Showing papers in "Iranian Journal of Pediatrics in 2007"

The effect of empowerment model on quality of life of Diabetic adolescents

Abstract: Background: The purpose of this research is to estimate the effect of empowerment model on quality of life of diabetic adolescents. Methods: The present semi experimental applied research was carried out on 47 diabetic adolescents in two health centers using census approach in order to investigate the effect of empowerment – model on their quality of life of diabetic adolescents in 2005-2006. The samples were randomly divided into two groups of case and control. The research tools included: the questionnaires of demographic information (characteristics), special quality of life, knowledge, self-efficacy and self-esteem of the adolescents. The validity and reliability of the questionnaires were evaluated by content validity and alfa–chrounbach tests respectively. After collecting the pre-intervention data, the empowerment–model was performed on the samples of the case group according to its triple steps (perceived threat, problem solving and evaluation). Then, the data were collected and analyzed 2/5 months after the empowerment intervention. Findings: The obtained results are as follows: Chi–square test showed no significant difference between the groups of case and control in terms of their demographic characteristics (such as age, gender, literacy) (P>0.05). Independent t-test indicated no significant difference between the two groups in terms of their quality of life before and after the empowerment intervention (P>0.05), but there was a significant difference between the two groups after the intervention in terms of dif-scores of the quality of life (P<0.001). Based on the results of applied paired t-test, there was a significant difference before and after the intervention in the case group in terms of their mean quality of life (P<0.001). Conclusions: Overwhelmingly, according to our findings in the present research, implementation of the empowerment–model intervention has been highly effective on the diabetic adolescent's quality of life, and we suggest this model to be applied on other age groups of our society in a wider range.

Craniofacial Anthropometry in Newborns and Infants

Abstract: Objective: The face is involved in many syndromes of dysmorphogenesis. The soft tissue facial landmarks are known to be influenced by age, race and sex and it is imperative to identify a balance between them before reconstructive surgery. Further, with knowledge of standard facial traits, an individualized norm can be established to optimize facial attractiveness. Material & Methods: Measurements were made on 60 infants (30 males and 30 females) aged between 1-4 months and 60 newborns (30 males and 30 females) with a view to establish the criterion of facial anthropometry for this age group in North Indians. A special emphasis was given in this study to sexual dimorphism. Findings: The mean value and range for all the parameters was determined for the North Indian population. A statistically significant sexual dimorphism was noted to exist in ear length (P<0.01) and length of the philtrum (P<0.05). Philtral–commissural ratio was determined for North Indians, philtrum width=oral width/3.2. Conclusion: The local values derived from well defined populations should be used as reference in the evaluation of a case with dimorphic features. This study demonstrates the existence of a partial positive correlation between philtral width and oral width, i.e. when one increases the other also increases and vice versa. The Philtral–commissural relationship is expected to assist in planning philtral construction in cleft lip patients.

Evaluation of the cause and predisposing factors in neonatal mortality by using international coding diseases version 10 in Valiasr Hospital.

Abstract: Background: According to the fact that the reduction of Neonatal Mortality Rate is correspondent to improvements in health and hygienic status of the society, understanding the major neonatal mortality causes will help the society to plan better prenatal and neonatal care systems. Methods: On this retrospective study, the major causes of the mortality of the dead neonates were extracted from files of Vali-Asr hospital according to the International Coding of Disease Ver 10 (ICD10). Data were analyzed in proportion to gestational age , birth weight , gender and neonatal age. Findings: Mortality rate was higher during the first week of life (78%). Generally five main causes of death were; prematurity, respiratory distress syndrome, intra cerebral hemorrhage, multiple congenital anomalies and air leak syndromes. It was also revealed that the causes of death of low birth weight neonates were similar to those of premature neonates (respiratory distress syndrome, prematurity, intra cerebral hemorrhage, septicemia and air leak syndromes). Similarly there was no difference between the causes the of death in mature neonates and appropriate for growth age neonates. The main causes of death in these two groups were; congenital disease, infections (septicemia and Pneumonia), asphyxia, diffuse intra vascular coagulation, intra cerebral hemorrhage, meconium aspiration and complications of pregnancy. Data analysis indicated significant relationships between death and gestational age, neonatal age and birth weight (P=0.001) but it was not related to gender. Conclusions: With due attention to the easy application of ICD 10 for determining the major and underlying causes of death of neonates and the fact that autopsy is not routinely applicable in neonatology wards, routine using of ICD 10 for classifying the causes of death in death certificates is highly recommended.

Seroprevalence of Hepatitis A in 7-10 Year-old Children

Abstract: Objective: Hepatitis A is one of the most common infections during childhood, especially in developing countries. Regarding the high prevalence of the disease in Iran, this study was performed to detect the rate of the contact of the children of Zanjan/Iran with the virus of hepatitis A (HAV). Material & Methods: In a cross-sectional study, total anti HAV was assayed by ELISA method in serum samples of 300 children, aged 7-10 years, selected by multistage random sampling. The results were statistically analyzed. 27 children did not agree to participate in the study. Findings: Out of 273 samples, including 134 males and 139 females, 121 children (44.3%) had serum antibody against Hepatitis A. Of these children, 42%, 45.4% and 45.3% were 7-8, 8-9 and 9-10 years of age, respectively. No significant difference was found among age groups or between sex groups. Conclusion: According to this study, 44.3% of 7-10 year-old children have had previous contact with hepatitis A virus. This shows a high rate of seronegativity and sensitivity in adult community. Therefore, especially with regard to the high frequency of travels of the people between Iran and neighboring countries, that have high prevalence of disease, revision of national prevention protocol is recommended.

Prevalence and Severity of Anemia in Pediatric Hemodialysis Patients; A Single Center Study

Abstract: Objective: To determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis and to identify independent predictor for anemia in children on hemodialysis. Material & Methods: A cross sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7−20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan, Iran. Findings: A total of 22 (82%) patients had hemoglobin level of 200 pg/ml in 16 patients (66%) and >400 pg/ml in 9 patients (37.5%). There was a reverse correlation between PTH level>200 pg/ml and hemoglobin level (r=-0.505, P=0.046). Conclusion: The prevalence of anemia in children on hemodialysis in Isfahan appears to be higher than that reported in the other studies in spite of extensive use of rHuEPO and iron supplementation. We found this to be especially true for patients new on hemodialysis (less than 6 months), low albumin and severe hyperparathyroidism.

Neonatal Mortality Risk Assessment in a Neonatal Intensive Care Unit (NICU)

Abstract: Objective: This study aims to assess the utility of a scoring system as predictor of neonatal mortality rate among the neonates admitted within one year to the neonatal intensive care unit (NICU) of the Children’s Medical Center in Tehran, Iran. Material & Methods: Data were gathered from 213 newborns admitted to the NICU from September 2003 to August 2004. In addition to demographic data, Apgar scores at 1 minute and 5 minutes, history and duration of previous hospitalization, initial diagnosis and final diagnosis, and scoring system by using the score for the neonatal acute physiology-perinatal extension II (SNAP-PE II) were carried out within 12 hours after admission to the NICU. All of the parameters were prospectively applied to the admitted newborns. The exclusion criteria were discharge or death in less than 24 hours after NICU admission. Findings: 198 newborn infants met the inclusion criteria. The mean and standard deviation (SD) of the variables including postnatal age, birth weight, SNAP, and finally Apgar scores at 1 minute and 5 minutes of neonates under this study were 7.6 (0.5) days, 2479.8 (29.4) grams, 21.6 (1.1), 7.47( 0.08), and 7.71 (0.06), respectively. Twenty five of the 198 patients died (12.6%). Gestational age (P=0.03), birth weight (P=0.02), Apgar score at 5 minutes (0.001), and SNAP-PE II (P=0.04) were significantly related to the mortality rate. By Analyzing through logistic regression to evaluate the predictive value of these variables in relation to the risk of mortality, it was shown that only SNAPPE II and Apgar score at 5 minutes could significantly predict the neonatal mortality. Conclusion: According to this study SNAP-PE II and Apgar score at 5 minutes can be used to predict mortality among the NICU patients. SNAP-PE II score had the best performance in predicting mortality in this study. More studies with larger samples are suggested to evaluate all of the abovementioned parameters among neonates who are admitted to NICUs countrywide.

Sleep Patterns and Sleep Problems among Preschool and School-aged Group Children in a Primary Care Setting

Abstract: Objective: To describe sleep patterns and sleep problems among preschool and school aged group children in a primary care setting in Iran. Material & Methods: This cross sectional study was conducted in two primary care pediatric clinics in Tehran from March 2006 to September 2006. Findings: Sleep patterns of 215 children studied (101 were in preschool age group; 2-6 years old, and 114 were in primary school age group; 7-12 years old). Sleep problems were common in study group, as follows: bedtime problems 21.05%-56.44%, excessive daytime sleepiness 26.73%-42.98%, awakening during the night 13.86%-32.46%, regularity and duration of sleep 17.54%-27.72%, sleep-disordered breathing 10.53%-17.82%. Conclusion: These high frequencies of sleep problems in children explains the importance and burden of sleep disorders in children which unfortunately are not noticed by primary care providers in Iran and inadequate attention to them may have negative consequences on a host of functional domains, including mood, behavior, school performance, and health outcomes.

"Developmental Outcome of Low-Birth-Weight Premature Infants "

Abstract: Fetal and extrauterine life form a continuum during which human growth and development are affected by genetic, environmental, and social factors. Perinatal mortality is influenced by prenatal, maternal, and fetal conditions and by circumstances surrounding delivery. The majority of infants' deaths and developmental disorders are due to disorders relating to prematurity and unspecified low birth weight (LBW), as well as maternal complications of pregnancy and congenital malformations (chromosomal and metabolic). Birth weight less than 2500 g (as result of preterm delivery and/or intra uterine growth restriction) is a major cause of both neonatal and infant mortality rates and, together with congenital anomalies (eg. cardiac, central nervous, and respiratory system), contributes significantly to childhood morbidity. Low birth weight is caused by preterm birth, intrauterine growth retardation (IUGR), or both factors. The predominant cause of LBW in developed countries is preterm birth, whereas in developing countries, the cause is more often IUGR. Although IUGR does not appear to further increase the risk of mortality in preterm infants, both morbidity and mortality are increased in term growth-restricted infants. Infants weghing less than 1500 g are most often premature (<37 weeks of gestation), although IUGR may also complicate the early delivery. Eventhough very low birth weight occurs in only 1-2% of all infants, these births represent a large proportion of the neonatal and infant mortality and infants with both short- and long-term complications, including neurodevelopmental handicaps. At school age, VLBW infants have poorer physical growth, cognitive function, and school performance. These disadvantages appear to persist into adulthood and therefore have broad implications for society. A number of well-designed clinical research studies have demonstrated a powerful interaction between biological and environmental risk and protective factors within the infant and the environment.

Comparison of salivary calcium, phosphate and alkaline phosphatase in children with severe, moderate caries and caries free in Tehran’s kindergarthens

Abstract: Background: The most common dental disease in childhood is dental caries. This study was carried out to recognize the components of saliva which are protective factors in children in order to evaluate and predict caries susceptible and caries resistant individuals. Methods: A total of 75 subjects of either sex aged 3-5 years old from kindergartens in Tehran were selected and divided into 3 groups (case group: dmft>6, control group 1: 1 0.05). However, the results showed that salivary phosphate and alkaline phosphatase in caries free group and calcium in the group with severe caries was somewhat more than those in other groups. Conclusions: Despite the results of the present study, the relationship between salivary components and caries rate in children remainslcontroversial. So, more and wide studies are necessary to achieve some practical criteria for predicting dental caries, recognition of susceptible persons and finally prevention of caries in children.

Prevalence of Shigella Species and Their Antimicrobial Resistance Patterns at Amirkola Children's Hospital, North of Iran

Abstract: Objective: In the few cases of acute childhood diarrhea that require antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains and pattern of antimicrobial resistance. Shigellosis is one of the most important examples in this group of intestinal infections. In order to establish such parameters in our city this study was carried out to determine the prevalence and pattern of antimicrobial resistance of Shigella species among patients with acute diarrhea admitted to the Amirkola children's hospital, North of Iran. Material & Methods: The study included all patients with acute diarrhea, 6 months to 12 years of age, who were admitted to the Amirkola children's hospital during March 2001 to March 2004. Incidence, phenotypic characteristics and antimicrobial resistance patterns of Shigella strains, isolated from hospitalized children with acute diarrhea, were studied Findings: We received 260 positive cultures for Shigella out of 1850 stool samples during 3 years (14.05%). Shigella specimens presented a high resistance rate to trimethoprimsulfamethoxazole (73.84%) and ampicillin (73.84%), and low resistance rate to Ciprofluxacine (2.69%) and cefotaxim (2.69%). S. flexneri (70%) was most frequently isolated, followed by S. Sonnei (30 %). No cases of S. boydii and S. dysenteriae were found. Conclusion: Our results provide data on antimicrobial resistance to choose a proper antibiotic for Shigellosis in our community. According to our findings cefotaxime for pediatric patients and quinolone derivatives for adult patients are the proper drug choices. Systematic monitoring is needed to identify changes in prevalence and antimicrobial resistance pattern.

Prevalence of Attention Deficit Hyperactivity Disorder in a Group of Elementary School Children

Abstract: Objective: The purpose of this study was to examine prevalence of three subtypes of attention deficit hyperactivity disorder (ADHD) including attention deficit type, hyperactivity type, and combined type in a group of elementary school children in Shiraz. Material & Methods: For this purpose 1311 students (644 boys and 667 girls) aged 7-12 years were recruited using cluster random sampling. The instrument used in this study was the SWAN questionnaire (Swanson, Schuck, Mann, Carlson, Hartman & Sergeant, 2004). Findings: The results revealed that 5% to 8.5% of elementary school children show symptoms of one of the subtypes of ADHD. The results also revealed that the prevalence of hyperactivity disorder decreased with age while the prevalence of attention deficit increased with age. The prevalence of hyperactivity and attention deficit disorder in boys was not significantly different than in girls. However, the prevalence of combined type of disorder was significantly higher in boys than in girls. In addition, mean scores of the attention deficit, hyperactivity and combined type of disorder were significantly different in different socio-economic groups. Conclusion: Prevalence of the subtypes of the disorder was different across age and gender and children with lower socio-economic status are in danger of higher mean scores in all subtypes of the disorder.

Clinical features and risk factors of pediatric urolithiasis

Abstract: Objective: Urolithiasis in children although occurring less often than adults, causes considerable morbidity. The main aim of this study is to evaluate clinical features and risk factors of pediatric urolithiasis. Material & Methods: All children with documented urolithiasis who were referred to department of pediatric nephrology between 1999 and 2005, were evaluated from the point of demographic features, family history, clinical symptoms, imaging results and laboratory findings. Findings: We investigated 184 patients (100 females and 84 males) with urolithiasis between 2 months and 14 years of age (mean age 3.66±3.49 years). The stones' diameter was 3-27 mm (mean 8.20±5.36). In 85.8% of cases the stone was located only in kidneys and in 3.3% only in bladder. The most common causes of presentation were urinary tract infection (UTI), restlessness and gross hematuria. Positive family history was detected in 41%, UTI in 40.8%, anatomic abnormality in 13% and sterile pyuria in 18.5% of patients. Metabolic evaluation, which was carried out in 162 patients, revealed that 104 (64%) of them had a metabolic risk factor including normocalcemic hypercalciuria (42%), Hyperuricosuria (10.5%), Cystinuria (7.4%), and Hyperoxaluria (4.3%). Conclusion: All children with urolithiasis should be completely evaluated, as most of them have an anatomic, infectious or metabolic risk factor.

Low birth weight among newborn infants at tehran hospitals

Abstract: Objective: This study was performed to determine the prevalence and risk factors of low birth weight (LBW) among the live born neonates at the hospitals in Tehran from Sep 2005 till Sep 2006. Material & Methods: This study was a cross-sectional study. Ten hospitals in Tehran were chosen randomly. During the period of study several days in a month were chosen randomly and all newborns born on those days were assessed. The studied characteristics included sex, gestational age, birth order, the interval to previous birth, existence of congenital anomalies, multiple pregnancy, maternal age, gravidity and parity number, history of maternal fertility (including previous LBW infants, infertility, abortion), history of recent pregnancy (including smoking, drug consumption, x-ray exposure, weight gain, vaginal bleeding, gestational illness, folate and iron consumption, gestational infection), chronic illness of the mother, maternal education and maternal job. Findings: We studied 514 (56.5%) females and 391 (43.5%) males. The LBW prevalence was 8.6% (78 newborns). There was significant statistical relationship between LBW and gestational age, the interval to previous birth, existence of congenital anomalies, multiple pregnancy, maternal age, history of maternal fertility (including previous LBW infants, infertility, abortion), history of recent pregnancy (including smoking, drug consumption, weight gain, vaginal bleeding, gestational illness, iron consumption, gestational infection), chronic illness of the mother and maternal education. Conclusion: Although our results regarding LBW prevalence and risk factors confirm the results of other studies, we recommend perspective studies to reconfirm the LBW risk factors.

Prevalence and Symptoms of Idiopathic Hypercalciuria in Primary School Children of Tehran

Abstract: Objective: Determining prevalence of idiopathic hypercalciuria (IH) in primary school children of Tehran. Material & Methods: We evaluated 778 primary school children (age 6-11, mean 9.1 years) in two steps: first (Screening test), we measured urine calcium to urine creatinine ratio (UCa/UCr) and in the second step (Definitive test), for those children who had UCa/UCr ratio more than 0.21 mg/mg we measured 24 hours urine calcium excretion. Children with secondary forms of hypercalciuria were excluded from the study. Children with idiopathic hypercalciuria were evaluated for manifestations of IH. Findings: Among 778 children, 195 (25.1%) had UCa/UCr ratio more than 0.21 mg/mg, but from these 195 children only 128 children delivered 24 hours urine samples. Among these 128 children for whom 24 hours urine calcium measurements were done 28 children excreted more than 4mg/kg/day calcium without hypercalcemia or any other known causes of hypercalciuria and we defined them as having idiopathic hypercalciuria. If all 195 suspicious cases of IH had delivered 24-hrs urine samples we would have 42 cases of IH. Conclusion: Prevalence of IH in our children was 5.4% and its manifestations were: hematuria, dysuria, recurrent abdominal pain, urinary incontinence, urgency, urinary tract infections and urolithiasis.

The Effect of Kangaroo Care on Physiologic Responses to Pain of an Intramuscular Injection in Neonates

Abstract: Objective: Pain in neonates can be associated with various risks. So, it seems essential to find a simple and acceptable method for relieving pain. Pharmacologic agents are not recommended in neonates for pain relief in minor procedures but nonpharmacologic interventions like Kangaroo Care (KC) is found to be effective. The objective of this study was to assess the efficacy of KC on physiologic responses to the pain of an intramuscular injection of vitamin K in term neonates. Material & Methods: One hundred healthy term neonates were enrolled for this study during 2 months. The inclusion criteria were gestational age 37-42 weeks, normal vaginal delivery, birth weight 2500-4000 gr, age more than 2 hours and Apgar score more than 7 at 1 minute. They were randomly assigned to intervention and control groups. In the intervention group, the neonate was held in KC for 10 minutes before the injection until 3 minutes after injection. In the control group, the neonate was in the prone position in the isolette. The primary outcome measures were heart rate and blood oxygen saturation rate before, during and 3 minutes after injection. Findings: The heart rate during and 3 minutes after injection for neonates given KC were significantly lower than for neonates in control group (P<0.001). The blood oxygen saturation rate during and 3 minutes after injection for neonates given KC were significantly higher than for neonates in control group (P<0.001). Conclusion: KC given before injection seems to effectively decrease pain from injection. It is a simple, safe and effective analgesic and should be considered for minor invasive procedures in term neonates.

Evaluation of Glucose-6-Phosphate Dehydrogenase Deficiency without Hemolysis in Icteric Newborns

Abstract: Objective: Glucose-6- phosphate dehydrogenase (G6PD) deficiency is an inherited deficiency that may be the cause of neonatal jaundice. Our aim was to study the prevalence of G6PD deficiency without hemolysis in relation to neonatal jaundice. Material & Methods: This prospective descriptive study has been conducted on 272 icteric newborns admitted to the Ekbatan Hospital from October 2002 to September 2004. The dataset included: age, sex, total and direct bilirubin, hemoglobin, reticulocyte count, blood group and Rh of mother and newborn, direct Coombs, G6PD level and the type of treatment. All data was analyzed by using statistical method. Findings: From 272 neonates, 12 neonates (4.4%) were found to have G6PD deficiency. The male to female ratio was 5 to 1 (10 male and 2 female neonates). From 12 neonates with G6PD deficiency, hemolysis was seen in 5 neonates (41.7%) and the rate of G6PD deficiency without hemolysis was 2.6%. There was no difference in the mean bilirubin level, hemoglobin level and also reticulocyte count between patients with G6PD deficiency and those without G6PD deficiency (p>0.05). Out of 12 patients with G6PD deficiency, 2 patients (16.7%) had blood exchange transfusion. Rh and ABO incompatibility were not seen in any of the12 patients with G6PD deficiency. Conclusion: In this study the prevalence of G6PD deficiency in icteric newborns was considerably high and most of them were non hemolytic, so we recommend G6PD test as a screening program for every newborn at the time of delivery.

Cryptosporidium Infection in Pediatric Patients with Lymphohematopoietic Malignancies

Abstract: Objective: Cryptosporidium parvum is a common protozoan pathogen with worldwide distribution. It localizes on the intestinal cells and prolonged diarrhea in immunocompromised patients. The aim of this study was to estimate the prevalence and the clinical features of enteric cryptosporidiosis in pediatric patients with lymphohematopoietic malignancies. Material & Methods: In this cross-sectional study stool samples were collected from 100 children (67 boys, 33girls) with lymphohematopoietic malignancies who underwent chemotherapy between the ages of 6 months and 17 years (mean age 7.5 years). All of the specimens were examined for the oocysts of C. parvum by modified Ziehl Neelsen (MZN) staining technique and coproantigens of C. parvum by ELISA. Findings: Cryptosporidium infection was detected in 22 patients. 16 (72.7%) of the infected patients were male and 6 (27.3) female. 7 (31.8%) patients were 10 years old. Parasites were detected in 19/85 (86.4%) patients with ALL, 2 of 5 (9.1%) with AML, and 1 of 10 (4.5%) with NHL. Clinical symptoms were found in 11 (50%) of the patients. We found longer duration of chemotherapy in patients who were positive for cryptosporidium infection (Mean=2067 days) in comparison to negative group (Mean=258.5 days) (ANOVA, f=2.82, P=0.04). Conclusion: The incidence of cryptosporidium infection was 22% among pediatric patients with lymphohematopoietic malignancies. We recommend evaluation of these patients with at least two different diagnostic methods in order to prevent possible life threatening outcomes.

The role of training workshops of newborn cares in promotion of mothers' knowledge

Abstract: Objective: Cerebral palsy (CP) is a static encephalopathy. In addition to motor developmental delay, most patients have speech and social developmental delay. Recently, complementary medicine like homeopathy has been used in the treatment of neurodevelopmental disorders. This study has been conducted to determine the effect of adding homeopathic treatment to rehabilitation on speech and social development of children with spastic cerebral palsy. Material & Methods: This study was a double blind clinical trial. Twenty-four subjects were recruited from a clinic in Tehran during 2004. In this study, minimization technique was used and subjects were divided into case and control groups. The routine rehabilitation techniques were performed for 4 months in both groups. The control group received placebo and the case group homeopathy drugs. The subjects were 1-5 years old with spastic cerebral palsy, speech and social developmental delay. Level of speech and social development were assessed by Denver Developmental Screening Test II (DDST II) in the two beginning of the study and 4 months later. Findings: The average age, in the case and the control group was 28 and 28.4 months respectively. The level of speech and social development in the case group in comparison with the control group had no statistically significant difference (PV=0.17 and PV=1 respectively). Conclusion: Adding homeopathy to rehabilitation had no significant effect on the level of speech and social development of CP children. Regarding the proved effects of homeopathy mentioned in different articles on the developmental status of children with CP, it is not possible to reject the effects of homeopathy on speech and social development of children with CP.

Childhood Accidental Poisoning in Tafila

Abstract: Objective: To asses the frequency, causes and how to increase the awareness of childhood poisoning. Material & Methods: A retrospective study of childhood accidental poisoning was conducted in Tafila Prince Zeid Hospital (PZH) by reviewing the files of 134 children admitted with accidental poisoning in 2003-2005. Findings: This study showed that accidental poisoning was frequent but morbidity was low and there were no deaths. Analgesics and antihistamines were the most frequently ingested drugs. Conclusion: The frequency of accidental poisoning is common in Tafila. Household chemicals and medication were the predominant. So, that merits the introduction of a public awareness campaign and increased use of child-resistant containers is important preventive measures that deserve more attention.

Impact of Maternal Ramadan Fasting on Growth Parameters in Exclusively Breast-fed Infants

Abstract: Introduction: There are many advantages of breast milk for infants. The impact of Ramadan fasting of breast-feeding mothers on their exclusively breast-fed infants’ growth is still not clear. The objective of this study is to determine the impact of maternal Ramadan fasting on growth parameters of exclusively breast-fed infants. Methods: This cohort study was conducted during Ramadan and five months after Ramadan on 116 healthy, exclusively breast-fed infants aged 15 days to 6 months. 36 infants, whose mothers fasted throughout Ramadan (case group) and 80 infants, whose mothers did not fast (control group), were enrolled in the study. All infants underwent periodic physical examinations, twice in Ramadan, 3 times in the second month and twice monthly in the next 4 months. The data analyses were done using a repeated measure analysis of variance. Statistical significance was defined as P 0.05). There is obvious increasing trend for all growth parameters; this trend depends on age and is almost similar for both groups. Conclusion: Ramadan fasting by breast-feeding mothers did not adversely affect the growth parameters of exclusively breast-fed infants in short-term.

Flatfoot in Children: How to Approach?

Abstract: Although the exact incidence of flatfoot in children is unknown, it is very common and is, in fact, one of the most common conditions seen in pediatric orthopedic practices. All children are born with flat feet, and more than 30% of neonates have a calcaneovalgus deformity of both feet. This condition is not painful and generally resolves without treatment; very rarely is corrective casting necessary. For the pediatrician evaluating flatfoot, it is important to differentiate between flexible and nonflexible (rigid) flatfoot, and to classify the condition as painful or painless. Most children who present to a pediatrician for evaluation of flatfoot will have a flexible flatfoot that does not require treatment. On the other hand, other conditions that do require treatment, such as congenital vertical talus, tarsal coalition, and skew-foot often present as nonflexible flatfoot. Surgical management is rarely indicated for a true flexible flatfoot. The longitudinal arch of the foot is not present at birth and slowly develops during childhood, usually by about age five or six. It is a process that occurs throughout growth and is not affected by the presence or absence of external arch support. Sometimes the arch takes even longer to take shape, but this still usually does not cause any problems. A variety of tendon transfers and reconstructive procedures have been advocated, but none has proved uniformly successful. Nor have any of the various types of supports ever been shown to change the arch architecture. It should be borne in mind that painful flexible flat foot requires treatment, often with several types of shoe inserts and supports and as a last resort by operative procedures. Although parents are often concerned about pediatric flatfoot, the child is usually found to be asymptomatic, and no treatment is indicated. In most instances, the best treatment is simply taking enough time to convince the family that no treatment is necessary.

Pattern of total antioxidant capacity in human milk during the course of lactation

Abstract: Background: In addition to numerous nutrients, human milk contains several antioxidants as bioactive components protecting newborns from a hyperoxic challenge due to transition to an environment much richer in oxygen. The aim of this study was to evaluate the changes of total antioxidant capacity of human milk during the first six months of lactation. Methods: 535 milk samples were collected from 145 healthy women with full term newborns. Analyses included colostrum (at 2±1 day postpartum), transitional milk (at 7±3 days postpartum) and mature milk (at 30±5, 90±7 and 180±10 days postpartum) and also maternal plasma at 90±7 days. The total antioxidant capacity of samples was measured by Ferric Reducing/Antioxidant Power (FRAP) assay. Results: Colostrum showed a significant higher antioxidant capacity than the transitional and mature milks (589.8±278.1 vs. 508.5±284.1, 453.5±210.8, 479.3±254.3 and 402.6±168.0 μmol/l respectively). Also a significant decrease in antioxidant capacity was observed in the mature milks (p<0.05). The relationship between the antioxidant content of breast milk and maternal plasma was significant too (p<0.05, r=0.267). Conclusions: These data suggest that colostrum, with high antioxidant capacity, during the first days of life is vital; moreover, reduction in total antioxidant capacity during the course of lactation is notable and requires sophisticated measures.

Kawasaki disease in 159 iranian children

Abstract: Objective: Kawasaki disease (KD) is an intense life-threatening vasculitis. The diagnosis of Kawasaki disease is made by clinical criteria. This disease is a common rheumatologic disease in Iran. The aim of this study was describe the demographics and clinical features of KD in Iranian patients. Material & Methods: A review was conducted for all cases of KD treated at Pediatric rheumatology department in Children's Medical Center between January 1994 and July 2004. The diagnostic criteria for typical Kawasaki were based on the criteria of the Japan Kawasaki Disease Research Committee. Atypical or incomplete KD has been described in which patients not strictly meeting the diagnostic criteria but have coronary artery changes. Color doppler echocardiograms were done at the time of diagnosis, 14 to 21 days, 60 days, and 1 year after treatment. Findings: One hundred fifty nine patients were identified. One hundred twenty five children (78.6%) fulfilled criteria for typical KD. Echocardiographic abnormalities were found in 30 cases (18.9%), including 9.6% with typical and 46.1% with atypical Kawasaki. The incidence of atypical Kawasaki in our study was about 22%. Coronary arteries aneurysms found in 66.7% and 33.3% was other abnormalities. Male to female ratio was more in patients with cardiac complication (2.3:1). Conclusion: Kawasaki disease should be considered in any infants or child (especially less than 2 years old) with a prolonged febrile illness. Demographic features of our patients were similar to reports from other country. The incidence of atypical Kawasaki in our study was about 22%.

Prevalence of Hypertension in Junior and Senior High School Children in Iran

Abstract: Objective: To determine the prevalence of high blood pressure in a representative sample of children and adolescents from Tehran, Iran, and also to compare our results with those reported by the Second Task Force. Material & Methods: This cross-sectional study was carried out from March 2004 to September 2005. Individuals between 13 and 18 years of age were selected randomly from the list of schools (grade 6 through 12) in various locations throughout Tehran. All measurements were performed at public and high schools. The size of the sample was defined based on the expected prevalence of hypertension for the age group. After randomization, data were collected through a questionnaire. Blood pressure was measured twice. Weight and height were also measured. High blood pressure was defined as systolic and/or diastolic blood pressure over the 95 th percentile in both measures. Findings: The final sample included 6038 (3280 boys 2758 girls) apparently healthy students. In all students who had a systolic or diastolic blood pressure equal or more than the 95th percentile, blood pressure was measured after 1 and 2 weeks (second and third rescreening). Blood pressure was elevated in 287 students in the initial screening (4.7%), with a decrease to 1.0% and 0.8% when this group was screened a second and third time respectively. According to the 1987 Task Force Report in United States, systolic hypertension was found in 2.8% and diastolic hypertension in 3.4% in screening. In rescreening, both systolic and diastolic hypertension had fallen to 0.7%. In the third screening systolic hypertension had fallen to 0.6% and diastolic hypertension to 0.5%. Conclusion: The prevalence of elevated blood pressure was 0.8% in the present study. No statistically significant difference was noted between the prevalence of elevated blood pressure between genders. Additionally, these results confirm the importance of the Task Force recommendation that multiple BP measurements should be obtained before making a diagnosis of hypertension.

Disease spectrum and mortality in hospitalized children of southern iran

Abstract: Objective: In medicine, especially in the field of pediatrics, it is necessary to perform regular epidemiologic studies in each geographic region. We designed this study in Nemazee Hospital, Shiraz (the major referral pediatric center in Southern Iran), to determine the disease spectrum, the mortality and also the rate of matching final diagnosis with the initial impression in pediatric wards. Material & Methods: All children older than 1 month (2731) who were admitted in Nemazee Hospital (except for surgical wards), from November 2005 to October 2006, were studied through questionnaire interviewing on admission and were followed till discharge or expire time. In some instances that final diagnosis or cause of death was unclear; we followed them through their files in clinics up to 1 year. Findings: Among 3057 admissions (related to 2731 patients), 56.8% were males (male to female ratio: 1.31). Patients’ age was 31 days to 25 years (mean: 5.16 years, SD: 4.98 years) and the significant portion was less than 2 years (1270= 44.2%). Admission duration varied from 1 to 62 days (mean: 5 days, SD: 5.13 days). The most common diseases were seizure disorder (315=11.1%), pneumonia (235=7.7%), febrile convulsion (136=4.79%) and gastroenteritis (128=4.18%). 17.93% of admissions came out of Fars Province (18 Provinces) with digestive system (19.1%), infectious (18.5%) and nervous system diseases (15.0%) as the most frequent referred patients. In 90.6% of admissions final diagnosis was clarified in the hospital (ranged from 86.45% in infectious ward to 93.4% in cardiology ward) (P=0.01). The total mortality rate was 5.30%; this rate was 9.49% for patients younger than 1 year and 5.0% in older patients (P<0.001). Conclusion: The most common age of admission in pediatric wards was less than one year. The most common diseases were seizure disorder, pneumonia and gastroenteritis. Congenital heart disease, sepsis and pneumonia were the most common diseases leading to death.

Dietary Pattern and Food Intake Habit of the Underprivileged Children Residing in the Urban Slums

Abstract: Objective: Nutritional status directly affects the growing up of children in terms of physical and mental development. In the urban slums the underprivileged children lag behind the basic necessary amount of food and nutrition which is likely to lead to their ill development. This study was undertaken to investigate the dietary food intake pattern among urban slum dwelling children attending schools Dhaka city and to examine the association with various social factors. Material & Methods: This study is a cross-sectional study among 396 school going children who are residents of slums in different parts of Dhaka Metropolitan city. Findings: The age of the children were categorized into three age groups; Mean age for the children of age group-1 was 6.51 (±1.01) years, for the age group-2 was 9.24 (±1.09) years and for the age group-3 was 12.5 (±0.91) years. In 77.8 % of the cases the child gets three meals per day but inadequate in amount. In most of the cases the common foods were rice, lentil, potato and green leafy vegetables. The food frequencies reported by the children were; eggs: 1.4 times per week, milk: 1.2 times per week, meat: 0.4 times per week, fish: 2.8 times per week and fruits 2.9 times per week. Those children from families with lower incomes and less educated parents had a dietary pattern which tended to be poor regarding egg, milk, meat and fruit. Conclusion: The diets of these urban slum school children were inadequate for macronutrients and micronutrient, which is a danger for significant nutritional and health implications. The need to develop healthy food supply and habits should be emphasized.

Urinary Tract Infection and Predisposing Factors in Children

Abstract: Objective: This study was designed to determine the predisposing factors in children with symptomatic urinary tract infection (UTI) according to age and gender. Material & Methods: We reviewed prospectively 183 pediatric patients with symptomatic UTI admitted to emergency department or referred to nephrology clinic from November 2002 through July 2005. All patients underwent renal ultrasonography and voiding-cystouretherography or radionuclide cystography. Diuretic renal scan or intravenous pyelography (IVP) was performed in those with urinary system dilatation. Urodynamic studies were done in patients with normal radiologic findings and recurrent infections or urinary-intestinal symptoms. Findings: Of 183 patients, 130 cases (71%) were female and 53 patients (29%) male. Most of the patients (61.9%) were between 2-24 months old ( P =0/001). Vesicoureteral reflux (VUR) was the most common predisposing factor in both genders (46.9% in girls and 48.9% in boys). Voiding dysfunction in girls and urinary obstruction in boys were found with a significant difference ( P =0/03 for both). In all age groups, except patients≤1 month, the most common predisposing factor was reflux. Reflux, urinary obstruction and nephrolithiasis were found with a significant difference in 2-24 months age group ( P= 0/001 for all). Conclusion: In our study vesicoureteral reflux (VUR) was as common in boys as in girls, and suggested urolithiasis as a significant UTI predisposing factor. This study showed that voiding dysfunction in girls and urinary obstruction in boys are as significant predisposing factors. We suggest urodynamic studies in patients with normal radiologic findings and recurrent infections or urinary-intestinal symptoms.

Rotational Deformities of the Lower Limb in Children

Abstract: Rotational deformities are common lower extremity abnormalities in children. Rotational problems include in-toeing and out-toeing. In-toeing is caused by one of the three types of deformity: metatarsus adductus, internal tibial torsion, and increased femoral anteversion. Out-toeing is less common than intoeing, and its causes are similar but opposite to those of intoeing. These include femoral retroversion and external tibial torsion. An accurate diagnosis can be made with careful history and physical examination, which includes torsional profile (a four- component composite of measurements of the lower extremities). Charts of normal values and values with two standard deviations for each component of the torsional profile are available. In most cases, the abnormality improves with time. A careful physical examination, explanation of the natural history, and serial measurements are usually reassuring to the parents. Treatment is usually conservative. Special shoes, cast, or braces are rarely beneficial and have no proven efficacy. Surgery is reserved for older children with deformity from three to four standard deviations from the normal.

Approach to the Patient with Nephrolithiasis; The Stone Quiz

Abstract: Calcium oxalate stones are the most common type of stones in patients with idiopathic nephrolithiasis. A calcium phosphate stones are more typical of patients with renal tubular acidosis, chronic urinary tract infection and primary hyperparathyroidism. A non-contrast enhanced helical computed tomography (CT) scan of the abdomen is the diagnostic procedure of choice with superior sensitivity and specificity of almost 100% compared to the KUB and abdominal ultrasound. Patients should be instructed to strain their urine and bring in any stone that passes for analysis. Stone identification enables better planning of subsequent therapy. The likelihood of stone passage is 95% for stones up to 5 mm in size. Stones larger than 5 mm in diameter that do not pass in several days merit referral to an urologist for lithotripsy, or lithotomy. No specific work-up or drug therapy is typically provided for patients who have passed a single stone. Long term management of patients who have passed their first stone includes recommendations to avoid a diet high in salt or animal protein and maintenance of a fluid intake greater than 2 liters per day. A low calcium diet is also an important risk factor for calcium nephrolithiasis. A low dietary calcium intake reduces the concentration of calcium in the intestinal lumen which can lead to increase in gastrointestinal absorption and urinary excretion of oxalate. Patient with recurrent disease should receive a complete evaluation to treat the identified risk factors and prevent stone formation.

Exercise and Diabetes Type 1: Recommendations, Safety

Abstract: Type 1 diabetic subjects without any complications and with a good control could participate in all levels of sports activities, both recreational and professional. But, there are some limitations for subjects who have chronic side effects of diabetes. A detail pre-participation physical examination is needed to find out these complications. All diabetics should be encouraged to perform suitable exercise and sports. To prevent acute diabetic side effects of exercise, hypo and hyperglycemia, diabetic athletes may need to adjust their nutrition and insulin dosage. Depending on the characteristics of the exercise, the ambient environment and the level of blood glucose before exercise, diabetic athletes need to consume some carbohydrate before, during and after exercise. Also, if the exercise takes more than 30 minutes, insulin should be reduced by 14-50%. Every athlete on the base of scientific recommendations, should find his or her own approach in the management of nutrition and insulin adjustment and integrity of them with exercise and sport. This could be achieved by trial and error.