فهرست مطالب akefeh ahmadiafshar

The aim of asthma treatment is to reduce airway inflammation by avoiding environmental triggers and using daily anti-inflammatory medications. This study aimed to compare the effects of fluticasone propionate (FP) and budesonide (Bud) on the clinical symptoms and control of asthma in children with moderate to severe asthma. In this open-label study, children with moderate to severe asthma were randomly selected to receive either FP 250 mcg or Bud 400 mcg for 3 months. Asthma control test scores were measured in both groups monthly. The clinical symptoms, drug adherence, and rescue medication were also evaluated. A total of 50 patients with ages between 4 and 7 years old were included in the study (25 cases received Bud and 25 cases received FP). Asthma control test scores, daily and nocturnal symptoms, and cough rates were significantly improved in both groups. The average asthma control scores for the fluticasone group were 21.68±3.32 in the second month and 24.84±2.67 in the third month, whereas the budesonide group had scores of 18.52±3.32 and 22.48±4.12 during the same periods. These variances were statistically significant. Additionally, the requirement for salbutamol use was notably reduced in the fluticasone group compared to the budesonide group throughout all three months. The efficacy of fluticasone propionate in decreasing the need for rescue medication and enhancing asthma control test scores was markedly superior to that of budesonide.

 Severe and moderate asthma attacks are among the major causes of children’s visits to emergency departments.

 The present systematic review is conducted to assess the effectiveness of inhaled budesonide on hospitalization and clinical presentations in children with asthma.

 A search was conducted on six English databases from 2000 to 2022. Quality assessment was done using Cochrane Collaboration’s tool for Assessing the Risk of Bias, and heterogeneity was assessed using I2. The risk of bias was calculated using a funnel plot and Begg and Egger tests. The data were analyzed using RevMan 5, and random effects, the risk ratio and means difference were reported with a 95% confidence interval.

 Totally, 1380 studies were identified. After the screening, ten studies with a sample size of 1859 were included in the systematic review. The asthma scores were improved following budesonide administration in 10 studies. Compared to the placebo, the effects of budesonide on hospitalization rate were not statistically significant, but they were statistically significant with zero heterogeneity compared to other corticosteroids. Compared to the placebo or oral corticosteroids, there were no significant differences in heart rate, respiratory rate, and oxygen saturation after budesonide administration.

 The effects of inhaled corticosteroids were similar to other oral corticosteroids and the placebo. Considering the high heterogeneity of the studies, future studies with larger sample sizes and longer follow-ups are recommended.

Selective IgA deficiency (SIgAD), is known as the most common antibody deficiency. This study, investigated the respiratory disorders among these patients.

In this retrospective descriptive study, the data of patients with SIgAD in “Iranian Primary Immunodeficiency Registry” were extracted. Then, demographic characteristics, frequency and type of respiratory disorders, in addition to immunologic findings were gathered and analyzed by SPSS software.

One hundred and twenty three patients with SIgAD (78 males/45 females), with the mean age of 18± 9.6 years old were investigated. Respiratory complications (recurrent cold, chronic cough and pneumonia), were the first presentation in 45% of the patients, and respiratory system involvement was detected among 66 patients (54.1%). The prevalence of pneumonia, otitis media and sinusitis, were 33.3%, 12.5% and 20.7%; respectively; which were significantly reduced after the diagnosis (P<0.05). Bronchiectasis had also been found in five patients (4.1%).

Respiratory problems were shown to be common presenting disorders in SIgAD. Early diagnosis and appropriate therapy could be crucial for better protection, and avoidance of severe respiratory complications in these patients.

 This study aims to investigate niacin sensitivity in schizophrenia patients compared to healthy people and examine the accuracy of niacin skin flush test in diagnosing schizophrenia.

 This diagnostic study was conducted in 2018 in Zanjan, Iran. Three niacin concentrations (0.001 M, 0.01 M, and 0.1 M) was first applied topically to the skin of 36 schizophrenia patients and 33 healthy controls. Flush responses were evaluated at 10 and 15 min after application. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the test were measured for each niacin concentration and evaluation time. 

 At 10 min, the highest test accuracy was reported when 0.001 M niacin solution was used (Sensitivity=94%, specificity=50%, PPV= 51%, and NPV= 94%). At 15 min, the highest test accuracy was observed at 0.01 concentration (Sensitivity=52%, specificity=92%, PPV=79%, and NPV=77%).

 Flush responses to niacin is more impaired in patients with schizophrenia. Therefore, niacin can be considered as a biological marker of schizophrenia and can be used for its diagnosis.

Kawasaki Disease or KD (also known as mucocutaneous lymph node syndrome) is an acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes in infants and young children. Regarding serious coronary complications of the disease, the coronary effects and consequences of the disease in KD diagnosed children were investigated at Ayatollah Mousavi Hospital of Zanjan during 2013 to 2017.

This is a cross-sectional study in which 40 diagnosed cases of KD were evaluated from 2013 to 2017. At the time of diagnosis and 2 to 4 years later, the necessary measures were taken to check cardiovascular complications. After documenting informed consent, the patients underwent follow up echocardiography and electrocardiography. The data analysis was performed by statistical software, SPSS-18.

Totally,21 patients participated in the follow up. The results were analyzed and compared based on coronary artery dimension and Z-score reference values. Next, left coronary artery size was calculated in primary echocardiography based on Z-score in terms of body surface area. In primary echocardiography, Left Coronary Artery (LCA) size was within the reference range in 36 patients (90%) and abnormalities were observed in 4 patients (10%). In the follow up echocardiography, 21 patients revisited (2 of the 4 patients with abnormal findings) and all of them were reported to be within the reference range (p=0.02). Regarding Right Coronary Artery (RCA), findings from primary echocardiography were normal in 38 patients (95%) and abnormal in 2 patients (5%),  and based on follow up echocardiography, RCA sizes of all patients were in reference range (p=0.15).Interestingly, 2 patients were within the normal range based on coronary artery dimension, but were included in the dilation range using the Z-score; also, 2 patients who were in the dilated coronary artery range measured by the coronary artery dimension criterion, were included in the normal range by the Z-score.

To prevent missed diagnosis and further complications, it is recommended to use standard Z-score based on body surface area to diagnose coronary artery aneurysm in addition to merely measuring the diameter of the vessels.

Allergies are manifested with a variety of signs and symptoms. In this study, the frequencies of asthma symptoms, allergic rhinitis, eczema, and related factors among 6- to 7-year-old schoolchildren were investigated.

Materials & Methods

This cross-sectional study was carried out among schoolchildren of 35 elementary schools of Zanjan by using the International Study of Asthma and Allergies in Childhood (ISSAC) questionnaire consisting of the following:  asthma symptoms, allergic rhinitis, atopic dermatitis, sex, weight, height, feeding, paracetamol and antibiotic use, maternal education, physical activity, exposure to pets or farm animals, heavy traffic exposure, and parental tobacco use. Data were gathered and analyzed by SPSS software.

In this study, 800 children (383 girls and 417 boys) were recruited. The prevalence of wheezing was 28.5% (95% confidence interval [CI] [27, 36]), rhinitis 20% (95% CI [19, 27]), and dermatitis 16.8% (95% CI [13.1, 17.5]). However, the rates of physician-diagnosed asthma, allergic rhinitis, and eczema were 1%, 8.9%, and 4.1%, respectively. The prevalence rates of asthma symptoms and atopic dermatitis were significantly higher in girls than in boys (P=0.01 and P<0.001, respectively). The weight of children with asthma was significantly higher than children without asthma (P=0.01). 

The frequencies of wheezing, rhinitis, and dermatitis among 6- to 7-year-old children were high. Thus, symptoms and history should be considered for the accurate diagnosis and management of children.

 Asthma is the most common inflammatory disorder of respiratory system.The aim of this study was to investigate the prevalence of asthma and association of asthma with anxiety among 13-14 year-old students in Zanjan.

 In this cross sectional study 1500 students were randomly selected by cluster random sampling ; ISSAC questionnaire was filled by face to face interview and patients with asthma were recognized and their anxiety status was also measured using  Zung questionnaire.

 A total of 225 students (15%) had symptoms of mild to moderate asthma. The frequency of anxiety among students with and without asthma was 38.7% and 26.7% respectively. There was a significant correlation between asthma with anxiety (P=0.0001). The odds ratio for anxiety in asthmatic group was 1.73, CI95% (1.16- 2.58).

 These results showed higher prevalence of asthma and anxiety inadolescents and significant  correlation between asthma and anxiety.

Toxic Epidermal Necrolysis (TEN) is a severe disease with high mortality, which can occur following the administration of some drugs such as antibiotics, anticonvulsants and non-steroidal anti-inflammatory drugs (NSAIDs). The condition is rare in children; therefore, providing a therapeutic experience and methods of care can be very helpful in similar cases.

A 32-month-old girl (2.8 years) was admitted at Mousavi Hospital of Zanjan (Iran) presenting weakness, illness, scattered macular lesions on the trunk and extremities, and several blisters on the trunk. He had a history of upper respiratory tract infection and had been administered a diclofenac suppository for fever. All the clinical manifestations appeared after diclofenac administration. The lesions rapidly progressed to extensive cutaneous necrosis with the involvement of more than 70% of the body surface. He was treated with high-dose intravenous immunoglobulin (IVIG), corticosteroid, and conservative management. Fortunately, the child was discharged in good general condition approximately one month after the onset of the illness.

Diclofenac can cause TEN in children, even in single doses and in suppositories. The most important prognostic factors include supportive therapy, contact isolation, hand hygiene, and administration of high dose IVIG for at least three days.

Sudden cardiac death occurs with higher prevalence in competitive athletes than general population. Thus, the purpose of this study was to evaluate the Electrocardiographic (ECG) patterns among 6 – 17 year-old competitive athletes in Zanjan city.

241 competitive athletes aged 6-17 years old were enrolled in this cross sectional study. ECG was performed for all study participants. Information including age, sex, height, weight, medical history and medications was collected.  Heart axis, QRS pattern, PR interval and QTC interval were evaluated.

In this study, out of 241 patients, 49 (20.3%) of them had at least one abnormality in their electrocardiogram, and 5 had two abnormalities at the same time. Abnormal axis deviations (right or left) were the most common abnormal patterns and were seen among 35 (14.5%)   participants. QRS complex abnormality, prolonged QTC interval, rhythm abnormality (Non-sinus rhythm), and prolonged PR interval were seen in 34 (14.1%), 26 (10.8), 5 (2.1%), and 2 (0.8%) of participants, respectively. Frequency of electrocardiogram abnormalities in athletes over 13 years old was 28.1% (n=25) and in athletes under 13 years old was 15.8% (n=24), (p=0.022). This frequency was 18.2% (n=28) among boys and 24.2% (n=21) among girls. Finally, the frequency of electrocardiogram abnormalities was 23.8% (n=37) among athletes performing dynamic exercises and 14% (n=12) among athletes performing static exercises.

Our study showed that about one fifth of the studied athletes showed some type of electrocardiographic disorder. Abnormal heart axis, QRS complex abnormalities, prolonged QTc interval, sinus rhythm abnormalities, and prolonged PR interval were the most common electrocardiographic findings among our study population, respectively. According to the results of the study, age and electrocardiographic abnormalities had a significant relationship. Given the greater frequency of ECG disorders among athletes aged 6-17, it is recommended to use ECG as a routine screening tool in the same community (athletes 6-17 years old).

IgA is the first line of defense in the mucous membranes. The secretion of Salivary IgA depends on many factors including physical activity. The aim of this study was to detect the effects of physical activity on Salivary IgA concentration in normal children. This interventional study was conducted on 24 healthy children who were visited in Society oriented clinic of Zanjan University of medical sciences. Salivary samples were collected in three times; at the beginning of the study, one hour after 30 minutes of exercising and finally after three weeks of moderate exercises. The data were analyzed by SPSS software through statistical tests. This study included 12 girls (50%) and 12 boys (50%), with the mean age of 11.37 ± 2.9 years. The mean concentration of salivary IgA (SIgA) level at the baseline, one hour and three weeks after exercise were 51.99±10.44, 83.66±62.26 and 74.38±33.36 micrograms per milliliter respectively. We found significant rising in the SIgA after exercises. However we didn''t find significant difference in SigA levels after one hour and 3 weeks of exercises.Discussion &The sIgA level increases after an acute exercise and slowly declines with the continuation of exercise however it is still above the basic level after 3 weeks. Therefore exercises might have beneficial effect on immune regulation and prevention of infections among children.

 Food allergy is an important and increasing problem in children. The aim of this study was to investigate the type and prevalence of food reactions in child care centers of Zanjan city (northwest, Iran).  This cross-sectional study was performed in 40 kindergartens from Zanjan city. A questionnaire containing information about the occurrence of food reaction, offending food, type of reaction, feeding and birth history, and atopy in the children and their families, was prepared and completed by the parents. Then, the data were gathered and analyzed by SPSS software.    In this study 801 children between the ages of 6 months to 5 years were recruited. Two hundred and one reactions (25.1%) were reported. Skin reactions including; urticaria (47.3%) and dermatitis (8%) were registered as the most common problems. Cow's milk (32.3%) was the most offending food. There was significant correlation between age, duration of breast feeding, personal and family history of atopy, and food reactions; however, we did not find any correlation between birth body weight, gender, time of complementary feeding and food reaction.   This study showed a high prevalence of food reaction in our region. Therefore, along with confirmatory diagnostic tests, family education for prevention and treatment of children is recommended.

Asthma is the most common chronic respiratory disease and a leading cause of school absenteeism. Awareness, attitude, and knowledge of asthma can play an effective role in controlling this disease and its consequences. Accordingly, this study aimed to determine the level of asthma awareness among primary school teachers in Zanjan.
This descriptive cross-sectional study was conducted on 403 teachers of boys- and girls-only primary schools, who were selected using single-stage cluster sampling. Data were collected using a researcher-made questionnaire, in which higher scores indicated higher level of asthma awareness. Findings were analyzed using descriptive and analytical statistics in SPSS.
Data analysis showed that 58 (14.4%) and 345 (85.6%) out of 403 participants were male and female, respectively. The means of age and work experience of the participants were 45±5.53 and 22±5.92 years old, respectively. In addition, teachers’ mean score for asthma awareness was at a good level (12±2.2). Teachers’ mean level of asthma awareness had a significant relationship with gender and history of dealing with asthmatic children (p = 0.03, p = 0.04), while it had no significant relationship with age, work experience, and education level.
In this study, the mean level of asthma awareness among the primary school teachers was good. Due to the importance of the disease in children and effective role of teachers in helping them, effective measures must be taken to increase teachers’ awareness.

BackgroundConstipation is one of the most common disorders in children. The purpose of this study was to compare paraffin and polyethylene glycol (PEG) in the treatment of children with chronic constipation.
Materials and MethodsThis study is a double-blind randomized trial. Total 160 children aged 2-12 years old with chronic constipation attending the pediatric clinic of Mousavi Hospital in Zanjan (Iran) were examined by the same pediatric gastroenterologist. They randomly received PEG solution (1cc/kg/day divided in two doses) or paraffin at the same dose. Patients were assessed regularly once a week up to one month and then monthly until 6 months. Data were analyzed by SPSS version 16 software.
ResultsFrom children enrolled in the study, 43.1% were boys with mean age 5.27±1.3 years. The male to female ratio in Paraffin and PEG groups was similar (35/45 vs. 34/46; respectively, P-value= 1.27). The mean age of the participants in paraffin group and PEG group were 5.28±1.4 and 5.24±1.9 years, respectively. The good and intermediate response to PEG in comparison to paraffin were 11.3% and 38.8% vs. 23.8% and 35%; respectively (P=0.111). In children lower than 3 years old, the improvement after receiving paraffin was significantly higher (P=0.048). The frequency of adverse effects was similar and didn’t differ significantly between the two groups.
ConclusionThere was no significant difference between two groups (PEG and Paraffin groups) in terms of gender and adverse effects of drugs. However paraffin had better therapeutic effect among children less than 3 years of age.

The asthma treatment and control might be associated with significant burden on family and community‚ thus exploring other therapeutic plans could be desirable. The aim of this study was to investigate the effect of salt space on clinical findings and peak expiratory flow rate among children with asthma. In this randomized crossover trial, 34 patients aged 6-14 years old with mild to moderate asthma were selected and randomly divided into two groups. The first group went through a period of salt therapy by staying in the salt room for one hour, three times a week for 3 consecutive weeks and then was under observation for three weeks. This process was reversed for the second group (three weeks under observation followed by salt therapy). The wash-out period was one week. During the study, the morning and evening peak expiratory flow (PEF), the frequency of coughing, wheezing, dyspnea and use of rescue medications were measured. Salt therapy had a significant effect on raising the morning and evening PEF in the second week in both groups (p=0.028 and p=0.032, respectively). However, there was no significant effect on PEF variabilities‚ cough‚ wheezing, dyspnea, and the frequency of rescue medication (p>0.05). No side effect was observed during salt therapy. This study showed the significant effect of salt therapy on PEF rate of the patients in the second week. However, further studies with different frequency and time of salt therapy on respiratory disorders are recommended.

There are differences in the age at menarche in different countries and it seems that in recent decades gradually the age of puberty is declining. The aim of the present study was to determine the age at menarche and its related factors in school girls in Zanjan city, Iran.
This cross-sectional study was conducted on 1,500 healthy school girls between 6-17 years old who were selected on the basis of a multistage probability sampling. Age at menarche, birth weight, family size, Body Mass Index (BMI), fast food consumption, and physical activity, were recorded. Data were analyzed using SPSS version 16.0.
Out of 1,500 students, 273 girls (18.2%) had experienced menarche with a mean age of 12.6±1.6 (95% confidence interval [C]: 12.4-12.8), and a median age of 13 years. The prevalence of early menarche, was 10.3%, (95% CI: 6.6%-14.1%). A significant association between menarche and BMI, frequency of fast food consumption and birth rank was observed; however, we didn’t find a significant association between physical activity (P>0.05) and birth weight (P>0.05) with menarche.
The mean age of menarche in our study was 12.6±1.6 years old, similar to other studies in Iran, and it was significantly associated with higher BMI.

Problem-based learning (PBL) is one of the most commonly used educational methods in medical schools of different countries. By working through this method, students think critically, generate ideas, and acquire the knowledge and skills required to become a doctor. This study aimed to compare problem-based learning with lecture-based learning in the education of medical students. This crossover interventional study was conducted on 40 medical students in pediatric ward of Zanjan University of Medical Sciences. All of the students were enrolled in the study and divided into two groups by simple randomization. Then two topics in pediatric courses were chosen. One of the topics was presented as LBL for the first group and as PBL for the second group. The other topic was presented as PBL for the first group and as LBL for the second group. The median score of the exam was higher in the intervention group compare to the control group for both topics. However, the difference was not statistically significant. Students preferred problem-based learning over lecture-based learning because of motivation boost, a higher quality of education, knowledge retention, class attractiveness, and practical use. Students’ knowledge was similar in both methods.

Childhood asthma and obesity are significant public health problems. Most prospective studies suggest that obesity increases the risk of asthma. But, some authors did not found this association. In this study the association between asthma and body mass index (BMI) was investigated. This case-control study was conducted on 200 asthmatic children aged 6-15 years and 200 children without asthma. The criteria for asthma diagnosis and its classification were on the basis of National Asthma Education and Prevention Program (NAEPP). BMI of patients and controls were also measured and BMI grater than 85% and 95% were defined as overweight and obese respectively. The data was analyzed by SPSS software. The BMI among the asthmatic children (17.9 kg/m2) was higher than the BMI among the non-asthmatics (16.5 kg/m2), P=0.0001. This relationship was significant in both males and females. 18% of asthmatic children were classified as overweight and 13.5% of them were obese versus 7.5% and 6% respectively in non asthmatics (P=0.0001). However, there was no significant relationship between severity, duration of asthma, kind of medication and BMI in children with asthma (P>0.05). Result of this study showed that there is an association between asthma symptoms and obesity in children. Therefore, any attempts for weight control in asthmatic children might be beneficial.

Specific local immunotherapy has been recently introduced as an alternative to classic subcutaneous immunotherapy in treatment of allergic rhinitis. In this study, the effects of sublingual immunotherapy (SLIT) on symptoms and medication score and skin prick test evaluation of patients with allergic rhinitis were investigated.In this placebo controlled trial, twenty four patients aged 5-18 years old with grass pollen induced rhinitis and sensitive to rye grass by positive skin prick test received randomly sublingual extract of rye grass or placebo for 6 months. Symptom and medication scores and adverse effects of SLIT were assessed during treatment. Skin prick test induced wheal at the beginning and the end of therapy were also measured. Data were analyzed with SPSS software.We found significant reduction of symptoms in intervention group from 21st week of immunotherapy (p<0.05). Medication scores were also reduced after 16th week (p<0.05), adverse effects were low and insignificant in both groups. Erythema induced diameter with skin prick test for grass and rye grass was significantly reduced in SLI group after immunotherapy.This study indicates that SLIT in grass-pollen rhinitis is well tolerated, improves overall clinical symptoms, and reduces drug consumes. We recommend this therapy as a safe therapy in patients with allergic rhinitis.

The prevalence of atopic disease in recent decades has been dramatically increased. It has been suggested that BCG vaccination may protect against development of allergic diseases.The purpose of this study was to identifying relation between scar of BCG vaccine and atopy. This cross-sectional study was done in 1000 children, 10-15 years of age, in Zanjan city. One thousand children (501 girls and 499 boys) were recruited in this study, 137, 121 and 141 cases of asthma, atopic dermatitis and allergic rhinitis, respectively were detected.Three hundred and three subjects had at least one of these disorders, which were diagnosed as atopy. There was reverse correlation between BCG scar and asthma (P=0.013), atopic dermatitis (P<0.01), and atopy (P<0.01). We did not find any association between the diameter of BCG scar and allergic rhinitis. Reverse correlation of asthma, atopic dermatitis and atopy with BCG scar are significant. This relied on history and symptoms of patients. Further studies with skin tests, measurements of total and specific IgE levels and spirometery are recommended.

Neutropenia is characterized by decrease in the absolute number of circulating neutrophils and an increase susceptibility to infections. The current study was performed in order to explain the clinical and laboratory findings of patients with antibody deficiency disorders associated neutropenia. The patients'' records of 19 neutropenic cases out of 207 patients with antibody deficiencies, who had been referred to Children''s Medical Center and enrolled in Iranian primary immunodeficiency registry, were reviewed. Nineteen cases (14 male and 5 female), with a mean age of 10.7±5.7 years, were associated with neutropenia (9.2%). The disorders with associated neutropenia were Hyper IgM syndromes (3 of 8), Common variable immunodeficiency (13 of 109), and X-linked agammaglobulinemia (3 of 45). The median age for the onset of disease and diagnosis age were 15 months (1-134) and 3.8 years (6 months-13 years), respectively. The most common infections during the course of illness were pneumonia (13 cases), diarrhea (12 cases), oral candidiasis (9 cases), otitis media (6 cases), sinusitis (6 cases), cutaneous infections (5 cases), and abscess (5 cases). Other less frequent infections were: conjunctivitis, oral ulcers, meningitis, and osteomyelitis. Three neutropenic patients died because of recurrent infections. Neutropenia may occur in any of the primary immunodeficiency disorders. Persistent or severe infections always pose a supposition, which deserves further evaluation for detecting an underlying immune deficiency syndrome and neutropenia, since a delay in diagnosis may result in a serious organ damage or even death of the patient.

Long-term intravenous immunoglobulin (IVIG) infusion is an effective treatment for children with humoral immunodeficiencies, already be complicated by systemic adverse effects. In order to determine the adverse effects of intravenous immunoglobulin in patients with antibody deficiency, 45 immunodeficient patients receiving intravenous immunoglobulin were studied during a 36-month period at Children’s Medical Center. The investigated group included 25 patients with common variable immunodeficiency, 14 patients with X-linked agammaglobulinemia and 6 patients with IgG subclass deficiency. A total of fifty adverse effects occurred through 955 infusions (5.2%). The most frequent immediate adverse effects were mild (40 infusions out of 955) in 22 cases, including: chills, flushing, fever, nausea and headache. Three patients experienced moderate effects (10 infusions out of 955) such as rash, severe headache, joint pain and chest tightness. None of the effects was anaphylactic type. It can be concluded that intravenous immunoglobulin is generally a well-tolerated medical agent for patients with antibody deficiency, but all patients should be monitored by a physician who is familiar with its indications, risks, adverse effects and their appropriate management.