Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Synbiotic for Prevention of Antibiotic-Associated Diarrhea in Children: A Randomized Clinical Trial5562212110.22038/ijp.2014.2121ENSeyed Ali Jafari1Department of Pediatric Gastroenterology, Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad, IranHamid Ahanchian2Inflammation and Inflammatory Disorder Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Mohammad Ali KianiDepartment of Pediatric Gastroenterology, Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-7869-0828Ali KhakshourDepartment of Pediatrics, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnourd, Iran.0000-0002-6174-6944Zeinab NoorbakhshDepartment of Pediatric Gastroenterology, Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad, Iran.Elham ZamaniInflammation and Inflammatory Disorder Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Hamid Reza KianifarDepartment of Pediatric Gastroenterology, Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad, Iran.kianifarhr@mums.ac.irJournal Article20131122<em>Introduction </em><br/>Antibiotic- associated diarrhea is a common problem in pediatric population. There is growing interest in probiotics, probiotics and synbiotics for prevention of this complication because of their worldwide availability as dietary supplements. The aim of this study was to assess the efficacy of a synbiotic mixture in prevention of antibiotic- associated diarrhea. <br/> <br/><em>Materials and Methods</em><em>:</em> <br/> In this randomized controlled trial, 218 patients ( 111 in the synbiotic and 107 in the placebo group) aged 6 months to 14 years with respiratory tract infection and/ or otitis media who needed antibiotic treatment in outpatient setting, were enrolled. They received 1 billion Colony Forming Unit of seven probiotics species plus Fructooligosaccharide in form of powder or placebo ( matched for size, shape, and volume) for 7 days. Amoxicillin, Amoxicillin-clavalanic acid, cefixim and Azithromicin were the most common drugs used by physcicians Mothers recorded stool frequency and consistency daily for 7 days. <br/> <br/><em>Results:</em> <br/>We found no significant difference (P>0.05) in occurrence of diarrhea between synbiotic and placebo groups. <br/> <br/><em>Conclusion:</em> <br/>This synbiotic mixture did not appear to reduce antibiotic- associated diarrhea in children. Further studies are needed to investigate the potential benefits of Synbiotics in prevention of this disease. <br/> Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Utility of Modeling End-Stage Liver Disease in Children with Chronic Liver Disease7174212310.22038/ijp.2014.2123ENHamid Reza KianifarDepartment of Pediatric Gastroenterology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.kianifarhr@mums.ac.irSanaz Jafarzadeh FakhariDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMaryam KhalesiDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMohammad Ali KianiDepartment of Pediatric Gastroenterology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-7869-0828Atefeh EzzatiGhaem Hospital Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.Seyed Ali JafariDepartment of Pediatric Gastroenterology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Journal Article20131123<em>Introduction:</em> <br/>Chronic liver diseases consist of wide spectrum disorders that may be complicated by cirrhosis and therefore need to transplantation. The pediatric end-stage liver disease (PELD) score and model of end-stage liver disease (MELD) score has been used as predictors of mortality chronic liver diseases listed for liver transplantation. The aim of this study is evaluation of relation between PELDMELD score and evidence of cirrhosis in children with choronic liver disease. <br/> <br/><em>Materials and Method: </em><br/>This cross-sectional study conducted on 106 patients of chronic liver disease referred to Ghaem Haspital, Mashhad University of Medical Science, Iran during 24 months period (2010-2013). PELD and MELD score were calculated for all patients. Clincal and patholoogical findings of cirrhosis were recorded. <br/> <br/><em>Results: </em><br/>Mean age of patients was 68/3 ± 41.8 months. Mean PELDMELD score was -1/59± 9/64. There was significant correlation between PELDMELD score and clinical icter, spelenomegaly, evidence of hepatopulminary syndrome, esophageal varices, evidence of cirrhosis in tissue specimences. <br/> <br/><em>Conclusion:</em> <br/>PELDMELD score appear to be benefit for detection of cirrhotic children among paients with choronic liver disease.Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Maternal Knowledge and Attitude toward Exclusive Breast Milk Feeding (BMF) in the First 6 Months of Infant Life in Mashhad6369212210.22038/ijp.2014.2122ENBibi Leila HoseiniMidwifery MSc; Faculty Member of Midwhfery Department, Sabzevar University of Medical Sciences, Sabzevar, Iran.0000-0003-0960-5359Rahim VakiliDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-7707-7052Mohammad Ali KianiDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-7869-0828Ali KhakshourDepartment of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran.0000-0002-6174-6944Masumeh SaeidiStudents Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Journal Article20131122<em>Introduction: </em><br />Breast milk is a complete food for growing children until 6 months of age, and mothers, as the most important child health care, play a decisive role in their growth. So promoting their attitude toward the benefits of breastfeeding ensures guarantee child health in the future. This study aimed to assess maternal knowledge and attitude of Mashhad toward exclusive BMF in the first 6 months of infant life. <br /> <br /><em>Materials and Methods</em><em>: </em><br />This cross-sectional descriptive-analytic study was conducted on 126 mothers who referring to Mashhad health-care centers for monitoring their 6-24 month year old infants. They completed questionnaire. Participants were selected by cluster and simple random sampling. Data were analyzed by descriptive- analytic tests and using SPSS 11.5. <br /> <br /><em>Results: </em><br />Mean score of maternal attitude toward exclusive BMF was 14.32±5.28 (out of 28) and maternal knowledge score toward advantages of breast milk was 19.59±4.80 (out of 28). The incidence of exclusive BMF in the first 6 months of life study was 73.8%. Child growth was as follows: excellent growth (5.6%) and good growth (42.1%). ANOVA showed a significant difference between parents' education and maternal attitude towards exclusive BMF; whatever higher education of parents, more positive maternal attitude towards exclusive BMF (P<0.05). There was a significant direct relationship between knowledge and attitude (Spearman test, P-value= 0.000& r= 0.4). <br /> <br /><em>Conclusion</em><em>: </em><br />Maternal attitude towards exclusive BMF was moderate. It is essential to plan for mothers by officials in order to promote breast-feeding in the first 6 months of baby's life to enhance positive maternal attitude in this regard.Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Mothers’ Experiences with Premature Neonates about Kangaroo Care: Qualitative Approaches7582212410.22038/ijp.2014.2124ENTahere SalimiDepartment of Nursing, Faculty of Nursing, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Mahsa KhodayarianDepartment of Nursing, Instructor of Nursing Management, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Mahshid BokaieDepartment of Midwifery, Faculty of Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Mahnaz AntikchiDepartment of Nursing, Nursing Student and Member of Student Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Samane JavadiDepartment of Nursing, Nursing Student and Member of Student Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Journal Article20131015<em>Introduction:</em> <br/> Premature neonates admitted in NICU besides being separated from their mothers are prone to inevitably painful and stressful situations. Kangaroo care is the most effective method to get rid of this separation and its negative consequences. This study was performed to determine the experiences of mothers having premature neonates concerning Kangaroo care. <br/> <br/><em>Material and Methods:</em> <br/>The present study is a qualitative research in which focus group discussion method is used for data collection. Research society consisted of mothers having premature neonates Research group reread and categorized the qualitative findings. Contents of interviews were analyzed using the conventional interpretation approach introduced by Dicklman Method. <br/><em> </em> <br/><em>Results:</em> <br/>Through content analysis of information emerged two major categories including mothers’ experiences about advantages of kangaroo care in interaction with neonate, and, feeling of physical-mental healthiness of neonate. Executive obstacles of kangaroo care from mothers’ standpoint were also discussed, which will be subsequently presented. <br/> <br/><em>Discussion:</em> <br/>According to the obtained results, it seems vital to highlight kangaroo care as a safe and effective clinical care-taking treatment in nursery of premature neonates in all hospitals. Nurses shall provide all mothers with the needed instructions for holding the premature and lower-weight neonate properly on their chests and shall promote their knowledge level concerning positive effects of kangaroo care including induction of tranquil sleep, optimization of physiological conditions of neonate, and removal of suckling obstacles.Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Association of Pediatric Stress Hyperglycemia with Insulin Metabolism Disorders8387222110.22038/ijp.2014.2221ENPeyman EshraghiDepartment of pediatric Endocrinology and Metabolism, Facultyof Medicine, Mashhad University of Medical Sciences(MUMS), Mashhad, Iran.Sepideh BagheriDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical sciences(MUMS), Mashhad, Iran.Setareh KamelMedical Student, Babol University of Medical Sciences, Babol, Iran.Journal Article20131015<em>Introduction:</em> <br/>Transient hyperglycemia is a condition that happens during acute physiologic stress in children. The aim of this study is to determine if there is any relation between stress hyperglycemia and diabetes mellitus and metabolic syndrome in pediatric patients. <br/> <br/><em>Materials and Methods:</em> <br/> The study was performed on children hospitalized in Amirkola pediatric hospital, North of Iran, between February 2011 to January 2013. Children with a history of stress hyperglycemia were studied for the presence of metabolic syndrome or Anti GAD65 Autoantibodies. A total of 50 patients were studied. <br/> <br/><em>Results</em>: <br/>None of our patients had developed type 1 diabetes. OGTT was normal in all patients. Metabolic syndrome was present in 2 cases (4%). The prevalence of insulin resistance was 16%. The most common metabolic abnormality noted was hypertriglyciredemia and one patient was positive for GAD 65 autoantibody. <em>Conclusion</em>: According to our data children with stress hyperglycemia do not appear to be at increased risk of developing type 1 diabetes but insulin resistance is relatively common in these patients.Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Viewpoints of Traditional Iranian Medicine (TIM) about Etiology of Pediatric Constipation8992212510.22038/ijp.2014.2125ENMohhad Reza NorasPhd student, Students Research Committee, Faculty of Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Mohammad Ali KianiDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-7869-0828Journal Article20131010<em>Introduction</em> <br/>Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. The diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Complementary and alternative medical therapies and practices are widely employed in the treatment of the children Constipation. This article aims to be a practical guide for paediatricians and primary care physicians, to outline the current etiology an TIM for the medical management of constipation in children. <br/><em>Materials and Methods:</em>To make the review more reliable, we collected the references on Pediatric Constipation epidemiology,pathogenesis and pathophysiology mainly from the journals and text book which authorized by Iranian and conventional Medical Association and represent the highest level of literature. <br/><em>Results:</em> Chronic constipation is a common pediatric problem affecting children worldwide. Exact etiology in conventional Medical is unclear in the majority and is thought to be functional in origin. “Constipation” in the traditional medicine books is known as “abdominal block”and three causes of constipation: nutritional factors, intra intestinal factors, extra intestinal factors. <br/><em>Conclusion:</em> Investigations from Iran and conventional medicine provide some new findings in the research and may help the future understanding of Pediatric Constipation .This detailed literature review may help the understanding and promoting the future studies on Pediatric Constipation.Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101A Treatable Refractory Epilepsy: A Case Report9396212610.22038/ijp.2014.2126ENJavad AkhondianProfessor of Pediatric Neurology Ward, Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-8469-3523Farah AshrafzadehProfessor of Pediatric Neurology Ward, Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-8345-5646Mehran BeiraghiAssistant Professor of Pediatric Neurology Ward, Faculty of Medicine,Mashhad University of Medical
Sciences, Mashhad, Iran.Forugh RakhshaniAssistant Professor of Pediatric Neurology Ward, Faculty of Medicine,Mashhad University of Medical
Sciences, Mashhad, Iran.Journal Article20131210<em>Introduction </em><br/>Biotinidase deficiency is a life threatening inborn error of metabolism specially when delayed in diagnosis. <br/>We report a 2-month-old male infant that presented with refractory infantile spasm, alopecia and seborrheic dermatitis. With a high suspicion of the biotinidase deficiency we started biotin 10 mg daily orally before definite diagnosis was made. Rapid treatment was life-saving and all complications disappeared rapidly. <br/>With this report we tried to explain the clinical manifestations of biotinidase deficiency and show the importance of early diagnosis and treatment in resolving the complications. <br/> Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Glutaric Acidemia Type 1: Case Report9799212710.22038/ijp.2014.2127ENZarin BanikazemiBiochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Mohsen MazidiBiochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Mohsen NematyBiochemistry and Nutrition Research Center, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Journal Article20131128Introduction: <br/>Glutaric academia type I is a metabolic disorder that is caused due to deficiency of glutaryl-CoA dehydrogenase. Macrocephaly is a common sign in GA1, although many infants usually appear healthy at birth. <br/> <br/>Case Report <br/>A 5.5 year old boy with GA1was admitted to NICU. Chief compliance of patient for hospitalization was pneumonia and sepsis and he was intubated and mechanically ventilated. This disease was diagnosed with signs of set developmental delay at 8 months oldand during these years; he was under control for nutritional counseling with a nutritionist and pediatrician. Nutritional support for this patient was in NICU. <br/> <br/>Conclusion <br/>Medical treatment combined with nutritional support in GA1 managementsigns of serious illness; also dietary treatment control may are needed to reduce progression of the neurological damage.Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50472120140101Congenital Rickets: Report of Four Cases101105212810.22038/ijp.2014.2128ENRahim VakiliDepartment of Pediatrics Endocrinology,Faculty of Medicine, Mashhad University of Medical Sciences(MUMS), Mashhad, Iran.0000-0002-7707-7052Peyman EshraghiDepartment of Pediatrics Endocrinology,Faculty of Medicine, Mashhad University of Medical Sciences(MUMS), Mashhad, Iran.Alireza Ataei NakhaeiDepartment of Pediatrics Endocrinology,Faculty of Medicine, Mashhad University of Medical Sciences(MUMS), Mashhad, Iran.0000-0002-5699-8880Saba VakiliStudents Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.Ali KhakshourDepartment of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran.0000-0002-6174-6944Masumeh SaeidiStudents Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.Behjat ZarifMashhad University of Medical Sciences, Mashhad, Iran.Somayeh NateghiMashhad University of Medical Sciences, Mashhad, Iran.Journal Article20131018<em>Introduction</em><em>:</em> <br/>Vitamin D deficiency and rickets continue to be health problems in developing countries and most of the infants with congenital rickets may present with hypocalcemic seizure. <br/> <br/><em>Case Report</em> <br/>In this article, the report on four infants who presented with hypocalcemic seizures but subsequently were found to have congenital rickets is presented. All of them had hypocalcaemia and low level of serum 25- hydroxy vitamin D. Their mothers had not received vitamin D supplementation during pregnancy and so evidence of vitamin D deficiency was presented. <br/><em> </em> <br/><em>Conclusion</em><em>: </em><br/>Although current vitamin D supplementation guidelines for infants was effective in prevention of rickets in Iranian children, it is necessary to evaluate women before pregnancy to prevent this entity. Also infants without vitamin D supplementation therapy who present with seizures during the first 6 months of age should undergo biochemical and other investigations for rickets.