محمد صادق رضایی

Animal bites are a frequent reason for primary care and emergency department visits by children. Rabies is endemic in Iran, with 5 to 11 deaths reported annually. Over 90% of rabies cases in the country are caused by dog bites, and more than 50% of the victims are children under 15 years old. The mortality rate of rabies is 100%. A 4-year-old girl, who had been bitten by a dog and sustained facial lacerations 16 days prior to admission, presented with fever and loss of consciousness. Despite wound washing, receiving four doses of the rabies vaccine and immunoglobulin, and taking cephalexin on the fifth day after the bite, she developed rabies encephalitis. Rabies was confirmed through a skin biopsy and saliva PCR. Treatment included vancomycin, meropenem, and acyclovir in addition to favipiravir. The patient was intubated due to impaired consciousness and respiratory issues, and her hypertension was managed with medication. A brain CT scan showed normal findings. Cerebrospinal fluid analysis revealed protein at 52, glucose at 63, and no cellular presence. Vancomycin and acyclovir were discontinued when blood culture, wound culture, cerebrospinal fluid, and PCR results returned negative. Echocardiography results were acceptable, and the patient’s lab tests showed no other abnormalities except for leukocytosis at admission, an ESR of 60, and a CRP of 40. The patient remained intubated for two weeks and continued to receive supportive measures, ongoing drug therapy, ventilator adjustments, and water and electrolyte balance management. During hospitalization, she showed no response to the apnea test, oculovestibular reflex, or doll's eye maneuver. Two weeks later, she developed bradycardia and subsequently died, with a final diagnosis of furious rabies. Despite receiving the rabies vaccine and immunoglobulin, the patient died within a month of the bite, which may be attributed to the location of the bite on her face, the timing of her treatment, or the quality of the vaccine.

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis and about 2 billion people are infected with tuberculosis. Every year, millions of children are exposed to Mycobacterium tuberculosis, and tuberculosis is still one of the main infectious causes of death among children in the world. Considering the importance of tuberculosis in children and the lack of information about the effects of the COVID-19 pandemic on it, this study aimed to investigate the characteristics and clinical outcomes of children with tuberculosis admitted to Buali Hospital of Sari before and after the COVID-19 pandemic.

In this descriptive-cross-sectional study, all children with tuberculosis who were admitted to Buali Hospital between 2014 to 2019 were divided into two groups before and after COVID-19 (Before: from June 2014 to the end of 2019; After: from the end of 2019 to June 2023). Demographic information, type of disease, contact history, underlying disease, clinical symptoms, laboratory tests, radiological findings, medications, duration of hospitalization, and clinical outcome of the patients were recorded. The data was statistically analyzed with SPSS software version 22.

In the present study, 15 children were hospitalized before the COVID-19 pandemic and 17 people after it. There were 19 girls (59.37%) and 13 boys (40.63%) with an average age of 6.60±4.24 years. The median duration of hospitalization after the COVID-19 pandemic was significantly longer (4 days vs. 5 days; P=0.019). 22 patients (68.75%) had active tuberculosis and the remaining cases were asymptomatic and diagnosed with latent tuberculosis (P=0.811). Pulmonary involvement was observed in 17 patients (53.12%) and extrapulmonary involvement was observed in 5 patients (46.87%) (P=0.323). 19 patients (59.37%) were new cases and other cases were disease recurrences (P=0.571). History of contact with TB patients was positive in 19 patients (59.37%). The skin tuberculin test of the patients was positive in 24 patients (75%), and the gastric aspirate examination of none of the patients was positive before COVID-19, but 4 patients (33.33%) were positive after COVID-19 (P=0.245). IGRA test was positive in 1 patient (3.12%) before COVID-19 and in 2 patients (6.25%) after the pandemic (P=1.000). The most common clinical symptom was cough (68.75%), followed by fever (43.75%), vomiting and weight loss (32.25%), rhinorrhea and anorexia (28.12%) and night sweats (15.62%). Three patients (17.5%) needed intensive care unit admission after the pandemic. The laboratory markers did not have a statistically significant difference between the two groups, and ESR was high in 66.67% of the patients before the pandemic and 81.2% after it. Disturbance in the laboratory tests including electrolytes and liver and kidney function tests was not observed in both groups. All patients recovered and no deaths were reported.

Comparing the results showed a significant increase in the duration of hospitalization after the pandemic. Although some studies have reported a more severe form of tuberculosis after the COVID-19 pandemic, finding the association between the changes in the clinical manifestations of TB and its type before and after COVID-19 and generalizing the results requires multicenter studies with higher sample sizes.

Multisystem Inflammatory Syndrome in Children (MIS-C) occurs after having COVID-19. The severity and outcomes of COVID-19 with gastrointestinal symptoms are higher. The aim of this study was to investigate gastrointestinal manifestations in MIS-C patients in selected referral hospitals in Iran to obtain comprehensive information about the treatment and prevention of MIS-C.

In this cross-sectional study, all MIS-C patients <21 years in Dec 2019 to Oct 2021 were included. The patients were identified by the Centers for Disease Control and Prevention (CDC) checklist and data were analyzed applying t-test and Chi-square in STATA11.

There were 225 patients with a median age of 55 months (26-96 months), including 59.56% boys and all had fever on admission. At least one gastrointestinal symptom was seen in 200 patients and the most common symptoms were vomiting (60.9%) and abdominal pain (45.77%). Almost 60% of the patients had positive RT-PCR results. Among the patients with and without gastrointestinal symptoms 85.5% and 48% were admitted to intensive care unit (ICU), respectively. There were significant differences between the two groups in respiratory symptoms, ALT, AST, NT-pro BNP, ESR, and PLT (P<0.05). All patients without gastrointestinal symptoms were discharged but nine patients in the group with gastrointestinal symptoms deceased.

According to the current study, gastrointestinal symptoms are common in MIS-C patients and are associated with higher rates of death and intensive care unit admission. Therefore, in providing services to COVID-19 patients, all typical and atypical signs and symptoms should be considered to prevent unnecessary interventions.

The emergence of Extended-Spectrum Beta-Lactamase- and Carbapenemase- Producing Enterobacteriaceae is a threat to global health. Fast and accurate detection of these strains plays a key role in controlling nosocomial infections and effective treatment. In the present study, the detection methods of carbapenemase and broad-spectrum β-lactam-producing Enterobacteriaceae have been investigated, focusing on the summary of culture-based techniques and molecular methods.

The present study is a narrative review. The articles published between 2000 and 2022 were searched in international authoritative databases namely Scopus, PubMed, Scholar, Google, Web of Science, Science direct.

To identify Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae, conventional culture methods, biochemical methods, mass spectrometry, molecular methods, next generation sequencing, microarrays, whole genome sequencing, hybridization-based system, starch iodine assay, immunochromatography, colorimetry, mass spectrometry, electrochemical measurement, and flow cytometry were used.

For the detection of Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae, MALDI-TOF (matrix-assisted laser desorption ionization-time of flight), next-generation sequencing and whole genome sequencing are among the new and selected techniques.

Controlling the severity and death of the COVID-19 disease is still a major challenge. This research aimed at identifying the factors associated with mortality in hospitalized patients with COVID-19 applying generalized linear model.

In this cross-sectional study, demographic and clinical data of COVID-19 patients hospitalized with positive RT-PCR test results (n=6759) in Mazandaran hospitals (August 2019) were obtained from the national registration system for COVID-19. SPSS V27 and R V4.0 were used for data analyses and multivariate generalized linear model test with an ordinal logistic scale was applied.

Findings showed that full recovery and relative recovery occurred in 5888 (87.11%) and 400 (5.92%) patients, respectively. Mortality rate was 6.97%. The chance of death in patients with relative recovery (49.55%) compared with those with full recovery (21.61%) was almost 2.3 times higher. Predictors of mortality in these patients included age over 60 years (OR: 1.60), ICU admission (OR: 5.09), intubation (OR: 4.10), SpO2≤ 93% (OR: 2.41), cancer (OR: 1.74), diabetes (OR: 1.29), heart disease (OR: 1.41), and chronic kidney disease (OR: 2.17).

Specific and timely medical care, considering the mentioned risk factors, should be introduced and provided to prevent mortality in patients hospitalized with COVID-19.

Kawasaki is an acute childhood vasculitis of unknown cause that if left untreated can cause coronary aneurysms in 25% of cases. The disease is reported as the leading cause of acquired heart disease in children in developed countries. The purpose of this study was to investigate the epidemiological and clinical features of Kawasaki disease in northern Iran.

In this descriptive-analytic review study, all registered cases of Kawasaki disease in Mazandaran province between 2007 and 2019 were investigated. Epidemiological, demographic, clinical, periodical tests, risk factors, disease burden, complications, and follow-up information were collected. Data analysis was done applying descriptive statistics, Chi-square test, and logistic regression.

The data of 136 children with Kawasaki disease were assessed. Clinical symptoms were found to be significantly different between children with complete and incomplete Kawasaki disease (P<0.001). Most children with complete and incomplete Kawasaki disease had heart disease (63.2% and 75.5%, respectively), and coronary artery disease (52.6% and 58.2%, respectively) but no significant differences were found between the two groups in terms of cardiovascular involvement (P>0.05). Multivariate regression analysis showed that fever for more than 5 days is a predictor of coronary artery involvement (P= 0.001).

The study showed that fever for more than 5 days is a risk factor for heart and coronary artery involvement as one of the complications leading to death in these children. Therefore, accurate control of fever and heart examinations are important in children with symptoms of

  Coronavirus (COVID-19) in children includes 1 to 5% of all cases but child mortality due to the disease is rare. The aim of this study was to determine the admission rate and factors associated with Covid-19 disease in children to better understand and control the disease.

In a descriptive-analytical and cross-sectional study 594 samples were selected by systematic random sampling from 1847 children under 18 years of age attending the emergency departments affiliated with Mazandaran University of Medical Sciences. Information was collected from medical records and telephone interviews with parents using a researcher-made questionnaire. Data were analyzed in SPSS V21 applying descriptive statistics, Fisher Exact test, Spearman, Kruskal–Wallis test, and Mann Whitney U test.

The mean age of patients was 69.4±71.7 months and 53% were boys. Common symptoms included fever (67%) and cough (29%) and mortality rate was 0.3%. Underlying diseases were seen in 9.3% and seizure was more prevalent (27.3%). Contact with COVID-19 patients was reported by 18.69%. The most common diagnostic method was based on clinical symptoms (80%). Among the children studied, 92.6% were admitted to hospital, of whom 13.5% were admitted to ICU. The mean SpO2 was 96.6% and 13.1% of the patients required respiratory support. The average fear of parents about their child getting Covid-19 was reported to be 5.1.

The disease is observed to be mild and moderate in children. Also, severity of the disease and the resulting mortality rate are higher in children with underlying diseases. The most important reason for the delay in referring to medical centers was fear of parents about their child developing COVID-19.

Alvin Goldman offered the theory of process reliablism as one of the criteria for justification in extroverted epistemology. This theory was basically offered in relation to psychology, cognitive sciences, and philosophy of mind. After the objections offered by Gautier on the theory of traditional epistemology, new theories entered the world of epistemology most of which in two groups: extroverted and introverted. The theory of process reliablism is one of the famous theories in extroverted epistemology and a subdivision of naturalistic approaches. The important point is that the naturalistic approaches (among which is the theory of process reliablism) are more apt to non-religious interpretations compared to other common approaches in epistemology. However, the question arises as follows: "is the reliablism theory in opposition to the normative, moral and religious issues and in opposition to behavioral theories like other naturalistic theories or it can be shown that – despite the common idea – the theories inside the naturalistic and extroverted framework are able to be reconciled with normative foundations?" This is a question dealt with in this article to be answered properly. In this article, we will see that among the various theories offered, Goldman attempts to explain normativity in a different way in his extroverted epistemology.

Cytomegalovirus (CMV) infection is a serious problem during pregnancy as it threatens the mothers’ health and also leads to fetal abnormalities and/or deaths. There is paucity of information about the incidence of CMV in pregnant mothers in Sari, Iran. Therefore, this study was carried out to investigate the frequency of CMV during pregnancy and the relationship between that and related epidemic parameters in Sari.

A descriptive-observational study was conducted in pregnant women participating in Sari Birth Cohort (SBC) Center during 2018-2020. A total of 1092 samples were investigated for serological markers of CMV using ELISA. Data analysis was performed applying Chi-square and logistic regression.

Prevalence of positive CMV-IgG and IgM in samples studied were 91.8% and 0.2%, respectively. Educational level (P= 0.03) and pregnancy stage (P= 0.02) were found to be significantly different between mothers with positive IgG and negative IgG.

In current study, pregnant women in third trimester whose educational level was bachelor’s degree or less had CMV infection. Despite prenatal screening, cytomegalovirus can be reactivated during pregnancy, therefore, follow-up of the fetus for fetopathy is recommended.

In 2019-2020, a new coronavirus called SARS-CoV-2 was identified as the cause of several acute respiratory infections named COVID-19. So far, more than 200 million cases of the disease have been reported. The disease is transmitted mainly through secretions and large and small respiratory droplets, and even very small particles suspended in the air or direct contact. Transmission of the infection occurs 2-3 days before the onset of the symptoms till 7-14 days after that. Contact within 2 to 14 days of the onset of symptoms with an infected person can cause infection. In children, symptoms usually appear between 2-14 days after sick contact. Although the course of the disease in children is much milder than in adults and most of the children are asymptomatic, mild symptoms similar to the common cold including fever, lethargy, fatigue, loss of appetite, cough and rhinorrhea, or gastrointestinal symptoms such as vomiting, diarrhea and abdominal pain are common complications in children. Skin manifestations include generalized maculopapular rash, petechiae, and urticaria, and the involvement of a variety of mucosal surfaces is seen. In a small number of patients, involvement of the heart and other organs including cardiac, skin, … occur in the second stage, as a syndrome related to COVID-19 called Multisystem-inflammatory syndrome-in children (MIS-c). Based on the probability of isolation of COVID-19 specific virus or antibody, radiological findings of the lung or other clinical signs, close contact with a suspected patient or a definite patient, the diagnosis of the disease is divided into three groups: definite, probable and suspicious. Suspected cases have symptoms and probable cases have radiological changes suggesting disease. The best way to diagnosing is RT-PCR. Stool RT-PCR is also helpful in patients with diarrhea. Chest imaging is performed according to the patient’s condition. Proper quarantine is required in infected people to prevent transmission of the infection. Covid-19 infection and disease, like most viral diseases, have no specific treatment. Supportive treatment of the symptomatic patients is supplying water-electrolyte and calories. In severe forms of the disease, non-specific antiviral drugs such as remdesivir or favipiravir, etc., other alternative therapies such as corticosteroids and IVIG, etc are used in addition to oxygen therapy and supportive treatment. To prevent the disease, in addition to appropriate social distancing and using masks and gloves, several vaccines have been proposed, none of which have been recommended under the age of 18.

Coronavirus 2 acute and severe respiratory infection virus (SARS-CoV2) has been identified as a pathogen of COVID-19 disease. Initially it was thought that children were safe from the virus, but several reports showed Multisystem Inflammatory Syndrome in Children (MIS-C) as a dangerous complication of COVID-19. There are similarities and differences between MIS-C and Kawasaki disease, Kawasaki shock syndrome, and toxic shock. It is a multisystem disease that affects major systems, including cardiovascular, respiratory, blood and coagulation, kidney, and nervous systems. Diagnosis of MIS-C is based on evidence of recent SARS-CoV2 infection and multiple system involvement, and laboratory criteria for high inflammation in the absence of other causes. In many of these patients chest imaging may show no evidence of COVID-19 involvement, or abnormal findings such as pleural effusion, ground glass patchy opacities, or local density and atelectasis may be seen. Echocardiography shows involvement of pericardium, myocardium, endocardium, and coronary arteries, which may be accompanied by cardiac arrhythmias. On abdominal imaging, evidence of ascites may be reported in these patients. In whole blood tests, lymphopenia, anemia, and thrombocytopenia are common, and inflammatory markers are very high. In mild cases, patients can be closely monitored, but many of these children develop severe forms and require hospitalization or pediatric intensive care unit. This study narratively reviews the clinical manifestations of multisystemic inflammatory syndrome in children following COVID-19.

Multisystem Inflammatory Syndrome in Children (MIS-C) is recognized as a life threatening complication of Coronavirus disease (COVID-19) in children which can affect major systems such as cardiovascular, respiratory, blood and coagulation, renal, and nervous system. Mild cases of MIS-C can be followed up closely, but, severe illnesses that require hospitalization or pediatric intensive care are also common. Treatment of these patients includes supportive measures to improve the function of vital organs such as the heart and arteries, respiration, and kidneys. Antiviral therapy is recommended in patients with clear involvement of the respiratory system. Treatment with empirical antibiotics and drugs effective in suppressing or modulating the immune system such as steroids in various doses, intravenous immunoglobulins, biologic drugs, anticoagulants, and antiplatelets are recommended. In case of shock or decreased cardiac function, vasopressor drugs are suggested along with supportive measures to maintain tissue perfusions such as albumin and compressed red blood cells. Timely diagnosis and appropriate treatments improve the patientchr('39')s condition and evaluation of long-term complications of this disease should be done.

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major hospital and non-hospital pathogens in children. This meta-analysis and systematic review aimed at exploring the data on prevalence of MRSA in Iranian children.

Primary articles in English and Persian were searched using the following keywords: prevalence, children, methicillin-resistant staphylococcus aureus (MRSA), and Iran. Electronic databases, including Pubmed, Web of Science, Google Scholar and Iranian databases such as Magiran and SID were searched for articles published in 2007-2019. Qualitative assessment of studies was done using STROBE checklist and data analysis was done in STSTA V11.

A total of 55 articles were identified and 23 met the study inclusion criteria. The prevalence of MRSA in children with S. aureus infection was 22%. The prevalence of community acquired and nosocomial MRSA was 17% and 38%, respectively.

The current meta-analysis showed considerable rates of nosocomial and community acquired MRSA infections among children in Iran. So, pediatricians should consider this issue in empirical treatment.

Hepatitis B vaccination is recommended in HBsAg-positive mothers to prevent hepatitis B in infants. Mother-to-infant transmission of HBV causes many health problems and it is important to identify HBV positive mothers. This investigation aimed at studying the prevalence of HBV and the immunogenicity of HBV vaccination in pregnant women to prevent HBV at birth in Sari, Iran.

This descriptive observational study was conducted in pregnant women attending Sari Birth Cohort (SBC) Center, 2018-2020. A total of 1018 samples were investigated for HBV serological markers by enzyme-linked immunosorbent assay (ELISA).

The prevalence of HBV was 1.57% and 46.6% (n=474) of expectant mothers had received HBV vaccine. Immunogenicity of HBV vaccination was 51.9%. HBV prevalence was found to be significantly associated with increase in age and gestational age (P= 0.009 and P= 0.005, respectively). HBV infection in women who were not immunized was significantly associated with family history of HBV and unprotected sex (P= 0.000 and P= 0.008, respectively).

Family history of HBV, maternal age, gestational age, and unprotected intercourse were the risk factors for HBV infection in pregnant women in Sari.

Escherichia coli (E.coli) is the most common cause of urinary tract infection. The treatment strategy has been hampered by the emergence of broad-spectrum beta-lactamase-producing E.coli and its resistance to most antibiotics. Bacteriophages are suggested as an alternative treatment option. This study aimed at evaluating the lytic activity of isolated phage from unpasteurized milk against Extended-Spectrum Beta-Lactamase (ESBLs) E.coli.

In this experimental study, E. coli was isolated from nine urinary tract infection samples and was confirmed as broad-spectrum beta-lactamase-producing by the Kirby-Bauer method. Bacteriophage was isolated from unpasteurized milk samples. Lytic activity of phage was determined by the spot test. Phage titer was calculated using the DLA assay. The phage latent period was detected and phenotype of the phage was determined by electron microscopy.

Lytic activity of phage against E.coli was confirmed by the formation of an inhibition zone. The phage titer was 15×1010 PFU/ml. The images of electron microscopy confirmed the phage cocktail belonged to Myoviridae and Podoviridae families. The latent period of bacteriophage was 20 min.

Isolated bacteriophage from unpasteurized milk is effective on broad-spectrum beta-lactamase E. coli.

Sepsis is a bacterial infection. Many patients lose their lives due to delayed diagnosis. The BACTEC method could be used for rapid and precise diagnosis of sepsis which can isolate different organisms in the shortest time with maximum sensitivity. This study aimed to identify the prevalence of positive blood cultures using the BACTEC in children with sepsis and to determine the type of pathogens.

A retrospective study was performed in 269 children hospitalized in different pediatric units in Sari Bouali Sina Hospital, who needed blood cluture in 2017-2019. Microbial diagnostic tests were conducted and antibiotic resistance was determined using the Kirby-Bauer test. Data analysis was done in SPSS V23.

Positive blood cultures were seen in 28.6% of the 269 samples. The most common gram-positive and gram-negative pathogenes were Staphylococcus aureus (n=20, 7.4%) and Pseudomonas aeruginosa (n=6, 2.2%), respectively. S. aureus isolates were highly resistant to ciprofloxacin(14.3%) and P. aeruginosa isolates were found to be highly resistant to meropenem, gentamicin, and nitrofurantoin (12.5%).

For empirical therapy of sepsis with S. aureus and P. aeruginosa, vancomycin and ceftazidime are recommended, respectively.

In the last months of 2019, the new coronavirus infection (COVID-19) spread worldwide. This study investigated the need for mechanical ventilation in children who were admitted for COVID-19.

This article provides a systematic review of studies about children with COVID-19 requiring invasive or non-invasive mechanical ventilation. Electronic databases including SID, Iran Medex, Magiran, PubMed, and Google Scholar were searched using related keywords in Persian and English until July 20, 2020. Also, references in the selected articles were screened.

Twenty studies were selected in which 1709 hospitalized children were included. Mechanical ventilation methods were used in 15% of the patients, while in 260 non-invasive ventilation (n=130, 7.6%) and invasive ventilation (n=130, 7.6%) were used. In critically ill children or those who needed intensive care (n=302), non-invasive ventilation and invasive mechanical ventilation were performed in 72 (23.8%) and 71 (23.5%), respectively. Mortality occurred in 1.3% of all admitted patients and 4% of critically ill children.

According to this review, 15% of hospitalized children with COVID-19 needed a form of mechanical ventilation.

Epiglottitis is an uncommon life threatening pediatric disease. Evidence suggests some changes in etiology and incidence of this disease after vaccination against H-influenza type b. This Meta-analysis and systematic review aimed at investigating the etiology and incidence of acute epiglottitis in pre and post H-influenza vaccination era. A systematic literature search was conducted in PubMed, Scopus, Google Scholar, SID, and Magiran using the following keywords: acute epiglottitis, H-Influ vaccination, pre-vaccine era, and post-vaccine era. Relevant studies published in Persian and English, between 1975 and 2016 were investigated. Finally, 29 articles meeting the study inclusion criteria were selected. Three pediatric specialists independently screened the articles. H-influenza was found as the main reason for acute epiglottitis. The rate of epiglottitis induced by H-influ in pre and post vaccination era was 27.54% [(95% CI=23.68-31.39), P= 0.000], and 18.41% [(95% CI= 9.29-46.10), P= 0.000], respectively. H-Influenza remains a common etiology of acute epiglottitis after H-Influ vaccination. But, this disease is predominantly seen in adults following the introduction of vaccination, and rarely other causative agents such as Staphylococcus aureus are identified to be associated with acute epiglottitis.

Assessing and improving the quality and educational capability of faculty members in universities is to improve the quality of programs, making appropriate policies and performing better educational activities. Faculty member’s evaluation by students is an important tool for both the lecturers and educational managers in educational planning. The aim of this study was to assess the trend of faculty member’s evaluation scores by students in Mazandaran University of Medical Sciences, 2012-2016. This descriptive cross-sectional study was conducted in faculty members in Mazandaran University of Medical Sciences selected via census sampling. We used the scores for faculty members using the electronic educational management system (SAMA). It allows all students to evaluate university lecturers before final exams in every semester using a checklist. Data analysis was done applying descriptive and inferential tests in SPSS V22. The evaluation scores for faculty members (2012-2016) were evaluated. The scores ranged between 4.25±0.4 and 4.49±0.3. The mean evaluation scores showed significant changes whithin the years studied (P<0.001). The average scores for evaluation of faculty members changed significantly during this period. Usually the accuracy of information collected from students is questioned, therefore, further studies with quantitative-qualitative approach are recommended.

Pertussis is a severe life-threatening respiratory infectious disease caused by the gram-negative Bordetella pertussis bacteria and is categorized into two typical and atypical types. Despite the relatively high coverage of the pertussis vaccine, the disease has reappeared periodically in recent years. In typical form, the patient has prolonged bronchiolitis along with lymphocytosis or whoop (long rasping indrawn breath). The atypical form usually occurs in younger infants and has no whoop and in these patients vomiting occurs following coughing. The severity of the disease ranges from mild to severe. Diagnosis in these patients is due to exposure to parents or adults with pertussis or chronic cough. The incubation period of the disease is 7-10 days ranging from 3 to 21 days, divided into three catarrhal, paroxysmal, and convalescent stages. Pertussis should be suspected in any person with prominent symptom or chief complaint of cough, especially in absence of fever, lethargy or muscle aches, exanthem or enanthem, sore throat, hoarseness, tachypnea, wheezing and rales. Infants under 3 months of age who are suspected of having pertussis are usually referred to hospital. Also, infants 3 to 6 months of age with severe paroxysms and other children with significant complications should be hospitalized. For the treatment, macrolides can be prescribed and Azithromycin is an optional in neonates. Until 5 days of treatment and 21 days if the patient is not treated, respiratory droplet isolation is necessary. Pertussis complications are common in younger infants, especially apnea. Although 3 first doses vaccination until 6 months of age is common in many countries, but booster doses varies in different countries based on the types of acellular vaccines.

Infections caused by multidrug-resistant (MDR) Gram-negative bacteria are rising. Bacteriophages are suggested as an alternative treatment option for the treatment of antibiotic-resistant bacteria. Bacteriophages in treatment of Gram-negative bacterial infections is not well investigated in vivo. The aim of this study was to review systematically the studies on bacteriophages against infection caused by Gram-negative bacteria in vivo. This systematic review was done using electronic databases, including Scopus, PubMed, Google Scholar, and Web of science; the articles published from 1983 to 2018 were investigated. Studies meeting the inclusion criteria were selected, and the data were estimated using a review method. 1310 articles were indexed from which 380 were selected based on their abstracts. Then, some were excluded including clinical trials and in-vitro studies. Finally, experimental studies (n = 31), that met the inclusion criteria and were published in English, were selected. This review showed that bacteriophages are an effective treatment against n-vivo Gram-negative bacteria infections even be used orally, topically, or subcutaneously injected.

Hyperbilirubinemia is the most common cause of neonatal hospitalization and can be a sign of urinary tract infection during infancy. Urinary tract infection (UTI) is one of the reasons for prolonged jaundice. This research aimed at studying the prevalence of urinary tract infection in neonates with hyperbilirubinemia admitted to Tonekabon Shahid Rajaei Hospital, 2015. This cross-sectional study was conducted in 259 infants. The samples were selected by census method. To diagnose the urinary tract infection, urine with a 2-cc syringe was taken by pediatrician through suprapubic method. Data were analyzed by Chi-square test. UTI was identified in 18 (6.9%) neonates, including 10 (55.5%) boys and 8 (44.4%) girls. Urine culture revealed 12 E. coli spp. and 6 Proteus spp. Also, in 49 (91.18%) were found to have prolonged jaundice. Due to the prevalence of UTI in neonates, urine culture is suggested in all infants hospitalized for jaundice even in those without prolonged jaundice.

Background and

Infections caused by multidrug-resistant gram-negative bacteria are rising. Phage therapy is an effective treatment in infections resistant to treatment and progress has been made with its use and development in recent years. Phage therapy in treatment of gram-negative bacterial infections is not well investigated in clinical trials. Therefore, the aim of this study was to systematically review studies on phage therapy against gram-negative bacterial infections.
Methods & Materials: This review was done using electronic databases, including Scopus, PubMed, Google Scholar, and Web of science and articles published from 1968 to 2017 were investigated. Studies meeting the inclusion criteria were selected and estimated using a review method.

A total of 128,009 articles were indexed from which 320 were selected based on their abstracts. Then, some were excluded including experimental studies and In vitro and In vivo studies. Finally, clinical trials (n=23) that met the inclusion criteria and published in English were selected.

This review showed that phage therapy is an effective treatment against gram-negative bacterial infections in humans orally, topically, and subcutaneously injected

In spite of the primary and secondary preventions from infections, the load of infectious diseases still accounts for a major part of children diseases. Irrational use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria all over the world. With the development of antibiotic-resistant bacteria, despite the development in the production of new antimicrobial compounds, the imminent return of a pre-antibiotic period is happening. Phage therapy is proposed as a preventive and therapeutic option for some infections in children. This study aimed at integrating and combining the results of phage therapy studies in children using the review method. This study was carried out based on the authenticated electronic databases of Web of Science, Google Scholar, Pubmed, and Scopus in 1990-2018. Eighteen articles out of 8140 articles in Google Scholar, 1 article out of 4 articles in Scopus, 1 article out of 4 articles in Web Science, and 1 article out of 5 articles in Pubmed were included in the study through selecting phage studies on prevention of infections in children in 1990-2018. Results proved that 5 studies on children used polyvalent phage to prevent diarrhea, shigellosis, and gastrointestinal infections and 1 study employed phage spray to prevent gastrointestinal infection in children. Phage therapy results indicated that 7 studies used the oral use of phages for diarrhea and salmonellosis, 3 studies used the subcutaneous and topical use of phages for osteomyelitis, skin diseases, and abscess, 1 study used phage intramuscular injection for urinary tract infection, 1 study used intramuscular injection for the infection of upper respiratory tract, 1 study used it for meningitis, and 3 studies used it for septicemia treatment.

The use of oral cocktail bacteriophages prevents from the gastrointestinal infections caused by Enterobacteriaceae bacteria. Phages are effective for oral treatment for gastrointestinal infections, local infections for skin infections, injections for sepsis, urinary tract infections, and respiratory tract infections.

Evidence-based medicine (EBM) as a dominant medical paradigm has been integrated in several components of medical education today. The aim of this study was to investigate the main necessities and challenges of teaching EBM to undergraduate medical students in Iran.
In this overview, several databases such as PubMed, Magiran and SID and search engine Google Scholar have been searched using relevant key words from inception to now. Researches conducted about necessities and challenges of teaching EBM to undergraduate medical students in Iran have been investigated in four categories namely knowledge and attitude about concepts of EBM, barriers to implementing EBM, teaching methods of EBM and evidence-based clinical training. To have an effective teaching of EBM principles to medical students it is necessary to change the teacher’s knowledge and attitude in first step and then integrate EBM education in undergraduate medical curriculum. Also teaching principles of critical thinking and clinical reasoning during the first years is the main prerequisite of effective teaching of EBM