Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Prescription Pattern of Antipyretics for Infection Induced Fever in Pediatric Ward of Nedjo General Hospital, Nedjo Town, West Ethiopia877987861124210.22038/ijp.2018.32600.2880ENGinenus FekaduDepartment of Pharmacy, College of Health Science, Wollega University, Nekemte, Ethiopia.0000-0002-4926-0685Ebisa TuriDepartment of Nursing, College of Health Science, Wollega University, Nekemte, Ethiopia.Dinka DugassaShambu General hospital, Shambu, Oromia, Ethiopia.Journal Article20180611<strong><em><span>Background </span></em></strong><br /> <span>Antipyretic therapy administration to patients who develop fever due to infection is controversial and its impact on clinical outcomes has yielded mixed results. We aimed to assess the prescription pattern and rational use of antipyretics for infection induced fever among hospitalized pediatric patients.</span><br /> <strong><em><span>Materials and Methods </span></em></strong><br /> <span>A retrospective cross-sectional study design was conducted to describe the use of antipyretics in hospitalized fever develop infectious patients from 2015 to 2016. A total of 290 patients were included in the study using random sampling method. Data was collected from</span><span lang="EN-GB"> the patients’ cards from February to March, 2016 </span><span>at Nedjo <span>g</span>eneral hospital, Ethiopia.</span><br /> <strong><em><span>Results </span></em></strong><br /> <span>Of the 290 patients, 164(56.6%) were males </span><span>while 126 (43.4%) were females. <span>The mean age of the patients was 3.41<span style="text-decoration: underline;">+</span>2.65 years with mean temperature of 37.21C<sup>0</sup>. The average hospital stay of patients was 4.65<span style="text-decoration: underline;">+</span>1.82 days and a total of 201 antipyretics were prescribed. </span>Among the patients’ cases, pneumonia accounts 96 (33.1%) of morbidity and 8 (42.1% of all mortality while neonatal sepsis accounts 79(27.24%) of morbidity and 7(36.8%) of all cause of mortality. During the study period there were 19(6.6%) in hospital mortality was recorded.<span> </span>The antipyretics ordered were Paracetamol</span><span style="font-family: Times New Roman; font-size: medium;">, Diclofenac and Ibuprofen. From these, Paracetamol was the most frequent ordered drug, (96.5%) and 98.5% of the antipyretics were ordered as required basis (PRN). </span><br /> <strong><em><span>Conclusion</span></em></strong><br /> <span>The pattern of antipyretic prescription during the study depends on the diagnosis of the infection identified. Further studies are needed to demonstrate the effect of antipyretics on clinically relevant outcomes in fever developed hospitalized infectious patients.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Diagnostic Accuracy of Acute Appendicitis by Ultrasound in Hospital Emergency878787931128010.22038/ijp.2018.33708.2978ENMohammad Ghasem HanafiDepartment of Radiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.0000-0003-1533-5244Afshin ShiriGeneral Physician, School of Medicine, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.Journal Article20180727<strong><em><span style="font-family: Times New Roman;">Background</span></em></strong><br /> <span style="font-family: Times New Roman;">Acute appendicitis is the most common medical condition requiring immediate abdominal surgery.Medical ultrasound is a non-intrusive, non-expensive and available diagnostic method. In this study, the accuracy of ultrasound in diagnosis of acute appendicitis in hospital emergency was evaluated.</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 retrospective cohort study was performed at Ahvaz Imam Khomeini hospital (Ahvaz city, Iran). The records of outpatient and inpatient of this hospital were studied to extract demographic information about the patients and radiological reports indicating the occurrence or exclusion of acute appendicitis and post-appendectomy report to allow for results comparison. Patient from 5-70 years included, with clinical suspicious to acute appendicitis, pathologic report also reviewed as gold standard of diagnosis. </span><br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">A total of 163 study subjects met the inclusion criteria,theage of the subjects ranged from 6 to 63 years. The accuracy, sensitivity and specificity were 98.1, 96 and 100%, respectively. The positive predictive value was 100%, while the negative predictive value was 82.35%. Diagnostic accuracy was 100% for the under-15 age group and 94.06% for the above 15 years age group. </span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong><br /> <span style="font-family: Times New Roman;">The results showed that the medical ultrasound reports could be considered more credible in diagnosing acute appendicitis in under-15 male subjects which paves the way for more accurate planning of treatment and presenting patients with abdominal pains for surgery. </span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Assessment of Health Related Quality of Life (HRQL) in Egyptian Children with Rheumatic Diseases; Its Relation to Disease Activity and Functional Disability879588031133710.22038/ijp.2018.34033.2999ENSheren MaherAssistant Professor of Pediatrics, Pediatric Department, Faculty of Medicin, Minia University, Egypt.0000-0001-6497-2704Rasha Abdel-magiedAssistant Professor of Rheumatology and Rehabilitation, Faculty of Medicin, Minia University, Egypt.Journal Article20180809<strong><em><span style="font-family: Times New Roman;">Background</span></em></strong><br /> <span style="font-family: Times New Roman;">Many pediatric rheumatic diseases persist into adulthood, with negative squeal from the disease or its treatment. We aimed to assess health related quality of life in a group of children with rheumatic diseases and its relation to disease activity and functional disability. </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;">Fifty one patients were divided into three groups: Group 1 includes 27 patients diagnosed as juvenile idiopathic arthritis (JIA), Group 2 includes 15 patients diagnosed as juvenile onset systemic lupus erythematosus (SLE) and Group 3 includes nine patients; three diagnosed as Juvenile Dermatomyositis, three diagnosed as Familial Mediterranean Fever and three female’s patients diagnosed as Juvenile Scleroderma. Childhood Health Assessment Questionnaire (CHAQ), Pediatric Quality of Life generic core scale version 4.0, Visual analogue scale for pain and Visual analogue scale (VAS) for global assessment were recorded. The activity index was assessed in each patient according to the nature of the disease.</span><br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">In JIA patients, the mean PedsQL score was 73.6+ 15.4, the mean CHAQ score was 0.7+ 0.7, the mean DAS28 was 3.5+ 0.9, with a significant negative correlation between PedsQL and CHAQ (p=0.48), VAS pain (p=0.001), and DAS 28 activity index (p=0.017). In SLE patients, the mean PedsQL was 66.4 + 20.3, mean CHAQ score was 0.7 + 0.67 and mean SLEDAI-2K was 24.2 + 14.6 with no significant correlation between functional disability and SLEDAI-2K (p=0.539). PedsQL showed a significant negative correlation with SLEDAI-2k (p=0.001), and positive correlation between CHAQ (p=0.022).</span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong><br /> <span style="font-family: Times New Roman;">Health related quality of life in patients with juvenile rheumatic diseases is correlated with disease activity and functional disability and should be assessed in regular basis.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Nutritional Risk Assessment in Children with Cancer: A Longitudinal Study in North East of Iran880588131038010.22038/ijp.2018.29270.2564ENHamid FarhangiDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0003-3577-464XElham BakhtiariEye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-2197-7975Nafiseh PourbadakhshanDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-3494-2085Journal Article20180121<strong><em><span style="font-family: Times New Roman;">Background</span></em></strong><br /> <span style="font-family: Times New Roman;">Children with cancer are in risk of malnutrition. Nutritional risk assessmentis more importance in developing countries. The aim of present study was to investigate the nutritional risk in admitted children with cancer.</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;">One hundred admitted children newly diagnosed with cancer were studied at the time of admission, after 3 and 6 months.Demographic characteristics and anthropometrics indexes were recorded via standard and calibrated tools. Nutritional risk assessed according to modified Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP).Statistical analysis was performed using SPSS software (version 16.0).</span><br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">Of the 100 children 55 patients (55%) were female. The average age was 3.46±3.3 years. Hematologic tumors constituted 73.5% of patient. All patients were in nutritional risk. There was no patient with low nutritional risk during study; 17 patients (17%), 53 patients (56.4%), and 41 patients (43.6%) diagnosed with medium nutritional risk at the time of admission, after 3 and 6 months, respectively; 83 patients (83%), 41 patients (43.6%), and 40 patients (43%) diagnosed with high nutritional risk at the time of admission, after 3 and 6 months, respectively. Difference was significant (p<0.001).After 6 months,weight, height, mid-upper arm circumference (MUAC), and body mass index (BMI) increased compared with the time of admission (p<0.05).</span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong><br /> <span style="font-family: Times New Roman;">According to modified STAMP results, all studied patients were in the nutritional risk. Nutritional risk decreased during study. The nutritional risk decreased after 6 months in children newly diagnosed with cancer compared with the time of admission. </span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Congenital Heart Defects in Children with Dextrocardia: A Ten-Year Study881588201124310.22038/ijp.2018.32766.2892ENMohsen MohebiPediatric Cardiology Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Hassan Mottaghi MoghaddamPediatric Cardiology Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000000239792151Mohsen HorriPediatric Cardiology Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Journal Article20180615<span style="font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Background</span></em></strong></span><br /> <span style="font-size: x-small;"><span style="font-family: Times New Roman;">Dextrocardia is a malposition of the heart defined as the right-sided development of the heart. It can increase the likelihood of congenital heart defects or diseases (CHD) and the risk of related morbidities and mortalities. We aimed to determine the frequency of CHDs among Dextrocardia patients.</span></span><br /> <span style="font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Materials and Methods</span></em></strong></span><br /> <span style="font-size: x-small;"><span style="font-family: Times New Roman;">In a retrospective cross-sectional study the records of patients with Dextrocardia who referred to Imam Reza Hospital (tertiary referral center) of Mashhad between 2006 and 2016 were studied. Data were analyzed using SPSS software version 16.0.</span></span><br /> <span style="font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Results</span></em></strong></span><br /> <span style="font-size: x-small;"><span style="font-family: Times New Roman;">In total 163 patients, 85 of whom (54%) were males were studied. Their mean age was 11.41<span style="text-decoration: underline;">+</span> 0.326 years. The frequency of major Dextrocardia subtypes were: Situs inversus in 77 (47%), Situs <span style="background: #f2f2f2;">Solitus in 59 (36%), and Situs ambiguous in 28 (17%) patients. The frequency of associated comp</span>lex congenital heart defects (CHD) was 55% in Situs inversus, 77% in Situs solitus and 100% in Situs ambiguous. Isolated associated CHD had a greater frequency in the Situs inversus and Situs solitus groups. The most common isolated associated CHD was septal defects.</span></span><br /> <span style="font-size: x-small;"><strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong></span><br /> <span style="font-size: x-small;"><span style="font-family: Times New Roman;">More than 90% of all patients with Dextrocardia, had CHD whereas all patients with Dextrocardia and Situs ambiguous had complex CHD.</span></span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101A Systematic Review of Instruments Measuring Family and Social Support of Breastfeeding Mothers882188291127510.22038/ijp.2018.33521.2959ENMasaudeh BabakhanianPh.D student of Behavioral Sciences, Social determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran0000-0002-6128-8023Soraya SayarPh.D of Sociology, Department of Social Sciences, Islamic Azad University, Tehran North Branch, Tehran, Iran.Faezeh Sadat AkramiDepartment of Clinical Psychology, School of Humanities and Social sciences, Islamic Azad University, Science and Research Branch, Tehran, Iran.Masumeh GhazanfarpourDepartment of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.0000-0003-4639-3711Leila KargarfardInstructor of Fatemeh School Nursing and Midwifery, Shiraz University of Medical Sciences, Iran.Fatemeh Rajab DizavandiEvidence-Based Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.Talat Khadivzadeh: Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20180718<span style="font-size: x-small;"><strong><em>Background</em></strong>: Due to the low rate of breastfeeding among working mothers and support of interventions to increase the duration of breastfeeding, this systematic review conducted to evaluate psychometric properties of instruments measured mother’s perception of Breastfeeding Support.</span><br /> <span style="font-size: x-small;"><strong><em>Materials and Methods</em></strong>: The search was carried in English language databases including Medline (via PubMed), Scopus, Cochran library and Web of Science since inception to March 2018 regarding published studies evaluating the psychometric properties of the Breastfeeding Self-Efficacy. The COSMIN checklist was used to assess the quality of related studies.</span><br /> <span style="font-size: x-small;"><strong><em>Results </em></strong></span><br /> <span style="font-size: x-small;">Authors of Perceived Breastfeeding Support Assessment Tool’ (PBSAT) suggested that instrument seem to should be two factors "workplace environmental support for breast-feeding working mother" and "the available social environmental support for working mothers". Total Cronbach's alpha was 0.85. In exclusive breastfeeding social support (EBFSS) instrument, based on exploratory factor analysis, 16 items grouped into three factors "instrumental", "emotional" and "informational factors" accounted 66% of total variance. EFA were followed by confirmatory factors analysis showed Modified model was partially fitted to the data. In the Workplace Breastfeeding Support Scale (WBSS), EFA identified four dimensions of breastfeeding support at workplace. These four factors labeled "technical support", "breastfeeding-friendly environment", "facility support" and "peer support". Cronbach’s alpha was 0.77 and split-half reliability was r=0.86. In Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q), data scaled by the Multidimensional Random Coefficients Multinomial Logit Model. A two-dimensional model (company polices/work culture and manager and her co-workers) were emerged. Cronbach’s alpha was excellent (almost 0.90). </span><br /> <span style="font-size: x-small;"><strong><em>Conclusion: </em></strong>Four instruments found to assess breastfeeding was valid and reliable to measure breast feeding in social and workplaces.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101The Effect of Breastfeeding Duration on Bone Mineral Density (BMD): A Systematic Review and Meta-Analysis883188431127910.22038/ijp.2018.32898.2905ENMarzieh Saei Ghare NazPhD Student of Reproductive Health, Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-1259-2459Vida GhasemiPhD Student of Reproductive Health, Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-9966-1604Zahra KianiPhD Student of Reproductive Health, Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000000245487305Farzaneh Rashidi FakariPhD Student of Reproductive Health, Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0001-7497-4180Giti OzgoliAssistant Professor, Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0003-2111-7024Journal Article20180622<span style="font-size: x-small;"><strong><em>Background</em></strong>: During lactation, metabolic changes in the bone in different areas of the body may affect the amount of bone mineral density.The aim of this study was to determine the relationship between breastfeeding and bone mineral density in women.</span><br /> <span style="font-size: x-small;"><strong><em>Materials and Methods</em></strong>: In this study, articles were searched at Cochran, Medline (via PubMed), Scopus, and Web of Science databases until June 2018. The search procedure was conducted with keywords related to breastfeeding and bone mineral density. The mean (SD) of bone mineral density was extracted in the lumbar spine and femoral neck. Funnel plot and Egger's test was used for publication bias assessing and I<sup>2</sup> index were used for heterogeneity.</span><br /> <span style="font-size: x-small;"><strong><em>Results</em></strong><strong>: </strong>In this study, 10 articles involving 3,613 healthy women included for Meta analyze. We observed the decreasing trend in mean bone mineral density (BMD) of lumbar spine, femur neck in non-breastfeeding subgroup to 24 months or more breastfeeding subgroup. BMD of lumbar spine in non-breastfeeding women were [M: 0.96, 95%confidence interval [CI]; 0.89-1.02, P=0.000], in subgroup with more than 24 months breastfeeding the BMD were [M: 0.87, 95%CI; 0.79-0.95, P=0.000]. The femoral neck BMD in non-breastfeeding were [M: 0.80 95%CI; 0.73-0.87, P=0.000], and in subgroup with more than 24 months breastfeeding the BMD were [M: 0.76, 95%CI; 0.71-0.81, P=0.000]. In subgroup analyze, the mean BMD in Asian and postmenopausal sub-group was lower than others. </span><br /> <span style="font-size: x-small;"><strong><em>Conclusion</em></strong><strong>: </strong>The results of this study showed that breastfeeding have reduced effect on bone mineral density in the lumbar spine and femoral neck of women, but there were high heterogeneity in sub-group analyze, so we recommended another studies in homogenous group of women.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Assessment of Antibiotics Use for Hospitalized Children in Butajira General Hospital, Southern Part of Ethiopia884588511128810.22038/ijp.2018.33582.2964ENEdao GenamoPharmacoepidemiology and Social Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Wollega University, P.O. Box 395, Nekemte, Ethiopia.0000-0001-8571-7796Habte BayisaClinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Wollega University, P.O. Box 395, Nekemte, Ethiopia.Red DetemoHealth Center Pharmacy, Somalia Region, Ethiopia.Journal Article20180721<strong><em><span style="font-family: Times New Roman;">Background</span></em></strong><br /> <span style="font-family: Times New Roman;">Drugs including antibiotics are among the important components of heath care systems. However, they are not used appropriately to their maximum potential. The aim of this study was to assess extent of antibiotics use among hospitalized pediatric patients in Butajira general hospital, Ethiopia.</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;">A<strong> c</strong>ross sectional study was conducted on the 120 hospitalized pediatric patients’ medical cards using data abstraction format. A patient’s medical card was selected by simple random sampling after cards were arranged in chronological order. Data were analyzed by using statistical package for social science for windows version 20.0.</span><br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">The results revealed that almost three quarter 74.7% (248/332) of pediatric patients were prescribed with antibiotics with an average of 2.07 antibiotics per a patient. Two thirds 66.9% (166/248) of antibiotics treatments were supported by laboratory investigations; and more than three quarters 83.9% (208/248) of them were administered through parenteral routes. Ceftriaxone 20.9% (52/248) and gentamicin 21.7% (54/248) were the most commonly used antibiotics; and acute gastroenteritis 14.2% (17/120) and pneumonia 48.3% (58/120) were the most common causes of hospitalization among the pediatric patients.</span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong><br /> <span style="color: #3c3c3b;"><span style="font-family: Times New Roman;">This study has demonstrated that there was high prevalence of antibiotics use and poly pharmacy practices among hospitalized pediatric patients. There was also prescribing of antibiotics without laboratory investigations. </span></span><br /> <br /> Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Assessment of Serum Amino Acid Chromatography in Children with Inflammatory Bowel Diseases885388601133510.22038/ijp.2018.33721.2981ENFarid ImanzadehPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Batool EmadiPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-0266-8149Pejman RohaniPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Amirhossein HosseiniPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0001-8103-8833Katayoun KhatamiPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, 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.0000-0002-1881-8893Beheshteh OlangPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Aliakbar SayyariPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Journal Article20180728<span style="font-family: Times New Roman;"><strong><em>Background: </em></strong>Given the important role of amino acids in regulating many metabolic pathways of the body and considering the scarcity of markers for the diagnosis of inflammatory bowel disease (IBD) and its differentiation, we aimed to investigate the status of serum amino acids chromatography in children with IBD.</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 case-control study was conducted among children with primary diagnosis of IBD who referred to Mofid Children's hospital in Tehran, Iran. Children with a definite diagnosis of chronic IBD on the basis of endoscopy and biopsy were enrolled. In addition, 100 children without any history of predisposing, chronic, or inflammatory disease who referred to the same hospital during the period of the study were also selected. All samples underwent serum amino acids chromatography via HPLC method.</span><br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">Of all the patients in the IBD group, 18 patients (18%) suffered from Crohn's disease and 82 patients (82%) had ulcerative colitis; the disease was active in 54 patients (54%). The results of serum amino acids chromatography showed that several amino acids were significantly higher in patients with IBD. Considering the normal serum levels of amino acids, only the levels of two amino acids of histidine and tryptophan were significantly different in the IBD group compared the control group. In total, of all the subjects, 30 children (15%) had abnormal amino acid serum chromatography; hence, its prevalence was significantly higher in the IBD group (P=0.048). </span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion </span></em></strong><br /> <span style="font-family: Times New Roman;">The current study showed that serum amino acid chromatography in children with IBD were different from that in healthy children. More specifically, the decrease in tryptophan level was more observed in patients with active disease.</span><br /> <br /> Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101The Impact of Obesity on Laparo-Endoscopic Single-Site (LESS) Appendectomy in Children886388651139010.22038/ijp.2018.34066.3006ENMohamed ZouariDepartment of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia.0000-0001-9491-816XAhmed Khalil Ben AbdallahDepartment of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia.Mahdi Ben DhaouDepartment of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia.Riadh MhiriDepartment of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia.Journal Article20180810 <br /> <span style="font-size: x-small;">Our study aimed to clarify the relationship between obesity and the risk of postoperative morbidity following LESS appendectomy. We performed a retrospective review of all patients who underwent LESS appendectomy from January 2013 to December 2016.LESS appendectomy was performed in 109 patients during the study period. Among these patients, 17 (15.6%) were obese.There were no significant differences in operative time, postoperative length of stay, surgical site infections, emergency department visits, or readmissions among nonobese and obese groups. In conclusion,obesity did not have any impact on the intraoperative course or short-term postoperative complications after LESS appendectomy.</span><br /> Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Complications following Bacille Calmette-Guérin Vaccination in Children under the Age of 18 Months: A Multi-center Study886788751109810.22038/ijp.2018.32789.2893ENRoxana Mansour GhanaeiPediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-4650-6715Abdollah KarimiPediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Seyed Mohsen ZahraeiCenter for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran.Sussan MahmoudiCenter for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran.Patrick Louis F ZuberWorld Health Organization Essential Medicines and Health Products/QSS.Ahmad Reza ShamshiriDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.0000-0002-7170-0106Seyedeh Mahsan Hoseini-AlfatemiPediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Journal Article20180617<span style="font-family: Times New Roman;"><strong><em>Background: </em></strong>The BCG vaccine, used since 1921 to prevent tuberculosis (TB), considered the world's most widely used vaccine. This study aimed to investigate the frequency and the type of complications associated with Bacillus Calmette-Guérin (BCG) vaccination in Iranian children.</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 cross-sectional study conducted for 6months among children aged up to 18 months who presented to primary health care centers in Tehran (under supervision of all three Medical Universities of Tehran) for their routine vaccinations. All children had received BCG vaccination at birth. We investigated the occurrence of BCG complications through history taking from the parents and physical examination by the study physician. Complications categorized into four major groups: local, regional, remote, and generalized and the rate of occurrence compared between the two genders.</span><br /> <span style="font-family: Times New Roman;"><strong><em>Results: </em></strong>Finally, 14,095 children enrolled during the study period; 574 patients (4%) had experienced at least one complication following BCG vaccination. The most common complications were local side effects observed in 304 children (2.1%); followed by lymph node involvement detected in 270 children (1.9%). Lymph node involvement was more common in males (P<0.001) and axillary lymph nodes were the most common site of involvement. There was a significant increase in the frequency of lymph node involvement at age 18 months in comparison to 2 month old infants (odds ratio=7.76, P<0.001).</span><br /> <span style="font-family: Times New Roman;"><strong><em>Conclusion: </em></strong>We found local adverse reactions as the most common complication following BCG vaccination and age was an independent predictor for the time of presentation of post vaccination lymph node involvement. Disseminated BCG and Osteitis not observed among vaccinated children.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Comparison of Abdominal X-ray Findings and Results of Surgery in Neonates with Gastrointestinal Obstruction887788801142210.22038/ijp.2018.34584.3042ENAbdolreza MalekDepartment of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-2581-2596Narges AfzaliDepartment of Radiology, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran.0000-0002-7869-0828Niloofar AbasiGeneral Practitioner. Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran.Journal Article20180901<strong><em><span style="font-size: 11pt;"><span style="font-family: Times New Roman;">Background</span></span></em></strong><br /> <span style="font-size: 11pt;"><span style="font-family: Times New Roman;">Gastrointestinal (GI) obstruction is one of the most important surgical emergencies in neonates. Surgeons should select between conservative and invasive strategies. Imaging modalities are important in proper diagnosis. This study evaluates the sensitivity of abdominal radiographies (with or without contrast) in detection of neonatal GI obstruction.</span></span><br /> <strong><em><span style="font-size: 11pt;"><span style="font-family: Times New Roman;">Materials and Methods</span></span></em></strong><br /> <span style="font-size: 11pt;"><span style="font-family: Times New Roman;">A cross-sectional study was performed on 62 neonates admitted in NICU of 22 Bahman and Dr. Sheikh Hospitals (Mashhad, Iran) from June 2013 for two years. Radiographic findings were recorded in questionnaires and compared with surgical results in patients who underwent surgery. Statistical analysis was used for determining the sensitivity of radiologic investigations in diagnosis of neonatal gastrointestinal obstruction.</span></span><br /> <strong><em><span style="font-size: 11pt;"><span style="font-family: Times New Roman;">Results</span></span></em></strong><br /> <span style="font-size: 11pt;"><span style="font-family: Times New Roman;">From 62 neonates with GI obstruction, 46.8% of cases were female and the others were male. According to surgery results, the frequency of colon obstruction was 51.6% and small bowel obstruction, gastric outlet obstruction and esophageal obstruction were seen in 27.4%, 9.7% and 17.7% of cases, respectively. The sensitivity of radiographies (with or without contrast) in detection of upper GI obstruction was 100% and in lower GI obstruction was 95.2%.</span></span><br /> <strong><em><span style="font-size: 11pt;"><span style="font-family: Times New Roman;">Conclusion</span></span></em></strong><br /> <span style="font-size: 11pt;"><span style="font-family: Times New Roman;">Generally, sensitivity of radiologic studies (radiographies with and without contrast) in neonatal GI obstruction was 96.5%, so it is a valua<span style="background: #f2f2f2;">b</span>le noninvasive diagnostic method in these diseases.</span></span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Positive Expiratory Pressure (PEP) versus Conventional Chest Physiotherapy in Pediatric Patients with Acute Exacerbation of Cystic Fibrosis888188881139910.22038/ijp.2018.34187.3019ENMasoumeh GhasempourPediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.Nemat BilanPediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.0000-0002-1849-4462Mohammadamin RezazadehsaatlouTuberculosis and Lung Disease Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.Journal Article20180815<strong><em><span style="font-family: Times New Roman;">Background</span></em></strong><br /> <span style="font-family: Times New Roman;">Pulmonary involvement is the main cause of mortality in cystic fibrosis (CF). Airway clearance techniques are non-pharmacological complement options for CF patients. The aim of this study was to evaluate the short-term outcome of airway cleaning treatment in patients with cystic fibrosis in a children's hospital.</span><br /> <strong><em><span style="font-family: Times New Roman;">Materials and Methods</span></em></strong><br /> This clinical trial study conducted on 40 CF patients referring to the specialized lung clinic of Tabriz Pediatric Center in Tabriz, Iran from April 2016 to April 2017. Patients were randomly divided into two equal case (PEP), and control (conventional) groups. The basic spirometry parameters were measured on the European Respiratory Society criteria. After therapeutic intervention, the patients were followed for the next six months and the number of hospital admissions were recorded.<br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">The mean of FEV1, FEV1/FVC and FEF25%-75% in the control group after treatment were 62.60±20.39, 86.70±19.39 and 55.20±32.78, respectively. Comparison of the control group means of FEV1, FEV1/FVC, and FEF25%-75% in the case group after intervention (57.52±14.62, 76.80±21.83 and 59.8±28.71, respectively) showed significant differences (p<0.05). The number of re-hospitalization during the following six months in the case and the control groups were 1.4±1.23 and 2.00±0.64, respectively, which was significantly different (p = 0.00).</span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong><br /> <span style="font-family: Times New Roman;">The patients undergoing treatment (PEP and control groups) showed better spirometry results. In the PEP group, the number of re-hospitalizations was significantly lower than the control group.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Evaluation of Gluten-free Diet on the Heart Functions in Children with Celiac Disease888989051129210.22038/ijp.2018.33947.2993ENNoor Mohammad NooriChildren and Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences and Health Services, Zahedan, IR Iran.0000-0002-0732-6412Alireza TeimouriChildren and Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences and Health Services, Zahedan, IR Iran.0000-0002-8356-4260Touran ShahrakiChildren and Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences and Health Services, Zahedan, IR Iran.0000-0003-3152-5830Journal Article20180806<span><strong><em>Background</em></strong> </span><br /> <span>Celiac disease (CD) is an autoimmune mediated gluten sensitive enteropathy and a chronic inflammatory condition caused by immune pathology in the small intestines in genetically susceptible individuals. This study aimed to determine the efficacy of gluten free diet on cardiac functions using conventional and Doppler tissue echocardiography (DTE) in children with CD compared to controls.</span><br /> <span><strong><em>Materials and Methods</em></strong> </span><br /> <span> This case-control study was conducted on 107 children with CD and 45 healthy children. The study was performed in the Ali Ebne Abi Talib hospital, affiliated to Zahedan University of Medical Sciences, Zahedan (ZaUMS), Iran. After considering exclusion criteria, participants underwent echocardiography. Data were analyzed through SPSS software version 20.0. </span><br /> <span><strong><em>Results</em></strong><strong>: </strong>Results showed that tTG-IgA was different in participants. Left MPI was different in control-positive (p<0.001), control-newly diagnosed (p=0.024), and positive-negative (p<0.001). Right MPI was different in control-positive (p<0.001), control-newly diagnosed (p=0.024), positive-negative (p<0.001), and negative-newly diagnosed (p<0.001). Left MPI’ was different in control-positive (p<0.001), control-newly diagnosed (p<0.001), positive-negative (p=0.014), and negative-newly diagnosed (p=0.010). Right MPI’ was different in control-positive (p<0.001), control-newly diagnosed (p<0.001), positive–negative (p=0.010), and negative-newly diagnosed (p=0.034). Left DT was different in positive-negative. Right ET was different in control-positive, control-newly diagnosed, positive-negative and negative-newly diagnosed. Right AT was different in positive-negative and positive-newly diagnosed. </span><br /> <span><strong><em>Conclusion</em></strong></span><br /> <span>It was concluded in patients with positive response to gluten free diet that some heart functions were similar to the controls and in patients with negative response, some were similar to newly diagnosed patients. Diastolic and systolic dysfunctions are important findings in CD children and TDE is a better method to identify cardiac involvements in subclinical patients with CD.</span><br /> <br /> <br /> Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Prophylactic Efficacy of Cinnarizine versus Propranolol in the Treatment of Childhood Migraine: A Single-Blind Randomized Clinical Trial890789131143510.22038/ijp.2018.34534.3036ENZahra AlebrahimDepartment of Pediatrics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.Ali Reza MoayediDepartment of Pediatrics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.0000-0002-1079-0750Abdolmajid NazemiDepartment of Pediatrics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.Abdolhossein MadaniSocial Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.Maryam MontaseriSocial Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.Journal Article20180829<strong><em><span style="font-family: Times New Roman;">Background </span></em></strong><br /> <span style="font-family: Times New Roman;">Although the development of effective and safe treatments for prophylaxis of migraine headaches represents an important public health concern, only a few medications have been approved by the specific treatment of patients with migraine. We aimed to compare the efficacy of cinnarizine with propranolol in the prophylaxis of pediatric migraine headache.</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;"><strong><em> </em></strong>In a Randomized Clinical Trial, children aged 6-14 years were selected from the patients with migraine admitted to the neurology clinic of Bandar Abbas pediatric Hospital, affiliated to Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Eligible patients (n, 56) were randomly divided into two groups, each comprising 28 patients: the first group administered cinnarizine (37.5 mg/day in children aged 6–12 years and 50 mg/day in children aged 12–17 years), and the second group received propranolol (1-mg/kg/day). The frequency, severity of headaches over the trial period were assessed. </span><br /> <span style="font-family: Times New Roman;"><strong><em>Results: </em></strong>After two months of treatment, both groups had significant reduction in headache frequency in comparison with baseline period (p= 0.047), although this difference between groups was not statistically significant. In addition, the mean severe migraine attacks at the end of the second month was significantly lower in the cinnarizine group compared with the propranolol group (p=0.048). At the end of the study 64% (n=18) of patients who had received the cinnarizine and 57% (n=16) of patients who had administered the propranolol, the drugs appeared to have a preventative effect on their headaches. </span><br /> <span style="font-family: Times New Roman;"><strong><em>Conclusion: </em></strong>According to the results, Cinnarizine appeared as effective as propranolol for the prophylactic treatment of childhood migraine.</span>Mashhad University of Medical SciencesInternational Journal of Pediatrics2345-50477120190101Effectiveness of Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuous Positive Airway Pressure in Preterm Infants after Less Invasive Surfactant Administration891589241147210.22038/ijp.2018.34600.3047ENRamadan MahmoudDepartment of Pediatrics, Faculty of Medicine, Sohag University, Sohag 82524, Egypt.0000000273107795Journal Article20180903<strong><em><span>Background</span></em></strong><br /> <span lang="EN-GB">Non-invasive ventilation is increased used in preterm infants. We aimed to compare the effectiveness of nasal intermittent positive pressure ventilation (nIPPV) versus nasal continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS) after less invasive surfactant administration (LISA). </span><br /> <strong><em><span>Materials and Methods</span></em></strong><br /> <span lang="EN-GB">In this clinical trial, eighty two preterm infants admitted in neonatal intensive care unit, Sohag University Hospital, Egypt with a gestational age of 28–34 weeks, mean ± standard deviation birth weight (1259.44±377.22 grams), suffering from RDS but not requiring intubation in the delivery room were included in the study. Forty one received nIPPV as an initial respiratory support (RS). If nIPPV failed, surfactant administration was given with the LISA approach and patients continued on nIPPV. This group was compared with a historical cohort group of 41 infants managed with nCPAP as an initial RS, and if nCPAP failed, the surfactant was given by LISA. </span><br /> <strong><em><span>Results</span></em></strong><br /> <span lang="EN-GB">There was no significant difference between the case and control group regarding the mean ± SD gestational age or birth weight. When nIPPV was used as the primary RS in preterm infants with RDS compared to nCPAP, it had a significantly less nIPPV failure (31.71% versus 53.66%, P = 0.04), had significantly fewer infants who needed invasive ventilation within the first seven days of life (12.20% versus 34.14%, P = 0.03), and the total days of supplemental oxygen was less (9 (3–18) days versus 12 (6–34) days, P = 0.02). </span><br /> <strong><em><span>Conclusion</span></em></strong><br /> <span lang="EN-GB">In infants born at 28–34 weeks gestation, nIPPV, when used as the primary RS, reduced the need for invasive ventilation and the surfactant requirement within the LISA technique.</span>