amir nasimfar

Group A beta-hemolytic streptococcus is the most important bacterial pathogen in pharyngitis. Although the disease is seen in all age groups, it is one of the most common bacterial infections in children. The aim of this study was to determine the frequency of Beta Hemolytic Group a Streptococcus colonization in the throat of 5 to 15 year-old children without respiratory symptoms, referred to children’s Clinics in Urmia, Iran.

This cross-sectional study was performed on children aged 5 to 15 years, referring to specialized pediatric clinics at Urmia University of Medical Sciences on 260 people from Jun 2021 to June 2022 in a row and available has been taken. Demographic information and clinical status were evaluated and then while taking a throat swab sample, the results were evaluated with positive culture in terms of sensitivity to common antibiotics.

The results of the present study showed that the prevalence of health carriers was 7.3%. There was a significant relationship between the father's job and the frequency of health carriers P=0.039. The most sensitive antibiotics were penicillin and ceftriaxone, and high resistance to erythromycin and chloramphenicol were observed.

Despite all the limitations of the present study, it seems that the prevalence of health carriers was moderate to low. The presence of antibiotic resistance indicates the lack of proper management of consumption, and the necessary measures should be taken to further control and monitor prescription and usage of antibiotics.

Accurate information on the causes of child mortality is required to achieve Millennium Development Goal 4 (MDG4). The causes of child mortality are used to assess the pattern of diseases and make health policies. The accuracy of these mortality statistics depends on the proper completion of death certificates.

The study aimed to measure the sensitivity and positive predictive value (PPV) of death certificates obtained from the hospital information system (HIS) in a children's specialized hospital in Iran.

This cross-sectional study assessed death certificates of 580 children of 1-59-month-old died in the hospital from 2011 to 2018. Pediatricians identified the minor and major errors and the underlying causes of death (COD). A misclassification matrix was used to measure agreement, sensitivity, and PPV using multiple causes obtained from death certificates and pediatrician reviews.

The HIS had a sensitivity of 43.27% and a PPV of 39.37%. The highest sensitivity was 73.33% for kidney diseases and urinary tract infections, and the lowest sensitivity was 18.18% for diarrhea and dehydration. The HIS had the highest PPV for accidents and injuries and the lowest PPV for diarrhea and dehydration (65.63% and 20.69%, respectively). The most identified underestimation and overestimation numbers were related to "respiratory disease and pneumonia" and "cardiac arrest", respectively.

A large proportion of CODs in death certificates were registered inaccurately. The mortality statistics should be used with caution for planning and policy-making.

Mycoplasma pneumoniae is one of the main causes of community acquired pneumonia in children with an incidence of nearly 40%.
The aim of this study was to evaluate the serum levels of IgM and IgG antibodies to identify Mycoplasma pneumoniae in laboratory samples of in asymptomatic preschool aged children in Urmia, Iran.

The present cross-sectional study was performed on 260 preschool children who referred to the pediatric clinic of Shahid Motahari Hospital in Urmia in January 2018 without any respiratory symptoms. Detection of IgM and IgG antibodies against Mycoplasma pneumonia was performed on the samples using specific ELISA kit, according to the manufacturer's instructions. IgM and IgG antibody titers more than 12 U / mL considered as positive, less than 8 U / mL as negative, and between 8 and 12 U / mL as intermediate result (. SPSS 21 software was used for data analysis.

According to the results of this study, 25.8 percent of children had at least one episode of mycoplasma pneumonia infection. Statistically significant relationship was detected between the positivity of IgG and IgM and attending kindergarten in the studied children (P=0.001). There was no significant relationship between positivity of IgG and IgM with sex (P values = 0.14 and 0.60, respectively), age (P values = 0.58 and 0.54, respectively), and age group (P values = 0.19 and 0.49, respectively) of the children.

There was a significant relationship between positive IgG and IgM antibody titers and presence in kindergarten, but there was no significant relationship between IgG and IgM antibody positivity with sex and age group.

 This study aimed to evaluate the cerebrospinal fluid results analysis and culture in infants under 18 months with the diagnosis of simple febrile convulsion in Urmia Motahari hospital.

 This retrospective descriptive study was conducted to evaluate the results of lumbar puncture in 223 infants under the age of 18 months with simple febrile seizures from 2011 to 2016. Patients’ information such as age and sex and the results of analysis and culture of cerebrospinal fluid culture were extracted from patients' records.

 Of 223 infants, 109 (48.8%) were male and 114 infants (51.2%) were female, with an average age of 9 months (age range between 5 to 15 months). Thirty-one of them (13.9%) had abnormal WBC (greater than 5/ mm3) and 192 (86.1%) had normal WBC (less than 5/ mm3). Twenty-four infants (10.8%) had an abnormal cerebrospinal fluid (protein more than 45 mg/dl) and 199 infants (89.2%) had normal cerebrospinal fluid (protein less than 45 mg/dl), 24 infants (10.8%) had abnormal CSF glucose level (less than 50 mg/dl) and 199 infants (89.2%) had normal CSF glucose level (more than 50 mg/dl). In 220 infants (99%), cerebrospinal fluid culture was negative and in 3 infants (1%), it was reported as unresponsive. Four out of 55 medical records (1.79%) were treated as bacterial meningitis and 5 (2.24%) of them were treated as aseptic meningitis.

 Findings suggested that the patients under one year with febrile seizures should be carefully examined, regarding decision about conducting lumbar puncture (LP) for them.

Health care-associated infections (HCAIs) are a major patient safety concern, and consequently prevention should be a top priority for institutions. Hand hygiene is the most effective way to reduce nosocomial infections.

296 medical students in different wards of university hospitals in Urmia participated in this descriptive study. They completed a hand wash checklist and a hand hygiene questionnaire. Finally, the obtained data were analyzed using SPSS25 software.

The results showed that 48% were male and 52% were female with an average age of 24.5 ± 2.9 years. Most of the participants were recruited from Imam Khomeini Hospital (%35) while only%5/8 of the participants were recruited from Razi Hospital. 34.7% of the participants were extern, 44.6% were intern and 20.6% were resident. The average level of awareness of hand hygiene was 47%, the minimum level of awareness was 31% and the maximum level of awareness was 69%. The average attitude toward hand hygiene principles among medical students was 31% (weak), the lowest attitude was 22% (weak) and the highest attitude was 58% (good). The average performance of hand hygiene practice principles was 39% (weak), the lowest was 22% (weak) and the highest was 51% (good). The average level of awareness of hand hygiene principles among female and male medical students were 50% and 44%, respectively. The average attitude among female medical students was 40% and average attitude among male medical students was 26%. The average performance of the principles of manual health practice among female and male medical students were 26% and 23% (acceptable), respectively. The average level of awareness, attitude, and performance of hand hygiene principles among students of external course, internship, and residency were 51%, 40% and 35%; 45%, 28% and 17%,; and 47%, 38% and 25%, respectively. In general, the average performance of hand hygiene principles among students in the ICU, surgical department and internal medicine department were 48%, 40%, and 27%, respectively.

Due to low-level attitude and knowledge of medical students regarding hand hygiene and the necessity of hand hygiene in preventing infection, as well as the importance of patient health during the hospitalization period, it is essential to hold in-service training classes in the field of hand hygiene to improve and promote hand hygiene.

Respiratory problems are the most commonly reported illness in children under the age of 5 years and are the leading cause of mortality in developed countries, with about 25-75% of children under 5 years old. Therefore, we decided that due to the importance of the issue and the high prevalence of hospitalization of children with respiratory problems and the lack of similar study in the region, this study examined the clinical signs and paraclinical information of pediatric patients referring to respiratory infections in Orumiyeh Shahid Motahari Hospital in Urmia Letchr('39')s examine.

Method & Materials: 

This is a descriptive cross-sectional study with the aim of evaluating clinical signs and paraclinical evidence in children with respiratory problems in Motahari Hospital. The number of patients under study was based on the findings of 403 patients and the records of the patients were evaluated for clinical signs and paraclinical information. Data were analyzed using SPSS 20 software.

Among the patients under study, 54% of patients were admitted to pneumonia, 20% were bronchiolitis, and 25% were HRAD crouped patients. Cough was the main clinical symptom in the hospitalized patients. There was no mortality among patients among the patientschr('39') experiments, only one positive blood culture was reported

Our results showed that in patients treated with laboratory data and other paraclinical information, there are significant differences in the studies that have to be taken into account because they can be important in determining the treatment route for these patients.

Lymphadenitis is a type of inflammatory lymphadenopathy that is caused by the infiltration of inflammatory cells that can occur with or without the formation of abscesses inside the lymph node. Infectious acute lymphadenitis causes are mostly associated with acute viral and bacterial infection. The purpose of this study was to provide a more comprehensive description of the causes and evaluations performed and the effective treatment for patients referred to Shahid Motahari Hospital with cervical infectious lymphadenitis.

This retrospective study was performed on 191 children aged 3 months to 14 years admitted to Urmia Shahid Motahari Hospital who were diagnosed with cervical lymphadenitis between 2013 and 2018. Disease records, biological information, type of antibiotic treatment, aggressive procedure, contrast-enhanced CT scan information, treatment duration, and clinical symptoms were collected and a checklist was filled out.

107 patients (56%) were male and 84 patients (44%) were female. The mean age of patients was 46.65±35.05 months (range 3–168 months). Mean hospitalization duration was 5.54±3.19 days (range 1–22). The most common clinical symptom of the patients referred to the hospital was fever, which was present in 151 patients (79.1%). In 135 patients (70.7%) no aggressive procedure was taken. Abscess drainage was performed in 40 patients (20.9%), mass biopsy in 14 patients (7.3%), and surgery in 2 patients (1%). Thirty-nine patients (20.4%) had cultures that reported negative results in all cases.

The most common diagnosis in children is acute inflammatory lymphadenitis and occurs usually in spring and urban children. It is common in boys under 5 years of age. The most commonly used antibiotic is clindamycin. In cases of abscess, surgical drainage is performed for treatment.

Unwanted drug-related reactions have remained a challenge in modern health care due to the increasing complexity of treatments and the increasing population of the world. Due to the lack of a similar study in this area, this study was conducted to investigate the unwanted drug-related skin reactions in children hospitalized in Motahari Hospital of Urmia from 2012 to 2016.

In this retrospective descriptive study, the medical records of all children hospitalized in Motahari Hospital in Urmia with the diagnosis of unwanted drug-related skin complications from the beginning of 2012 to the end of 2016 were studied. All the information was entered into an organized checklist designed already for this purpose. Data were analyzed by SPSS 19.

Our study showed that 76 (58.5%) of the children were male and 54 (41.5%) were female. The results of this study showed that phenobarbital is the most common drug that causes skin complications (In 90 cases (69.2%)). Maculopapular rash was the most common skin complication in the studied patients (In 96 cases (73.8%)).

The results of our study showed that skin complications in children are rare but potentially dangerous and special attention should be paid to them and immediate medical measures should be taken for these patients.

Diarrhea is a major health problem in developing countries; and on a global scale, it is the most common cause of death after heart diseases and cancer in many populations. Gastroenteritis is a symptom of the gastrointestinal infection (GI) which is caused by pathogenic bacterial, viral or parasitic infections. In some centers, without complete diagnostic tests to approve bacterial infection, antibiotics are prescribed; and antibiotic therapy is stopped after diagnosing non-bacterial infection. Antibiotics should not be prescribed arbitrarily without medical indications due to complications associated with antibiotic therapy, such as antibiotic-resistant strains that would create problems in the future treatment of diseases resistant to antibiotic treatment. The current study was conducted to investigate the pattern of antibiotic usage for nonbacterial (viral) gastroenteritis in patients hospitalized at Motahari Hospital In this retrospective study, all the information was collected from the available medical records in Hospital archives and the results are presented by tables and the average frequency graphs. Children were divided into three age groups (6 months to 3 years - 3 years to 5 years - over 5 years). Data from the medical records of patients including demographic characteristics, duration of diarrhea, fever, clinical symptoms, the results of laboratory tests (analysis, stool cultures, biochemistry, urine analysis) and the antibiotics prescribed in the instructions sheet were all recorded and the related data were analyzed using SPSS. Of 104 patients, 81 patients (77.9%) were six months to three years and 16 patients (15.4%) were three years to five years, and 7 patients (6.7%) were over five years. Sixty patients (57.7%) were males and 44 patients (42.3%) were female. Most patients were male and aged six months to one year (49 patients). Ceftriaxone was the most commonly prescribed antibiotic and 83 patients (79.8%) received it, and 6 patients (5.8%) received ceftizoxime, and 15 patients (14.4) did not receive any antibiotic. The maximum length of hospital stay and antibiotic therapy was 9 days. However, with stool, urine and blood tests being normal, the fever of age groups were 45%, 35%, and 32%, respectively. In order to avoid imposing additional costs and to prevent microbial resistance in diarrhea, it is recommended and urged to prescribe antibiotic for suitable and necessary cases based on laboratory results (culture, stool analysis tests), since the major cause of gastroenteritis is viral infection.

Hydatid disease is a zoonotic parasitic infection that affects humans in many parts of the world, including Iran. It is caused by the larval stage of a tapeworm called Echinococcus. Human is an intermediate host infected accidentally by the ingestion of eggs excreted in the feces of dogs. This infection most commonly involves the liver and lung. Other site localizations are rare including kidney that is seen in 2% to 4% of cases.
Here we report a 9-year-old boy with kidney involvement in a village near Poldasht city, West Azerbaijan, Iran, admitted on Jan 2013. He referred to our hospital with a left upper quadrant (LUQ) mass without any other symptoms, which was discovered by his mother accidentally. Sonography and CT scan with and without contrast revealed large hypodense fluid containing a mass arising from the left kidney that stretched renal parenchyma. Surgery consult was done and radical nephrectomy with left adrenalectomy and retroperitoneal lymphadenectomy due to the suspicion of malignancy was performed. In addition to surgery, he received the first dose of chemotherapy for Wilms tumor and after the pathologic report, albendazole started for him. A definitive presurgery diagnosis is not always possible by radiographic evidence. Therefore, the hydatid disease should be in the differential diagnosis of renal mass. Only surgery and pathologic findings can confirm the diagnosis. In our case, due to the lack of a definitive radiologic evidence for hydatid diagnosis, we did not start albendazole presurgery and albendazole started and continued for six months after the pathologic report confirmed the hydatid disease.
We recommend that albendazole starts in endemic areas for abdominal masses with a non-definitive diagnosis.

Cytomegalovirus (CMV) and Human Herpes Virus-6 (HHV-6) activation after liver transplantation have been associated with increased graft rejection and adverse outcomes. This study aimed at investigating the development and timing of CMV infection after liver transplantation and its relation to post-transplantation HHV-6 activation.
Patients undergoing liver transplantation were enrolled, regardless of their age, place of residence, or their liver failure etiology. Blood samples were collected at baseline and every week for a period of 12 weeks and were tested for anti-CMV IgG and anti-HHV-6 IgG, CMV pp65 antigenemia, as well as CMV and HHV-6 DNA using the Polymerase Chain Reaction (PCR) method.
Among 46 liver transplant recipients, 17 (36.9%) developed CMV infection within 3 months after transplantation. Before transplantation, 42 (91.3%) and 41 (89.1%) recipients were seropositive for CMV and HHV-6, respectively. Fifty percent of patients were positive for CMV antigenemia, among which 73.9% became symptomatic for CMV infection. Half of the patients had positive test results for CMV PCR with a significant relationship between the CMV viral load and the development of symptomatic CMV infection (P = 0.001). Twenty-five (54.3%) patients had positive test results for HHV-6 PCR with a significant relationship between HHV-6 positivity and the development of clinical presentation (P = 0.002). The average post-transplantation time to HHV-6 and CMV activation was 19.4 ± 86.5 and 28.4 ± 60.5 days, respectively, with a linear relationship in the regression analysis.
The HHV-6 infection, either as primary infection or reactivation, leads to an increased risk of CMV infection and symptomatic disease after liver transplantation. Activation of HHV-6 precedes the CMV activation in time.

Vitamin D deficiency is known as a one of the underlying causes of Idiopathic musculoskeletal pain (IMSP). This study aimed to evaluate the correlation between serum vitamin D (Cholecalciferol) status in patient with Non-specific Musculoskeletal Pain and healthy children.
Seventy-seven children (aged 3–14 years), with IMSP were included as cases and 90 healthy subjects were selected for control group. Demographic characteristics and biochemical levels of vitamin D and Parathyroid hormone (PTH), were obtained. Data were analysis using SPSS version 17.0 software.
Results showed that vitamin D means levels of patients and healthy children were significantly different (19.5 8.84 ng/mL versus 12.7 11.89 ng/mL), respectively (P Deficiency of vitamin D was suggested as the probable identified risk factors for IMSP in children. The results of our study did not reveal clear correlation between vitamin D deficiencies in children which suffer IMSP compared the healthy children.

Nasal Colonization with Methicillin Resistant Staphylococcus aureus (MRSA) is known as an important risk factor in the development of dangerous infections.
The present study seeks to investigate the prevalence of MRSA nasal colonization among the preschool and school children under 14 in Urmia. To do so, specimens for culture were obtained from 400 children. Cultures and antibiograms with oxacillin discs were performed in Shahid Motahari hospital of Urmia.
81 cases (47 females, 34 males) out of 400, nasal colonization were observed. Of which 12 (5 females, 7 males) were resistant to methicillin. Colonization was slightly higher among the females with no statistically significant difference (P.value>1).
The results indicate that colonization with MRSA is present among healthy children in the studied population. Fortunately, the respective prevalence was not higher compared to other areas. Further attention is required by the health authorities to prevent the transmission of such organisms among children.

H syndrome (OMIM 612391) is an autosomal recessive disease with some features such as hyperpigmentation, hypertrichosis, heart anomalies, hepatosplenomegaly, hearing deficit, hypogonadism, short stature, flexion contracture of fingers and toes and hypertriglyceridemia..
A 17-year-old boy with hyperpigmented, hypertrichotic and indurated seborrheic keratosis-like cutaneous patches mainly involving the extremities referred to Namazi hospital, an academic center affiliated to Shiraz university of medical sciences. The patient belonged to a consanguineous family with Arab origin..
We described a case with many clinical manifestations of H syndrome in addition to new characteristics such as microphallus. H syndrome should be considered in individuals with a constellation of symptoms as hyperpigmentation, hypertrichosis, heart anomalies, hepatosplenomegaly, hearing deficit, hypogonadism, short stature, flexion contracture of fingers and toes and hypertriglyceridemia..

Urinary Tract Infection (UTI) is one of the most common pediatric infections. UTI may create cystitis or pyelonephritis by involving bladder or renal parenchyma, respectively. Pyelonephritis, especially in pediatric patients, can lead to scar formation in kidneys and consequent complications such as hypertension, proteinuria, dysfunction and chronic renal insufficiency. The current study aimed to determine risk factors of acute rental cortical lesions in renal scintigraphy in children with UTI. Fifty-three patients with significant renal cortical lesions and 53 cases without significant renal cortical lesions were compared based on the intensity of findings of DMSA scintigraphy within the first two weeks of diagnosis. Patients were divided into three groups of 1 month to 2 years, 2 to 4 years and 4 to 10 years. Of 106 patients, 11 males (20.8%) and 42 females (79.2%) had significant acute renal cortical lesions, whereas 15.1% of males and 84.9% of females had no significant acute renal cortical lesions. There was a significant difference in the degree of fever, the average interval between the onset of fever and treatment, mean level of CRP, leukocytosis and ESR in the two studied groups. The presence of Vesicoureteral Reflux (VUR), low initial hemoglobin and low initial BMI as random findings were associated with significant renal cortical lesions. Gender, age, grade of VUR and type of organism in urine culture had no significant association with significant renal cortical lesions. In this study, delaying in treatment, high degree fever, leukocytosis, high initial ESR and CRP, existence of VUR and low initial BMI and hemoglobin levels were associated with an increase in the value of acute renal cortical lesions, so in these cases, DMSA scan is suggested.

Human fasciolosis is deemed as an emerging/re-emerging infection, hence making it an important hu-man parasitic disease. In contrast to northern parts of Iran, human cases of fasciolosis in southern Iran are rare and sporadic. We report a sporadic case of fasciolosis in southern Iran (Fars Province) who presented with prolonged fe-ver. Our report could suggest that there might be new foci emerging in the region, which indicates the need for further investigations.