فهرست مطالب hossein akhavan

 To systematically review the recent alternative medical interventions on renal colic pain and compare their efficiency with conventional treatments.

 This was a systematic review and network meta-analysis (NMA) study, based on the PRISMA guidelines on online databases of PubMed, Scopus, and web of science. We quarried these databases with relevant keywords for clinical trial studies that aimed at reducing renal colic pain in patients refereeing to the ED from after January 2011 to February 2022. Randomized clinical trials that used the Visual Analogue Scale (VAS) for assessment of renal colic pain before and after medical interventions in adult patients were included in this study. NMA was conducted based on the continuous values of the mean difference of the pain after 30 and 60 minutes of the medication administration.

 Twenty-four studies that were meeting the inclusion criteria were included in our review with 2724 adult participants who were mostly male. Study arms included conventional medications (NSAID, Opioid, paracetamol), ketamine, MgSo4, desmopressin, and lidocaine. Based on the qualitative synthesis, ten studies (41.7%) did not find significant differences between conventional and alternative treatments. Also, there is no agreement on some more recent medications like using ketamine or desmopressin while MgSO4 and lidocaine use are supported by most studies. NMA revealed that desmopressin is significantly having worse pain reduction properties. NMA did not show any difference between ketamine, lidocaine, and MgSo4, versus the conventional treatment.

 To conclude, lidocaine and MgSo4 might be good alternative treatments for renal colic when conventional treatments are contraindicated or pain is not responding to those. Ketamine might be indicated in patient-based circumstances. Desmopressin may be agreeably avoided in further research or clinics.

Lidocaine is one of the medications that is proposed as an alternative in acute pain management. Lidocaine is routinely used in topical and dental anesthesia and is known for its analgesic effects. But various evidences are proposing an intravenous administration of lidocaine for pain management; while in acute limb pain, its safety, and efficacy are not reviewed yet. In this review study, PubMed, Medline, Scopus, and EMBASE were quarried for studies on an acute traumatic limb injury pain treated with intravenous lidocaine. Critical Appraisal Skills Program and GRADEpro tools were used to critically evaluate the collected literature based on the evidence-based approach. Recommendations were synthesized based on the highest levels of evidence.  Eleven studies were included in the review. While some studies were showing effective analgesic properties of intravenous lidocaine for pain relief in extremities when compared with conventional opioids, the ‎high rate of Adverse Events (AEs) reported in some studies and the need for a close observation of patients for major side effects restrict clinical application of the systemic lidocaine. ‎ Blood lidocaine level studies are required but are missing in the literature. ‎Post-operative outcomes of limb trauma patients who receive lidocaine are not clear. The AEs’ monitoring is not followed during the hospitalization or after discharge. Systematic review and meta-analyses on the topic are heterogeneous due to different indications of intravenous lidocaine administration.  Our systematic review of literature could draw the conclusion of cautions on high dose intravenous lidocaine administration due to potential side effects and unclear outcomes.

Children who have undergone cardiac surgeries due to congenital heart disease are prone to various kinds of infections.

This study was done to investigate the prevalence of nosocomial infections and microbiology of post-cardiac surgery infections in pediatric patients with congenital heart disease (CHD).

In this cross-sectional study, the epidemiology and microbiology of post-cardiac surgery for pediatric patients with CHD at Imam Reza Hospital of Mashhad University of Medical Sciences between 2014 and 2017 were investigated. Demographic and clinical information was recorded, and the findings were analyzed using SPSS 16.

Out of 1128 patients with open heart surgery during the four years of the study, 135 patients, including 80 males (60.1%) and 55 females (39.9%) with a mean age of 8.06 ± 3.86 months, were enrolled in the study. The prevalence of infection was 11.96%. The most common isolated bacteria were Acinetobacter (19/135, 14.1%), Pseudomonas spp. (13/135, 9.6%), and Enterobacter (13/135, 9.6%) as Gram-negative ones and Corynebacterium diphtheria (10/135, 7.4%) and Staphylococcus epidermidis (10/135, 7.4%) as Gram-positive types. Candida albicans (14/135, 10.4%) were also the most frequent fungi. The frequency of infection-causing masses did not differ significantly between different cardiac abnormalities (P = 0.831), sex (P = 0.621), age (P = 0.571), and weight (P = 0.786) groups. Also, the duration of hospitalization, intubation, bypass time, and urinary catheterization in positive culture cases were significantly longer than in negative cases.

In our study, the most common infections in children who underwent heart surgery were Acinetobacter, C. albicans, Pseudomonas, and Enterobacter. It is suggested to reduce the hospitalization, intubation, bypass, and urinary catheterization time to reduce nosocomial infections in these patients and decrease treatment costs.

The interaction between premature infants and the ectopic environment requires special care due to developmental defects in various systems of their body. In this regard, the results of various studies have introduced the stimulation of premature infants with the smell of breast milk as an effective way to improve the physiological responses caused by prematurity and reduce the problems associated with prematurity. The aim of this study was to systematically review the intervention studies of aromatherapy with breast milk on improving behavioral and physiological responses and reducing prematurity problems in premature infants. A comprehensive search of related scientific studies, published until February 2020, was conducted in scientific databases of PubMed, ISI, Web of Science, Cochrane Library,  and  Scopus using the following keywords: Breast Milk, Maternal Milk odor, Mother's Milk, Mother's odor, Premature Birth, Olfactive stimulation, Pain, Aromatherapy, Apnea, Preterm infant, Preterm infant pain, Infant behavior, Infant physiological response. After applying the entry and exit criteria, 14 Articles were selected. The results revealed a decrease in transition feeding days in premature infants of the intervention group in exposure to an impregnated pad with breast milk as olfactory stimulation, when compared to the control group. Based on the results, longer sucking bouts, more bursts (>7 sucking movements) and more consumed milk were reported for the intervention group during each breastfeeding session, when compared to the control group. The frequency of sucking in response to fresh breast milk was also higher than frozen breast milk, but not statistically significant (p = 0.09). There was an elevation in the high-amplitude non-nutritive sucking frequency among the preterm infants within the last three days of 14-day study after presenting the odor of the maternal breast milk for a 60-second period. Beneficial effects occurred in the hospitalized infants due to the odor of mother; they included increasing mouth movements and pacifier acceptance, calming stressed or crying infants, and relieving their pain. The infant's ability to feed increases and the duration of the first lactation decreases due to the olfactory stimulation of the breast milk odor; and the number of sucks (260.4 [95% CI = 206-315]) and suck bursts (41.0 [95% CI = 36-46]) was unexpectedly observed in group 1 (breast milk odor), as compared to group 2 (144.8 [95% CI = 87-203] versus 27.4 [95% CI = 21-34]) This study showed that the use of aromatherapy with the mom’s milk is very effective in improving the behavioral and physiological response; and reduces the problems resulting from prematurity in premature babies. Therefore, the smell of breast milk can be used as a complementary method to accelerate the health promotion of premature infants.

Skin and soft tissue infections are important causes of outpatient visits to medical clinics or hos-pitals. This study aimed to review the literature for the accuracy of Clinical Resource Efficiency Support Team(CREST) guideline in management of cellulitis in emergency department.

Studies that had evaluatedcellulitis patients using the CREST guideline were quarried in Scopus, Web of Science, and PubMed database,from 2005 to the end of 2020. The quality of the studies was evaluated using Scottish Intercollegiate GuidelineNetwork (SIGN) checklist for cohort studies. Pooled area under the receiver operating characteristic curve (AU-ROC) of CREST guideline regarding the rate of hospital stay more than 24 hours, rate of revisit, and appropriate-ness of antimicrobial treatment in management of cellulitis in emergency department was evaluated.

Seven studies evaluating a total of 1640 adult cellulitis patients were finally entered to the study. In evaluation ofthe rate of the appropriate treatment versus over-treatment, the pooled AUROC was estimated to be 0.38 (95%confidence interval (CI): 0.06 – 0.82), indicating low accuracy (AUROC lower than 0.5) of guideline for antimicro-bial choice. CREST II patients had a significantly lower odds ratio (OR) of revisiting the Emergency Department,OR=0.21 (95% CI: 0.009 – 0.47). Pooled AUROC value of 0.86 (CI95%: 0.84 – 0.89) showed accuracy of the CRESTclassification in prediction of being hospitalized more or less than 24 hours.

CREST classificationshows good accuracy in determining the duration of hospitalization or observation in ED but it could lead toinevitable over/under treatment with empirical antimicrobial agents.

Accidents are one of the most important causes of child mortality in the world and in Iran. Epidemiological studies play an effective role in preventing and controlling pediatric accidents by identifying the causes of accidents and environmental factors affecting the occurrence of accidents. Therefore, this study was conducted to investigate the epidemiology of accidents in Iranian children as a systematic review study.

The present study is a systematic review. Studies published in Persian on the epidemiology of accidents and incidents in Iranian children in Persian journals were searched with the keywords "accidents", "accidents", "children" and examined using the Prisma checklist. Review of studies from 2000 to 2020 was searched in Google scholar databases, Sid, Magiran.

In the present study, 531 studies were selected to review the title and abstract. The studies started in 2000 in Tehran and the last article is related to the year 2020 in Mazandaran. After deleting low quality studies based on study quality review criteria and deleting studies that had shortcomings in data reporting, 17 studies entered our quantitative synthesis. Out of 17 articles, 2 studies were in Tehran province, 2 studies in Fars and one study in Ahvaz, Mazandaran, Yazd, Qazvin, Birjand, Hamedan, Tuyserkan, Fasa, Kerman, Aligudarz, Mashhad, Rafsanjan, Yasuj. Among the studied studies, the highest prevalence of gender was related to boys with 14 studies. The highest age group is related to children under 5 years with 10 studies. The highest prevalence of accidents in children was in summer with 6 studies. The highest frequency in terms of the cause of the accident is related to trauma with 5 studies. The highest incidence of accidents is related to home with 7 studies. The highest area of ​​damage is related to urban areas with 10 studies.

The results of the present study showed that the highest prevalence of accidents in children in summer and the highest frequency in terms of the cause of the accident is related to trauma and the highest location of the accident is related to home. Therefore, training should be appropriate for each age group and the events that are most involved; and should be given more attention in control and prevention planning. Planning to promote parental culture in this area can also be effective.

Poisoning is one of the most common causes of visits to hospital emergency departments in many countries. Considering the prevalence of poisoning in Iran, this study aims to investigate the epidemiology of child poisoning in Iran as a systematic review study.

The present study is a systematic review. Studies published in Persian on the epidemiology of child poisoning were searched using Persian keywords translating to "poisoning", "children", and "poisoning in children" and examined using the Prisma checklist. Searches were performed in Google scholar, Sid, and Magiran databases to find studies published in the period from 2001 to 2020.

After searching, screening, and qualitatively evaluating the studies during the systematic review, in the end, syntheses were performed on 21 articles. In terms of gender, in 20 studies, poisoning had a higher prevalence among boys and in one study the prevalence was higher in girls. The highest prevalence of poisoning was observed among children under 3 years of age. Also, in terms of the prevalence of poisoning in various seasons, one study reported the highest prevalence in spring, 6 studies in summer, and 2 studies in autumn. The toxic agent was reported to be medication in 10 studies, opium in 8 studies, and hydrocarbons (oil) in 3 studies. The most common cause of poisoning was accidental in 17 studies and intentional in one study.

The results of this study showed that medication poisoning is the most common cause of poisoning in Iran and has increased in recent years. Considering the fact that most of the poisonings in the studies were accidental, it is necessary to inform parents about the proper storage of medications and also paying attention to the labels of medications.

Living without sufficient amount of physical activity is known as a contributing factor to countless diseases. This research study aimed to determine the relationships between the constructs of the theory of planned behavior and female students’ physical activity with a path analysis approach.

The present research is a descriptive-analytic study conducted through cross-sectional data collection procedure. 185 female students were selected via multi-phase random sampling in elementary schools in Mashhad, Iran, from February to November 2018. Path analysis was performed by AMOOS version 22.0 and SmartPLS 2.0 to test the causal relationship among physical activityand constructs of the theory of planned behavior.

The age range of female students was between 10 and 13, with mean and standard deviation of 11.51 ±0.76, respectively. The results showed that the constructs of attitude (r=0.177, p=0.018), and perceived behavioral control (r=0.234, p=0.001) had a direct and significant relationship with physical activity intention. However, the direct relationship between the constructs of subjective norms and physical activity intention was not significant (P>0.05). Also the direct relationship between the constructs of physical activity intention and physical activity behavior was not significant (P>0.05).

Based on the results, the constructs of attitude, and perceived behavioral control had a direct and significant relationship with physical activity intention in female students.

A double-blind, placebo-controlled randomized trial was designed to investigate the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on the prognosis of preterm infants with early onset neonatal sepsis (EONS). Fifty preterm infants were selected from the neonatal intensive care unit (NICU) of Qaem Hospital, Mashhad, Iran in 2011. They were randomized to rhG-CSF (intervention group, n = 25) or identical placebo (control group, n = 25) for 3 days. The following blood parameters were measured: White blood cells count (WBC), absolute neutrophil count (ANC), serum level of high-sensitivity C-reactive protein (hs-CRP), and the ratio of immature to total neutrophils. In addition, the mortality rate, adverse effects, and duration of hospital stay were evaluated as clinical parameters. At baseline, both groups were not significantly different (P > 0.05) except for the hs-CRP level (P = 0.024) and hypoglycemia (P = 0.001). Compared with the controls, significant improvements were only observed in WBC (P = 0.001) and ANC (P = 0.010) of the intervention group. The mean difference in the WBC, ANC, hs-CRP level, and the ratio of immature to total neutrophils between the baseline and 3-day post-treatment values was higher in the controls than the intervention group. More than 90% of the patients exposed to either rhG-CSF or placebo hospitalized for over 72 hours and no significant difference was found between them (P = 0.946). In each group, a decease was recorded (4.0%) during the hospitalization. The rhG-CSF administration could effectively improve WBC and ANC. No significant changes were observed in mortality rate, adverse effects, and hospital stay after the treatment.

Failure to thrive (FTT) is a common underlying condition in patients with Congenital diaphragmatic hernia (CDH). The aim of current study was to evaluate nutritional status and growth pattern in CDH patients. In current study, we investigated a total of 146 CDH patients who had undergone surgery in Dr. Sheikh Hospital, Mashhad, Iran between April 2006 to November 2013. Due to inaccessibility or lack of cooperation by some parents, 61 cases completed the study. Demographic and anthropometric data along with postoperative complications were taken into consideration. Among the 61 studied cases, 32.7% had died during the initial 6-months after surgery. The mean age of participants was 24.21 ± 30.26 months. According to Z-score classification of weight for height following surgery, 7.3% had severe malnutrition, 4.8% moderate malnutrition and 24.3% mild malnutrition while 51.2% were normal. While current evaluation indicates that the majority of subjects were in the normal range. Most children with congenital diaphragmatic hernia had a normal growth following surgery; however, few cases experienced a reduced growth rate in the early years of their life. Highlighting the need for additional calories to prevent FTT and other complications are recommended.

BackgroundUrinary tract infection (UTI) is one of the most common bacterial infections in children, if not diagnosed leads to serious complications such as hypertension, chronic renal failure and renal scar. Constipation is one of the main risk factors for recurrent UTI. The aim of present study was to investigate the relationship between chronic constipation and urinary tract infection in children.
Materials and MethodsIn this case-control study 105 patients with functional chronic constipation as case group, compared with 104 children without chronic constipation as control. The control group was matched according to gender and age. The prevalence of UTI in children with and without constipation as well as their improvement was compared after treatment.
ResultsThe prevalence of UTI in case and control groups was 13.3% and 6.7%, respectively (P=0.17). The prevalence of UTI in case group decreased to 3.8% after treatment of constipation. Escherichia coli (E coli) was the most commonly isolated organism in both groups.
ConclusionResults of present study showed that despite of no significant urinary tract infection incidence between children with constipation and those without constipation, the constipation should still be considered as a predisposing risk factor for the UTI occurrence.

Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, which are known as the meninges. This infection may be caused by Streptococcus pneumonia bacteria. In this study, we presented the case of a female newborn with meningitis secondary to Streptococcus pneumonia. Her birth weight and height were normal. After 24 hours of birth, the neonate was diagnosed with tachypnea, without presenting any signs of fever or respiratory distress. The newborn was referred to Sheikh Children's Hospital, where chest X-ray showed clear lungs with no evidence of abnormality. Furthermore, the cardiothoracic ratio was normal. A complete blood count demonstrated white blood cell (WBC) count of 5400/uL. In Blood/Culcture ratio (B/C) test, Streptococcus pneumonia was reported, and the results of the cerebrospinal fluid (CSF) analysis confirmed this result. Following 14 days of receiving antibiotic therapy, the results of CSF analysis were within the normal range. Her visual and hearing examinations were normal, and demonstrated improved situation. The infant was discharged with exclusive breastfeeding.