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1.  Periodic Fever: A Review on Clinical, Management and Guideline for Iranian Patients - Part II 
Iranian Journal of Pediatrics  2014;24(3):229-240.
Periodic fever syndromes are a group of diseases characterized by episodes of fever with healthy intervals between febrile episodes. In the first part of this paper, we presented a guideline for approaching patients with periodic fever and reviewed two common disorders with periodic fever in Iranian patients including familial Mediterranean fever (FMF) and periodic fever syndromes except for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA). In this part, we review other autoinflammatory disorders including hyper IgD, tumor necrosis factor receptor–associated periodic syndrome (TRAPS), cryopyrin associated periodic syndromes, autoinflammatory bone disorders and some other rare autoinflammatory disorders such as Sweet’s and Blau syndromes. In cryopyrin associated periodic syndromes group, we discussed chronic infantile neurologic cutaneous and articular (CINCA) syndrome, Muckle-Wells syndrome and familial cold autoinflammatory syndrome. Autoinflammatory bone disorders are categorized to monogenic disorders such as pyogenic arthritis, pyoderma ;gangraenosum and acne (PAPA) syndrome, the deficiency of interleukine-1 receptor antagonist (DIRA) and Majeed syndrome and polygenic background or sporadic group such as chronic recurrent multifocal osteomyelitis (CRMO) or synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome are classified in sporadic group. Other autoinflammatory syndromes are rare causes of periodic fever in Iranian system registry.
PMCID: PMC4276575  PMID: 25562014
Periodic Fever; Hyper IgD; TRAPS; Autoinflammatory Bone Disorder; Cryopyrin Associated Periodic Syndromes; Sweet’s Syndrome; Blau Syndrome
2.  Autonomy of Children and Adolescents in Consent to Treatment: Ethical, Jurisprudential and Legal Considerations 
Iranian Journal of Pediatrics  2014;24(3):241-248.
Autonomy is usually considered as a main principle in making decisions about individuals’ health. Children and particularly adolescents have the capacity to take part in medical decision-making to some extent. For the most part the parent-doctor-child/adolescent triangle sides are essentially in agreement, but this may not be true in some cases, causing physicians to face problems attempting to determine their professional duties. According to Islamic jurisprudent upon reaching the age of Taklif (15 full lunar years for boys and 9 full lunar years for girls) no one can be treated as incompetent based on mental immaturity unless his or her insanity or mental immaturity is provend Moreover the Islamic Sharia, decrees that parents should lose their authority to make medical decisions for their children, if their bad faith or imprudence is proven, in which case a fit and proper person or an institution will be appointed to make decisions in this respect based on the child’s best interests.
PMCID: PMC4276576  PMID: 25562015
Pediatrics; Autonomy; Medical Ethics; Islam; Jurisprudence; Iranian Legal System; Iran
3.  The Association between Carotid Intima-Media Thickness and the Duration of Type 1 Diabetes in Children 
Iranian Journal of Pediatrics  2014;24(3):249-254.
Objective: Carotid intima-media thickness (cIMT) has been known as a criterion of generalized atherosclerosis and a marker of cardiovascular disease progression in many studies which can be measured by ultrasound using high-resolution device.
Methods: This is a case-control study. A total of 40 children (16 males and 24 females) with type1 diabetes mellitus and control group consisting of equal numbers (17 males and 23 females) who were otherwise healthy were included in the study from May 2007 to January 2008. The two groups were age matched, with the mean age of 10.56±3.21 years in control group and 10.67±4.18 years in diabetic patients. Left and right cIMT were measured by ultrasound.
Findings : There was a significant difference between case and control subjects in terms of mean cIMT (P<0.001). cIMT was significantly higher in the diabetic group. Among variables including age, BMI and diabetes, diabetes was the only influential parameter in this respect. The mean time length of type 1 diabetes in our diabetic group was reported 4.24±3.02 years, with a minimum of four months and a maximum of ten years. There was a statistically significant difference between the two diabetic patients with below and above four years of disease duration (P=0.03 for right carotid artery and P=0.01 for left carotid artery).
Conclusion: cIMT has been identified as an early indicator of atherosclerosis in many studies. It increases in patients with type 1 diabetes as the disease progresses and this can be followed by macro and microvascular atherosclerotic changes.
PMCID: PMC4276577  PMID: 25562016
Type 1 Diabetes Mellitus; Carotid Intima-Media Thickness; Vascular Diseases; Atherosclerosis
4.  What Has National Screening Program Changed in Cases with Congenital Hypothyroidism? 
Iranian Journal of Pediatrics  2014;24(3):255-260.
Objective: Since congenital hypothyroidism (CH) is the most important cause of preventable mental retardation, its screening is important. In this present study, it was aimed to evaluate congenital hypothyroidism cases before and after the initiation of screening program in year 2007 in our country.
Methods: A total of 400 patients diagnosed with CH at our outpatient clinic were retrospectively evaluated. Age of diagnosis, complaint, clinical signs, and etiological distribution were detected and changes in those parameters were evaluated before and after year 2007, which was the initiation date of our national screening program.
Findings : After year 2007, 70.6% of patients were diagnosed in the first month; 21.2% in 1-3 months; 6.5% in 3-6 months, and no patient was diagnosed after 9 months. Before initiation of the screening program, 48.4% of cases were diagnosed in the first month, the percentage was increased to 62.8% after the program; the increase was significant. While mental retardation was detected in 13.3% of patients before the screening, it was decreased to 4% after initiation of the program. An interesting finding was that age of treatment onset in girls was significantly higher than in boys before the screening; there was no difference between them after initiation of the screening.
Conclusion: In this present study, it was observed that ages of diagnosis and treatment as well as mental retardation rates were significantly decreased in girls after the screening program, but ideal results have not been reached yet, and is expected to be reached in the future.
PMCID: PMC4276578  PMID: 25562017
Congenital Hypothyroidism; Neonatal Screening; Infant; Thyroid Hormones
5.  Isolation and Identification of E. cowanii from Powdered Infant Formula in NICU and Determination of Antimicrobial Susceptibility of Isolates 
Iranian Journal of Pediatrics  2014;24(3):261-266.
Objective: Enterobacter cowanii is a genus of common gram-negative, facultatively anaerobic, rod-shaped, non-spore-forming bacterium of the Enterobacteriaceae family. This organism can be potentially a powdered infant milk formula-borne opportunistic pathogen. The aim of this study was to isolate and identify E. cowanii from consumed powdered infant formula milk (PIF) in intensive care units (NICU) and to determine antimicrobial susceptibility patterns of this bacterium.
Methods: E. cowanii was isolated according to FDA method in 125 samples of PIF milk purchased from drug stores between Jun 2011 and March 2012. For final confirmation, biochemical tests embedded in API-20E system were used. The drug susceptibility test was performed using the disc diffusion method according to CLSI recommendations.
Findings : Out of the 125 PIF samples investigated, 4 (3.2%) samples were positive for E. cowanii. All four isolates from PIF samples were uniformly susceptible to imipenem, meropenem, ceftazidime, ciprofloxacin, and colistin. Fifty percent of isolates were resistant to ampicillin, amoxicillin, and cotrimoxazole
Conclusion: Analysis of the results indicated that complementary studies are necessary to clarify the possible role of E. cowanii as a food contaminant, in common NICU infections and high risk groups including persons with underlying disease and immunocompromised individuals.
PMCID: PMC4276579  PMID: 25562018
Powdered Infant Formula Milk; Neonatal Intensive Care Unit; E. Cowanii; Antimicrobial Susceptibility
6.  Blood Eosinophil Levels in Newborns with Severe Indirect Hyperbilirubinemia Treated with Phototherapy 
Iranian Journal of Pediatrics  2014;24(3):267-272.
Objective: Newborns who suffer from jaundice and/or receive phototherapy (PT) are at a higher risk of developing asthma. In this study we aimed to investigate the relationship between bilirubin and peripheral eosinophil counts in newborns with severe hyperbilirubinemia needing PT.
Methods: In this study, a retrospective analysis was performed on 306 newborns with severe hyperbilirubinemia with gestational age ≥35 weeks (Group 1) and the control group consisted of 295 age and gender-matched newborns (Group 2). Total serum bilirubin, hemoglobin, albumin, leucocyte and eosinophil counts before and after PT were recorded from medical charts.
Findings : All the patients in Group 1 received phototherapy and 77 (25.2%) of them needed exchange transfusion (ET). Before receiving PT, the patients in Group 1 had lower levels of Hb and higher levels of total serum bilirubin and lymphocytes than those in Group 2 although there was no statistically significant difference with regard to peripheral eosinophil counts. Eosinophils were detected to be numerically lower in Group 1. Higher bilirubin subgroups had also lower eosinophil counts. The patients in Group 1 had lower levels of Hb, leucocyte, albumin and higher levels of eosinophil following PT.
Conclusion: Peripheral eosinophil count may be affected by bilirubin levels and/or phototherapy. There is a need for further clinical research based on different models.
PMCID: PMC4276580  PMID: 25562019
Newborn; Jaundice; Phototheraphy; Eosinophil; Asthma
7.  The Effect of Malnutrition on Protein Glycosylation in Children 
Iranian Journal of Pediatrics  2014;24(3):273-279.
Objective: The goal of this study was to evaluate the effect of protein energy malnutrition on protein glycosylation by investigating transferrin isoform pattern and its relationship to the degree of malnutrition and the biochemical markers of nutritional status in children.
Methods: Forty one children with mild (n=23) and severely/moderately (n=18) acute malnutrition and 29 controls were enrolled in the study. Serum transferrin isoforms were determined by isoelectric focusing electrophoresis. Transferrin, prealbumin, zinc, iron and insulin-like growth factor-1 (IGF-1) were measured using automated analyzers.
Findings : Asialotransferrin and disialotransferrin were significantly higher in severely/moderately malnourished patients compared to controls (P=0.04 and P=0.04, respectively). Other transferrin isoform patterns were not different among three groups. Serum IGF-1, transferrin and iron levels of severely/ moderately malnourished group were significantly lower than tose of controls (P=0.001, 0.02 and 0.03, respectively). Serum prealbumin and zinc levels were similar in all three groups. Serum IGF-1, transferrin and iron levels, and all transferrin isoform patterns were not significantly different in mildly malnutrition group from other two groups.
Conclusion: The changes in transferrin isoform pattern observed in malnourished patients may indicate that malnutrition is a catabolic state which has effects on glycosylation.
PMCID: PMC4276581  PMID: 25562020
Glycosylation; Isoelectric Focusing; Protein Energy Malnutrition; Transferrin; Isoform
8.  Prevalence of Celiac Disease in Turkish Children with Idiopathic Epilepsy 
Iranian Journal of Pediatrics  2014;24(3):280-284.
Objective: This study has examined the prevalence of celiac disease in Turkish children with idiopathic epilepsy.
Methods: Children with idiopathic epilepsy were screened for celiac disease using the IgA anti-tissue transglutaminase antibody and compared with the healthy control group in order to find the association of celiac disease (CD) with idiopathic epilepsy. Upper gastrointestinal endoscopy and small intestinal biopsies were offered to all antibody-positive patients.
Findings : A total of 214 children with the diagnosis of idiopathic epilepsy and 166 healthy children as control group were studied. Of the patients recruited, 55.1% had generalized epilepsy, and 44.9% had partial epilepsy. In 33 patients with partial epilepsy, electroclinical features were consistent with a diagnosis of childhood partial epilepsy with occipital paroxysms (CPEO). Two of 33 patients with CPEO had positive IgA anti-tissue transglutaminase antibodies in serology. Pathological examination of small intestinal biopsy specimens showed total villous atrophy in both of them. The prevalence of celiac disease among children with idiopathic epilepsy and CPEO was 0.9% and 6%, respectively.
Conclusion: The results of the present study revealed that prevalence of CD is increased in children with epilepsy. On the other hand, as high as 6% prevalence of CD among patients with CPEO found in this study should be kept in mind and the clinicians should be aware of this association.
PMCID: PMC4276582  PMID: 25562021
Celiac Disease; Epilepsy; Occipital Paroxysms
9.  The Effects of Decreasing Maternal Anxiety on Fetal Oxygenation and Nucleated Red Blood Cells Count in the Cord Blood 
Iranian Journal of Pediatrics  2014;24(3):285-292.
Objective: Vasoconstriction during anxiety reduces fetal oxygenation and leads to hypoxia. Hypoxia in turn results in increase of the number of nucleated red blood cells (NRBCs) in the cord blood. The present study aimed to assess the effect of decreasing maternal anxiety on fetal oxygenation and NRBCs count in the cord blood.
Methods:. In this study, 150 women were randomly divided into two intervention groups [supportive care and acupressure in BL32 (bladder) acupoint] and a control group (hospital routine care). The infants' cord blood was investigated regarding the number of NRBCs and the intensity of hypoxia after birth. Then, the data were entered into the SPSS statistical software (v. 16) and analyzed using ANOVA, Chi-square test, and logistic regression analysis.
Findings : The significant difference was found between the two groups regarding the number of NRBCs counted in the peripheral blood smear (P<0.001). Besides, a significant relationship was observed between the length of the first and second stages of labor and the number of NRBCs in the cord blood (P=0.01). Also, a significant association was observed between the type of delivery and the number of NRBCs in the cord blood in both intervention (P<0.001) and control groups (P=0.03).
Conclusion: Doula supportive care and acupressure at BL32 point reduced the length of labor stages as well as the anxiety level. Also, nucleated red blood cells were less in the 2 groups of intervention than in control group. Regarding the fact that nucleated red blood cells cannot be the only factor for hypoxia predicting, for affirmation of this theory study with higher sample size and survey of mothers at high risk are needed.
PMCID: PMC4276583  PMID: 25562022
Acupressure; Anxiety; Delivery Outcome; Doula
10.  Effect of Pubertal Suppression on Linear Growth and Body Mass Index; a Two-Year Follow-Up in Girls with Genetic Short Stature and Rapidly Progressive Puberty 
Iranian Journal of Pediatrics  2014;24(3):293-299.
Objective: Gonadotropin-Releasing Hormone agonists (GnRHa) are used to improve the final adult height in short stature children. There are limited studies which address the potential side effect of these agents: excessive weight gain. We have followed girls with rapidly progressive puberty receiving GnRHa and results were focused on the effect of treatment on final height, weight and body mass index
Methods: Thirty girls between 8.5 and 12 years with short stature and predicted adult height of less than 155 cm were enrolled in the study. All had rapidly progressive puberty. Weight and height measurements were done at the beginning of treatment, 6 and 12 months after starting and 6 and 12 months after the cessation of treatment. Bone age and stages of puberty were estimated at the beginning of treatment, after 12 months of starting and 12 months after the treatment was stopped.
Findings : Predicted adult height (PAH) changes during treatment were not significant. There was no significant difference between final height and weight according to the body mass index (BMI), PAH or bone age.
Conclusion: We conclude that girls with genetic short stature and rapidly progressive puberty will not benefit receiving a one-year course of GnRHa and there is no significant difference between the final height and final weigh among children according to BMI.
PMCID: PMC4276584  PMID: 25562023
Short Stature; Puberty; Gonadotropin Releasing Hormone Agonists; Body Mass Index
11.  Clinical and Neuroimaging Findings of Sydenham’s Chorea 
Iranian Journal of Pediatrics  2014;24(3):300-306.
Objective: Sydenham’s chorea (SC) is thought to be an autoimmune disorder. MRI is generally used to exclude other causes of chorea. There are no typically defined MRI features of SC. In this study we aimed to determine clinical and neuroimaging findings of SC.
Methods: In this study 17 patients with acute SC were retrospectively evaluated. Sydenham’s chorea was diagnosed according to the 1992 revision of the Jones criteria. The other causes of chorea were excluded. Cranial MRI was performed in all patients during the acute phase of SC. Walking, speech and swallowing disorders, muscle weakness, behavioral disorders, treatment, symptom recovery time and recurrence were evaluated.
Findings : The patients’ mean age was 11.2 years. Behavioral changes, muscle weakness and dysphagia occurred in 70%, 64% and 23% of the patients, respectively. Nonspecific signal hyperintensities were observed in the white matter, brain stem and caudate nucleus in 47% of patients. Two patients who had chorea paralytica were treated successfully with a high dose of intravenous methylprednisolone.
Conclusion: Nonspecific hyperintense white matter abnormalities may be due to the inflammatory process associated with a longer duration of clinical signs. To explain the MRI findings and the pathogenesis of SC, comprehensive studies are needed.
PMCID: PMC4276585  PMID: 25562024
Sydenham’s Chorea; MRI Findings; Chorea Paralytica; Corticosteroids
12.  Orofacial Pathologic Lesions in Children and Adolescents: A Clinicopathological Study in Southern Iran 
Iranian Journal of Pediatrics  2014;24(3):307-312.
Objective: Oral and maxillofacial lesions vary regarding their clinical presentation in different populations. Until now, oral and maxillofacial lesions in Iranian children and adolescents have not been studied. The aim of this study was to determine the type and distribution of biopsied oral lesions among children and adolescents in Southern Iran.
Methods: All the patients referred to the pathology department of Shiraz Faculty of Dentistry from 1991-2009 were enrolled in this retrospective, case-series study. The information regarding the patients’ age, gender as well as the histopathologic type and anatomic location of the biopsied oral lesions in patients under 18 years was collected from patients’ medical documents and were analyzed by SPSS version 11.
Findings : Out of 2984 patients, 576 (19.3 %) cases were children and adolescents under 18 years. The most prevalent category was soft tissue lesions (45.5 %). The most common lesion was peripheral giant cell granuloma (15.6%) followed by dentigerous cyst (14.2%) and pyogenic granuloma (11.3%). Gingiva was the most common affected site. Male to female ratio was 1.2.
Conclusion: Our results revealed that near 20% of orofacial lesions occur in children and adolescents with rather equal male to female ratio. The majority of lesions were soft tissue diseases with a reactive nature. Unlike other studies we had higher rates of soft tissue lesions. These data can help dentists and surgeons for more accurate management of their patients.
PMCID: PMC4276586  PMID: 25562025
Pathologic Lesion; Oral Pathology; Maxillofacial Malignancy
13.  Prepregnancy Maternal Weight and Body Mass Index of Children with and without Congenital Heart Disease 
Iranian Journal of Pediatrics  2014;24(3):313-318.
Objective: Congenital heart diseases are among the most frequent major congenital anomalies. One of the suspected reasons for congenital heart defects is overweight and obesity of mother during prepregnancy and pregnancy. We studied the relationship between maternal overweight and obesity and the risk of congenital anomaly.
Methods: All of children with congenital heart defect (164 infants with major nonsyndromic heart disease) referred to our pediatric cardiology clinic or admitted to our ward during 2011-2012 were included in this study. Controls were 158 live-born infants without any major malformations and their mothers. Mothers of these infants were studied for weight, height and body mass index (BMI).
Findings : The most frequent congenital heart disease was ventricular septal defect (39%), patent ductus arteriosus (11%), complete atrioventricular septal defect (10%), pulmonary stenosis (9.1%), and atrial septal defect (8.5%). There was no significant difference between maternal age (P=0.1), weight (P=0.8) and height (P=0.3) in the two groups. The mothers had not significantly higher BMI than that of the control mothers. Compared with underweight (BMI <18.5) and normal weight women (OR: 1.24, 95%CI: 0.40-3.89), overweight (OR: 0.98, 95%CI: 0.31-3.10) and obese women (OR: 1.16, 95%CI: 0.34-4.00) were not more likely to have an infant with a congenital heart defect.
Conclusion: This study suggests that there may not be a relation between maternal BMI and having a child with congenital heart defect.
PMCID: PMC4276587  PMID: 25562026
Congenital Heart Defects; Maternal Obesity; Maternal Overweight
14.  Absence of Association between -1131T>C Polymorphism in the Apolipoprotein APOA5 Gene and Pediatric Metabolic Syndrome 
Iranian Journal of Pediatrics  2014;24(3):319-322.
Objective: In the present study, we evaluated the association of rs662799 variant of the APOA5 gene with Metabolic syndrome (MetS) in a sample of children and adolescents from Isfahan.
Methods: This case control study comprised 50 cases of MetS and 50 controls. Mismatched polymerase chain reaction–restriction fragment length polymorphism (mPCR-RFLP) was used to genotype -1131T>C polymorphism.
Findings : No significant association was documented for APOA5 genotypes with the measured laboratory parameters for CC, CT, and TT genotypes in the two groups studied. By logistic regression using a dominant model, the odds ratio (95% confidence interval0 for the MetS was 0.38 (0.139–1.0350 and 0.29 (0.08–1.071 for the unadjusted and adjusted models, respectively.
Conclusion: This study suggests that among studied children and adolescents, -1131T>C polymorphism in the APOA5 gene may not be a major contributor to the MetS risk.
PMCID: PMC4276588  PMID: 25562027
Apolipoprotein A5 Gene; Metabolic Syndrome; Children; Adolescents; Triglyceride; Cholesterol
15.  Treatment Outcome of Neurogenic Bladder Dysfunction in Children; A Five-Year Experience 
Iranian Journal of Pediatrics  2014;24(3):323-326.
Objective: A neurogenic bladder is one which functions abnormally due to disorders of sacral nerves that control the bladder's ability to fill, store and empty urine. Abnormal bladder function can cause the bladder to be underactive or overactive. This study was planned to evaluate the treatment outcome of our patients with neurogenic bladder dysfunction (NGBD).
Methods: Thirty three patients who have been treated for NGBD were evaluated. Diagnosis was confirmed by voiding-cysto-urethrography (VCUG) and urodynamic study. The patients were treated medically and all had clean intermittent catheterization (CIC). Data regarding age, sex, clinical and paraclinical findings, sonography, imagings, renal scan, associated anomalies, treatment and outcomes were collected and entered in SPSS software version18 and analyzed by descriptive statistical.
Findings : Totally 33 patients aged three days to four years (mean 6.8 months) were included in this study. There were 20 (61%) males and 13 (39%) females. Mean follow-up period was 3.4±1.2 years (1.5 months to 5 years). Eighty two precent cases had bilatral and 18% unilatral hydronephrosis and bilatral vesicouretral reflux (VUR) existed in 67% and unilatral in 33% of the patients. Treatment consisted of antibiotherapy and CIC in all patients, which was only in 33% of the cases succesful. The most common associated anomaly was meningomyelocle in 8 patients. Vesicostomy was performed in 22 (67%) cases. Kidney scan showed scar in 10 patients at follow-up study. Complete continence on follow-up was achieved in 24 (71% ) patients, and it was improved in 6 (18% ) cases. Mortality rate was 9% (3 cases). Cure rate was 85% in urinary tract infection, 82.7% in hydronephrosis, 80% in VUR and 86.5% in kidney function.
Conclusion: Anticholinergic medications was not effective in all our patients. We believe that permanent vesicostomy is an effective and acceptable surgical intervention for protection of upper urinary tract decompression, especially in those who do not respond to medical treatment and have high risk position.
PMCID: PMC4276589  PMID: 25562028
Neurogenic Bladder;Treatment Outcome;Urinary Diverssion
16.  Minimally Invasive Transthoracic Device Closure of an Acquired Sinus of Valsalva-Right Ventricle Fistula in a Pediatric Patient 
Iranian Journal of Pediatrics  2014;24(3):327-330.
Background: Sinus of Valsalva-right ventricle fistula is a recognized but very rare complication after surgical repair of subaortic ventricular septal defect. Surgical repair with cardiopulmonary bypass and percutaneous transcatheter closure guided by x-ray has been the traditional treatment for fistula of sinus of Valsalva.
Case Presentation: Recently, we have used a novel approach, that avoids the need for either secondary open surgical repair or radiation exposure; that is, minimally invasive transthoracic device closure guided by transesophageal echocardiography to occlude an acquired sinus of Valsalva-right ventricle fistula in a 4-year-old patient.
Conclusion: To our knowledge, there have been no prior cases reported of this technique applied to close an acquired sinus of Valsalva-right ventricle fistula. This report aims to provide a detailed description of the procedure.
PMCID: PMC4276590  PMID: 25562029
Fistula of Sinus of Valsalva; Minimally invasive; Device Closure; Transesophageal Echocardiography
17.  Term Infant with Gallbladder Stone: a Case Report 
Iranian Journal of Pediatrics  2014;24(3):331-332.
PMCID: PMC4276591  PMID: 25562030
Gallbladder Stone; Hyperbilirubinemia; Infant
18.  Leukoerythroblastosis Mimicking Leukemia: A case report 
Iranian Journal of Pediatrics  2014;24(3):332-333.
PMCID: PMC4276592  PMID: 25562031
Leukoerythroblastosis; Leukemoid reaction; Leukemia; Abscess
19.  Association of Juvenile Idiopathic Arthritis and Digeorge Syndrome; a Case Report  
Iranian Journal of Pediatrics  2014;24(3):334-336.
PMCID: PMC4276593  PMID: 25562032
Digeorge Syndrome; Juvenile Idiopathic Arthritis; Velocardiofacial Syndrome
20.  Accidents in Children Under 5 Years in Isfahan, Iran 
PMCID: PMC4276594  PMID: 25562033
Accident; Under 5 years; Isfahan; Iran
21.  The Necessity for Emotional Support of Severely Diseased Children: A World-Wide Role Model from Iran 
PMCID: PMC4268829  PMID: 25535528
Social support; Emotional support; Depression; Chemotherapy
22.  Fundamental Movement Skills Development under the Influence of a Gymnastics Program and Everyday Physical Activity in Seven-Year-Old Children 
Iranian Journal of Pediatrics  2014;24(2):124-130.
The objectives of this study were: a) to examine the influence of an 18-week basic artistic gymnastics program on fundamental movement skills (FMS) development in seven-year-old children; b) to determine correlations between children’s daily activities and successful performance of FMS and basic artistic gymnastics skills.
Seventy five first grade primary school children took part in this study. A physical education teacher specialized in artistic gymnastics conducted a gymnastics program for 18 weeks, three times a week. The level of gymnastics skills and FMS were identified at the beginning and at the end of the program. The level of gymnastics skills was evaluated by performance of eight artistic gymnastics skills, while FMS were evaluated by the use of FMS-polygon. Physical activity and inactivity was evaluated by using a proxy-questionnaire “Netherlands Physical Activity Questionnaire˝ (NPAQ).
According to the dependent samples t test, significant differences were found in the FMS-polygon and all gymnastics skills before and after the 18-week gymnastics program. Increasing correlations were established over time between gymnastics skills and the FMS-polygon. Unorganized daily activity of children significantly correlated with their mastering of gymnastics skills and FMS. The presented findings confirm: (1) the thesis that basic artistic gymnastics skills and FMS could be developed simultaneously, (2) the theory of positive transfer of similar skills between FMS and artistic gymnastic skills.
Mastering basic artistic gymnastics skills will provoke improvement of FMS and finally become a prerequisite for successful introduction of learning more complex gymnastics skills. The obtained results imply that an increase of children’s unorganized daily activities can improve the mastering of basic gymnastics skills and simultaneously the development of FMS.
PMCID: PMC4268830  PMID: 25535529
Transfer of Learning; Artistic Gymnastics; Motor Skills; Polygon; Organized Activities; Unorganized Activities
23.  Acute Flaccid Paralysis and Its Differential Diagnosis in in Kurdistan Province, Western Iran; an 11-Year Surveillance 
Iranian Journal of Pediatrics  2014;24(2):131-139.
The surveillance of acute flaccid paralysis (AFP) is a key strategy for monitoring the progress of poliomyelitis eradication and is a sensitive measure for detecting potential cases of poliomyelitis and poliovirus infection. This study was conducted to describe the characteristics of patients reported with AFP, and to evaluate the performance of the surveillance system in Kurdistan province, western Iran, using indicators recommended by the World Health Organization (WHO).
This observational study was conducted from January 2000 to December 2010 at the Kurdistan Center for Disease Control and the Department of Pediatrics. All children who fulfilled the WHO definition for AFP were included in our study. The stool samples of all the children were sent for poliovirus isolation. All the patients were evaluated for 60 days after the onset of symptoms to identify the signs of residual weakness.
One-hundred thirty nine children aged <15 years were reported to the Center for Diseases Control with AFP. In 138 (99%) stool samples no poliovirus was isolated. None of the patients was diagnosed as having acute poliomyelitis or polio-compatible paralysis. Guillain-Barré syndrome was the most frequent final diagnosis (79 cases) followed by Transverse Myelitis (7 cases) and Encephalitis (6 cases). By detecting 1.3 to 3.6 (mean 3.2) AFP cases per 100 000 population in Kurdistan during the study period, we achieved the WHO target for AFP surveillance. All performance indicators but one consistently met the WHO requirements and therefore demonstrated the effectiveness of the AFP surveillance program in Kurdistan.
The effective surveillance system in Kurdistan and its evaluation may serve as a model for the surveillance of other infectious diseases.
PMCID: PMC4268831  PMID: 25535530
Poliomyelitis; Paralysis; Surveillance; Epidemiology; Acute Flaccid Paralysis
24.  Magnitude and Factors Associated with Child Abuse in a Mega City of Developing Country Pakistan 
Iranian Journal of Pediatrics  2014;24(2):140-146.
Child abuse is one of the major challenges for health care providers. This study was conducted to determine the burden of child abuse (physical & emotional) and the factors associated with it in an urban city of Pakistan.
This cross-sectional study was conducted in primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan between March to December 2010. Mothers with children aged between 6 and 12 years were included in the study. Those mothers’ suffering from any acute illness like high grade fever, were excluded. A total of 412 mothers were recruited through consecutive sampling and written informed consent was taken. A pre-tested questionnaire was used to seek information about child abuse. Data was analyzed using SPSS version 19 and multivariable logistic regression was used to identify the factors (age, gender of child, family structure, educational status of parents, and mother’s perception of her home environment) associated with child abuse.
Of the total 412 mothers, final analysis was conducted on 379 mothers. In all, 32.5% of children had been abused, 25.5% physically and 17.9% emotionally. Abuse was reported more among children whose mothers had minimal or no schooling (P=0.02), who were abused by their husbands (P<0.001), not satisfied with their marital life (P<0.001), and stressful home environment (P=0.02). In the multivariate analysis, the factors found to be independently associated with child abuse were mothers abused by their husbands (AOR=4.2; 95%CI: 2.2–7.9) and child being a girl (AOR=8.7; 95%CI: 4.5–16.8).
The prevention of child abuse can be achieved through comprehensive, multifaceted and integrated approaches requiring joint efforts by the government, policy makers, stake holders, social workers, educationists, and public health practitioners.
PMCID: PMC4268832  PMID: 25535531
Child Abuse; Physical Abuse; Emotional Abuse; Maternal Abuse; Pakistan
25.  The Role of Lung Ultrasound in Diagnosis of Respiratory Distress Syndrome in Newborn Infants 
Iranian Journal of Pediatrics  2014;24(2):147-154.
The aim of this study was to evaluate the value of lung ultrasound in the diagnosis of respiratory distress syndrome (RDS) in newborn infants.
From March 2012 to May 2013, 100 newborn infants were divided into two groups: RDS group (50 cases) and control group (50 cases). According to the findings of chest x-ray, there were 10 cases of grade II RDS, 15 grade III cases, and 25 grade IV cases in RDS group. Lung ultrasound was performed at bedside by a single expert. The ultrasound indexes observed in this study included pleural line, A-line, B-line, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, lung pulse etc.
In all of the infants with RDS, lung ultrasound consistently showed generalized consolidation with air bronchograms, bilateral white lung or interstitial syndrome, pleural line abnormalities, A-line disappearance, pleural effusion, lung pulse, etc. The simultaneous demonstration of lung consolidation, pleural line abnormalities and bilateral white lung, or lung consolidation, pleural line abnormalities and A-line disappearance co-exists with a sensitivity and specificity of 100% for the diagnosis of neonatal RDS.
This study indicates that using an ultrasound to diagnose neonatal RDS is accurate and reliable tool. A lung ultrasound has many advantages over other techniques. Ultrasound is non-ionizing, low-cost, easy to operate, and can be performed at bedside, making this technique ideal for use in NICU.
PMCID: PMC4268833  PMID: 25535532
Lung Ultrasound; Respiratory Distress Syndrome; Newborn

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