Assessments of Serum 25-Hydroxy Cholecalciferol Levels in Neonates with Physiological Jaundice Candidate for Phototherapy
Nagwan I.
Rashwan
Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
author
Ahmed
El-Abd Ahmed
Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
author
Mohammed H.
Hassan
Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
author
Faten
Bakheet Taqi
Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
author
Mohamed Elsayed
Mohamed Ahmed
Chemistry Department, Faculty of Science, Sohag University, Sohag, Egypt & Analytical Biochemistry Diploma, Chemistry Department, Faculty of Science, Menoufia University, Menoufia, Egypt.
author
Ali
Helmi Bakri
Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
author
text
article
2021
eng
Background In newborns, jaundice is the most common ailment that necessitates medical treatment and hospital readmission. The aim of this study was to evaluate vitamin D3 status and investigate the role of phototherapy in the treatment of jaundice and the improvement of vitamin D3 status in neonates with physiological jaundice. Materials and Methods: This prospective research included 50 full-term neonates with physiological hyperbilirubinemia who were phototherapy candidates. They came from Egypt's Qena University Hospitals' Neonatal Intensive Care Units. Colorimetric assays of albumin and ionized calcium, as well as daily serum bilirubin and an ELISA assay of vitamin D3 were performed on the included cases before and 5 days after phototherapy, in addition to clinical assessments. Results: The findings revealed a high prevalence of vitamin D3 deficiency (96.7%), and a lower frequency of optimal and insufficient vitamin D3 status (3.3%) with lack of optimal vitamin D3 status among cases. Post-phototherapy total, direct, and indirect bilirubin levels were significantly lower than pre-therapy levels, with substantial improvement in vitamin D3 status (p <0.05 for all). Furthermore, both serum total bilirubin (r=-0.703, p <0.001) and serum indirect bilirubin (r=-0.710, p <0.001) had significantly negative associations with vitamin D3 serum levels. Conclusion Without vitamin D3 supplementation, neonates with low vitamin D and physiological jaundice who were received phototherapy had considerably improved vitamin D status 5 days later.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13445
13454
https://ijp.mums.ac.ir/article_17774_37e102766aca67276d698df80066432d.pdf
dx.doi.org/10.22038/ijp.2021.56258.4427
Evaluation of Vitamin D Status and Effective Maternal Factors on Vitamin D Levels in Cord Blood of Infants Born in Zahedan, Iran
Maryam
Nakhaee Moghadam
Pediatric Endocrinologist, School of Medicine, Children and Adolescents Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
author
Gholamreza
Soleimani
Associate Professor of Pediatric Infectious Disease, Department of Pediatrics, School of Medicine, Children and Adolescents Health Research Center, Ali-Ibn-Abitaleb Hospital, Zahedan, Iran.
author
Elham
Shafighi Shahri
Assistant Professor, Fellow of Pediatric Endocrinology, Department of Pediatrics , Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
author
Fatemeh
Akbarirad
Assistant Professor of Pediatrics, Department of Pediatrics, Ali-Ibn-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
author
text
article
2021
eng
Background: The available sources indicate our insufficient knowledge about vitamin D levels in infants born in Iran. Therefore, the aim of this study was to investigate the vitamin D status and effective maternal factors on vitamin D levels in cord blood of neonates born in south-east of Iran.
Materials and Methods: This descriptive-cross sectional study was performed on neonates who were born in Ali-Ibn-Abitaleb Hospital (Zahedan, Iran), and their mothers from August 2020 to January 2021. To assess the maternal serum and umbilical cord level of vitamin D, 5 ml of whole blood (umbilical cord blood and maternal venous blood) was evaluated by enzyme-linked immunosorbent assay. The relationship between different levels of the infants’ vitamin D and some maternal vitamin D deficiency factors were evaluated.
Results: A total of 190 pregnant women & 190 infants participated in this study. The mean serum level of vitamin D in newborns was 37.90 ngr/ml, of which 41(21.8%) were vitamin D deficient. Vitamin D status of neonatal cord blood was significantly related to using vitamin D supplements by mother during pregnancy, parity, maternal literacy level, infant gender, maternal exposure to sunlight and maternal vitamin D status (p<0.05 for all).
Conclusion: Our study showed that using vitamin D supplements by mother during pregnancy, parity, maternal literacy level, infant gender, maternal exposure to sunlight and maternal vitamin D status are related to the infants’ vitamin D status. Further research is needed to determine the reason behind some established relationships in the present research including the relationship between parity and vitamin D in neonates.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13455
13462
https://ijp.mums.ac.ir/article_17659_4339f97a72dccb2ae9abd38714f9f114.pdf
dx.doi.org/10.22038/ijp.2021.56140.4415
Maternal Exposure to Environmental Risk Factors and Risk of Adverse Health Outcomes in Offspring: An Overview
Maryam
Noorzadeh
Assistant Professor, Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University Of Medical Sciences, Tehran, Iran.
author
Mahsa
Naemi
Assistant Professor, Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University Of Medical Sciences, Tehran, Iran.
author
text
article
2021
eng
Exposure to environmental risk factors are common events in pregnant women and it can affect several health outcomes adverse in the offspring. Many observational studies, systematic reviews and meta-analysis have documented the aforementioned association. This narrative review highlights the results of previous studies about different types of adverse health outcomes during infancy, childhood, adolescent and adults that are related to maternal exposure to leading environmental risk factors e.g. smoking, alcohol consumption, infection and air pollution. Also, the review outlines the potential biological plausibility of the association. Hope this review will help to highlights the bivariate association between maternal health during pregnancy and child health as well as further researches to ascertain the potential mechanisms.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13463
13478
https://ijp.mums.ac.ir/article_16494_8a94d8b0cf4b859b4e7bc7a9b6c386b2.pdf
dx.doi.org/10.22038/ijp.2020.51711.4112
Comparison of the Efficacy of Fluvoxamine and Desmopressin-Oxybutynin Combination in the Treatment of Nocturnal Enuresis: A Clinical Trial
Alireza
Attaei Nakhaei
Assistant Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Anoush
Azarfar
Kidney Transplantation Complication Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Mona
Nasiri
Assistant Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Sarah
Ghahremani
Assistant Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Mohadese
Golsorkhi
Kidney Transplantation Complication Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Ali
Alizade Noghabi
Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Yalda
Ravanshad
Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran.
author
text
article
2021
eng
Background: Primary nocturnal enuresis (PNE), with a prevalence of 5-30%, is a common and important disease in children. We aimed to investigate the efficacy of fluvoxamine in the treatment of refractory PNE and to compare it with standard desmopressin-oxybutynin treatment. Materials and Methods: In this pilot clinical trial study,children with PNE referred to the Dr. Sheikh Hospital (Mashhad, Iran, 2019) who were resistant to the first line of behavioral and drug treatment and did not have any other psychological disorders were enrolled in the present pilot clinical trial. Patients were randomly divided into fluvoxamine (25 mg at bedtime for one month), combination therapy (desmopressin, 10μg intranasal), and oxybutynin (0.1 mg/kg for one month). The recovery status of patients in the two groups was investigated and compared based on the number of wet nights during one month. Results: 30 patients with PNE were included in this study. Three patients of the treatment group were excluded from the study due to lack of referral and follow-up. At the end of follow-up in the fluvoxamine treatment group, full recovery was observed in 8 patients (66.7%), partial recovery in 2 patients (16.7%), and no recovery in 2 patients (16.7%). Also, the desmopressin-oxybutynin treatment resulted in full recovery in 7 patients (46.7%), partial recovery in 4 patients (26.7%), and no recovery in 4 patients (26.7%), but there was no significant difference between the two groups in terms of therapeutic results (P> 0.05). Conclusion: Based on the results, there was no difference between the two groups of fluvoxamine and desmopressin-oxybutynin combination in the treatment of nocturnal enuresis.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13479
13488
https://ijp.mums.ac.ir/article_15775_dca7bf39b1b24acf99ca1cfd30798505.pdf
dx.doi.org/10.22038/ijp.2020.49200.3937
Evaluation of Electronic Dental Anesthesia as a Non-Invasive Method in Children: A Review Study
Sina
Sezavar
Department of Dentistry, Golestan University of Medical Sciences,Gorgan, Iran.
author
Mahdieh
Jafari
Department of Anesthesiology, faculty of medicine, Mashhad University of medical sciences, Mashhad, Iran.
author
Fatemeh
Fakhari
Psychologist, Department of Psychology and Education Science, Payame Noor University, Kerman, Iran.
author
Saeed
Abedin
Anesthesiologist ,Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
author
Somayeh
Nazari
PhD Student of Neuroscience, School of Advanced Technologies in Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran.
author
Maryam
Soleimani Houni
Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran.
author
Maryam
Naseri
Pediatrician, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
text
article
2021
eng
Background The findings of various studies have supported the analgesic effect of transcutaneous electrical nerve stimulation (TENS). Studies yielded contradictory findings on electronic dental anesthesia (EDA) as a non-invasive method. This review study aims to evaluate the EDA as a non-invasive method. Materials and Methods This review study was conducted by screening all clinical trials evaluating the EDA in children. An electronic search was performed in Scopus, EMBASE, Cochrane, Web of Science, and Medline with no language or time restrictions. Results Six clinical trials were included in this study. The results of the first study showed that EDA was less effective than local anesthesia. Another study indicated no statistically significant difference between the two groups in terms of perception of pain intensity and comfort. The third study revealed no significant differences between the two methods in terms of the level of pain in the first deciduous molars, but a higher level of pain was reported in the second deciduous molar in the case of the injection method. A comparison of behavioral responses and changes in vital signs of children in local anesthesia and electronic anesthesia methods showed positive responses to the latter. A combination of music and electronic anesthesia was reported to be effective in the relief of pain in children under the treatment of two corresponding deciduous molars. Another study showed that the vibraject technique led to a statistically significant reduction in pain among children. Conclusion The findings of this review study emphasize the importance of analgesic techniques in pediatric dental procedures. The use of new techniques along with conventional methods of analgesia should be taken into consideration, especially in pediatric dentistry.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13489
13494
https://ijp.mums.ac.ir/article_17859_4c5947d1c780aabf097e30c204fa9e6c.pdf
dx.doi.org/10.22038/ijp.2021.57145.4482
Rectal versus Intramuscular Hyoscine: its Effects on Shortening the First Stage of Labor in Term Primigravid Women
Nooshin
Babapour
Faculty of Medicine, Islamic Azad Medical University, Mashhad, Iran.
author
Masood
Hoseini
Resident of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Parisa
Zarif Najafi
Faculty of Medicine, Islamic Azad Medical University, Mashhad, Iran.
author
text
article
2021
eng
Background
Spasmolytic drugs such as hyoscine have been proven to enhance cervical dilatation and accelerate the stages of labor. The aim of this study was to compare rectal and intramuscular hyoscine in shortening the first stage of labor in term primigravid women.
Materials and Methods: In this randomized clinical trial, 80 pregnant women were selected by convenience sampling. One group received two 10 mg rectal suppositories, whereas 2ml intramuscular (IM) hyoscine was administered for the other group, both at the onset of the active phase of labor. The two groups were compared in terms of labor stages, cervix dilatation rate, maternal blood and heart rate, Apgar score at birth and fetal heart rate. The collected data were analyzed using SPSS software (version 21.0).
Results: The mean age of women in the rectal and intramuscular hyoscine groups was 24.5±3.2 and 24.65±4.45 years, respectively. The duration of first and second stages of labor was not significantly different between the two groups (P>0.05); whereas the third stage of labor in the rectal hyoscine group was significantly shorter than IM hyoscine group (P=0.001). The mean 1st and 5th min Apgar scores and the fetal heart rate after drug administration were significantly different between the two groups (P<0.05).
Conclusion
Hyoscine rectal suppository, which is faster absorbed and avoids gastric irritation, was significantly more effective in shortening the duration of labor in comparison to IM hyoscine, although the difference was only in the 3rd stage of labor. Therefore, it is recommended in all pregnancies for accelerating the process of labor.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13495
13502
https://ijp.mums.ac.ir/article_15345_3c1936a84c0eb51a561c5ca5b963ed5d.pdf
dx.doi.org/10.22038/ijp.2020.47645.3859
Thyroid Disorders in Pediatric Patients with Turner Syndrome; A 16 Years' Experience
Moein
Mobini
Department of Pediatric Endocrinology and Metabolism, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
reza
Jafarzadeh Esfehani
Medical Genetic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Saba
Vakili
Medical Genetic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Ahmadreza
Zarifian
Center for Excellence in Clinical Research, Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Rahim
Vakili
Department of Pediatric Endocrinology and Metabolism, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran AND Medical Genetic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
text
article
2021
eng
Background Turner syndrome patients are more likely to develop autoimmune diseases in contrast to the general population. Many research have had controversial results suggest a possible relation between the cytogenetic findings and development of autoimmune thyroid disease in Turner syndrome. Therefore, we aimed to evaluate the prevalence of thyroid disorders and the possible relationship between thyroid disorders with the cytogenetic findings in these patients. Materials and Methods: The present retrospective study took place in pediatric endocrinology clinic of Imam Reza Hospital (Mashhad, Iran), and every pediatric patient who were younger than 18 years old with the clinical phenotype of Turner syndrome and had complete thyroid function tests enrolled. The medical records of these patients were evaluated and patients were recalled if any further information was needed. The study data including thyroid function tests as well as patients' age, height, weight, and karyotype findings were entered in a check list and the relationship between thyroid functions tests and karyotype findings were evaluated. Results: Among the 79 patients enrolled in the present study, the mean ± standard deviation of age was 10.82 ± 2.6 years. The most of the study population had negative anti-TPO results (62 patients, 78%). Among all patients, eight patients (10.1%) had autoimmune hypothyroidism There was not any significant relationship between thyroid function tests with different cytogenetic findings (P>0.05). Conclusion Hypothyroidism (26.6%) was the most common thyroid disorder among Turner syndrome patients. Although there was not any significant relationship between thyroid function tets, Z-scores for hight and weight with cytogenetic findings; however, our findings highlights the need for more specific screening programs for evaluating the thyroid functions in turner patient.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13503
13513
https://ijp.mums.ac.ir/article_17769_51fa12b64453cd013721203cf9214b70.pdf
dx.doi.org/10.22038/ijp.2021.56094.4411
Ultrasound Evaluation of the Relationship between Fetal Lateral Ventricle Diameter and Biometric Parameters
Narges
Nahavandi
Obstetrician and Gynecologist, Perinatology Fellowship, Obstetrics and Gynecology Department, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
author
Ashraf
Jamal
Obstetrician and Gynecologist Professor, Perinatology fellowship, Obstetrics and Gynecology Department, Tehran University of Medical Sciences, Shariati hospital, Tehran, Iran.
author
Maryam
Moshfeghi
Obstetrician and Gynecologist, Perinatology Fellowship, Royan Institute, Department of Endocrinology, Reproductive Biomedicine Research Center, ACECR, Tehran, Iran.
author
Fatemeh
Etemad
Obstetrician and Gynecologist, Infertility Fellowship, Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
author
text
article
2021
eng
Background: We aimed to assess the relationship between fetal lateral ventricular width and biometric measurements with ultrasound examination.
Materials and Methods: A prospective case-control study on 178 fetuses as the control group with lateral ventricle diameter 4-7.9 mm and 80 fetuses as the case group with lateral ventricle diameter 8-12 mm. The study was done at Shariati hospital (Tehran, Iran), from 2015 to 2019. All patients underwent a detailed ultrasound exam according to ISUOG guideline and biometric measurements, including head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, cerebellar diameter, cisterna magna width, average ultrasound gestational age, and estimated fetal weight was done. At least two follow-up ultrasound examinations at 26-28 weeks of gestational age and 32-34 weeks of gestational age were performed to evaluate ventricle size, and fetuses with lateral ventricle width above 12 mm were excluded. Then we compared fetal biometric measurements, mentioned above, in these groups.
Results: The mean maternal age, maternal past medical history, obstetrical history, mode of conception, fetal presentation, and fetal gender did not differ between the groups. We compared 187 patients as the control group with 80 patients as the case group at the same gestational age and gender. The mean ventricular width in the case group was 8.6 mm, and in the control group was 5.9mm. The study group had significantly larger head circumference, biparietal diameter, femur length, and estimated fetal weight compared with the control group (P<0.05).
Conclusion: The lateral ventricular width is dependent on other biometric parameters such as head circumference, biparietal diameter, and general fetal size, and larger ventricle width is associated with larger parameters.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13515
13521
https://ijp.mums.ac.ir/article_15488_38018d1c642a559beb7a93fd6cbbece3.pdf
dx.doi.org/10.22038/ijp.2020.47716.3860
The Effect of oral Administration of Cichorium Intybus on Reduction of Liver Enzymes in Patients with Major Thalassemia: Randomized Clinical Trial Study
Mohammad Reza
Golpayegani
Associate Professor of Pediatrics Hematology and Oncology, Department of Pediatrics, School of Medicine, Dr. Kermanshahi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
Yalda
Shokoohinia
Ric Scalzo Botanical Research Institute, Southwest College of Naturopathic Medicine, Tempe, AZ, USA.
author
Sevda
Khashman
Pediatrician, Department of Pediatrics, School of Medicine, Dr. Kermanshahi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
Nasim
Jamshidi
Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
Reza
Tahvilian
Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
Mansour
Rezaei
Professor of Biostatistics, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
Fereshteh
Jalilian
Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
text
article
2021
eng
Background: Beta-thalassemia is a common hematological disorder. The aim of this study was to determine the effect of oral administration of Cichorium intybus on reduction of liver enzymes in patients with major thalassemia. Materials and Methods: This study was randomized clinical trial study that was conducted on 100 patients with age over 2 years and major thalassemia referred to Mohammad Kermanshahi Hospital of Kermanshah city (Iran) in 2019-2020. Eligible patients were randomly divided into two intervention (n=50), and control (n=50)groups.The intervention group received 0.028mg/kg/day Cichorium intybus as a medicinal supplement and control group received placebo for 3 months. All patients were evaluated and followed up for 6 months. The Liver enzymes levels (AST and ALT) were measured at four time periods (baseline, 1.5, 3 and 6 months after intervention). Ferritin was also measured at three time periods (baseline, 3, and 6 months after the intervention).The SPSS software version 24.0 was used to data analysis. Results: The results of Repeated Measure ANOVA test showed that therewere significant statistical differencebetween the two groups of intervention and control in term of ALT and AST at different time periods, so that the means of ALT and AST after the interventionwere lower in intervention group than control group(p <0.05). However, there wasno significant statistical differencebetween the two groups of intervention and controlin term of ferritin at different time periods (P>0.05). Conclusion: Oral administration of Cichorium intybus can reduce liver enzyme levels (ALT and AST) in patients with thalassemia major. Therefore, Chicory administration in patients with major thalassemia is suggested.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13523
13532
https://ijp.mums.ac.ir/article_15538_7668c622f67316e737c32b48629f034a.pdf
dx.doi.org/10.22038/ijp.2020.47996.3870
Influence of Speed-Power Abilities on Memory in Children with Different Strength of the Nervous System
Georgiy
Polevoy
Vyatka State University, Kirov, Russia AND Vyatka State Agrotechnological University, Kirov, Russia.
author
text
article
2021
eng
Background The aimof this studyis to determine the effect of speed-strength training on memory in schoolchildren aged 13-14 years, taking into account the strength of their nervous system. Materials and Methods This case control study was conducted in a secondary school in the city of Kirov in Russia for a period of 3 months (January 12 to March 20, 2020). 40 boys and girls were engaged in physical education 2 times a week for 40 minutes. 20 schoolchildren from the control group were engaged in physical education according to the usual program. 20 schoolchildren from the experimental group additionally performed exercises for the development of speed and strength abilities. The strength of the nervous system was determined using a tapping test. Memory indicators in children were measured using the «Method of Jacobs» test. Data were analyzed using SPSS software version 16.0. Results 40 children participant in this study. After the pedagogical experiment, the indicators in all subgroups changed. In the control group, memory indicators in children with a strong nervous system improved only by 5% (p>0,05), and in children with a weak nervous system from 5.5±0.5 to 5.7±0.5, this is only 4% (p>0.05). At the same time, in the experimental group of children with a strong nervous system, memory indicators improved by 21% (p <0.05), and in children with a weak nervous system from 5.1±0.7 to 6.0±0.9, this is 18% (p <0.05). Conclusion Memory performance in children aged 13-14 years will improve if we perform speed-strength exercises at each lesson in physical culture. The load for children with a strong and weak nervous system should be differentiated.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13533
13538
https://ijp.mums.ac.ir/article_17863_45438ce6dd4e1b8f951594e12a2c505d.pdf
dx.doi.org/10.22038/ijp.2021.57107.4477
Prevalence of Hypomagnesaemia in Children Admitted to the Pediatric Intensive Care Unit and its Related Factors in Zahedan, Iran
Simin
Sadeghi-Bojd
Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan 9816743111, Iran.
author
Noormohammad
Noori
Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan 9816743111, Iran.
author
Elham
Zarifi
Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
author
Alireza
Teimouri
Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan 9816743111, Iran.
author
text
article
2021
eng
Background: Clinical status of children admitted to the intensive care units (ICUs) is important. We aimed to investigate prevalence of hypomagnesaemia in children admitted to the pediatric intensive care unit (PICU), and its relation factors. Materials and Methods: This cross-sectional study was conducted in Ali Ebne Abitalib Hospital Zahedan, Iran, in 2018. From total children who were admitted to the PICU, 150 individuals aged one month to 12 years that were entered to the study. Magnesium level was estimated by XYLIDYL BLUE method using Erba kits. Children were divided into two groups based on their serum magnesium concentration defined as normal and abnormal. Data were analyzed using SPSS software version 18.0. Results: From 150 admitted children to the PICU, 44.7% were hypomagnesaemia with longer hospital stay, higher levels of Na, K and Ca (p>0.05). During the first five day of hospitalization, 58 children died, most of them were hypomagnesaemia. About 39.6% of 101 children who consumed diuretic medicine were hypomagnesemia. This pattern was 43.8% and 40.00% from 130 and 85 patients who used digital or aminoglycoside medicines. About half of the children who had heart diseases were hypomagnesemia. These trends were 33.3% in kidney and sepsis; about 50.00% and 43.5% were hypomagnesaemia from those who had central nervous disorder and respiratory problems, respectively. The eldest children had 1.79 times higher odds (95% CI=0.76 to 8.30) to be hypomagnesaemia compared to the youngest, and girls had 1.01 times higher odds (95% CI=0.44 to 2.30) to be hypomagnesaemia. Conclusion: Prevalence of hypomagnesaemia in children admitted to the PICU was high and it was associated with the major electrolytes of sodium, potassium, and calcium.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13539
13549
https://ijp.mums.ac.ir/article_16090_a9b499b56dc6cd2072ef0b65d9f8033a.pdf
dx.doi.org/10.22038/ijp.2020.49643.3969
Investigation the Lifestyle in Patients with Cystic Fibrosis According to Iranian Traditional Medicine
Saeed
Sadr
Department of Pediatrics Pulmonary Diseases, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
author
Hanieh
Tahermohammadi
Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
author
Shahpar
Kaveh
Traditional Medicine and Materia Medical Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
author
text
article
2021
eng
Respiratory involvement in cystic fibrosis (CF) is one of the most complaints in pulmonary disorders. Though symptomatic treatment of the patients with chemical medications is efficient in sign reduction, medications side effects and permitting the disease to become chronic are precarious for patients. Today, the World Health Organization considers traditional medicine. Iranian Traditional Medicine (ITM) makes a priority for disease prevention by suggesting some strategies. We intended to investigate the lifestyle effect on cystic fibrosis patients. In this review, we searched the most important ITM sources [such as Qanoon fi al-teb (The canon of medicine), Zakhire-Kharazmshahi ,and Exir-Azam), and scientific databases such as Data sources included (Pub Med and Google Scholar] in English and without time restriction from inception up to April 2020. According to ITM, the six essential principles must be observed in the management of patients with thick and sticky airway secretions that include nutritional pieces of advice about food and drink, exercise quality, evacuation and retention quantity, advising calmness, no prolonged and daytime sleep and avoidance from air pollution. Anunhealthy lifestyle can play an important role in these patients that confirmed by classical medicine. Therefore, further clinical trials should be performed to confirm the long-term efficacy of a healthy lifestyle in cystic fibrosis patients’ management.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13551
13557
https://ijp.mums.ac.ir/article_16768_59f007967d94e2d95605a188e06ac739.pdf
dx.doi.org/10.22038/ijp.2020.51785.4122
Perinatal Outcomes following Radiofrequency Ablation in Complicated Monochorionic Multiple Pregnancies
Fatemeh
Rahimi Sharbaf
Department of Perinatology, Yas Hospital, Tehran University of Medical Sciences, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran.
author
Mansooreh
Haghiri
Department of Perinatology, Yas Hospital, Tehran University of Medical Sciences, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran.
author
Mahboobeh
Shirazi
Department of Perinatology, Yas Hospital, Tehran University of Medical Sciences, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran.
author
Fatemeh
Golshahi
Department of Perinatology, Yas Hospital, Tehran University of Medical Sciences, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran.
author
Arezoo
Arabipoor
Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
author
Zahra
Zolfaghari
Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
author
text
article
2021
eng
Background Radiofrequency ablation (RFA) is considered as an optional treatment method in complicated monochorionic (MC) twin pregnancies. The purpose of this study is to investigate the main factors of fetal death after such treatment procedure. The study also compares the perinatal outcomes among various groups of indication and gestational age (GA) at procedure. Materials and Methods: This prospective cohort study considers 195 cases of MC multiple pregnancies including one twin with twin-twin transfusion syndrome, selective intrauterine growth restriction ,sever anomaly and twin reversed arterial perfusion sequence(TRAP) which underwent selected reduction using RFA from 2016 to 2018 at Yas Hospital, Tehran, Iran. The GA at RFA categorized as 16- 19+6 wks., 20-23+6 wks., and 24-28 wks. The analysis of risk factors of fetal death after RFA is based on multivariable logistic regression model. Results: The result of analysis reveals that the rate of co-twin anemia after RFA in anomaly indication was higher than the other indications significantly (p=0.038) while according to GA categories, it is significantly lower in 20-23+6 weeks. (p=0.016). Three independent significant factors contributing in fetal death after RFA were co-twin anemia after RFA, TRAP and anomaly indications of RFA and GA at RFA, respectively. Conclusion The co-twin anemia after RFA was found the most contributing factor of fetal death. As the results showed that the rate of co-twin anemia after RFA is significantly low in 20-23+6 weeks of GA, such GA is suggested for RFA procedure to reduce the fetal death.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13559
13568
https://ijp.mums.ac.ir/article_15672_1c12016a8b7b73298e954cd6ca636352.pdf
dx.doi.org/10.22038/ijp.2020.48501.3904
Diagnostic Value of Changes in Serum Calprotectin Level and Patients' Sputum in Response to Treatment of Cystic Fibrosis Exacerbation in Children
Nemat
Bilan
Pediatric Pulmonologist, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
author
Farinaz
Amirikar
Pediatric Pulmonology Fellowship, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
author
Sina
Raeisi
Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
author
text
article
2021
eng
Background Today few studies have focused on using calprotectin as an effective biomarker for monitoring the exacerbation of pulmonary complications in cystic fibrosis (CF). Thus, the present study aimed to assess the diagnostic value of the changes in the calprotectin level of patient's serum and sputum during responding to the therapy of exacerbated CF in children. Materials and Methods: The cross-sectional study was conducted among 21 CF patients, which received required supportive and therapeutic procedures based on the protocol related to pulmonology ward in the Children Medical Research and Training Center of Tabriz University of Medical Sciences. The sputum and serum samples of all patients were collected to evaluate calprotectin level at 1-2 days after starting therapy with routine antibiotics such as cephalosporin and macrolides, and they were again gathered at the end of therapy process. Results: Assessing outcome in 21 patients under study represented complete and partial recovery in 12 (57.2%), and 9 (42.8%) ones, respectively. The mean decrease in calprotectin level in the serum and sputum of the patients was respectively obtained as 40.7289.08 μg/ml and 99.03225.94 μg/ml. The calprotectin decrease in serum with the cutoff point of 15.70 μg/ml possessed the sensitivity of 66.7% and specificity of 55.6% in predicting complete recovery outcome; while that of sputum with the cutoff point of 26.20 μg/ml had the sensitivity and specificity of 66.7 and 22.2%, respectively. Conclusion The mean age of participants were 8.61±4.19 years. It can be concluded that serum and sputum calprotectin decrease with cutoff point of 15.70 μg/ml and 26.20 μg/ml, respectively in have high sensitivity for determining response to treatment in cystic fibrosis exacerbation.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13569
13579
https://ijp.mums.ac.ir/article_16624_2010a932100461b06de7f535bdcaad70.pdf
dx.doi.org/10.22038/ijp.2020.51898.4130
Sickle Cell Anemia Child presented with Bell's palsy: A Rare Case Report
Amar
Taksande
MD, FIAE, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra : 442004, India.
author
Gnanvelu
Injeti
MBBS, Resident, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra : 442004, India.
author
Maithali
Joshi
MBBS, Resident, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra : 442004, India.
author
Revat
Meshram
MD, Associate Professor, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra : 442004, India.
author
text
article
2021
eng
Sickle cell anemia (SCA) is an inherited red blood cell disorder that results from the replacement of a valine residue for glutamic acid at position 6 in the beta-subunit of haemoglobin.This can lead to tissue ischemia, microcirculation obstructions, infarction, and acute stroke while Bell’s palsy is a neuropathy caused by traumatic, inflammatory, infective, or compressive conditions on the facial nerve. In patients with SCA, however, stroke may occur as an acute clinical syndrome presenting with hemiplegia with the unilateral facial nerve. Until now, no case has been reported in the literature with unilateral facial nerve palsy in SCA patients. Here, a rare case of idiopathic unilateral Bell’s palsy is presented in an SCA patient.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13581
13584
https://ijp.mums.ac.ir/article_16339_a4150a86aa1ac6b6093e5cd939bcf9b4.pdf
dx.doi.org/10.22038/ijp.2020.50431.4014
A Multifaceted Disease of Problematic Diagnosis in Childhood; Hereditary Hemorrhagic Telangiectasia: A Case Report
Sibel
Yavuz
Cukurova University Medical Faculty, Dept. Of Pediatric Gastroenterology, Adana, Turkey
author
Dinçer
Yıldızdaş
Cukurova University Medical Faculty, Dept. Of Pediatric Intensive Care , Adana, Turkey
author
Özden
Özgür Horoz
Cukurova University Medical Faculty, Dept. Of Pediatric Intensive Care , Adana, Turkey
author
Önder
Özden
Cukurova University Medical Faculty, Dept. Of Pediatric Surgery Adana, Turkey
author
Kıvılcım Eren
Erdoğan
Cukurova University Medical Faculty, Dept. Of Pathology, Adana, Turkey
author
Hüseyin
Tuğsan Ballı
Cukurova University Medical Faculty, Dept. Of Radiology, Adana, Turkey
author
Kairgeldy
Aikimbaev
Cukurova University Medical Faculty, Dept. Of Radiology, Adana, Turkey
author
Halise Neslihan
Önenli Mungan
Cukurova University Medical Faculty, Dept. Of Pediatric Metabolısm and Nutrition, Adana, Turkey
author
Gökhan
Tümgor
Cukurova University Medical Faculty, Dept. Of Pediatric Gastroenterology, Adana, Turkey
author
text
article
2021
eng
Hereditary hemorrhagic telangiectasia (HHT) is a vascular dysplasia inherited in an autosomal dominant manner and may involve skin, mucosa, and internal organs. HHT may cause arteriovenous, arterioportal, and portovenous shunts in the liver, resulting in cirrhosis and portal hypertension. An eight-year-old male patient with a diagnosis of myelodysplastic syndrome for two years was admitted with melena. Portal doppler ultrasonography showed a heterogeneous appearance of the liver parenchyma and splenomegaly (spleen size of 14 cm) with no portal hypertension. An extended etiological investigation for chronic liver disease was conducted. Afterliver biopsy, the patient’s general condition deteriorated, with abdominal distension and reduced hematocrit. The Doppler and hepatic angiography results together with a history of recurrent episodes of epistaxis led to the diagnosis of HHT. The patient was referred to the transplant center for liver transplantation due to the irreversible bleeding from the liver. Hepatic telangiectasias may be present in patients without hematologic disorders who have uncontrollable bleeding after liver biopsy.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13585
13590
https://ijp.mums.ac.ir/article_17360_4271bfe80e9556c7db6d10b1851b8b43.pdf
dx.doi.org/10.22038/ijp.2021.54438.4306
Prevalence of Ectopic Eruption of First Permanent Molars in Panoramic Images of 5-8-Year-Old Children in Sari, Mazandaran Province, North of Iran in 2013-2020
Haleh
Hali
Assistant Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
author
Maede
Salehi
Assistant Professor, Department of Oral Medicine, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
author
Tahereh
Molania Jelodar
Associate Professor, Department of Oral Medicine, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
author
Foroozan
Farahbod
Assistant Professor, Department of Oral and Maxillofacial Radiology, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
author
Hamzeh
Maghfouri
Dentistry Student, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
author
text
article
2021
eng
Background Ectopic eruption is a tooth eruption disorder in which the tooth does not erupt in its proper eruption path. The most common type of ectopic eruption is the mesial eruption of the maxillary first permanent molar, which results in the loss of the second deciduous molars, resulting in a reduction in arch length and loss of space. Therefore, this study aimed to investigate the prevalence of ectopic growth of this tooth in children. Materials and Methods: This descriptive cross-sectional study was performed on panoramic radiographic images of children aged between 5-8 years. Census sampling method was used in this study. A general dentist under the supervision of an oral and maxillofacial radiologist assessed ectopic eruption according to a grading system described by Barberia et al., all radiographs. The data was analyzed using SPSS software version 16.0. Results: 772 panoramic radiographs were examined in this study, panoramic radiographs of 79 patients were considered to have ectopic eruption, which 61% of cases were in girls and 39% in boys. 25.6% of the patients had a mild, 60.3% had a moderate, and 14.1% had a severe ectopic eruption. All patients (except one) had a mesial ectopic eruption, 19% of the ectopic eruptions occurred in the maxilla, 59.4% in the mandible, and 59.5% in both jaws. Ectopic eruption in the mandible was more frequent in the mandible than in the maxilla and this finding was statistically significant (P <0.05). Conclusion The results of the present study showed that the frequency of ectopic eruption of the first permanent molars in Sari was 10.2%, which is higher than the values reported in studies in other regions of Iran.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13591
13597
https://ijp.mums.ac.ir/article_17200_346a7f51b27744921822d7347f00df1f.pdf
dx.doi.org/10.22038/ijp.2020.54228.4288
Evaluating the Effectiveness of Using Merrill Component Display Theory in Performance and Retention of the Concept of Fraction in Kids Grade Elementary Mathematics
Maryam
Manuchehri
Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran.
author
Mohammad Hassan
Behzadi
Department of Statistics, Science and Research Branch, Islamic Azad University, Tehran, Iran.
author
Ahmad
Shahverani Semnani
Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran.
author
Mohsen
Rostamy
Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran.
author
text
article
2021
eng
Background The concept of fraction is one of the most difficult concepts of math in all levels of education. We aimed to investigate the effect of Merrill’s component display theory in the learning of students in math. Materials and Methods: In this case-control study, the number of students under investigation was 183 boys where 31 students were randomly selected as experimental group and 30 as control group. The concept of teaching was designed based on the teaching design pattern of Merrill’s Component Display Theory and based on which the students in experimental group was taught for 10 sessions of 45 minutes; control group also received the traditional teaching. After two months, students were post-tested for their performance by a 10-question exam taken from teacher’s guidebook. Then, after three more weeks, they were again post-tested to ascertin their retention of the topic. Data were analyzed using SPSS software version 16.0 Results: The T-test results showed that the mean of students in experimental group increased about four grades and from 13.9 reached to the significant number of 18 for the performance post-test with the standard deviation of 0.63. In retention, the mean of students changed from 15.4 to 15 which is not a lot. It also means that there was no significant difference between mean scores of retention of Merrill’ group and the scores of post-test Merrill’s group. It means that education materials used Merrill’s design have been positively effective. Conclusion Considering the findings, it can be stated that the Merrill’s component display theory has been effective in both performance and the retention of the students.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13599
13607
https://ijp.mums.ac.ir/article_16778_16d5b88d487979fa8c23e6bea0d0d1e9.pdf
dx.doi.org/10.22038/ijp.2020.52220.4149
Evaluation of the Use of Fiberoptic Bronchoscopy Following Rigid Bronchoscopy in Foreign Body Aspiration
Marjan
Joodi
Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran. AND Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Seyed Javad
Sayedi
Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Mehdi
Fathi
Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran AND Department of Anesthesia, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Shiva
Ghaderifar
Master of Science in Environmental Health Engineering, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Zahra
Abbasi Shaye
Clinical Research & Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Ehsan
Keykhosravi
Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Ali
Azadmand
Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
author
text
article
2021
eng
Background: Foreign body aspiration (FBA) is a life-threatening problem that can be lethal in some cases. It usually occurs in children between 1–3 years old. Bronchoscopy is the best way for recognition, treatment and management of this problem. We aimed to evaluate the use of fiberoptic bronchoscopy after rigid bronchoscopy in foreign body aspiration in pediatric population.
Materials and Methods: 275 pediatric patients with a history of choking were entered to this cross-sectional study, from August 2015 to September 2018. The study was done in a Dr. Sheikh hospital, Mashhad, Iran. The age and gender of the patients were recorded individually. Rigid bronchoscopy was done for all patients. After that, fiberoptic bronchoscopy was performed immediately or 72 hours after the first procedure based on the patients' symptoms, time and personnel conditions. Data were analyzed by the SPSS software version 16.0.
Results: Among 275 patients, 175 cases (63.6%) were male. The patients' age was 3 months to 15 years old. In rigid bronchoscopy, 85 cases had no foreign body and in 190 cases, foreign body was found. In 43 cases fiberoptic bronchoscopy found a residual organic material in spite of negative rigid bronchoscopy.The most residual organic material pertained to 0-3 year age group and the cases with residue in males were more than females. There was a significant difference between FBA and age and gender (p <0.001).
Conclusion: FBA in airway branches may not be seen by rigid bronchoscope due to the limited access to the distal branches. We suggest fiberoptic bronchoscopy as a complementary management along with rigid bronchoscopy to investigate distal branches, especially if the foreign body is soft in material.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13609
13615
https://ijp.mums.ac.ir/article_16948_e79ca8d7a8d545e6d3a17999c2aed7bd.pdf
dx.doi.org/10.22038/ijp.2020.51148.4064
The Effect of International Economic Law on the Process of Political Development of Children's Rights
Abtin
Amiri
Ph.D Student in Public International Law, Department of Law, Qeshm Branch, Islamic Azad University, Qeshm, Iran.
author
Mohammad
Sadeqi
Department of Law, Hormozgan University, Hormozgan, Iran.
author
Seyyed Bagher
Mirabbasi
Department of Law, Tehran University, Tehran, Iran.
author
Aboomohammad
Asgarkhani
Department of Law, Tehran University, Tehran, Iran.
author
text
article
2021
eng
International economic law has a transformational role in developing the economy, where the transformation leads to economic prosperity and growth, including changing several aspects of progression, especially social and political progress. One of the unknown aspects of development, specifically in developing societies, is the impact of international economic law on the political development of children's rights. Like other aspects of social law, children's rights have an economic-political aspect whose study needs comprehensive research. Implementing international economic law is linked with different aspects of domestic development, and the question is raised of what impact international economic law has on developing an area such as children's rights. On the other hand, can developments in international economic law in political development help strengthen children's rights? The article is written in a library research format and seeks to answer the question of the basis of the connection between international economic law and political development. In addition, how does the connection help to realize children's rights? On the one hand, international economic law strengthens political law and contributes to children's rights in both legal and social aspects, and on the other hand, strengthening the free market may pose a threat for implementing children's rights and its use; therefore, supervision of international economic law on the commitment of the benefiting states is one of the advantages of this type of economic system and a guarantee for the rights of the vulnerable groups of society, such as children.
International Journal of Pediatrics
Mashhad University of Medical Sciences
2345-5047
9
v.
5
no.
2021
13617
13634
https://ijp.mums.ac.ir/article_17014_9a6ef964ac87204666e11841d97caad1.pdf
dx.doi.org/10.22038/ijp.2020.48782.3917