seyed javad sayedi

Subglottic hemangioma, especially in the absence of an evident skin lesion is a very rare congenital abnormality. Beside this rarity, the diagnosis is very challenging and needs assessment with rigid bronchoscopy and Computed Tomography (CT) angiography.

Here, we report the case of a 3-month-old boy with subglottic hemangioma, which was diagnosed after several visits and through several imaging procedures, including CT angiography and bronchoscopy visualization. Our case responded well to the medical treatment and was followed to find further regressions of the tumor.

When an infant presents with biphasic stridor and barking coughs within the first few months of the child birth, the diagnosis of a subglottic hemangioma should be kept in mind along with other differentials.

Cerebral palsy stands as the main cause of mobility disability in childhood, and the accompanying sialorrhea exacerbates health and psychological issues for both the child and the family. We aimed to assess the effect of botulinum toxin type A on reducing sialorrhea in children with cerebral palsy.

This self-controlled clinical trial was executed among children afflicted with cerebral palsy. The Teacher Drooling Scale was used as the data collection tool. The intervention involved the administration of botulinum toxin A, with a dosage ranging from 30 to 50 units in each parotid gland, skillfully guided by a radiologist using ultrasound. Sialorrhea scores were compared before and after the injection.

Our study included 21 children with cerebral palsy and sialorrhea. After the two post-injection weeks, a noteworthy drop was observed in the sialorrhea score (4.10±0.831) compared to the pre-injection score (4.71±0.463). The sialorrhea score until the ninth month after injection (1.121±3.43) was still significantly lower than the score before injection.

The injection of botulinum toxin A emerges as a potent medication, significantly curtailing the drooling among patients with cerebral palsy. This finding can be used to prevent aspiration pneumonia and reduce social and psychological complications in this population.

The effect of SPARK physical education program on lung function in cystic fibrosis patients is not yet determined. SPARK (Sports, play and active recreation for kids) includes moving skills, aerobic games, jogging or walking, aerobic dance and jump rope. Regarding the high prevalence of cystic fibrosis and its destructive effects on the lungs, the aim of this study was to evaluate the lung function and quality of life before and after undergoing the SPARK physical education program, in children with cystic fibrosis. In this quasi-experimental study, all patients with cystic fibrosis aged 6-18 years referred to the cystic fibrosis clinic of Dr. Sheikh Hospital in Mashhad, Iran, were enrolled. The patients attended the 12-week SPARK training program (3 sessions per week, each session 45 minutes). The quality of life questionnaire for patients with cystic fibrosis, including self-examination and parental tests, along with spirometry indices (FEV1, FVC, FEV1/FVC, FEF25-75) were filled out before and after intervention for all patients. The mean and standard deviation of patients' age were 9.85±2.67 years, and 65% of patients were female. The FEV1 was significantly different before and after the SPARK physical education program (P=0.03), and the respiratory component of quality of life significantly increased after intervention (P=0.002). The overall score of quality of life from parents’ point of view was 2.87 ± 0.38 which increased to 2.99 ± 0.38 after the intervention. SPARK training program may improve the spirometric parameters in children with cystic fibrosis. It also had a significant effect on improving the patients’ quality of life, especially in the respiratory component.

Hydatid disease is an important health problem in endemic areas like Iran. Unlike adults, the occurrence of pulmonary hydatid cyst is greater than hepatic cysts in pediatric population. In this study we evaluated the characteristics of pediatric pulmonary hydatid cyst in our region. We reviewed the medical records of all children with the diagnosis of pulmonary hydatid cyst in Dr Sheikh’s children hospital between 2015-2019. 30 patients were enrolled during the study period. Diagnosis was confirmed using imaging and serology tests.Mean age of patients was 8.5±2.1 years (range:6-14 years). 73% were male and 80% were living in rural areas. All patients were symptomatic at presentation and the most frequent symptom was cough (76%) followed by dyspnea (43%). The most frequent site of involvement was the lower lobe of the right lung (30% of patients) and bilateral involvement was seen in 16.7% of patients. 13.3% of patients had simultaneous hepatic involvement. Complications were reported as follows: pleural effusion 30%, superinfection and abscess formation 16.7% and pneumothorax in one patient. All patients underwent surgical treatment. Lobectomy was performed in 5 cases (16.6%). Pulmonary hydatid cyst must be considered in children with respiratory symptoms in endemic areas. Early diagnosis might lower the risk of complications and lobectomies.

Epiglottitis is an inflammatory disease involving the epiglottis, vallecula, arytenoid cartilage, and aryepiglottic wrinkles. Acute epiglottitis is relatively rare, but it can quickly lead to a life-threatening airway obstruction. Diagnosis of epiglottitis is clinical, but radiography and direct vision of the epiglottis can also help with the diagnosis. Clinical manifestations of epiglottitis include fever, sore throat, and in the event of imminent airway obstruction, symptoms of muffled sound, falls, tripod position, and stridor might be presented as well. Epiglottitis can be caused by some bacterial agents or viruses such as adenovirus and measles. COVID-19 was first detected in December 2019 in a group of patients with severe respiratory symptoms in Hubei Province, China. Common symptoms include fever, cough, fatigue, difficulty breathing, and loss of smell and taste. Although COVID-19 disease has a variety of manifestations, only one case of epiglottitis following COVID-19 disease has been reported in adults. However, no cases of epiglottitis have been reported in children with COVID-19.

The patient, a 4-year-old boy, came to our center and the patient's family complained about shortness of breath and progressive lethargy of the child from 10 days ago. Since last week, he had been sleeping in a sitting position due to the aggravation of shortness of breath. On physical examination, respiratory distress, tachypnea, subcostal retraction, tail stridor, and crackle was heard in both lungs. Diagnosed with suspected bronchoscopy epiglottitis; and a large, swollen, and cherry-red epiglottis was observed. Based on the patient's history of respiratory symptoms and the prevalence of COVID-19, a reverse pharyngeal polymerase (RT-PCR) transcript test was requested for COVID-19 and the COVID-19 infection was positive. The patient was intubated due to decreased oxygen scorching and was treated with antibiotics due to the diagnosis of epiglottitis and recovered.

In this article, we reported the case of a 4-year-old child with epiglottitis in the context of COVID19. To the best of our knowledge, no case of epiglottitis had been, previously, reported in children with COVID19. Therefore, in our opinion, epiglottitis can probably be one of the manifestations of COVID19 in children.

Pulmonary sequestration (PS) is characterized by a separate segment of the lung that receives anomalous vascular supply separate from the pulmonary arteries. Here we report the case of a 4-year-old girl with dyspnea and recurrent pneumonia who was finally diagnosed as a case of PS.

A 4-year-old girl was admitted to Imam-Reza hospital, Mashhad city, Iran, with a history of coughing and dyspnea from two years ago. On the CXR, consolidation can be seen in the left lower lobe. As there was a high likelihood of aspiration or pneumonia following her past medical history, the patient underwent bronchoscopy. More investigation with HRCT revealed vascular anomaly. CMRI (Cardiac Magnetic Resonance Imaging) showed no cardiac abnormality. More findings showed a large collateral artery originated from left lateral side of abdominal aorta. This collateral artery went upward to the LLLL (the Lower Lobe of Left Lung) and anastomosed directly with two large posterior segmental tributary of the left lung pulmonary veins. Hyper-vascular pattern of both lungs was also observed in the MRI.

To avoid misdiagnosis, PS should be considered in differential diagnosis in infants with chronic cough and dyspnea. These patients should be referred to a tertiary center to receive appropriate treatment.

Cystic fibrosis (CF) is an inherited disease which involves multiple organs including respiratory tract. It results in chronic respiratory signs and symptoms which exacerbate with frequent lung infections. The majority of exacerbations require hospitalization and intravenous antibiotic therapy as part of the management. The aim of this survey was to study the effectiveness of outpatient management of pulmonary exacerbations on pulmonary function tests. This randomized clinical trial included all CF patients older than 6 years old who presented with a pulmonary exacerbation and were able to perform Spirometric tests. All eligible CF patients first referred to pulmonary function tests center to determine forced expiratory volume in the first second (FEV1), residual volume (RV), total lung capacity (TLC) and airway specific resistance (SRaw). Then, they were treated outpatiently for 2 to 4 weeks and after that, they underwent all the tests again; and the participants’ improvements in pulmonary function tests after outpatient treatment were investigated. In this study, 32 patients were enrolled including 13 women (40.6%) and 19 men (59.4%). Mean and standard deviation (SD) of pulmonary variable, before and after the treatment were investigated. All of them were statistically significant. Sub-analysis of data based on gender was also performed showing that outpatient treatment led to significant improvements in all of the variables except for the percentage of RV in females (p value = 0.08). The findings revealed that outpatient management of CF exacerbations effectively improved values of FEV1, SRaw and TLC along with reducing RV values and air trapping. Thus, applying this method on appropriately selected CF patients, may prevent unnecessary hospitalization and subsequent disadvantages.

the present study aimed to translate the cystic fibrosis questionnaire for adolescents and adults (CFQ-R 14+) into Persian, and assess its validity and reliability.
In total, 35 patients with cystic fibrosis (CF) completed the Persian version of CFQ-R 14+, and Forced Expiratory Volume in one second (FEV1) and body mass index (BMI) were measured. In addition, the Pediatric Quality of Life inventory (PedsQL) was completed by the subjects. The validity of the CFQ-R 14+ was assessed using the face validity, Content Validity Ratio (CVR), and Content Validity Index (CVI), along with concurrent and know-group validities for checking its construct validity. The scale’s reliability was also estimated by test-retest and Cronbach's alpha coefficients.
After forward-backward translation, the values of the total CVR and CVI and their sub-items were higher than 0.8 and 0.49 respectively. Most of the scales had strong internal consistency (Cronbach's Alpha≥0.70), and the test-retest correlations were within the range of 0.72-0.95, considered significant for all the scales. Moreover, strong correlations were observed between the total CFQ-R and PedsQL 4.0 (r=0.9; P<0.001), as well as moderate-to-strong incomparable domains (r=0.4-0.8). A significant correlation was denoted between the total CFQ-R scale and FEV1 (r=0.42; P=0.01), while a reverse correlation was observed between the total CFQ-R scale and age group discrimination (r=-0.35; P=0.03).
According to the results, the Persian version of the CFQ-R 14+ is a reliable and valid instrument for measuring the health-related quality of life among Iranian adolescent and adult patients with CF.

The present study aimed to translate the cystic fibrosis questionnaire-revised (CFQ-R) for children with cystic fibrosis (CF) into Persian and evaluate the reliability and validity of the instrument.
About eighty individuals including children and their parents were enrolled in this cross-sectional study. Demographic characteristic and disease severity parameters of the subjects were recorded. After translation of the CFQ-R to Persian, the participants completed the parent or child translated version of the CFQ-R, as well as the PedsQL 4.0. Reliability and validity analyses were, then, carried out.
The forward-backward translation was employed in this study. The total content validity ratio (CVR) and content validity index (CVI) were above 0.8 and at least 0.49, respectively. The internal reliability of each domain was acceptable (Cronbach alpha coefficients 0.65-0.91). Appropriate domains of the CFQ-R and pediatric quality of life inventory (PedsQL 4.0) were correlated, indicating the acceptable concurrent validity (r=0.5-0.7). In addition, test-retest reliability was assessed using correlation-coefficients, which were considered significant for both the child version (r=0.88; P˂0.001) and parent version (r=0.78; P˂0.001). Moreover, the CFQ-R scales showed significant correlations with the clinical indices and the construct of disease severity in the child and parent version.
According to the results, the Persian version of the child and parent CFQ-R has acceptable reliability and validity indices; and may be suggested to be used in clinical trials for the clinical evaluations and follow-ups of Iranian children with CF.

Cystic fibrosis (CF) is an autosomal recessive disorder caused by a mutation in CF transmembrane conductance regulator gene (CFTR). Clinical manifestations of the disease and their severity have considerable variations in patients having similar mutations in CFTR gene. This can be due to different polymorphisms, epigenetic changes and microRNAs (miRNAs) as gene modifiers. Considering the proven roles of miR-301b and miR-302b on infection and inflammation, expression of these miRNAs might change in CF patients.

In this study, 30 CF patients (homozygous for ΔF508 mutation) and 30 healthy individuals were participated and their demographic data were recorded. The whole RNA was extracted from serum samples and cDNA was synthesized. Using Real-Time PCR, expression levels of miR-301b and miR-302b were measured between the patient and normal groups. Patient classification was carried out based on Shwachman-Kulczycki score, and expression levels of these miRNAs were determined in these classifications. All statistical analyses were performed using IBM SPSS software, version 21.

Statistical analyses of qRT-PCR results showed a significant increase in serum levels of miR-301b and miR-302b expression (p-Values of 0.02 and 0.03; fold changes of 3.73 and 1.95, respectively) in CF patients compared to healthy controls. A significant increase (p<0.05) in miR-301b expression level was observed in severe, moderate and mild groups, while miR-302b expression level was increased in CF patients of severe and moderate groups according to Shwachman-Kulczycki score.

Expression levels of miR-301b and miR-302b are different based on the clinical scoring system. This data suggests that expressions of these two miRNAs are influenced by infection and inflammation of CF patients. Further studies can lead to the development of innovative treatment strategies.

One of the most important factors in maintaining and improving children's health is the quality of diet. The aim of this study was to determine the micro and macro nutrient intakes in children aged less than five years old with malnutrition. The cross-sectional study included 75 under-five children referring to primary health care center in Taft. Children classified in two groups by nutritional status according to a variety of anthropometric indicators. Food intake was assessed using 24 hour food recalls and then was compared to the recommended daily amount (RDA). Anthropometric measures of age, height/length and weight and measurements head circumference were obtained and compared with reference anthropometric indices to assess nutritional status The subjects consisted of 41 boys and 34 girls who were 36 (48%) in the malnourished group and 39 (52%) in another group. The analysis of food intake indicated that most micronutrients were within recommendations, except for calcium, zinc, iron and folate (P<0. 05). The intake of macronutrients, was above recommendations and energy intake was in the general appropriate level. The findings of the study indicated that the appropriate level of macronutrients intake was used and the problem was mainly existed in micronutrients’ consumption. Based on the results we recommended planning for nutrition education program.

Invasive candidiasis in infants has high mortality rate and is often associated with colonization on medical devices such as catheters. Candida colonization is considered as a predisposing factor for Candida related infection. The aim of this study was to evaluate the rate of catheters infectivity by Candida species.

In this descriptive cross-sectional study, sampling was done from catheters of hospitalized children (0-18 years old) in pediatric intensive care unit (PICU) in Mashhad Dr. Sheikh Hospital, June-November 2018. All catheters were evaluated to determine the extent of contamination and early identification of isolates was done by morphological and molecular methods.

The types of catheter infectivity for 114 samples included colonization or infective (n=25 isolates, 21.92%), contamination (n=4, 3.5%), and no growth (n=85 isolates, 56.74%). The most isolated species was C. albicans (n=18, 13.39%), followed by C. glabrata (n=9, 19.56%), C. krusei and C. parapsilosis (n=7, 15.21%, each isolate), C. tropicalis (n=3, 6.25%), and C. lusitaniae and C. kefyr (n=1, 2.17% each isolate).

Isolation of Candida species in 25% of catheters raised the possibility of colonization, considering the catheters as an exogenous potential source of candidiasis which is very important in PICU.

Foreign body aspiration (FBA) is a life-threatening problem that can be lethal in some cases. It usually occurs in children between 1–3 years old. Bronchoscopy is the best way for recognition, treatment and management of this problem. We aimed to evaluate the use of fiberoptic bronchoscopy after rigid bronchoscopy in foreign body aspiration in pediatric population.
  275 pediatric patients with a history of choking were entered to this cross-sectional study, from August 2015 to September 2018. The study was done in a Dr. Sheikh hospital, Mashhad, Iran. The age and gender of the patients were recorded individually. Rigid bronchoscopy was done for all patients. After that, fiberoptic bronchoscopy was performed immediately or 72 hours after the first procedure based on the patients' symptoms, time and personnel conditions. Data were analyzed by the SPSS software version 16.0.
  Among 275 patients, 175 cases (63.6%) were male. The patients' age was 3 months to 15 years old. In rigid bronchoscopy, 85 cases had no foreign body and in 190 cases, foreign body was found. In 43 cases fiberoptic bronchoscopy found a residual organic material in spite of negative rigid bronchoscopy.The most residual organic material pertained to 0-3 year age group and the cases with residue in males were more than females. There was a significant difference between FBA and age and gender (p <0.001).
  FBA in airway branches may not be seen by rigid bronchoscope due to the limited access to the distal branches. We suggest fiberoptic bronchoscopy as a complementary management along with rigid bronchoscopy to investigate distal branches, especially if the foreign body is soft in material.

The diagnostic value of spirometry in the evaluation of pulmonary function is known; however, the predictive potential of this method has always been undervalued. In the present systematic review, we aimed to collect all available data to analyze whether spirometry can be used in screening programs to predict future pulmonary diseases.

A database search was performed in Ovid, Science Direct, PubMed, Scopus, Web of Science, Embase, and Google Scholar using “spirometry” and “predictive value” as the main search terms.

After excluding irrelevant articles, 19 related studies were selected, and data extraction was performed. The results of the included literature showed that spirometry is a safe and reliable method for the evaluation of pulmonary function. It was also reported that spirometry can provide useful information, which can be complementary to other methods of evaluation.

Findings showed that spirometry is a valid and non-invasive method of assessment for the diagnosis of respiratory diseases such as asthma and airway obstruction. Moreover, spirometric parameters may help to predict future pulmonary conditions, at least in children.

The COVID-19 infection, which has been a pandemic since early 2020, can occur in pregnant women and can be transmitted to the baby after birth. There are few reports of this transmission in newborns. Because there are several causes for respiratory symptoms in a neonate, it is difficult to diagnose COVID-19 infection in the newborn. Evaluation of antibody in the blood umbilical cord may be an option in the future. We studied the COVID-19 infection in newborns.

In this longitudinal follow-up study, pregnant mothers who had suspicious symptomsof coronavirus infection before or after childbirth were consulted by the medical team for neonatal infection. Newborns were evaluated for respiratory symptoms. PCR test for corona virus was performed on pharyngeal swab or tracheal tube sample of the newborns.

Twenty-five pregnant women with symptoms suspicious coronavirus infections were consulted by the team of specialists from March 15 to April 15, 2020. After delivery their babies were carefully examined and followed up. Four neonates had coronavirus confirmed by PCR test.

Our study showed that neonates can become infected with Covid-19 and it should be considered amongst various differential diagnosis of neonatal respiratory diseases.

Toxocariasis is a zoonotic and telluric disease caused by the Toxocara species mostly in tropical areas. The relationship between toxocariasis and asthma has always been a subject of discussion.

This study evaluated the seroepidemiology of Toxocara among asthmatic children.

This cross-sectional study evaluated 150 children aged 3 - 12 years with asthma presentations, who were referred to Dr. Sheikh Hospital of Mashhad University of Medical Sciences from April 2017 to March 2018. Serum samples were tested for the presence of anti-Toxocara antibodies using Enzyme-linked Immunosorbent assay (ELISA). Positive sera were confirmed by the Western Blotting (WB) method.

Out of 150 asthmatic patients, Toxocara immunoglobulin G (IgG) antibody responses were observed in two (1.3%) patients by ELISA and one (0.6%) patient by both ELISA and WB. Moreover, none of the patients was detected as hypereosinophilia.

It seems there is no significant relationship between Toxocara infection and asthma in Northeastern Iran. These findings suggest the need for WB immunodiagnosis and ELISA using Toxocara antigens to improve human toxocariasis diagnosis in patients with asthma.

Cystic fibrosis (CF) is a common progressive genetic disorder among children which involves lungs, kidneys, intestine and liver. Apart from the significance of genetic factors, various environmental factors particularly bone mineral density are directly associated with CF. Remarkably, bone disease is appeared as a routine and common trait in long term CF survivors which implies that environmental parameters including calcium and vitamin D intake as well as drug inducement are the most important risk factors causing low bone mineral density. Conspicuously, absolute and notable treatment of cystic fibrosis associated to bone disorder must involve investigating the risk factors including the reduced intake of certain vitamins and minerals due to pancreatic inadequacy, modified hormone production, severe and chronic lung infection with increased ranges of bone function cytokines for a weak bone health situation. In this review, focus is on these considerable factors alongside the genetic factors in cystic fibrosis.

Foreign body aspiration is a potentially life-threatening event especially in those who are younger than 5 years old. Aspiration could be presented as a spectrum, ranging from absolutely asymptomatic event to more sever events including choking, respiratory distress and cyanosis or even death. Although foreign bodies in lung may not be visualized on X-ray, X-ray radiography is considered as a first step in localizing aspirated foreign bodies. Bronchoscope as rigid or flexible optic fiber is the main device used in removing aspirated foreign bodies.
However, in some cases, as the present case report, previous foreign bodies which were localized in lung could travel back to the mouth and be ingested. In this report, we discussed a case of foreign body aspiration in a 10 year-old girl referred to Dr. Sheikh Hospital, Mashhad, Iran, whose foreign body located in the lower lobe of the left lung returned and was ingested before bronchoscopy after some episodes of sever coughing

  Cystic fibrosis (CF) is the most common lethal genetic disorder of Cystic Fibrosis Trans-membrane Conductance (CFTR) Regulator gene mutations. We aimed to investigate common mutations in CF patients and to assess its possible relationship with clinical presentations. This cross sectional study was conducted on 36 CF patients who were referred to a tertiary pediatric hospital in Isfahan, Iran. They were evaluated for 34 common mutations in CFTR gene by using reverse dot blot strip assay. Other parameters such as the age of diagnosis, the sweat chloride level, and clinical manifestations due to lung involvement and pancreatic insufficiency were also assessed. According to genotype mutations, children were divided in three groups: ΔF508 mutation (group 1), non-ΔF508 mutation (group 2), without current mutations (group 3). Finally, genotype, and phenotype relationship were reported. The mean age of patients was 8.1+2.3 months, and 23 of them (63%) were male. CFTR mutations were found in fourteen patients (38.8%). ΔF508 mutation has the highest prevalence in the studied samples with allele frequency of 15.27%, and c. 2183 AA>G was in the second standing. Furthermore, p.R553X, p.G542X, C.1766+1, p.N1303K mutated alleles also were obtained in lower level. Mean age at the diagnosis time of CF, sweat chloride level and pancreatic insufficiency were not different between groups but lung complications were significant in children with common mutations. Our findings showed that commercial kit designed to identify 34 common CFTR mutations failed to detect 61.2% of alleles of our patients. This necessitates designing local diagnostic kits for proper diagnosis of CF in Iranian children

  Cystic Fibrosis (CF) is a hereditary autosomal recessive genetic disorder that can affect many organs including the lungs and the digestive system. We aimed to assess the effects of coenzyme Q10 level on clinical parameters in cystic fibrosis patients. This cross-sectional study was performed on 40 patients (13 females and 19 males) with cystic fibrosis who were admitted in Masih Daneshvari Hospital in Tehran- Iran, in 2017. A researcher-made questionnaire was distributed among them, and then the height, weight and arm circumference of the patients were measured and also their serum Q10 levels were evaluated. Then, the pulmonary function was evaluated using a 6-minute respiration test and a spirometry test. Finally, their total scores were calculated based on Shwachman score. The age range of participants was from 6 to 27 years old. Anthropometric indices such as weight (p=0.02, r=-0.408), age (p=0.016, r=-0.422), height (p=0.002, r=-0.520), birth weight (p=0.0113, R=-0.286), and height at birth (p=0.037, r=-0.37) had a significant negative relationship with coenzyme Q10. There was relationship between anthropometric indices and spirometry tests, including the association of FEV1 (act) with weight (p=0.00), and arm circumference (p=0.00) which were determined. According to the results, there was no direct relationship between muscle mass and Q10. Besides, the mean age of Q10 was greater than that of in age group of 9-16 years old, which can be considered for nutrition or childhood reserves for coenzyme Q10 production, which is decreased due to increasing age and lack of intake or loss of body power for the production of coenzyme Q10.

Lead is a strong and stable toxin, harmful especially to children, pregnant women, and the elderly. Nearly 27% of children aged under 5 years suffer from failure to thrive (FTT). Due to the probable harmful effects of lead poisoning on children’s growth, in this study we aimed to assess the blood lead level in children with unexplained failure to thrive. This analytic cross-sectional study was performed on 200 children under 2 years of age who were referred to Ghaem hospital, a referral hospital in Mashhad city-Iran. The participants were divided into two equal groups, one with unexplained FTT (group A), and children with normal weight (group B). Baseline characteristics were obtained by a research-made questionnaire. Blood samples were taken by the hospital nurses who were blind to the study groups. Blood lead level was measured by atomic absorption spectrophotometric method (Perkin Elmer 3030). The mean ± standard deviation (SD) of blood lead level in FTT group and control group were 7.3±3.32 µg/dL and 6.37±5.93 µg/dL, respectively. Blood lead level was significantly higher in FTT group than control group (P=0.001). Baseline Charactistics (such as hgender, parental educational level, gestational age, and socio-economic status of the family) were not significantly different between the two groups (P>0.05). The results of our study revealed that blood lead level was higher in children with FTT. So Lead poisoning may be a potential cause of unexplained FTT. So, measuring blood lead level can be useful in diagnostic workup of patients with FTT.

Cystic fibrosis (CF) is an inherited genetic disorder with chronic respiratory manifestations. The respiratory symptoms may start very early in life. The aim of this study was to evaluate the prevalence and antimicrobial susceptibility of respiratory pathogens in children with CF. In this clinical laboratory study, 100 CF patients were prospectively collected from February 2016 to March 2017. Microbiological cultures and antimicrobial susceptibility tests of the most frequently isolated upper respiratory tract bacteria were performed. According to the results of this study, Staphylococcus aureus was the most frequent microorganism 24 (24%) in CF patients followed by Pseudomonas aeruginosa 21 (21%). In children younger than one-year-old, Enterococci and Klebsiella pneumonia were the most frequently isolated pathogens. In other age groups, Staphylococcus aureus and Pseudomonas aeroginosa were most frequent. All pathogens showed more sensitivity to Ceftriaxone, Amikacin, and Ceftazidime. However, Staphylococcus aureus was most sensitive to Cefoxitin, Clindamycin, and Linezolid and Pseudomonas aeroginosa were most sensitive to Amikacin, Ceftazidime, and Ceftriaxone respectively. In conclusion, Staphylococcus aureus and Pseudomonas aeroginosa were the most frequent microorganisms in CF patients in our population. In patients younger than one-year-old, the most frequent pathogens were Enterococci and Klebsiella. All pathogens and Pseudomonas aeroginosa were sensitive to Ceftriaxone, Amikacin, and Ceftazidime but Staphylococcus aureus was most sensitive to Cefoxitin, Clindamycin, and Linezolid respectively. It seems that Ceftriaxone, Amikacin, and Ceftazidime are the most suitable antibiotics for the treatment of pulmonary infections in CF patients in our population.

The decrease in physical activities following increased usage of computer and digital games has led to serious health consequences in children. This study investigates the prevalence of obesity, cellphone and computer usage and physical activity levels and their relationship with spirometry indicators in Iranian children.
This is a cross-sectional study during 2013 to 2014 on high-school students in Isfahan, Iran. Sample size determined 1,690 students and sampling performed from 10 girls and 10 boy's high schools, based on multi-staged cluster randomized scheme. A research-made questionnaire was developed to complete by students interview and also contact with teachers and parents and measuring height and weight by researchers. If the asthma was probable (based symptoms and examined by physician) the spirometry was performed.
Overall 1,622 high-school students with the average age of 12.9 ( 1.1) years were recruited. Prevalence of obesity and overweight were significantly higher in boys (PThe overall prevalence of obesity in 12 to 14-year-old students was more than 7% and its prevalence was influenced by physical activity. Spirometry indicators were correlated with physical activity and lifestyle.

Intraoral synechia is a rare congenital condition, generally associated with other maxillo-facial malformations. We present a neonate with congenital intraoral bilateral synechia without any other facial anomalies.
Case Report: In this paper, we present a 19-day-old male neonate with congenital intraoral bilateral synechia without any other facial anomalies. We review the literature to discuss the surgical andanesthesia management of this rare congenital disease.
The disease manifested with a wide spectrum of symptoms. Most cases need surgery and airway management. In patients with a low risk of bleeding or a compromised airway, it is possible to manage them withfacemask-inhalation anesthesia and maintain spontaneous breathing.

Type 1 diabetes mellitus (T1DM) is by far the most common metabolic disease in children. Asthma is the most common chronic disease in pediatric population, and its prevalence has increased in the last decades. In this study, the prevalence of asthma among these children with T1DM has been described and its association with the demographic and clinical characteristics of Iranian children has been evaluated.
A cross sectional study was carried out on children with T1DM who referred to pediatric endocrinology clinics of Isfahan University of Medical Sciences. The participants were classified as a group with asthma and the second group as diabetic children without asthma. After selection and evaluation of the diabetic patients with asthma, their glycemic status was evaluated three times in the past year. All data were analyzed using the SPSS version 23.0 statistical software package.
A total of 419 patients (49.4% male and 50.6% female) diagnosed with T1DM were included in the study. The mean age of patients at the time of recruitment was 12.65 ± 3.9 years with a range from 3.8 to 18 years. The mean of disease duration was 5.3 ± 2.7 years. Among all participants, asthma was detected in 24 children with T1DM (5.7%). Glycemic control was significantly poorer among asthmatic patients with diabetes compared with diabetic patients without asthma.
The study demonstrated a lower prevalence of asthma among T1DM children rather healthy ones. Hence, diabetic child patients with asthma experience poorer glycemic control in comparison with T1DM patients without asthma.