Fisher exact test, student t test and Mann-Whitney U test were used for comparing the background characteristics and treatment outcomes between the two groups. In the present study, a total of 53.3% of the patients in both groups were boys and the rest were girls. The mean lengths of hospital stay in the buprenorphine and morphine groups were 5.97 ± 3.38 and 7.53 ± 4.83 days, respectively (p=0.15). Also, apnea was observed in 33.3% of the total neonates in the buprenorphine group and 43.3% of the neonates in the morphine group (p=0.43). The two groups were homogenous in regards to apnea complications, oral intolerance, hypotension and blood culture result (p>0.05) The results of the present study showed no significant difference in the outcomes of treatment and reduction of treatment complications between the buprenorphine and morphine-treated neonates.

A review of research in the field of children shows that with the expansion and deepening of studies on children, in addition to physical development, their emotional-behavioral development has also received more attention. The aim of this study was to compare the effectiveness of cognitive-behavioral and Psychodrama on executive functions of children aged 7 to 12 years. The research is pretest-posttest quasi-experimental study with control group and follow-up. It was conducted in the second half of 1398 in Avae Mehr Counseling Center in Pasargad (Fars Province, Iran) Available sampling was administered, based on which 24 children registered at the Avae Mehr Pasargad Counseling Center with the diagnosis of externalized disorder and met the necessary criteria participated in the study. The participants were divided into two experimental groups and one control group (8 individuals each). Cognitive-behavioral and Psychodrama    therapies were performed for the experimental groups, but the control group did not receive any special intervention. Cognitive-behavioral therapy protocol was performed in 1-hour sessions during 11 consecutive weeks, once a week; and Psychodrama treatment in 1-hour sessions during 12 consecutive weeks, once a week. The research instruments included of executive functions saftware (Stroop word color test, and working memory reinforcement test); and the collected data were analyzed using frequency distribution, mean, standard deviation, analysis of variance, and analysis of covariance in SPSS-25 software. The results of analysis of covariance by modulating the effect of pre-test in post-test showed that there was a significant difference between the three groups in all variables except reaction time in Stroop test. This means that the groups of cognitive-behavioral therapy and psychotherapy had a significant effect on executive function. The results in the follow-up phase also showed that there was a significant difference between the three groups in all variables except the trial time and the number of errors (in the London Tower test), the incorrect number and the reaction time (in the Stroop test). However, there was no significant difference between the cognitive-behavioral and Psychodrama groups on the variable of executive function, meaning that the two therapies did not have different effects on executive function. Both of the cognitive-behavioral and Psychodrama treatments have been significantly effective in the improvement of the participants’ executive functioning. This means that the groups of cognitive-behavioral therapy and psychotherapy had a significant effect on executive function. But the effectiveness of these two treatments does not show a significant difference with each other.

Biliary atresia (BA) is one of the most common etiologies of cholestasis in infants and toddlers. The most important factor in case of patients’ prognosis is its early diagnosis. There are many diagnostic tools in this field, sonography seems to be the most appropriate and fastest tool in early detecting and differentiating BA from other causes of neonatal cholestasis. The aim of this study was to evaluate the diagnostic value of new ultrasound and Doppler ultrasound methods in BA in infants and toddlers.

This cross-sectional study was performed during a one-year period on 35 infants and toddlers admitted to the gastrointestinal department of Akbar Children's Hospital with suspicion of cholestasis. These children underwent sonography by a radiologist to diagnose BA. All required information was extracted from the hospital records of these children and analyzed after entering the checklist. Data were analyzed using SPSS software version 26.

Totally, 35 patients including 18 boys (51.4%) and 17 girls (6.48%) with a mean age of 4/29±4/17 months were enrolled. According to the findings of the analysis, 21 patients (60%) had bile duct atresia and 14 patients (40%) had other diseases. Ultrasound sensitivity in the diagnosis of bile duct atresia was 90%, with an accuracy of 74%, specificity of 50% and positive and negative predictive value of 73% and 77%, respectively. The highest diagnostic value was related to the former hepatic capsular flow.

Biliary atresia can be accurately diagnosed by ultrasonography. The high sensitivity and accuracy of ultrasound indicate the appropriateness of this method in diagnosing this disease

Experiencing pain and fear caused by venipuncture in children and its management is challenging. Massage is a safe way to manage pain; however, no evidence was found about its effects on pain and fear of venipuncture in children. This study aimed to determine the effects of massage on pain and fear levels during venipuncture among children aged between 3 to 6 years old. This pre-experimental factorial research was performed on 140 children admitted to the surgery ward. The participants were randomized into four groups; the children in group 1 received EMLA cream, the children in group 2 received massage, those in group 3 received both EMLA cream and massage, while those in group 4 (control group) received no method. The pain and fear levels were assessed independently from the perspective of children, mothers, and a nurse. The Wong-Baker Pain Scale and the Children's Fear Scale were applied for evaluating the levels of pain and fear in children, respectively. The data were analyzed by running the chi-square test and ANOVA at the significance level of P < 0.05. This study is presented in line with the CONSORT checklist. The groups were found to have a significant difference regarding the pain and fear scores in venipuncture (P<0.05). The lowest level of pain and fear perception was reported in the EMLA cream group. The group with massage and the EMLA cream and the massage group showed significantly higher scores compared to the EMLA cream group (P<0.05). Massage does not beneficially affect children’s pain and fear during venipuncture; consequently, employing this intervention requires more extensive studies.

Nephrotic syndrome (NS) is the most common pediatric chronic kidney disease characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Corticosteroids, as the mainstay of treatment, resolve symptoms in most patients. However, some patients experience a relapsing-remitting course. Currently, there is no specific biomarker for the prediction of steroid response in patients with NS. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are inexpensive, readily accessible parameters that are proved to be related to the inflammatory state in many disorders.

We evaluated NLR and PLR ratios before and after steroid therapy in 50 pediatric patients with NS in a single pediatric referral center. Data analysis was carried out using SPSS software and the significance level was considered as 0.05.

Medical response to steroid was compatible with steroid-dependent (SD) nephrotic syndrome (NS) in 30% (n=15), steroid-resistant (SR) NS in 12% (n=6), steroid-sensitive (SS) NS in 36% (n=18), and frequently relapsing (FR) NS in 22% (n=11). Fourteen patients (29.2%) did not experience recurrence. Before and after steroid therapy, the mean PLRs were 10.9 and 11.7 and the mean NLRs were 1.9 and 2.2, respectively, which were not statistically different (P>0.05).

We do not recommend NLR and PLR as predictors of steroid response in pediatric patients with NS.

Today, due to the increase in the number of children with Multiple sclerosis (MS) compared to previous years and the difference in severity of the disease in each child, new methods and appropriate exercises are required to help them have a better life. Therefore, the main purpose of this study was to compare the effectiveness of braitonic and Yoga exercises and rhythmic movements on the perceptual and motor skills of children with MS.

The present study was a pretest-posttest quasi-experimental applied research. The study sample included 45 MS children referring to Qazvin Pishgaman Rehabilitation Center, who were selected voluntarily. To evaluate the conditions of the participants before and after the intervention, a short form of the Bruininks-Oseretsky motor proficiency test (BOMP), consisting of eight components of sprinting and agility, balance, two-way coordination, strength, response speed, visual-motor control, upper limb speed and agility, and upper limb coordination tests was used.

Braitonic and Yoga exercises had a positive and significant effect on increasing the level of perceptual and motor skills (static balance, dynamic balance, strength, speed, accuracy and coordination) of children with MS (p>0.05). The effect of braitonic exercises on increasing the perceptual motor skills of children with MS was greater than that of the Yoga exercises (p>0.05).

According to the findings of this study, it is possible to increase the perceptual-motor skills among MS children with very simple, low-cost and joyful methods

Unilateral Pulmonary aplasia with absent right pulmonary artery is a rare disorder, caused by the developmental arrest of primitive lung during embryonic life. It’s a complete absence of lung parenchyma vasculature and its main bronchus. The most common variant consists of carina and main stump bronchial stump with the absence of distal lung. It is frequently associated with many other congenital disorders like VACTERL syndrome (V-vertebral anomalies, A-anal atresia, C- cardiovascular anomaly, T- tracheosophageal fistula, E- esophageal atresia R-renal anomalies L- limb defects) and cardiac anomaly. These patients usually present with respiratory distress. Here we are presenting a case of a 2-month-old male infant suffering from unilateral lung aplasia with absent right pulmonary artery.

Eosinophilic gastrointestinal disorders (EGIDs) are a group of uncommon inflammatory diseases. In this study, we aimed to evaluate the prevalence of EGIDs, clinical manifestation and their response to treatment in a Children Medical Center in Iran. Between 2011 and 2016, all patients, aged <18 years old, who had pathology-confirmed diagnosis of EGIDs and underwent endoscopy in our center, were included in the study. Patient demographics, clinical presentation, laboratory data, radiologic findings, endoscopic findings, histological findings and the results of treatment were retrieved from the participants’ medical records. The prevalence of EGIDs in children in the gastrointestinal unit of our hospital during these years was reported as 5 per 1000 children. The most reported clinical symptoms in patients with EoE were nausea (75%), vomiting (69%), and epigastric pain (62.5% each). All of the patients had a hypoallergenic diet. Seventy-five percent of the patients used fluticasone spray.  The most frequent symptom in the patients with EoC was rectal bleeding (100%), followed by diarrhea (73%), irritability (23%), and loss of weight gain (18%). All of the patients had a hypoallergenic diet. Twenty-seven percent of the patients used Neocate milk and the use of cetirizine and ketotifen were reported in 18% of patients. EoGE was reported in only two patients (mean age: 10.25 years). During the 5-year period, most cases of EGIDs were related to EoC and EoE, and all cases improved in response to treatment. The hypoallergenic diet was identified as a common effective treatment for the studied patients.

Fibrodysplasia ossificans progressiva (FOP) is a rare form of genetic disorder categorized by progressive heterotopic ossification and congenital deformity of the big toes. Heterotopic ossification follows gradual inflammation of the soft tissues (flare-up) and results in limited movements in joints such as the Temporomandibular joint (TMJ). No effective medical treatment has been recognized for the treatment of FOP. FOP is commonly misdiagnosed, especially in the maxillofacial region. Patients with FOP often experience temporomandibular joint ankylosis. Therefore, dental professionals should be careful in planning treatment, including avoiding anesthesia injections, especially in the mandible. This study presents a case of FOP with temporomandibular joint ankylosis. An eight-year-old boy with the chief complaint of reduced mouth opening and clinical and radiological features of FOP.  The patient was referred to Mashhad Dental School in January 2016. He had not previously been diagnosed with FOP.

This research was conducted to determine the Internet and social media usage status of young people who do sports. The research group consisted of 1521 (927 Males, 594 Females) young volunteers attending sports branches. As a data collection tool, an online questionnaire form was applied in which the participants’ demographic information, social media usage status, Internet usage status and purposes were questioned. It was determined that the research group used mobile phones frequently and at high rates for Internet access and social media. The participants’ self-reported purposes of participating in the Internet included doing research, watching videos and movies, communicating with friends, making use of their spare time and following sports news, respectively. It was observed that the majority of the participants used the Internet almost every day. It was determined that the participants use Instagram, e-mail, Facebook and twitter, respectively, in social media, and 99.1% of them use social media for 1-3 hours every day. It was also revealed that the rate of using social media among women is higher than that among men, along with the increase in age, the rate of using Instagram and the rate of using email decreases, and the rate of using e-mail and Instagram increases in line with the increase in the level of education. It was observed that a large part of the research group frequently used the Internet and social media. It is recommended that the athletes use the Internet and social media to follow their professional development, sports news and organizations.

Self-reported studies showed that physical activity is associated with health-related quality of life in children with ADHD. Considering the limitations of self-reporting methods, we aimed to assess the association between accelerometer-measured physical activity and health-related quality of life among children with ADHD. 68 participants (28 girls, mean age of 10.22±1.55 years) wore the accelerometer for seven consecutive days. PedsQL was used to measure health-related quality of life. Mann-Whitney U, Spearman correlation test, and regression analysis were used to analyze data. On average, the daily moderate-to-vigorous physical activity (MVPA) was 36.46 minutes, which is below the WHO guideline. Boys engaged significantly more in daily MVPA than girl. Moreover, gender significantly predicted health-related quality of life (F = 4.58, p = 0.03, Adjusted R2 = 0.08, β = 0.75). Sedentary time% has inversely predicted health-related quality of life (F = 2.81, p = 0.04, Adjusted R2 = 0.03, β = 0.53). Finally, daily MVPA predicted health-related quality of life (F = 5.73, p = 0.02, Adjusted R2 = 0.09, β = 0.13). These finding indicate that physical activity and quality of life are critical concerns for children with ADHD. Accordingly, it is necessary to adopt appropriate strategies to develop more active lifestyles among this population

Molecular analysis of SARS-CoV-2 genome is important to predict viral pathogenicity. In addition to transmission, replication is a key factor in pathogenicity of the virus. Notably, mutations in non-structural proteins (NSP3 and NSP12) can affect host immune response and viral replication. Therefore, this study was conducted to investigate different mutations of SARS-CoV-2 NSP3, and NSP12 during different waves of COVID-19 infection.

We recruited 57 NGS sequences including 8 NGS sequences from Golestan SARS-CoV-2 RNA samples, obtained as part of clinical testing in different referral centers of Iran. After obtaining sequences from the global initiative on sharing all influenza data (GISAID), and evaluating and processing data, all sequences were aligned to the Wuhan variant genome (NC_045512.2) using MEGA6. The HDOCK server was used for molecular docking.

In NSP3, mutations in positions (nts 315, 545, 2666, 3264) were more frequent and among them mutation in positions including nt 545 (aa182) and nt 2666 (aa889) were associated with an increase in codon usage. In the term of NSP12, mutations in positions such as nts 406 (aa137), 965 (aa323), 1233, 1653, 1836, 2733 were more frequent. The molecular docking results showed more affinity in some variants of NSP3 and NSP12 as well.

This study has assessed mutation in SARS-CoV-2 Nsp3, and NSP12 which are viral protease, and viral polymerase (RdRp). The mutations reported in this study may help this virus to replicate faster and evade the pharmaceutical agents which target viral polymerase activity and be very effective in viral pathogenesis. In addition, this study highlights the importance of ongoing genomic variation studies to be performed on SARS-CoV-2 variants.

Atopic Dermatitis (AD) is the most common chronic skin disease, which can lead to some complications in adulthood. According to the possibility that some environmental factors like vitamin D are effective in AD, this study was conducted to clarify the effect of serum level of vitamin D on it. This study was performed as a case-control study, in Hamadan University of Medical Science, comparing the serum level of vitamin D in 20 children with and 20 children without atopic dermatitis. Atopic dermatitis was confirmed by standard criteria of Hanfin Verajka and the severity score was assessed using the SCORAD scoring system. Data was analyzed using SPSS software. In this study, no significant differences were found in age, gender and place of residence between two groups.  And, there was no significant difference in serum level of vitamin D between two groups (P-value: 0.394) but a significant, direct relationship was observed between disease severity and serum levels of vitamin D (P-value: 0.0431). The results of this study showed that vitamin D deficiency alone may not trigger atopic dermatitis, but it can worsen the disease, so it seems that the serum level of vitamin D in children with atopic dermatitis should be checked and in case of deficiency, a supplement should be prescribed.

Patients with thalassemia major require regular monthly blood transfusion and excess iron from multiple blood transfusion deposits in different organs of the body, causing different organ damages. Cardiac iron overload is the main cause of death in patients with thalassemia major. The aim of this study was to determine the effectiveness of Deferasirox (Nanojade) produced in Iran for the first time as a medicine in reducing iron overload of chronic blood transfusion in patients with Beta-thalassemia major. This is a pre-post quasi-experimental study that was performed on patients with thalassemia major involved in lifelong regular monthly blood transfusions. In this study, based on the existing protocols, injectable and dissolving iron chelating regimes were changed to a new generation of deferasirox oral tablets. To determine the effect of Nanojade, the mean level of the last three serum ferritin levels, before changing chelation, was compared with the serum ferritin levels after starting Nanojade. In the course of treatment, the possible side effects of Nanojade in various organs were monitored regularly. The mean age of the patients was 16 years (ranging between 3 and 39 years). None of the patients had renal failure, elevated creatinine, or proteinuria with Nanojade. The most important side effect was elevated liver enzyme levels. The mean starting dose of Nanojade was 19.86± 5.78 mg/kg and the mean of the last dose was 23.41 ± 5.49 mg/kg. There was a statistically significant difference between the amount of ferritin at baseline with the serum ferritin of 6 and 18 months after chelation with Nanojade (P = 0.001). chelation with Nano Jade had less renal and hepatic side effects; and all of the patients had good compliance and significant reduction in the serum ferritin level in comparison to the results of other studies regarding the similar foreign deferasirox products.

Liver cirrhosis is one of the major causes of mortality worldwide. Finding new methods to stratify patients with liver cirrhosis can affect the treatment plan and improve the outcomes. The present study aimed to determine the prognostic value of the serum D-dimer level in pediatric patients with liver cirrhosis. All cirrhotic pediatric patients admitted to Namazi Hospital (Shiraz, Iran) between November 2020 and November 2021 underwent serum D-dimer level testing on admission and were prospectively analyzed for 90 days. The Mann-Whitney U test was used to evaluate the correlation between D-dimer level and patient mortality. In addition, ROC (Receiver Operating Curve) analysis was used to evaluate the specificity and sensitivity of the D-dimer level in predicting mortality. In total, 38 patients with cirrhosis were included in this study. The serum D-dimer level was significantly correlated with the mortality of children with liver cirrhosis (P = 0.01), and the area under the ROC of the serum D-dimer level for this prediction was 0.777 (P = 0.01). The best cut-off D-dimer value was 1641.5 ng/ml, which offered a sensitivity of 70.0% and specificity of 82.14% for predicting mortality. We detected no significant correlation between the D-dimer level and the PELD (Pediatric End-stage Liver Disease) or MELD (Model for End-stage Liver Disease) score. The D-dimer level is significantly associated with the mortality of children with cirrhosis. Therefore, D-dimer testing can be used as a stratification marker to prioritize patients waiting on the liver transplant list

Postural disorders and spinal deformities are one of the common conditions in children and adolescents. The aim of this systematic review and meta-analysis was to study the prevalence of spinal deformities among school age children in Iran.

The search strategy was developed using keywords relating to kyphosis, lordosis, scoliosis, child and Iran in the databases of Medline, Scopus, CINAHL, Psycinfo as well as Persian local databases up to January 2020. Articles were appraised by two reviewers using the checklist of Joanna Briggs Institute (JBI) and data was extracted in the designed tables and analyzed using R software with a random effects model. The heterogeneity and dispersion of data was presented in Forest plots.

Eighteen studies were included in the meta-analysis. The total population included 84195 students consisting of 39202 boys and 45947 girls. The mean age of the participants was 12.71±1.18 years. The total prevalence of kyphosis was 13.06% [95% CI 0.07; 0.22], the total prevalence of scoliosis was 2.61% [95% CI 0.014; 0.045] and the total prevalence of lordosis was 32.59% [95% CI 0.23; 0.43]. The prevalence of deformities was higher in girls. Kyphosis and scoliosis was more frequent in elementary school children but lordosis was more frequent in middle school students. Confirmation of diagnosis with radiology as well as clinical examination yielded a lower prevalence compared to diagnosis only made by clinical examination.

The prevalence of spinal deformities in school age children in Iran is on the average level compared to the other countries and lordosis is more common in girls. Designing further studies to evaluate etiology and risk factors of this condition is recommended

Leishmaniasis is endemic in 98 countries, and 350 million people in the world are at risk of this disease. It is necessary to evaluate the influencing leishmaniasis preventive behaviors to manage this disease in endemic areas. The present study aimed to determine the factors associated with cutaneous leishmaniasis preventive behaviors in parents using the BASNEF model. The research was an analytical cross - sectional study. The sample consisted of154 parents selected via the available sampling method. The instrument for gathering data was a standard questionnaire based on the BASNEF model that was completed by parents. SPSS software version 16 was used for data analysis and the significance level was considered at 0.05. The knowledge of 32.4% of parents about cutaneous leishmaniasis preventive behaviors was lower than the average level. In the case of subjective norms, the most influential people for preventive behaviors were health liaisons (73.4%). The behavior of parents was directly correlated with subjective norms (r = 0.352, P <0.05) and intention (r = 0.384, P <0.01). Cutaneous leishmaniasis can be controlled and managed in the family by creating a favorable attitude and using the power of the most influential people and providing enabling factors to perform leishmaniasis preventive behaviors by parents.

This article aimed to report an infant case of congenital neutropenia (CN) with periorbital ecthyma gangrenosum (EG) due to pseudomonas aeruginosa septicemia.

A previously healthy six-month-old male infant with fever, diarrhea, poor feeding, pancytopenia, periorbital swelling, and eyelid ulcers in the left eye was admitted in pediatric intensive care unit (PICU). He had positive blood and eyelid wound cultures for pseudomonas aeruginosa. He was treated with broad spectrum intravenous antipseudomonal antibiotics and debridement of periorbital lesions and discharged after 18 days with a stable condition. Adequate hematologic workup for pancytopenia revealed the diagnosis of CN.

There is a possibility that EG be developed in patients with immunodeficiency as preseptal cellulitis with isolated typical lesions, and this should be considered in the treatment.