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Allgrove syndrome (triple A syndrome) is a rare autosomal recessive condition with adrenal insufficiency, achalasia and alacrima. This syndrome is caused by mutations in AAAS gene. In this article we introduce six patients of Allgrove syndrome, in whom genetic analysis of the triple A gene was used to identify gene mutation, DNA was extracted from blood samples. Exon 1 to 16 and some introns of the AAAS gene were amplified by polymerase chain reaction (PCR). PCR products were evaluated by complete nucleotide sequence analysis. After sequencing, alignment and analysis were carried out. In one patient we identified a IVS14 + 1 G > A mutation, which is previously reported. In 4 patients, we couldn't detect any mutation. We determined a new mutation (c.446 + 87del T) in the AAAS gene in a patient that this deletion causes splicing defect in intron 5 which results in a premature termination and non-functional ALADIN protein. In conclusion, since molecular genetic testing results may influence the therapy and prognosis of Allgrove patients, this paper contributes to understanding of the molecular basis of Allgrove syndrome in Iranian patients. [ABSTRACT FROM AUTHOR]

The Mashhad University of Medical Sciences and the Sheikh Hospital in Mashhad sponsored a Cleft Lip and Palate Workshop 30 April--1 May 2009. During the Workshop, 6 surgical cases were performed and televised live to the audience attending the conference. Two of those cases were unilateral cleft lip repairs. The surgical technique used to repair these patients by the primary author (JGM) is a hybrid technique. It has evolved over the last decade as a result of prior surgical literature as well as first hand observation of various surgical colleagues. The following manuscript describes the surgical technique used at the Cleft Workshop in a step-wise or atlas-like fashion. The technique portion of the paper describes the repair of the unilateral cleft lip and nasal deformity in roughly the order the first author typically performs the procedure. More importantly, the final section of the paper details the principles that form the foundation for the techniques described. [ABSTRACT FROM AUTHOR]

Objective: The paper presents a new trend of weight-for-height index of 2397 school children (1268 boys and 1129 girls) aged 6.5-11.5 years by sex in a representative sample from primary schools of Shiraz (Southern Iran) at an interval of 15 years (1988-2003) and its relation to the Center for Disease Control and Prevention (CDC) data (2000).Methods: The data relate to a multi-stage random sample of healthy school children in Shiraz, southern Iran, collected in 2002-2003 academic year. The mean±SD age of these children was 9.1±1.4 years. The weight and height were estimated as 28.2±6.9 kg and 131.3±9.6 cm, respectively. Cross-sectional weight-for-height curves were constructed for both sexes. Parametric Lambda-Median-Standard Deviation (LMS) method was applied to estimate weight-for-height centiles. Findings: Weight-for-height centiles for boys and girls were nearly close to each other, except for the children of older age in which boys' centiles lay below those of girls. Centiles of the present study lay above previous ones. In both sexes CDC weights were greater than those of Iranians for a given height. This discrepancy was more pronounced in extreme high centiles. Conclusion: The necessity for updating local weight-for-height reference data for clinical work in Iran is emphasized. The positive trend in weight-for-height had been influenced by socio-economic development and improvement of health indicators in Iran during the post war reconstruction period. [ABSTRACT FROM AUTHOR]

Context: Blood pressure (BP) tracks from childhood to adulthood, and has ethnic variations. Therefore, it is important to assess the situation of pediatric BP in different populations. This study aims to systematically review the studies conducted on BP in Iranian children and adolescents. Evidence Acquisition: We conducted a systematic review on published and national data about pediatric BP in Iran, our search was conducted in Pub Med, Medline, ISI, and Scopus, as well as in national databases including Scientific Information database (SID), IranMedex and Irandoc from 1990 to 2014. Results: We found 1373 records in the primary search including 840 from international and 533 from national databases. After selection and quality assessment phases, data were extracted from 36 papers and four national data sources. Mean systolic BP (SBP) varied from 90.1 ± 14 mmHg (95% CI 89.25, 90.94) to 120.2 ± 12.3 (118.98, 121.41) mmHg, and for diastolic BP (DBP) from 50.7 ± 11.4 (50.01, 51.38) to 79.2 ± 12.3 (77.95, 80.44) mmHg. The frequency of elevated BP had large variation in sub-national studies with rates as low as 0.4% (0.009, 1.98) for high SBP and as high as 24.1% (20.8, 27.67) for high DBP. At national level, three surveys reported slightly raised rates of elevated BP from 2009 to 2012. Conclusions: The findings provide practical information on BP levels in Iranian pediatric population. Although differences exist on the findings of various studies, this review underscores the necessity of tracking BP from childhood, and implementing interventions for primordial prevention of hypertension. [ABSTRACT FROM AUTHOR]

Background: Coronary heart diseases (CAD) and their risk factors are among the major causes of death in Iran. Since these risk factors begin to develop early in life, it is vital to diagnose those newborns at high risk of CAD. Objectives: The present study investigated the umbilical cord blood lipid profile of term and preterm neonates. Methods: In this cross-sectional study, the lipid profiles of 292 neonates, of which 276 were term and 16 preterm, were examined at a teaching hospital. Results: The lipid profile results of total cholesterol, triglycerides, high density lipoprotein, and low density lipoprotein were 69.8, 34.9, 23.6, and 31.5 in term neonates and 80.5, 25.5, 25.1, and 38 in preterm neonates, respectively. Conclusions: According to the current paper, the lipid profiles of eastern Iranian neonates were similar to those reported in global studies. Moreover, except for triglycerides in the female neonates, lipid profiles were significantly higher among the male neonates. [ABSTRACT FROM AUTHOR]

Context: Hepatitis C is one of the most dangerous viral infections causing chronic liver disease. Objectives: The current study aimed to estimate the pooled prevalence of hepatitis C in Iranian prisoners. Evidence Acquisition: Articles were identified through searching international databases, including PubMed, Scopus, Elsevier, Google Scholar, andWeb of Science and Iranian databases, including Scientific Information Database (SID), Health.barakatkns, Iran-Doc, Civilica, and MagIran. We systematically reviewed all studies reporting the prevalence of HCV in Iranian prisoners. All studies conducted ELISA tests for the evaluation of HCV antibodies. In this study, a multilevel meta-analysis method was used to estimate the pooled prevalence. Results: The electronic search identified 147 records, 33 of which were relevant papers used for the pooled meta-analysis of HCV prevalence. Overall, the prevalence of HCV using a multilevel meta-analysis approach was 24.88% (95% CI = 19.12 - 31.69). The highest pooled HCVrate was related to Markazi province (59.47% [95% CI = 51.70 - 67.25]), while the lowest pooled HCVrate belonged to North Khorasan province (5.00% [95% CI = 2.44 - 7.55]). A decreasing HCV prevalence trend was observed between 1995 and 2018. Conclusions: The results of the study showed that the prevalence of HCVis significantly highamongprisoners in Iran. An enhanced training program is needed for prisoners and prison staff to improve the prisoners' health status. [ABSTRACT FROM AUTHOR]

Periodic fever syndromes are a group of diseases characterized by episodes of fever with healthy intervals between febrile episodes. In the first part of this paper, we presented a guideline for approaching patients with periodic fever and reviewed two common disorders with periodic fever in Iranian patients including familial Mediterranean fever (FMF) and periodic fever syndromes except for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA). In this part, we review other autoinflammatory disorders including hyper IgD, tumor necrosis factor receptor-associated periodic syndrome (TRAPS), cryopyrin associated periodic syndromes, autoinflammatory bone disorders and some other rare autoinflammatory disorders such as Sweet's and Blau syndromes. In cryopyrin associated periodic syndromes group, we discussed chronic infantile neurologic cutaneous and articular (CINCA) syndrome, Muckle-Wells syndrome and familial cold autoinflammatory syndrome. Autoinflammatory bone disorders are categorized to monogenic disorders such as pyogenic arthritis, pyoderma ;gangraenosum and acne (PAPA) syndrome, the deficiency of interleukine-1 receptor antagonist (DIRA) and Majeed syndrome and polygenic background or sporadic group such as chronic recurrent multifocal osteomyelitis (CRMO) or synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome are classified in sporadic group. Other autoinflammatory syndromes are rare causes of periodic fever in Iranian system registry. [ABSTRACT FROM AUTHOR]

Context: Despite various studies, there is no overall estimation about the efficacy of Hepatitis B virus (HBV) vaccine among healthcare workers (including healthcare personnel and healthcare students). The present meta-analysis study was conducted to investigate the efficacy of HBV vaccine in healthcare workers in Iran. Evidence Acquisition: This study was performed according to the PRISMA guidelines for systematic review and meta-analysis studies. A comprehensive search was conducted using national and international databases including: Magiran, Iranmedex, IranDoc, SID, Medlib, Scopus, Pubmed, Science Direct, Cochrane, Embase, Web of Science, Springer, wiley online library, Trials Register, DOAJ, and Google Scholar search engine without time limit up to 2016. Just papers which were qualified according to inclusion criteria were examined. The data were analyzed using meta-analysis method in STATA software Ver.11.1. Results: 1726 healthcare workers had been examined in 12 studies. The efficacy of HBV vaccine, 1 - 6 months after the injection of the third dose was determined to be 93.1% (95% CI: 90.3 - 97); this rate was 95.9% (95% CI: 93.1 - 98.6) for male and 91.3% (95% CI: 87.1% -95.5%) for female participants. HBV vaccine efficacy was 90.9% (95% CI: 86.5-95.3) for8 studies conducted on healthcare personnel and 97.3% (95% CI: 94.7-97.7) for3 studies on healthcare students. Conclusions: Immunogenicity of HBV vaccine was 90 - 97 in healthcare workers. Hence, the complete course of vaccination is sufficient forprevention of HBV and there is no need for booster dose or dose re-administration. [ABSTRACT FROM AUTHOR]

Reports of acute hepatitis with unknown origin in children have been published worldwide since April 2022. Due to the unfamiliar nature of the disease and the alarming trend of increasing reports worldwide, health workers must become aware of its diagnosis and treatment. Accordingly, the committee for developing guidelines for the Department of Pediatrics, Tehran University of Medical Sciences, prepared a clinical guideline for more efficient management of these patients. Due to the limited information about this disease, it has been tried to categorize and specify the required diagnostic and treatment measures based on the latest published data. Herein we express this algorithmic approach and diagnostic and therapeutic guidelines for acute hepatitis with unknown origin in children. [ABSTRACT FROM AUTHOR]

Background: In pediatrics, many drugs are used without marketing authorization. Recommendations are often based on clinical experience. Therefore, the risk of inappropriate prescription (IP) is high. It is necessary to have a tool for pediatric IP detection. Objectives: This study was performed to develop and validate a Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions (POPI) screening tool to facilitate its use in pediatric practice in Iran. Methods: Using forward- and backward-translation procedures, an efficient and effective tool was provided in the current study and clinical settings. The two-round Delphi technique established content validity. The criteria were then piloted in a cross-sectional study in the pediatric patients of Khorasan Razavi and East Azerbaijan in Iran. Results: A total of 104 explicit criteria (79 IPs and 25 omissions) were obtained and submitted to an 18-member expert panel (including 8 pharmacists, 2 clinical pharmacists, and 8 pediatricians working in a hospital or the community). Then, 98 out of the 104 criteria submitted to the experts were selected after two Delphi rounds (75 IPs and 23 omissions). The content validity and reliability of the tool were obtained by expert assessment (Cronbach's alpha for the entire criteria: 0.60). At least, the rate of one inappropriate prescribed medication was 69% in Mashhad, almost twice that of Tabriz (35%). Conclusions: The modified POPI criteria comprise the first screening tool to assess rational prescriptions for pediatric patients in hospital and outpatient settings. Clinical validation and reliability studies are needed and planned by the authors to evaluate the usability and reliability of this tool. [ABSTRACT FROM AUTHOR]

Context: The hepatitis C virus (HCV) is classified into seven genotypes and more than 100 subtypes. The treatment regimen, duration and efficacy of HCV therapy may vary according to the HCV genotype. Therefore, the HCV genotype should be determined prior to antiviral therapy. The objective of the current study was to review systematically all studies reporting the distribution of HCV genotypes in the countries that make up the Middle East. Evidence Acquisition: Articles were identified by searching electronic databases, including Scopus, PubMed and Google scholar, with timeline limits (articles published between 1995 and 2016). We carried out a systematic search regarding the distribution of HCV genotypes in Middle Eastern countries. Results: A total of 579 studies were identified by the electronic search. Of these, a total of 187 were identified as eligible papers including 60,319 patients who were meta-analyzed for pooled distribution of HCV genotypes. In Turkey, Israel, Cyprus, and Iran, genotype 1 was the most prevalent HCV genotype with rates of 82% (95% CI, 82%-83%), 68% (95% CI, 67%-69%), 68% (95% CI, 59%-77%), and 55% (95% CI, 54%-55%), respectively. In Egypt, Iraq, Saudi Arabia, and Syria, HCV genotype 4 was the most common genotype with rates of 86% (95% CI, 85%-88%), 60% (95% CI, 56%-64%), 56% (95% CI, 54%-55%), and 57% (95% CI, 54%-61%), respectively. On the basis of adjusted data, HCV genotype 4 was the most prevalent genotype in the Middle East region, with a rate of 74.7% (95% CI, 73.4%-76%), followed by genotype 1 at 15.1% (95% CI, 14.1%-16%). Conclusions: Our results showed that HCV genotype 4 is the most prevalent genotype in the Middle East region. However, HCV genotype 1 is the most prevalent among non-Arab countries in the region including Turkey, Iran, Cyprus, and Israel. [ABSTRACT FROM AUTHOR]

Context: The hepatitis B virus (HBV) is a major global public health problem, affecting more than 2 billion people worldwide. Accurate and updated data on HBV prevalence is important for further planning to control the infection. The aim of this study was to update the prevalence estimate of HBV infection in the general population of Iran. Evidence Acquisition: A systematic review was done for data on the prevalence of HBV infection in the general Iranian population published between Jan. 1, 1990, and Jan. 1, 2016, in both international and national databases, including PubMed, Scopus, Web of Science, Scientific Information Database, IranMedex, and Magiran. All papers with clearly described time and location of the study, proper sampling strategies, and proper analysis methods were included in the present study. Data were extracted by two independent reviewers. Prevalence of HBV infection with a 95% confidence interval (CI) was calculated using Stata software, version 13. Results: The polled estimated prevalence of HBVinfection in the general population of Iranwas2.2% (95% CI: 1.9% - 2.6%). The highest prevalence of HBV infection (8.9%, 95% CI: 7.6% - 10.2%) was reported from Golestan province, and the lowest prevalence (0.7%, 95% CI: 0.4% - 1.1%) was seen in Kermanshah province. The prevalence of HBV infection was estimated at 3% (95% CI: 2.2% - 3.8%) for Iranian males and 1.7% (95% CI: 1.2% - 2.3%) for Iranian females. The prevalence of HBV infection in the general population of Iran was 2.9% (95% CI: 2.5% - 3.4%) before 2010 and 1.3% (95% CI: 0.9% - 1.7%) after 2010. Conclusions: In total, Iran was classified within the low--intermediateHBVprevalence areas (2% - 4%), while according to recent data (after 2010), Iran was classified within the low HBV prevalence areas (< 2%), indicating that preventive measures conducted in Iran have been effective. [ABSTRACT FROM AUTHOR]

Context: Hepatitis C virus (HCV) is a global public health problem and a major etiology of chronic liver disease, which may develop into cirrhosis and hepatocellular carcinoma. Genotypes of HCV indicate the route of acquisition, the clinical outcome, response to treatment, prognosis and control strategies. Objectives: The aim of this study was to estimate the overall prevalence and trend of HCV genotypes or subtypes in Iran Data Sources: A literature review was done for papers reporting HCV genotypes in Iranian patients in PubMed, Magiran, IranMedex, Scientific Information Databank, and Google scholar databases. Study Selection: Data were selected according to inclusion and exclusion criteria. Data Extraction: Data were abstracted by two independent authors. Data were analyzed based on random-effects model using the Meta R. Pooled statistical software. Prevalence of HCV genotypes in cities and provinces of Iran with 95% confidence interval (CI) were calculated. Results: Fifty-three articles published between 1999 and 31 June 2014 including 22952 HCV infected individuals were included in the meta-analysis. Subtype 1a was predominant with a rate of 39% (95% CI: 34-44%); followed by subtype 3a, 32% (95% CI: 26-39%); subtype 1b, 13% (95% CI: 10-15%); genotype 4, 5.18% (95% CI: 3.27-7.5%); and genotype 2, 3.6% (95% CI: 1.6-8.3%). Untypeable HCV had a rate of 0.11% (95% CI: 0.07-0.16%). Conclusions: The most frequent subtypes of HCV in Iran were 1a, 3a and 1b, respectively. This frequency differed in various provinces of Iran and fluctuated with time. It is important to determine the distribution of HCV genotypes in different geographical areas and its trend with time for epidemiological and patients' management purposes. [ABSTRACT FROM AUTHOR]

Objective: Unrecognized congenital hypothyroidism (CH) leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. In this systematic review, the local results of the national CH screening program in different provinces in Iran are reviewed and evaluated. Methods: Literature on the CH screening, the national databases including SID, Medlib, Iran Medex, Magiran as well as international databases including PubMed/Medline, ISI Web of Knowledge and web of science, EMBASE, SCOPUS and Google Scholar. Appraisal was guided by a checklist assessing clarity of aims and research questions. The 95% confidence intervals were calculated by I-square models. Meta regression was introduced to explore the heterogeneity between studies. Findings: We identified 25 samples including 1425124 neonates in our country. Data were Meta analyzed using random-effects models, and we found a TSH levels of 19633 babies in the first sampling were greater than the cut-off level (TSH ≥5mIU/L). The pooled recall rate was 0.014 (95 % CI: 0.013 - 0.015). According to Meta analysis the overall incidence of CH was 2/1000 (95% CI: .002 - .002). The incidence of CH did not appear to be increasing over time (P=0.08). Conclusion: Considering TSH ≥5mIU/L as a cut-off point for recalling neonates and low positive predictive value (14%) of this point shows that more investigation and research is needed for establishing accurate level of TSH as a criterion for recalling patients. [ABSTRACT FROM AUTHOR]

Background: Because of the high daily mortality and quarantine procedures, coronavirus disease 2019 (COVID-19) can cause several psychological problems, especially in younger people. Objectives: Since most studies have mainly focused on physical problems of COVID-19 and they have neglected children in their analysis, this study aimed to evaluate the frequency and severity of stress symptoms and associated factors amongst children and adolescents aged 4 - 18 years during the COVID-19 outbreak. Methods: Using a convenience sampling technique, this descriptive-analytic cross-sectional study was conducted in Shiraz, Iran, from March 2020 to June 2020. To collect data, the link of the online Children's Self-Reported Stress Symptoms Questionnaire was sent to eligible participants via SMS and WhatsApp. The data were analyzed using SPSS software version 21. Results: According to our results, 270, 77, and 16 cases had low, moderate, and severe stress, respectively. Age group, living with both parents, and birth rank had a significant relationship with the degree of stress. Furthermore, more than 50% of participants reported cognitive-emotional symptoms more than physical ones. There was a significant relationship between the age group and physical symptoms, the duration of quarantine with bad temper and sadness, and between no clear thoughts with mother's workplace and father's job. Conclusions: Generally, almost 25% of participants reported moderate-to-severe stress. The most common symptoms of stress in children and adolescents were worrying, anger, and weakness. Furthermore, older children, those being the first child, and children living with both parents were more exposed to stress. Therefore, these items should be included in the healthcare team's training. [ABSTRACT FROM AUTHOR]

Background: Micronutrients, such as vitamin A, vitamin D, iron, and zinc have several useful functions in the body and are necessary for normal growth and development, especially among children. Unfortunately, recent research has showed different levels of deficiency of these two vitamins among children. Objectives: This study aimed to compare the prevalence of micronutrient deficiencies, including vitamin A, vitamin D, iron, and zinc, among under-2- and 6-year-old children in Iran in two National Integrated Micronutrient Surveys (NIMS-I, NIMS-II). Methods: In NIMS studies, sampling was done using a single-stage cluster sampling method. The country was divided into 11 study zones. Using simple random sampling, more than 4,400 individuals (about 400 samples in each zone) were included in each study (NIMS-I, NIMS-II). At least 4-mL venous blood samples were taken from all children and transferred to the central laboratory of Tehran University of Medical Sciences (TUMS) with special identification code for further analysis. Then, the levels of vitamin A, vitamin D, iron, and zinc were measured. Results: In NIMS-I, the prevalence of vitamin A deficiency among under-2-year-old children was 0.5%, which significantly increased to 18.3% in NIMS-II. Regarding vitamin D deficiency, the rate of deficiency was 3.7% in NIMS-I and 23.3% in NIMS-II, which was statistically significant. In none of the NIMS studies (I and II), vitamin A was measured in under-6-year-old children. Also, in the NIMS-I study, vitamin D was not measured among under-6-year-old children, and in NIMS-II study, the prevalence of vitamin D deficiency was 6l.8%. Zinc deficiency among under-2-year-old children in both studies was nearly the same (l9.l% vs. l9.4%); but in NIMS-II study, zinc deficiency among under-6-year-old children was 13.6%, which significantly decreased compared to the NIMS-I (31%). Iron deficiency status among under-2-year-old children significantly decreased from 37.8% in NIMS-I to 17.1% in NIMS-II. A significant reduction in iron deficiency status was also observed in the NIMS-II study compared to the NIMS-I in under-6-year-old children (9.9% in NIMS-II compared l8.2% in NIMS-I). Conclusions: The increase in both vitamin A and vitamin D deficiency rates in NIMS study is alarming. Due to the special roles of these two vitamins in health, special considerations and effective actions are needed in this respect. Data from two national studies indicated a decrease in the prevalence of iron deficiency in both age groups, which could be due to the successful implementation of nutritional intervention programs in Iran, such as iron supplementation and iron fortification. [ABSTRACT FROM AUTHOR]

Background: Liver transplantation is a life-saving intervention for many patients with end-stage liver disease. In the past, evaluation of successful liver transplantation was based on patients' survival rate. However, in recent years this evaluation has been based on patients' quality of life. Various instruments have been developed to evaluate patients' quality of life. Nonetheless, scholars still believe that it is crucial to develop a standardized and disease specific instrument for evaluating the quality of life in liver transplant recipients. Objectives: The aim of this paper was to describe the development and psychometric testing process of a quality of life instrument specific to liver transplant recipients. Materials and Methods: Initial items of this instrument were extracted from a conventional content analysis study, and then were completed with findings of related international literature. The face validity was assessed by interviewing with four liver transplant recipients, and the content validity was evaluated by eleven experts in the field of transplantation. The construct validity was achieved by involving 250 liver transplant recipients through exploratory factor analysis method, and reliability was calculated by Cronbach's alpha. Results: Three main factors with 40 items were extracted from the exploratory factor analysis: Health Satisfaction, Concerns, and Complications. Reliability of the instrument was confirmed (alpha = 0.922). Conclusions: Given the special considerations regarding liver transplant recipients, this questionnaire is more accurate in evaluating the success of liver transplantation. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease. Seven genotypes and more than 80 subtypes have been identified for HCV so far. To date, 10 subtypes (3a to 3i; and 3k) of HCV genotype 3 have been identified. In 2006, two HCV isolates were reported from Iran that belonged to a new subtype of genotype 3. However, considering the consensus proposal for HCV genotype nomenclature, the available sequences of the new subtype did not correspond to the regions that are required to be analyzed prior to subtype assignment. During a study on the molecular epidemiology of HCV in Iran, an HCV isolate (FSM165) which seemed to belong to a new subtype of genotype 3 was obtained from a patient residing in Tehran, Iran. Objectives: The aim of this study was to assess the relatedness of isolate FM165 together with several sequences retrieved from the database to the new HCV-3 subtype reported from Iran in 2006. Materials and Methods: Various parts of the genome including the core/E1 region and two segments of the NS5B region were amplified and sequenced for isolate FSM165. Furthermore, using the Basic Local Alignment Search Tool (BLAST), the HCV database was searched for sequences that had a high level of similarity with sequences of FSM165 isolate and such sequences were retrieved from the database. To investigate the relatedness of isolate FSM165 and also the retrieved sequences to a new HCV-3 subtype reported previously, phylogenetic analyses were performed using the Kimura two-parameter model and the neighbor joining method. Results: Phylogenetic analysis of the partial NS5B region demonstrated the relatedness of isolate FSM165 to the new subtype reported from Iran in 2006. Moreover, some core/E1 and NS5B sequences that had a high level of similarity with FSM165 isolate were found through searching the HCV database. These sequences were previously either misclassified or could not be accurately classified. Phylogenetic analyses showed that all of the described sequences belonged to the new subtype of HCV genotype 3. Conclusions: Data suggests that the new subtype has a vast geographical distribution in Iran. The core/E1 and the NS5B sequences described in this paper can be used as references for the new HCV-3 subtype in future studies. [ABSTRACT FROM AUTHOR]

Objective: Febrile seizure (FS) as the most common form of seizures in childhood, affects 2-5% of all children across the world. The present study reviews available reports on FS recurrence frequency and evaluates its associated risk factors in Iran. Methods: We searched the Persian database such as: SID, MagIran, Medlip, Irandoc, Iranmedex as well as English databases PubMed, ISI, and Scopus. Random effects models were used to calculate 95% confidence intervals. Meta regression was introduced to explore the heterogeneity between studies. Findings: The overall FS recurrence rate was 20.9% [95% confidence interval (CI): 12.3-29.5%]. The frequency of FS simple and complex types was 69.3% (95% CI: 59.5-79.0) and 25.3% (95% CI: 19.6-31.0), respectively. A positive familial history of 28.8% (95% CI: 19.3-38.4%) was observed for childhood FS including 36.2% (95% CI: 27.3-39.6%) for the simple and 29.4% (95% CI: 23.1-33.5%) for the complex type. The heterogeneity of recurrent FS was significantly affected by sample size (P=0.026). Conclusion: Almost one-third of FS children had a positive familial history. The increased risk of recurrence in patients with symptomatic seizures needs to be fully considered by parents, physicians, nurses and health policy makers. [ABSTRACT FROM AUTHOR]

Objective: The paper aims to study the prevalence of depression in epileptic children and adolescents by reviewing the existing literature, looking for any association between depression in these children and their demographic or seizure related factors to highlight the potential risk factors for depression in epileptic children.Methods: A search of MEDLINE, NLM Gateway, Ovid and EMBASE was carried out to study original English language articles published during the last 15 years, focusing on only epileptic children and adolescents,studying of depression as co-morbidity of epilepsy, and describing demographic and epilepsy-related factors associated with depression.Findings: The 11 articles included in this study have reported data on 1095 epileptic children aged 4-19 years old and showed that the prevalence of depression has continued to be very common in epileptic children and adolescents, ranged from 5.2% to 39.6%. On the whole, the findings did not support the presence of an association between depression and demographic or seizure variables in children.Conclusion: Pediatricians and other physicians working with epileptic children should have a high index of suspicion for depression as a co-morbid condition in children with epilepsy. Early diagnosis and more comprehensive packages of care for depression in epileptic children will enable them to have a better quality of life. [ABSTRACT FROM AUTHOR]

Hepatitis B infection is the main cause of liver related mortality in many countries including Iran. Liver transplantation in cirrhosis due to HBV infection before 1990 was an absolute contraindication. Recurrent infection was a significant event in post liver transplant setting and resulted in increased risk of graft failure and death except successful transplanted individuals. Advances in antiviral prophylaxis have now made graft reinfection majority patients as a rare event. Graft and patient survival have been improved significantly during the past two decades, and consequences of transplantation for hepatitis B virus are now superior to those achieved for most other indications. This has encouraged many centers including the major liver transplantation center of Iran, in Shiraz, to provide liver transplantation to more patients with HBV related end stage liver disease. Management of these patients begins before transplantation along with special care after transplantation. There are some myths and doubts in the management of these patients and one should always balance the cost and efficiency. One of the major concerns is the high economic and social cost of recurrence and all possible efforts should be performed to avoid the ominous consequences of reinfection. Having a clear scientific grasp on the management of HBV cirrhosis before and after liver transplantation, options and protocols, and changing the concept which HBV infected are contraindicated ones for liver transplantation, and future hopes in increasing patients survival after liver transplantation using the new nucleosides analogues and availability of hepatitis B immunoglobulin in the transplantation setting. This scientific report paper outlines the insights communicated at the HBV and liver transplantation symposium during 10th Congress of the Iranian Society for Organ Transplantation, May 2011, Shiraz, Iran. [ABSTRACT FROM AUTHOR]

The rising concerns for future health burden of hepatitis C virus (HCV) in global scale has continuously encouraged preventing measures particularly public awareness programs. There is an increasing necessity for allocating HCV awareness issues in public scope, especially for high risk populations and patients. Proper knowledge of health care professionals and treating physicians and their attitude with regard to hepatitis C management is also crucial. Achieving this can be a constructive step forward in controlling and hopefully eradicating hepatitis C virus in our community. Having a clear scientific grasp on treatment options and protocols, the concept of "CURE" achievement in hepatitis C and the future hopes in enhancing virological response with the coming direct antiviral agents can significantly add to the current practices of treating hepatitis C. This scientific report paper outlines the insights communicated at the HCV symposium during the 4th Tehran Hepatitis Congress, November 2011, Tehran, Iran. [ABSTRACT FROM AUTHOR]

Context: Hepatitis B virus (HBV) is the most common disease commuted through blood transfusion. Occult hepatitis B infection (OBI) is a form of the disease which does not present Hepatitis B surface antigens (HBsAg) in the serum of patients; however, HBVDNA is detectable in the serum and hepatocytes of patients. OBI is an important risk factor to induce post transfusion hepatitis (PTH), cirrhosis, hepatocellular carcinoma (HCC) and reactivation of the HBV. Recently, several reports from various regions of the world have been published regarding PTH among blood recipients as well as HCC, and cirrhosis among patients who require permanent blood transfusion, including diseases such as hemophilia, hemodialysis and thalassemia. This form of the hepatitis also creates problems for individuals that are co-infected with other viruses such as HCV and HIV. To determine the prevalence of OBI among hemophilia, hemodialysis and thalassemia patients is important because it is a high risk factor for PTH, HCC and cirrhosis therefore, its detection is a critical strategy for most health care services. This review addresses recent information regarding prevalence of OBI in relation to the mentioned diseases. Evidence Acquisition: The data presented here was collected by searching the key words in Pubmed and Scopous databases Results: Our searching in the published papers revealed that OBI prevalence is frequent in patients receiving frequent blood transfusions. Conclusions: it seems that one of the main mechanisms for OBI transmission is most likely through infected blood and its component and evaluation of the prevalence of OBI in donors and patients, especially those with hemophilia and thalassemia should be foul considered. [ABSTRACT FROM AUTHOR]

Context: On the strength of epidemiological data,biological studies, and clinical findings, hepatitis C virus appears to be involved in the pathogenesis of a proportion of patients with non-Hodgkin lymphoma and cryoglobulinemia. Objectives: The aim of this paper is to review the published literature focused on the current knowledge concerning hepatitis C virus and its potential role in the production of non-Hodgkin lymphoma and cryoglobulinemia in susceptible individuals. Evidence Acquisition: In this review, databases such as pubMed, embase, ISI, and Iranian databases including Iranmedex, and SID were searched. Results: The results of this review indicate that HCV infection may be a likely cause of various B cell dysregulation disorders such as non-Hodgkin lymphoma and cryoglobulinemia. Conclusion: Based on current findings, it has been hypothesized that NHL and cryoglobulinemia in HCV infection may have an immune-mediated pathogenesis. In HCV infected patients, we showed an elevated risk of these two diseases. These finding suggested a possible role for chronic hepatitis C in the pathogenesis of NHL and cryoglobulinemia. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B virus (HBV) infection is an important health problem worldwide with critical outcomes. The nucleoside analog lamivudine (LMV) is a potent inhibitor of HBV polymer­ase and impedes HBV replication in patients with chronic hepatitis B. Treatment with LMV for long periods causes the appearance and reproduction of drug-resistant strains, rising to more than 40% after 2 years and to over 50% and 70% after 3 and 4 years, respectively.Objectives: Artificial neural networks (ANNs) were used to make predictions with regard to re­sistance phenotypes using biochemical and biophysical features of the YMDD sequence.Patients and Methods: The study population comprised patients who were intended for surgery in various hospitals in Tehran-Iran. An ACRS-PCR method was performed to distinguish muta­tions in the YMDD motif of HBV polymerase. In the training and testing stages, these parameters were used to identify the most promising optimal network. The ideal values of RMSE and MAE are zero, and a value near zero indicates better performance. The selection was performed using statistical accuracy measures, such as root mean square error (RMSE), coefficient of determina­tion (R2), and mean absolute error (MAE). The main purpose of this paper was to develop a new method based on ANNs to simulate HBV drug resistance using the physiochemical properties of the YMDD motif and compare its results with multiple regression models. Results: The results of the MLP in the training stage were 0.8834, 0.07, and 0.09 and 0.8465, 0.160.04 in the testing stage; for the total data, the values were 0.8549, 0.115, and 0.065, respec­tively. The MLP model predicts lamivudine resistance in HBV better than the MLR model. Conclusions: The ANN model can be used as an alternative method of predicting the outcome of HBV therapy. In a case study, the proposed model showed vigorous clusterization of predicted and observed drug responses. The current study was designed to develop an algorithm for pre­dicting drug resistance using chemiophysical data with artificially created neural networks. To this end, an intelligent and multidisciplinary program should be developed on the basis of the information to be gained on the essentials of different applications by similar investigations. This program will help design expert neural network architectures for each application auto­matically. [ABSTRACT FROM AUTHOR]

Objective: This paper presents the incidence rates of childhood cancers using the data obtained from Golestan population based cancer registry (GPCR) between 2004 and 2006. Methods: GPCR registers only primary cancers based on standard protocols of the international association of cancer registries (IACR). We collect data on newly diagnosed (incident) cancer cases from all public and private diagnostic and therapeutic centers of the whole province. CanReg-4 software was used for data entry and analysis. Findings: Totally 5076 cancer cases (all ages) were diagnosed in GPCR between 2004 and 2006. Of these, 139 (2.74%) were children (aged 0-14 years) with mean (±SD) age of 8.06 (±4.48) years. The age standardized incidence rates for childhood cancer were 119.8 and 78.3 per 1000000 person-years in male and female children, respectively. Leukemia was the most common childhood cancer in Golestan province of Iran. Lymphomas and central nervous system tumors were second and thirds ones, respectively. Conclusion: The incidence rates of childhood cancers were relatively high in Golestan province of Iran. So, controlling of childhood cancers should be mentioned as an important issue in health policy making in this area. [ABSTRACT FROM AUTHOR]

Background and Aims: There is no overall estimate of hepatitis C infection (HCV) in Iran. We reviewed all of the published and unpublished evidence related to HCV infection in Iran in order to accurately estimate the prevalence of HCV infection in the Iranian general population to inform future health system programs. Methods: In this systematic review, all papers, medical congresses, HCV-related reports, projects of Iranian research centers and medical universities, reports from the Deputy for Health Affairs (published or unpublished), and online theses about HCV in Iran were included. We selected descriptive and analytic cross-sectional studies and surveys related to the prevalence of HCV infection in the Iranian general population between 2001 and 2008 that have sufficiently declared objectives, proper sampling methods with identical and valid measurement instruments for all study subjects and proper analysis methods regarding sampling design and demographic adjustments. We used a survey data analysis method to estimate the national prevalence rate. Results: From the 6,431 studies we investigated, eight eligible studies reported a prevalence of HCV infection in the general population. They were from six (out of 30) provinces, in which about 43 percent of the country's population lives. We calculated that the HCV infection prevalence rate in Iran is 0.16% (95% confidence interval [CI]: 0%-0.59%). Conclusions: In comparison with similar studies, the prevalence of HCV infection in Iran is low. This might be a result of having prevention programs for high-risk groups and strict blood screening programs. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis B virus (HBV) infection is a worldwide problem. It is estimated that 400 million people are suffering from this infection. We conducted a systematic review to put all evidence on HBV infection in I.R. Iran and to make an accurate estimate of HBV infection prevalence in Iran for further planning to control the infection. Study Design: Meta-analysis and survey data analysis of all national and international papers, theses, congresses, reports, Iranian medical universities projects, research centers, reports of Deputy for Health affairs (published or unpublished). Setting & Population: Iranian general population with positive HBsAg in blood samples Selection Criteria for Studies: All descriptive/analytical cross-sectional studies/surveys from April 2001 to March 2007 that have sufficiently declared objectives, proper sampling method with identical and valid measurement instruments for all study subjects and proper analysis methods regarding sampling design and demographic adjustments Outcomes: Presence of positive HBsAg in blood samples of study samples Results: Fourteen studies met the inclusion criteria. They were from 7 (out of 30) provinces in which about 40 percent of the country population live. These provinces (HBsAg positive prevalence) were Golestan (6.3%), Tehran (2.2%), East Azarbaijan (1.3%), Hamedan (2.3%), Isfahan (1.3%), Kermanshah (1.3%) and Hormozgan (2.4%). The HBV infection prevalence in Iran is estimated to be 2.14 percent (95%CI: 1.92-2.35), in men and women 2.55 percent (95%CI: 2.25-2.85) and 2.03 percent (95%CI: 1.6-2.46 percent) respectively. Conclusions: About 1.5 million people in Iran are living with HBV infection (mild to moderate prevalence according to WHO classification) and it is assumed that 15% to 40% of them are at risk of developing cirrhosis and/or hepatocellular carcinoma (HCC) without intervention. The prevalence of HBV infection has been reported higher in more recent studies compared to the study in 2000-2001. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, causing a significant public health disaster. Objectives: The present study aimed to evaluate the clinical features and laboratory data of neonates born to mothers with COVID- 19. Methods: A retrospective multicenter cohort study was conducted from March 20 to September 5, 2020, on all neonates born to mothers with positive real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 or clinically suspected COVID-19. Neonates enrolled in this study were from five different hospitals affiliated with the Tehran University of Medical Sciences. All the newborns were tested for SARS-CoV-2 using nasopharyngeal swabs during the first 24 - 48 hours of life, and a second-time swabbing was performed as indicated at subsequent visits. All categorical data were manifested as frequency (%), and continuous data were shown as mean±SD. Results: Forty-four neonates born to 39 infected mothers were evaluated during the study period. Nineteen women had complications during pregnancy, including hypertensive disorders, gestational diabetes, preterm labor, etc. Besides, 54.5% of the neonates were born preterm. The mean gestational age and birth weight were 35.11 ± 4.01 weeks and 2,567 ± 898 g, respectively. Fifteen (34.1%) neonates were symptomatic at birth, and during the observation, more neonates became symptomatic. Finally, 27/44 (61.3%) neonates became symptomatic, and 17/44 remained asymptomatic. The most common clinical manifestations were respiratory distress (77.7%), followed by fever or hypothermia (18.5%), gastrointestinal problems (14.8%), and neurologic findings (3.7%). Also, the most common clinical feature of eight neonates with positive RT-PCR was respiratory distress, followed by neurologic symptoms, temperature instability, and gastrointestinal disorder, in sequence. Few abnormalities were seen in laboratory findings. Chest Xrays were abnormal in 22.2% of the neonates. Conclusions: The SARS-CoV-2 infection during pregnancy may cause severe maternal and neonatal morbidities. Neonates with positive SARS-CoV-2 may demonstrate a spectrum of clinical features. The most common feature of neonates born to mothers with COVID-19 was respiratory distress. [ABSTRACT FROM AUTHOR]

Introduction: Since mid-April 2020, infection with coronavirus disease of 2019 (COVID-19) has affected more than 2 million people worldwide. Little is known about the effects of COVID-19 infection on kidney transplant patients treated with immunosuppressive (IS) drugs. Case Presentation: Here, we report three Iranian pediatric kidney transplantation cases who acquired COVID-19 infection and were admitted to Hazrat Ali Asghar Hospital in Tehran, Iran, in March-April 2020 (first wave). They were treated with prednisolone, cyclosporine, and cellcept. All of them had gastrointestinal symptoms, and one patient also had respiratory symptoms. In two patients who had only gastrointestinal symptoms, chest radiographies were considered normal. They did not need the intensive care unit (ICU), ventilator respiratory support, and dialysis due to a temporary increase in serum creatinine and no change in urine volume. Cellcept was stopped and other medications continued. The patient, who had pulmonary and gastrointestinal symptoms, expressed more severe manifestations that led to ICU admission and dialysis. Prednisolone was increased to a stress dose and the other drugs were discontinued. Conclusions: Pulmonary manifestations significantly worsen the prognosis compared to gastrointestinal manifestations in pediatric kidney transplants with COVID-19. [ABSTRACT FROM AUTHOR]

COVID-19 as a viral infection is usually asymptomatic in children, but complication of this disease in children is not rare and may be fatal. Hyper inflammation of COVID-19 is a potential fatal in undiagnosed children. It is very similar to Kawasaki disease but with higher mortality and morbidity. Multisystem inflammatory syndrome in children (MIS-C) and multi-organ involvement was reported in hyper inflammation syndrome following COVID19. Herein we report our algorithmic approach to Kawasaki-like syndromes due to COVID-19 in our center. Based-on this approach we had no mortality during the last 5 months. [ABSTRACT FROM AUTHOR]

Background: Cystic fibrosis (CF) is an autosomal recessive disease characterized by respiratory, gastrointestinal, and reproductive tract problems. Patients with CF often suffer from chronic pulmonary infections due to the Pseudomonas aeruginosa, which frequently ends in pulmonary exacerbations. With their anti-inflammatory, anti-virulence, and anti-biofilm properties, macrolides such as azithromycin (AZM) play a beneficial role in the treatment of CF. Objectives: We evaluated the ability of biofilm formation among P. aeruginosa isolates from CF patients and compared the antibacterial and anti-biofilm effect of the AZM on them. Methods: Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of AZM against 21 P. aeruginosa isolates from Iranian CF patients were determined. Then, we investigated the ability of biofilm formation by P. aeruginosa and also anti-biofilm effect of AZM on biofilm producing P. aeruginosa isolates. Results: The results showed a high level of AZM MIC (≤ 512 µg/mL) and MBC (≤ 2048 µg/mL) against P. aeruginosa isolates. Most isolates (70%) were biofilm producers, 20% being strong producers. The AZM anti-biofilm effect showed that sub-MIC concentration (≤64 µg/mL) could inhibit biofilm production. Conclusions: P. aeruginosa isolated from CF patients showed a high level of MIC and MBC for AZM that indicated aweakanti-bacterial effect of AZM. However, AZM inhibited biofilm formation in low doses; this might lead to dangerous chronic pulmonary infection by P. aeruginosa. [ABSTRACT FROM AUTHOR]

Background: Health systems have adopted financing to enhance access to care for patients with cancer. The cost of acute lymphoblastic leukemia (ALL) treatment is a blurred image for hospitals and third party payers. The cost of each component of the care should be analyzed to differentiate justifiable cost and to act on wasteful practices. Objectives: Therefore, this is a study on the direct and indirect costs of ALL based on the United Kingdom protocol (UKALL), in pediatric ALL management in Iran. Methods: A retrospective study design was used to study children with ALL managed with UKALL protocol in specialized pediatric hospitals from 2010 - 2015. The data was collected from patients' medical records. Results: Total direct medical cost per patient was 8282 USD. Most of costs were from inpatient beds (3338 ± 1110 USD) and drug expenditures (2157 ± 1035 USD). The direct non-medical cost incurred by study participants was 1286.4 USD, the total indirect cost of productivity loss was 769.9. Conclusions: The cost of ALL management imposed huge treat on financial capability of peoples caring for children. The treats will affect the whole society and the health system of the country unless strategies are designed to contain the costs. The policy makers from the top level of the country to the service providers should be hand and glove to devise a suitable national ALL management protocol which will avert the observed alarms. [ABSTRACT FROM AUTHOR]

Background and Objective: The most common index in dental studies is the decayed, missing or filled teeth (dmft)/DMFT. Risk factor evaluation in order to investigate the significant factors that affected this dmft in children has an important role in dental epidemiological studies. This study aims to use a zero inflated binomial model for investigating the risk factors that affected the dmft in children aged 5 - 6 years in Tehran, Iran. Methods: This cross - sectional study was a part of a national survey for assessing the oral health status of Iranian citizens in 2012. The target population was children aged 5 - 6 years. The information and oral examination were collected by the WHO recommended clinical examination form and a trained calibrated dental team (dentists and hygienists). A binomial zero inflated model (ZIB) with random effect was used for evaluating the effect of all variables on dmft. Results: In general, 593 subjects were studied. From the entire subject in this study the frequency of zero was 1071 (45%). The result of ZIB model with random effect in zero part showed that brushing the teeth (OR = 3.5; P value = 0.012) and mothers with university education (OR = 11.24; P value = 0.016) had significant relation with zero dmft. The variance component of random intercept in zero part was significant too (σ²=4.68, P < 0.001). Conclusions: Zero inflated binomial model with random effect in zero part fitted better to this data. Brushing the teeth and high education of mothers had protective effect for dmft in children aged 5 - 6 years in Tehran. [ABSTRACT FROM AUTHOR]

Background: Influenza viruses and human metapneumovirus (HMPV) are among the common causes of acute respiratory tract infections in children worldwide. Objectives: The aim of this study was to determine the frequency of HMPV and influenza viruses in children less than 5 years old hospitalized with severe acute respiratory infections (SARI) during 2013 - 2016. Methods: For this study, 770 nasopharyngeal swabs from children with SARIs were tested for detection of influenza viruses by One step real time RT-PCR method in National Influenza Center, Tehran, Iran. Influenza virus negative samples were tested for HMPV using One step RT-PCR kit. Results: Influenza viruses were detected in 263 of 770 specimens (34%) with influenza A/H1N1 being the prominent subtype. All 507 influenza negative samples were tested for HMPV. HMPV was detected in 7 (1.4%) cases. Conclusion: In this research two different viruses were detected in 35% of cases, the remaining 65% of the patients might have been infected by other viruses or bacteria. Active surveillance studies with large sample size in different geographical regions and population based studies besides hospitalized patients with SARIs are needed to obtain more data about respiratory infections epidemiology. [ABSTRACT FROM AUTHOR]

Context: Children's health is one of the priorities in most societies. Nevertheless, the highest prevalence rate of malnutrition occurs among under five-year-old children worldwide. Objectives: The aim of this study was to estimate the rate of malnutrition in Iranian children through a systematic review and meta-analysis. Also we tried to identify the most prevalent factors causing malnutrition. Data Sources: The required data were collected by searching the keywords of nutrition, malnutrition, under-nutrition, prevalence, epidemiology, etiology, occurrence and Iran in PubMed, Google Scholar, Scopus, Index Copernicus, DOAJ, EBSCO-CINAHL, SID, Magiran and Iranmedex. Results: Twenty studies were selected for the final analysis stage, dating from 1999 to 2014. Number of children investigated for wasting, stunting and underweight was 53612, 54312 and 55012 respectively. The results showed that the prevalence of each type of malnutrition, in terms of wasting, stunting and underweight were 7.8% (95% CI: 4.8% - 12.6%), 12.4% (95% CI: 8.3% - 18.5%) and 10.5% (95% CI: 7.1% - 15.4%), respectively. Parents' educational level, in particular mothers', gender, birth weight, the place of residence, and mother's occupation were mentioned as important factors causing malnutrition. Conclusion: The rate of malnutrition in Iran's under five-year-old children is lower than the average of that in world and the Eastern Mediterranean region. Breastfeeding, the proper use of complementary feeding, and the principled spacing between births and improving the quality of maternal care have important role in prevention of malnutrition. [ABSTRACT FROM AUTHOR]

Background: Mutations in gene are the most common single genetic cause of autism-spectrum disorders, therefore we investigated the possibility that the intermediate alleles may also contribute to the origin of Autistic disorder. Methods: We screened 96 males, recruited from North West of Iran, who were diagnosed with autistic disease for CGG repeat size. The frequencies of either intermediate or premutation alleles were matched with 168 male controls. All patients and normal controls were of Azeri Turkish ethnicity. Results: Three mutated, five intermediate and four premutation carriers were identified among Autistic patients, compared with one premutation carrier in normal controls, representing a significant excess in small size FMR1 allele carriers (= 0.006). There was also a significant excess of the intermediate carriers compared with normal controls (= 0.006). Conclusions: Both of these alleles may show roles in the etiology of autism, possibly as a result of the rise of mRNA. Considering that there are individuals in the general population are carriers of intermediate and premutation alleles, further screening of larger samples of Autism patients is recommended, in order to estimate the role of small size of CGG repeat alleles in the aetiology of autism. [ABSTRACT FROM AUTHOR]

Background: Immunoglobulin (Ig) replacement therapy is used for treating a variety of primary immunodeficiency diseases (PIDs). Ig replacement therapy is the most important therapy for these diseases, since it protects the body against infections and reduces autoimmune disease symptoms. The purpose of this research was to estimate the cost of subcutaneous and intravenous Ig therapy in Iran. Methods: This study is carried out from the perspective of Iran’s healthcare system and all the medical costs are calculated. Cost variables include personnel, equipment, and supplies. The data required for cost estimation are obtained from the records of children’s Medical center of Tehran for 2015. Personnel and medical treatment costs are calculated based on relative value units. For SCIg, cost items are extracted from the literature. Results: The total cost of IVIg and SCIg for the health system in the first year of treatment is $1370 and $121 respectively. The results indicate that SCIg reduces costs and is the preferred treatment for PID patients. Conclusions: SCIg therapy significantly reduces the costs of the healthcare system compared to IVIg therapy, and this is enough economic justification for introduction of this treatment in the Iranian healthcare system. SCIg is also critical in reducing the direct costs of patients. [ABSTRACT FROM AUTHOR]

Background: Neonatal period is one of the most important critical phases of human life. Intensive care unit has a stressful environment for the infant in which the patient will be under the pressure of factors such as noise, nursing intervention and harsh light; the most important factor in this regard being separation from parents. Objectives: This study aimed to investigate the effect of skin-to-skin care by fathers on salivary cortisol of his infant. Methods: This study was a randomized clinical trial on 45 premature infants paired by their fathers at the neonatal intensive care unit (NICU) of Tabriz Alzahra teaching hospital conducted during November 2015. The control group received standard care and the intervention group had 45 minutes of skin to skin care. Saliva samples were collected from infants before, during, and after this intervention to measure the cortisol level. The SPSS 13 statistical software was used to analyze the data with the significance level of P < 0.05. Results: Salivary cortisol in babies in the control group had a mean value of 66.36 (SD = 71.22) and intervention group a mean value of 59.56 (SD = 59.20) (P = 0.56). Conclusions: Both groups showed decreasing cortisol levels during the study, the reduction in the skin-to-skin care group was more than the control group, but with no significant difference. Thus, making it possible for fathers to take care of their infants in an effective, helpful and secure way. [ABSTRACT FROM AUTHOR]

Background: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. Objectives: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. Patients and Methods: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran’s ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98% coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. Results: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300%, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. Conclusions: Assuming that the illness episodes are 100% and 300% for Rotarix and 300% for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested. [ABSTRACT FROM AUTHOR]

Background: The latest national census reports the population of Iranian children (1 - 8 years old) about 11 millions. On the other hand, the latest population policies approved by supreme cultural revolution council (SCRC) will make this population increase faster. Childhood development is one of the social determinants of health, of which “child’s play” is a part. Objectives: This study is an effort to identify difficulties and challenges of the plays influential on Iranian children’s health nationwide, in order to present enhancive strategies by utilizing the views of stakeholders and national studies. Patients and Methods: Analyzing children’s play stakeholders, main organizations were identified and views of 13 informed people involved in the field were investigated through deep semi-structured interview. A denaturalized approach was employed in analyzing the data. In addition to descriptions of the state, interventions development, and designing the conceptual model, national reports and studies, and other countries’ experiences were also reviewed. Results: Society’s little knowledge of “children’s plays”, absence of administrators for children’s play, shortage of public facilities for children’s play and improper geographical and demographic availability, absence of policies for Iranian “toy”, and little attention of media to the issue are the five major problems as stated by interviewees. Conclusions: The proposed interventions are presented as “promoting the educational levels of parents and selected administrators for children’s play”, “approving the play and toy policy for Iran 2025”, and “increasing public facilities for children’s play with defined distribution and availability”. [ABSTRACT FROM AUTHOR]

Background: Thalassemia is an inherited blood disease. It is a serious public health problem throughout the Mediterranean region, the Middle East and the Indian subcontinent, as well as in Southeast Asia. Objectives: Thalassemia is an inherited blood disease. It is a serious public health problem. In this study we assessed psychological aspects in Iranian children and adolescents with thalassemia major. Patients and Methods: In this case-control study sixty healthy subjects aged 7-18 years and Sixty Patients with confirmed diagnosis of major thalassemia were enrolled. After obtaining informed consent from parents of all participating thalassemia patients and healthycontrols, we assessed psychological aspects and quality of life by Pediatric Quality of LifeTM (PedsQL™), Strengths and Difficulties Questionnaires (SDQ), State and Trait Anxiety, Children's Depression Inventory (CDI). Results: The results of this study indicate that there are significant changes in depression, anxiety, QOL and behavioral screening between children with thalassemia major compared with healthy subjects by means of both parents and children reports. According to the results, children with thalassemia major have more psychological problems than healthy ones. Patients with thalassemia have a lower QOL than their peers (P = 0.001), the rate of depression is higher in this group (P = 0.015), Also behavioral problems in these children are more than healthy subjects (P = 0.009). Conclusions: We recommend appropriate treatment and counseling procedures in addition to specific treatment of thalassemia. According to the results we suggest to establish pediatric psychiatric clinics beside thalassemic clinics to cure psychological aspects of the disease. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity is increasing among Iranian youngsters like other developing countries. Objectives: This study was conducted to assess regional disparities in sedentary behaviors and meal frequency in Iranian adolescents. Patients and Methods: In this national survey, 5682 students aged 10 - 18 years from urban and rural districts of 27 provinces of Iran were selected via stratified multi-stage sampling method. The country was classified into four sub-national regions, based on criteria of the combination of geography and socioeconomic status (SES). Mean of meal frequency and physical activity levels as well as prevalence of omitting meals and sedentary behavior were compared across regions with different SES after stratifying with sex and age group. Results: Meal frequency in lower socio-economic regions was significantly higher than two other regions in 10 - 13 and 10 - 18 years old groups (P trend < 0.001). However, the mean of working hours with computer was linearly increased with increasing the SES in studied regions (P trend < 0.001), whereas the corresponding figure was not significant for the mean of watching TV (P trend > 0.05). Frequency of adolescents omitting their meals was higher in higher SES regions especially in West Iran (P < 0.001) in 10 - 13 years old age group. Having personal computer and working with it more than two hours per day mainly was observed in central Iran which ranked as the highest SES group. Conclusions: Efforts to ensure Iranian youth meet healthy food habits and screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time is required. [ABSTRACT FROM AUTHOR]

Objective: Trust is proposed as the necessary foundation to achieve better performance in the nursing of children. In this regard, Pediatric nurses need to achieve a deeper understanding of parents' experiences, and find out how these experiences are being related to the nursing practice. So to increase nurses' understanding of this concept based on the experiences of the recipients of nursing, the present study aims to express the factors that affect the formation of trust in mothers of hospitalized children towards the nurses. Methods: In this study, a qualitative design, conventional content analysis, was used. Pediatric Ward of hospitals in Yazd, Iran were the research environment. 14 mothers whose children were hospitalized in pediatric wards were selected through purposive sampling. They were deeply interviewed and data was analyzed with conventional content analysis. Findings: Data analysis led to emerging a major category “nurses' attempt for professional nursing” which includes sub-categories of commitment and empathetic caring, skill in performing duties, mothers' participation in the process of caring, being interested in pediatric nursing and establishing effective communication. Conclusion: Findings from the study showed that mothers know different factors involved in establishing confidence in nurses. Managers and people in charge in the field of nursing - regarding these findings - can design and perform necessary training programs to increase knowledge and skills for pediatric nursing, to win the trust of mothers and children in hospital for an effective step towards providing a better nursing care. [ABSTRACT FROM AUTHOR]

Objective: Celiac disease is an autoimmune disorder in which the risk of autoimmune liver disease is high. Autoimmune hepatitis is a chronic and progressive entity and the risk of its being associated with other autoimmune disorders such as celiac disease is high also. The aim of this study was to determine the prevalence of celiac disease in patients with autoimmune hepatitis and vice versa. Methods: In a cross-sectional study children with autoimmune hepatitis underwent serological screening and endoscopy for celiac disease. In patients with celiac disease, serum aminotransferases were measured and, if abnormal, autoantibodies related to autoimmune hepatitis were checked and needle liver biopsy was performed. Findings: Of the 96 patients, 64 had autoimmune hepatitis and 32 celiac disease. Among patients with autoimmune hepatitis only three (4.7%) were compatible with celiac disease. In the group of patients with celiac disease, autoimmune hepatitis was confirmed in four (12.5%) cases. We consider important to state that 3.1% of this group had celiac hepatitis. Conclusion: Autoimmune liver disease is sometimes associated with latent celiac disease. Serological screening for celiac disease should be routinely done in patients with abnormal serum aminotransferases, particularly those with chronic liver disease. On the other hand, celiac disease is often accompanied by other autoimmune diseases, including autoimmune hepatitis. [ABSTRACT FROM AUTHOR]

Objective: The periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a nonhereditary idiopathic febrile syndrome belonging to the group of autoinflammatory diseases. No longtime sequel was reported in this disease. Early diagnosis can lead physicians to treatment of this disorder with a short course steroid application and provide satisfaction of the patient’s family. Methods: This study is a prospective review of patients diagnosed with PFAPA syndrome who were registered in Iranian Periodic Fever and Autoinflammatory Registry (IPFAIR) through periodic fever clinic in the Children's Medical Center, Pediatric Center of Excellence in Tehran, Iran from January 2013 to March 2014. Findings: One hundred thirty patients were registered in our databases. Twenty-one (16.1%) patients including 15 males and 6 females had PFAPA. Normal growth was seen in all patients. The median age at onset was 18 months. The mean duration of fever was 4 days and the mean duration of intervals between fever episodes 21 days. Along with fever, all patients had characteristic symptoms. All patients were asymptomatic between fever episodes. Steroid was used in all patients and causing immediate reduction by 84.61%. Two patients received both steroid and colchicine because of their clinical feature and positive laboratory tests for PFAPA and familial Mediterranean fever. No patient received biological therapy or a tonsillectomy. Conclusion: The long diagnostic delay of PFAPA gives cause to concern indicating a need for greater awareness of the disease so that the diagnosis may be made timely. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the prevalence of celiac disease (CD) in the patients with dilated cardiomyopathy (DCM). Simultaneous presentation of these two diseases has been recently reported in some studies; however, few researches have been done on children. The sooner CD is diagnosed, the better the prognosis will be, especially in the patients with a chronic disease like DCM. Methods: In this study, 82 cases were screened for CD by measuring the level of anti-body against transglutaminase (anti tTG). These cases included 41 patients with DCM labeled according to clinical evaluation and echocardiography and 41 healthy children who had been referred for routine checkup. All the patients were between 1 and 18 years old. The expired patients and those with previous diagnosis of CD were excluded from the study. Besides, the patients with positive antibody results underwent intestinal biopsy to match the serology findings with histopathology of CD in the intestine. Finally, the data were analyzed by the SPSS statistical software (v. 16) and through t-test and Pearson correlation coefficient. Findings: According to the findings, 1/41 (2.5%) DCM cases had positive tTG antibody level and negative intestinal biopsy which is classified as potential CD in the children with DCM. In addition, 7/41 (17%) patients had borderline anti body level. A direct correlation was observed between age and anti tTG level. [ABSTRACT FROM AUTHOR]

Objective: Juvenile systemic lupus erythematosus (JSLE) is a common rheumatologic disorder that involves multi organ systems. Prognosis of lupus in children may be poorer than in adults. In this study, we determine d mortality and morbidity rates in the pediatric SLE in Iran. Methods: In a cross sectional study, we evaluated 120 children with SLE who had registered in our pediatric rheumatology database within 2004-2010. Data including sex, age, remission, age at the time of diagnosis, age at the time of study, various types of organ involvement, mortality and remission were extracted from this database. Findings: From 120 cases, 77% (92 cases) were female s and 23% (28 cases) male s (F:M=3.3). Mean follow up period was 56±32 months and mean age at the time of manifesting disease 10.34±2.9 years. Mortality rate was 10% (12 cases) in our investigation. Musculoskeletal involvement showed significant difference between various age groups (P <0.01), that was more frequent in group of 7 years and older. Frequency of oral ulcer and ophthalmic involvement in boys was significantly higher than in girls (P <0.05). Frequency of cardiovascular involvement (P <0.01) and renal involvement (P <0.01) was significantly higher in the patients who had no remission. There was a significant association between mortality rate and cardiac (P <0.02, OR=4.9), pulmonary (P <0.01, OR=10.167) and liver (P <0.05, OR=1.19) involvement. Conclusion: In our investigation 1-year survival rate was 97% and 5-year survival rate 89%. Liver, cardiac and pulmonary involvements have an association with higher mortality in JSLE patients. [ABSTRACT FROM AUTHOR]

Autonomy is usually considered as a main principle in making decisions about individuals' health. Children and particularly adolescents have the capacity to take part in medical decision-making to some extent. For the most part the parent-doctor-child/adolescent triangle sides are essentially in agreement, but this may not be true in some cases, causing physicians to face problems attempting to determine their professional duties. According to Islamic jurisprudent upon reaching the age of Taklif (15 full lunar years for boys and 9 full lunar years for girls) no one can be treated as incompetent based on mental immaturity unless his or her insanity or mental immaturity is provend Moreover the Islamic Sharia, decrees that parents should lose their authority to make medical decisions for their children, if their bad faith or imprudence is proven, in which case a fit and proper person or an institution will be appointed to make decisions in this respect based on the child's best interests. [ABSTRACT FROM AUTHOR]