International Journal of Pediatrics
Volume:8 Issue: 82, Oct 2020

Search of the literature reveals that there is no published systematic review on the effect of aromatherapy therapy on the pediatric and adolescent burns. For this reason, we conducted a systematic review to inspect the effects of massage therapy on reducing pain, itching, and anxiety levels in children with burns.

In this systematic review, English databases such as Medline, Scopus, Web of Science, EMBASE and Cochrane Library, no time limitation were conducted from inception until February 2019.

Three studies evaluated the effect of aromatherapy in pediatric burn patients Results In the first study, massage therapy with Johnson's Baby Bedtime Oil decreased significantly all the pain, itching, and anxiety level of adolescents in a burn unit (p < 0.001). In the second study, 284 children were massaged with aromatherapy in a burns ward, no significant difference were observed in terms of comfort behavior scores (p=0.18), or heart rates (p=0.18) among the groups’ oil. The third study was conducted on 71 pediatric burn patients, aromatherapy significantly decreased the pain, itching, and anxiety level (p <0.001). Heart rate showed a significant decrease from 118 to 109 and respiratory rate decreased significantly from 34 to 30, p

Inhalation with essential oils can improve the pain, itching, state anxiety, respiration, the child's falling asleep, and the calmness in the pediatric burn patients. This method of treatment can be beneficial and the findings of these studies should be interpreted with caution due to the high heterogeneity between the studies, the small number of studies and small sample sizes.

To increase the effectiveness of orthodontic treatment in children with various degrees of dental enamel caries resistance using a personified orthodontic treatment. The present study included 108 adults (6-16 years old) with the first class of occlusion who referred for the Department of Pediatric Dentistry with orthodontics in Voronezh pediatrics’ dental clinic №2" Russian Federation. According to the study design, it can be characterized as open, prospective, and clinical. The electrometric diagnostics of dental enamel and electromyography of the masseter and temporalis were recorded. Functional therapy with the proposed personified orthodontic treatment normalized the mean number of biopotential masseters and temporalis muscles and improved caries resistance of hard dental tissues. However, the examination on the group of children with a low degree caries resistance of dental enamel resulted in the decrease in the mean number of electrometric diagnostics from 4.0 (3.6; 6.0) μA-1.6 (1.5; 3.37) μA (differences are statistically significant, p˂0.05) after 18 months of replacement therapy. In turn, the mean number of bioelectric activity of masseter and temporalis muscles changed from 324.25 (303.75; 345.75) μV-332.5 (318.75; 347.25) μV, p˂0.05. Employing the personified orthodontic treatment depending on the degree of caries resistance of the tooth enamel, determination of the functional state of the masseter and temporalis, and electrometric diagnosis of dental hard tissues enhanced the effectiveness of orthodontic treatment.

Non-pharmacological methods of pain relief are widely used in some societies/places today. They are readily available, inexpensive and uncomplicated methods that have an acceptable efficacy. Acupressure is one of these methods which is a branch of acupuncture. The aim of this study is to assess the effect of LI14 acupressure on children and infants undergoingpainful procedures and infants’ Apgar score.

In this overview, the research was conducted by screening the relevant articles evaluating the effect of LI14 acupressure on children undergoingpainful procedures and the application of LI14 acupressure during labor on infants’ Apgar score. The electronic databases included Scopus, EMBASE, Cochrane, Web of Science, and Medline with no language or time restrictions (until March 10, 2020).

LI14 acupressure is safe and effective in improving pain in children undergoing tonsillectomy, insertion of cannula, immunization, and IV insertion in pediatric patients with thalassemia. However, LI14 acupressure changed Apgar scores at one and five minutes. 

LI14 acupressure is a safe and effective method in improving pain relief in children undergoing painful procedures. According to the results, the use of He Gu point acupressure can be suggested as a non-pharmacological method to relieve pain in children.

Background :

Infantile spasm is a rare condition in infants from 4 to 7 months old. Treatment varies in different cases. Corticosteroids and adrenocorticotropic hormone (ACTH) are the most widely used treatment options; however, there are debates on their efficacy. The aim of our study is to compare corticosteroid treatment with ACTH in patients with infantile spasm.

In a randomized clinical trial, 51 patients with infantile spasm were enrolled in the study and distributed into two groups, including the corticosteroid (twenty-six patients), and ACTH (twenty-five patients) groups. The patients in the corticosteroid group received a dose of 8 mg/kg/day (max: 60 mg) of prednisolone in three divided doses for three weeks, and the dose was later tapered in responders. Non-responders after two weeks received 2-3 U/kg/day of ACTH (max: 100 U) for five days. The outcome was assessed using EEG and clinical remission of the disease. The comparison of the two groups was made using SPSS software version 20.0.

Twenty-six patients were treated with prednisolone and 25 patients with ACTH. There was no significant difference in gender, age, age of seizure onset, and growth abnormalities. At the end of the study, 13 patients in the prednisolone group and 17 patients in the ACTH group had normal EEG rhythm with no significant difference (p=0.33). As to clinical response, 18 patients in the prednisolone group (69.2%), and 19 in the ACTH group (76%) responded to treatment with no significant difference regarding the treatment outcome (p=0.58).

 Conclusion:

 There was no considerable difference regarding treatment of infantile spasm with high dose prednisolone or ACTH in in this study.

Background:

 Substance abuse is regarded as a principle issue in the world which causes numerous devastating challenges for family members of the abuser. This study explores how family head addiction affects women’s and children’s lives.

This is a qualitative content analysis study that was conducted in 2018 in Gorgan city, Iran. Using a qualitative study design and purposive sampling, 36 participants (11 children including 5 boys and 6 girls who had substance-dependent fathers, 15 women whose husbands were involved in substance abuse, 10 service and healthcare providers) were subjected to a semi structured, in-depth individual interview. A conventional content analysis approach using the Granheim method was employed to analyze the data.

Results are divided into four main categories: 1) Psychological and physical disadvantages included three subcategories of family psychological breakdown, Family deprivation in terms of emotional, physical health concern, 2) Social isolators consisted of three subcategories of disadvantaged social status, family violating norms, and addiction as a family phenomenon, 3) Disrupted family included three subcategories of decline in sex, Rule of doubt in the family and marital conflicts, and 4) Economic constraint consisted of the family deprivation financially and addiction in contrast to welfare.

Conclusion:

 Given that children and women in these families have problems in various aspects, our results emphasize the importance of comprehensive interventions by therapists, healthcare providers, to maximize behavioral adaptation in children and women that live with family head substance abuser.

Background:

 In 2019, an unknown disease called coronavirus disease 2019 (COVID-19) began to spread in China. The disease is now widespread in almost all countries and has endangered the lives of many people. For this reason, a systematic review and meta-analysis were conducted with the aim of assessing the clinical characteristics of the disease in children and adolescents with COVID-19.

This systematic review and meta-analysis have been conducted by reviewing most of the epidemiologic studies on the worldwide prevalence of COVID-19 in children and adolescents. The following international databases were used: EMBASE, Scopus, Web of Science, PubMed/Medline, Science Direct, and the Google Scholar Search Engine. The keywords used for searching included "child", "pediatric", "adolescents", "COVID-19", "Coronavirus", and "diagnosis”. The data were analyzed using STATA statistic software version 11.0.

The total number of patients was 2579, of which 1467 (56.9%) were male and 1110 (43.1) were female.All patients were in their childhood and adolescence years. At the beginning of the research, 1356 studies were reviewed, of which 987 entered the next reviewing stage. Finally, 14 studies were selected for the systematic review and meta-analysis. The prevalence of fever in children and adolescents was 55.0% (95% CI 0.55 [0.40, 0.70]), of cough 41.0% (95% CI 0.41 [0.27, 0.56]), of nasal discharge 9.0% (95% CI 0.09 [0.05, 0.12]), and of diarrhea 5.0% (95% CI 0.05 [0.02, 0.08]). 

Conclusion :

The results of this study can be a guide for pediatricians and specialists in the field of infectious diseases to identify the clinical signs of COVID-19 in children and adolescents.

Background :

The present study aimed to evaluate the effect of sleep pattern modification on reducing the math learning disorder in the sixth-grade elementary school students in the Kerman city, Iran.

This study was carried out using a semi-empirical, pre-, and post-survey method. A control group and sample population of 2,950, including all of the girl students studying in the sixth grade of the elementary school in the of Kerman in the 2019-2020 academic year, and 40 people with the highest score in the Sleep Disorder Scale for Children (SDSC), who were willing to cooperate with the researcher, were selected as samples and were randomly put into two groups of 20 individuals. The subjects participated in 45-minute sleep pattern modification sessions one day a week for six weeks, and the control group did not receive any council or treatment during this period. At the end of this period, both groups were evaluated using a post-survey approach. The tools used in this study include SDSC questionnaires and Keymath test. Multivariate Analysis of Covariance (MANCOVA), and Analysis of Covariance (ANCOVA) was used to analyze the theories.

The results of the study showed that sleep pattern modification has a significant effect on math learning, and the modification of sleep pattern effect coefficient on math learning was 0.974. The further results of the study showed that sleep pattern modification significantly affected learning basic concepts, mathematical operations, and applications of mathematics, and the effect of sleep pattern modification on learning basic concepts, mathematical operations, and applications of mathematics was 0.922, 0.904, and 0.935, respectively. 

Conclusion: 

According to the results, sleep pattern modification can reduce students’ math learning disorder; therefore, it is suggested to examine, and if needed, modify the sleep pattern of students with a math learning disorder.

Background :

  Septic arthritis is an acute infection of the joint space and a pediatric emergency. Delay in proper diagnosis and treatment, while prolonging the course of treatment, can have serious complications. The present study aimed to assess the clinical and laboratory profile of septic arthritis among patients hospitalized in the pediatric ward of Imam Reza Hospital of Mashhad, Iran.  

This retro-prospective study was conducted on the medical files of children from 2 months to 16 years old hospitalized in Imam Reza Hospital, Mashhad, Iran, from March 2011 to March 2019 due to a diagnosis of septic arthritis. A checklist capturing the age, gender, clinical symptoms, laboratory symptoms, affected joint, and type of treatment was prepared and completed according to the medical files of the patients.  

Out of 173 studied patients, 91 (53%), and 82 (47%) of cases were boys and girls, respectively. The patient was two months to 16 years old. The hip joint was affected more in 78 patients (45%). Among the clinical symptoms, fever was the most common found in 134 cases (77%). Moreover, 11 cases had positive blood culture where staphylococcus aurous with five positive reported cases (45%) was a major observation. Furthermore, four cases were reported to have a positive joint culture. CRP was positive in 94.8% of patients. 

 Conclusion: 

  Septic arthritis is one of the pediatric emergencies that should be diagnosed rapidly, and immediate treatment should be started to prevent irreversible complications. The most common symptom of arthritis in infants is restlessness and immobility and limp in children.

Background :

Paracetamol and Pethidine are two prevailing analgesics prescribed for postoperative orthopedic patients, each having different side effects and impacts on fracture healing. The present study was conducted to compare the impacts of Paracetamol and Pethidine on postoperative pain relief of children with bone fractures.

Fifty children with orthopedic bone fracture surgery candidates were selected in a double-blinded clinical trial study. A random number table was utilized to classify children into two groups of Paracetamol or pethidine treatment. First, the pain intensity of each group was checked using the Visual Analog Scale (VAS). Six hours after the surgery, the first group received Pethidine (1mg/kg of body weight), and the second group received Paracetamol (1gr). Moreover, the VAS scales were checked for both groups 6, 12, and 24 hours later. Afterward, the pain intensity of both groups was assessed according to the VAS scale.

Independent t-test results revealed a significant difference between the pain intensity of paracetamol (44.24 ± 6.44), and Pethidine (52.68 ± 10.47) groups 6 hours after the surgery (p=0.03). Moreover, there was also a significant statistical difference between the pain intensity of two groups 12 and 24 hours after the surgery. 

 Conclusion:

 Given the effectiveness of Paracetamol and Pethidine on postoperative pain, both medications can be used for children with bone fractures.

Telemedicine refers to a kind of treatment in which all medical interventions, diagnoses, treatment decisions, and recommendations are made using the patient’s data, documents, and other information transmitted through telecommunication systems. Telemedicine might run between one patient and one physician or one patient and several physicians, including other healthcare specialists. Telemedicine and E-Health have brought about great advantages to the current healthcare systems. Healthcare services are provided comprehensively through these innovative technologies. However, there are plenty of legal, ethical, security, and confidentiality concerns regarding a patient’s medical information. These concerns cause a series of complications for the patient, the medical team, and healthcare service providing systems, among which the disclosure of medical records can be mentioned, which might result in all types of discriminations, accusations, and violation of the patient’s basic rights. The present study reviews some ethical issues in the field of telemedicine.

Background:

 Ultrasonography is a non-invasive and accurate diagnostic method to evaluate urinary system and its anomalies in the neonates. Kidney sonographic measurement can be used as an alternative method to estimate gestational age. The aim of this study was to measure kidney size in preterm neonates and to provide a guide reference for gestational age.

Four hundred kidneys (in both sides) of 200 preterm neonates born with gestational age less than 37 weeks were evaluated in the present cross sectional study. Newborns with intrauterine growth retardation (IUGR), asphyxia, high grade hydronephrosis, single kidney, polycystic kidney, duplex kidney, dysplastic kidney and hydroureteronephrosis were excluded. Ultrasound investigations were performed in supine and lateral decubitus positions. Birth weight, gestational age, height and sex were recorded. Data were analyzed using SPSS software version 16.0. 

The mean gestational age of patients was 33.8±2.2 weeks. Mean kidney length, width, and thickness were 38.8±3.8 mm, 18.9±2.6 mm, and 21.3±2.6 mm, respectively. In addition, the kidney volume was 84037±2533.4 mm3. Mean diameter of the kidney and its volume were significantly higher in male neonates (p <0.05). Kidneys length and volume had a strong correlation with neonatal birth weight (r =0.608, p <0.001, r =0.663, p <0.001, respectively). 

Conclusion:

 A significant positive correlation was observed between renal dimensions and birth weight, gestational age, and height of patients. The results of this study showed that the trend of kidney growth can be used as a reference guide for gestational age in premature neonates.

Exclusive breastfeeding is the best pattern for feeding infants in the first 6 months of life. On the other hand, lactation patterns may be influenced by cultural factors. The present study aimed to determine relationships of Hofstede's cultural dimensions and lactation patterns in lactating mother.

The present cross-sectional study was conducted on 452 mothers with infants 6 months old and younger in 2018. Eight centers were selected from all health centers in Isfahan, Iran through cluster random sampling. The samples were lactating mothers who referred to health centers for receiving self and infant care. Data was collected using two questionnaires. The first questionnaire examined personal and fertility characteristics and lactation patterns. The second questionnaire was a self-administered structured questionnaire for cultural dimensions. Content validity index and relative content validity coefficient were respectively 0.80 and 0.70 for the cultural dimension questionnaire. Data were analyzed using SPSS software version 18.0.

The majority of mothers (64.4%, n=291) had exclusive breastfeeding. In the masculinity-femininity dimension, the mean score of exclusive breastfeeding pattern was higher than the non-exclusive breastfeeding (3± 0.48, 2.48±0.50) and there were significant statistical differences between exclusive and non-exclusive breastfeeding groups (p = 0.03). In other cultural dimensions, despite there being a difference in mean of the dimensions in exclusive breastfeeding and non-exclusive breastfeeding groups, it was not statistically significant.

Masculinity-femininity as a cultural dimension was associated with lactation patterns, so that mothers with greater orientation towards masculinity had higher focus on gender roles of a woman such as breastfeeding and they had greater exclusive breastfeeding.  But others dimensions were not associated with lactation patterns.

Breath holding spells (BHS) are paroxysmal events with apnea and postural tone with Electrocardiography (ECG) abnormality and epilepsy status reports. The study aimed to compare the ECG parameters’ in epilepsy and breath-holding children compared with healthy children. This case control study conducted on 270 participants consisted of 90 children in each group of epilepsy, breath-holding and control (healthy children) that were collected from pediatric clinics of Ali Asghar Hospital, Zahedan, Iran, for a period of one year starting in 2018. QT, QTd, QTc and QTcd were recorded after ECG for participants. Data were analyzed using SPSS 20.0 and the level of 0.05 was considered significant. From children, 45.6% were girls. Height and weight were the highest in controls and the lowest in breath-holding group, significantly (p <0.001). QT had the highest value in BHs, followed by epilepsy when dispersion QT, corrected QT had the highest values in epilepsy (448.62±56.14), and then BHS (433.00±32.76). QT abnormality in epilepsy, controls and BHs frequency of 16 (17.8%), 3(3.3%), and 7(7.8%), respectively (Chi-square=11.321, p=0.003). The abnormal individuals based on corrected QT frequency of 43(47.8%), 14(15.6%), and 26(28.9%) in epilepsy, controls and BHs groups and this trend was 44(48.9%), 9(10.00%), and 24 (26.70%) (Chi-square=33.611, p <0.001) for dispersion QTc, It was concluded that QTd, QTc and QTcd were higher in epilepticus children compared with breath-holding and controls. To maintain a good strategic treatment in patients with epilepsy, there is a need to assess alternations in ECG parameters, especially QT changes that lead to better comprehensive autonomic changes.

Background :

Drug abuse and its unfavorable consequences are considered the most important concerns and social issues of the present era, and drug abuse and its destructive consequences are challenging issues concerning the students’ health. The present study aimed to investigate the relationship between health beliefs and family functioning with drug attitudes among high school students of Lali city, Iran.  

This descriptive cross-sectional study was performed by path analysis. The study’s population included all the girls and boys of high school students of Lali city, Khuzestan Province, Iran, in the academic year 2017-2018. The sample included 133 male and 142 female students selected by multistage stratified sampling. The research instrument included the Health Beliefs Inventory (Thought Fusion Inventory, TFI), Family Assessment Device (FAD), and the Drug Attitude Scale (DAS). Data analysis was performed using SPSS software (version 23.0), and AMOS software (version 23.0).  

The mean age and age range of participants were 17.06±2.40 and 15 to 20 years, respectively. The results showed a significant negative relationship between health beliefs and attitudes towards drugs in females (β = -0.46, P ≤ 0.01), and male (β = -0.49, P ≤ 0.01) students. There was no significant relationship between family functioning and drug attitudes in students (P > 0.05).   

Conclusion: 

  In this study, it was found that health beliefs reduced attitudes toward drugs in students. Health beliefs change students’, and adolescents’ attitudes toward addiction. For instance, the adolescents, who exhibit more health behaviors, hold a higher perception of the addiction threat and more negative attitudes toward addictive drugs.

Background:

Obsessive-compulsive disorder (OCD) is a heterogeneous condition with distinct subtypes. This study aims to compare the severity of obsession and working memory in children with obsessive compulsive disorder and healthy children.  

In this correlation-comparative study, 140 students (70 healthy and 70 with OCD, diagnosed according to Obsessive-Compulsive Inventory, child-version score) were selected through simple random sampling method in in Tehran, Iran, (2018-19).  The multistage cluster sampling method was applied. The subjects were selected after purposeful clinical evaluation and according to the qualifications of the study. Assessments were made using the Obsessive-Compulsive Inventory, child-version (OCI – CV), and the Working Memory Rating Scale (WMRS). Data were analyzed using SPSS software version 25.0.  

A total of 80 girls and 60 boys with a mean age of 9 ±1.36 years were studied. The correlation between working memory and obsessive-compulsive disorder of girls and boys (r= -0.482; p =0.001) at the level of 

Conclusion :

The findings showed that the working memory scores in both girls and boys increased by reducing the obsessive-compulsive disorder accompanied. Moreover, the working memory of the healthy group was higher than that of the patients.

Background:

 Breath-holding spells (BHS) are brief periods when young children stop breathing for up to 1 minute and are widely recognized types of non-epileptic severe occasions in early stages of childhood. This study aimed to evaluate QTd and QTc changes in children with breath-holding spells compared with healthy children. 

Materials and Methods:

 This case-control study was conducted to evaluate ECG parameters' changes in 90 children with breath-holding spells compared to 90 healthy children, who were included as controls, without any breath - holding in pediatric neurology clinic of Ali Asghar Hospital of Medical Sciences, University of Zahedan (ZaUMS), Iran, in 2018. Electrocardiography measures were measured from 12-lead surface electrocardiograms of the patients and the control group. Data were analyzed using SPSS software version 18.0.

Results:
 In the study there were 46 (51.1%), and 35(38.9%) females in controls and Breath Holding patients, respectively. QT max (p=0.002), S in V1 (p <0.001), R in V5 (p <0.001), R in aVL (p <0.001), S in V3 (p=0.002), LV mass (p <0.001), QTd (p <0.001), QTc max (p <0.001), and QTcd (p <0.001) were different in patients compared to controls, significantly (p <0.05). QTd (p <0.001), QTc max (p=0.03), and QTcd (p <0.001) were higher in pallid attacks, significantly. QT max (p=0.039), and QT min (p=0.039) were different in boys and girls so that QT max and QT min were higher in girls. 

Conclusion:

 From the present study it can be concluded that QT, QTc, QTd and QTcd were higher in BHS. QTd, QTc max and QTcd were higher in pallid and QT max and QT min were higher in girls. However, in spite of what is reported in some studies, we suggest that obtaining ECG parameters is necessary to assess rhythm abnormality in children with BHS.

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.

The present study aimed to assess the efficacy of Meperidine for pain relief in children after orthopedic, abdominal surgery, and laceration repair.

A systematic serch was performed using the following online databases: Medline, Cochrane, Web of Science, Scopus, and Embase to 2 June 2020, with keywords: (Meperidine OR Pethidine) AND (Pain) AND (Child OR Children) with no language restriction.

The Acetaminophen had slightly higher pain scores compared to Meperidine after dental restoration among children. There was better sedation along with more rapid onset and recovery in the combined regimens of Atropine/Midazolam/Ketamine compared to Meperidine/Midazolam. Two studies reported the superiority of Morphine over Meperidine for pain management. A study found a significant increase in the mean pediatric pain scores in the Tramadol group compared to the Meperidine group after 24 hours. There was no difference in the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) between MPC (Meperidine/Promethazine/Chlorpromazine), and OTFC (Oral Transmucosal Fentanyl Citrate) groups during the laceration repair. In the study on the incidence of sleep on the way home or shortly after arriving at home, there were differences in chloral hydrate, Meperidine, and Hydroxyzine regimen compared to Midazolam alone among children being sedated during endodontic procedures.

Meperidine was effective for controlling pain in orthopedic, abdominal surgery, laceration repair, and dental restoration. However, it was only superior to the Tramadol group. Regarding dental surgery, a combination regimen were more effective compared to single Midazolam. The pain intensity during early recovery was slightly lower in Meperidine group. The regimen had better sedation with more rapid onset and recovery compared to Meperidine/Midazolam.