International Journal of Pediatrics
Volume:10 Issue: 104, Aug 2022

Chronic kidney disease (CKD) is a worldwide medical condition with increasing frequency that impairs the quality of life of children. This study aimed to assess the clinical signs and causes of CKD in children in Zahedan, Iran.
This cross-sectional study was run on 489 children up to 20 years with stages of 3 to 5 CKDs, in Zahedan during 2010-2019. Informed written consent was obtained from the patients’ parents. Data analysis was performed by SPSS 20 considering 0.05 as significant level.
Amongst the clinical manifestations, edema (16.4%), (FTT) (13.5%), urinary symptoms (12.3%) and vomiting (11.5%) were more common and congenital structural anomalies (41.7%) were the most common cause of hospital admission. From among the studied children with CKD, 65.8% had stage 5, about 44.4% had conservative treatment and in total, 19.00% died. Most of the laboratory parameters were different in death and survival cases, for instance, Systolic and diastolic BP were higher in deaths when platelet blood was lower. Main causes of CKD (congenital structural anomalies, cystic/hereditary/congenital disease, glomerular diseases, Renal Tubular Disease, unknown origin and stone) had a significant association with gender (X2=13.42, p=0.02), treatments (X2=70.77, p<0.001), stage of CKD (X2=40.31, p<0.001) and survival (X2=11.59, p=0.041). Stages of CKD had a significant relation with treatment (X2=118.18, p<0.001), and survival (X2=26.5, p<0.001).
The causes of CKD were significantly associated with treatments, stage of CKD, and survival. Stages of CKD had significant associations with treatment and survival. Therefore, more attention to children with these signs is essential for early diagnosis and proper treatment.

Diabetes mellitus is the most common childhood metabolic disease whose prevalence has been increasing worldwide in recent decades. Diabetic nephropathy is one of the most important chronic complications of both types of diabetes (type one and two), which seriously increases the morbidity and mortality of diabetes. The present study evaluated the epidemiology and risk factors of diabetic nephropathy in children with diabetes in the northwestern region of Iran.
In this cross-sectional study, 80 diabetic children, 33 (41.3%) males and 47 (58.7%) females with a mean age of 16.69± 4.50 years at the time of assessment, have been identified, evaluated, and followed up in the endocrinology clinic of Tabriz Children's Hospital from 2000 to 2015. The patients were divided into two groups based on the presence or absence of micro- or overt albuminuria, and different variables were compared between the two groups to determine risk factors.
The mean age at the diagnosis was 7.75 ± 3.69 and the mean duration of diabetes was 8.98± 4.07 years. Good glycemic control was presented in 19 (23.8%), microalbuminuria in 36 (45%), overt albuminuria in 1 (1.3%), and retinopathy in 5 (6.3%) of patients; 7 (8.8%) had hypertension. Chronic kidney disease was found to be stage I in 90% and stage II in 10% of the patients. There was a significant difference between cases with and without albuminuria in terms of age at the time of the study (p=0.003), duration of diabetes (p=0.02), and serum cholesterol level (p=0.04). Linear Regression test showed that «the age at diagnosis» has a significant ability to predict the incidence of albuminuria (p = 0.03).
Due to the significant frequency of poor glycemic control in children and adolescents and the high prevalence of albuminuria in them, it is recommended to evaluate the renal function in diabetic children, especially in older patients, those with longer duration of diabetes or poor glycemic control.

This study aimed at investigating the attitudes of young adults towards e-learning and playing digital games for learning sports.
The research group consisted of 189 (77 female, 112 male) young volunteered athletes in the province of Elazig, turkey. A “Personal Information Form”, “Attitude Scale Towards E-Learning in Sports” and the “Digital Gaming Attitude Scale” (DOOTÖ) were implemented to assess the attitudes of the athletes towards playing digital games with e-learning in sports.
The findings revealed that the attitudes of the research sample towards e-learning in sports and playing digital games differed significantly according to their gender, and there was no significant difference in neither of the scales according to the years of exerience in sports and the type of their sport  (individual and team sports) (p>0.05). Furthermore, the young adults' attitudes towards e-learning in sports and playing digital games were inversely correlated (R=-.047; R2=.002; p<0.05)
In general, a weak negative relationship was found between young adults' attitudes towards e-learning in sports and playing digital games.

Hypertensive disorders of pregnancy including preeclampsia can be associated with preterm birth and infant mortality and morbidity. It seems that intraventricular hemorrhage (IVH) in preterm neonates born to hypertensive mothers is less common compared to the other ones. In this study, we assessed the relationship between hypertensive disorders of pregnant mothers and the incidence of intraventricular hemorrhage in preterm neonates weighing less than 1500 grams.
In this case-control study, 305 singleton preterm neonates with a birth weight less than 1500 g were entered. The presence of IVH in all preterm neonates was assessed using brain ultrasonography and its correlation to hypertensive disorders of their mothers were evaluated.
The prevalence of preeclampsia in mothers with and without pre pregnancy hypertension was 40%, and 15.09% respectively. The prevalence of IVH in preterm neonates was 26.9% (n=82). The incidence of IVH in preterm neonates of mothers with and without preeclampsia was 16.07%, and 29.31%, respectively (p=0.028). The prevalence of IVH in preterm neonates of mothers with hypertension and without hypertension was 12.5% and 29.05%, respectively (p=0.018). Preterm neonates with IVH had a lower mean birth weight, smaller gestational age and lower Apgar scores compared to preterm neonates without IVH with p values of <0.001, <0.001 and <0.01, respectively.
Hypertensive disorders of pregnancy increase the risk of preterm delivery, but the incidence of IVH in preterm neonates weighing less than 1500 gr is lower in infants born to mothers with hypertension including preeclampsia compared to those born to non-hypertensive mothers. And also lower gestational age, birth weight, and Apgar scores were important predicting factors for IVH in preterm neonates.

Attention-deficit/hyperactivity disorder (ADHD) is an important behavioral disorder that causes considerable individual and social difficulties, creating significant emotional distress for preschoolers and their caretakers. The present study aimed to investigate the effects of parent-child interaction therapy (PCIT) on behavioral problems of children with attention deficit/hyperactivity disorder in Ahvaz, Iran.
This was a pretest-posttest quasi-experimental study with an experimental and a control group. The statistical population comprised all children aged 5-12 years visiting psychology and psychiatry clinics in Ahvaz (Iran) in 2020 who were diagnosed with ADHD by specialists. A sample of 30 children was conveniently selected and randomly allocated to experimental and control groups (n= 15 per group). The research instrument was The Child Symptom Inventory (CSI-4). Analysis of covariance in SPSS-24 was used to analyze the data.
In the post-test, the mean ± standard deviation (SD) of ADHD signs and symptoms was 28.33 ± 4.65 in the experimental group and 32.67 ± 3.65 in the control group. The results showed that there was a significant difference between the experimental and control groups in the research variables (symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, generalized anxiety disorder, major depressive disorder, persistent depressive disorder, social anxiety disorder, and separation anxiety disorder) (P<0.001).
As the findings supported the effectiveness of PCIT on the behavioral problems of children with ADHD, workshops are recommended to be held on the treatment of behavioral problems in these children and their parents.

Natural selection such as mutations is known as a constant process for viral fitness and selective adaptation. Understanding the effects of each mutation, especially on structural proteins in the viral life cycle, is important in tracking the viruses behavior. Here, we evaluated the effects of mutations in SARS-CoV-2 nucleoprotein (N) and spike (S) genes on the protein stability, immunogenicity, and pathogenicity in Iranian COVID-19 patients from Golestan province.
In this study, 8 SARS-CoV-2 RNA samples were enrolled from referral hospitals in Golestan province. These samples were confirmed using a real-time RT-PCR assay targeting the SARS-CoV-2 nucleoprotein (N) and ORF1ab genes (Pishtazteb, Iran). Next-generation sequencing (NGS) was done on samples and subsequent sequences were retrieved from Global Initiative on Sharing All Influenza Data (GISAID) EpiCoV database. Structural analysis was performed between wild type (Wuhan accession number: NC_045512.2) and mutant N and S proteins to evaluate their stability, immunogenicity, and pathogenicity via bioinformatics servers such as Dynamut, Prodigy, IEDB, and software’s (Mega XI and Pymol II.V.II visualizer).
Amino acid codon changes in N and S proteins show that mutations could alter the translation efficiency. Normal Mode Analysis (NMA) by Dynamut server shows that stability and flexibility are changed by the mutations of these proteins. Immunogenicity analysis indicates the potential effects of some mutations such as P681H, Q675R, L699I, and D3L on immune escape. Interaction complex binding energy and affinity are higher in the mutant type compared to the Wuhan wild type, indicating higher pathogenicity.
The results indicate that there are some important mutations in N and S genes that affect the virus behavior in the infectivity. Regarding the sample size limitation and various mutations in SARS-CoV-2 variants, other studies using whole-genome sequencing with larger sample sizes will be required. Therefore, continuous monitoring of the SARS-CoV-2 genome seems important.

Celiac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. The role of human leukocyte antigen (HLA) DQ2 heterodimer (DQA1*0501-DQB1*0201) in presenting gluten peptides to effectors T cells in celiac disease (CD) has been well documented. Epidemiological studies of the disease in Iran are not available. This study was aimed to investigate the frequency of HLADQ2 and HLADQ8 in children with celiac disease in Mashhad city.
This case-control study was conducted on 25 celiac patients and 25 matched healthy controls for HLA typing of DQ2/DQ8. CD diagnosis was reached in 25 subjects, according to the revised criteria of the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition criteria (NASPGHAN). Sensitivity, specificity, and negative and positive predictive values were calculated.
Mean age was 134.06±30.48 months in case and control groups, with no statistical difference between the two groups. 48% of cases and controls were male, and 52 % were female. HLA-DQ2/8 was positive with 80% (CI 95%:64-95), sensitivity was 80% (CI 95%:58-92), specificity 48% (CI 95%:28-68), NPV 70.58% (CI 95%:44-88), PPV 61(CI 95%:42.2-76.5) and accuracy was 64%.
A positive association was found between HLA DQ2/8 and Iranian celiac disease. As negative and predictive values were high, HLA typing may be considered a beneficial test for diagnosis confirmation.

Oral Immunotherapy (OIT) is an effective strategy for improving food allergy tolerance. OIT has been introduced as a novel immune-modulating medication for food allergies. Other immunomodulatory approaches, such as sublingual (SLIT) or epicutaneous (EPIT) immunotherapy, may be less effective due to lower frequencies of systemic responses. Wheat and milk have lately been identified as a more prevalent cause of food-induced anaphylaxis than previously thought, particularly in young children worldwide. An immunoglobulin E (IgE)-dependent pathway may be responsible for wheat or milk allergy. The goal of our study was to offer a comprehensive evaluation of the effects of OIT in children with IGE-dependent food allergies to milk or wheat. Keywords related to OIT, food allergy, milk, wheat, and children were searched in MEDLINE, PubMed, Google Scholar, and ScienceDirect databases. Although oral immunotherapy for wheat allergy has recently been proposed, research studies have had encouraging results; despite, more research is still needed to determine the optimum strategy for promoting tolerance in wheat/milk-allergic children

While there is a strong link between rumination and internalizing psychopathology over the lifespan, the development of rumination is not well understood. This study aimed at investigating the effectiveness of psychological well-being training on negative automatic thoughts and resilience of female adolescents with rumination in Tehran.
The present study followed a quasi-experimental pretest-posttest design with a control group. The study population was all female adolescents with rumination in District 6, Tehran, Iran in 2018-2019. Sample of the study included 30 adolescent girls with rumination, referred to counseling centers and psychological services in Tehran. They were selected through convenience sampling and randomly assigned to experimental (n = 15) and control (n = 15) groups. The experimental group received psychological well-being interventions (10 one-hour training sessions, one session per week). Then, female adolescents with rumination in both groups underwent a posttest. The instruments used included the Negative Automatic Thoughts Questionnaire (ATQ-N, Ingram et al. 1995), and the Resilience Questionnaire (Connor and Davidson, 2003). The data were analyzed by SPSS software version 23.
The results showed that 6.6% in the experimental group and 11.11% in the control group were 14 years old. Moreover, psychological well-being training was significantly effective in negative automatic thoughts (F= 50.89, P=0.001), and resilience (F= 1.24, P=0.001) of adolescents with rumination (p>0.05).
The 10-session Psychological well-being training was effective on negative automatic thoughts and resilience of adolescents with rumination in Tehran.

Literature suggests that chronic headaches, particularly migraines, in adolescents are crucially affected by psychological problems. In addition, groundbreaking studies have shown that preexisting personality traits are important to accelerate the likelihood of migraine onset, maintenance, and outcome. This study aims, therefore, to investigate the mediating role of perceived stress in personality traits and negative automatic thoughts, in adolescents with migraine. In this cross-sectional, descriptive study, the participants consisted of patients with chronic migraine referring to two neurology clinics in Ahvaz City, Iran, from 2019 to 2020. The diverse sample of patients (n =200) completed Cohen's Perceived Stress Scale, NEO Five-Factor Inventory (NEO-FFI), and Automatic Thoughts Questionnaire (ATQ-N).  To analyze the obtained data, SPSS V. 21 and Amos 18 were used. Based on the standard path coefficients and the P-values, the relationship between personality traits and the negative dimension of perceived stress (β = -46, P≥ 0.001), personality traits and the positive dimension of perceived stress (β = 0.44, P≥ 0.001), the negative dimension of perceived stress and negative spontaneous thoughts (β = 0.45, P≥ 0.008), and the positive dimension of perceived stress and negative automatic thoughts (β = -0.28, P≥ 0.004) were significant. According to the results, the indirect relationship between personality traits and n negative automatic thoughts was established and significant through the negative dimension of perceived stress. Moreover, the indirect relationship between personality traits and negative automatic thoughts was established and significant through the positive dimension of perceived stress.

An important determinant of health and wellbeing is socioeconomic status as it can influence an individual’s exposure to several risk factors across the lifespan. Previous studies, using the self-report scales, have demonstrated that parental socioeconomic status is associated with physical activity in children. However, due to limitations of self-reporting methods, we aimed to assess the association between the parental socioeconomic statuses with accelerometer-measured physical activity among children. Motivation was included as a mediator.
126 participants (45 girls, mean age of 10.92±1.89 years) wore the accelerometer for seven consecutive days. Parental socioeconomic status was measured by two items, namely, the parents’ education level and household income. The Intrinsic Motivation Scale was applied to measure motivation. Structural equation modeling was performed to analyze data.
74% of our sample was at medium level of parental socioeconomic status. Accelerometer data demonstrated that children spent 74.29% of the total time in sedentary behaviors, 17.20% in light physical activity, and 8.81% in Moderate-to-Vigorous Physical Activity (MVPA). On average, the daily time spent in MVPA was 45.19 minutes, which is below the WHO guideline. In fact, 27.7% (n=35) of children fulfilled the guideline. The results showed that parental socioeconomic status had significant effects on motivation (T=4.129) and MVPA (T=5.097). Moreover, motivation had a significant effect on MVPA (T=2.679). Finally, motivation significantly mediated the association between socioeconomic status and MVPA (P<0.001).
As demonstrated in the findings, the socioeconomic statuses of parents and physical activity have become critical concerns about children. Accordingly, in order to increase the level of MVPA among children, large scale programs should be developed by the stakeholders to increase the parents’ socioeconomic status level.

Childhood Nutrition plays an important role in people's health. The purpose of this study was to investigate the relation between family nutritional status and the body mass index (BMI) of children.
This observational cross-sectional-analytical study considered documents of 2697 kids with five years of age who were under the auspices of Mashhad University of Medical Sciences, Mashhad, Iran in 2019. Their related documents as well as their nutritional status were registered in the Iranian integrated health information system. Household demographic information including family nutritional information like fruit consumption, vegetable consumption, and daily dairy consumption, fast food consumption per week and type of oil consumed were questioned. Based on the weight percentile, they were categorized in four groups underweight, normal, obesity and overweight.
There were significant differences between the frequencies of the participants’ consuming low or high daily amounts (under 2 and more than 2 shares) of the nutritional components (fruit, veg, dairy, and fast food) in each weight category (P <0.001). The frequencies of the consumers of liquid oil, in different weight categories, were also significantly different with the frequencies of those who used a combination of solid and liquid oils (P <0.001). However, there was not a significant relationship between the different consumed nutritional components and the BMI (P>0.05). Moreover, the children’s BMI was not significantly correlated with education, smoking and age of mothers.
The results of the study showed that the daily consumption of fruits, vegetables, dairy products, different types of oils consumed and food consumption per week significantly correlated with weight categories of the five-year-old children under study. Therefore, in order to have a healthier population, it is critical to evaluate the nutritional condition of children during this period.

The birth of a mentally retarded child can have a profound impact on the entire family; parents face many logistical and emotional difficulties that can impact their happiness and mental adjustment. We aimed to investigate the effectiveness of the parent training protocol based on an acceptance and commitment therapy on happiness and mental adjustment among mothers with slow paced children. The population of this quasi-experimental included all the mothers with slow-paced children in Tehran, Iran, from 2020. Samples of the study were selected using purposive sampling and randomly divided into an experimental group (Parent training protocol) (n=15), and a control group (n=15). Each of the experimental participants was trained for ten 90-minute sessions, while no therapy was provided to the control group.  The subjects were assessed before and after treatment using the Persian Version of the Mini-MAC and Oxford happiness questionnaire (OHQ). The data was analyzed Using version 18.0. The total sample was 30 mothers with slow-paced children, among whom the highest frequency was for the age group of 37-45 years with the mean age of 43.3. The results showed that the acceptance and commitment therapy had significant effects on happiness (F= 83.4; P=0.04) and mental adjustment (F = 80.9; P=0.06) of the mothers with slow-paced children. Parent training protocol based on an acceptance and commitment therapy increased the happiness of mothers with slow-paced children and improved their mental adjustment.

Pregnancy is a complex and vulnerable period that causes some challenges including the development of postpartum psychiatric disorders (PPDs) for women. Identifying the factors associated with these disorders can be effective in reducing maternal symptoms and supporting mother, child and family. The aim of this study was to identify the relationship between postpartum mental health and mediating social determinants of health in Iran.

In this systematic review, the Persian and English observational studies in Iran were obtained through advanced search in online databases, such as PubMed, Scopus, EMBASE, SID, Magiran, Psycinfo, and Google Scholar search engine in the period of January 2005 to August 5, 2021 using the following keywords: social determinants, mediating factors, social support, mental health, risk factors, postpartum, Iran, and their English equivalents through Mesh. Articles were selected based on the inclusion and exclusion criteria and quality assessment of articles was performed using the standard Newcastle-Ottawa Scale (NOS).

Out of 42 eligible articles (total sample: 39216), 40 articles examined the relationship between postpartum depression and 2 articles studied the relationship of maternal grief with some mediating social determinants. In general, these factors were classified into five categories, including midwifery and pregnancy-related factors, psychosocial conditions, factors related to postpartum status, behavioral factors and material status or conditions, and health care.

Mothers' mental health is affected by many underlying factors; Therefore, identifying the risk factors associated with mental disorders in this population based on the model of the WHO (World Health Organization), especially in the mediating area (Material and environmental conditions, Psychosocial, Behavioral factors, Health system) due to the extent of this area is very important.

Multiple brain abscesses in neonates are extremely rare and occur as an unusual complication of bacterial meningitis or sepsis. There are many bacterial pathogens reported to cause brain abscesses in newborns; however, brain abscess caused by Enterobacter cloacae has rarely been described previously in neonates and only a few reports exist in English literature. After 4 weeks in the neonatal intensive care unit, a preterm neonate developed multiple brain abscesses as a complication of E. cloacae sepsis which were revealed on TFU and confirmed on MRI. Consequently, a limited craniotomy was performed for the biggest abscess for evacuation of pus and followed by aspiration of other abscesses.

Caudal duplication syndrome is a rare congenital disease caused by duplication of cloaca and notochord embryonic structures in various forms. The estimated prevalence of this syndrome is 1 per 100,000 births. A range of anomalies is observed in urinary and gastrointestinal tracts as well as in skeletal and neural structures of the spine and even limbs of these patients. Various factors such as genetic disorders and conjoined twinning have been mentioned in etiology of the disease. We introduce a case of this rare disease referred to our center for imaging as an infant with increased soft tissue in perineum without excretion of meconium from birth but with evidence of duplication in the genitourinary system (vagina and urethra) and gastrointestinal tract (rectum and colon) that was subject to reconstructive surgery.