farzad ferdosian

 Since it is necessary to detect changes in lung function for the follow-up of the patients with respiratory and functional complications caused by COVID-19, in this study, we decided to examine the results of spirometry in children over 5 years old with Covid-19.

 In this cross-sectional study, 52 over-five-year-old children, hospitalized due to COVID-19 for at least six past months, were examined. The participants’ demographic information, respiratory symptoms, underlying diseases, severity of COVID-19 according to WHO, severity of lung involvement in CT scan, type of lung involvement, oxygen saturation at admission as well as FEV1, FVC, and FEV1/FVC were collected and analyzed, the results were analyzed using SPSS version 16 software and t-test and Chi-square tests.

 Of all investigated patients،, 26 were boys (50%) and 38 (73.1%) were 5-12 years old. The minimum age of the children was 5 years and the maximum was 18 years. The mean age of children was 3.41±10 years. The FEV1/FVC ranged from 61% to 79% in five patients (9.6%) and from 80% to 100% in 47 patients (90.4%). The FEV1 was lower than 80% in 28 and higher than 80% in 24 patients. FEV1/FVC had no significant relationship with the participants’ age, gender, clinical manifestations, and disease severity in terms of pulmonary involvement, but it had a significant association with blood oxygen saturation level (P: 0.001).

 The changes in pulmonary function tests vary in different months following contamination with COVID-19. In the present study, 9% of the patients, who were examined in the sixth month after infection, had abnormal pulmonary function test results. Based on the findings, the pulmonary function test results had no significant relationship with the patients’ age, gender, and clinical symptoms, while it was significantly associated with their blood oxygen saturation intensity.

As there is limited research on COVID-19 in children, and reports have indicated low adverse clinical outcomes and mortality rates, our team conducted this study to investigate the clinical outcomes in hospitalized children with COVID-19.  This historical cohort study included children aged 1 month to 18 years with COVID-19. They were admitted to a referral hospital in Yazd, Iran, over a year from February 2020. Demographic information such as age and sex, the length of hospitalization, and the reverse transcription-polymerase chain reaction (PCR) test results were recorded. We also evaluated Patients' outcomes, including admission to the pediatric intensive care unit (PICU), need for mechanical ventilation, and mortality.  Our study included 94 patients, of which 52.1% were female and 29.8% were under one year old. Children aged 1-59 months accounted for more than half of the sample (53.2%). The most common symptoms reported were fever (85.1%), respiratory problems (47.9%), and gastrointestinal symptoms (46.8%). The mean duration of hospital stay was 6.4±5.7 days. About 38.3% of cases required admission to the PICU, and 11.7% needed mechanical ventilation. 75% of deaths occurred in children with confirmed COVID-19 who had an underlying disease. Moreover, respiratory distress at the time of referral was significantly associated with admission to the intensive care unit (P=0.008), requiring mechanical ventilation (P=0.003), and mortality (P=0.02). Our findings suggest that children under one year old, patients with underlying diseases, and those experiencing respiratory distress at the time of referral are high-risk groups and require special attention in care and treatment.

The World Health Organization first reported outbreaks of COVID-19 in 2019 in Wuhan, China. Limited studies have been performed on long-term complications after the acute phase of this disease in children. This study aimed to evaluate the long-term outcomes of children who had previously been hospitalized with COVID-19.

In this cross-sectional study, long-term complications in 105 children less than 18 years of age suspected of having Covid-19 disease were assessed (2020-2021). This evaluation was performed by completing a questionnaire by patients' families three months after discharge and collecting information from the patients' records at the time of hospitalization. Participants were also classified into four age groups. Finally, the data were analyzed using SPSS software version 19. P-value less than 0.05 was considered statistically significant.

All 105 children suspected of having COVID-19 who were hospitalized during the mentioned period were included in this study, but the families of 80 children completed the questionnaire. The most common long-term complications in the patients were mood disorders (35.2%), loss of appetite (22.9%), and fatigue (20%), respectively. It has also been found that with the increasing age of the patients, the incidence of complications has increased.

 This study results demonstrated that the most common side effects observed in trimester follow-up of children with COVID-19 are mood disorders, loss of appetite, and fatigue, respectively. Thus, post-COVID-19 complications cannot be dismissed among children and adolescents. Controlled population-based studies and further in-depth analyses are needed to confirm their impact on individuals and health care systems.

Coronaviruses (CoVs) are single-stranded RNA viruses described for >50 years. Novel coronavirus (SARS-Coronavirus-2: SARS-CoV-2) emerged in Wuhan and has spread globally. Coronavirus Disease 2019 (COVID-19) symptoms are primarily pulmonary (fever, dry cough, fatigue, pneumonia); however, other organs can be affected, including the gastrointestinal tract, kidneys, liver, heart, and brain. Pediatric COVID-19 is milder than the adult’s type. Children with severe disease often have an underlying co-morbidity, such as chronic lung disease or immunosuppression. SARS-CoV-1, MERS-CoV, HCoV-OC43, and HCoV-229E are associated with neurological complications. Neurological manifestations of COVID-19 are not well understood in adults or children, and these manifestations are not rare. The number of patients with neurological manifestations has been increasing Recently, especially in the third peak of the disease. Early diagnosis and timely management may lead to a better outcome. There are limited reports of neurological complications in the pediatric population. Further studies are required for early diagnosis and better results. We reported the third case of encephalitis in children without any respiratory or gastrointestinal manifestation. A 7-year-old male was admitted with fever and loss of consciousness. He presented no respiratory or gastrointestinal symptoms. He reported no medical history and history of substance abuse. Laboratory findings confirm that neurological manifestations might be expected in covid-19 infections, despite the absence of respiratory symptoms. The patient was treated, and the level of consciousness was gradually improving. Supportive treatment and outpatient follow-up were recommended.

Mild symptoms of COVID-19 in children may lead to delayed or misdiagnosis. Reverse transcription polymerase chain reaction (RT-PCR) is an approved laboratory method for detecting COVID-19 virus. Given that COVID-19 is considered an emerging disease, its diagnostic methods in children have not yet been well compared. Therefore, this study was designed to compare RT-PCR, lung CT scan, and anti-COVID-19 antibody results in hospitalized children suspected for COVID-19. This cross-sectional study was conducted on patients less than 18 years of age, suspected fot COVID-19, and admitted to Shahid Sadoughi Hospital in Yazd, Iran, from February 2020 to February 2021. All hospitalized children who had suspected COVID-19 based on their initial clinical symptoms or signs, and had undergone RT-PCR were included in the study. Demographic data such as age, sex, contact history with COVID-19 patients, clinical manifestations, outcome, comorbidities, and information on other paraclinical procedures were collected by checklist. In total, 53.3% of the patients were male, and 59% were under five years old. The most common symptom was fever (81%), followed by respiratory distress (34.3%) and diarrhea (26.7%), and cough (19%). Additionally, a significant relationship was observed between respiratory symptoms and a positive PCR test (P = 0.020) and positive lung CT findings (P = 0.017). This study failed to find a significant association between PCR, chest CT scan, and anti-COVID-19 antibody results with ICU admission, endotracheal intubation, and death (P>0.05). Our findings showed a significant association between respiratory symptoms, positive RT- PCR, and positive CT findings. But ICU admission, endotracheal intubation, and death were not significantly correlated with PCR, chest CT scan, and anti-COVID-19 antibodies

  Kawasaki disease (KD) is an acute vasculitis that affects small and medium-sized arteries. During the coronavirus disease 19 (COVID-19) pandemic, a significant increase in children with KD symptoms who had COVID-19 was reported, known as the multisystem inflammatory syndrome in children (MIS-C). We describe 2 cases of KD following the COVID-19.

Two 2.5 and 3.5-year-old boys presented to the Shahid Sadoughi Hospital with weakness, fever, nausea, and vomiting for several days. The other symptoms were maculopapular rash, cracked lips, erythematous palms, conjunctivitis, and lymphadenopathy. Respiratory symptoms were observed in none of them. The course of the disease was moderate to severe in both, and they were treated entirely.

COVID-19 infection in children may present without any respiratory symptoms. Thus, Pediatricians should consider these atypical presentations and not restrict COVID-19 tests only for patients with typical presentations to prevent missing such cases and irreversible complications.

Acute poisoning is a common cause of emergency department visits in childhood and can increase children’s morbidity and mortality. Since the causes of child poisoning in different parts of Iran may differ due to cultural differences, this study was conducted to evaluate the most common causes of poisoning in Yazd. This retrospective cross-sectional study is based on the medical records of children less than 18 years of age admitted to the pediatric emergency department at Shahid Sadoughi Hospital in Yazd during 2018. The collected data included demographic information, the cause, and the outcome of acute poisoning. Out of 105 cases, 61.9% were boys. The highest poisoning rates were in the age group of 1 to 4 years (55.2%). In 50% of the participants, the family size was five or more, and 91% had Iranian nationality. Drugs were identified as the most common causes of poisoning (51.4%), and opioid analgesics were the most frequent drugs. The most common complaint at the time of referral in patients was the loss of consciousness (33%). The mean hospital stay was 56 hours, and no death was reported. According to the findings of this study in Yazd, the probability of accidental poisoning in boys under four years and due to different types of drugs, especially opioids, was higher than others. It seems that increasing parents’ awareness about keeping drugs used by family members in a safe place and out of children’s reach is essential in preventing poisoning.

Diagnosis of neonatal chylomicronemia, as a very rare condition, is very difficult and usually is diagnosed when acute pancreatitis sets in. Early diagnosis can prevent the complications such as acute pancreatitis and pancreatic necrosis which are associated with the condition.

A 5.5 month- old female breastfed baby presented to us suffering from splenomegaly because of respiratory infection. Anemia and leukocytosis were seen in laboratory data. The result of bone marrow aspiration (BMA) performed to diagnosis was normal. Following the study, the patient had a high triglyceride, which improved with the treatment of symptoms and blood indices.

Our case reports a rare disorder that was initially admitted with suspicion of malignancy, organomegaly, anemia and leukocytosis. In the course of hospitalization, the diagnosis of malignancy was rejected after BMA, and chylomicronemia was diagnosed and the patient's leukocytosis and high uric acid were eliminated by treatment of the disease and the patient's symptoms were improved.

Kikuchi Fujimoto Disease (KFD), also known as necrotic histiocystic lymphadenitis, is a condition with unknown etiology. Probably, infectious, viral, and also autoimmune etiologies, especially lupus erythematosus, contribute to this disorder. The common signs are lymphadenopathy along with fever and leukopenia. Our case was a13-year-old boy with fever of unknown origin. He underwent ordinary fever of unknow origin (FUO) investigations and the only positive finding on his examination was lymphadenopathic fever of posterior cervical chain. The results of primary tests and also cultures of blood and urine samples did not have any specific contribution to diagnosis of infectious causes. Besides, bone marrow aspiration and biopsy led to the exclusion of chances of lymphoma or other malignancies. Finally, diagnosis of KFD was confirmed by the use of dissection of cervical lymph nodes and also via immunohistochemical tests and simultaneous positive antinuclear antibody (ANA). Hence, the patient was put on suitable medical treatment for lupus. Given the rare demonstrations of this case, i.e., the male sex and fever of unknown origin, and also the positive ANA despite clear clinical symptoms of lupus, this case was presented to provide both proper education and make a faster and more appropriate diagnosis.

Lumbar puncture (LP) is a worth procedure in diagnosis of oncological diseases and intrathecal administration of antineoplastic drugs. The effort should be to minimize pain of LP in children with cancers. This clinical trial was done to compare success rates in performing LP and reducing anxiety and pain of LP in sitting and lateral decubitus positions in 1 to 5-year-old children.

In a not-blinded clinical trial, 80 children aged 1-5 years, undergoing LP in Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran, from May to September 2019, were randomly allocated to two groups. Intravenous 0.5mg/kg midazolam was injected in all patients five minutes before LP, and LP was performed in sitting position in group I and in lateral decubitus position in group II. Primary outcomes included rate of successful LP, anxiety and pain scores before LP and during needle insertion to skin for LP, and secondary outcomes comprised of success rates in decrease of anxiety (anxiety score of four and more) and pain (pain score of less than three) when the needle was inserted to skin for LP.

Thirty-eight girls and 42 boys with the mean age of 2.51 ± 0.32 years were evaluated. Success rates in performing LP (70 % in sitting vs. 65% in decubitus position, P=0.5), decrease of LP anxiety (77 % in sitting vs. 75% in decubitus groups, P=0.8) and reduction of pain during skin needle insertion for LP (72 % in sitting vs. 67% in decubitus position, P=0.7) were not significantly different between the two positions.

Rates of success in performing LP and reduction of its pain and anxiety in children were equal in lateral decubitus and sitting posi tions and, in 1 to 5-year-old sick children with or without cardiorespiratory difficulties, LP can be done in lateral decubitus or sitting position.

Abstract Objectives Midazolam at a dosage of 0.51 mg/kg induces anxiolytic effects in 90% of children. This study was performed to elucidate whether intravenous midazolam with maternal presence is more efficient than intravenous midazolam alone in the reduction of pain and anxiety of lumbar puncture (LP) in 6 to 24-month-old children.Materials & MethodsIn this not-blinded clinical trial, we included 60 children aged 6 to 24 months old undergoing LP in the Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran, from September 2014 to March 2015. The participants were randomly assigned to two groups, and all of them received painless injection of 0.5 mg/kg midazolam five minutes before LP. In group I, LP was performed with maternal presence and in group II, the mothers were absent. The primary outcomes included anxiety and pain scores before LP and during needle insertion to the skin for LP. The secondary outcomes comprised of success rates in the reduction of anxiety (anxiety score of four and more) and pain (pain score of less than three) when the needle was inserted to the skin for LP.Results Twenty-eight girls and 32 boys were evaluated in the two groups. Maternal presence was found to be effective in the reduction of anxiety (2.7±0.65 vs. 3.83±0.87; P=0.001) and pain scores (3.8±1.75 vs. 6.1±1.63, P=0.001). In the maternal presence group, success rate in anxiety (76.7% vs. 16.6%; P=0.0001) and pain reduction (63.3 % vs. 6.7%; P=0.0001) was higher than in the midazolam alone group.                                                                                                                  ConclusionMaternal presence during lumbar puncture  can reduce pain and anxiety among 6 to 24-month-old children.

Isolated cerebral mucormycosis can be life-threatening in immunocompromised patients. Sinus and lung were the most involved organs, while cerebral infection by mucormycosis is more fetal. This infection needs proper debridement and antifungal therapy. We report a 12-year-old diabetic girl with manifestations of fever, headache, and weakness in the right upper and lower extremities without any involvement of sinuses and lung. The patient had approximately normal routine laboratory data, and its CSF was not diagnostic. Because of its features in brain CT and MRI that suggested a necrotic lesion in the left parietal lobe, she was undergone craniotomy and received broad-spectrum antibiotics along with anti-fungal and anti-tuberculosis drugs. Histopathological findings of the mass, which was excised in craniotomy, confirmed the diagnosis of mucormycosis. Unfortunately, the patient died because of this invasive infection. The fatality of fungal infections, especially cerebral types, warn us to be aware of them in immunocompromised patients and perform the proper treatment to reduce its mortality.

This study was done to answer the question that whether or not previous antiepileptic drugs with combination of omega-3 and risperidone is more efficient than previous antiepileptic drugs with risperidone alone in decreasing of seizures monthly frequency of children with refractory epilepsy and attention-deficit/hyperactivity disorder (ADHD).
In a randomized clinical trial, sixty four 7-11 year old children with refractory epilepsy and ADHD who were referred to Pediatric Neurology Clinic of Shahid Sadoughi Hospital, Yazd, Iran from June 2015, were distributed into two groups, randomly. In group I, one capsule of omega-3 daily and 0.5 mg of risperidone was divided into two doses with previous antiepileptic drugs and in group II, 0.5 mg of risperidone was divided into two doses with previous antiepileptic drugs were given. The drugs use was continued for three months and the children were followed up monthly for three consecutive months. Primary outcomes included seizure monthly frequency and good response (more than 50% of reduction in seizures monthly frequency). Secondary outcome was clinical side effects.
23 girls and 33 boys with mean age of 9.24.15(29 children in omega-3 group and 27 children in control group) were evaluated. Omega-3 therapy was effective in decreasing of seizures monthly frequency (10.41±3.92 times vs. 17.01±4.98, P = 0.03). Good response was seen in three children (11.1%) in control (95% confidence interval: 8%-22.8%) and in 9 children (20%) in Omega-3 (95% CI: 47.83%-14.17%) group, which showed that omega-3 was more effective in seizure controlling. (P=0.001) Frequency of side effects was not different in the two groups (14.8 % in control vs. 20.7% in omega-3 groups, P=0.5).
Omega-3 might be used as an effective and safe drug in seizures control of children with refractory epilepsy and ADHD.

Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non- parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist.

Seizures are the most common pediatric neurologic problem. Research of the association between iron deficiency and seizures has shown conflicting results.This study evaluates iron status of children with a first seizure attack (febrile seizure (FS) or first unprovoked afebrile seizure (FUS) and healthy control group. In a cross sectional case control study, iron status of 6–60 month year old admitted children with first seizure to Shahid Sadoughi Hospital from August 2011–December 2012 were evaluated and compared with healthy control children that were referred to primary health care center of Azadshar, Yazd, Iran.150 children were compared in three equal (FS, afebrile seizure, and control) groups.Hemoglobin levels in FUS (11.39 ± 1.07 g/dl) and FS (11.46 ± 1.18 g/dl) were lower than the control group (11.9 ± 0.89 g/dl) group.Serum iron levels in FS (38.52 ± 11.38 μg/dL) and FUS (42.68 ± 14.76 μg/dL) were lower than the control group (54.32 ± 13.46 μg/dL).Serum ferritin level in FUS (46.21 ± 27.63 ng/mL) and FS (48.91 ±22.96 ng/mL) was lower than the control group (75.13 ± 35.57 ng/mL).Iron deficiency (48% in FS, 44% in FUS and 28% in control group) and iron deficiency anemia (26% in FUS, 22% in FS, and 10% in healthy children) was more frequent in children with seizures.Iron status should be evaluated in children with a first attack of febrile or afebrile seizures.

The major complication of Kawasaki disease is coronary artery dilatation and aneurysm. It occurs in approximately 15-25% of untreated children with Kawasaki Disease. Early diagnosis and treatment with Intravenous immune globulin (IVIG) and aspirin (ASA) can reduce the incidence of coronary artery abnormality to 2%-5%. We report one case of Atypical Kawasaki Disease with Multiple giant coronary artery aneurysms despite early adequate treatment with IVIG and ASA.