International Journal of Pediatrics
Volume:11 Issue: 114, Jun 2023

This study aimed to investigate the effectiveness of play therapy on reducing behavioral problems, attention deficit and hyperactivity in children.

The present study followed an applied-experimental design (pre-test-post-test) with a control group. The statistical population consisted of all the hyperactive 7-12-year-old boys of an elementary school in the 2nd district of Shiraz in the academic year 2018-2019. A sample of 24 individuals in the fifth and sixth grades (average age of 11 years) were selected based on the inclusion criteria and were randomly divided into two groups (12 in the control group and 12 in the experimental group). The experimental group underwent play therapy training in eight 90-min sessions with the cooperation of school psychologists. In order to collect data, Rutter's Behavioral Problems Questionnaire (Parent Form) and Conners Rating Questionnaire were used to evaluate the subjects, and the collected data was analyzed in the form of descriptive statistics (mean and standard deviation) and inferential statistics (analysis of covariance, for hypothesis testing). Data analysis was performed using SPSS-24 software.

The results of data analysis showed that play therapy was associated with significant effectiveness in reducing behavioral problems and reducing attention deficit and hyperactivity in primary school children, and it reduced behavioral problems and the severity of hyperactivity symptoms.

In recent years, an abundance of research has been conducted on the effects of bilingualism, with varying conclusions.
This study was designed to assess the executive functions of the brain (working memory, cognitive flexibility, and inhibitory control), metacognitive awareness, and cognitive flexibility between advanced English language learners and typical students.
this applied comparative study was conducted in the academic year 2022-2023. The population included all primary school students in Tehran's districts 5 and 18 between the ages of 7 and 12 years old. Sample of the study consisted of 180 individuals, divided into two groups (90 individuals each), using the convenience sampling method. Data was collected by the use of the executive function questionnaire developed by Delis and Kaplan (2001), the metacognitive awareness questionnaire developed by Mokhtari and Richards (2002), and the cognitive flexibility test (Wisconsin card sorting) (2006). Using SPSS 24, an independent t-test was conducted on the collected data.
The findings indicated that the advanced language learners outperformed the general group in all aspects of working memory, including mental flexibility and inhibitory control, general study strategy, problem-solving strategy, supportive study, and the number of correct categories. However, the general group exhibited a higher average perseveration error compared to the advanced language learners (P<0.05).
The superiority of bilingual students over monolingual students in executive functions, metacognitive awareness, and cognitive flexibility, can be suggestive for early planning of second language instruction in schools.

Aortic valve stenosis is a relatively common disorder, and many patients undergo surgical treatment annually. Thus, this study was designed to assess the results of aortic valve replacement in Tabriz’s referral hospital from 2006 to 2018.
Children aged 1 month to 15 years who were diagnosed with congenital aortic valve stenosis and undergone valvular surgery, were included. Based on the findings of echocardiography, the extent of remaining aortic stenosis and aortic insufficiency were evaluated and compared according to different types of surgery, immediately after the surgery and during the 6 months of follow-up. Finally, the results were analyzed comparing the morbidity and mortality of surgical methods.
Among the included patients, 73.8% had left ventricular outflow stenosis at one level, and the remaining had more than one level of stenosis. Prior to surgery, 82.2% of patients had severe ventricular outflow tract stenosis. Immediately after surgery, 91.25% of the patients had no stenosis, or showed mild stenosis. The overall mortality of the operations was 5%. Six months after surgery, only 20% of the patients showed moderate-to-severe stenosis. Web resection and myomectomy showed higher insufficiency rates, and commissurotomy showed increased insufficiency and stenosis. Benthal surgery was shown to reduce remaining rates of insufficiency. Also, a correlation was observed between the mortality rate and commissurotomy surgery. There was no significant relationship between mortality and different levels of aortic stenosis.
The overall success rate of surgery in aortic valve stenosis was acceptable. As different surgical methods implemented in aortic valve stenosis have their own specific pros and cons, regular pediatrician visits are necessary to map-out any possible future complications.

Early diagnosis of intestinal obstruction is critical for preventing subsequent complications. In this study, we compare the accuracy of plain abdominal X-ray and ultrasound imaging among children with intestinal obstruction, in terms of the diagnosis of obstruction and its underlying causes. This analytical cross-sectional study was performed at Akbar Children’s Hospital of Mashhad, Iran, in 2019-2021. Children with clinical manifestations of bowel obstruction underwent abdominal ultrasound examination and plain abdominal X-ray imaging, and the diagnostic findings were compared with the final definite diagnosis. Radiologic signs of obstruction were bubble signs in obstructions until the jejunum, and sausage-shaped air-filled bowel in obstructions of the rest of the bowel. The ultrasound signs were fluid-filled dilated loops, tubular or sausage-shaped dilated bowels, parallel valvulae conniventes (stack of coins), the to-and-fro motion, and the cause of the obstruction. Overall, 60 children with a mean age of 3.05 ± 0.87 years were studied. Post-operative adhesion was the most common cause of obstruction (28%). Plain radiography revealed a normal pattern in 15% of cases, bubble sign and/or decreased abdominal gas pattern in 15% of patients (high-level obstruction), and sausage-shaped pattern of low-level obstruction in 70% of cases, with 72% accuracy. The sonographic signs of bowel obstruction were seen in all patients, with 96.6% accuracy. The cause of obstruction could be determined in 91% of patients, with 91.6% accuracy. Plain abdominal X-ray had a normal pattern in 15% of bowel obstructions while sonography revealed all obstructions with 91.6% accuracy. Therefore, ultrasound imaging can be used as the preferred imaging modality to diagnose gastrointestinal tract obstructions.

The COVID-19 pandemic has disrupted healthcare systems globally, leading to the suspension of many elective surgeries. The impact of the pandemic on pediatric surgical care in tertiary centers is not well understood. This retrospective study aims to examine the effect of COVID-19 on the management of surgical diseases in children.
A retrospective single-center cross-sectional study was performed to collect information on the children who were operated either emergently or in an elective setting. The demographics, field of surgery, outcomes, and the rates of mortality and morbidity were measured. Moreover, this study evaluated the associations between coronavirus disease 2019 (COVID-19) infection and surgical outcomes and length of hospital stay.
A total of 1028 children were included in the study with an average age of 60.51 ± 50.3 months. Only 33 children (3.2%) were positive for COVID-19 during the admission days. Moreover, 87 (8.5%) patients developed pulmonary, gastrointestinal, or infectious complications, and 22 patients (2.5%) expired. Morbidity was significantly associated with the presence of COVID-19 infection (p < 0.001). Furthermore, the rate of complications was much higher in patients who underwent emergency operations (p < 0.001). In addition, mortality in positive cases was remarkably higher than that in negative cases (22.2% vs. 1.9%, p < 0.001).
The overall rates of complications, morbidity, and mortality were much higher in emergency operations compared to elective surgeries. Also, the presence of COVID-19 infection in this population led to more cases of morbidity.

Elementary School closures are much less effective than other social distance interventions in controlling the COVID-19 pandemic because of the low rate of SARS-CoV-2 transmission between children in educational settings. Therefore, Identifying facilitators and barriers to school re-opening can help parents and school staff plan for students' return to school. In this study, we examined the facilitators and barriers of school re-opening during COVID-19 from the perspective of parents and school staff of Zahedan, southeast of Iran.
We did a qualitative study using conventional content analysis. Participants were selected by purposive sampling in May 2021, in Zahedan, southeast of Iran. Data was collected through semi structured and in-depth interviews. Credibility, dependability, confirmability, and transferability were established to assure data trustworthiness. Audio-recorded interviews were transcribed verbatim and analyzed in accordance with Graneheim and Lundman.
We recruited 14 parents, five teachers, and five school principals from 7 elementary schools in Zahedan. Data analysis showed that overcrowding, financial problems, failure to comply with protocols and lack of proper educational space were identified as barriers to school re-opening. Also, teaching health protocols, providing health conditions for schools and preference for in-person learning were identified as facilitators of school re-opening.
Parents and school staff expressed their views on facilitators and barriers to reopening schools. Due to the different strains of covid 19, there is a possibility of re-peak at any time. Identifying facilitators and barriers of school re-opening will be effective in planning and policy-making of school re-opening programs during the COVID-19 and after Corona pandemic for promoting the health of school staff and students.

Retinopathy of Prematurity (ROP) is a disease in the retina of premature infants, which is one of the preventable causes of blindness in children.

the present study is performed with the purpose of determining the prevalence and outcomes of ROP in Iran through a systematic review and meta-analysis. Study design: All original published articles on the prevalence of ROP in premature infants in Iran were included in the study. On the other hand, intervention articles, meta-analysis, case reports, congress articles, medical dissertations, and articles with low quality were excluded from the study.

53 articles were included in the meta-analysis stage. Based on the results, the overall prevalence of ROP in Iran was 22.2% (95% CI: 18.5-26.5); the overall prevalence of the disease in ZONE I was 10.5% (95% CI: 3.0-30.6), the overall prevalence of the disease was 45.5% (95% CI: 33.8-57.8) in ZONE II, and 43.8% (95% CI: 25.1-64.4) in ZONE III. Regarding the stage of the disease, rate of 39.9% (95% CI: 29.2–51.7) was reported in STAGE I, rate of 30.3% (95% CI: 21.8–40.5) in STAGE II, and 14.9% (95% CI: 11.0 -19.9) in STAGE III.

Considering the high prevalence of ROP in premature infants in Iran, it is suggested to take necessary preventive measures in this field.

Flatfoot (FF) is one of the most common deformities in children, which is divided into two flexible or rigid types. Given the prevalence of FF and the importance of orthopedic diseases, this meta-analysis was conducted to determine the prevalence of FF in children and adolescents in Iran.

  This study has extracted data related to the prevalence of FF in people under 18 years of age by a meta-analysis of articles published in ISI-PUBMED-SCOPUS-EMBASE-SID-MAGIRA-GOOGLE SCHOOL databases. Original studies published in Persian or English reporting the prevalence of FF in the Iranian population were included in the study. If there was no access to the full file of the article for any reason, it was excluded from the study. Data was analyzed by CMA 3.

It was revealed that the prevalence of FF in girls was equal to 20.8%, and 20.3% in boys. The total prevalence of FF was equal to 20.1%. The prevalence of unilateral FF was equal to 3.9%. The prevalence of bilateral FF was 6.1%. The prevalence of FF was 17.7% for mild FF, 14.2% for moderate FF and 2.8% for severe FF.

Given the high prevalence of FF in Iran, it is suggested that necessary measures be taken to prevent FF while training parents about different effective and risk factors

Diabetic Neuropathy (DN) is one of the prevalent complications of Type 1 Diabetes (T1D), which reduces the patient's ability to maintain his/her balance by reducing proprioception.

In this meta-analysis, conducted by the use of PARISMA and SMART checklists, articles published on the prevalence of DN in T1D patients in Iran were included in the study. The search was carried out by two specialists in internal medicine who were well versed in the subject of search and meta-analysis articles; and the validity of the search was confirmed by a third person who had a specialist degree in pulmonary (internal medicine). After entering references into Endnote 8 software and removing duplicate articles, data extraction was performed and analysis was done using CMA3 software.

The prevalence of DN in 10 reviewed articles was 33.3% (confidence interval (CI) =23.5-44.7), and in 3 articles, mild and moderate DN status was reported, and the prevalence of mild DN was 32.6% (confidence interval (CI) = 19.1-49.7) and the average DN was equal to 6.8% (confidence interval (CI) = 2.6-16.5). Also, the prevalence of DN in people over 15 years old was reported as 30.9% (confidence interval (CI) = 15.9-51.5) and in people under 15 years old was 43.1% (confidence interval (CI) = 28.5-59.1).

It is suggested that further meta-analysis studies be conducted on the other complications of diabetes in these patients.

Although the application of Photo-Dynamic Therapy (PDT) has been increased for the treatment of cutaneous disease in adults with various skin problems, it seems that the effectiveness of the approach has been less investigated in children. Therefore, this systematic review aimed to assess the application of photodynamic therapy in children with skin disease.

The present review has followed Cochrane’s methods for conducting systematic reviews of interventions. Relevant studies were collected by searching four electronic databases, including PubMed, Scopus, Medline, and Web of Sciences using such keywords as "photodynamic therapy " and "PDT", in combination with "cutaneous disease ", "skin disease ", and "Children" or "pediatric" up to 2022.

In total, 42 studies were included in this review, among which 14 were conducted on patients with acne vulgaris (treatment success rate: 26.3% to 100%) and eight articles studied plantar warts and condyloma acuminatum (treatment success rate: 30% to 100%). Other cutaneous diseases in children treated by PDT included porokeratosis, port-wine stain, basal cell carcinomas, leishmaniasis, tinea capitis, xeroderma pigmentosum, Langerhans cell histiocytosis, lymphomatoid papulosis, and Bowen’s disease, with treatment success rates between 30% and 100%.

It seems that PDT has a treatment potential to be used for children with cutaneous disease. However, due to the existence of non-uniform parameters for PDT treatment, optimization of the treatment protocol (distinct for each disease) is necessary to ensure a better result with long-term remission in children with cutaneous disease.

Urinary tract infections (UTIs) are classified as upper or lower and can be asymptomatic or manifest fever, abdominal pain, sepsis, hematuria, and typical renal colic. Therefore, this study was to determine the prevalence of UTIs in patients with febrile seizure (FS).

The studies published between 2010 and 2022 and indexed in Web of Science (ISI), Scopus, PubMed, EBSCO, SID, and Magiran databases were searched for the purpose of this meta-analysis and systematic review. The study checklist included the author's name, year of publication, location and prevalence of UTI. Prevalence of UTI was analyzed using the RANDOM model after entering the CMA3 software.

Six articles, with the total sample size of 1480 people (778 boys and 702 girls), were selected for the final analysis. They were published between 2011 and 2018; the lowest prevalence rate (11.1%) was reported in a study by Akbar et al., in Golestan city, and the highest prevalence (15.2%) was related to a study by Mahyar et al., in the city of Qazvin. In general, the prevalence of UTI was found to be 3.7 (95% CI: 1.3-10.4), and in boys, 15 (95% CI: 12.2-18.2) in girls with FS; and the overall rate was equal to 9.8 (95% CI: 7.6-12.6).

Considering the overall prevalence of UTIs (9.8%) and its high rate in girls (15%), preventive interventions are suggested.

Exosomes are among the factors whose importance has been shown in many diseases today. Recently, it has been shown that exosomes play an important role in the pathogenesis of Intrauterine Growth Restriction (IUGR); however, few studies have been conducted in this regard.

The articles in this review study were retrieved from some databases including PubMed, Google scholar, and Scopus. All the included articles were in English, and those in other languages were excluded. Search keywords included IUGR, exosome, pathogenesis, Mechanism, Cell Signaling, Oxidative Stress, Inflammation, and Endothelial Dysfunction.

Studies have shown that exosomes contain factors, molecules and gene activators that affect molecular pathways regulation. These molecules play an important role in regulating inflammatory reactions, oxidative stress, and production of Reactive Oxygen Species (ROS). The activation of these pathways can aggravate the clinical symptoms of IUGR. In addition, exosomes can impress induction or inhibition of endothelial dysfunction, which leads to the development of IUGR. Hence, identifying upstream and downstream pathways helps design therapeutic strategies to treat patients.

Children with neurodevelopmental disorders across the world receive pediatric rehabilitation services. The Coronavirus (COVID-19) pandemic challenged the rehabilitation community providing services for these children. The aim of the study was to outline the number, variety and characteristics of telerehabilitation services for children with neurodevelopmental disorders in the era of Covid-19.

To identify relevant literature, the scoping review method was used. Our results were presented according to PRISMA Extension for Scoping Reviews guidelines. The nine-step updated scoping review method by Peters et al. including some pre-search, search and post-search steps was conducted. A structured search of three databases of the Web of Science, PubMed, and Scopus was conducted for the studies published during 1 January 2020 to 12 December 2022. The extracted literature was reviewed in two steps by two independent reviewers.

Twenty-seven articles met the inclusion criteria. Most of the studies were conducted in the United States. Services provided by telerehabilitation were mostly tele-intervention (n=19, 70.37%) followed by tele-evaluation (n=5, 18.52%). More than half of the studies used tele-conferencing for providing their services (n=15, 55.56%).

Although the variety of telerehabilitation service deliveries seems to have increased and even the number of participants in the studies has increased, still considering the rapid spread of the pandemic, the studies seem not to be adequately organized in terms of methods.

This study aimed to report the case of a 3-year-old child with Idiopathic Thrombocytopenic Purpura (ITP) presented with massive bilateral spontaneous suprachoroidal hemorrhage.

Case report:

 A three-year-old boy with a history of ITP was referred with acute painful vision loss from 2 days ago. Visual acuity was No Light Perception (NLP) for the Right Eye (RE) and Light Perception (LP) for the Left Eye (LE). Anterior segment examination showed bilateral red eye, mild corneal edema, as well as relatively shallow and symmetric anterior chamber. Bilateral massive suprachoroidal hemorrhage with retinal apposition was apparent in B-scan ultrasonography. The patient underwent bilateral SCH drainage through four sclerotomy windows, one in each quadrant of each eye. In the last follow-up examination, one week after the surgery, the visual acuity was light perception and hand motion in RE and LE, respectively. Serial B-scan sonography indicated the reduction of hemorrhage in the suprachoroidal space.

Spontaneous Supra-choroidal Hemorrhage (SSCH) is an extremely rare condition that can occur in the case of ITP. Despite the anatomical recovery of the patient following suprachoroidal drainage surgery, the visual outcome remained poor.

Alkaptonuria is a rare autosomal recessive disease, in which the metabolism of homogentisic acid is defective. Homogentisate 1, 2- dioxygenase deficiency results in homogentisic aciduria, ochronosis, and ochronotic arthritis, in which pigments precipitate in joints especially those under pressure like vertebrae. In this case of isolated alkaptonuria, we faced an atypical manifestation of alkaptonuria in a seven-year-old girl, which had not been previously detected by our colleagues