Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Evaluation of Clarithromycin and Metronidazole Resistance of Helicobacter Pylori Infection in Symptomatic Iranian Children892589331140610.22038/ijp.2018.34347.3028ENMohammad Bagher HaghighiPediatric resident, Mofid Children Hospital, Faculty of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Naghi DaraPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-1881-8893Roxana Mansour GhanaiePediatric Infectious Research center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Leila AzimiPediatric Infectious Research center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-7216-2530Amirhossein HosseiniPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0001-8103-8833Saleheh TajalliNeonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-2045-6430Mahmoud HajipourStudent Research Office, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0001-8187-9114Aliakbar SayyariPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Farid ImanzadehPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Katayoun KhatamiPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Pejman RohaniPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Beheshteh OlangPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Journal Article20180820<span style="font-family: Times New Roman;"><em>Helicobacter Pylori</em> (H. pylori) as a gram-negative bacterium is the most common infection of the gastrointestinal tract, and worldwide it affects the children over three years of age. H. pylori could cause gastrointestinal and extra-intestinal manifestations. Antibiotic resistance can happen primarily and occurs during treatment. We aimed to evaluate the resistance gene of H. pylori obtained from gastric biopsy by polymerase chain reaction (PCR) method in Iranian children over 3 years old. </span><br /> <strong><em><span style="font-family: Times New Roman;">Materials and Methods</span></em></strong><br /> <span style="font-family: Times New Roman;">This study was a cross-sectional to evaluate the resistance gene of H. pylori obtained from gastric biopsy by polymerase chain reaction method for metronidazole and clarithromycin in children over three years old referring to the Mofid Children's Medical Center in Tehran, Iran.</span><br /> <span style="font-family: Times New Roman;"><strong><em>Results: </em></strong>Finally, data from seventy-nine samples included (mean age=10.7 years and male gender = 60.8%). <em>Beta Globulin (BG)</em> gene were detectable in 75 (94.93%) specimens of 79 (100%). Seventeen out of 75 specimens showed positive results for molecular detection of H. pylori. The results of RFLP-PCR technique showed that mutation of <em>RdxA</em> gene in seven of 17 (41.1%) for Metronidazole resistance and one case of 17 (5.8%) mutation of 23Y RNA gene that leads to clarithromycin resistance.</span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion: </span></em></strong><br /> <span style="font-family: Times New Roman;">Regarding the results of our study, it is better to check microbial resistance by culture and antibiogram for the antibiotic regimen of the first and second line of H. pylori treatment in children.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Genotype Pattern of Pediatric Familial Mediterranean Fever in Jordan: A Single Center Experience893589401147110.22038/ijp.2018.34530.3037ENRaed AlzyoudPediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, King Hussein Medical Center, Amman, Jordan.0000-0002-4972-5809Motasem AlsweitiPediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, King Hussein Medical Center, Amman, Jordan.0000000194946312Hiba MaittahPediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, King Hussein Medical Center, Amman, Jordan.Boshra AdaylehPediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, King Hussein Medical Center, Amman, Jordan.Mohammed AlnobaniPediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, King Hussein Medical Center, Amman, Jordan.Adel AlwahadnehPediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, King Hussein Medical Center, Amman, Jordan.Mohammed Abu-ShukairPediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, King Hussein Medical Center, Amman, Jordan.Journal Article20180830<strong><em><span>Background</span></em></strong><br /> <span>Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder caused by mutations in the MEFV gene. The disease is especially common among Mediterranean ancestry, mostly Armenian, Turkish, Jewish and Arab populations. We aimed to describe genotype pattern of FMF in the Jordanian children and to compare it with other populations.</span><br /> <strong><em><span>Materials and Methods</span></em></strong><br /> <span>A retrospective analysis of MEFV mutations in pediatric patients, who were below 14 years of age, diagnosed as FMF and followed up <span> </span>at Queen Rania Children’s Hospital in Jordan between 2014 and 2017.</span><br /> <strong><em><span>Results</span></em></strong><br /> <span>A total of 196 pediatric patients were diagnosed with FMF; 54% Females and 46% males. The mean age of patients was 7.8 ± 3.1 years; mean age at disease onset was 4.9 <span style="text-decoration: underline;">+</span> 2.3 years old. MEFV gene mutations were homozygous in 47(24%) patients, heterozygous in 87(44.4%) patients, compound heterozygous in 55(28.1%), and negative genotype in 7(3.6%) patients. Five mutations were the most frequent; M694V, E148Q, M680I, M694I, respectively. </span><br /> <strong><em><span>Conclusion</span></em></strong><br /> <span>The five-founder FMF mutations were the most detected in Jordanian children but in different order than what had been reported.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Nurses' Attitudes and Beliefs about the Provocative Psychological Factors for Self-Injury: A Descriptive Qualitative Study894189501126910.22038/ijp.2018.33584.2968ENFatemeh Ghaedi HeidariPhD Candidate of Nursing, Student Research Committee, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0002-0313-6347Jahanger MaghsoudiAssistant Professor, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0001-5129-9258Masoud BahramiAssociate Professor, Cancer Prevention Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0001-6783-848XGholamreza KheirabadiAssociate Professor, Behavioral Sciences Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20180722<strong><em><span>Background </span></em></strong><br /> <span>Nurses have an important role in taking care of self-injury patients <span>and</span> their attitudes would affect the quality of care for these patients<strong>. </strong>Controversial results have been reported about the nurses’ attitude.Also, culture and context affect nurses’ attitudes. The study aimed to explore the nurses' attitudes and beliefs about the <span>provocative</span> psychological factors for self-injury in an Iranian context. </span><br /> <strong><em><span>Materials and Methods: </span></em></strong><span>The present study was a descriptive qualitative research that was conducted on 12 experienced nurses in taking care of self-injury patients from three hospitals of Isfahan, using purposive and snowball sampling. Data were gathered from January to July 2017 through individual semi-structured interviews and were analyzed using conventional content analysis approach and Graneheim and Lundman method. </span><br /> <strong><em><span>Results</span></em></strong><br /> <span>Findings of the study were described in two main categories including intrapersonal factors of self-injury and interpersonal factors of self-injury. The first main category contained two subcategories including poor self-awareness and self-esteem and personality immaturity. The second category <span>consisted</span> of three subcategories including outburst of emotions, losing spirituality and low psychosocial efficiency. </span><br /> <strong><em><span>Conclusion</span></em></strong><br /> <span>The study provide an insight into how people's mental immaturity contributing to the framing of people as vulnerable to self-injury. Therefore, it is necessary to develop and perform multiple psychological interventions such as training coping strategies to decrease the risk of self-injury. Also, policies should be adopted to promote psychosocial support for these patients.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Investigation of the Risk Factors for Congenital Hypothyroidism in Iran: A Population-Based Case-Control Study895189581148210.22038/ijp.2018.32945.2909ENSima BaridkazemiImam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.Hamid Reza BahramiDepartment of Complementary and Chinese Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-5756-0952Reza Eftekhari GolDepartment of Health Network Development and Health Promotion, Mashhad University of Medical Sciences, Mashhad, Iran.Ehsan Mosa FarkhaniDepartment of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-0474-5611Seyed Javad HoseiniDepartment of Medical Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-9836-7745Journal Article20180624<strong><em><span>Background</span></em></strong><br /> <span>Congenital hypothyroidism (CH) is one of the most common causes of mental disability, which can be prevented in the case of early diagnosis and treatment. We aimed to study the some relevant risk factors for CH in neonates born in Khorasan Razavi Province, Iran. </span><br /> <strong><em><span>Materials and Methods: </span></em></strong><br /> <span>This was a population-based case-control study conducted on 97,380 neonates.</span><span>The study population consisted of neonates born from April, 2016 to March, 2018 and undergone a screening program for CH</span><span>.</span><span>Overall, 530 neonates diagnosed with CH by a specialist were assigned to a case group and the remaining were considered as controls. Information was extracted from the Sina Electronic Health Record System (SinaEHR<sup>®</sup>, Iran). Bivariate and multivariate logistic regressions were carried out to determine the associations between independent variables and CH.</span><br /> <strong><em><span>Results: </span></em></strong><span>Of the 97,380 neonates, the case and control groups included 530 (248 females) and 96,860 (47,061 males) newborns, respectively. In multivariate analysis, the use of neonate formula (adjusted odds ratio [AOR]=0.63; 95% confidence interval [CI]: 0.43-0.93, P=0.02), medication during pregnancy (AOR=1.29; 95% CI: 0.86-1.94, P=0.23), maternal hypertension (AOR=3.25; 95% CI: 1.15-9.19, P=0.03), maternal depression (AOR=2.19; 95% CI: 1.16-4.14, P=0.02), maternal diabetes (AOR=0.65; 95% CI: 0.51-0.83, P=0.001), <span>consanguineous marriage</span> (AOR=1.34; 95% CI:1.12-1.60, P=0.002), place of residence, and birth season after adjusting for confounding variable remained in the final model. </span><br /> <strong><em><span>Conclusion: </span></em></strong><span>The study findings showed that birth season, place of residence, maternal hypertension and depression, and consanguineous marriage can be the main risk factors for CH. However, further studies are needed to analyze the findings of the present study to be more confident about the causality of these relationships. </span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Psychometric Properties of the Revised Osteoporosis Knowledge Test in Iranian Adolescent895989681132710.22038/ijp.2018.33857.2987ENFatemeh GhelichkhaniMaster of Science in Midwifery, Midwifery Department, Faculty of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Islamic Republic of Iran.0000-0002-2911-9756Mojgan MirghafourvandAssociate Professor of Reproductive Health, Midwifery Department, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.0000-0001-8360-4309Mohammad Asghari JafarabadiProfessor of Biostatistics, Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.0000-0003-3284-9749Solmaz Ghanbari HomayiPhD Student in Midwifery, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.0000-0001-5105-9828Ellahe Bahrami-vazirMaster of Science in Midwifery, Midwifery Department, Faculty of Nursing and Midwifery, Tuyserkan Branch, Islamic Azad University, Tuyserkan, Islamic Republic of Iran.0000-0001-7542-0972Azam MohammadiMaster of Science in Midwifery, Midwifery Department, Faculty of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Islamic Republic of Iran.0000 0002 8477 0939Journal Article20180801<strong><em><span>Background: </span></em></strong><span>Osteoporosis knowledge test is a comprehensive questionnaire that evaluates risk factors, nutrition and exercise recommendations, as well as general subjects such as bone evolution, diagnosis, and osteoporosis treatment. The aim of this study was to determine the psychometric characteristics of the revised version of osteoporosis knowledge test (OKT) in Iranian adolescent population.</span><br /> <strong><em><span>Materials and Methods: </span></em></strong><span>This is a cross-sectional methodological study that studied 330 high school students. Sampling was conducted in public and private schools in Saveh, Iran. Schools and students in each school were randomly selected.The translation validity was examined using Forward and Backward translation. Content validity was examined in two qualitative (assessment of experts’ opinions) and quantitative (using the content validity ratio (CVR) and Content Validity Index [CVI]) parts. Face validity was determined on 30 high school students. The generalized factor analysis (GFA) was used to evaluate the construct validity of the instrument. The reliability was determined in terms of reproducibility via intra-class correlation coefficient (ICC) by test–retest and internal consistency (Cronbach’s alpha) on 20 participants. </span><br /> <strong><em><span>Results: </span></em></strong><span>Content validity indices, CVI and CVR, for OKT were 0.97 and 0.99, respectively. Reliability was confirmed in two dimensions of intra-class correlation coefficient (ICC = 0.69), and internal consistency (α = 0.81). Construct validity was confirmed using the generalized factor analysis.</span><br /> <strong><em><span>Conclusion: </span></em></strong><span>Findings support the validity and reliability of osteoporosis knowledge test. </span><span>Therefore, it is recommended that the instrument can be used in both clinical practice and research </span><span>in Iranian adolescent population.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Fetal Echocardiography Indications: A Single- Center Experience896989761124610.22038/ijp.2018.33268.2938ENShirin Sadat GhiasiFaculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.https://orcid.org/00Hassan Mottaghi Moghaddam ShahriDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000000239792151Elahe HeidariDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0001-6995-9779Journal Article20180708<span style="color: #333333; font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Background</span></em></strong></span><br /> <span style="color: #333333; font-size: x-small;"><span style="font-family: Times New Roman;">Congenital heart disease (CHD) is the most common lethal congenital anomaly. Early diagnosis of CHD by fetal echocardiography based on maternal and fetal indications is important and lifesaving. The aim of study was to assess the referral aspects of pregnant women to pediatric cardiologist.</span></span><br /> <span style="color: #333333; font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Materials and Methods</span></em></strong></span><br /> <span style="color: #333333; font-size: x-small;"><span style="font-family: Times New Roman;">This was a retrospective cross-sectional study on 250 documents of referred pregnant women, which was conducted in Imam Reza hospital (Mashhad city, Iran) from 2012 to 2017. Relevant factors of referral to pediatric cardiologist were assessed in an unselected population of pregnant women, mostly based on guideline indications. Data were analyzed using SPSS software version 16.0.</span></span><br /> <span style="color: #333333; font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Results</span></em></strong></span><br /> <span style="color: #333333; font-size: x-small;"><span style="font-family: Times New Roman;">From 250 fetuses 59.8% were male. The most common reasons of referral were abnormal ultrasonography and family history of CHD with 83% and 28.8 %, respectively, which were referred mostly by gynecologist (53.7%). Fetuses were mostly singleton (98. 8%). Five and six percent had associated extra-cardiac anomalies, mostly central nervous system and renal disorders. The mean age of referred pregnant women was 31.5+5.14 years. The mean age of gestation was 24.5<span style="text-decoration: underline;">+</span> 6.09 weeks. Seventy-one cases (28.4 %) have similar history in prior children. </span></span><br /> <span style="color: #333333; font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong></span><br /> <span style="color: #333333; font-size: x-small;"><span style="font-family: Times New Roman;">Timely referral to pediatric cardiologist as an extraordinary benefit for pregnant women and also ongoing follow- up for the baby is requires an organized observation. Assessment and comparison with universal guidelines reveals our shortcomings. More than half of referred cases were identified too late in time and the whole indications were not done accurately.</span></span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Effect of Vitamin D Supplementation on Pancreatic Β -Cell Function in Patients with Type 1 Diabetes Mellitus and Vitamin D Deficiency: A Clinical Trial Study897789841133210.22038/ijp.2018.33805.2986ENMorteza Alijanpour AghamalekiNon-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran.0000-0002-0031-4718Mahmoud HajiahmadiNon-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran.0000-0001-9721-1629Mohammad PornasrollahNon-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran.0000-0002-3161-1440Zahra OrujiNon-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran.0000-0001-5079-3246Faeze AghajanpourUniversity of Mazandaran, Babolsar, IR Iran.0000-0002-1698-6906Journal Article20180730<strong><em>Background</em></strong><br /> Considering the increasing prevalence of type 1 diabetes mellitus (T1DM) as an autoimmune disease in recent years and the positive effects of vitamin D (VD) on this disease, especially the preventive effect of VD on progressive reduction of pancreatic β-cells, we aimed to investigate the effect of VD on <em>pancreatic β-cell function in </em>T1DM patients.<br /> <strong><em>Materials and Methods</em></strong><br /> From Sep 2016 to Nov 2017, this single-blind clinical trial study was performed on patients who have affected with T<sub>1</sub>DM in the last five years, referred to Endocrinology Clinic of Amirkola Children's Hospital in Babol city of Iran. The patients with VD level less than 30 ng/mL were treated with <em>50, 000</em>IU Pearl <em>VD for 9 months.</em> The patients' C-peptide, 25 (OH) D, HbA1C and total <em>daily dose</em>(<em>TDD</em>) <em>insulin </em>were compared at the beginning and end of the study. Data were analyzed using <em>SPSS software version 22</em>.0.<br /> <strong><em>Results</em></strong><br /> By examining all 30 randomly selected children meeting the inclusion criteria, it was found that VD increased the C-peptide level (0.06 nmol/L), slightly improved the pancreatic β-cell function as well as decreased their HbA1c (0.64%), and TDD<span style="font-family: Times New Roman; font-size: medium;"> insulin</span> levels (0.05 unit) although none of the relationships was significant. However, a significant decrease in HbA1c level was found in the female group (p=0.04) as well as in the age group less than 10 years (p=0.007).<br /> <strong><em>Conclusion</em></strong><br /> VD intake had no significant effect on serum C-peptide levels and reduction of HbA1c and TDD<em> insulin</em> though a significant decrease in HbA1c level was observed in the female group and in the patients less than ten years.Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201The Association between Dental Health Status and Oral Health-Related Quality of Life of Children Diagnosed with -Thalassemia Major in Zahedan City, Iran898589911147510.22038/ijp.2018.34517.3034ENForoogh AmirabadiAssistant Professor, Oral and Dental Diseases Research Center, Department of Pediatric Dentistry, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran.0000-0002-6867-0348Shirin SaravaniAssociate Professor, Oral and Dental Diseases Research Center, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran.0000-0002-6647-9611Ghasem Miri-AliabadAssociate Professor, Children and Adolescent Health Research Center, Department of Pediatric Hematology-Oncology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.0000-0002-9112-5567Mahnaz Khorashadi-Zadehentist, Zahedan University of Medical Sciences, Zahedan, Iran.Journal Article20180829<strong><em><span>Background: </span></em></strong><span><span>b</span></span><span>-thalassemia major is a common hereditary blood disease that can affect patients’ oral health and quality of life. The present study aims to determine the relationship between health of deciduous teeth and the Oral Health-Related Quality of Life (OHRQoL) in children diagnosed with β-thalassemia major compared with healthy children.</span><br /> <strong><em><span>Materials and Methods</span></em></strong><br /> <span>This cross-sectional study was performed on 50 children diagnosed with β-thalassemia major and 50 healthy children aged 3-6 years old. Decayed, missing, and filled teeth (dmft) of the participants were measured according to the World Health Organization (WHO) criteria and the OHRQoL with the Early Childhood Oral Health Impact Scale (ECOHIS). Data were analyzed using SPSS software version 19.0.</span><br /> <strong><em><span>Results: </span></em></strong><span>The results showed that the dmft index of the patient group with a mean of 5.36 was significantly higher than the healthy group with a mean of 3.36. The mean OHRQoL in the patient group (19.24) was significantly higher than that of the healthy group (11.24). The mean dmft had a significant positive relationship with the ECOHIS score of the children with thalassemia major (r=0.769, p=0.000), and healthy children (r=0.756, p=0.000).</span><br /> <strong><em><span>Conclusion: </span></em></strong><span>According the results, the positive correlation between the dmft index and the mean OHRQoL indicated that dental problems in most children with β-thalassemia major are associated with a poorer OHRQoL. Since the dmft index and ECOHIS were higher among children diagnosed with β-thalassemia major, the prevention and treatment of dental problems seem necessary for improving their quality of life.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Psychometric Properties of Breastfeeding Attrition Prediction Tool (BAPT): A Systematic Review899390011136910.22038/ijp.2018.34001.2996ENNajmeh Rajabi GharaiiMidwife, Hasheminejad Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0001-6814-3954Zahra HesarinejadMashhad University of Medical Sciences, Mashhad, Iran.Masoome NasibiFaculty Member of Neyshabur University of Medical Sciences, Neyshabur, Iran.Masumeh GhazanfarpourDepartment of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.0000-0003-4639-3711Faezeh GhorbaniDepartment of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.Leila KargarfardInstructor of Fatemeh School Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.Journal Article20180807<span style="font-size: x-small;"><strong><em>Background</em></strong></span><br /> <span style="font-family: Times New Roman; font-size: x-small;">It is necessary to identify women who discontinue the breastfeeding to achieve the purpose of increasing the length of breastfeeding. To this end, Breastfeeding Attrition Prediction Tool (BAPT) has been developed. The current systematic review aimed to comprehensively review the validity and reliability of BAPT scale with different versions to give comprehensive information for authorities in this field.</span><br /> <span style="font-size: x-small;"><strong><em>Materials and Methods</em></strong></span><br /> <span style="font-size: x-small;">Three English databases including Medline (via PubMed), Scopus, and Cochran library until May 2018 with no date restriction were searched. The search strategy was developed based on main terms of (Breastfeeding Attrition Prediction Tool OR BAPT) AND (Reliability OR validity OR Psychometrics OR Factor Analysis). Two reviewers separately extracted the required data available in full-text of all the quality of related studies was investigated using COSMIN checklist.</span><br /> <span style="font-size: x-small;"><strong><em>Results</em></strong></span><br /> <span style="font-size: x-small;">All Cronbach alpha coefficient (both overall and subscale) were in excess of 0.7 except for subscale "NBS" in American version and subscale PBS in Persian version. In term of discriminant and predictive validity, BAPT revealed a good ability to classify women with or without breastfeeding. BAPT predicted breastfeeding status at postpartum period but it was not able to predict breastfeeding status in the third trimester of pregnancy. In term construct validity, four-factor solution of original English version was confirmed in Turkish, Persian and English other version.</span><br /> <span style="font-size: x-small;"><strong><em>Conclusion</em></strong></span><br /> <span style="font-size: x-small;">Overall, the findings of systematic review supported that BAPT may be a valid (content, predictive and construct validity), and reliable (internal consistency and re-test reliability) instrument to use in both researches and clinics to identify mothers who are at risk of breastfeeding stop.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201The Role of Rapid Shallow Breathing Index in Predicting Successful Weaning of Pediatric Patients with Respiratory Failure900390121151210.22038/ijp.2018.34592.3045ENAzar DastranjiFellowship of Pediatric Pulmonology, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.Nemat BilanPediatric Pulmonologist, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.0000-0002-1849-4462Journal Article20180902<strong><em><span>Background </span></em></strong><br /> <span>About 40 to 60% of all patients admitted to pediatric intensive care unitsundergo mechanical ventilation and 10 to 20% will fail to be extubated. We aimed to determine the role of the rapid shallow breathing index (RSBI) in predicting successful weaning of pediatric patients with respiratory failure.</span><span><span> </span></span><br /> <strong><em><span>Materials and Methods: </span></em></strong><span>This cross-sectional study, was performed on 72 mechanically ventilated children (36 in the lung failure group and 36 in the pump failure group) who were admitted in Tabriz children’s hospital in pediatric intensive care unit (PICU), Tabriz city, Iran. In order to spontaneous breathing trial (SBT) criteria, the patients who had FiO<sub>2</sub> less than 40%, PEEP less than or equal to 5 cmH<sub>2</sub>O and PaO<sub>2</sub> higher than 60<sub> mmHg</sub>, was placed on spontaneous ventilation mode (PSV+CPAP) to maintain a PEEP of less than or equal to 5 cmH<sub>2</sub>O, PS of less than or equal to 8 cmH<sub>2</sub>O and FiO<sub>2</sub> of less than or equal to 40%. After 2 hours, measured tidal volume and respiratory rate to calculate the RSBI then the patient was extubated<span lang="FA" dir="RTL">.</span></span><br /> <strong><em><span>Results: </span></em></strong><span>From 72 patients were enrolled in this study, 26 patients failed in extubation. The total RSBI threshold was 6.7 breath/min/ml/kg (AUC = 0.739, 95%CI = 0.618 – 0.861; p = 0.001)) with a sensitivity of 73.1% and a specificity of 80.4% for success of extubation. Patients successfully extubated had significantly lower RSBI 4.65 ± 3.03 breath/min/ml/kg compared to extubation failuregroup.</span><br /> <strong><em><span>Conclusion</span></em></strong><br /> <span>Based on the result of this study, the rapid shallow breathing index with a threshold of 6.7 breath/min/ml/kg was considered to be an acceptable and practical criterion for predicting the outcome of weaning in children.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Availability and Accessibility of Fruit and Vegetable in Home and School for Iranian Students: A Cross-sectional Research in Schools of Tehran, Iran901390251156610.22038/ijp.2018.34681.3051ENSakineh RakhshanderouEnvironmental and Occupational Hazards Control Research Center, Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Yadollah MehrabiEnvironmental and Occupational Hazards Control Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Mohtasham GhaffariEnvironmental and Occupational Hazards Control Research Center, Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0003-1756-5297Journal Article20180905<span><strong><em>Background: </em></strong>Availability and accessibilityarereported as the main determinants of fruit and vegetable consumption among children. The present study was conducted to assess the status of availability and accessibilityto fruit and vegetable at school and home among Iranian adolescents in Tehran, Iran.</span><br /> <span><strong><em>Materials and Methods: </em></strong>This cross-sectional study was conducted to assess status of fruit and vegetable availability and accessibilityamong Iranian adolescents. In this study, 500 adolescents aged 11 to 14 years old were investigated in Tehran, Iran. Subjects were chosen by multi-stage random sampling method. The data collection tool was a valid researcher-made questionnaire consist of 21 questions. The data was analyzed using SPSS software version 16.0.</span><br /> <span><strong><em>Results </em></strong></span><br /> <span>68% (n=344) and 27.2% (n=136) of students reported that fruit and vegetables is available in their home always, respectively. Also, 19.6% (n=98), and 58.4% (n=292) of students reported that most of the times and always unhealthy foods were sold in schools’ buffets, respectively; 88% (n=440) of students declared that they are allowed to take fruit and vegetable from the refrigerator and eat any time they want to. Results showed no significant difference between boys and girls in terms of availability and accessibility(P=0.268). In addition, there was a significant relationship between variables of residential area, family and home size, birth order and the parents’ education level and availability and accessibility (P<0.05). </span><br /> <span><strong><em>Conclusion: </em></strong>Fruit and vegetable availability and accessibility was not acceptable yet among guidance school students in Tehran.It is recommended to implement proper interventions for families, school managers as well as students to promote availability and accessibilityof fruit and especially vegetable for adolescents. </span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Predictors of Intravenous Immunoglobulin (IVIG) Resistance in Children with Kawasaki Disease in Calabria Region, Italy902790361157010.22038/ijp.2018.34895.3074ENValentina TalaricoUnit of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.0000-0001-9027-6921Sara RizzoDepartment of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.Maria CirilloUnit of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.Paola ChiarelloUnit of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.Roberta BianchiUnit of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.Roberto MinieroDepartment of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.Maria Concetta GalatiUnit of Pediatric Oncohematology, Pugliese-Ciaccio Hospital, Catanzaro, Italy.Giuseppe RaiolaUnit of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.Journal Article20180915<strong><em><span style="font-family: Times New Roman;">Background</span></em></strong><br /> <span style="font-family: Times New Roman;">Kawasaki disease (KD) is the second most common childhood vasculitis and one of the main causes of acquired heart disease in children. Recent work focuses on the early diagnostic importance of those risk factors that indicate resistance to intravenous immunoglobulin (IVIG) treatment. The objectives of this study were to identify clinical, laboratory and/or instrumental factors that could be correlated with the risk of resistance to IVIG and the applicability of standard score systems. </span><br /> <strong><em><span style="font-family: Times New Roman;">Materials and Methods</span></em></strong><br /> <span style="font-family: Times New Roman;">We retrospectively reviewed clinical records of 23 children with KD, diagnosed in five consecutive years. They all underwent laboratory and echocardiography investigations and initial treatment with IVIG. Based on the response to IVIG they were divided into two groups: IVIG responders (n=14), and IVIG non-responders (n=9). </span><br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">39% (n= 9) of patients were non-responders. Laboratory exams were overlapping between the two groups except for platelets (p <0.05), and for triglycerides (p<0.01). Among the patients who showed cardiac involvement, 67% were IVIG-resistant (p=0.0094; odds ratio [OR] = 20.0). Coronary artery abnormalities (CAA) at onset were present in 8.69% of patients, all non-responders (p=0.1423; OR=9.66). In this group of patients there were lower values of sodium (p<0.05), and of albumin (p<0.04), and higher bilirubin (p<0.01). </span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong><br /> <span style="font-family: Times New Roman;">In our population it has emerged that some laboratory (low platelet levels, high triglyceride levels), and instrumental factors (CAA at onset, especially if associated with hyponatremia, hypoalbuminemia and hyperbilirubinemia) should be evaluated at the time of diagnosis, as important prognostic factors with a more severe KD shape and greater resistance to IVIG.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Frequency and Clinical Manifestations of Pediatric Brucellosis in Iran: A Systematic Review903790471121710.22038/ijp.2018.33178.2927ENShirin DjalaliniaDeputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran AND Non–communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.Reza ArjmandNon-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.0000-0003-4960-5943Mehri GholamiSocial Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran. 5Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran.Yasaman ShakerStudent Research Committee, Alborz University of Medical Sciences, Karaj, Iran.Sahar Saeedi MoghaddamNon–communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.Kumars PourrostamiDietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran.Omid SafariDietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran.Nasrin ElahimehrDepartment of Pediatric, Emam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran.0000-0001-6379-0458Saeed Nik KhahDepartment of Pediatric, Emam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran.Ehsan ZahmatkeshDepartment of Pediatric, Emam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran.Esfandiar Najafi TavanaDepartment of Pediatric, Emam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran.Mostafa QorbaniNon-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.0000-0001-9465-7588Journal Article20180704<span style="font-size: x-small;"><strong><em>Background</em></strong> </span><br /> <span style="font-size: x-small;">Brucellosis is a zoonotic disease that is widely distributed throughout the developing countries. Children are considered as at risk groups for infection. The aim of this study was to assess the frequency and clinical manifestations of Brucellosis in Iranian children and adolescents.</span><br /> <span style="font-size: x-small;"><strong><em>Materials and Methods</em></strong>: We systematically searched international databases; ISI, Medline (via PubMed), Scopus, and national databases Irandoc, Barakat knowledge network system, Magiran, and Scientific Information Database (SID). The search strategy was developed based on main terms of "Brucellosis," "Brucella fever", "Gibraltar", "Rock Fever", "Undulant Fever", "Cyprus Fever", "Malta Fever", and "Bang Disease".</span><br /> <span style="font-size: x-small;"><strong><em>Results</em></strong><strong>: </strong>A total of 885 studies were identified, from them a total of 12 studies that were conducted between 2001 and 2016 were included. Following the relevancy assessments and quality control, data from the 1,429 participants were presented in our review. The age of the patients ranged from 2 to 18 years. Only one out of twelve studies provided the prevalence of 4.30% and 3.4 incidence. Studies varied greatly in reporting high risk behavior of animal contact (8.4 to76.0%) and unpasteurized dairy (22.4 to 91.6%). </span><br /> <span style="font-size: x-small;"><strong><em>Conclusion</em></strong></span><br /> <span style="font-size: medium;"><span style="font-size: x-small;">Our finding reveals the disparity of reported prevalence and clinical manifestations of Brucellosis in Iranian children. Fever and joint pain were the most frequent reported signs. Differences in study design, measurement tools and methods, and sub population sampling, does not provide the possibility of aggregation of data for more comprehensive inference.</span> </span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Mastoiditis, Bezold Abscess, Dural Sinus Thrombosis, and Bilateral Abducens Nerve Palsy in a Child with Chronic Suppurative Otitis Media: A Rare Case Report904990521166310.22038/ijp.2018.33617.2969ENSuresh AnguranaDepartment and institute, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, 160012.0000-0001-6370-8258Arun BansalDepartment and institute, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, 160012.0000-0001-6212-6889Ankit MehtaDepartment and institute, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, 160012.Sandeep BansalDepartement of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, 160012.Muralidharan JayashreeDepartment and institute, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, 160012.Journal Article20180723 <br /> <span style="font-family: Times New Roman; font-size: x-small;">Chronic suppurative otitis media (CSOM) is a common childhood infectious disease in developing countries. It may be associated with various life threatening intra-cranial or extra-cranial complications. We report a 10 year-male child with a rare combination of right sided unsafe CSOM, mastoiditis, Bezold abscess, sigmoid and transverse sinus thrombosis, and bilateral abducens nerve palsy and he was successfully treated with antibiotics, surgery, and anticoagulation. The combination of CSOM with mastoiditis, Bezold abscess, sigmoid and transverse sinus thrombosis, and bilateral abducens nerve palsy is rare. Aggressive management with prompt antibiotic therapy, surgery, and anticoagulation can lead to favorable outcome.</span><br /> Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477220190201Evaluation of GJB2 and GJB6 Mutations in Patients Afflicted with Non-syndromic Hearing Loss905390601144710.22038/ijp.2018.34154.3017ENSeyed Hamid Reza AbtahiAssociate Professor of Otolaryngology, Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Ali MalekzadehResident of Otolaryngology, Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Saeed SoheilipourProfessor of Otolaryngology, Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Mansour SalehiProfessor of Medical Genetic, Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Roya TalebanCommunity Medicine Specialist, Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Reyhaneh RabieianMSc. in Medical Genetic, Department of Genetics and Molecular Biology, Isfahan University of Medical Sciences, Isfahan, Iran.Mohammad MoafiPostdoctoral Research Fellow, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0003-4290-1432Journal Article20180814<strong><em>Background</em></strong><br /> Non-syndromic hearing loss (NSHL) is assumed as one of the highly prevalent congenital defects in the world. In this regard, <em>gap junction protein beta</em> <em>2</em>(<em>GJB2</em>), and <em>gap junction protein beta 6</em>(<em>GJB6</em>) mutations are considered as the leading congenital causes of deafness. The present study aimed to assess the prevalence of GJB2 and <em>GJB6</em> mutations in NSHL cases.<br /> <strong><em>Materials and Methods</em></strong><br /> This cross-sectional study was implemented from Jan. 2015 to Sep. 2017 at Alzahra Hospital (Isfahan, Iran).46 patients afflicted with NSHL were recognized and recruited by physicians. Heparinized blood was collected and DNA of each participant was extracted. Genetic analysis of GJB2 and GJB6 genes was performed using PCR and GAP-PCR methods respectively.<br /> <strong><em>Results: </em></strong>35delG mutation had the highest prevalence with allelic frequency of 6.12%. The allelic frequencies of 35delG, and delE120 were 6(6.12%), and 3(3.06%), respectively. Allelic frequency of W77R, Y65H, G160, and R127H was 2(2.04%) for each of them. In addition, 2 patients were heterozygous for p.V153I rare polymorphism (2.04%).<br /> <strong><em>Conclusion</em></strong><br /> Overall, the present study indicated that 35delG mutation could be considered as the foremost causative factor of NHCL. <em>GJB2</em> mutations were highly prevalent among NSHL cases (23.9%). As a result, the mutation analysis of this gene could be appropriately used for prevention and early diagnosis of NSHL.