nemat bilan

Community-acquired pneumonia (CAP) in childhood is an acute lung infection in a child caused by a pathogen originating outside the hospital, i.e., in the community. This disease is a significant cause of illness in developed countries and a major cause of death in developing countries.

This study aims to assess the factors predicting the incidence of pulmonary complications in children with community-acquired pneumonia.

This study involved all children hospitalized in Zahra Mardani Azari Children's Hospital in Tabriz due to CAP between October 2022 and October 2023. Patients were compared in terms of demographic information, prescription records, medicines prescribed during hospitalization, clinical signs and symptoms, laboratory findings at admission and during hospital treatment; imaging results, and the clinical course of the disease. The study data was analyzed using SPSS version 23 software; and we used logistic regression analysis for identifying the related risk factors.

We included 361 patients, of which 104 (28.8%) were in the case group, and 257 (71.2%) were in the control group. The frequent complication was parapneumonic effusion (81.7%) following necrotizing pneumonia (27.9%), empyema (20.2%), and lung abscess (6.7%). Risk factors for pulmonary complications in children with CAP were weight (OR = 1.129), height (OR = 1.112), Body Mass Index (BMI) (OR = 1.112), administration of oral and intravenous acetaminophen during hospitalization (OR = 1.112, 1.209), Tachypnea (OR = 5.178), duration of Fever (OR = 1.290), ESR (OR = 1.312) and HRAD (OR = 3.473).

We found that high weight and BMI, receiving acetaminophen during hospitalization, Tachypnea, and Fever duration until hospitalization, as well as high WBC and ESR, were predictive factors of pulmonary complications in children with CAP.

In the process of intubation, inappropriate placement of the endotracheal tube can lead to hypoxemia, aspiration, insufficient ventilation, atelectasis, barotrauma and pneumothorax. The above complications may be difficult for a patient with severe disease to tolerate; especially when inappropriate placement is not detected by the specialist in the initial evaluation and the diagnosis lasts until the confirmatory chest x-ray is performed. This study evaluated the validity of three formulas in measuring the depth of endotracheal intubation in children under mechanical ventilation. 60 intubated children aged 2 months to 12 years were included in this study. The patients were randomly divided into three study groups. Endotracheal tube length for each patient was calculated on the basis of the endotracheal tube length formulas (12 + age (years) / 2; endotracheal tube diameter * 3; and 5 + height (cm) / 10). The ideal depth of the endotracheal tube based on chest x-ray was measured as the median distance between the first thoracic vertebra (T1) and the carina in cm. The distance between the ideal depth of the endotracheal tube and the end location of the endotracheal tube was also measured and recorded. The mean age of the patients was 42.90 months and 58.3% of them were boys. The most common indication for intubation was pneumonia, along with respiratory distress (33.3%). Considering the difference in endotracheal tube depth between the two values calculated using the formula and chest X-ray equal to± 0.5 cm, formula 12 + (2 / age) in 55% of patients, formula 3 * endotracheal tube length in 70% patients and formula 5 + (10 / height) in 85% of patients, were correctly estimated endotracheal tube length. On the other hand, it was observed that in 15%, 45% and 40% of the patients, the formula predicted the correct length of the endotracheal tube for correct intubation without any difference while compared to the chest X-ray. In evaluating the results obtained from the formula and length of the endotracheal tube measured by chest X-ray, it was also observed that the formulas 12 + (2 / age), 3 * length of the endotracheal tube and 5 + (10 / height) were significantly correlated with CXR. According to the obtained results, it can be concluded that the formulas used to estimate the depth of endotracheal tube placement in children have low accuracies compared to the gold standard of measurement (chest X-ray). Of course, in comparison to the three formulas (height, weight and diameter of the ETT), the height formula was more accurate than others.

Respiratory diseases are the most common cause of death in the pediatric population and acute or progressive respiratory failure, which requires mechanical ventilation, is the most common cause of children’s hospitalization in the intensive care unit. Despite advances in recent decades regarding the treatment of acute respiratory diseases in children and innovative settings in mechanical ventilation, there are no clear and comprehensive guidelines for the use of mechanical ventilation in children. This research aimed to evaluate the correlation between oxygenation and ventilation indices in predicting the duration of mechanical ventilation in children aged two months to 14 years old admitted to PICU. In this cross-sectional study, 56 patients were included. The required information was extracted from the patients' clinical records and entered into the prepared questionnaires. They included age, sex, and diagnosis, duration of intubation, extubation time, mechanical ventilation parameters, and blood gas parameters. Patients' blood and ventilation data were collected and calculated from the first day of mechanical ventilation until 7 days later to calculate Oxygenation (OI) and Ventilation (VI) indices. Pneumonia, the most common cause of hospitalization in the intensive care unit and the need for intubation, was present in our population (82%) due to aspiration and Covid-19 disease. There was a significant relationship between higher levels of FiO2 and longer duration of patients' intubation (P <0.001). The amount of PIP in each of the first days of intubation was significantly correlated with the duration of the study. A significant direct relationship was found between the ventilation index and oxygenation index. (P <0.05) Except for the sixth day, oxygenation index and duration of intubation were significantly correlated. (P <0.05) This means that along with the increase in oxygenation index, the duration of intubation was also increased. Ventilation index and duration of intubation were also significantly correlated, except on the fourth and fifth days (P <0.05). None of the extubated patients required re-intubation. Eventually, a very weak statistical correlation was found between the intubation period and the final result in the form of discharge and recovery of the patient or his death. Using variables such as gender, PIP and oxygenation, and ventilation indices, in the early days of mechanical ventilation, the prognosis of these patients and better management of their treatment can be judged. It is, finally, emphasized that further studies on larger populations, with more variables and long-term follow-ups are required.

This case report describes a 30-month-old child with primary pulmonary rhabdomyosarcoma with a congenital cystic adenomatoid malformation (CCAM). In the current literature, primary pulmonary neoplasms have been reported for similar cases. The tumor was located in the anterior-basal segment of the left lower lobe with a thin-walled cystic appearance and lobulated margins. A histology examination showed rhabdomyosarcoma origin with an embryonal subtype. Postoperative systemic chemotherapy was carried out. After a 6-month follow-up, the patient had no residual or recurrent disease.

 Continuing assessment of the quality of evaluation programs promotes the quality of exams and ensures learners’ accurate evaluation. This study aimed to examine the quality of the competency-based evaluation program for dentistry based on the context, input, process, and product (CIPP) model.

 In a mixed-methods study (quantitative-qualitative), dentistry students’ evaluation program using competency-based assessment methods was examined by dentistry professors based on the CIPP model and via a reliable and valid researcher-made questionnaire. The questionnaire had three sections on demographic information, evaluation questions, and open-ended questions. Descriptive statistics (mean and SD) were used to analyze the questionnaire items. Open-ended questions were analyzed by content analysis, and the quantitative part was analyzed using SPSS.

Twenty-five faculty members from the departments of orthodontics and dental prosthesis completed the questionnaires. The overall level of faculty members’ satisfaction with the new evaluation program was above average (54±17.02). They had the highest degree of satisfaction with output indices and the lowest degree with input indices. The analysis of the open-ended questions yielded two general categories of “providing the human and physical infrastructure” and “spiritual support and encouragement of educational innovation.”

The competency-based evaluation program needs the support of managers and planners. The faculty should provide the infrastructure for the implementation of these methods. By meeting the requirements, the professors will be motivated to implement these methods, and the paradigm can shift from traditional to novel evaluation methods.

Background :

Today few studies have focused on using calprotectin as an effective biomarker for monitoring the exacerbation of pulmonary complications in cystic fibrosis (CF). Thus, the present study aimed to assess the diagnostic value of the changes in the calprotectin level of patient's serum and sputum during responding to the therapy of exacerbated CF in children.

The cross-sectional study was conducted among 21 CF patients, which received required supportive and therapeutic procedures based on the protocol related to pulmonology ward in the Children Medical Research and Training Center of Tabriz University of Medical Sciences. The sputum and serum samples of all patients were collected to evaluate calprotectin level at 1-2 days after starting therapy with routine antibiotics such as cephalosporin and macrolides, and they were again gathered at the end of therapy process.

Assessing outcome in 21 patients under study represented complete and partial recovery in 12 (57.2%), and 9 (42.8%) ones, respectively. The mean decrease in calprotectin level in the serum and sputum of the patients was respectively obtained as 40.7289.08 μg/ml and 99.03225.94 μg/ml. The calprotectin decrease in serum with the cutoff point of 15.70 μg/ml possessed the sensitivity of 66.7% and specificity of 55.6% in predicting complete recovery outcome; while that of sputum with the cutoff point of 26.20 μg/ml had the sensitivity and specificity of 66.7 and 22.2%, respectively.

The mean age of participants were 8.61±4.19 years. It can be concluded that serum and sputum calprotectin decrease with cutoff point of 15.70 μg/ml and 26.20 μg/ml, respectively in have high sensitivity for determining response to treatment in cystic fibrosis exacerbation.

Background:

 Influenza viral infections lead to a wide range of respiratory diseases which have an annual pattern and are responsible for significant morbidity and mortality among children. It was found that influenza among children has significant rates of mortality and morbidity. We aimed to evaluate the diagnostic value of Pediatric Risk of Mortality (PRISM) III scoring system in children with influenza for clinical outcomes of patients.

In this cross-sectional study, 50 children referred to the Children's Hospital of Tabriz (Iran) with flu symptoms who were admitted to the ward or pediatric intensive care unit (PICU) were evaluated through the PRISM III model.

In this study, 50 children (48% female and 52% male) with a mean age range of 70.28 ±22.46 months with the flu were studied. The mean PICU of patients’ hospitalization was 34.2 ±36.5 days and the mortality rate was 16%. There was no statistically significant relationship between patient mortality and the variables of age, gender, length of hospitalization in PICU and the length of general hospitalization (p <0.05). However, only a statistically significant inverse relationship was observed between blood urea nitrogen (BUN) level and patient mortality among other variables evaluated in the PRISM III model (p = 0.016). In addition, there was a statistically significant relationship between PRISM III model score and mortality in the studied patients (p = 0.002).

 Conclusion:

 In the present study, considering the cut-off point 14, the sensitivity and specificity of the PRISM III model in estimating the mortality of children with influenza are equal to 87.5% and 85.7%, respectively; so the PRISM III model had excellent diagnostic and estimation power.

Background :

Empyema is a complication of bacterial pneumonia which has a particular importance due to its significant morbidity and mortality in children. The aim of this study was to investigate the prognostic factors of empyema in children with parapneumonic pleural effusion.

This retrospective cross-sectional study investigated all patients under 14 years old with parapneumonic pleural effusion associated with community-acquired pneumonia (CAP) who were hospitalized in Tabriz Children's Hospital, Tabriz, Iran, between March 2016 and March 2020 (4 years). Demographic and clinical characteristics were collected via medical records of patients and assessed as possible factors for empyema. These included: pre-treatments with ibuprofen, antibiotic therapy before admission, duration of the disease, underling diseases, fever, tachycardia, tachypnea, and also some paraclinical variables such as leukocytosis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acidosis, blood, and pleural fluid culture results.

Empyema associated with parapneumonic pleural effusion was detected in 47 patients (41.2%) of 114 hospitalized children. Based on logistic regression modeling, ibuprofen consumption history (OR = 7.16; 95% CI: 1.35-37.80; p = 0.02), tachypnea (OR = 17.13; 95% CI: 1.63- 179.90; p = 0.01), and leukocytosis (OR= 5.66; 95% CI: 2.10-15.24; p = 0.003) had a significant relationship with empyema occurrence. 

Conclusion:

 Based on the findings of this study, the history of ibuprofen use, tachypnea, and leukocytosis were predictive factors for empyema in children with parapneumonic pleural effusion as a result of community-acquired pneumonia.

After the outbreak of 2019 novel corona virus infection in China, we have the outbreak of disease in Iran and until March 05, 2020 have been reported a total number of confirmed cases more than 3500 and approximately 3.3% deaths. The corona virus disease 2019 (COVID-19) infection as a newly emerging disease in East Asia has caused a great challenge in managing the patients and controlling the disease especially in children. This algorithm is based on the standard diagnosis and treatment strategies for pediatric viral infections and available strategies to prevention of COVID-19 infection. It is hoped that with international co-operation, this global dilemma will end with the least burden of disease. Due to the lack of scientific evidences in children, this algorithm is essential for decision making.

Asthma and intermittent asthma attacks impose a heavy mental and financial burden on families and serum level of resistin influences the incidence of childhood asthma and response to drug therapies. The purpose of this paper was to assess the serum level of resistin in asthmatic children in the division of pulmonary and respiratory diseases at Tabriz Children’s hospital.

This study was conducted on 50 subjects in the control group and 50 subjects in the case group (asthmatic and healthy prepubertal children under 12 years old with a normal (BMI) (5-84th percentile); asthmatic and healthy overweight prepubertal children under 12 years old (85-94th percentile); and obese prepubertal children under 12 years old (BMI ≥95) without any other illnesses. The control group was matched to the case group in terms of age and sex and did not have inflammatory, acute and chronic infectious diseases or a history of medication consumption. Venous blood samples were collected from the subjects after 8 hours of fasting. Serum levels of resistin were measured using Elisa.

The level of resistin increased with asthma severity. Increased weight and BMI also led to a significant increase in the severity of asthma. The serum levels of resistin were significantly higher in the subjects of the control group who did not receive drug therapy. Response to drug therapy was significantly poorer in tall, heavier and high-BMI subjects than in other groups. The number of cases with severe persistent asthma was greater in formula-fed and breastmilk/formula-fed babies. History of allergy or asthma in first-degree relatives was significantly higher in the case group than in the control group (P = 0.001). Indoor smoking had a significant effect on the type of asthma (P = 0.001). The history of non-asthmatic allergy had a significant effect on the type of asthma (P = 0.001).

Obesity and overweight are among the influential factors in the severity of asthma. The amount of resistin is significantly higher in children with severe persistent asthma and uncontrolled asthma than in healthy children. However, the results showed that smoking may also increase serum resistin in at-risk individuals

Death has long been considered because of its substantial impacts on population dynamics. Specifically, child mortality is one of the most important indicators of development and one of the determinants of life expectancy. Investigation of child mortality causes and elimination of preventable cases can play a major role in the health and productivity of the community.

The present research was a retrospective study in which the medical records of dead children in Children’s Hospital of Tabriz were extracted from 2011 to 2016 and their demographics were recorded in special checklists. Finally, the obtained data were statistically analyzed.

The most common causes of child mortality in the studied hospital were congenital heart defects (15%), cancer (8.8%), and other congenital anomalies (8.6%), respectively. The mortality rate for males and females was equal to 55.8% and 44.2%. In addition, the highest mortality rate was related to those aged one month to 2 years (83.8%) and then 2-7 years (10.2%), and 7-18 years (6.1%). The findings also indicated that most dead children were living in urban areas.

Maternal nutrition improvement, gestational diabetes control, vaccination improvement, and increased awareness of health sector staff can be effective in reducing genetic anomalies and deaths caused by them. Therefore, special planning should be done for interventions such as referral for genetic counseling and genetic tests before cousin marriages. Moreover, pregnant women should be trained in unnecessary drug use and non-exposure to radiation and chemicals.

The change in venous oxygen saturation occurs earlier, and even its reduction is faster than arterial oxygen saturation. The aim of this study was to validate SvO2 and PvO2 for O2 content measurement in children hospitalized with respiratory distress. In this cross-sectional study, 80 children who were admitted with respiratory distress were included in the study according to the study inclusion and exclusion criteria. Baseline characteristics such as age and gender were recorded in the data collection form, designed by the researcher. In order to determine the amount of SaO2 and PaO2 the arterial blood sample was prepared, venous blood sample was prepared to determine the amount of hemoglobin, SvO2 and PvO2. The gold standard for the determination of O2 content was the arterial blood sample. All samples were examined by a blood gas analyzer and then calculated using the formula of O2 content values. For SvO2 and PvO2 validation, we used diagnostic analysis methods including sensitivity, specificity, positive and negative predictive values. Cut-point value for SvO2 and PvO2 were 76.50 and 44.30, respectively. In this study, the patients’ mean age was 5.15 ± 4.20 years. 62.5% (n=50) were male and 38.5% (n=30) were female. The values ​​of arterial and venous O2 content were 14.13 ± 3.05 and 11.95 ± 3.04 from a total of 80 patients. SvO2 and PvO2 for measuring O2 content had a sensitivity of 80.5 and 71.80%, respectively, and specificity of 80.5 and 78%, respectively. SvO2 and PvO2 have good validity for evaluating O2 content in patients admitted to PICU. So that SvO2 had a sensitivity and specificity of over 80%, and PvO2 had a sensitivity and specificity of over 70%.

About 40 to 60% of all patients admitted to pediatric intensive care unitsundergo mechanical ventilation and 10 to 20% will fail to be extubated. We aimed to determine the role of the rapid shallow breathing index (RSBI) in predicting successful weaning of pediatric patients with respiratory failure. This cross-sectional study, was performed on 72 mechanically ventilated children (36 in the lung failure group and 36 in the pump failure group) who were admitted in Tabriz children’s hospital in pediatric intensive care unit (PICU), Tabriz city, Iran. In order to spontaneous breathing trial (SBT) criteria, the patients who had FiO2 less than 40%, PEEP less than or equal to 5 cmH2O and PaO2 higher than 60 mmHg, was placed on spontaneous ventilation mode (PSV+CPAP) to maintain a PEEP of less than or equal to 5 cmH2O, PS of less than or equal to 8 cmH2O and FiO2 of less than or equal to 40%. After 2 hours, measured tidal volume and respiratory rate to calculate the RSBI then the patient was extubated. From 72 patients were enrolled in this study, 26 patients failed in extubation. The total RSBI threshold was 6.7 breath/min/ml/kg (AUC = 0.739, 95%CI = 0.618 – 0.861; p = 0.001)) with a sensitivity of 73.1% and a specificity of 80.4% for success of extubation. Patients successfully extubated had significantly lower RSBI 4.65 ± 3.03 breath/min/ml/kg compared to extubation failuregroup. Based on the result of this study, the rapid shallow breathing index with a threshold of 6.7 breath/min/ml/kg was considered to be an acceptable and practical criterion for predicting the outcome of weaning in children

Pulmonary involvement is the main cause of mortality in cystic fibrosis (CF). Airway clearance techniques are non-pharmacological complement options for CF patients. The aim of this study was to evaluate the short-term outcome of airway cleaning treatment in patients with cystic fibrosis in a children's hospital.
This clinical trial study conducted on 40 CF patients referring to the specialized lung clinic of Tabriz Pediatric Center in Tabriz, Iran from April 2016 to April 2017. Patients were randomly divided into two equal case (PEP), and control (conventional) groups. The basic spirometry parameters were measured on the European Respiratory Society criteria. After therapeutic intervention, the patients were followed for the next six months and the number of hospital admissions were recorded.
The mean of FEV1, FEV1/FVC and FEF25%-75% in the control group after treatment were 62.60±20.39, 86.70±19.39 and 55.20±32.78, respectively. Comparison of the control group means of FEV1, FEV1/FVC, and FEF25%-75% in the case group after intervention (57.52±14.62, 76.80±21.83 and 59.8±28.71, respectively) showed significant differences (p The patients undergoing treatment (PEP and control groups) showed better spirometry results. In the PEP group, the number of re-hospitalizations was significantly lower than the control group.

Making decision on asthma as an inflammatory disease is done mostly on the airways function and the patient symptoms which most of them are nonspecific and subjective. Also, the children are not able to express their signs and collaboration in examination of the lungs function. Evaluation of serum level inflammatory biomarkers can be useful in assessment of the response to treatment and severity of asthma. In this regard, we aimed to examine the changes of serum levels of biomarkers which may occur as a result of treatment in children with asthma.
This study was conducted in 2017 and 54 children who referring to the respiratory clinic of Tabriz University of Medical Sciences, Tabriz city (Iran), were studied by convenience sampling method. To evaluate the changes of biomarkers (Immunoglobulin E, Eosinophil, Periostin and Eosinophil Cationic Protein), 5ml peripheral blood samples were drawn before and after the treatment period of six-month. They were measured by ELISA method. The data were analyzed by SPSS software ver.16.0 using descriptive statistics and Paired Sample t test.
The mean age of the children was 6.27±2.25 years. There was a significant difference between the studied biomarkers before and after treatment (P>0.05) and the serum level of Immunoglobulin E, Eosinophil, Periostin and Eosinophil Cationic Protein was reduced after receiving the treatment.
The biomarkers serum levels in the children was reduced after the end of the treatment period. Thus, in this study, the role of selective biomarkers in asthma management was confirmed. The physicians could decide about the stop or continuation of the treatment by measuring their serum levels.

BackgroundCough variant Asthma (CVA) is defined as chronic cough without wheezing, and may be precursor of typical asthma. Thus, the diagnosis of CVA and early intervention can partly inhibit asthma progression.This study aimed to evaluate the role of spirometry in diagniosis of Cough variant Asthma in Iranian Children.
Materials and MethodsThis descriptive observational study included a total of 73 patients, who were referred to the specialized lung clinic of Tabriz Pediatric Center, Tabriz city, Iran. Patients were divided into two groups with classic asthma (n=37) and cough variant asthma (n=36) and basic spirometry parameters such as FEV1, FVC, FEV1/FVC, FEF 25-75% and PEF were measured, and the spirometry findings of each individual were measured based on the European Respiratory Society (ERS) criteria.
ResultsThe mean of FEV1 and FVC in the classic asthma group were 83.45 ± 20.49% and 86.45 ± 21.57%, respectively; and in the cough variant asthma group were 87.44 ± 13.99% and 86.8 ± 14.71%, respectively. There was no significant difference between the two groups for the basic spirometry parameters of FEV1 and FVC (p=0.343, P=0.916; respectively). The average FEV1/FVC parameter in the cough variant asthma group was 89.44±13.07, but it was 72.35±8.47 in the classic asthma group, with a significant difference between the two groups (pConclusionThere was a significant difference in the FEV1 / FVC value between two groups of cough and classic asthma. Spirometry of patients with cough variant asthma showed the FEF values (25 -75%) were lower than expected; we suggest using spirometry in the diagnosis of cough variant asthma considering small airways changes.

BackgroundCough variant asthma (CVA) is a chronic or recurrent cough without wheezing accompanied by bronchial hyper-responsiveness and eosinophilic inflammation of the airways. This study aimed to evaluate the validity of spirometry in the diagnosis of CVA, as well as determining the specificity and sensitivity of spirometry parameters in CVA.
Materials and MethodsThis descriptive observational study was conducted from March 2015 to February 2016. The subjects were 73 patients 5 to 15 years of age who referred to the pulmonology clinics of Tabriz Pediatric Center, Tabriz city, Iran. The patients were divided into two groups of classic asthma (n=37), and CVA (n=36). Basic spirometry parameters such as FEV1/FVC and FEF25-75% were measured and the spirometry findings of each individual were measured based on European Respiratory Society (ERS) criteria. After intervention (β2 (beta2) adrenergic receptor agonists as bronchodilator test), in two groups, spirometry was again performed. The FEV1/FVC and FEF 25-75% parameters were examined for intervention. Data analysis was performed using SPSS (version 16.0).
ResultsCut-off points for the diagnosis of CVA and classic asthma were obtained using FEV1/FVC and FEF 25-75% spirometry. The cut-off point for FEV1/FVC for the diagnosis of CVA was calculated to be 80%. When the FEV1/FVC ratio was higher than 80%, diagnosis of CVA was possible with a specificity of 94.59%, and sensitivity of 66.67%. These findings suggest a specificity and sensitivity of 94.59%, and 66.67%, respectively, for the diagnosis of classic asthma (with an FEV1/FVC ratio of below 80%). Analysis showed a positive predictive value of 100% for CVA at FEF 25-75% with a negative predictive value of 55.4%.
ConclusionSpirometry can be a sensitive method for the diagnosis of CVA at a FEF 25-75% below 65%; however, it lacks the specificity for accurate diagnosis of CVA.

Asthma is the most common chronic disease of childhood and adolescents worldwide that can result in variable restriction in the physical, emotional and social aspects of the patient’s life.The purpose of this study was to assess the effect of asthma stimulants modifying education program on the attitude of adolescents with asthma.
This study was based on pretest-posttest control group design. A sample of 60 adolescents from 12 to 18 years of age participated in the study. Groups were assigned randomly to intervention and control groups. Measurement of child’s attitude toward illness scale (Austin and Huberty,1993) was collected prior to intervention and five weeks post intervention in both groups. The intervention group received the asthma stimulants education program and followed up by telephone. Data Analysis was conducted with SPSS 13.0. Descriptive analysis (i.e. Chi-square and t-tests) were used.
The difference in scores of pre and post changes of the child’s attitude toward illness between the two groups showed statistically significant differences (P This type of educational intervention to adjust stimulants has the potential to improve the attitude toward illness in adolescents with asthma. Promoted attitude by educating adolescents about modifying asthma triggers can empower them to control the disease and reduce the participation of parents.

Pulse-oximetry (Spo2) widely uses as a help tools for therapeutic interventions in the pediatric intensive care units (PICU). The aim of this study was to evaluate the validity of Spo2 in measuring of oxygenation index (OI) in children.
In a descriptive analytical study, 100 patients who were admitted to PICU Tabriz Children's Hospital were studied. Oxygenation index measured by using two methods, including SpO2 which obtained from Spo2 and partial pressure of oxygen in arterial blood (PaO2) which obtained from Arterial Blood Gases analysis.
Based on findings, there was a linear correlation between SpO2 and PaO2, and also about OI which measured with Spo2 and PaO2. Based on Receiver Operating Curve (ROC), sensitivity and specificity of OI with considering PaO2 as denominator and in values less or more than 0.145, were 100%, and 76.9%, respectively; and with considering SpO2 as denominator and in values less or more than 0.145, were 98.6%, and 67.7%, respectively.
This study indicates that SpO2 instead of pao2 for measuring OI can be useful.

Acute lung injury (ALI) is defined as PaO2/FiO2 less than 300 with bilateral pulmonary infiltrates, without pressure is the top of the left atrium. Early diagnosis and treatment of pediatric ALI and find new cases is very important. Accurate diagnosis and effective steps to treating these patients is essential in the outcome of ALI. This study was conducted to show the impact of recruitment in the treatment of ALI patients.
This clinical trial study was conducted in Pediatric Educational-Medical center of Tabriz University of Medical Sciences (Tabriz, Iran) and 42 patients with ALI were enrolled. All patients were underwent echocardiography. The patients were divided in 2 groups randomly (intervention and control groups consisted of 21 patients for each group). Patients were followed for 6 months to be evaluated in terms of clinical status and mortality.
Difference on level of PaO2 in intervention group was -26±4 in comparison to the control group which was -4±4 (P Implementation of recruitment could play an important role in decreasing of mortality in patients with acute lung injury.

Children with severe asthma attack are a challenging group of patients who could be difficult to treat and leading to significant morbidity and mortality. Asthma attack severity is qualitatively estimated as mild, moderate and severe attacks and respiratory failure based on conditions such as respiration status, feeling of dyspnea, and the degree of unconsciousness. Part of which are subjective rather than objective. We investigated clinical findings as predictors of severe attack and probable requirement for Pediatric Intensive Care Unit (PICU) admission. In a cross sectional and analytical study, 120 patients with asthma attack were enrolled from April 2010 to April 2014 (80 admitted in the pediatric ward and 40 in Pediatric Intensive Care Unit). Predictors of PICU admission were investigated regarding to initial Heart Rate (HR), Respiratory Rate (RR), Oxygen Saturation in Arterial Blood (SaO2) and Partial Pressure of Carbon Dioxide in Arterial Blood (PaCo2) and clinically evident cyanosis. Initial heart rate (P=0.02), respiratory rate (P=0.03), Arterial oxygen saturation (P=0.02) and PaCo2 (P=0.03) and clinically evident cyanosis were significantly different in two groups (Ward admitted and PICU admitted). There was a significant correlation between initial vital sign and blood gas analysis suggesting usefulness of these factors as predictors of severe asthma attack and subsequent clinical course.

The multiple-choice questions (MCQs) are the most commonly used type of test items in medical education examinations. This method could be reliable tool for guarantee of education quality if develop carefully and according to standard test preparation criteria. This study aimed to compare some quality indicators of multiple-choice questions of pediatric, general surgery, internal medicine and genecology and obstetrics residency in pediatric residency promotion examinations (2010 and 2011) held at the Tabriz university medical science (TUMS), with board certification questions in these disciplines during the above years, and special consideration for improved quality management and monitoring of university internal examinations. Methods and Materials: In this cross-sectional study, we evaluated 2400 MCQs format of preboard examination of (TUMS) and national board examination in these disciplines. Individual MCQs evaluated for taxonomy levels (Bloom levels I, II and III) and following structural principles (based on Millman check list). Data analyzed by SPSS (version 18) software. Quality of MCQs in preboard examination of (TUMS) and national board examination in these disciplines was different and this difference was significance in some discipline. We find more perfect quality in national board MCQs examinations in general surgery and in preboard examination of (TUMS) in internal medicine. Pediatric and general surgery residency preboard MCQs examinations of (TUMS) were significantly low level of learning in comparing to national board MCQs examinations,and had more structural problems. To prevent descending quality of national and internal university examinations, management and monitoring of these exams is recommended.

Mechanical ventilation may be lifesaving intervention,It can be associated with complications,Thus,successful weaning is constitutive.One of the factors which is important in successful weaning is method of weaning. It is shown that weaning is conducted successfully by using Spontaneous Breathing Trial (SBT) through T-piece and pressure support (PS) ventilation.But few studies have not accepted it.In this study,we evaluated the role of SBT in extubation of patients in pediatric intensive care. In a cross sectional and analytical study, three hundred sixty patients with adequate gas exchange (indicated by PaO2 higher than 60 mm/Hg while FIO2 of 0.40 or less (or PaO2 ∕ FIO2ratio> 300) were enrolled. Patients underwent a 2-hours trial of spontaneous breathing with pressure support ventilation.They were monitored during the test for 2 hours and were classified as failing the test if at any time in the 2-hours period, there was tachypnea, excessive work of breathing,Tachycardia and SPO2<90%.Extubation failure was defind as needing reintubation within 72 hours of extubation. 240 patients(66%) of 360 patients successfully underwent SBT and were immediately extubated.In 120 patients(33%), the trial of spontaneous breathing was stopped.(trial failure;33% vs. 66% P=0.04). Of the 240 patients with successful SBT,29 patients were re-intubated (extubation failure) and 211 patients had successful extubation.(12% vs. 88% p=o.oo2).For patients experienced successful extubation, the mortality rate was 5% While the rate of mortality was 27% in patients with needing re-intubation.(5% vs. 27% p= o.oo3) The spontaneous breathing trial with pressure support prior to elective extubation may predict successful extubation in ventilated children.

The procedure for weaning from mechanical ventilation in many patients is a difficult and long process and increases the time of mechanical ventilation. There are numerous ways to achieve weaning. One common method is the use of CPAP. Considering the lower price of a humidifier, blender, and T-piece compared with CPAP and in light of the limited number of studies in this field the current study purposed to compare these two procedures.Fifty-one patients with neurological disorders who were under mechanical ventilation and ready to wean were allocated randomly into two groups: the CPAP group and the humidifier, blender, and T-piece group. Duration of hospital and PICU stay, number of days under mechanical ventilation, frequency of re-intubation, and mortality rate among patients were documented.The patients were 33 males and 18 females (64.7% and 35.3%, respectively) with an average age of 22.5 ± 4.5 months.The main indication for intubation was impending respiratory failure.Hospital stay was 22±15 and 21±13 days for the humidifier and CPAP groups, respectively.PICU stay was 13±11 and 21±13 days for the humidifier and CPAP groups, respectively. Re-intubation rates were 17.2% and 45.5% for the humidifier and CPAP groups, respectively.Mortality rates were 3.4% and 22.5% for the humidifier and CPAP groups, respectively.Considering no statistically significant difference between the two groups, using the humidifier, blender, and T-piece is recommended.

Diagnostic criteria for acute lung injury (ALI) and Acute RespiratoryDistress syndrome (ARDS) includes acute onset of disease, chest radiographdemonstrating bilateral pulmonary infiltrates, lack of significant left ventriculardysfunction and Pao2/Fio2 (PF) ratio ≤300 for ALI or ≤200 for ARDS. Recent criteriarequire invasive arterial sampling. The pulse oximetric saturation Spo2/Fio2 (SF) ratiomay be a reliable non-invasive alternative to the PF ratio. In this cross-sectional study, we enrolled 70 patients with ALI or ARDSwho were admitted in Tabriz children’s hospital pediatrics intensive care unit (PICU).Spo2, Fio2, Pao2, charted within 5 minutes of each other and calculated SF and PFwere recorded to determine the relationship between SF and PF ratio. SF values wereexamined as a substitute of PF ratio for diagnosis ARDS and ALI. The relationship between SF and PF ratio was described by the followingregression equation: SF=57+0.61 PF (P<0.001). SF ratios of 181 and 235 correspondedof PF ratio 300 and 200. The SF cutoff of 235 had 57% sensitivity and 100% specificityfor diagnosis of ALI. The SF cutoff of 181 had 71% sensitivity and 82% specificity fordiagnosis of ARDS. SF ratio is a reliable noninvasive surrogate for PF ratio to identify childrenwith ALI or ARDS with the advantage of replacing invasive arterial blood sampling bynon-invasive pulse oximetry.