فهرست مطالب leila moslemi

Bisphenol A (BPA) is known as an endocrine disruptor that has harmful effects on general health. It iscommonly used in various industrial products. In this study we tried to evaluate the amount of BPA in urine samplesof the men referred to an infertility center.

The cross-sectional study population consisted of male partners of infertile couples, who werereferred to infertility clinic in Mazandaran, a northern state of Iran. Questionnaires included demographic characteristics,medical history, lifestyle factors, physical examinations. A semen sample and a spot urine sample were taken from eachparticipant. In the initial study group of 240 men, 3 groups were excluded, and 122 men remained for the analysis. Highperformanceliquid chromatography (HPLC) was applied to measure the amount of BPA in the urine samples.

BPA was not detected in about half of the samples (53.3%). Multiple linear regression analysis showed thatno significant relationship existed between the urine concentrations of BPA, semen parameters and male reproductivehormones. However, in a comparison with semen parameters in people with detectable urine BPA versus nondetectableones, an inverse association was noticed with sperm concentration. In other parameters, differences were notsignificant. Smoking had no effects on sperm parameters, but body mass index (BMI) ≥25 reduced the percentage ofnormal sperm parameters.

In most participants, urinary BPA was not detected. Probably in this study low environmental exposure toBPA is the cause of lower urine BPA concentrations compared to other industrially developed countries. Therefore, nooverall relationship was observed between BPA level and male infertility.

Gastroduodenal perforation (GDP) is a rare cause of acute abdominal pain in children.

A 12-year-old boy presented with abdominal pain around the periumbilical and epigastric region on 7previous days. His familial history was significant for sickle cell anemia in the mother and minor thalassemia in the father. He had been diagnosed with sickle cell anemia at the age of 4 years and had received blood transfusion and hydroxyurea every month. At physical examination, a distended abdomen and decreased intestinal sounds were seen. Also, he had a history of cholecystectomy (for cholelithiasis). Fecal occult blood was detected, while no Helicobacter pylori antigen was present. Abdominal ultrasound examination revealed splenomegaly and evidence of free fluid. Surgical results showed bile discharge in the abdominal cavity, and perforation of duodenum and pylorus.

Since the symptoms of GDP in children are non-specific, especially in children with sickle cell anemia, it should be considered in these patients with abdominal pain.

 One of the most common functional problems in children is functional abdominal pain (FAP), and dysmotility is one of the possible causes of FAP. Domperidone is a prokinetic drug that increases gastrointestinal motility.

 The aim of this study was to evaluate the effect of domperidone on the treatment of FAP in children.

 In this double-blind clinical trial study, FAP was diagnosed in 80 children aged 5 - 14 years, who were referred to Amirkola Children's Hospital in Babol for one year based on the criteria of the Rome IV. Then, they were randomly divided into two groups of 40 patients. Group A received domperidone tablets (0.25 mg/kg, three-time/day) for two months, and group B received a placebo. The primary outcome was at least a 50% reduction in both frequency and severity of pain, and the secondary outcome was a significant reduction in the duration, frequency, and intensity of pain according to the Wong-Baker scale compared to baseline.

 A total of 80 children completed the trial (40 with domperidone). The recovery rate was higher in the domperidone group than in the placebo group after eight weeks (71.8% vs. 28.2%; P < 0.0001), and domperidone had significant superiority over the placebo in reducing the duration (4.58 ± 7.71 vs. 24.5 ± 41.45, min/day, P < 0.001), frequency (3.35 ± 3.99 vs. 10.63 ± 10.55, episode/week, P < 0.001), and intensity (2.20 ± 2.16 vs. 5.05 ± 2.37, P < 0.001) of the pain.

 Based on the results, domperidone can be useful in the treatment of FAP in children.

Sleep disorder is complex comorbidity in children with attention-deficit/hyperactivity disorder (ADHD), and there is generally a reciprocal effect between them. Considering its adverse consequences on children and their families, the aim of this study was to investigate the frequency of sleep disorders in children with ADHD and the relationship between the sleep problems and mental health of their parents.

In this cross-sectional study, 100 ADHD children aged 4-12 years were selected using simple and available sampling method among all children referred to the Pediatric Psychiatric Clinic of Yahyanejad Hospital during 2020.  The data were collected using a demographic questionnaire, Children’s Sleep Habits Questionnaire (CSHQ) for children and Depression Anxiety Stress Scale-21(DASS-21) for both parents completed by the same researcher through interview method. A value of p<0.05 was statistically considered significant.

One hundred 4-12-year-old children with a mean age of 7.72±2.31 years participated in this study. The mean CSHQ for ADHD children was 54.07±6.29. The most common sleep disorders were bedtime resistance (92%), sleep duration (69%) and sleep anxiety (64%). There was relationship between CSHQ score with depression (R=0.31, P=0.002), anxiety (R=0.26, P=0.008) and stress (R=0.23, P=0.02) in mothers.

Bedtime resistance was the most common complaint of ADHD children. Moreover, sleep problems in children were related to depression, stress and anxiety in their mothers.

To the best of our knowledge, limited studies explored gastrointestinal (GI) symptoms and hepatopancreatic involvement in children with coronavirus disease 2019 (COVID- 19) infection. 

This review study aimed to evaluate the GI symptoms and abnormal liver and pancreas function in children with COVID-19 infection.

In this review study, databases of Scopus, PubMed, Google Scholar, and Web of Science were searched using the relevant keywords of “COVID-19,” “children,” “gastrointestinal,” “liver,” and “pancreas.” Descriptive and cross-sectional studies were reviewed in the current study, with the main focus on GI symptoms and elevated liver enzymes in children with COVID-19 infection. 

Overall, 27 studies from countries of Iran, Spain, Turkey, Italy, and the United States were selected. Although the prevalence of GI symptoms varied in different studies, our review showed that most children with COVID-19 infection experienced GI symptoms. In addition to GI symptoms, there is the possibility of elevated liver enzymes, such as alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine phosphokinase in children with COVID-19 infection. 

COVID-19 infection may present various GI, hepatic, and pancreatic manifestations in children. The difference in the prevalence of these symptoms can probably be attributed to the geographical region of the study and the history of the disease.

Congenital hypothyroidism (CH) is one of the most common endocrine diseases and one of the major causes of mental retardation in children. So we aimed to evaluate the developmental outcome of children with CH.

This case-control study was performed on two 3-6-year-old groups of 100 patients. The case group was children with CH, referred to Endocrine Clinic of Amirkola Children's Hospital (2011-2017) and the control group was healthy children and normal from other states. The Denver developmental screening test-II (DDST_II) was used to assess the developmental factors and disorders in four areas of gross motor, fine motor, personalsocial and language. Data were analyzed by SPSS 21 using descriptive statistics, t-test and chi-square, and a p<0.05 was considered significant.

The mean age of 200 children in the case and control groups was 54.62±15.72 and 59.68±15.64 months, respectively. In the case group, 45% and 55% of them had transient and permanent CH, respectively. All four criteria of DDST_II in the control group as well as gross motor in the case group were normal, but fine motor, personal-social and language were reported normal in 94, 95 and 93% of the case group, respectively. All subjects with abnormal DDST_II, had a negative neonatal screening tests.

The results obtained from DDST_II indicated that 6% of children with CH had an abnormal development, all who had an onset of medical treatment over 30 days, which makes it important to screen the neonatal thyroid disease and diagnose this disease timely

Cyclic Vomiting Syndrome (CVS) is an idiopathic disorder, identified by recurrent stereotypic episodes of severe nausea and vomiting and intervals of normal health between episodes. There is no specific diagnostic test for CVS, and clinical features are relied on for diagnosis. Many medications have been used to treat CVS, such as antiemetic, anti-migraine, and sedative medications. Nevertheless, treatment is difficult in some resistant cases.

We report a child with frequent and intensive vomiting episodes after an asymptomatic 2-year period. The patient was unresponsive to many medications but was successfully treated with chlorpromazine and then controlled using olanzapine, followed by aripiprazole. We also performed a brief literature review related to this case report in international databases.

Since CVS management has remained challenging to the clinician in the severe and resistant patients, the empiric treatment of CVS is recommended.

Cow’s milk intolerance can lead to chronic constipation in children. The present study seeks to determine the effect of cow’s milk-free diet (CMFD) on chronic constipation in children who are not responding to laxatives.

Seventy children suffering from chronic constipation (described as the Rome III criteria) were enrolled in an open-label randomized clinical study. Each group included 35 children aged 4-14 years treated with laxatives for at least three months with no improvements. The intervention group received CMFD plus calcium supplements for four weeks and the control group did not have any restrictions in consuming cow’s milk and dairy products. Also, both groups received polyethylene glycol (PEG; 1 gr/kg/day) and high-fiber foods (at least 10 gr/day) for four weeks. Responsiveness was described as a reduction in symptoms and signs according to the Rome III criteria after four weeks.

After four weeks, 25 (71.4%) children in the CMFD group responded to the treatment compared to four (11.4%) children in the control group (P<0.001). Significant differences were found between the CMFD and control groups in terms of the seven Rome III criteria post-intervention; history of large stools (25% vs. 53.6%), large fecal mass in the rectum during examination (17.1% vs. 50%), history of painful defecation (18.2% vs. 55.6%), history of retentive posturing (10% vs. 46%), ≥1 episode/week of incontinence (25 % vs. 50%, P=0.001), ≤ 2 defecations/week (17.4% vs. 52.3%) and history of thick stool with toilet obstruction (22.2% vs. 52.3%)

This study showed that children with functional constipation with no response to laxatives could benefit from a cow’s milk-free and dairy-free diet.

Background:

Acute diarrhea is a major cause of mortality in children. Few studies have addressed the administration of lactose‑restricted diets in breastfed children with acute diarrhea. The present study was conducted to investigate the effects of a lactose‑restricted regimen on breastfed children with acute diarrhea treated with zinc supplements.

Methods:

The present single‑blind randomized clinical trial was conducted on children aged 6‑24 months in Amirkola Children’s Hospital (2015‑2017). 90 children were randomly assigned to two groups. Group A was daily treated with 20 mg of zinc and a lactose‑restricted diet and breast milk for two weeks.Group B  received 20 mg of zinc and breast milk and an age‑appropriate diet for two weeks. The data collected in all the subjects included the frequency of diarrhea and the mean duration of hospitalization and recovery from diarrhea.

Results:

The two groups were not significantly different in terms of mean age, weight and ratio of males to females. The mean duration of hospitalizationwas found to be 3.1 ± 0.8 days in group A and 3.2 ± 0.6 in group B (P = 0.3), the mean duration of recovery to be 2.9 ± 0.8 in group A and 2.6 ± 1.1 in group B (P = 0.2) and the mean frequency of diarrhea 2.9 ± 0.7 in group A and 2.8 ± 0.8 days in group B (P = 0.5), suggesting no significant differences between the two groups. No adverse effects associated with zinc therapy were reported.

Conclusions:

A lactose‑restricted regimen was found not to be beneficial for children with acute diarrhea under continuous breastfeeding and zinc therapy.

Eosinophilic gastroenteritis (EG) is a rare inflammatory disorder affecting both children and adults. The exact etiology of the disease is not clear. A child presented with episodic generalized abdominal pain since a year ago without fever at first. After endoscopic and colonoscopic examinations, histopathological examination showed an increased number of eosinophils and diagnosis of EG was made. After elimination of dairy products from his regimen, abdominal pain attacks was reduced, but he got a fever. Familial Mediterranean Fever (FMF) diagnosis was made by genetic evaluation which showed MEV gene mutation. Symptoms were resolved with the treatment of colchicine which confirmed FMF diagnosis.

Rickets is failure in mineralization of growing bone and cartilage due to extreme vitamin D deficiency (VDD). The study aimed to identify rickets among vitamin D deficient children and determine any relationship between clinical findings and paraclinical evidence. This study was conducted in two stages. In the first stage, blood was drawn from 406 children aged 30–72 months for measurement of 25(OH)D level. Of these children, 108 had 25(OH)D levels of <20 ng/dL and were evaluated physically for signs and symptoms scores (0-1) of VDD and rickets. Biochemical analysis and radiography of the child’s left wrist and hand was performed. Of the 119 children (29.67%) with 25(OH)D levels of <20 ng/dL, 42 (10.3%) had vitamin D levels of ≤15 ng/dL. There was no correlation between serum 25(OH)D level and levels of calcium (Ca) (r = −0.16), alkaline phosphatase (ALP) (r = −0.12), P (r = 0.13), and parathyroid hormone (PTH) (r = −0.15,) in children with VDD. The mean of signs and symptoms scores had no significant difference between children with (1.59 ± 0.8) and without (1.73 ± 1.01) VDD (P = 0.3). None of the children with VDD had radiographic evidence of rickets. Radiographic data showed that 69.2% (72), 10.6% (11), and 20.2% (21) of the children had delayed, normal, and advanced bone age, respectively. Abnormal radiological findings of rickets were not found on wrist X-rays. Thus, this investigation is not necessary within the range of vitamin D levels described in the current study.

Type 1 diabetes mellitus (T1DM) as an autoimmune disorder is associated with other autoimmune diseases such as autoimmune thyroid (AIT) disease. The aim of this study was to determine the prevalence of AIT in children who were referred to Amirkola Endocrine Clinic (north of Iran).
This cross-sectional study was carried out on 100 diabetic children aged 1-15 years during 2008-2013, who were referred to the pediatric endocrine clinic. Serum levels of anti-thyroid peroxidase (Anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies and Thyrotropin Stimulating Hormone (TSH) were measured by Immune Chemiluminescence assay, and demographic information was obtained from patientsmedical records. The collected data were analyzed using SPSS 18.
AIT was found in 13% of patients (8% female and 5% male). Significant levels were found for Anti-TPO (3%), anti-Tg (2%), and both antibodies (8%) in patients with AIT. Thyroid dysfunction was observed in 8 of 13 patients with AIT versus 2 of 87 patients without AIT (P Because the majority of diabetic children with significant titers of antibodies developed thyroid disease, so thyroid function tests are necessary to reduce the risk of undiagnosed hypothyroidism in these patients.

This study aimed to determine effects of synbiotics on treatment of functional constipation in children aged 2-10 years old.
This randomized single blind clinical trial study carried out on children who had functional constipation based on the Rome III criteria. The polyethylene glycol synbiotic group (P group, n=38)received the synbiotic with polyethylene glycol 0.6 gr/kg daily for 4 weeksfollowed bytonly polyethylene glycol for the following four weeks. The polyethylene glycol group (P group n=41) received polyethylene glycol for eight weeks. Then 8 after treatment, frequency of defecation, stool consistency, pain during defecation, fecal constipation and the percentage of patients who needed to continue their drug after 12 weeks treatment were compared between two groups.
The differences in the mean frequencies of defecation (P=0.36), stool consistency (P>0.05), pain during defecation (P>0.05), incontinence (P>0.05) between the two groups at the end of eight weeks were not significant (P>0.05). The end of 12 weeks, 27.8% of (P S) group and 15.6% of (P) group needed to continue medication more than one time /week (P>0.05).
In this study,adding synbiotic to polyethylene was not more effective than only polyethylene in the treatment of childhood functional constipation.

Intussusception represents as the invagination of a part of the intestine into itself and is the most common cause of intestinal obstruction in infants and children between 6 months to 3-years-old.
The objective of this study was to determine the recurrence rate and predisposing factors of recurrent intussusception.
Patients and The medical records of children aged less than 13-years-old with confirmed intussusception who underwent reduction at a tertiary academic care in northern Iran (Mazandran), from 2001 to 2013 were reviewed. Data were extracted and recurrence rate was determined. The two groups were compared by chi square, Fisher, Mann-Whitney and t-test. Diagnosed cases of intussusception consisted of 237 children.
Average age of the patients was 19.57 ± 19.43 months with a peak of 3 to 30 months. Male to female ratio was 1.65 and this increased by aging. Recurrence rate was 16% (38 cases). 87 (36.7%) underwent surgery. These were mainly children under one year old. In 71% (40) of episodes recurrence occurred 1 to 7 times within 6 months. The recurrence occurred in 29 (23.5%) children in whom a first reduction was achieved with barium enema (BE) and 5 (5.7%) children who had an operative reduction (P The recurrence of intussusception was related to the method of treatment in the first episode and it was 5-fold higher in children with BE than in operative reduction. Recurrent intussusceptions were not associated with PLPs, they were more idiopathic.

Epidemiology of hepatitis A virus (HAV) is changing over time. Giving awareness of this issue can be developed as a plan to prevent complications of the disease; it is especially very helpful in high risk children, such as those with chronic liver disease. The current study aimed to investigate the seroprevalenceof anti-HAV antibodies in children with and without chronic liver diseases during two different periods.Patients and Two studies were conducted on anti-HAV seroprevalence antibodies in children aged one to fifteen years who were referred to Amirkola Children’s Hospital (Babol, North of Iran). The first study was conducted on 73 patients with chronic liver disease (CLD) in 2006, and the second study on 180 cases without it (NCLD) in 2011. Blood samples were collected from children and the sera were evaluated for anti-HAV antibodies via ELISA assay by Dia. Pro kit. Seroprevalence of HAV was 17.8% and 10% in the first and second study, respectively. There was no significant difference in age, sex, and place of residence between anti-HAV negative and positive subjects in the studies. It appears that anti-HAV antibody seroprevalence has declined among children below 15 years with and without chronic liver disease, and it is likely that more children would be susceptible to HAV infection. Therefore, it is important to employ preventative strategies against HAV in chronic liver diseases.

Labor pain is an important factor in increasing mother anxiety. The objective of this study was to assess the efficacy of transcutaneous electrical nerve stimulation (TENS) on specific acupuncture points for reducing labor pain in the first stage of labor. In this double-blind clinical trial study, 64 nulliparous healthy women who were selected based on inclusion criteria and were in their active phase of labor’s first stage, were randomly divided into 2 equal groups; according to their admittance file numbers and by lottery, the odd numbered patients were assigned to the TENS group and the even numbered to the control group. In either groups two electrodes were put on the Hegu points of both hands and two electrodes were put on the Sanyinjiao points of both feet, after cervix was dilated 4 cm. Pain scores (through visual analogue scale) were studied in both groups. Finally, the collected data were analyzed by independent t-test. The pain intensity was significantly decreased in the TENS group compared to the control group (p=0.001). Duration of the labor’s first stage in the TENS group (180 min) was significantly shorter than control group (238 min) (p=0.001). The number of labor induction with oxytocin were 16 in the TENS group (50%) and 25 in the control group (78.1%) (p=0.019). Application of TENS on acupuncture points can be used as a non-medicinal and without complication method for mother and fetus to reduce pain in the first stage of labor.

Comparing the effect of topical human milk application and dry cord care on cord separation time. This research was a randomized clinical trial study on 130 singleton and mature newborns. Newborns were placed randomly in groups of topical application of human milk and dry cord care. The umbilical separation time was compared in the two groups. Data was analyzed by SPSS software. Independent Samples t-Test, χ2, Fisher were used in this study. Median time of cord separation in human milk application group (150.95±28.68 hours) was significantly shorter than dry cord care group (180.93±37.42 hours) (P<0.001). Topical application of human milk on the remaining part of the cord reduces the cord separation time and it can be used as an easy, cheap and non invasive way for cord care.

Background and primary dysmenorrhea is described as pelvic pain around the time menstrual bleeding in the absence of an identifiable pathologic lesion. It is a common gynecologic problem among women in reproductive age groups. Our objective was to compare the effect of vitamin E and Fennel extract on intensity of primary dysmenorrhea A randomized single blind, Placebo-controlled trial among 65 single female students who suffered from primary dysmenorrhea that divided into 3 groups: Fennel extract, vitamin E and placebo. Groups used treatment four times a day from the onset of bleeding and continued through three days for two consecutive menstrual periods. In the Fenalgin group, pain severity was lower in compare to before treatment (P<0.000) and vitamin E group either cycle (P<0.02). Comparison 3 groups showed that there was significant difference in pain severity in second cycle and reduction was greater in Fenalgin group (P<0.019). Painkiller using was lower in compare to before treatment in Fenalgin and vitamin E vitamin E groups but reduction in both drugs was not significant in compare to placebo. Fenalgin, which has few side effects, can be taken for treatment of primary dysmenorrhea. More clinical trial needed to establish the efficacy of this herbal drug.