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Introduction: It is believed that tubulointerstitial inflammation plays a role in the formation of renal scarring secondary to acute pyelonephritis (APN). Vitamin A is an anti-inflammatory agent that is involved in the re-epithelialization of damaged mucosal surfaces.Objective: The aim of this study was to evaluate the efficacy of vitamin A supplementation in combination with antibiotics for improving urinary tract infections (UTIs) symptoms and preventing renal scarring in girls with APN.Study Design: This randomized, double-blind, placebo-controlled clinical trial was conducted on 90 girls aged 2 to 12 years old between 2015 and 2017. Patients with UTIs and first episode of APN diagnosed based on 99 mTc-DMSA scintigraphy (uptake defect) were assessed for eligibility. Patients were randomly divided into two groups that either received 10 days of oral vitamin A (intervention group) or 10 days of placebo (control group) in addition to antibiotics during the acute phase of infection. The clinical response was considered as the primary outcome [duration (positive days) of UTI symptoms during trial treatment period] and secondary outcomes (no change, improving and or worsening of 99 mTc-DMSA scan results 6 months after treatment from baseline). P < 0.05 was considered to be statistically significant.Results: Seventy-four patients (vitamin A group: 36 patients, placebo: 38 patients) were included in the analysis. The mean age was 5.25 ± 1 year old. Three patients (7.89%) in the placebo group and 2 patients (5.55%) in the vitamin A group had vesicoureteral reflux (VUR) (p = 0.114). Duration of fever (vitamin A group: 1.8 days, placebo: 3.1 days, p = 0.0026), urinary frequency (1.3 days vs. 2.8 days, p = 0.003) and poor feeding (2.3 days vs. 4.2 days, p = 0.005) were significantly lower in the vitamin A group. Following the second 99 mTc-DMSA scan, worsening of lesions was observed among 8 (22.2%) and 17 (44.7%) patients in the vitamin A and placebo groups, respectively (p = 0.003). 63.8% (23 patients) of the vitamin A group and 21% (8 patients) of placebo group showed lesion improving in the photopenic region. (P < 0.0001) There was no evidence of vitamin A intolerance.Discussion: Our results show the efficacy of vitamin A supplementation on reducing renal scarring secondary to APN and on fever, urinary frequency and poor feeding duration in girls with APN.Conclusion: Vitamin A supplementation is effective for improving the clinical symptoms of UTI and reducing renal injury and scarring following APN in girls with first APN. However, larger randomized clinical trials (RCTs) with longer follow up are needed to confirm these effects. [ABSTRACT FROM AUTHOR]

Introduction: Inherited and acquired renal tubular disorders including cystic Kidney disease, cystinosis, Bartter's syndrome, Liddle syndrome, Gordon syndrome, nephrogenic diabetes insipidus, and drug- induced tubular injury are the frequent causes of end stage renal disease (ESRD) in children manifesting with chronic kidney disease (CKD). This is a report of the etiology and incidence of tubulopathies in a cohort of Iranian children across the country. Materials and Methods: This descriptive observational study was conducted from March 2013 to October 2013. A list of tubulopathy disorders was emailed to 70 members of the Iranian Society of Pediatric Nephrology in different provinces of Iran practicing in both university affiliated and non- affiliated hospitals. They were requested to report the number of patients with specific International Classification of Disease (ICD-10) codes admitted to their hospitals between 2006 and 2013. Data are presented as numbers and percentages. Results: Of 31 participating centers, 23 completed and returned the spreadsheets. Of the 2940 reported cases, the three most frequent tubulopathies were renal tubular acidosis (RTA) (33%), calcium disorders (27%), and cystic diseases (17%). Considering Tehran and Shiraz as referral centers, RTA and cystinosis were mostly reported from Kerman and Urmia, respectively. Furthermore, idiopathic hypercalciuria, cystinuria, and hyperoxaluria were the most common causes of hereditary kidney stone in 281 children reported from Bandarabas, Tabriz, and Shiraz, respectively Conclusions: Our findings regarding the high incidence and different etiologies of inherited tubulopathies may provide a basis for designing targeted therapeutic interventions in the future and strategies for gene therapy of these complex disorders. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Febrile seizure is one of the most prevalent childhood convulsions with the most common age of onset at 14-18 mo old. Fever decreases the brain threshold for seizure. Attention Deficit Hyperactivity Disorder (ADHD) is also a neurologic-behavioral problem defined by attention deficit and hyperactivity according to DSM-IV criteria in which the child must have these signs in two different environments. There is controversy on the possible relation between febrile seizure and ADHD; while some studies approve a strong relation, some exclude any relation and some attribute ADHD to the side effects of other reasons. MATERIALS & METHODS: This descriptive-analytic study enrolled all children of 3-12 yr old with febrile seizure (according to Nelson Pediatrics Textbook diagnosed by the pediatrician in charge) referring to Amir Kabir Hospital, Arak, central Iran in 2010-2011. Overall, 103 of them with no corporeal or psychological disorder (like depression, anxiety, schizophrenia and other CNS maternal disease) were compared to 103 children of the same age and gender admitted due to disease other than febrile seizure utilizing DSM IV criteria for ADHD. Data were analyzed using SPSS version 18. RESULTS: The hyperactivity disorder in the control and case group was 34.3% and 16.7%, respectively, denoted a significant relation between simple febrile seizure and hyperactivity. CONCLUSION: Hyperactivity has a significant relation with febrile seizure in male gender, making further investigation in these children prudent for early diagnosis and management. [ABSTRACT FROM AUTHOR]

Montelukast by inhibiting leukotriene receptors in the bladder can prevent the activation of mast cells. We investigated the effectiveness of Montelukast in reducing the symptoms of children with bladder pain syndrome (BPS). In this randomized clinical trial, children were allocated into groups of intervention (Montelukast and oxybutynin) and the control (oxybutynin). At the beginning and after 14 days, questions from mothers of children about their urinary condition were asked about the frequency of nocturnal enuresis, frequent urination, urinary incontinence, urinary urgency, and their pain severity. There was no significant difference between two groups in terms of frequency of nocturnal enuresis, frequent urination, urinary incontinence, and urinary urgency. Regarding the frequency of pain distribution, the frequency of pain-free people in the Montelukast group was higher than control group (84.4% vs 56.3%, P = .023). The results showed that adding Montelukast to oxybutynin has a significant decrease in pain in children with BPS., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Kidney damage can result from various factors, leading to structural and functional changes in the kidney. Acute kidney injury (AKI) refers to a sudden decline in kidney function, while chronic kidney disease involves a gradual deterioration lasting more than 3 months. Mechanisms of renal injury include impaired microcirculation, inflammation, and oxidative stress. Cysteinyl-leukotrienes (CysLTs) are inflammatory substances contributing to tissue damage. Montelukast, a leukotriene receptor antagonist, has shown potential renoprotective effects in experimental models of kidney injury., Methods: The authors conducted a scoping review using PubMed, Scopus, and Web of Science databases to identify relevant studies investigating the impact of montelukast on renal diseases. Articles published until 2022 were included and evaluated for quality. Data extraction and analysis were performed based on predetermined inclusion criteria., Results: The scoping review included 30 studies from 8 countries. Montelukast demonstrated therapeutic effects in various experimental models of nephrotoxicity and AKI induced by agents such as cisplatin, lipopolysaccharide, diclofenac, amikacin, Escherichia coli , cyclosporine, methotrexate, cobalt-60 gamma radiation, doxorubicin, and cadmium. Studies involving human subjects with nephrotic syndrome, pyelonephritis, and other renal diseases also reported positive outcomes with montelukast treatment. Montelukast exhibited anti-inflammatory, anti-apoptotic, antioxidant, and neutrophil-inhibiting properties, leading to improved kidney function and histopathological changes., Conclusions: Montelukast shows promise as a renoprotective medication, particularly in early-stage kidney injury. Its ability to mitigate inflammation, oxidative stress, and neutrophil infiltration contributes to its therapeutic effects. Further research is needed to explore the clinical applications and mechanisms underlying the renoprotective action of montelukast., Competing Interests: The authors disclose no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Febrile convulsion (FC) is the most prevalent type of seizure in children. Febrile diseases have been associated with alterations in kidney function and urine indices. Therefore, in this study, renal function and urine analysis were examined in children with simple FC. The study comprised children with simple FC who were referred to the Amirkabir hospital in Arak between 2020 and 2021. Children were examined for urinalysis and kidney function by assessing the estimated glomerular filtration rate (eGFR). A total of 157 patients with FC were admitted. Hematuria, proteinuria, and pyuria were detected in 8.9%, 1.9%, and 5.1% of cases, respectively. The urine cultures of 2 children were positive. Moreover, it was found that in simple FC, eGFR decreases regardless of gender ( P > .05), although kidney function decreases more in children older than 24 months. In conclusion, all children with FC must undergo renal function assessments. Furthermore, urinalysis and urine culture are advised to rule out infection.

Child abuse is a major global concern in terms of healthcare and social welfare. Child abuse is associated with numerous physical and mental health issues, including anxiety and depression. Overactive bladder (OAB) is a bladder storage functional disease defined by urine urgency with or without urge incontinence and is frequently accompanied by frequency and nocturia. This disorder's origin is not entirely understood. Since OAB can be caused by problems of nervous system maturation or behavioural disorders, its correlation with child maltreatment is possible., Objective: This study aimed to compare the occurrence of maltreatment in children with OAB to healthy children referred to Amirkabir hospital, Arak., Method: This study included 100 children with overactive bladder and 100 healthy children without overactive bladder (ages 5-12 years) as case and control groups, respectively. Children referred to paediatric clinic at Amirkabir hospital in Arak, were selected as participants. Child abuse domains including psychological/emotional, physical, and neglect were diagnosed using a standardized child abuse questionnaire answered by the children. Data were analyzed by SPSS version χ 2 test, t -test, and Pearson's χ 2 test., Results: The Prevalence of child maltreatment was significantly greater in the case group (31 cases) than in the control group (12 cases) ( P <0.0001). The psychological/emotional domain of child abuse was observed in 19 case group participants and 4 control group participants ( P =0.001), and the physical domain was observed in 29 case group participants and 11 control group participants ( P <0.0001). Despite this considerable difference, 10 and 8 children in the case and control groups, respectively, scored positively for the neglect domain ( P =0.112)., Conclusion: Child abuse is considerably more common in children with OAB than in healthy children, especially in the psycho-emotional and physical domains, and it is possible to prevent and treat this condition by notifying parents. Children with OAB should also be subjected to child abuse screening., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

In bacterial meningitis, the Viridans streptococci group is not considered a prevalent pathogen. In contrast, the S. viridans group may cause endocarditis and fatal infections in immunocompromised children and adults. We report a 5-year-old immunocompetent boy with signs of meningitis. The CSF tested positive for meningitis with streptococcus viridans., Competing Interests: The authors have no conflict of interests to declare., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Renal insufficiency is one of the inevitable complications in patients with Wilms tumor (WT). The purpose of this study was to assess the renal function in children with WT at baseline and every 3 months to 2 years., Materials and Methods: In a descriptive-analytical study from 2018 to 2020, 48 children with WT were included in the study. Urine creatinine (U Cr ), serum calcium (S Cr ), blood pressure (BP), estimated glomerular filtration rate (eGFR), and urinary protein (U Pro ) were evaluated at baseline and every 3 months during the study. Spot U Ca /U Cr and spot U Pro /U Cr ratio were calculated. Kidney ultrasonography was used in all patients. Independent Sample t -test and Chi-square tests were utilized to compare age and sex, respectively., Results: The mean age of patients at follow-up was 7.3 years. There was no significant difference in mean U Cr , S Cr , eGFR, 24-h U Pro , U Ca /U Cr ratio, and spot U Pro /U Cr ratio at baseline and end of study ( P baseline > 0.05, P end of study > 0.05). Analysis of kidney size showed a statistical association with tumor stage ( P < 0.05). Comparison of the kidney size in patients showed that there is a statistically significant difference ( P < 0.0001) at baseline and end of the study., Conclusion: This study showed that as WT progressed, the size of the kidneys increases without any renal insufficiency. Therefore, it seems that urinalysis of patients with WT along with sonography is necessary to determine renal insufficiency and the use of ultrasound alone to determine kidney insufficiency is not recommended., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Advanced Biomedical Research.)

Background: In patients with β-thalassemia major (TM), one of the long-term complications of regular blood transfusion is renal dysfunction. The purpose of the current study was to evaluate the renal function in TM patients receiving Exjade ® dispersible tablets and a new film-coated tablet formulation of deferasirox (Nanojade ® )., Materials and Methods: In this descriptive cross-sectional study, a total of 80 TM patients aged 11-48-year-old entered the study. Patients received 20-30 mg/kg/d (single dose) Exjade® (Exjade group, n = 40) and Nanojade® (Nanojade group, n = 40) orally. To evaluated renal function, serum creatinine (S Cr ), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), 24-h urine protein (U Pro ), U Ca /U Cr , spot U Pro /U Cr ratio, and serum ferritin were calculated at baseline and every 3 months to 9 months., Results: There was no significant difference in S Cr , BUN, eGFR, 24-h U Pro , U Pro /U Cr ratio, U Ca /U Cr ratio, and serum ferritin between groups at baseline and end of study ( P baseline > 0.05, P end of study > 0.05). There was no significant difference in proteinuria between groups at baseline and end of study ( P baseline > 0.05, P end of study > 0.05)., Conclusions: The proportion of S Cr , BUN, eGFR, 24-h U Pro , U Pro /U Cr ratio, and U Ca /U Cr ratio was not significantly different in TM patients treated with Nanojade ® compared to patients' received Exjade ® . Nanojade ® had similar effects to Exjade ® , and therefore, the use of Nanojade ® is safe in TM patients and does not seem to be associated with increased renal failure, proteinuria, and hypercalciuria., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Advanced Biomedical Research.)

Purpose: Knowing the epidemiological aspects of chronic kidney disease (CKD) in children is crucial for early recognition, identification of reversible causes, and prognosis. Here, we report the epidemiological characteristics of childhood CKD in Iran., Materials and Methods: This cross-sectional study was conducted during 1991 - 2009. The data were collected using the information in the Iranian Pediatric Registry of Chronic Kidney Disease (IPRCKD) core dataset., Results: A total of 1247 children were registered. The mean age of the children at registration was 0.69 ± 4.72 years (range, 0.25 -18 years), 7.79 ± 3.18 years for hemodialysis (HD), 4.24 ± 1.86 years for continuous ambulatory peritoneal dialysis (CAPD), and 3.4±1.95 years for the children who underwent the renal transplantation (RT) (P < .001). The mean year of follow-up was 7.19 ± 4.65 years. The mean annual incidence of CKD 2-5 stages was 3.34 per million age-related population (pmarp). The mean prevalence of CKD 2-5 stages was 21.95 (pmarp). The cumulative 1-, 5-, and 10-year patients' survival rates were 98.3%, 90.7%, and 84.8%, respectively. The etiology of the CKD included the congenital anomalies of the kidney and urinary tract (CAKUT) (40.01%), glomerulopathy (19.00%), unknown cause (18.28%), and cystic/hereditary/congenital disease (11.14%)., Conclusion: The incidence and prevalence rate of pediatric CKD in Iran is relatively lower than those reported in Europe and other similar studies. CAKUT was the main cause of the CKD. Appropriate management of CAKUT including early urological intervention is required to preserve the renal function. Herein, the long-term survival rate was higher among the children with CKD than the literature.

Introduction: Cefotaxime is one of the third generation cephalosporins, which is used against many infections. This drug has a urinary excretion and potentially may have nephrotoxic effects. Hypercalciuria can cause important complications, including the formation of kidney stones. In the recent study, we decided to evaluate hypercalciuria in children receiving cefotaxime., Materials and Methods: This case-control study was conducted in Amirkabir hospital (Arak, Iran), where 30 children received intravenous cefotaxime were placed in the case group and 30 children without intravenous administration of cefotaxime were included in the control group. The ratio of calcium to creatinine was measured in both groups. Data were analyzed by SPSS software version 23., Results: This study showed that the ratios of male and female children in both the groups were 19 (63.3%) and 11 (36.7%) respectively, the mean age of children in the case group was 2.36 years with a standard deviation of 0.71 and the mean age of the children in the control group was 5.18 years with a standard deviation of 3.31. The ratios of urine calcium to creatinine in the case and control groups were 0.90 with a standard deviation of 1.79 and 0.37 with a standard deviation of 0.44 ( P value = 0.003)., Conclusion: According to the above results, it is concluded that receiving intravenous cefotaxime may increase calcium to creatinine ratio in children., Competing Interests: There are no conflicts of interest.

Objective: Febrile seizure is one of the most prevalent childhood convulsions with the most common age of onset at 14-18 mo old. Fever decreases the brain threshold for seizure. Attention Deficit Hyperactivity Disorder (ADHD) is also a neurologic-behavioral problem defined by attention deficit and hyperactivity according to DSM-IV criteria in which the child must have these signs in two different environments. There is controversy on the possible relation between febrile seizure and ADHD; while some studies approve a strong relation, some exclude any relation and some attribute ADHD to the side effects of other reasons., Materials & Methods: This descriptive-analytic study enrolled all children of 3-12 yr old with febrile seizure (according to Nelson Pediatrics Textbook diagnosed by the pediatrician in charge) referring to Amir Kabir Hospital, Arak, central Iran in 2010-2011. Overall, 103 of them with no corporeal or psychological disorder (like depression, anxiety, schizophrenia and other CNS maternal disease) were compared to 103 children of the same age and gender admitted due to disease other than febrile seizure utilizing DSM IV criteria for ADHD. Data were analyzed using SPSS version 18., Results: The hyperactivity disorder in the control and case group was 34.3% and 16.7%, respectively, denoted a significant relation between simple febrile seizure and hyperactivity., Conclusion: Hyperactivity has a significant relation with febrile seizure in male gender, making further investigation in these children prudent for early diagnosis and management.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood psychiatric disorder. This disorder is more prevalent in some chronic diseases., Objectives: To investigate ADHD in children with overactive bladder., Patients and Methods: A number of 92 children with overactive bladder and 92 healthy children without overactive bladder (age range of both groups 5 to 12 years old) were included in this study as case and control groups, respectively. Participants were selected from children who had referred to a pediatric clinic in Arak city, Iran. ADHD types (inattentive, hyperactive-impulsive, and mixed) were diagnosed by Conner's Parent Rating Scale and Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM-IV-TR) criteria. Data were analyzed by chi-square and t tests., Results: In both groups, 51 children (27.7%) had ADHD. The prevalence of ADHD in the case group (33 cases, 35.9%) was significantly higher than the control group (18 cases, 19.6%) (P = 0.021). Inattentive ADHD was observed in 22 participants (23.9%) of the case group and nine participants of the control group (9.7%) (P = 0.047). Despite this significant difference, three (3.2%) and four (4.3%) children were affected by hyperactive-impulsive ADHD (P = 0.73), and eight (8.6%) and five (5.4%) children were affected by mixed ADHD (P = 0.42) in the case and control groups, respectively., Conclusion: ADHD bladder is significantly more common in children with overactive bladder than healthy children. The observed correlation between ADHD and overactive bladder makes psychological counseling mandatory in children with overactive bladder.

Background: Clinical reasoning process leads clinician to get purposeful steps from signs and symptoms toward diagnosis and treatment. This research intends to investigate the effect of teaching clinical reasoning on problem-solving skills of medical students., Methods: This research is a semi-experimental study. Nineteen Medical student of the pediatric ward as case group participated in a two-day workshop for training clinical reasoning. Before the workshop, they filled out Diagnostic Thinking Inventory (DTI) questionnaires. Fifteen days after the workshop the DTI questionnaire completed and "key feature" (KF) test and "clinical reasoning problem" (CRP) test was held. 23 Medical student as the control group, without passing the clinical reasoning workshop DTI questionnaire completed, and KF test and CRP test was held., Results: The average score of the DTI questionnaire in the control group was 162.04 and in the case group before the workshop was 153.26 and after the workshop was 181.68. Compare the average score of the DTI questionnaire before and after the workshop there is a significant difference. The difference between average KF test scores in the control and the case group was not significant but between average CRP test scores was significant., Conclusion: Clinical reasoning workshop is effectiveness in promoting problem-solving skills of students.

Introduction: Urinary tract infection (UTI) is very common in children. Precocious diagnosis and appropriate treatment are important because of the permanent disease complications. Zinc increases the response to treatment in many infections. In this study, we explored the effect of zinc in treating UTI., Materials and Methods: Two hundred children with UTI were divided into 2 groups of 100 who were comparable in terms of age, sex, urine laboratory profiles, and clinical signs and symptoms. The control group received a standard treatment protocol for UTI and the intervention group received oral zinc sulfate syrup plus routine treatment of UTI., Results: A faster recovery was observed in the patients receiving zinc, but abdominal pain was exacerbated by zinc and lasted longer. Three months after the treatment, there was no significant difference between the two groups in the time of fever stop and negative urine culture., Conclusions: In children with UTI, zinc supplementation has a positive effect in ameliorating severe dysuria and urinary frequency while the use of this medication is not recommended in the presence of abdominal pain.

Introduction: Enuresis is defined as the repeated voiding of urine into clothes or bed at least twice a week for at least 3 consecutive months in a child who is at least 5 years of age. The behavior is not due exclusively to the direct physiologic effect of a substance or a general medical condition. Diurnal enuresis defines wetting, whereas awake and nocturnal enuresis refers to voiding during sleep. Primary enuresis occurs in children who have never been consistently dry through the night, whereas secondary enuresis refers the resumption of wetting after at least 6 months of dryness. Monosymptomatic enuresis has no associated daytime symptoms, and nonmonosymptomatic enuresis, which is more common, often has at least one subtle daytime symptom. Monosymptomatic enuresis is rarely associated with significant organic underlying abnormalities. Obsessive-compulsive disorder (OCD) is a chronic disabling illness characterized by repetitive, ritualistic behaviors over which the patients have little or no control. The purpose of this study was to investigate the relationship between OCD and nonmonosymptomatic nocturnal enuresis (NMNE)., Materials and Methods: In this case-control study, we evaluated 186 children aged 6-17 years old who were visited in the pediatric clinics of Amir Kabir Hospital, Arak, Iran. The control group included 93 healthy children, and the case group included 93 age- and sex-matched children with stage 1-3 chronic kidney disease (CKD). Then, the children's behavioral status was evaluated using the Children's Yale-Brown Obsessive-Compulsive Scale., Results: The difference in compulsion was significant ( P = 0.021), whereas the difference in obsession was significant between the two groups ( P = 0.013). The most common symptom in CKD children with compulsion was silent repetition of words., Conclusion: Compulsive and obsessive are more common in NMNE versus healthy children. The observed correlation between compulsive-obsessive and NMNE makes psychological counseling mandatory in children with NMNE.

Background: Nocturnal enuresis, often called bedwetting or sleep wetting, is a common problem in children after the age of five and may lead to symptoms such as infection, incontinence and frequent urination. This problem refers to a state in which children after the age of five have no control of their urine for six continuous months and it cannot be attributed to any organic factors or drug use., Objectives: In this study we aimed to study generalized anxiety disorder as one of the possible causes of primary nocturnal enuresis., Materials and Methods: In this case-control study 180 children with primary nocturnal enuresis and same number of healthy children with a mean age of 7 - 17 years old with the same demographic characteristics were selected. The study took place at Amir Kabir hospital of Arak, Iran during year 2014. After collecting the information, diagnosis was verified based on the diagnostic and statistical manual of mental disorders (DSM) IV-TR criteria. Results were analyzed using the SPSS software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, version 20.0. Armonk, NY: IBM Corp.)., Results: Frequency of generalized anxiety disorder, panic disorder, school phobia, social anxiety, separation anxiety, history of anxiety in mother, history of primary nocturnal enuresis in parent's family and body mass index had a significant difference between the two groups (P = 0.005)., Conclusions: With the results obtained from this study we could say that there was a clear significant difference between the two control and patient groups for all subgroups of anxiety disorders such as generalized anxiety disorder and their relationship with primary nocturnal enuresis. Given the higher prevalence of generalized anxiety disorder, panic disorder, school phobia, social anxiety, separation anxiety and comparison with healthy children, it is recommended for all children with primary nocturnal enuresis to be investigated and treated for generalized anxiety disorder.

Introduction: Urinary tract infection is the most common genitourinary disease in children so about 40% of the children with urinary tract infection suffering from reflux that caused some consequences such as pyelonephritis and kidney parenchymal injury., Objectives: This research was conducted to compare the timing of voiding cystourethrogram (VCUG) in children with urinary tract infection in first week and after the first week of urinary tract infection., Patients and Methods: This research is a case-control study that both case and control groups include 208 children from 1 month to 12 years old with the complain of urinary tract infection. In case group, the VCUG was performed at the first week of infection and in control group, the VCUG was performed after the first week of infection., Results: complication such as dysuria was observed in two-thirds of children who VCUG was performed during first week after urinary tract infection. Parents stress in case group was more than the other (P=0.015). For overall, the incidence of reflux in case and control groups was 49.5% and 50%, respectively. The mean of reflux grading in right kidney in case group was lower than control group resulting in significant differences between two groups., Conclusion: According to higher grade of stress in parents and complications due to VCUG at the first week of urinary tract infection, it is suggested that VCUG be conducted on selective patients in the hospital at the first week of urinary tract infection and during hospitalization.

Background: Chronic kidney disease (CKD) is a common medical condition among children and obsessive-compulsive disorder (OCD) is a frequent, chronic, costly, and disabling disorder among them., Objectives: The aim of this study was to investigate obsessive-compulsive disorder (OCD) in children with early stages of CKD, and to compare it with the occurrence of OCD in healthy children., Patients and Methods: In this case-control study, we evaluated 160 children aged 7 to 17 years old who were visited in the pediatric clinics of Amir-Kabir hospital, Arak, Iran. The control group consisted of 80 healthy children and the case group included 80 children with Stage 1 to 3 CKD. The ages and sex of the children in the two groups were matched. OCD in children was evaluated using the obsessive compulsive inventory-child version (OCI-CV)., Results: The mean scores of doubting/checking (case: 3.52 ± 2.54, control: 2.5 ± 2.32, P = 0.007) and ordering (case: 2.59 ± 1.81, control: 1.5 ± 2.56, P = 0.005) in the children with CKD was significantly higher than in the healthy ones. Moreover, the mean total scores for the OCI-CV of the children with CKD at 15.32 ± 7.69 was significantly higher than the scores of the healthy ones at 11.12 ± 2.54 (P = 0.021). There was a significant correlation between the CKD duration and doubting/checking (P = 0.004, correlation coefficient (CC): 0.4), obsessing (P = 0.06, CC: 0.02), washing (P = 0.031, CC: 0.8), ordering (P = 0.001, CC: 0.2), and the total scores of the OCI-CV questionnaire (P = 0.04, CC: 0.4)., Conclusions: The risk of OCD in children with CKD is significantly higher than that in healthy children. Although the results seem to suggest that psychiatric intervention can be helpful in treating OCD in children with CKD, further investigation into the medical condition is required so as to obtain more definitive conclusions.

Background: Nephrolithiasis in children is associated with a high rate of complications and recurrence., Objectives: Since some evidences reported that zinc has an important place amongst inhibitors of crystallization and crystal growth, we decided to assess the effectiveness of oral zinc sulfate as adjuvant treatment in children with nephrolithiasis., Patients and Methods: This was a randomized, double-blind, placebo-controlled clinical trial. 102 children in the age range 1 month to 11 years with first nephrolithiasis were recruited. Patients were randomly divided into two equal groups (intervention and control groups). Intervention group received conservative measures for stones and 1 mg/kg/day (maximum 20 mg/day) oral zinc sulfate syrup for 3 months. Control group received placebo in addition to conservative measures, also for 3 months. Patients were followed up by ultrasonography for 9 months, in 5 steps (at the end of 1st, 2nd, 3rd, 6th and 9th month after treatment) assessing size and number of stones in the kidneys., Results: Only at the end of the first month, the average number (intervention: 1.15 ± 3.78, control: 1.3 ± 2.84) (P = 0.001) and size (cm) (intervention: 0.51 ± 1.76, control: 0.62 ± 1.39) (P = 0.001) of stones was significantly lower in the intervention group, and in other points there was no significant therapeutic efficacy in oral zinc adjuvant treatment compared to conservative treatment alone. Also, during the 9-month follow-up, the number and size of stones in both groups decreased significantly (both: P < 0.0001) in a way that the decrease in the intervention group showed no difference with the control group., Conclusions: Adjuvant treatment with zinc is not more effective than consecutive treatment in children with nephrolithiasis. However, further studies are recommended due to the lack of clinical evidence in this field.

Introduction: Congenital hypothyroidism (CH) may be significantly associated with congenital malformations. However, there is little evidence on the relationship between renal and urinary tract anomalies and CH., Objectives: The aim of this study was to compare the renal and upper urinary tract anomalies in children with and without primary CH (PCH)., Patients and Methods: This case-control study was conducted on 200 children aged 3 months to 1 year, referring to Amir-Kabir hospital, Arak, Iran. One hundred children with PCH, as the case group, and 100 children without CH, as the control group, were selected. For all children, ultrasonography and other diagnostic measures (if necessary) were performed to evaluate renal and upper urinary tract anomalies (ureter and bladder)., Results: The frequency of renal and upper urinary tract anomalies among 43 children with primary CH, with 83 cases (72.8%), was significantly higher than the frequency of anomalies among the 19 children in the control group, with 31 cases (27.1%) (OR = 3; CI 95%: 1.6-5.4; P = 0.001). Among the anomalies studied, only the differences in frequency of uretero-pelvic junction obstruction (UPJO) (OR = 6; CI 95%: 1.3-28; P = 0.018) and hydronephrosis (OR = 22; CI 95%: 5-95; P = 0.001) was significant between the two groups., Conclusion: Our study demonstrated that PCH is significantly associated with the frequency of congenital anomalies of the kidneys and upper urinary tracts. However, further studies are recommended to determine the necessity of conducting screening programs for anomalies of the kidneys and urinary tract in children with CH at birth.

Introduction: Hypercalciuria may be a sign of over active bladder, these symptoms may be treated if we get rid of hypercalciuria., Objectives: This paper is intended to get to the prevalence of hypercalciuria in girl kids with over active bladder., Patients and Methods: All patients with index of over active urinary bladder who admitted to Amir-Kabir hospital of Arak and children who have admitted without any particular disease just for a laboratory check were studied simultaneously. Urine sample was taken from both groups., Results: The prevalence of hypercalciuria in the group with normal urinary bladder was 22.6% and in the case group was 42.9%. Hypercalciuria was reported in 30 (22.6%) children of control group and 57 (42.9%) children of case group. Based on chi-square test, hypercalciuria distribution between the two groups is not homogeneous (P = 0.001). Mean calcium to creatinine ratios were 2.384330 ± 0.55694 (mg/mg) and 2.186552 ± 0.56714 (mg/mg) for control and case groups respectively and no significant difference is observed between the two groups (P = 0.976). Based on logistic regression test, there is a significant relationship between both case and control groups and the occurrence of hypercalciuria with 2.58 times more than control group observed in case group., Conclusion: Based on the high prevalence of hypercalciuria in case group, examination and treatment of hypercalciuria in patients with over active bladder may be effective.

Background: Idiopathic hypercalciuria (IHC) can be one of the causes of nocturnal enuresis (NE) and hydrochlorothiazide (HCT) ameliorates hypercalciuria., Objectives: The aim of this study was to assess the therapeutic efficacy of HCT in boys with primary monosymptomatic NE (PMNE)., Patients and Methods: This study was a randomized double-blind placebo-controlled clinical trial. A hundred boys with PMNE and IHC were randomly assigned into two groups of experimental (treated with HCT 1 mg/kg/day) and control and all patients were followed for 4 months for the number of wet-night episodes., Results: The mean numbers of wet-night episodes in the first (intervention: 8.34 ± 8.54, control: 9.1 ± 9.3, P = 0.3), second (7.1 ± 7.3, 7.9 ± 8.1, P = 0.4), third (7.8 ± 8, 7.9 ± 8.1, P = 0.1) and fourth (4.9 ± 5.1, 5.9 ± 6, P = 0.3) months were not significantly different between the two groups. However, the decrease in the average wet-night episodes during the 4 months of treatment in the intervention group (P = 0.019) unlike the control group. Not more significant compared to control group (P = 0.191). All patients who were treated by HCT became normocalciuric. However, in 21 patients the dose was increased to 2 mg/kg/day., Conclusions: Single daily dose of HCT is a safe and effective therapeutic option in the treatment of PMNE in children with IHC.

Introduction: Vesicoureteral reflux (VUR) is a backward flow of urine from bladder to ureter or kidney. Potential reflux is harmful because of kidney being faced with the hemodynamic high-pressure during urination. This project was carried out for high prevalence of VUR and delay in growth of children with chronic diseases. In case of growth disorder in children with this disease and its difference with healthy person, treatment can be tried by treating the growth disorder., Objectives: The purpose of this study is survey of children with VUR about growth and developmental impairment., Patients and Methods: All patients who performed voiding cystourethrogram (VCUG)because of UTI, divided into 2 groups, healthy and sick. History and checklist filled, patients' height and weight measured in a standard way and ASQ questionnaires adjusted to age, used for the studying development effect. The height and weight of children measured by standard meter and scale and used the curves adjusted to age and sex. Control group entered the study with the same characteristics of case group without VUR, however, their height and weight were recorded. The way of evolution studied according to Nelsons evolution table and ASQ questionnaire., Results: The both groups (total of 150 studied children) in the area of development of fine motor, gross motor and indicators of mean and percentile of height and weight and parents' literacy, had a significant difference (P< 0.05). It is can be due to better assessment and follow, higher education levels and better socioeconomic situation., Conclusion: Children with VUR, in terms of height and weight growth and index of gross and fine movements and communicate were better than normal children.

Introduction: Febrile seizure is an important issue in pediatric practice. Even some pediatricians do not have a proper approach to febrile seizure, making the sick child undergo complex laboratory tests or invasive procedures or even long-term treatment with anticonvulsant drugs. In spite of multiple studies, many controversies have still remained about the significance of febrile seizure. The goal of this study is to assess the prevalence distribution of routinely requested laboratory tests results in simple febrile seizure., Materials and Methods: In a descriptive study, 549 patients with simple febrile seizure were studied. The routine lab tests including complete blood count, electrolyte, urine analysis, and cerebrospinal fluid (CSF) analysis had already been performed for all patients and the results had been recorded in their medical data. These results were collected and statistically analyzed through SPSS software., Results: About 58.7% of our cases were male. Most of the cases were 12-24 months old and the mean body temperature of them was 38.2°C. 99.3% of blood sugar tests, 98% of blood calcium tests, 100% and 99.5% of sodium, and potassium tests, respectively, 100% of blood creatinine, 96.9% of blood urea nitrogen, and 99.1% of urine analysis tests were normal. CSF analysis was done in only 49 cases and the results were normal in all of them., Conclusion: The percentage of abnormal laboratory test results was not statistically significant in febrile seizure and shows that performing all these tests in all patients with simple febrile seizure as routine is not necessary.

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood psychiatric disorder. This disorder is more prevalent in some chronic disease., Objectives: The aim of this study was to investigate ADHD in children with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) and to compare the results with those of healthy children., Patients and Methods: This case-control study was conducted for six months (December 22, 2013 to June 21, 2014) on five to 16-year-old children, visiting the Pediatric Dialysis Unit of Amirkabir Hospital, Arak, Iran, and Taleghani Hospital, Kermanshah, Iran. A total of 100 children with ESRD who had undergone CAPD for at least six months and 100 healthy children were included in this study as case and control groups, respectively. ADHD was diagnosed by Conner's Parent Rating Scale-48 (CPRS-48) and DSM-IV-TR criteria, and was confirmed through consultation by psychologist. Data were analyzed by Binomial test in SPSS 18., Results: The ADHD inattentive type was observed in 16 cases (16%) with CAPD and five controls (5%) (P = 0.01). Moreover, ADHD hyperactive-impulsive type was observed in 27 cases (27%) with CAPD and seven controls (9%) (P = 0.002). Despite these significant differences, no children were diagnosed with ADHD combined type among all subjects., Conclusions: Inattentive type and hyperactive-impulsive type of ADHD are more prevalent in children with ESRD undergoing CAPD. Therefore screening methods for ADHD is necessary in these patients.

Introduction: Vitamin E is a fat-soluble vitamin that functions as an antioxidant. The aim of this study was to investigate the effects of vitamins E supplementation in combination with antibiotics for the treatment of girls with acute pyelonephritis., Materials and Methods: This double-blinded randomized controlled trial was conducted on 152 girls aged 5 to 12 years with a first acute pyelonephritis episode based on technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA). They were randomized to receive a 14-day treatment with only antibiotics (control group; n = 76) and 14-day treatment with supplements of vitamin E (intervention group; n = 76) in addition to the antibiotics. Patients' clinical symptoms were monitored for 14 days and urine culture was performed 3 to 4 days and 7 to 10 days after the start of the treatment and its completion, respectively. All of the girls once underwent DMSA scan 4 to 6 months after the treatment., Results: During the follow-up days, the mean frequency of fever (P = .01), urinary frequency (P = .001), urgency (P = .003), dribbling (P = .001), and urinary incontinence (P = .006) were significantly lower in the intervention group compared to the control group. There was no significant difference in the results of urine culture 3 to 4 days after the start of treatment (P = .16) and 7 to 10 days after its termination (P = .37). There was also no significant difference between the results of DMSA scan 4 to 6 months after the start of treatment (P = .31)., Conclusions: Vitamin E supplementation has a significant effect in ameliorating sign and symptoms of UTI. However, further studies are recommended to confirm these findings.