mohammadali kiani

COVID-19, caused by severe acute respiratory syndrome (SARS), is known for high mortality rates across theglobe. Nonetheless, early diagnosis and treatment of this infectious disease are critical for increasing the recovery and survival ofpatients. The present study aimed to investigate the causes of delays in referring to hospitals regarding COVID-19 deaths in thefirst 48 hours of hospitalization to reduce mortality.

In this cross-sectional study, we extracted data from the families of 213 patients who died of COVID-19 betweenFebruary 2020 and February 2021 in Mashhad, Iran. The data were collected via phone using an 18-item checklist designed bya panel of experts and related to the causes of hospitalization delays.

Out of the 213 patients who died of COVID-19 in hospitals, 62.5% (133) were male, older (64 ± 12 years), illiterate (42%),and with one or more comorbidities (92.4%). Regarding the effect of 10 delay causes in the checklist related to hospitalization,it was reported that the highest score pertained to the fear of hospitalization (55.8%), following physicians’ advice about notreferring to hospitals (44.1%), and taking herbal medicines (32.3%), respectively.

Certain groups at higher risk of COVID-19 mortality included males, older individuals, and those with comorbidities.Fear of hospitalization was the main reason for delays in referring to hospitals, suggesting the role of demographic characteristics,socioeconomic status, and, most importantly, the role of social factors in increasing premature mortality

Inflammatory Bowel Disease (IBD) is a multifactorial disease, posing significant challenges to public health. The aim of this study is to determine the effect of silymarin on the symptom severity in pediatric patients with IBD.

Methods & Materials: 

This randomized clinical trial was conducted on children aged 5-18 diagnosed with IBD referred to the GI clinic at Akbar Children's Hospital in Mashhad. Those who met the inclusion criteria were randomly allocated into either the intervention or placebo group, each group consisting of 20 participants. In the intervention group, silymarin was administered three times daily in divided doses for three months. The control group received a placebo. To assess the efficacy of silymarin, PUCAI and PCDAI were evaluated for all patients at three different time points: before the intervention, during the first visit, and after the intervention. Data were analyzed utilizing the SPSS version 25, with a significance level set at p < 0.05.

The comparison of the disease activity index scores in patients with IBD between the silymarin and placebo groups revealed that during the initial evaluation, no significant difference was observed in the disease activity index score between the two groups before the intervention (p>0.05). However, a statistically significant difference was observed in the disease activity index score between the two groups during the second, and third evaluations (p<0.05).

"Health for All by 2000" was launched by WHO in 1978 and is based on primary healthcare availability worldwide. During the month of Safar, many people from neighboring cities and countries travel to Mashhad. Since the qualitative approach can lead to a better understanding of access to healthcare from the perception of consumers, this study aimed to assess the perception of Pilgrims and healthcare providers of healthcare services and gain more profound knowledge about healthcare consumers’ experiences.  This qualitative study was conducted in Mashhad during Safar based on conventional content analysis from September 20-27, 2022. This study used a semi-structured in-depth interview on 36 participants, including pilgrims (n=27) and healthcare providers (n=9) such as medical doctors, nurses, and health experts selected through purposeful sampling. The interviews were transcribed word for word. The MAXqda software and Graneheim and Lundman’s qualitative content analysis were used for data analysis.  Data analysis revealed three categories, including 1. Understanding the challenges of the treatment services in terms of three subcategories: A. Lack of medical doctors, drug shortages, and higher prices of medicines, B. Experiencing the diseases (skin, cardiovascular diseases, poisoning, and digestive problems, musculoskeletal pain and asthma), and C. Lack of an appropriate place for patient examination and serum injection. 2. Understanding the challenges of health services, including three subcategories: A. Time and place insufficiency of services, B. Lack of access to sanitary detergents, C. Improper cleaning of resting spaces and places, and finally, 3. Understanding the challenges of welfare services, including two subcategories: A. Inadequacy and lack of access to the appropriate rest place, and B. poor quality and sortage of food.  The results indicated that access to healthcare, treatment, and welfare is more than just these services. Health policymakers’ commitment to improving healthcare equity, hopefully, leads to positive changes in the healthcare system. Therefore, enhancing social participation in the healthcare system and providing comprehensive education on the optimal use of healthcare services is necessary to empower pilgrims to access better healthcare.

Gastric inflammatory myofibroblastic tumor (IMT) is a rare tumor that is almost seen in children with a wide range of clinical features. However, radiologic imaging and gastro endoscopy can be helpful, but the confirmation of the IMT diagnosis is via a histopathologic gastric specimen evaluation. Here we present the 2nd case of IMT with the clinical manifestations of a gastric outlet obstruction (GOO) in an eleven month old infant. Surgical treatment should be considered for the treatment of IMT

Early diagnosis and treatment of Wilson's disease in childhood can reduce long-term and life-threatening complications in these patients. Considering the lack of a database of Wilson's patients in Iranian patients, the present study was carried out with the primary objective of determining clinical and laboratory presentations in children with Wilson's disease referred to Akbar Hospital in Mashhad.

This cross-sectional descriptive study was conducted on children under 18 years of age with Wilson's disease who had presented to Akbar Children's Hospital in Mashhad during 2018-2019. The acquired information included demographic information, primary clinical symptoms (hepatic, cerebral, and psychological symptoms), and laboratory findings, including liver laboratory profile (AST, ALT, and ALP tests), coagulation tests, albumin, total serum protein, and direct and indirect bilirubin, and Wilson's diagnostic tests.

In total, 25 patients with an average age of 15.88±4.54 years were included in this study. Hepatosplenomegaly, Kayser–Fleischer ring, and jaundice were observed in 72%, 68%, and 48% of patients, respectively. Gender of patients was not significantly correlated with the clinical and laboratory findings of Wilson’s disease (P<0.05). 24-hour urine copper level was higher than 100 micrograms in 82.6% of patients. Serum ceruloplasmin level was lower than 200 mg/liter in 90% of patients. Serum ceruloplasmin levels in patients with ascites (P=0.04) and patients with lower limb edema (P=0.02) were higher than those in patients without these findings. Moreover, a lower 24-hour urinary copper level was detected in patients with seizures (P=0.03), and patients with depression (P=0.005) compared to patients without these conditions. The 24-hour urine copper levels were higher in patients with jaundice than in those without jaundice (P=0.01).

Hepatosplenomegaly, Kayser–Fleischer ring, and jaundice are common symptoms in under 18-year-old patients with Wilson's disease. Considering the findings regarding the high levels of serum ceruloplasmin and copper in 24-hour urine in a significant

The prevalence of celiac disease, which is gastrointestinal enteropathy, is increasing. This study aimed to assess the clinical presentations of celiac disease in children.
The current research is a descriptive-cross-sectional study conducted on 200 children with celiac disease who presented to the gastroenterology clinic of Ghaem Hospital. All patients with celiac disease, presented between 2016 and 2021 were included. For all patients, a checklist including demographic information such as age, sex, weight, weight Z score, height, height Z score, the initial clinical presentations leading to the diagnosis, laboratory examinations including CBC, Anti-TTG IgA, as well as pathological findings including biopsy, and Marsh score were recorded. Subsequently, the findings were described using the frequency table.
Out of 200 children examined, 65.5% were girls, and 34.5% were boys. The average age of the patients was 7.70±3.71 years. The most common clinical presentations were: growth failure (38.5%), diabetes (21%), and abdominal pain (15.5%). The average Anti TTG (IgA) level of the patients in the study was 202.03, with a standard deviation of 146.05. Also, the weight z score for the age of the studied subjects varied between 64 and 147, and its average was 2.06 with a standard deviation of 10.85. The height Z score for age ranged between 6 and 6.7, with the average was 0.87, and a standard deviation of 1.63.
In the current study, growth failure was the most common clinical presentation. As children with celiac disease do not always have the typical presentations such as diarrhea, abdominal pain, steatorrhea, and bloating, it is recommended that the atypical presentations be also noted, particularly growth failure.

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

Immunodeficiency, Centromeric region instability, and Facial anomalies syndrome (ICF) is a rare autosomal recessive disorder with Centromeric instability as a hallmark.

In this case report, we describe an Iranian 6-year-old male who was diagnosed with ICF syndrome. He had a history of recurrent infections, hydrocephalus report in pregnancy, failure to thrive, facial anomalies, global developmental delay, and umbilical hernia.

The investigation showed esophageal dilatation in barium swallow, ascending aortic dilatation in echocardiography and cutis laxa in skin biopsy. In laboratory data, impaired antibody function was observed. Finally, to find the probable causative genetic variant, a whole exome sequencing was performed. The data analysis using bioinformatics tools revealed c.1592G>A mutation in the exon 15 of DNMT3B. With respect to the diagnosis of ICF syndrome, our patient was treated with intravenous immunoglobulin (IVIG).

It is necessary to perform periodic neurologic and ophthalmologic examinations. Echocardiography must be done annually. In addition, the possibility of HSCT should be evaluated

Concern about possible GI dysfunction in ASD is intensified by high rates of feeding concerns and consequent medical sequelae in ASD. Etiological factors contributing to the pattern and prevalence of atypical intake in ASD remain elusive, but may involve pathophysiological processes in the GI tract. In this study, we evaluated the gastrointestinal symptoms of patients with autism spectrum disorder in Mashhad, Iran.

This is a cross-sectional study performed during September 2015 and April 2018 on patients referred to pediatric gastrointestinal clinics of Ghaem and Noor Hedayat centers by definite diagnosis of autism spectrum disorder (ASD). All subjects were interviewed to answer some questions about the gastrointestinal manifestations like constipation, chronic abdominal pain, diarrhea, recurrent vomiting, gastro-esophageal reflux, nausea, and agitation. For each patient a checklist was completed including demographic, history and physical examination variables.

During the period of study, 46 definite ASD patients were enrolled in the study. The mean age of the participants was 7.72± 2.80 years (range: 2-16). Most of the patients were male (37, 80.4%). Diarrhea (occasional or chronic) was seen in six patients (13%) and constipation in 21 patients (45.7%).  There was no significant difference between the gastrointestinal symptoms and gender or age of the patients (P>0.05). An important finding in physical examination was tooth decay, which was found in 21 patients (45.7%).

GI symptoms, with the high prevalence in ASD patients, should be considered as major problems; and preventive strategies must be taken for resolving them. Constipation was the most prevalent symptom, which can be related to the nature of the disease or other mechanisms.

In this research, a nanocomposite of microspherical polypyrrole and dandelion-like Nickel-Cobalt oxide was successfully synthesized on the Nickel Foam (NF) substrate with a hydrothermal method and employed as the electrode material for supercapacitor. The prepared nanocomposite was characterized by, Scanning Electron Microscopy (SEM), X-Ray Diffraction (XRD), Energy-dispersive X-ray, and Fourier-Transform InfraRed spectroscopy (FT-IR). Also, electrochemical techniques were used for electrochemical characterization. NiCo2O4/PPy/NF electrode exhibits a high specific capacitance of 2342 F/g at a current density of 2.33 A/g and good cycle stability (79% capacitance retention after 2500 cycles) on the three-electrode system. Also, an asymmetric supercapacitor device was successfully assembled using a hybrid of NiCo2O4/PPy/NF and rGO/NF as positive and negative electrodes. The fabricated device showed a specific capacitance of 186 F/g at a current density of 1.8 A/g and good stability 80% after 1500 cycles. Results show that prepared electrode is suitable candidate for construction of high performance supercapacitors.

Proper management of the Corona pandemic is one of the most critical issues causing a serious crisis for the health care system in all countries. This management includes the prevention, treatment and control of complications. Due to the large number of cases in the recent pandemic and the limited health facilities in the hospitals, the use of more cost-effective solutions, especially home care and the use of telemedicine in the management of coronavirus is increasing day by day.
Candidates for home treatment must meet certain requirements, including the stability in the patient’s general condition, the possibility of care taking at home by other family members or health care staff, access to personal protective equipment (at least gloves and masks), and not having people with heart, lung or kidney disease among the people living at home. It is also necessary to monitor the person's symptoms regularly. If the patient's symptoms worsen, especially in cases of shortness of breath, worsening of the coughs, decreased level of consciousness or fever for more than 5 days, there is a need to contact the medical system. Providing home care treatment solutions can be considered as a part of Transformation management in the recent Corona epidemic.
There is still a lot unknown about how to manage the Covid 19 patients and information in this field is rapidly increasing

 This study aimed to assess the relationship between intimate partner violence (IPV) and quality of life (QOL) among menopausal women.

 The present cross-sectional study was conducted on 202 postmenopausal women admitted to different healthcare centers. The primary data collection tools were the revised Conflict Tactics Scale (CTS2) and Menopause-Specific Quality of Life (MENQOL).

 The participants encompassed 202 postmenopausal women with the mean age of 52.14 ± 5.93 years. The analysis revealed that 70.8% of women were 45 - 55 years, 29.2% of women were 56 - 65 years, and 62.7% of the participants had more than two children. Compared to the non-smoking participants, the smoking women reported more injury violence (P = 0.008). In this study, the effect of the husband and wife’s level of education on IPV was not significant. The menopausal women or their spouses experienced more psychological (P = 0.008) and injury (P = 0.01) violence following their second marriage. The present findings suggested that three types of violence, including psychological (P < 0.001), physical (P = 0.003), and injury (P < 0.001), reported higher levels of psychological symptoms. The women experiencing psychological (P < 0.001) and sexual (P = 0.012) violence reported more severe physical problems than those with no history of violence in menopause.

 This study provided more profound insights into the relationship between menopause-related quality of life and types of violence among menopausal women. The quality of life in postmenopausal women is significantly declined under domestic violence. Healthcare providers are recommended to be trained on detecting and managing IPV and the corresponding physical and psychological problems.

 In Modern technology, using mobile phones is the most exposed to waves in the world. As far, public concern has been rising regarding exposure to phone waves, especially in critical periods such as intrauterine life and early childhood. This study aimed to conduct a systematic review of literature have investigated the relationship between exposure to radiofrequency waves during pregnancy and early childhood with physical and behavioral problems in children.

 We searched databases (PubMed, Web of Science, ISI, Cochrane Library, and Scopus), along with Persian databases such as SID and Magiran with the keywords: "Prenatal Period", "Pregnancy", "Mobile phone", "Children", "Radiofrequencyexposure", "Cell phone'', ''electromagnetic field'', and ''Behavioral problems'' from 1st. January 2010 until 1st. March 2020. After applying the inclusion and exclusion criteria, out of 55 articles, 15 were selected.  

 The results of some studies have not demonstrated the occurrence of behavioral problems in children who were exposed to radiofrequency waves during pregnancy until 36 months. But between the ages of 7 and 11, emotional-behavioral problems were reported. In contrast to other studies, one study showed a positive effect of reducing sentence complexity and improving motor skills in three-year-old children of mothers exposed to cell phone waves. Although, the Findings of dose-response (low, medium, and high exposure) were Controversial. In this review, meta-analysis studies found a significant relationship between the effects of exposure and the incidence of leukemia in children. Also, The incidence of migraine and children's exposure to magnetic fields showed a significant association. However, there was a weak association in the case of hearing loss problems. 

 Although, the results indicated a significant relationship between physical and behavioral problems in children due to exposure to the waves. However, We emphasize the importance and necessity of further research to investigate the biological effect of waves during pregnancy, and childhood to recognize the factors affecting children's diseases.

This study aimed at evaluating how the patient’s clinical manifestations and his/her anti TTG level are correlated with the intensity of histological damage based on the classification of Marsh Oberhuber.
This cross-sectional study was performed on 186 children suspected of celiac disease who referred to gastroenterology clinics between 2014 and 2015 and had Anti TTG >20. All patients underwent upper gastrointestinal endoscopy and multiple biopsies of duodenum were taken; histological classification was performed based on Marsh Oberhuber criteria. Finally, the relationship between serum levels of Anti TTG and histologic findings was assessed based on Marsh Oberhuber criteria.
There was a statistically significant difference between Anti TTG and different classes of grading March (P=0.01). Moreover, the intensity of intestinal damage based on Marsh Oberhuber criteria was significantly higher in children who had gastrointestinal complaints, the classic form of celiac disease and growth disorder. Anti TTG level of 148 IU/ml was the best positive cutoff point suggested by the ROC. For anti TTG levels of 148 IU/ml, sensitivity, specificity, positive predictive value and negative predictive value were 46.8%, 82.4%, 91.7%, and 27.2%, respectively.
Anti TTG level of 148 IU/ml has a high positive predictive value and a low negative predictive value for histologic changes more than grade 1 in Marsh classification

Erythema nodosum (EN) is a condition in which the skin suffers from oval-shaped and tender erythematous patches, mostly on the anterior region of the leg and sometimes other parts of the body, including the arms and affects subcutaneous adipose tissue. These patches are self-limiting and usually heal on their own within one to two weeks. This is a case report of a patient who is a 14-year-old boy complained of oval-shaped tender erythematous lesions on the legs of both legs and referred and was hospitalized 5 days ago. The patient continued to complain of pain in both thighs when standing and sitting. The patient developed a high fever upon admission. There was no history of the disease while we were taking his history. All laboratory tests were performed and rheumatic diseases and possible malignancies were evaluated and rejected. The patient was treated with the anti- naproxen, an inflammatory drug, and then the patient’s pain and fever decreased. However, the patient suffered from multiple ulcerative lesions in the mouth on the final day of hospitalization. Infectious counseling was performed and he was discharged with a diagnosis of EN in the context of oral herpes. Two days after discharge, the patient suffered from hematochezia. Consequently, he was hospitalized and underwent colonoscopy, which showed multiple mucosal lesions in the esophagus and duodenum, and a sample was sent for pathology. The test result showed Crohn’s disease, and the patient was treated immediately.

Despite the studies have been published as review or systematic, the effect of ormeloxifene on mastalgia has not been well elucidated. Therefore, this study was performed with aim to determine the effect of ormeloxifene on mastalgia in clinical trial studies.

To perform this review study, the English electronic databases including ISI Web of Science, PubMed, Scopus, and Cochrane Library; also, Magiran and Scientific Information Database (SID) were searched without time limitation until January 1, 2021, by using the keywords of Mastalgia or Mastalgias or Mastodynia, or Mastodynias or Mammalgia or Mammalgias, and Breast Pain, Breast, pain, and Centchroman or Selective Estrogen Receptor Modulators (SERM), and Systematic Review, and Meta-Analysis.  

Twelve studies were included in this systematic review, and the results of nine studies were combined in the meta-analysis. The percentage difference before and after treatment with ormeloxifene was significant (p<0.001), and ormeloxifene resulted in 86% improvement in breast pain relief (87%; CI:0.83-0.90). The result of the Q test showed moderate and insignificant heterogeneity between the studies (P=0.14; I2=33%). Also, the findings of the two studies have indicated significant efficacy of ormeloxifene.

The results of the meta-analysis supported the efficacy of ormeloxifene in relieving breast pain. However, the analysis of the findings in this meta-analysis should be interpreted with caution due to the high heterogeneity between the studies, small sample size, and the limited number of studies.

In this study, a simple and efficient approach is reported to product graphene using electrochemical exfoliation of graphite electrodes, in acidic solutions. The electrolyte concentration, applied voltages, electrodes distance and preparation time were taken as control parameters to optimize the produced graphene structures. The optimized graphene sample was prepared in a H2SO4 (0.5 M) at a bias of +10 V. The interlayer spaces, crystallite size and the average number of layers were determined by XRD. Surface morphology, layer thickness and characteristics of obtained samples were investigated by Scanning Electron Microscopy (SEM), Atomic Force Microscopy (AFM), and FTIR. The obtained results confirmed the graphene structures.

Background :

Coronavirus Disease-2019 (COVID-19) is a recently evolving public health problem. This study aimed to establish home care system for patients with acute respiratory infections in treatment centers and hospitals covered by Mashhad University of Medical Sciences, Mashhad, Iran.

In this pilot study, which was done as cross-sectional design from February 29, 2020 until May 4, 2020, all the patients with acute respiratory infections suspected of corona and referred to centers of health comprehensive services and outpatient clinics of Mashhad, Iran (referral level 1), were assessed based on protocol developed by Ministry of Health. Then, patients who do not need hospitalization services based on diagnosis of specialized health care team were referred home by prescription of medication and self-care training (home quarantine). Afterward, the required information based on care need, improving and thoroughly improved along with patient home visit and follow-up calling were implemented by physician. In the last phase, patients’ and their families’ satisfaction regarding health care team was assessed by a researcher-made questionnaire.

In this pilot study, 200 patients (men: 62.9%) with Covid-19 underwent home quarantine and care and treatment by a specialized treatment team comprised of physician, nurses, and psychologist and health experts. The findings showed that 84.5% of patients and family had partial satisfaction regarding the way of treatment of the health care team. Satisfaction on explanations provided regarding disease, diagnosis, and treatment method in 68% of patients was full satisfaction.

Conclusion:

 Home quarantine decreases stress and fear in patients and their family and prevents social labelling for these individuals. Patients were highly satisfied regarding being cared for in their home and by family members.

The aim of present study was evaluation and comparison of the white blood cell, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in febrile children with or without convulsion.

Three hundred sixty eight febrile children aged 6-60 months with or without convulsion were studied. Demographic, white blood cell (WBC), ESR and CRP were compared and analyzed.

There was 368 children (184 patients with febrile convulsion as case group and 184 febrile patients without convulsion as control group), with the average age of 26.6±14.4 months and 17.71±15.4 months respectively (p=0.001). In case group 59.78% and in control group 43.48% were male (p=0.002). There was no significant difference between groups regarding WBC, ESR and CRP. There was significant relationship between leukocytosis and convulsion in patients with longer than 15 minutes convulsion (p=0.03). There was not any significant relationship between febrile convulsion patients according to type, duration and frequency of convulsion in ESR and CRP.

Leukocytosis and elevated ESR and CRP in patients with febrile convulsion can represent underlying etiology of the fever and it may not be due to convulsion itself. But in longer than 15 minutes convulsion, it can lead to leukocytosis itself.

Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. These technologies allow communications between patient and medical staff with convenience as well as the transmission of medical, imaging and health informatics data from one site to another. It is also used to save lives in critical care and emergency situations. Although telemedicine systems have many advantages, including the distribution of high quality medical services to remote areas, failure to comply with infrastructure will reduce the efficiency and quality of their services. Issues such as building the infrastructure of the medical information industry, including the legal infrastructure, and thus providing a suitable platform for the legal and ethical issues of Telemedicine, as well as obtaining the necessary permits and requirements, will play an important role in the successful implementation of a Telemedicine system. The purpose of this study was to become more familiar with the field of Telemedicine and its services, as well as to review some legal issues in the field of e-health. Telemedicine is not able to solve the problems of the health and social systems, but the problems of the health and social systems cannot be solved without Telemedicine.

Asthma is a growing problem worldwide and the limitations of the current therapy for allergic asthma highlight the need for novel therapeutics. We conducted a systematic review and meta-analysis to find out the role of probiotics in the treatment of Asthma.

 In this systematic review, a comprehensive search of the major electronic databases was done till October 2017. Clinical trials comparing the effect of probiotics versus placebo on treating asthma were included. Trials focusing on prevention of asthma were not included. A predefined set of outcome measures was assessed. Continuous data were expressed as standardized mean difference with 95% confidence interval (CI). Dichotomous data were expressed as odds ratio with 95% CI. P-value < 0.05 was considered as significant.

11 studies with 2,027 participants were included. Probiotic intake was associated with a significant improvement in pulmonary function test and slight benefits in asthma control test. Probiotics did not reduce asthma exacerbation and wheezing episodes although there was a high degree of heterogeneity in studies. It also has no significant effect on viral respiratory infection in asthmatics and no improvement in quality of life. Probiotic intake improved the following parameters: longer time free from episodes of asthma. Adverse events were not significant.

Although trials showed promising effects of probiotics as an additive on therapy on some parameters of asthma, as this evidence was generated from only a few trials with high degree of heterogeneity, routine use of probiotics as an additive on therapy of asthmatic patients cannot be recommended at this time.

Massage therapy has been commonly practiced as a traditional complementary therapy in neonates. This study was designed to evaluate the effects of massage on decreasing bilirubin levels in infants undergoing phototherapy. Materials and Methods A total of 60 term icteric infants without known risk factors who were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran from 2016 to 2018 were involved in this preliminary clinical trial. The infant participants were randomly divided into the massage + phototherapy (intervention group, n=30) who received massage therapy (with field technique) thrice daily (every 8 hours) for 30 minutes each, and phototherapy alone (control group, n=30) who received phototherapy and routine care. Serum bilirubin samples were obtained at different time points in both groups.

The mean feeding time in the intervention and control groups were 22.5 and 21.4 min, respectively. The mean birth weights in the intervention and control groups were 3052 and 3187 gr, respectively. No significant differences were found between the two groups in age, sex, Apgar score, maternal profile, and previous history of jaundice (P>0.05). Rates of bilirubin loss were 0.81±0.19 mg/dl/h and 0.59±0.18 mg/dl/h in the intervention and control groups, respectively (P=0.043), in the first 8 hours of admission which dropped to 0.46±0.16 and 0.37±0.22, respectively (P=0.958), in the first 30 hours of admission. Conclusion Based on the results, massage is suggested as a complementary method for phototherapy, especially in the first eight hours of treatment during toxic high bilirubin levels and at the peak risk of kernicterus.

Epilepsy is a brain disorder in which a person has repeated seizures over time. A seizure is a sudden change in the electrical and chemical activity in the brain. A single seizure that does not happen again is NOT epilepsy. Most children with epilepsy live a normal life. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. Nearly 80% of people with epilepsy live in low- and middle-income countries. The risk of premature death in people with epilepsy is up to three times higher than for the general population. There is no known way to prevent epilepsy. Proper diet and sleep may decrease the chances of seizures in children with epilepsy. Reduce the risk of head injury during risky activities. This can decrease the likelihood of a brain injury that leads to seizures and epilepsy. Treatment for epilepsy includes: Medicines, Lifestyle changes and Surgery. Three quarters of people with epilepsy living in low-income countries do not get the treatment they need.

Feedback is a conscious, unbiased, and objective evaluation of performance in order to improve clinical skills, not to assess students' personal talents and values. This study aims to compare the views of pediatric residents and general medical students at Mashhad University of Medical Sciences regarding method of providing feedback in clinical education. This cross-sectional study was conducted in the pediatric ward of hospitals affiliated to Mashhad University of Medical Sciences in 2018. The census method was used to select 35 pediatric residents and simple random sampling method was used to select 35 general medical students who had completed internship and apprenticeship. Data collection was carried out using a standard 21-item feedback questionnaire. Pediatric residents and general medical students were asked to identify the importance of feedback received during their clinical education using a 4-point Likert scale. The majority of residents believe that feedback was only sometimes expected (27.1%), clearly and explicitly outlined (17.1%), fair (21.4%), and useful in correcting their attitude (18.6%), performance (17.1%), and behavior (27.1%). Majority of general medical students believed that clear, explicit (24.3%) feedback was related with their future career (14.3%) and most of them received positive feedbacks (20). Apart from propositions items 20, 18, and 17, most medical students and residents have selected the Often and Sometimes options, respectively to respond to items. Pediatric residents were less satisfied with the feedback received during the clinical education as compared to the general medical students.

Every year, some 3.9 million girls aged 15 to 19 years undergo unsafe abortions (1). Approximately 16 million girls aged 15 to 19 years and 2.5 million girls under 16 years give birth each year in developing regions (2, 3). Complications during pregnancy and childbirth are the leading cause of death for 15 to 19 year-old girls globally (4). Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years (5, 6).The term "adolescent" is often used synonymously with "teenager". In this sense "adolescent pregnancy" means pregnancy in a woman aged 10–19 years (2, 7). Pregnant teenagers face many of the same pregnancy related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth (8). For girls aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age (9). Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc.) (5, 6).