فهرست مطالب fereshteh karbasian

This study aims to assess the safety level of the different home parts for children with a bleeding tendency disorder (especially hemophilia) and identify the elements that affect this safety.

We conducted a cross-sectional study on the children referred to the Mofid Children’s Hospital from the beginning of 2018 to the end of 2020. Information was gathered via a checklist. Inclusion criteria were children between 1 to 5 years old with bleeding tendencies, and exclusion criteria were the presence of other disorders. The safety was measured in five areas at home: 1- physical conditions 2- kitchen 3- bathroom 4- toys 5- first aid equipment and essential phone numbers.

Forty-one children participated in this study which 31 (75.61 %) were boys. Eleven (28.95 %) children experienced zero accidents at home and eight (21.05 %) children experienced more than three accidents at home. The Mean and 95% confidence interval scores were 7.97 (7.37-8.57) for the physical condition section, 8.22 (7.73-8.70) for the kitchen section, 8.15 (7.66-8.65) for the bathroom section, 7.93 (7.15-8.71) for the toys section, and 7.30 (6.60-8.01) for the first aid equipment and essential phone numbers section. The physical condition safety score was significantly higher in families whose fathers had a college education than in fathers with secondary and diploma education (P-value = 0.024). The kitchen section safety score was significantly higher in families where the father has a freelance job than the employee or worker (P-value = 0.040).

The mother’s age, father’s educational level, and father’s job are the factors that affect the level of safety significantly. Providing toys that are age-appropriate and safe (without separable parts or holes) could be an important point for parents with children with bleeding disorders.

Congenital colonic stenosis is a condition in which there is a narrowing or blockage of the colon (large intestine) present at birth. This can occur due to multiple etiologies, including abnormal development of the colon during fetal development and some genetic defects. The condition may lead to symptoms such as abdominal pain, on and off constipation, abdominal distention and vomiting. Treatment may involve surgery to remove or widen the narrowed segment of the colon.

Antibiotics should be used to treat bacterial infections, while prescribing antibiotics for viral infections is ineffective. Sometimes, physicians do not diagnose diseases correctly and misdiagnose viral infections as bacterial.

In this study, we aimed to evaluate the appropriateness of prescribed antibiotics in the Children’s Emergency Department of Mofid Hospital, Tehran, Iran.

This cross-sectional study was conducted in the Emergency Department of Mofid Children’s Hospital during January-December 2019. All children younger than 16 years who were hospitalized and received antibiotics were included in this study. The degree of fever, diagnosis of disease, and laboratory findings were assessed.

We found 12.6% (38/301) inappropriate antibiotic prescriptions in the studied cases. The causes of antibiotic inappropriateness were incorrect diagnosis in 4.31% of patients (13/301), incorrect medication dose in 1.99% (6/301) patients, and no indication for the prescribed medicine in 6.31% (19/301) patients. Erythrocyte sedimentation rate, C-reactive protein, and neutrophil count were not significantly different between the two groups (P > 0.05).

According to our results, incorrect antibiotic prescription is common in Mofid Hospital. Therefore, it is an urgent need to monitor and train the treatment system.

Large-volume paracentesis has become the first treatment choice for patients with severe and refractory ascites. The studies have reported several complications after therapeutic paracentesis. But there are few published data on the complications with or without Albumin therapy.  We aimed to analyze the safety and complications of large-volume paracentesis in children with or without albumin therapy.  

This study was conducted on children with severe ascites with chronic liver disease who underwent large-volume paracentesis. They were divided into albumin-infused and albumin non-infused groups. In the case of coagulopathy, no adjustment was made. Albumin was not administered after the procedure. The outcomes were monitored to evaluate the complications. To compare two groups, a t-test was utilized, and the ANOVA test was used to compare several groups. If the requirements for using these tests were not met, Mann-Whitney and Kruskal-Wallis tests were applied.  

Decreased heart rate was observed in all time intervals and was meaningful six days after paracentesis. MAP also decreased statistically at 48 hours and six days after the procedure (P < 0.05). Other variables did not show any meaningful change. 

Children having tense ascites with thrombocytopenia, prolonged PT, Child-Pugh class C, and encephalopathy can undergo large-volume paracentesis without any complication. Albumin administration before the procedure in patients with low levels of Albumin (<2.9) can effectively overcome the problems of tachycardia and increased mean arterial pressure. There will be no need for Albumin administration after paracentesis.

Coronavirus disease-2019 (COVID-19) has rapidly disseminated worldwide. In children, the most prevalent manifestations of COVID-19 are fever, cough, and fatigue.

Here, we describe a case of croup secondary to COVID-19 with a preexisting laryngomalacia who presented with fever, dyspnea, and severe cough. The patient had respiratory stridor and diffuse wheezing on lung auscultation.

Although a certain association between COVID-19 and croup has yet to be proven; but as it showed, SARS-CoV-2, like other viruses, can be a leading cause of croup. Therefore, we suggest in children with croup and upper airway symptoms, SARS-CoV-2 infection be ruled out.

vitamin D insufficiency is a common disorder worldwide and children are involved with this disorder. In this study we aimed to evaluate of effectiveness of treatment of vitamin D insufficiency with vitamin D 50,000 unit in children who had vitamin D insufficiency.

children’ vitamin D levels were evaluated and if they had vitamin D insufficiency, 1 pearl of vitamin D 50,000 unit was prescribed weekly for 6 weeks, and after 6 weeks, vitamin D levels were checked again. Then all data were analyzed in SPSS 20 software.

ninety-seven children were evaluated and 61.9% were boys. The average age of children was 101.01 ± 19.27 months. The average BMI of these children was 15.46 ± 2.52 kg/m2. Initial vitamin D level was 18.21 ± 6.42 ng / mL with a range of 4.2 to 29.8. After treatment, this level reached 41.08 ± 14.61ng / mL (12.2 - 98.4 ng / mL) and this increase was statistically significant (P-value< 0.005). There was no correlation between age, gender, height, and BMI with the increase of efficacy of vitamin D level with 1 pearl of vitamin D 50000 unit.

using one pearl of vitamin D 50000 unit weekly for 6 weeks is a good method for vitamin D insufficiency treatment in children.

Liver cirrhosis is one of the major causes of mortality worldwide. Finding new methods to stratify patients with liver cirrhosis can affect the treatment plan and improve the outcomes. The present study aimed to determine the prognostic value of the serum D-dimer level in pediatric patients with liver cirrhosis. All cirrhotic pediatric patients admitted to Namazi Hospital (Shiraz, Iran) between November 2020 and November 2021 underwent serum D-dimer level testing on admission and were prospectively analyzed for 90 days. The Mann-Whitney U test was used to evaluate the correlation between D-dimer level and patient mortality. In addition, ROC (Receiver Operating Curve) analysis was used to evaluate the specificity and sensitivity of the D-dimer level in predicting mortality. In total, 38 patients with cirrhosis were included in this study. The serum D-dimer level was significantly correlated with the mortality of children with liver cirrhosis (P = 0.01), and the area under the ROC of the serum D-dimer level for this prediction was 0.777 (P = 0.01). The best cut-off D-dimer value was 1641.5 ng/ml, which offered a sensitivity of 70.0% and specificity of 82.14% for predicting mortality. We detected no significant correlation between the D-dimer level and the PELD (Pediatric End-stage Liver Disease) or MELD (Model for End-stage Liver Disease) score. The D-dimer level is significantly associated with the mortality of children with cirrhosis. Therefore, D-dimer testing can be used as a stratification marker to prioritize patients waiting on the liver transplant list

non-celiac gluten sensitivity (NCGS) is a condition characterized by gastrointestinal and extra-intestinal symptoms which triggered by ingestion of Gluten contained compounds i.e., wheat, rye, and barley, in subjects without celiac disease or wheat allergy.

hereby we present five children and adolescents with final diagnosis of NCGS. All patients had failure to thrive and abdominal pain. Following gluten free diet, clinical symptoms reduced and we detected significant weight and height gain after 1 month of diet.

relationship between failure to thrive and NCGS is still unknown, hence according to mentioned cases, NCGS may be one of the main causes of FTT, which can be prevented by gluten free diets.

Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus.

This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital.

This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the IranianMinistry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records.

On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI.

The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.

Approximately 4–7 percent of all live births are led to a very low birth weight (VLBW) situation where the morbidity and mortality rate are very high. A large number of VLBW newborns in the intensive care unit (ICU) require mechanical ventilation due to various conditions. To reduce mortality in this group, identification of risk factors is important. This study aimed to determine the prognosis of mechanical ventilation in VLBW neonates at Mahdiye hospital in Tehran, Iran.

This study is a prospective cohort study. VLBW neonates who consecutively were put on mechanical ventilation during the study period were en-rolled. Then, the enrolled neonates were divided into two groups: neonates who died after implementing the ventilator were in group-I and neonates who survived after re-ceiving mechanical ventilation were in group-II. Demographic, clinical, and paraclinical variables were gathered to find out the predictors of mortality of ventilated neonates. The data were analyzed by SPSS software version 21.

During the study period, a total of 177 neonates were ventilated due to differ-ent causes. 56% were male with a male to female ratio of 1.27:1. Mean birth weight and gestational ages were 1024.8 ± 247.5 grams and 27.9±2.2 weeks respectively. Out of 177 mechanically ventilated VLBW neonates enrolled for this study, 53% died. Significant factors determining mortality rate were mean weight, mean gestational age, pulmonary hemorrhage, advance resuscitation, and duration of hospital stay (p<0.05). APGAR score, gender, Pneumothorax, IVH>II, Sepsis, and Maternal Disease were not significantly associated with mortality in VLBW neonates requiring mechanical ventila-tion (P>0.05).

This study showed that among the analyzed factors weight <1000gm, ges-tation <28weeks, pulmonary hemorrhage, and complications during ventilation were the most significant predictors of mortality in ventilated VLBW neonates in the intensive care unit.

 In December 2019, a new coronavirus appeared in China, as a cause of acute respiratory disease. Healthcare Workers (HCWs) in children's hospitals are one of the groups who are at a high rate of exposure to COVID-19 patients. The detection of antibodies is useful and helps diagnose late or recent SARS-CoV-2 infection. Most children may present with asymptomatic or mild SARS-CoV-2 infection and can be silent sources of infection in the community and hospitals.

 This study was conducted to determine the antibodies (IgM and IgG) against SARS-CoV-2 in Mofid children's hospital staff.

 This cross-sectional study evaluated 475 staff from Mofid children's hospital from April 20 to May 5, 2020, in Tehran. We collected blood samples for the antibody assay with a rapid test kit. A questionnaire was used to collect demographic and clinical data.

 Of 475 staff who participated in this study, 25 (5.3%) were diagnosed with COVID-19 by Polymerase Chain Reaction (PCR) and/or CT scan. Besides, 140 (29.4%) of them were positive for IgM and/or IgG SARS-CoV-2 antibodies.

 The seropositivity of antibodies against SARS-CoV-2 among children's hospital staff was higher than expected. Approximately 5% of the participants were diagnosed as definitive positive COVID-19 cases by PCR and/or CT scan, but 29.4% of them were seropositive. The difference is a warning, as it shows seropositive people could be silent sources of transmission during asymptomatic infection.

Hepatic involvement in Wilson disease consists of isolated elevated liver enzyme, asymptomatic hepatomegaly, cirrhosis and acute liver failure. Here, we report three patients with unexplained elevated liver enzymes. By considering the level of urinary excretion of copper after penicillamine challenge test, we had some problems in the process of diagnosis. Therefore, we thought of cautiously applying the diagnostic cut-off in the mentioned challenge test.

Vaginal foreign body is an uncommon clinical entity in the pediatric population but it is more common in mentally retarded and young children. In this case report, we present a 4-year-old girl who was brought to the emergency room with a history of self-insertion of a pen cap into the vaginal orifice which had no vaginal bleeding, vaginal discharge, abdominal pain or urinary symptoms.

Increasing demand for blood and blood products mostly due to increased individual access to health care services rises the concerns over lack of adequate amounts of blood products. It also can impose additional costs to blood transfusion centers and may increase transfusion-related complications. We aimed to investigate the impact of the Iranian Blood Transfusion Organization (IBTO) standards after three years of blood-bank committee activities on optimizing the consumption of the blood products. 

All request forms of blood and blood products of Mofid Children’s Hospital were reviewed according to the department and type of the product in 2013 and indexes of “cross-matched to transfusion ratio” (C/T ratio), “transfusion index” (TI) and “transfusion probability” (%T) were calculated. Following 3 years of training by the Blood Bank Committee of the hospital and holding different meetings and workshops using IBTO standards, the same parameters were reassessed in 2017. 

In 2013, 13653 units of blood and blood products were ordered of which 10472 units (77%) were transfused and 3181 units (23%) were returned. C/T Ratio was equal to 1.43. After about 3 years of intervention, 17946 units of blood and blood products had been cross-matched of which 14775 units (83%) were transfused and 3171 units (17%) were returned. C/T Ratio after 3 years of intervention was equal to 1.33 (P<0.0001). T% was 69% in 2017 compared to 62% in 2013. Also, TI was 0.97 in 2017 compared to 0.83 in 2013. The blood bank committee’s activities in surgical departments improved C/T ratio of 2.83 to 2.13. 

This study showed that holding scientific sessions and blood bank academic activities during more than 3 years was successful to optimize the use of blood and blood products in our hospital, particularly in surgical departments.

Acute parvovirus infection may cause different complications and comorbidity in Pediatric Intensive Care Unit (PICU) patients. This study was conducted to investigate the effect of parvovirus infection on death, Hb, WBC count, and liver function tests in patients admitted to Mofid Children Hospital PICU from September 2015 to September 2016. 66 children admitted to Mofid Children Hospital PICU were selected. Data on age, sex, underlying disease, anti-parvovirus IgG and IgM antibody, death, Hb, WBC count, AST, and ALT were gathered by questionnaire and data analysis was performed by the SPSS 21. Age range of children was 1-156 [Mean: 36.5(±41.3 SD)] months. Underlying diseases were gastrointestinal disease (13 cases), respiratory tract illnesses (14 cases), urinary tract diseases (6 cases), nervous system diseases (3 cases), hematological and oncological diseases (7 cases) and other diseases (3 cases). Quantitative results on IgG and IgM were analyzed. IgG and IgM were not significantly associated with Hb and WBC count. ALT over 12.5 IU was more significant in IgM positive cases and AST over 67 IU in IgG positive cases. IgM positivity was significantly associated with death (p<0.05). Parvovirus serologic antibody can be an important measure in PICU patients because it can be associated with anemia, neutropenia, and LFT tests.

According to increasing rate of using assisted reproductive technology (ART) which result in higher rates of multiple birth and natal difculties, we aimed to determine the prevalence rate of multiple birth pregnancies.
A descriptive cross?sectional study evaluating birth fles in 2009–2010 of main hospitals of Isfahan, Iran.
Among 31640 fles’ studies, 614 cases of multiple birth pregnancies were investigated. Te product of these pregnancies were 1286 (50.2% females) infants including 557 twins (17.6/1000), 56 triplets (1.8/1000), and one case of quadruple (0.03/1000). Infants weigh Te prevalence of multiple birth pregnancies is growing. Te need for more mother and child care is important.

Deep vein thrombosis (DVT) is a relatively prevalent disease which causes high costs due to the required diagnostic tests, specialized treatments, and hospital admission. In recent decades, implementation of thromboprophylaxis protocols has significantly reduced the incidence of thromboembolism in hospitals. The present study aimed to compare the incidence of venous thromboembolism before and after implementation of the mentioned protocol in hospital with identified risk factors and underlying diseases. In this case-control group, 385 patients at the risk of DVT, some before and some after implementation of the protocol, were studied. Therefore, the level of thromboprophylaxis and the incidence of venous thromboembolism were compared before and after the protocol. Data was entered into SPSS15 and analyzed by chi-square and t tests. Out of 385 patients, 34 patients (8.8%) had venous thromboembolism while 351 (91.2%) were not affected. The incidence of venous thromboembolism was significantly different before and after the implementation of the protocol (17.7% vs. 5.9%; P < 0.001). The incidence of venous thromboembolism in patients not receiving thromboprophylaxis was almost 5 times higher than those who received it (20.7% vs. 5.1%). The frequency distribution of thromboembolism had a significant difference in the two above mentioned groups (P < 0.001). Thromboprophylaxis protocol reduced venous thromboembolism incidence in patients with underlying diseases which increase the risk of the complication.