International Journal of Pediatrics
Volume:11 Issue: 110, Feb 2023

Endoscopy is an invasive diagnosis and treatment procedure that can create anxiety in children. The use of nursing theories as a comprehensive nursing care model has a significant role in improving people's health. This study aims to examine the effects of the comfort- theory-based care model on the anxiety level of children undergoing endoscopy at the endoscopy center of Hajar Hospital in Shahrekord, Iran.

This clinical trial was conducted with on 56 children referred to the endoscopy center of Hajar Hospital in Shahrekord, in 2022. Sampling was done by convenience method among eligible children, who were later divided into two intervention and control groups by random allocation method. The intervention group received a care program based on comfort theory two hours before the start of endoscopy. Data collection tools included a demographic information form and the modified Yale anxiety scale; and the statistical analysis were performed through SPSS-22 software, using independent t-test, paired t-test, chi-square test and Fisher's exact test at a significance level of p<0.05.

Mean score of anxiety before the intervention was 42.04±11.47 in the intervention and 44.03±8.86 in the control group, which showed no statistically significant difference (p=0.470). But after the intervention, the mean score of anxiety increased to 24.11.73 in the intervention group and 49.88±11.98 in the control group, which showed a statistically significant difference (p=0.009).

According to the results, using a care program based on comfort theory was effective in reducing the anxiety of children undergoing endoscopy; so, this care model is recommended to be implemented for children undergoing invasive procedures.

Considering the higher rate of suboptimal glycemic control in type 1 diabetic(T1DM) children and the increasing trend of T1DM in our community and worldwide and the role of glycemic control in preventing complications of the patients along with the lack of studies regarding the role of family socioeconomic status (SES) and its indicators in our community, we aimed to investigate the association between family SES and glycemic control in children and adolescents with T1DM in Isfahan, Iran.
In this cross sectional study, T1DM patients aged 1-18 years were enrolled. The patients were classified into two groups, with and without appropriate glycemic control, based on the mean of the last three HbA1c mean levels. The characteristics of the patients in different categories of family SES were compared and the associations were evaluated.
In this study 312 children with T1DM (156 with and without optimal glycemic control) and their families were evaluated. Low, moderate and high family SES was presented in 20.4%, 71.6% and 8% of the total population. Frequency of low SES was significantly higher in patients with poor glycemic control (P<0.001).There was significant positive association between family SES and appropriate glycemic control (P<001, OR=6.63, CI95%; 2.2-19.3).
Our findings indicated that in accordance with previous studies, the SES of Iranian families, assessed by multiple factors of parents’ and families’ characteristics, is associated with glycemic control of children with T1DM. These findings would be helpful for health care professionals to design more comprehensive programs based on the SES of the patients' families as well as healthcare policymakers to properly allocate resources in order to obtain more appropriate glycemic control for all patients with T1DM.

Vaccination is one of the most common and painful methods of disease prevention that imposes stress on infants, and affects their parents, as well. Nurses are the main designers of nursing practices and one of their primary tasks is to play a supporting role in reducing pain during injections; so, they should be able to choose the most useful and safest methods of care. The present study, thus, aimed to determine the effect of foot reflexology massage on pain during vaccine injection in infants.
This study was a double-blind clinical trial. The study population included 90 healthy infants aged 2-7 months who were brought by their parents to one of the comprehensive health centers of Rasht (Guilan province, Iran) for pentavalent vaccine injection. The infants were randomly divided into three groups: foot reflexology massage, neutral point massage (sham group) and control. Data collection instruments included a demographic information form and the Face, Legs, Activity, Cry, and Consolability scale (FLACC). Data were analyzed using Chi-square, ANOVA, independent t-test and repeated measures ANOVA in SPSS ver. 22.
There was no significant difference between the three groups in terms of pre-vaccination pain level. Means ± standard deviations of pain during vaccine injections in the intervention, sham, and control groups were 4.83 ± 1.08, 7.96 ± 0.99, and 8.40 ± 1.13, respectively, which were significantly different (p<0.001).
Foot reflexology massage can reduce the pain during pentavalent injection in infants and can be used as a simple and accessible non-pharmacological method to manage vaccination pain in infants.

Asthma is an inflammatory disease of the airways which is highly prevalent in children. Treatment of the disease is based on the relief of obstruction and inflammation of the airways. Artemisia persica Boiss. Has antioxidant and anti-inflammatory effects. The aim of this study was to investigate the acute effect of A. persica on pulmonary function in patients with asthma aged 6-18 years.

In this double-blind clinical trial, 118 asthmatic patients in the age range of 18-6 years, referred to the Spirometry Unit of Imam Ali Clinic, in Shahrekord, southwest of Iran, were randomly divided into control and intervention groups. Patients in the two groups were exposed to a placebo (distilled water) and 10 ml of inhalant A. persica 1.5% formulation for 15 minutes, respectively. Spirometry was performed before and 20 minutes after the completion of inhalation and the values were recorded. Data was analyzed by SPSS 20.

Before the intervention, spirometric indices (including FEV1, FVC, FEV1/FVC, PEF25, PEF50, PEF75, and PEF2575) were not significantly different between the control and case groups. After the intervention, these indices were not significantly different between the two groups. In the group exposed to A. persica inhalation, after the intervention, spirometric indices including FEV1/FVC, PEF50, PEF75, and PEF2575 significantly decreased (P<0.05), while FEV1, FVC, and PEF25 indices did not change significantly after the intervention.
In the control group, FEV1/FVC, FVC, PEF25, PEF50, PEF50, PEF75 and PEF2575 significantly decreased (P<0.05) after the intervention, but FEV1 did not change significantly.

Acute inhalation of A. persica and placebo caused no improvement in spirometric indices in asthmatic patients.

Endocrinopathies are common complications in Thalassemia Major (TM) patients. They are important as secular trends of complications in childhood as a critical period for growth and development. The present study, then, aimed to investigate these complications in children and young adults.

34 TM patients, with the mean age of 19 ± 6 y/o, entered this study. Female to male ratio was 21/13. Their medical history was obtained by review of medical records. Data about FBS, AST, ALT, TG, cholesterol, and ferritin, TSH, LH and FSH was collected. Due to the lack of normality of some continuous variables, an appropriate transformation method was implemented to convert them to normal distribution. Repeated measure ANOVA was used to assess change of outcomes across time. Correlations between different parameters were also calculated.

After 3 years, only FBS changed significantly in comparison to phase 1 and 2 results (P-value=0.028).  Ferritin in the first phase significantly correlated with ALT (P-value = 0.021), in the second phase with AST (P-value=0.029) and ALT (P-value=0.002) and in the third phase with FSH, LH and TG (P-value=0.047, 0.020, 0,027, respectively). In the first phase AST correlated with TG and cholesterol (P-value=0.015, 0.001, respectively) and ALT with cholesterol (P-value <0.001). ALT correlated with TG in the second phase (P-value=0.040). ALT and AST correlated with cholesterol in the third phase (P-value=0.002, 0.007, respectively).

Hormonal parameters do not show significant change during a 3 years period in TM patients.

Malnutrition is a major contributor to children’s low growth, development and also disease. To inform policymakers’ planning and action, this study aimed to assess malnutrition in under-5 children and its relationship with the household socioeconomic status.

The data of this cross-sectional survey was collected through a valid and reliable questionnaire including demographic, nutritional and socioeconomic data. Through proportional and random cluster sampling, 3980 children aged 6 to 59 months old were selected as the participants of the study. The data were analyzed through Chi-Square and ANOVA tests using EpiNut and Stata software.

138 (3.5%) had severe stunting (height for age), 58 (1.5%) severe low weighting (weight for age), 81 (2%) severe weight loss, 87 (2.2%) obesity based on BMI for age, 66 (1.7%) severe wasting and 84 (2.1) obese based on weight for height. Height and weight for age were significantly associated with father’s job and BMI for age was associated with household socio-economic status (p<0.05).

In spite of performing nationwide programs targeting under 5 children, the prevalence of malnutrition problems was high. This study indicated that the household socio-economic status is an effective factor. This indicates that the supporting measures such as insurance and free services for the poor are not well designed, targeted and administered.

Food allergy is a risk factor for asthma. In this study, we investigated the prevalence of food allergy in children with asthma.

This cross-sectional study included 200 children with asthma selected through available sampling; and was conducted in Taleghani Children’s Referral Hospital, Gorgan, Northern Iran, from 2014 to 2016. Greer® (USA) Skin Prick test (SPT) was used to recognize food allergens in all participating children. A questionnaire recorded children’s demographics. Statistical analysis was based on t-tests and chi-square using SPSS 16.

The children's mean age was 10.29 ± 4.06 years. One hundred three children (51.5%) were females. The SPT of garlic, banana, kiwifruit, soybean, tomato, peanut, wheat, and walnut was significantly different between age groups (p<0.05). No statistically significant differences in food allergens were found between different genders, different age groups, and between the two groups of breastfeeding only and breastfeeding plus complimentary food. Allergy to curry powder, peanut, garlic, egg, and pepper was detected to be significantly higher than to other food allergens, (p<0.05). Atopia was detected in approximately all participants (99.5%).

Atopia seems to be an associated condition in asthmatic children. Allergy to curry powder, peanut, garlic, egg, and pepper, was significantly higher than other food allergies in children with asthma in Gorgan, Northern Iran.

Coronavirus disease 2019 pandemic had a great effect on the lives of asthmatic children. In this study we assessed changes in medication adherence and asthma control rate among our registered children with pediatric asthma.

This cross-sectional study was conducted on 113 patients registered in our asthma and allergy clinic in Mashhad, Iran. We called them via phone and completed a questionnaire on the level of asthma medication adherence and the asthma control test (ACT) before and in the 6 months after COVID-19 emergence. We investigated the changes in medication adherence and asthma control due to COVID-19 pandemic.

A total of 113 asthmatic children in the age range of 1 to 15 (mean, 7.02±3.24 years) were included in the study. There were zero confirmed positive cases among them since COVID-19 introduction. The minority of patients (8.8%) had weak adherence, most of the children (35.4%) completed one course of prescribed medications, 33% had longer adherence, and only 25 patients (22.1%) had full adherence during the pandemic. Overall, our patients experienced better asthma control with a 1.51 rise in ACT score to arrive in 23.64 points out of 25. They had no asthma exacerbation and emergency visit. Over half of the families compiled the national preventive measures; as 85% of children had followed the stay-at-home order during the first peak of the pandemic.

Our patients managed to come to a higher asthma control level despite their generally decreased adherence to medications during the pandemic. COVID-19 not only could not worsen asthma status in our children but surprisingly improved it. This shows that the preventive measures should be strongly applied for the asthmatic population.

Metabolic syndrome (MetS) is characterized by metabolic and anthropometric abnormalities which are associated with an increased risk of cardiovascular disease (CVD). Red blood cell distribution width is a candidate biomarker for CVD. Nine hundred and eighty-eight girls who were between 12 to 18 years old were enrolled. Anthropometric parameters and blood pressure were measured, together with biochemical and hematological variables, using routine measures. International diabetes federation (IDF) criteria were used for the diagnosis of MetS. Some of the demographic parameters such as weight, neck circumference (NC), waist circumference (WC) and hip circumference (HP) were significantly different between the groups with and without MetS, as may be expected. Significantly higher values for red blood cell distribution width (RDW) were observed only in subjects with waist circumference (P= 0.017) and fasting blood glucose levels (P= 0.038). RDW measures were directly associated with MetS status (r=0.076 (P =0.043)), WC (r=0.097 (P =0.016)), and fasting blood glucose (FBG) (r= -0.085 (P =0.037)). It was found that the RDW had specificity and sensitivity for MetS-based IDF criteria 48.01 and 77.78, respectively. RDW related cure area (95% CI) for MetS was reported to be 0.588 (0.380- 0.796). We found that an elevated RDW was associated with the presence of MetS and with some its components; but ROC analysis revealed that a weak specificity in spite of good sensitivity of RDW for MetS, along with a low AUC may make it unusable for the diagnostic prediction of MetS in this population.

Brain tumor (BT) is one of the types of tumors that, despite their low prevalence, have many destructive effects on the survival of patients. This study aimed to determine the prevalence of BT in children and adolescents with cancer in Iran. This meta-analysis was according to the PRISMA checklist. Out of 784 articles extracted in the first stage of systematic review, eight studies examining the incidence rates of brain cancer in people under 18 years of age in Iran met the necessary conditions to be included in the meta-analysis. Data extraction was done using the researcher's checklist; and data analysis was done using CMA3 software. The prevalence of BT in male patients was revealed to be 1.8% (95% CI, 1.4-2.3), in females, it was 1.9% (95% CI, 1.5-2.3), and its total prevalence was 2.1% (95% CI, 1.7-2.7). Although the prevalence of BT is not high, due to the important role of these types of tumors in determining the health status of patients, it is required to take the necessary measures including prevention and treatment in the fields of rehabilitation and Drug treatment.

Epiglottitis is an inflammatory disease involving the epiglottis, vallecula, arytenoid cartilage, and aryepiglottic wrinkles. Acute epiglottitis is relatively rare, but it can quickly lead to a life-threatening airway obstruction. Diagnosis of epiglottitis is clinical, but radiography and direct vision of the epiglottis can also help with the diagnosis. Clinical manifestations of epiglottitis include fever, sore throat, and in the event of imminent airway obstruction, symptoms of muffled sound, falls, tripod position, and stridor might be presented as well. Epiglottitis can be caused by some bacterial agents or viruses such as adenovirus and measles. COVID-19 was first detected in December 2019 in a group of patients with severe respiratory symptoms in Hubei Province, China. Common symptoms include fever, cough, fatigue, difficulty breathing, and loss of smell and taste. Although COVID-19 disease has a variety of manifestations, only one case of epiglottitis following COVID-19 disease has been reported in adults. However, no cases of epiglottitis have been reported in children with COVID-19.

The patient, a 4-year-old boy, came to our center and the patient's family complained about shortness of breath and progressive lethargy of the child from 10 days ago. Since last week, he had been sleeping in a sitting position due to the aggravation of shortness of breath. On physical examination, respiratory distress, tachypnea, subcostal retraction, tail stridor, and crackle was heard in both lungs. Diagnosed with suspected bronchoscopy epiglottitis; and a large, swollen, and cherry-red epiglottis was observed. Based on the patient's history of respiratory symptoms and the prevalence of COVID-19, a reverse pharyngeal polymerase (RT-PCR) transcript test was requested for COVID-19 and the COVID-19 infection was positive. The patient was intubated due to decreased oxygen scorching and was treated with antibiotics due to the diagnosis of epiglottitis and recovered.

In this article, we reported the case of a 4-year-old child with epiglottitis in the context of COVID19. To the best of our knowledge, no case of epiglottitis had been, previously, reported in children with COVID19. Therefore, in our opinion, epiglottitis can probably be one of the manifestations of COVID19 in children.

Gastric inflammatory myofibroblastic tumor (IMT) is a rare tumor that is almost seen in children with a wide range of clinical features. However, radiologic imaging and gastro endoscopy can be helpful, but the confirmation of the IMT diagnosis is via a histopathologic gastric specimen evaluation. Here we present the 2nd case of IMT with the clinical manifestations of a gastric outlet obstruction (GOO) in an eleven month old infant. Surgical treatment should be considered for the treatment of IMT

Hepatoblastoma (HB) is a rare malignant tumor of the liver; but is the most common malignancy of liver in infancy and childhood that usually occurs in the first three years of life. These tumors are usually present by abdominal mass, abdominal pain, anemia, thrombocytosis, and high serum levels of AFP; and may cause decreased appetite and weight loss.
Complications such as ascites, GIB, icterus, splenomegaly and vascular thrombosis may occur, while hepatic vein or inferior vena cava thrombosis is quite rare especially with a spread to right atrium and pulmonary artery branches. Multidisciplinary therapy by a pediatric oncologist, a pathologist, an experienced radiologist, a pediatric cardiologist and a pediatric surgeon is very important to diagnose and manage the condition. We report on the case of an infant with a huge abdominal mass and much extended tumor thrombosis till the pulmonary artery branches that shrunk appropriately after the first course of chemotherapy.