International Journal of Pediatrics
Volume:3 Issue: 15, Mar 2015

Zinc is an essential trace element required for the functional activity of several enzyme systems. Several studies have been carried out to assess the effect of zinc supplementation on children’s growth, but controversy exists as to the effect of zinc on growth and growth hormone - insulin-like growth factor-I (GH-IGF-I) system. The aim of this study was to evaluate the effect of zinc supplementation on linear growth and serum level of IGF-I, Calcium(Ca), Phosphorus (P), Alkaline Phosphatase (ALP) in elementary school children living in a low socioeconomic suburbs of Mashhad, Iran. The study was a randomized double-blind, placebo-controlled efficacy trial. Subjects were 200 volunteer primary school children. Both case and control groups comprised of 100 individuals each with 50 males and 50 females. Intervention supplementation was zinc sulfate tablets (10 mg elemental) and placebo tablets for both groups, administrated for a period of six months. The height, weight, height for age and weight for age Z-scores and Body Mass Index (BMI) were measured at 0, 2, 4, and 6 months. After six months the level of IGF-I, ca, p and ALP were measured using blood samples taken from 50 volunteer children, 33 from the case and 17 from the control group. The statistical analysis was performed by SPSS version 11.5. There was a significant increase in linear growth and weight amongst both male and female of the case group compared to the control after six months of receiving zinc(p<0.05). However, there was no significant difference in the serum level for the measured parameters between the two groups. This study provides evidence of positive effect of zinc supplementation on the growth of school children living in a low socioeconomic suburbs of Mashhad city in Iran.

Chest X-ray is usually the first radiography performed for a newborn. This test is easily accessible and yet a basic screening method. Different results have been reported in various studies regarding the diagnostic value of chest X-ray in cardiovascular disease in children. The study was carried out retrospectively using the medical files of 100 patients under 10 years of age who were referred to Tabriz Children’s Hospital, Tabriz-Iran, during 2013-2014. The data obtained were analyzed with SPSS-17. The mean difference test was used to compare the quantitative variables. Fifty-two patients (52%) were male. Their mean age was 4.54  1.22 (0-108) months, and the patients’ mean weight was 4.38  0.34 (1.25-27) kg. Cardiovascular examination and radiology report were negative in 70% and 57% of the patients, respectively, while cardiologic assessments revealed cardiovascular problems in 70% of the cases. The diagnostic accuracy, sensitivity, and specificity, and the positive and negative predictive value of chest X-ray in this study were 61%, 80%, 53%, 86%, and 42%, respectively. In addition, gender, age, weight, the presence or absence of clinical signs, and the type of cardiovascular disease had no effect on the diagnostic accuracy of chest X-ray. According to the results, chest radiography cannot be referred to as a test to confirm or rule-out cardiovascular disease in children. Therefore, when a cardiovascular disease is suspected in physical examination, echocardiography can be recommended without a need for chest X-ray.

Breastfeeding is one of the most effective ways to promote children's health. The purpose of this study is to determine the relationship between Emotional Intelligence (EI) and success of breastfeeding. In a cross-sectional study in referring of multiple health centers in Shiraz, sample of 150 mothers with children aged one to three 3 years were selected using convenience sampling method and divided to breast fed and formula fed children groups, they obtained Bar-on and demographic questionnaire. Data were analyzed by SPSS software and significant level for all tests was considered as 5%. Mean age of mothers was 28.8±4.3 and the mean age of children was 19.80±5.8 months in breast fed and 18.98±6.25 in formula fed infants (p=0.406); 45.3% of mothers were high school graduates or low literate, and the rest of them were college educated. 71.3% of the women were housewives and most of them were nulliparous. 71.3% of all women had cesarean delivery. The mean duration of breastfeeding in children were 14.80±4.35 months in breast fed and 3.98±1.25 months in formula fed infants (p<0.001).In terms of the average age, education and child birth rank, the two groups were not significantly different (P>0.05). Emotional intelligence in the group of lactating mothers was significantly higher than non-lactating mothers (347 versus 296; P<0.001). Mothers who success in breastfeeding have higher EQ than non-lactating mothers. Since it is possible to identify and promote EQ, therefore, we can help to breastfeeding success of mothers.

The prevalence of disordered eating behaviors has been reported to increase in recent decades; therefore, the search for specific psychological variables that may contribute to the etiology of this disorder is of great importance. The current study examined the mediating role of the emotion regulation difficulties on the relationship between body image disturbance and disordered eating behavior among students. This cross-sectional study was performed in 2015 upon a sample consisting of 264 students in Allame Tabatabaie University were selected based on a Morgan formula and multi-stage cluster random sampling. Then, participants responded to the questionnaires of emotion regulation difficulties of Gratz and Roemer (2004), The Multidimensional Body-Self Relations Questionnaire (MBSRQ) of Cash (2000) and eating attitudes test of Garner and Garfinkel (1979). The data were analyzed by correlation techniques and multiple regressions. The results showed that there was internal significant correlation among emotion regulation difficulties, body image disturbance and disordered eating behaviors (p<0.01). Also, regression analysis indicated that emotion regulation difficulties significantly mediated the relationship between body image disturbance and disordered eating behaviors (p<0.01). According to the findings of the present study, considering the role of emotion regulation difficulties in the relationship between body image disturbance and eating disorders is important for prevention and therapy programs.

Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis. Respiratory failure is the most serious short-term complication of GBS and invasive mechanical ventilation is required in 30% of patients. Moreover, 60% of those who are intubated develop major complications including pnemonia, sepsis,GI bleeding and pulmonary embolism. Thus respiratory failure prediction is crucial. The aim of this study was to determine clinical predictors of respiratory failure to avoid respiratory distress and aspiration. In a cross sectional and analytical study 140 patients with clinically diagnosis of Guillain-Barre syndrome were enrolled in study, of October 2008 to October 2014. Demographic data, nerologic examination, cranial nerve and autonomic nervous system involvement, and respiratory failure were recorded prospectively. 15 out of 140 patients (10.7%) developed respiratory failure and underwent mechanical ventilation. The male/female ratio in patients with respiratory failure and patients without respiratory involvement were and respectively (p-value=0.4). The mean age in these two groups were 2.7±1.9 and 5.5±3.2(P= 0.003). Cranial nerve involvement (7, 9, 10) was recorded in patients with respiratory failure and without respiratory failure 54% and 25% respectively (P =0.03). Absent upper limb deep tendon reflexes in these two groups were 70% and 44% respectively (P =0.03) and autonomic nervous system involvement 24% vs. 14% (P=0.3). This study suggests that younger age, cranial nerve involvement and absent upper limb deep tendon reflexes are predictive factors of respiratory failure in patients with Guillain-Barre Syndrome (GBS).

Reflection is considered as a critical characteristic in professional competitions. Despite propagation of reflection as an important educational issue and existence of several helpful patterns, instructions conducted by teachers to explaining and expanding of it, are very little. Studies related to this topic were mainly performed in the field of nursing. Therefore, we decided to evaluate the effects of reflection on medical students. This study was conducted between August 2012 to January 2013, and 100 medical students who were training in Pediatric Department of Tabriz Children’s Hospital, were included in this interventional (before and after) study. At the beginning a questionnaire was filled by participants as "pretest". Then, in the workshop, principles of reflection and learning domain were taught to them. A notebook entitled "What I have learned" was prepared by them and daily learning was recorded in three aspects of reflection (mirror, microscope and binocular). After three months the same questionnaires were filled as "posttest". Results obtained from comparing pretest and posttest and information acquired from students notebook were the basis for statistical analyze. There was statistically significant difference for each question (P < 0.05). Deepening the learning, reducing errors, organizing and integrating of individual knowledge, increasing confidence and responsibility, improved patient care and accuracy of interventions were some benefits of reflection method. Reflection is very helpful educational strategy and can help the students in their communication and increasing skill and knowledge. It also helps to organize and integrate their learning by guiding them in clinical situations.

Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was to investigate chronic diarrhea, its etiologies, clinical features and outcomes in infancy. Retrospective study investigating infants hospitalized in the Gastroenterology Department of Tehran Tertiary Care Center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyzed by SPSS software, version 16. In this study, 63.9% of cases were female and 36.1% were male. 24 cases (66.7%) had osmotic diarrhea and 11 (30.6%) had secretory diarrhea. In this study there was no significant statistical correlation between type of diarrhea and sex, gestational age, severity of dehydration, birth weight and nutrition. The majority of patients with osmotic (58.3%) and secretory diarrhea (63.6%), had weight percentile below 3%, which showed a significant statistical difference (P <0.03). Etiologies found in newborns included: food allergy (41.7%), glucose/ galactose malabsorption (19.4%), post gastroenteritis malabsorption (11.1%), sepsis (8.3%), autoimmune enteropathy (5.6%), galactosemia (2.8%), pseudo membranous colitis (2.8%), cystic fibrosis (2.8%), intestinal malrotation (2.8%), congenital chloride diarrhea (2.8%). Atotal of 4 out of 36 patients (%11.1) had early onset of diarrhea. Intestinal biopsy was done in 7(20%) cases. Chronic diarrhea in infancy has different etiologies and outcomes. According to high prevalence of allergy in this study, more attention needs to be paid to this issue. On the other side, food allergy was more common in nonexclusive breast fed infants, which shows breast feeding has a protective effect against neonatal diarrhea.

The mortality rate of children is one of the most important indicators to measuring the development of countries. Equitable access to pediatricians is an important factor in reducing child mortality and promoting society health. The aim of this study was to investigate the inequality and trend of geographic accessibility to Pediatricians in Iran in the period 2007 to 2013. We used the Gini coefficient and the index of dissimilarity for investigating the geographic distribution of pediatricians in the period 2007 to 2013 in Iran. Also, a regression model used for determining time trend of inequality. Data about the number of pediatricians and number of live birth in each province were obtained from the Statistical Center of Iran (SCI). The Gini coefficient was 0.27, 0.24, 0.26, 0.23, 0.23, 0.23, 0.25 and 0.21 in 2007 to 2013, respectively. It means that the pediatricians approximately had equal distribution during the studied period. The dissimilarity index of pediatricians were 18.35, 17.4, 19.4, 16.73, 14.93, 14.66 and 11.99 during 2007-2013. It shows that 18.35 percent of total pediatricians should be redistributed to achieve complete equality in pediatrician’s distribution in 2007. The time trend analysis showed that inequality have been decreased during the studied period but it was not statistically significant (p>0.05). The results showed that there are some inequality in Pediatricians distribution and most of pediatricians are in developed provinces. Thus, policy makers for improving child’s health in Iran should develop a comprehensive plan for appropriate distribution of pediatricians.

In children with Nephrotic Syndrome (NS), it is probable to determine a hypothyroid state because of Thyroxine (T4), Triiodothyronine (T3) and Thyroid-binding globulin loss in presence of proteinuria. The aim of this study was to examine thyroid function in pediatric cases of nephrotic syndrome. In a cross-sectional study, from march 2010 to march 2012, thyroid function tests were performed in 104 patients referred to the Nephrology Department of Children’s Medical Center, Tehran-Iran; because of nephrotic syndrome. Collected data analyzed with SPSS 17 software and p<0.05 used to denote statistical significance. Sixty one cases identified as hypothyroid patients and were treated with supplementary levothyroxine. There were 41 (67.2%) males and 20 (32.8%) females with the mean age of 3.72±3.35 years. Our patients showed lowered T3 (68.3%) and T4 (64.4%) in comparison with normal values. Median Thyroid-stimulating hormone (TSH) was 11.65±6.71 Micu/ml and 2.82±0.82 in the hypothyroid and euthyroid patients respectively. In all, TSH was negatively correlated with the total urinary protein content. According to this study, the occurrence of hypothyroidism in any child with nephrotic syndrome needs to be mentioned. It is proposed to systematically search hypothyroidism by measuring TSH and free T4 in these patients particularly when proteinuria is prolonged.

Mental disorders are a major cause of morbidity and disability in the world and can reduce the success and academic achievement. Experts believe that exercise can be used as a means to achieve favorable mental status. The aim of this study was to investigate the effect of physical education course (1) on mental health of Bu-Ali Sina University students, Hamadan. In this descriptive study, 108 students of Bu-Ali Sina University, were randomly selected as research sample. Data collection tool was the 28-item standard questionnaire of Mental Health of Goldberg (GHQ-28) with 0. 89 reliability. To determine the suspected cases of mental disorders, cutoff point 23 has been used. Data were analyzed using descriptive and inferential statistics (pair t-tests) at the significance level less than 0.05. The findings showed that the average pretest score of students’s mental health were (21.86 ± 8.96) and the average post-test scores were (22.55 ± 10.83). 40.7 percent of participants were suspected to have mental disorders before participation in physical education classes (scores above 23) and decreased to 37% after the end of the semester, the dependent t-test results showed no significant difference between students’s mental health before and after the general physical education (p> 0.05). The post-test results showed that depressive symptoms were significantly increased (p>0.05; 2.81 ± 5.64). The results showed that participation in general physical education classes had no significant effect on mental health; also the depression of students had increased. Thus, regarding the results of this study, in order to promote students’s mental health and increase physical education efficacy and, attention to this problem seems necessary.

Bronchiolitis is a significant cause of acute morbidity in children less than 2 years old and some children with bronchiolitis are admitted to the hospital. In this study we aimed to identify the clinical predictors of hospital admission in children aged 0-24 months with acute bronchiolitis. All children in the age group of 0-24 months presenting with acute bronchiolitis to a dedicated pediatric emergency department of GB Pant Cantonment Children Hospital, Government Medical College Srinagar, India; during April 2012 to March 2013 were included in the study, provided they met the inclusion criteria. The data was analyzed using SPSS software version 17.0. 763[552(72.3%) male, mean age 8.52+ 3.59 months] children (0-24 months) presented with acute bronchiolitis during the study period. 435[313 (72%) male, mean age 6.69+3.8 months] patients were admitted to the hospital. The eight best predictors of admission (age, respiratory rate, heart rate, oxygen saturation, fever, grunt, dehydration and duration of symptoms) were determined. This study has identified clinical predictors of admission in children aged 0-24 months with acute bronchiolitis. This information can be used as a guide in deciding whether to admit a child with bronchiolitis.

Some otolaryngologists administer topical phenylephrine for bleeding control in adenoidectomy surgery. Absorption of this drug from surgical site can lead to increase in blood pressure due to vasoconstriction and then bradycardia related to baroreceptore reflex. Our case was an intraoperative arrest of a 9-year-old girl related to administration of topical phenylephrine during adenoidectomy however, bradycardia is a rare complication of topical phenylephrine in Otorhinolaryngology (Ear, Nose and Throat) (ENT) surgeries probably due to preoperative administration of atropine or glycopirolate. Due to severe complications have been ever seen, avoidance of topical administration of phenylephrine or other vasoconstrictors with undetermined doses is reasonable.

Cytomegalovirus (CMV) is a virus that can be consider as invasive infection after transplantation or chemotherapy, long-term corticosteroid users or in immunodeficient patients such as Human Immunodeficiency Virus (HIV). Different complications, were seen in immunocompetent patients but colitis rarely occurs. The diagnosis of CMV was based on pathology by colonoscopy, positive CMV antigen and high Cytomegalovirus Immunoglobulin M (CMV-IgM) titer serum samples and a good response to systemic gancyclovir treatment. We reported a 20 months girl with bloody diarrhea that her colonoscopy showed CMV ulceration.

Immunoproliferative Small Intestinal Disease (IPSID) is the syndrome associated with Mediterranean lymphoma (a rare form of non-Hodgkin’s lymphoma). Many of the patients diagnosed with secretory IPSID have variable level of abnormal immunoglobulins in serum or other bodily fluids, identified as truncated alpha heavy chain globulins. Most cases are characterized by a loss of ability to synthesize light chains. As such, IPSID has been classified as a heavy chain disorder B-cell lymphoma. We present here the case of a 12-year-old boy admitted in our department for edema, abdominal pain and Failure to Thrive (FTT), in whom we suspected the diagnosis of IPSID.

Neonatal Progeroid Syndrome (NPS) is a premature aging syndrome in which features of human aging are apparent at birth, including larger than normal sized head; prominent scalp veins; triangular, aged face; wrinkled skin; and decreased fat under the skin. This differentiates this syndrome from other premature aging syndromes such as Hutchinson–Gilford Progeria Syndrome (HGPS) more commonly called "progeria" in which characteristics of premature aging typically become apparent some time after birth. Although the exact cause of neonatal Progeroid Syndrome (PS) is unknown, it is believed to be genetic and inherited in an autosomal recessive fashion. Treatment is based on the individual's specific symptoms. A female one month old with features supporting a diagnosis of neonatal progeroid syndrome: Weidman Rautenstrauch Syndrome (WRS) presented to our Neonatology Ward of GB Pant Children Hospital, Srinagar-India. She had prenatal and post natal growth failure, generalized lipoatrophy, triangular face, pseudo hydrocephalous, sparse scalp hair and eye brows, prominent scalp veins and greatly widened anterior fontanelle.

Neonatal Malaria manifests most commonly as fever, anemia, hepatosplenomegaly, jaundice, loose stools and poor feeding however hyperglycemia and hyperlipedemia associated with malaria is not mentioned in literature. A full term neonate was admitted in December 2014, in Neonatal Intensive-care Unit (NICU) as fever and anemia with splenohepatomegaly, his peripheral smear was positive for falciparum malaria with negative sepsis screen however there was hyperglycemia, glucosuria and hyperlipidemia associated with it, malaria was and hyperglycemia was treated with antimalarials and insulin respectively although hyperlipidemia persisted on discharge.

Minimal Change Disease (MCD) is the leading cause of childhood Nephrotic Syndrome (NS). Therefore in pediatrics nephrotic syndrome, most children beyond the first year of life will be treated with corticosteroids without an initial biopsy. Children with NS often display a number of calcium homeostasis disturbances causing abnormal bone histology, including hypocalcemia, reduced serum vitamin D metabolites, impaired intestinal absorption of calcium, and elevated levels of immunoreactive Parathyroid Hormone (iPTH). These are mainly attributed to the loss of a variety of plasma proteins and minerals in the urine as well as steroid therapy. Early diagnosis and management of these abnormalities, could prevent the growth retardation and renal osteodystrophy that affects children with nephrotic syndrome. Here we reviewed the literature for changes of calcium and vitamin D metabolism in nephrotic syndrome and its consequences on bones, also the effect of corticosteroid and possible preventive strategies that could be done to avoid long term outcomes in children. Although the exact biochemical basis for changes in levels of calcium and vitamin D metabolites in patients with NS remains speculative; because of the potential adverse effects of these changes among growing children, widespread screening for vitamin D deficiency or routine vitamin D supplementation should be considered.

In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization (EPI) to ensure that all children have access to routinely recommended vaccines. Since then, global coverage with the four core vaccines (Bacille calmette guérin vaccine [for protection against tuberculosis], Diphtheria-tetanus-pertussis vaccine [DTP], Polio vaccine, and Measles vaccine) has increased from <5% to ≥ 84%. Coverage with the third dose of DTP vaccine (DTP3) by age 12 months is a key indicator of immunization program performance. Estimated global DTP3 coverage has remained at 83%- 84% since 2009, with estimated 2013 coverage at 84%. Global coverage estimates for the second routine dose of Measles-containing Vaccine (MCV2) are reported for the first time in 2013; global coverage was 35% by the end of the second year of life and 53% when including older age groups. Results showed that more than 111 million infants received vaccines in 2013 to protect them from deadly diseases. These infants account for about 84 percent of the world’s children, but an estimated 21.8 million infants remained unvaccinated, according to new estimates from WHO. Three of WHO’s regions reported very high immunization coverage: the Western Pacific with 96 percent; the European Region with 96 percent; and the Region of the Americas with 90 percent. Coverage was slightly lower in the: Eastern Mediterranean Region at 82 percent; in the South-East Asia Region at 77 percent; and in the African Region at 75 percent. Improvements in equity of access and use of immunization services will help ensure that all children are protected from vaccine-preventable diseases.