International Journal of Pediatrics
Volume:9 Issue: 87, Mar 2021

One of the most common lip lesions pediatricians and pedodontists may encounter is recurrent herpes labialis. Herpes Virus Type 1 is from the herpes virus family. Contact with infectious secretions of the mucosa of the mouth, skin, and eyes can lead to primary infection. Primary HSV-1 infections are subclinical and generally occur in children, teenagers, and young adults. Reactivation of the virus can cause an asymptomatic release of the virus into saliva and oral secretions, which is itself an important risk factor for the transmission of the disease. Herpetic whitlow, recurrent herpes labialis, and herpes keratitis are usually caused by reactivation of this virus. Recurrent herpes labialis infection is a potential professional risk for oral health care workers. The purpose of this letter was to inform health professionals about the clinical symptoms, complications, and treatment of the herpes virus.

Preterm birth is one of the major problems of the health system. There are still many questions that remain unanswered for researchers and there is a need for continuous research to improve the ability to predict and prevent preterm birth. The aim of the present study was to review cervical elastography studies in predicting the onset of preterm birth.

In this systematic review, to assess the prediction of preterm birth using cervical elastography, systemic search of online databases (Medline, Cochrane Central Register, EMBASE, Web of Science and Scopus complete) was done using the combination keywords of: (cervix uteri OR cervix) AND (elasticity OR elasticity imaging techniques OR elastography AND (preterm birth OR premature birth) up to Jun 2020. Study selection was done by two reviews.

Elastographic evaluation of cervical os at 18-22 weeks of pregnancy is very useful in detecting patients at high risk for preterm birth in the population of asymptomatic women. Also, abnormalities detected in this technique, prior to clinical findings and ultrasound findings suggest the cervical shortening ​​and funneling can predict the onset of preterm birth. As women with very short cervical length (CL

Elastographic evaluation of cervical os at 18-22 weeks of pregnancy is very useful in diagnosing patients at high risk for preterm birth in the population of asymptomatic women. However, there is a need for further research to investigate the role of elastography in predicting preterm birth.

Today, parental violence against children is regarded an important public health, human rights issue and a social problem that leads to devastating consequences affecting the family, society and the country, and is passed on to future generations. The aim of the present study was to review the prevalence and risk factors for parental violence against children. In this narrative review a search of online databases (Medline, EMBASE, Scopus and Google Scholar) for studies published till Nov 2020, 57 articles have been reviewed, of which 11 related articles were included in this review. Study selection was done by two reviews. The present study showed high prevalence of parental violence against children in most countries and the most common type of violence is physical and psychological violence. Poor socioeconomic status, low level of education of one or both parents, experience of physical violence of parents in childhood, and the number of children in the family are among important risk factors for increasing prevalence of parental violence against children. Considering the high prevalence of parental violence against children and subsequent psychological effects on children, there is a growing need to inform parents of the consequences of violence against children and to adopt preventive measures. In this regard, educational authorities such as schools and the media can play a very important role and it is necessary to provide the necessary educational programs for parents.

The main purpose of this study was to demonstrate the effect of gentamicin on hearing tests in newborns treated with gentamicin in our NICU, and to contribute to the selection of antibiotics more consciously.

Infants who were hospitalized and followed up in the NICU of Karabük University Medical Faculty Hospital, Karabük, Turkey, between December 2019 and November 2020 were included in our study. During the study period, 331 infants hospitalized in the NICU and meeting the inclusion criteria were included.The infants were divided into two groups, with and without gentamicin treatment, and their demographic characteristics, respiratory support treatment and hearing test results were retrospectively analyzed and the results were compared. Automated auditory brainstem response (ABR) was used for newborn hearing screening at discharge.

Demographically, maternal age and birth weight were found to be significantly lower in gentamicin patients. Delivery method and gestational age were similar between the two groups. While the rates of passing the first test in the ABR screening were higher in the gentamicin group (p=0.051), only 1 infant in the same group failed the ABR second screening. This infant was 34 weeks old, a fraternal twin born at 2200 g, and no hearing loss was found in the infant’s twin. When the anamnesis was observed in detail, the infants’ uncle manifested a history of hospitalization for the treatment of urinary tract infection in his youth. In the meantime, his history of amikacin treatment and consequent experience of sensorineural hearing loss was revealed.

We concluded that gentamicin does not affect the hearing test when it is not used in the short-term (5-7 days), extended dosing intervals (24-48 hours), and ototoxic drugs such as loop diuretics.

Background Maternal obesity increases the risk of pregnancy complications such as preeclampsia, postpartum hemorrhage, weight gain and the need for cesarean section. We compared the role of metformin on pregnancy outcome in overweight mothers.

This double-blinded parallel randomized clinical trial was carried out on 360 pregnant women at 12-16 gestational weeks who referred to the gynecology clinic of Motahari hospital, Urmia, Iran, during 2019 to 2020. The intervention group received 1000 mg of metformin orally every day up to the end of pregnancy. Demographic and clinical characteristics of patients such as age, gravidity, parity, preterm infant weight, live birth, abortion, previous delivery method, maternal weight, body mass index, birth weight, delivery method, blood sugar at birth, gestational age at birth, neonatal hypoglycemia, infant mortality and anomalies were also recorded. Finally, the pregnancy outcomes (gravidity, parity, abortion and weight) were compared between the two groups.

Of 180 patients, 169 patients remained in the intervention group and 171 patients remained in the control group based on the eligibility criteria. In the control group, 13 patients (7.6%), and in the intervention group, five patients (2.9%) had preeclampsia and high blood pressure during pregnancy (P= 0.053). In the control group, the mean maternal weight gain during pregnancy was 10.22 ± 3.3  kg and in the intervention group was 7.6 ± 2.3 kg (P <0.001). The two groups were homogeneous regarding gravity, parity, abortion (P>0.05).

The administration of 1000 mg metformin daily has been shown to be effective in preventing overweight in pregnancy, but has not affected the birth weight. Metformin did not have any side effects on pregnancy outcomes.

Infective endocarditis is a rare disease which can lead to serious morbidity and mortality in children if not managed timely. The clinical features of the disease could vary in children and most of its immunological and micro-embolic features are rarely seen. This case report describes the cutaneous and neurological manifestation of infective endocarditis in a child. The case is a 4.5-year-old male child admitted at AVBRH hospital in Sawangi, Central India, with high grade fever and hemiparesis and later diagnosed with infective endocarditis.

Acute Disseminated Encephalomyelitis (ADEM) is an inflammatory disease that causes demyelination and affects the white matter of the brain and spinal cord through an immune response. The patient, an eight-year-old Iranian Kurdish boy with a height of 125 cm and a weight of 24 kg, complained from fever for three days which didn’t respond to acetaminophen medication. After three days, the symptoms developed into headache, vomiting, and decreased consciousness. The patient was admitted to the emergency department of Imam Hasan hospital in Bojnourd, Iran, in July 2019. LP diagnostic testing, Wright Agglutination test, Brain CT, and MRI examination were performed. Finally, a diagnosis of acute disseminated encephalomyelitis (ADEM) was confirmed. Following the ADEM diagnosis, methylprednisolone 500 mg was administered immediately and continued for five days. This case study suggests that MRI is the most effective method of diagnosis for ADEM, and high-dose methylprednisolone is the treatment of choice for this syndrome.

Many tobacco-growing countries are facing the issue of child labor in tobacco farming and production, which involve a high risk of various adverse health effects. Thailand has limited information about these circumstances. Accordingly, we aimed to examine the prevalence and factors related to child labor in tobacco farming among the Burley growers in Thailand.

This cross-sectional study was done with 720 Burley tobacco farmers in lower Northern Thailand, selected using a systematic random sampling technique. A structured questionnaire, designed by the researchers, was used to assess demographic characteristics, knowledge, and attitudes. SPSS software version 17.0 was applied for data analysis, involving the use of descriptive statistics, Chi-square test, and multivariable logistic regression.

Eighty-three households (12.4%) employed underage youth in tobacco cultivation. The most common process involving child labor was that of tobacco leaf collection, harvest, and drying. In multivariable analysis, child labor has never been investigated (ORAdj: 5.62; 95% CI: 3.17-9.97; p = 0.046); having a low level of knowledge about negative health consequences on child workers (ORAdj: 2.11, 95% CI: 1.29-3.44, p = 0.001); and having a high level of positive attitudes towards child labor (ORAdj: 1.69; 95% CI 1.01-2.84; p = 0.003) were associated with child labor behavior.

Based on the results, underage youths were still employed in tobacco agriculture. The farmers who had not been inspected for child labor, had poor knowledge about health risks, and high positive attitudes towards child labor were more likely to employ this young group. It is important to systematically monitor the potential health impacts on these child workers in the cultivation of tobacco.

Atopic dermatitis (AD) is the most common skin disease in childhood, and Cow's milk protein allergy (CMPA) is the most common cause of food allergies in infancy and may be characterized by atopic dermatitis with skin involvement as the first finding. The aim of this study is to determine the serum eosinophil cationic protein (sECP) levels, eosinophil counts and the frequency of AD and other skin manifestation among infants with CMPA.

This cross-sectional study was conducted in Karabük province, Turkey. Eighty-three infants who were diagnosed with CMPA and followed at the Karabük Training Hospital Pediatric outpatient clinic. The first group consisted of 52 infants presenting with skin manifestations. The second group consisted of 31 infants who were not presenting skin manifestations. The sECP level of infants in both groups was measured using an Immulite 2000 XPi analyzer Immunoassay System (Germany).

Of 83 infants with CMPA, 62.6% (n=52) were detected skin involvement as the first finding. The proportions of atopic dermatitis and urticaria in CMPA infants with skin involvement were 90.4% and 9.6% respectively. The median sECP level and eosinophil counts (56.5 ng/mL vs 470/mm3, p-value=0.001), in skin manifestations with CMPA group were significantly higher than that in the CMPA group without skin manifestations (33.1 ng/mL vs. 270/mm3, p-value=0.006).

This study revealed that AD is the most common skin manifestation of CMPA and also found higher sECP levels in infants with skin involvement. The frequency of both diseases, which are easily treated with elimination diet, is increasing day by day.

It is reported that pregnant women have shown different behaviors during the outbreak of COVID-19. The present study aimed to review existing studies concerning pregnant women’s mental health during the COVID-19 outbreak.

In this systematic review, two independent researchers reviewed the impact of COVID-19 on health mental in databases, including Scopus, EMBASE, Cochrane, Web of Science, and Medline, without time and language restrictions from inception up to June 10, 2020. The searches were performed using the following keywords: (Pregnant OR Pregnancy) AND (COVID-19 OR SARS-COV 2) AND (anxiety OR Anxiety).

The following risk factors affect the pregnant women’s anxiety levels: underweight during pregnancy, employment, primigravida, lower than 35 years old, low family level and social support, and low physical activity. Women’s psychological responses during the COVID-19 outbreak include anxiety, depression, fear, and stress. Besides, pregnant women in the COVID-19 pandemic have refused to receive prenatal care and have preferred social isolation. Generally, women’s levels of anxiety and depression had an ascending order. Moreover, findings concerning the relationship between age and pregnancy and levels of anxiety were contradictory. Moreover, anxiety levels had a relationship with the race as levels of anxiety, and the symptoms of psychological tensions were higher in Arab women than Jewish women.

The anxiety and depression levels among pregnant women during the COVID-19 outbreak have been reported as average to high. It is required for women to be under social support and encourage pregnant women to have more physical activities.

We aimed to compare the effects of high tidal volume (Vt) versus low Vt mechanical ventilation (MV) on systemic interleukin-8 (IL-8), and tumor necrosis factor alpha (TNF- α) cytokines production and induction of lung injury in mechanically ventilated children.

Thisprospectiveobservational study was performed on 60 critically ill mechanically ventilated children from 2018 to 2019, at PICU of South Valley University and Minia University hospitals, Qena and Minia cities, Egypt. After application of the inclusion and exclusion criteria, we compared MV with high Vt of 9-11 ml (group I) versus low Vt of 5-7ml (group II) per kilogram of predicted body weight in critically ill children. Plasma levels of IL8 and TNF- α cytokines were estimated at the onset of MV and after 24 hours in both groups. Lung injury development was evidenced by change in oxygenation parameters. 

Sixty patients on MV (30 with high Vt versus 30 with lower Vt) were enrolled in the study. Plasma levels of interleukin-8 and TNF- α were increased in both groups 24 hours after initiation of MV, but this rise was significantly higher in high Vt group (p <0.05). There were significant positive correlations between tidal volume and oxygenation index (p-value <0.05, r=0.32), and with plasma IL-8 (r=0.34, p= 0.01), while negative correlation between tidal volume and change in PaO2/fiO2 ratio after 24 hours MV (r= -0.34, p <0.05).

Mechanical ventilation with high Vt was associated with increased IL-8, and TNF- α cytokines production, and will induce lung injury as evidenced by acute hypoxemia and deterioration in oxygenation parameters (PaO2/FiO2 ratio less than 300 mmHg).

The early diagnosis of invasive fungal diseases is important because the therapeutic outcome depends on the prompt initiation of appropriate interventions. In this study, we present the feature of ultrasound of pulmonary fungal infection in six children with leukemia.

Between June and November 2020, this cross-sectional study was conducted in the radiology department at Dr. Sheikh Children’s Hospital, Mashhad, Iran. During this period, we reviewed imaging findings of fungal lung infections in six patients with leukemia (ages 5-11 years old) who were referred for chest ultrasound and CT-scan. High-resolution computed tomography (HRCT) of patients showed multiple nodular lesions with/without ground-glass opacity (halo sign or reverse halo sign), and wedge-shape consolidations. In some patients, there were thick wall cavitary lesions with intra-cavitary fungus ball and the air-crescent sign. Ultrasound findings of the lung included the target lesion, the cavitary lesion, wedge-shape consolidation, and extra-pulmonary invasion to the chest wall or sub-diaphragm. The galactomannan test or debridement of para-nasal sinuses confirmed fungal infections; Aspergillosis or Mucormycosis.

Four characteristic features of pulmonary invasive fungal disease on ultrasound can help in faster diagnosis and monitoring of treatment response in these patients.

Systemic toxicity is an obstacle against the oral administration of colchicine. The high body surface area to mass ratio in pediatrics would dramatically enhance the toxicity risk. This issue could be jettisoned by formulation of an optimized nanofiber-based fast dissolving delivery system. It could enhance the drug's bioavailability, reduce the administered dose, and bring more convenience and compliance for pediatrics with the problem of consuming conventional dosage forms. The optimized colchicine loaded nanofibers of polyvinyl alcohol 10%w/v with 220.47±16.87 nm mean diameter size exhibits smooth surface and continuous structure in SEM micrographs. No incompatibility was seen in FT-IR analyses. The thermal study illustrated stability enhancement by colchicine loading. The water angle analysis demonstrated its superhydrophilicity and the in vitro release profile illustrated a quick release of colchicine in 30 seconds. As a conclusion, nanofiber-based fast dissolving formulation of colchicine could be suggested as a localized and systemic transmucosal delivery system, immediate-release oral dosage form, and even topical colchicine delivery system that may reduce the risk of systemic toxicity in pediatrics. The antitumor property of CL may also suggest it in rapid neoadjuvant or adjuvant localized chemotherapy protocols for the management of topical tumors in pediatrics.

 Considering the effective role of the environment, family, and especially parents in the development of children, this study was conducted to compare parenting styles in parents of 3-5 year-old kindergarten children with and without developmental delay.

This descriptive cross-sectional study was performed on 280 children aged 3 to 5 years and their parents by multi-stage-cluster sampling (based on the division of the Welfare Organization) in kindergartens in Tehran, Iran, in 2019. Parents completed the following questionnaires to collect the data: a demographic, Baumrind's parenting styles, and the Ages and Stages Questionnaires (ASQ). The data were analyzed using SPSS software version 19.0.

The mean age of children was 3.98+ 0.71 years, and the rate of developmental delay was observed in 9% (n=25). The highest frequency of developmental delay was observed in the age group of 3 years and in the field of problem-solving and the lowest developmental delay was observed in the age group of 5 years and the personal-social domain. 95.7% of mothers and 91.1% of fathers had an authoritative parenting style, 1.4% and 3.6% had permissive parenting style and 2.9%, and 5.4% had authoritarian style, respectively. Mothers of children without developmental delays had higher levels of education (p <0.05). In addition, fathers who had an authoritative parenting style had a higher level of education (p <0.05). The results showed no significant difference between parenting style in parent’s children with and without developmental delay.

According to the results of the present study, parenting styles show no differences between children with and without developmental delay. Further research is recommended.

The location of placenta is essential for the proper growth of fetus. This study was conducted to assess the relationship between placental location and perinatal and neonatal outcomes. The present retrospective cohort study was carried out on 1000 pregnant women who had delivered in Baqiyatallah Hospital, Tehran, Iran, during 2016-2018. We used a researcher-made questionnaire for collection of clinical and demographic information of patients from their medical records. All women had undergone a detailed ultrasound and Doppler examination at 20–23 weeks. We classified placenta position to four types: Lateral, Posterior, Anterior and Fundal. The data were analyzed using SPSS software version 20.0. Placental site location in 44%, 42.1%, 8.2% and 5.7% of cases were anterior, posterior, lateral and fundal, respectively. The mean birth weight in subjects with lateral and posterior placental site location were 2999.3±643.9, and 3269.7±1776.9 gr as lowest and highest, respectively (p <0.001). Among the newborns in lateral group, 4.88% of them were pre-term, which was significantly higher than other groups (P=0.035). The rate of IUGR birth in lateral group was 4.88% which was higher than other groups (P=0.023). Also, among perinatal outcomes the rate of twin pregnancy was higher in lateral group, while the percentage of female birth in this group was lower than other groups (p <0.001). Lateral placental locations are associated with a number of adverse pregnancy, delivery and infant outcomes. Placental implantation and location at 14 to 24 weeks can be used in the evaluation of pregnancies. In other words, knowing the placenta location can help obstetricians and gynecologists in the better diagnosis of pregnancies at higher risk of complications.

Numerous meta-analyses of childhood leukemia have been published, but no comprehensive study has examined the factors influencing childhood leukemia. We aimed to scrutinize the modifiable and non-modifiable factors affecting the risk of childhood leukemia.

In this overview, two independent researchers screened the articles studying the effect of modifiable and non-modifiable factors on the childhood leukemia from the related databases, including Scopus, EMBASE, Cochrane, Web of Science, and Medline, without time and language restrictions from inception up to March 10, 2020.

Eight meta-analyses were included in this overview. Breastfeeding compared with non-breastfeeding was associated with 9% reduction in the risk of childhood leukemia (OR = 0.91). The children with the birth weight of ≥4,000 g were at a higher risk of acute lymphoblastic leukemia compared with those with low birth weight (OR = 1.26, 95% CI = 1.17, 1.37). There was a significant relationship between childhood leukemia and residential pesticide exposure (SOR=1.57). There was a relationship between influenza during pregnancy and higher risk of ALL (POR=3.64; 95% CI = 1.34-9.90), and childhood leukemia (POR=1.77). The childhood AML had a statistically significant relationship with no alcohol consumption during pregnancy. The SOR of childhood ALL had an association with paternal smoking. A statistical relationship exists between magnetic field intensity of ≥0.4 μT and childhood leukemia. The exposure to NO2 and benzene exhibited the OR of 1.64 (95% CI = 0.91-2.95) and 1.21 (95% CI = 0.97-1.52), respectively.

Decreased breastfeeding, high birth weight, viral infections during pregnancy, alcohol consumption, maternal exposure to direct and indirect smoking, and exposure to electromagnetic fields and airborne pollutants are found to be significant risk factors for childhood leukemia.

In iron deficiency anemia (IDA), several changes in platelets indices have been reported in several studies. The aim of this study was to evaluate the platelet parameters in children with iron deficiency anemia before and after treatment.

This cross-sectional study was conducted over a period of 18 months. A total of 110 IDA subjects were selected from those who referred to the pediatric hematology clinic, Zahedan, Iran, during the study period. Age range was 12 months to 16 years were selected. Children in the study were given 3 months course of oral iron as ferrous sulfate with a daily dose of 4mg/kg/day in 2 divided doses. Platelet parameters including platelet count and mean platelet volume (MPV) were measured before and after treatment. The obtained data were analyzed using SPSS version 20.0.

The mean age of boys and girls were 4.30±4.55 years and 2.46±3.21 years, respectively. The results of the paired t- test showed that platelet means were 409±120 103 /mm3 and 384±99 103 /mm3 before and after treatment (p<0.001), respectively. The means of MPV increased from 8.07±1.01 fL before treatment to 8.86±1.05 fL after treatment (p<0.001), respectively.

The result of this study showed that treatment of iron deficiency anemia leads to decreased platelet count and increased MPV.

Chronic colonization with Helicobacter pylori (Hp) has been shown to significantly increase the risk of gastric ulcer and duodenum as well as chronic gastritis in children and adults. Due to the importance of early detection and treatment of HP infection especially in children, this study aimed to compare the clinical, endoscopic and histopathological findings in children with HP gastroduodenitis and control group.

In this cross-sectional study, all children referred to the gastroenterology clinic of children´s hospital, Qazvin, Iran, between 2016 and 2018, with a history of gastrointestinal complaints underwent upper gastrointestinal endoscopy if necessary, then tissue samples were taken, and rapid urease test was performed; subsequently the patients were divided into two equal groups of 200: HP positive (patient group), and Hp negative (control group).

The mean age in the Hp positive group and in the control group was 8.11±3.68 and7.22±2.96 years, respectively (p <0.05). The most common clinical manifestation in the Hp positive group was chronic abdominal pain (n=66, p <0.001). Endoscopic examinations revealed that the evidence of mucosal erythema, erosions and nodular mass of the corpus, antrum and bulb were significantly higher in Hp positive group. Histopathologic studies also showed more evidence of corpus, antrum and bulb inflammation in the Hp positive group compared to the control group.

Overall, based on the results of this study, it seems that endoscopic evidence of mucosal appearance of erythema, obvious nodularity and mucosal erosion in the corpus and antrum as well as bulb of duodenum in children with HP gastroduodenitis has a diagnostic value.

The relationship between anthropometrical and physiological parameters with running time is important. We aimed to investigate relationship between anthropometrical and physiological parameters with running time of elite girls.

In this Cross-sectional study, subjects were selected from 197 elite runner girls 14-16 year, participated in the national championship of the country selection 2019 in Ardabil, Iran. All anthropometrical and physiological parameters (such as Length of limbs and strength) were measured with appropriate and reliable tools. Pearson correlation coefficient was used to examine the relationships between variables.

There was a significant negative relationship between trunk flexibility (r=-0.448, P=0.022), left hand strength (r=-0.445, P=0.023), and left leg strength (r=-0.472, P=0.015) with 60m time; hip length (r=-0.504, P=0.010) with 400m time; between head circumference (r=-0.571, P=0.004), forearm length (r=-0.435, P=0.035), and static balance (r=-0.454, P=0.026) with 800m time; between arm length (r=-0.411, P=0.041), hip circumference (r=-0.487, P=0.014), leg length (r=-0.509, P=0.009), hand length (r=-0.595, P=0.002), and length jump (r=-0.482, P=0.015) with 1500m time; between wrist circumference (r=-0.439,P=0.041) with 3000m  time; between arm length (r=-0.420, P=0.026), and leg length (r=-0.434, P=0.021) with 4×100m relay race  time. Whereas there was a significant positive relationship between trunk circumference at hip (r=0.462, P=0.020) with 400m time; between length jump (r=0.408, P=0.048) with 800m time; between palm length (r=0.481, P=0.015) with 1500m (n=25) time; between dynamic balance (lateral) (r=0.455, P=0.033) with 3000m time; between trunk circumference at hip (r=0.394, P=0.038) with 4×100m relay race time.

Based on the results, there was a significant relationship between anthropometrical and physiological parameters with running time. So, it´s recommended that coaches pay attention to the results of this study to select and substitute of talented runners for gaining more success in reaching the peak of athletic performance.

The researches emphasize the importance of the relationship between psychological hardiness and differentiation of self with cognitive flexibility and self-regulation with academic engagement. Thus, the purpose of this study was to predict cognitive flexibility and academic engagement based on self-regulation, psychological hardiness and differentiation of self by mediating family functioning in students.
For this purpose, in a descriptive-correlational study 499 of the second-high school students of Tehran in the academic year, 2019-2020 were selected by random cluster sampling method. The statistical population includes four hundred and ninety students of Tehran who were selected by the multistage cluster random sampling method. Data collection tools included the Cognitive Flexibility Inventory (CFI), The Maslach Burnout Inventory, Self-Regulation Questionnaire, Psychological Hardiness scale, The Differentiation of Self Inventory (DSI), and The McMaster family assessment device. Data were analyzed using the Structural Equation Modeling method using the SPSS software version 20.0 and Amos software version 24.0.
The most frequent were in the 17-year-old group (11th level) with 169 participants and the least abundant belongs to the 18-year-old group (12th level), with 167 participants. The findings showed that there was a significant full effect relationship between self-regulation and academic engagement (p <0.001). According to the results, there was a significant full effect between the differentiation of self with cognitive flexibility (p <0.037). The results showed that there was a significant full effect between self-regulation and academic engagement (p <0.001). 
Based on the results, the students who are at a lower level of differentiation of self may be frustrated by the family's excitement, which leads to emotional breakdown or confusion with others.

Quality of school life is defined as the well-being and general satisfaction of students in terms of the positive and negative experiences in school activities. The present study aims at investigation of the effect of difficulty in emotional regulation on the quality of school life of high school girl students.

The research method was descriptive correlation using structural equations. The statistical population of the study is 4,734 high school girl students in Kerman, Iran, in 2018-2019. The sample size was determined to be 353 by Cochran's formula using random cluster sampling method. The Ainley and Burke’s School Quality of Life Questionnaire and the Gratz and Roemer’s Difficulty in Emotion Regulation Scale (DERS) were used to collect data. The validity of the questionnaires was calculated and confirmed using factor analysis and the reliability was calculated using Cronbach's alpha. The data were analyzed using descriptive and inferential statistical indicators, including simple regression, structural equation modeling and confirmatory factor analysis, using SPSS software version 16.0 and AMOS software version 22.0.

Data analysis through structural equation modeling of the results showed the effect of the difficulty in emotional regulation on quality of school life (β=0.32, p <0.001) is significant and inverse and the effect of components of difficulty in emotional regulation on quality of school life is significant and inverse (p <0.001).

According to the results, the components of difficulty in emotional regulation have significant and inverse effects on the quality of school life and also there is a significant and inverse effect between the components of difficulty in emotional regulation with quality of school life.