elham bakhtiari

The use of opioids for pain relief after cesarean section (C/S) can result in adverse maternal and neonatal outcomes. Therefore, it is important to consider non-opioid analgesics as an alternative. This study examined the effect of intravenous ketamine on analgesic requirement after spinal anesthesia in C/S.

This double-blind randomized clinical trial 80 pregnant women under spinal anesthesia during a planned C/S were recruited from trainig hospitals of Mashhad, Iran between February and August 2022. The participants were selected using convenience sampling and assigned to two intervention (40) and control (40) groups through random allocation. The intervention group received intravenous ketamine (0.5 mg/kg) and midazolam (0.02 mg/kg) immediately after umbilical cord clamping, while the control group received midazolam alone (0.02 mg/kg). Pain scores were recorded at the 0th, 6th, 12th, and 24th hours after elective C/S using the Visual Analog Score (VAS), along with the amount of requiremen to analgesics. Data analysis was performed by SPSS software (version 16) using Chi-square, T-test and repeated measure ANOVA test.

A significant difference in pain scores between the two groups at different hours and over time (P=0.009). The intervention group reported significantly lower levels of pain than the control group (P=0.002) and a significantly lower need for painkillers during the first hour (P=0.04).

Administration of intravenous ketamine in elective C/S with spinal anesthesia in the first hour has a significant effect on reducing pain. Therefore, it can be considered the drug of choice for alleviating pain.

Adequate sleep is important to children's overall health, as sleep disturbances can result in both cognitive and mental challenges. The global COVID-19 pandemic, with its significant lifestyle disruptions, potentially altered children's sleep patterns. This study investigates the prevalence of sleep problems in children and the factors associated with these issues during the pandemic.

This cross-sectional analysis was conducted between March and April 2020 on 270 children aged 6-11 during the COVID-19 pandemic. Sleep behaviors were assessed using the Children's Sleep Habits Questionnaire (CSHQ), which was distributed online to the participants. The data were analyzed using SPSS 16, Chi-square test, and independent t-test.

Finally 262 were studied (131 boys and 131 girls). The mean age of participants was 8.56±1.97 years. The mean score of CSHQ was 51.99±7.85, with 95.8% (251 children) demonstrating sleep-related issues. Notably, children with highly educated parents exhibited significantly fewer sleep problems.

The study reveals a high prevalence of sleep disturbances among children aged 6-11, particularly during the COVID-19 lockdown. The findings highlight the significant role of parental education in mitigating these sleep issues, emphasizing the need for further investigation into the effects of familial environments on children's sleep patterns during periods of stress and confinement.

To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia.

This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups.

The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 ± 10.8 years and 58.06 ± 11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 ± 9.52 minutes vs intervention: 26.03 ± 10.5 minutes; P < 0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 ± 48.19 ml) and control (47.74 ± 60 ml) groups (P < 0.001).

Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery.

To evaluate the effect of cataract surgery and visual impairment and the associated risk factors on the frequency of falls among older adults in northeast Iran.

This cross-sectional study, conducted between 2019 and 2020, analyzed the potential risk factors of falling in older adults over 50 years of age. To this end, 380 patients were randomly selected by convenience sampling and classified into two groups: those who had undergone cataract surgery in the last 12 months (surgery group) and those who had not (cataract group). The data were collected from the medical records and face-to-face interviews, and logistic regression was used to identify potential risk factors for falling.

The frequency of falls in the cataract and surgery groups was 18.9% and 11.6%, respectively. The mean decimal visual acuity of the dominant eye was significantly lower in the cataract group than in the surgery group (P < 0.001). There were no significant differences in the mean number of medications used, Charlson Comorbidity Index score, Instrumental Activities of Daily Living score, and 10-Meter Walk Test speed between the two groups. According to the results of backward logistic regression, taking more than four medications per day and slow gait speed were the most important factors influencing the frequency of falls in older adults.

Logistic regression analysis indicated that undergoing cataract surgery is not a significant protective factor against falls. However, older adults in the surgery group experienced fewer falls than in the other group. Besides, the results suggest that taking more than four medications daily and having a slow gait speed are significant fall risk factors.

Sentinel lymph node biopsy (SLNB) is primarily performed to detect axillary lymph node involvement and determine the need for surgical axillary lymph node dissection (ALND). However, the procedure is expensive and necessitates the use of radio-labelled colloids that are not readily available to a large number of patients. It also carries the risk of producing occasional false negative results.

This study aimed to define highly specific ultrasound parameters to ascertain axillary lymph node involvement as an alternative or complementary method to SLNB in selected patients who require ALND.

In this prospective cross-sectional study, 256 patients with confirmed breast cancer were selected through non-probability purposive sampling. The selected patients were referred to Omid Hospital, a tertiary educational oncology center in Mashhad, Iran, from 2018 to 2022. This study identified highly specific cut-off points for ultrasound parameters to determine lymph node involvement in comparison with the histological diagnosis post-SLNB or ALND. Measurements were taken of the tumor size, the cortical thickness of the axillary lymph node, the short axis diameter of the node, and the count of lymph nodes with a cortical thickness of ≥ 3 mm.

Among 256 patients with a mean age of 46.41 ± 10.77 years, 202 (87.9%) had histologically confirmed metastatic adenopathy. The ultrasound cut-off values identified to define metastasis with high certainty were as follows: A tumor size > 50.5 mm (with 97% specificity), a difference in cortical thickness of ≥ 4.5 mm (with 100% specificity), a short axis diameter of the node > 12 mm (with 95% specificity), more than three lymph nodes with a cortical thickness of ≥ 3 mm (with 94.3% specificity), and a cortical thickness of ≥ 6 mm (with 95% specificity).

Highly specific ultrasound findings can diagnose lymph node metastasis with a high degree of certainty and can used as an alternative method to SLNB. A difference of ≥ 4.5 mm between the cortical thickness of the suspected lymph node and the contralateral lymph node and a cortical thickness of ≥ 6 mm are ultrasound findings that can detect lymph nodes involvement, with a specificity ranging from 95% to 100%.

to compare the refractive error measurements achieved through three distinct techniques: retinoscopy, subjective method, and the subjective fogging method.

Participants included 223 young adults aged 18 to 36 years (mean age: 25.63±5.31). The refractive error of one eye was measured under three different accommodation control conditions: subjective refraction, fogging subjective refraction and retinoscopy.

Data were collected for 223 young adults. The average Spherical value obtained by the retinoscopy method was 0.21 and the average cylinder was -0.76. These values were -0.01 and -0.75, respectively, in the subjective with fog method The Spherical value and cylinder obtained by the regular subjective method were -0.13 and -0.74 D, respectively; The mean spherical equivalent with subjective refraction method was more minus than fogging subjective refraction and retinoscopy provided the most plus results. the difference in spherical and spherical equivalent value between three methods was significant (p- value< 0.001) but the difference in cylindrical value between three groups was not significant (p- value> 0.05). According to the Intraclass Correlation Coefficient analysis, the agreement between three methods for measuring sphere (ICC= 0.99), cylinder (ICC= 0.95) and spherical equivalent (ICC= 0.99) was good.

The results showed that retinoscopy and fogging subjective refraction were the most similar methods, with a small mean difference. However, the comparison between retinoscopy and subjective refraction had wider limits of agreement than retinoscopy and fogging subjective refraction. 

To assess the agreement between biometric parameters measured by a spectral‑domain optical coherence tomography optical biometer device (Optopol Revo NX) with a validated swept‑source biometer (IOLMaster 700) and a validated optical low‑coherence reflectometry biometer (Lenstar LS 900), in cataract surgery candidates.

In this prospective comparative study, 100 patients (100 eyes) who were eligible for cataract surgery were involved. Bland–Altman plots were used to assess agreement between devices for biometric parameters including axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT).

AL measurements were successful in 82 eyes (82.0%) with Revo NX, in 91 eyes (91.0%) with Lenstar LS 900, and in 97 eyes (97.0%) with IOLMaster 700. When Revo NX was compared to IOL Master 700 and Lenstar LS 900, the mean differences were as follows: −0.02 ± 0.02 mm and −0.02 ± 0.03 mm (P = 0.313, P = 0.525) for AL, 0.01 ± 0.03 mm and 0.10 ± 0.03 mm (P = 0.691, P = 0.002) for ACD, −0.15 ± 0.03 mm and 0.001 ± 0.04 mm (P < 0.001, P = 0.95) for LT, and −2.29 ± 0.92 µm, and 0.73 ± 1.43 µm (P = 0.015, P = 0.612) for CCT. Three devices were highly correlated for AL, ACD, LT, and CCT (interclass correlation coefficient > 0.75). Bland–Altman plots showed a narrower 95% limit of agreement (−0.35 to 0.31) between Revo NX and IOLMaster 700 in measuring AL.

Despite the higher measurement failure rate in eyes with cataract, the Revo NX showed very good agreement with the IOLMaster 700 and Lenstar LS 900 optical biometers in measuring AL, ACD, LT, and CCT. However, ACD and LT measurements cannot be considered interchangeable between these devices.

The prevalence of Retinopathy of Prematurity (ROP) is rising in Iran. We aimed to evaluate the clinical and demographic characteristics of ROP infants who need treatment, the type of treatment, and the complications in the years 2018 to 2022.
This is a cross-sectional study. We evaluated the patient’s electronic medical records from 2018 to 2022. The required data was extracted from the registry dataset, including demographics, clinical characteristics of infants who required treatment, and the type and severity of treatment-related complications.
From 10,159 infants referred to the retinopathy of prematurity clinic from the beginning of 2018 to 2022, 5008 subjects (49.29%) were suffering from ROP, among whom 416 (8.3%) patients needed treatment for ROP. The mean ± Standard Deviation (SD) of birth age and birth weight were 28.66 ± 2.24 weeks and 1227.24 ± 375.97 grams. While most of our patients (742 eyes, 96.4%) underwent Intravitreal Bevacizumab (IVB) injection as the treatment modality, laser photocoagulation was performed for 25 eyes. Four eyes received pars plana vitrectomy treatment. The recurrent disease occurred in 23 patients (44 eyes). Birth age, birth weight, and the time of oxygen therapy were significantly different between the treatment responders and the neonates who experienced the recurrent disease.
In this study, we showed that the birth age and weight of neonates who experienced a relapse were significantly lower. Besides, the results of treatment with IVB injection were satisfactory, with a relatively low recurrence rate and minimal complications.

Airway safety for difficult intubation or failure to intubate is important during anesthesia. This study assessed the airway before anesthesia, and the diagnostic value of neck circumference (NC) and sternomental distance (SMD) tests was investigated in predicting difficult tracheal intubation during cesarean section. In a cross-sectional study, 101 women who were candidates for cesarean section were selected through the convenience and non-random sampling method. The modified Mallampati test (MMT), upper lip bite (ULBT), thyromental distance (TMD), neck circumference (NC), and sternomental distance (SMD) tests were performed to estimate the laryngoscopy problem. The success rate of airway assessment by SMD and NC was evaluated using the Cormack-Lehane score. Data analysis was performed using the software SPSS version 16.0. TMD (p=0.034) and NC (p<0.001) indicated substantial association with laryngoscopy grades. The sensitivity was 35.29% and 58.82%, and the specificity was 93.93% and 59.09% for NC and SMD. The accuracy, NPV, and PPV of NC was higher than the SMD test (74% vs. 59%, 73.80% vs. 73.58, and 75% vs. 42.55%). The PPV and NPV were 43.63% and 77.77% for TMD. MMT, with high sensitivity (73.52%) and specificity (90.90%), increased the risk of difficult laryngoscopy up to 24-fold when adjusted for TMD, SMD, and NC [p<0.001; OR=24.38 (6.31-94.25)]. Although NC indicated low sensitivity, it had maximum specificity (93.93%) in predicting difficult intubation. High Mallampati grades increase the risk of difficult laryngoscopy. NC presented low predictive values, and SMD and TMD lack predictive values for difficult intubation.

Angiotensin receptor blockers (ARBs) are commonly prescribed in pediatric hypertension because of the fundamental role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertension. We, therefore, aimed to systematically review articles that investigated efficacy and safety of ARB agents in the pediatric population aged over six years. To do so, the databases of Web of Science, PubMed/MEDLINE, and Scopus were searched to conduct a systematic review by using the following keywords: (“angiotensin receptor blocker” OR “valsartan” OR “losartan”) AND (“pediatric” OR “children” OR “child”) AND (“high blood pressure” OR “hypertension”). Finally, 12 studies were included in our review, and we found that almost all of them supported the effectiveness and tolerability of different ARB agents. Candesartan cilexetil lowered blood pressure (BP), with a 9 mmHg decline in both systolic and diastolic BP, and proteinuria after four months of treatment. Valsartan and Losartan similarly were shown to be effective in lowering BP in a dose-dependent manner. Headache, dizziness, upper respiratory infection, and cough were the most reported side effects. However, almost all reviewed studies indicated that the safety profile was satisfactory. In conclusion, ARBs are beneficial and well-tolerated antihypertensive medications.

The effect of SPARK physical education program on lung function in cystic fibrosis patients is not yet determined. SPARK (Sports, play and active recreation for kids) includes moving skills, aerobic games, jogging or walking, aerobic dance and jump rope. Regarding the high prevalence of cystic fibrosis and its destructive effects on the lungs, the aim of this study was to evaluate the lung function and quality of life before and after undergoing the SPARK physical education program, in children with cystic fibrosis. In this quasi-experimental study, all patients with cystic fibrosis aged 6-18 years referred to the cystic fibrosis clinic of Dr. Sheikh Hospital in Mashhad, Iran, were enrolled. The patients attended the 12-week SPARK training program (3 sessions per week, each session 45 minutes). The quality of life questionnaire for patients with cystic fibrosis, including self-examination and parental tests, along with spirometry indices (FEV1, FVC, FEV1/FVC, FEF25-75) were filled out before and after intervention for all patients. The mean and standard deviation of patients' age were 9.85±2.67 years, and 65% of patients were female. The FEV1 was significantly different before and after the SPARK physical education program (P=0.03), and the respiratory component of quality of life significantly increased after intervention (P=0.002). The overall score of quality of life from parents’ point of view was 2.87 ± 0.38 which increased to 2.99 ± 0.38 after the intervention. SPARK training program may improve the spirometric parameters in children with cystic fibrosis. It also had a significant effect on improving the patients’ quality of life, especially in the respiratory component.

Present study was carried out evaluating the level of job satisfaction and related factors among female staffs of Mashhad University of Medical Sciences

A cross-sectional study was conducted in 2019. The job descriptive index (JDI) questionnaire was used. Some questions about demographic and work properties were also added at the beginning of the questionnaire.

Totally 1106 participants with an average age of 39.62±7.56 years were enrolled. The average work experience and working hours per week were 13.45±7.38 years and 41.19±10.67 hours, respectively. Regarding the level of education, bachelor's and master's were the most common with 817 participants (73.9%) and employees were the most frequent staffs (723 participant, 65.4%).  About 890 participants (80.5%) had an income between 30 and 60 million Rials. One hundred sixty five participants (14.91%) worked in the night shift and 598 participants (54.1%) were working in the official departments. The average score of JDI questionnaire was 212.21±45.05. Job satisfaction was higher in clinical faculty members, participants aged more than 45 years, participants with more than 20 years of work experience, participants working in the official departments, participants who did not work in night shifts, and participants with an income of more than 90 million Rials.

The highest level of job satisfaction was reported by clinical science faculty members. Age, work experience, higher income and faculty rank directly and having night shift, work in medical wards and more hours of work per week inversely affect the score of Job satisfaction.

The present study aimed to determine the effect of training parents by film, poster or graphics, and verbal explanation, on the enhancement of their satisfaction with the performance of this procedure.

This cross-sectional quasi-experimental study was conducted on the children with febrile seizures referred to the Emergency and Pediatric Wards of hospitals affiliated with Mashhad University of Medical Sciences. They were LP candidates; nonetheless, their parents did not consent to the performance of this procedure. The children were randomly assigned to three groups. In the first group, videos of the location and method of LP were presented to the parents. The second group received this information via posters, and the parents in the third group were given a verbal explanation.

The children included 49 (4.54%) females with a mean age of 15 months. There was a significant relationship between the reason for parental refusal of LP and their final satisfaction (P=0.022). There was a significant relationship between parents' satisfaction with the performance of LP and their education (P=0.029). The film method had the lowest chance of success, and the verbal explanation method enjoyed the most remarkable success in enhancing parental satisfaction (P= 0.013).

Although the use of posters and videos was less effective than verbal explanation, it increased the satisfaction of LP in some parents. In fact, it is more beneficial to try to alter parental misperceptions of LP in non-emergency situations.

The present study aimed at evaluating the demographic and laboratory factors associated with the recurrent seizure during hospitalization in the children with the first febrile seizure. This cohort study was performed in Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran, from 2018 to 2019. Totally 483 admitted children aged 6-60 months with the first febrile seizure were included. The repetition of seizure during hospitalization was considered as incidence of recurrent seizure. Among 483 children with the first febrile seizure, recurrent seizure occurred in 57 patients (11.8%). The serum level of potassium, magnesium and calcium in children with recurrent seizure significantly was lower in comparison to the patients without repeated seizure. Complex seizure was the major risk factor for recurrent seizure (relative risk: 377.74, p=0.001). The risk of recurrent seizure decreased with the increase of serum level of potassium, calcium and magnesium. The risk of recurrent seizure increased with the increase of body temperature but not significantly. The incidence rate of recurrent seizure in children with the first febrile seizure was 118 cases per 1000 population. Complex seizure was the main risk factor for the seizure recurrence. Higher serum levels of potassium, calcium and magnesium may decrease the risk of recurrent seizure.

Postoperative pain has detrimental physiologic and psychologic effects on patients’ outcomes, such as increased postoperative morbidity, delayed recovery, and reduced patient satisfaction. This study aimed to determine the effect of preoperative sublingual melatonin on pain severity after colorectal surgery.  

We performed a randomized, placebo-controlled, triple-blinded study to test the efficacy of 6 mg of sublingual melatonin or placebo 1 hour preoperative on pain severity and sedation of 60 patients after colorectal surgeries. Pain and sedation were assessed by numerical verbal response (NVR) and the Ramsey sedation score, respectively, at the baseline, 1, 2, 6, 12, and 24 hours after surgery. The repeated measures analysis of variance was used to assess group × time interaction, and the Bonferroni adjustment was used for between-group comparisons.  

A total of 60 patients with a mean ± SD age of 49.35 years were equally randomized to the study groups. There was no significant difference between groups with respect to the baseline characteristics. The mean score of pain severity of patients in the melatonin group was significantly lower compared with the placebo group at 2, 6, 12, and 24 hours after surgery. The total mean pain score for the first 12 hours (mean difference [MD] [SE], 0.41 [0.12]; 95% CI, 0.17-0.65; [P = 0.012]) and the mean score of pain in 24 hours after surgery were significantly lower in the melatonin group in comparison with the placebo group (MD [SE], 0.44 [0.13]; 95% CI, 0.19-0.69; [P = 0.001]). Compared with the placebo group, the percent of patients who were cooperative, aware, and calm was significantly higher in the melatonin group at the baseline (43.3% vs 53.3%) and at 1 (36.7% vs 60%) and 2 hours (33.3% vs 80%).  

The use of 6 mg preoperative melatonin sublingual tablet in patients with colorectal surgeries could reduce the severity of postoperative pain, patients’ restlessness and anxiety, and increase patients' cooperation and calmness. Therefore, it seems that sublingual melatonin is an effective drug in controlling postoperative pain.

Biliary atresia (BA) is one of the most common etiologies of cholestasis in infants and toddlers. The most important factor in case of patients’ prognosis is its early diagnosis. There are many diagnostic tools in this field, sonography seems to be the most appropriate and fastest tool in early detecting and differentiating BA from other causes of neonatal cholestasis. The aim of this study was to evaluate the diagnostic value of new ultrasound and Doppler ultrasound methods in BA in infants and toddlers.

This cross-sectional study was performed during a one-year period on 35 infants and toddlers admitted to the gastrointestinal department of Akbar Children's Hospital with suspicion of cholestasis. These children underwent sonography by a radiologist to diagnose BA. All required information was extracted from the hospital records of these children and analyzed after entering the checklist. Data were analyzed using SPSS software version 26.

Totally, 35 patients including 18 boys (51.4%) and 17 girls (6.48%) with a mean age of 4/29±4/17 months were enrolled. According to the findings of the analysis, 21 patients (60%) had bile duct atresia and 14 patients (40%) had other diseases. Ultrasound sensitivity in the diagnosis of bile duct atresia was 90%, with an accuracy of 74%, specificity of 50% and positive and negative predictive value of 73% and 77%, respectively. The highest diagnostic value was related to the former hepatic capsular flow.

Biliary atresia can be accurately diagnosed by ultrasonography. The high sensitivity and accuracy of ultrasound indicate the appropriateness of this method in diagnosing this disease

Trace elements deficiencies are reported in dialysis patients. We aimed to define the frequency of Selenium deficiency in dialysis patients and its correlation with age, gender, duration of dialysis, dialysis modality, and serum levels of blood urea nitrogen (BUN), albumin, total cholesterol and hemoglobin.

Patients under dialysis in dialysis sections of Dr.Sheikh hospital from April 2017 to April 2019 were enrolled the study after taking written consent from patients or their parents. Blood samples were obtained for measurement of serum Selenium levels at time of routine monthly sampling.

Forty patients enrolled the study .Totally 45% were under hemodialysis and 55% peritoneal dialysis .The ages in first and second groups were 12.77±2.94 and 9.34 ±4.03 years, respectively (P= 0.04) .Serum selenium levels in hemodialysis and peritoneal dialysis patients were 91.95 ±8.43 and 94.1 ± 8.67 microgram (µgr) per liter, respectively (P= 0.374). Thirteen cases (32.5%) including 38.9% of hemodialysis and 27.3% of peritoneal dialysis patients had Selenium deficiency (P= 0.435). No correlation were found between age, gender, modality of dialysis, dialysis duration , serum levels of BUN , albumin , total cholesterol and hemoglobin with Selenium deficiency (P> 0.05 for all ) .

Selenium deficiency is common in dialysis patients. Demographic factors , dialysis modality , dialysis duration , serum levels of BUN , albumin , total cholesterol and hemoglobin are not related with presence of Selenium deficiency .Periodic checking of serum levels of Selenium is recommended

Jaundice is the most common problem among neonates. Although neonatal jaundice is highly prevalent in Iran and the prevention and treatment of this disease is incredibly important, few studies have been conducted on the effect of probiotics in the prevention of hyperbilirubinemia in Iran so far. Considering the contradictory results in this regard, this study was conducted to investigate the effect of probiotics in preventing jaundice among neonates.

The statistical population of this three-blinded clinical trial on the first of January 2021 consisted of 196 neonates who were divided into two groups of placebo and intervention. The neonates with a gestational age of more than 37 weeks, birth weight of more than 2,500 grams, and without risk factors for jaundice were included in the study after that the research objectives and procedures were explained to their parents and their informed consent was obtained. Patients were randomly divided into the intervention and placebo groups. The intervention group underwent treatment with probiotics (1010 Saccharomyces boulardii daily for 5 days), while the other group received treatment with a placebo. The level of bilirubin was measured with a skin bilirubin meter and, if necessary (i.e., bilirubin more than 15), a blood test was administered before the intervention and on the third and fifth days after the intervention. The effect of probiotics on jaundice was compared in the two groups.

Based on the study results, the level of forehead and chest bilirubin was not significantly different between the study groups before the intervention and 3 and 5 days after the intervention (P> 0.05). In cases that skin bilirubin levels were higher than 15 on the fifth day ,the mean serum bilirubin level was obtained at 15.71±0.99 mg/dl and 17.42±1.17 mg/dl in the intervention and placebo group, respectively, which was statistically significant (P = 0.03).

 The results of this study showed that the use of Saccharomyces boulardi decreased the level of serum bilirubin (P=0.03).

Association of constipation with incomplete bladder emptying, functional bladder outlet un-coordination, urinary tract infection (UTI), and upper urinary tract dilatation has been reported. We designed a study to determine the impact of chronic functional constipation on kidney and bladder ultrasound parameters, the results of the uroflowmetry test, and its association with UTI.

The study group consisted of 24 cases and 48 controls, who were children between 5 to 18 years-old, from June 2017 to June 2018. The case group included children with chronic functional constipation. The healthy children with urinary continence and regular bowel habits without any history of UTI were considered as the control group. The variables were bladder volume, post- voiding urinary residual volume, full and empty bladder wall thicknesses, uroflowmetry parameters and, UTI prevalence.

There were no significant differences in the prevalence of UTI, upper urinary tract dilatation on kidney ultrasound, uroflowmetry and, bladder ultrasound parameters between the case and control groups (P > .05 for all). We found abnormal uroflowmetry curves in 58.3% and 35.4% of the case and control groups, respectively (P > .05) and a higher rate of staccato curves in constipated compared to healthy children.

the prevalence of UTI and upper urinary tract dilatation on kidney ultrasonography are not significantly different between constipated and healthy children. Moreover, it seems that chronic constipation has no significant impact on the storage and emptying functions of the bladder. The higher frequency of staccato curves in constipated compared to healthy children can indicate that fecal mass causes detrusor sphincter dyssynergia.

The use of a laryngeal mask airway is associated with complications, such as a sore throat. This study aimed to evaluate the effect of taking the licophar pill on reducing sore throat due to laryngeal mask implantation in cataract surgery candidates.

In this study, 241 patients over 18 years of age with cataract surgery and ASA Ι or ΙΙ were randomly divided into the intervention and control groups. The intervention group received one licophar pill half an hour before surgery; however, the control group received nothing. The sore throat severity was measured 1, 3, 6, 12, and 24 h after surgery using the Visual-Analogue Scale (VAS). The data were analyzed in SPSS software (version 16).

Out of 241 patients, 120 cases received licophar pills. There was no significant difference between the two groups in terms of gender; however, the mean age was lower in the control group. On the other hand, the rate of sore throat was significantly higher in the control group, compared to the intervention group. In addition, postoperative pain scores in the intervention vs. control group 1, 3, 6, 12, and 24 h were 0.466 (1.454) vs. 3.842 (3.359), 0.383 (1.298) vs. 3.280 (3.056), 0.275 (1.102) vs. 2.694 (2.580), 0.200 (0.890) vs. 2.074 (2.271), and 0.108 (0.574) vs. 1.429 (1.714), respectively. Moreover, 103 and 40 patients in the intervention and control groups reported no pain (VAS=0), respectively, 1 h after surgery.

The present study showed that the use of licophar lozenge half an hour before surgery has a significant effect on reducing postoperative sore throat.

Vesicoureteral reflux (VUR) is a well-known risk factor for urinary tract infection (UTI). We aim to define diagnostic values of kidney ultrasonography (US) as a predictor of VUR and high grades VUR in children presented by UTI.

This retrospective study was conducted during October 2003 to 2016. Children aged ≤ 18 years with history of UTI who had underwent kidney US and direct cystography [voiding cystourethrography (VCUG) or radionuclide cystography (RNC)] enrolled in the study. Diagnostic values of hydronephrosis, hydro ureter, renal scaring, hydroureteronephrosis, decreased kidney size and abnormal kidney US for diagnosis of VUR and high grades VUR (grades IV-V) were evaluated.

Hydro-ureter, renal scaring, and hydroureteronephrosis were significantly more prevalent in VUR+ versus VUR- cases, also in higher grades compared with lower grades (grades I-III) VUR (P < .05 for all). Additionally, hydronephrosis was more common in VUR+ compared with VUR- patients (P < .0001). As a predictor of VUR and higher grades of VUR, abnormal kidney US had the highest sensitivity (24.87% and 40.84%, respectively), abnormal kidney US and hydro ureter reached the highest NPV (70.42% and 81.27%, respectively), hydroureteronephrosis and hydro ureter showed the highest accuracy (68.51% and 82.21%, respectively) .

Kidney US is a valuable screening test, abnormal renal US significantly increases the probability of VUR and high grades VUR , but if used as the only screening test , about 2/3 and 1/3 and 20% of VUR , high grades VUR and grade V VURs will be missed.

To evaluate the dimensions of lower punctum in a sample of Iranian normal population using spectral domain anterior segment optical coherence tomography (OCT).

In this cross‑sectional study, 102 eyes of 102 healthy volunteers were enrolled. All participants underwent a detailed history and complete ophthalmic examination. Lower punctum metrics were measured using OCT (Spectralis, Heidelberg) with the anterior segment module. External punctal diameter was defined as the largest diameter at the surface of the punctum. Internal punctal diameter was measured at two different depths of 100 µm and 500 µm from the external surface. Measurements were repeated for 30% of data by another grader. The agreement was measured using intraclass correlation coefficient (ICC).

The mean age of the participants was 61.5 ± 7.9 years. The mean external punctal diameter was 425.6 ± 124.3 µm. The mean internal punctal diameter at 100 µm and 500 µm was 183 ± 97.5 µm and 77.7 ± 51.4 µm, respectively. The agreement between the graders was high in assessing all punctal characteristics (ICC >0.9 for all measurements).

The spectral domain OCT can be used for measuring lower punctum diameter with acceptable reproducibility

The current study aimed to investigate the prevalence and risk factors of seizure in acute bacterial meningitis.

In the present study, a total of 180 children (age range, 2 months to 14 years) with acute bacterial meningitis, were separated into two groups based on the diagnosis of seizure. The study was conducted in Mashhad (Iran) from 2002 to 2016.

Seizure occurred in 37.4% of children with bacterial meningitis. Streptococcus pneumonia (S. pneumonia) was the most common organism. Most of the children with seizures (53.7%) had more than one episode. Also, 35% of patients had neurologic complications. Complications were more related to the seizure occurrence, the number of episodes, prolonged seizure, and being younger than 12 months. Age categories of less than 1 year and 1-5 year were associated with increased risk of seizure (odds ratio: 4.33 and 6.54, respectively). The more episode of seizure was associated with more complications (odds ratio: 6.33).

The prevalence of seizures in acute bacterial meningitis was 37.4%. Besides, the seizure was associated with more complications. Hence, timely diagnosis and treatment of bacterial meningitis are necessary for preventing future consequences.

The patient’s self-discharge from the hospital is a process in which the patient leaves the hospital voluntarily without completing the course of treatment, despite medical advice, and can indicate patient dissatisfaction and a significant challenge for health system managers. This study was conducted to investigate the causes and consequences of a patient's self-discharge from Dr. Sheikh Hospital as a referral center in the northeast of Iran.

All patients who were discharged with the personal consent from the hospital with personal consent between October 2014 and March 2015 were included in the study. A checklist was used to collect data. The patients' outcome was completed by telephone a week later. Finally, SPSS statistical software was used to evaluate the results.

Totally, 51 patients were included in this study. The leading causes of discharge with personal consent were including dissatisfaction with the physician and medical staff in 23 patients (45.1%), home care preference in 12 patients (23.5%), distance from the hospital in 5 patients (9.8%), teaching at the hospital in 3 patients (،5.9), the high cost of treatment in 3 patients (9 5.9), the overcrowding of the hospital in 3 patients (9 5.9) and the lack of specialist or diagnostic and therapeutic devices in 2 patients (3.9%). Also, in the study of patients' outcome, 21 patients (41.1%) referred to the doctor again, 18 patients (35.3%) continued treatment at home, 9 patients (17.7%) were readmitted and 2 patients (3.9%) died.

The most common cause of discharge with personal consent was dissatisfaction from the treatment team. Given that 3.9% of patients have died and a large number of patients have been re-referred to the doctor and be readmitted, it seems that justifying patients to refrain from self-discharge is in the patient's best interest.

Background

 Studies on colonic motor function in pediatric patients with constipation have revealed some dysfunctional patterns of colonic transit. The aim of this study was to evaluate the times and patterns of colon transit time to diagnose and categorize of colon abnormalities.

This descriptive, cross-sectional study was performed at Dr. Sheikh Pediatrics Hospital of Mashhad University of Medical Sciences, Mashhad, Iran during 2013-2019. Sixty-four children with chronic constipation that were referred to the radiology department were enrolled in the study. Segmental and total colon transit times (CTT) were calculated by using plastic markers and Metcalf Protocol. Data were analyzed using SPSS software (version 22.0).

Among 64 children with constipation (aged between 2 and 18 years), about half (51.5%) of patients had normal segmental and total CTT. Of 43 patients with a normal total CTT, 10 (23%) had a prolonged segmental CTT. the normal upper limits of CTT were considered for the right colon, left colon, rectosigmoid, and total colon at 20, 20, 30, and 60 hours, respectively. These times had a 97% specificity with AUC = 0.74 to 0.93 to differentiate the normal from the abnormal transit time. The transit abnormalities were included rectosigmoid retention (22%), colon inertia (17.2%), left colon retention (6.2%), and right colon retention (3.1%).

Both segmental and total CCT were found normal in half of our constipated patients and Rectosigmoid retention and colon inertia were the most common abnormalities. The normal upper limits for colon transit time in the northeast of Iran were less than those found in Western countries.