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Context: Within only 30 days after the first announcement of infection with "SARS-CoV-2" in Wuhan, it spread to more than 20 countries and become a pandemic by WHO as a "high alarming level of infection" with 136,343 involved cases all over the world. Methods: To uncover more about the probable gastrointestinal transmission and its clinical manifestations, we reviewed all research publications with keywords including: "COVID-19", "SARS-CoV-2", "Coronavirus", "outbreak", "ARAS-CoV" in Medline, Scopus, Google Scholar as well as all news in social media about "novel COVID-19 pandemic". Out of 40 recent publications, 10 articles were studied by 2 authors. Results: Although the SARS-CoV-2 tends to infect respiratory epithelial cells through the respiratory tracts, recent investigations detected the virus in the stool specimen, raising the question of the fecal-oral transmission route. Different studies showed that almost all gastrointestinal signs and symptoms were seen in elderly patients (more than 65 years old). including anorexia (40%), nonspecific abdominal pains (8%), diarrhea (10%) and nausea and Vomiting in about 8% of patients. Anorexia and generalized abdominal pain suffer many treated cases even 10-20 days after negative blood tests (like CRP, lymphopenia) and negative PCRof respiratory samples. The main reason for this prolonged anorexia and abdominal pain may be due to the long persistence of COVID-19 in the gastrointestinal tracts after primary treatment. Conclusions: Comparing to SARS, patients with COVID-19 showed less diarrhea, nausea, vomiting and/or abdominal discomfort before respiratory symptoms. Feces as a potential contagious source of Viral RNA can last even after viral clearance in the respiratory tract. We strongly recommend all cured patients of COVID-19 to disinfect and clean their toilets until 17-20 days after negative blood tests and solving their respiratory disorders. Gastrointestinal manifestations have seen in all men while no women referred with GI signs. [ABSTRACT FROM AUTHOR]

Background: This study aimed to systematically evaluate the effectiveness of a clinical nurse specialists training program in Zhejiang Province, China, from participants' perspectives. Methods: This cross-sectional study was conducted with 209 PICU nurse specialists who participated in the training program from 2016 to 2021. All participants completed an online questionnaire two years after graduation. We collected their demographic characteristics and their development status after the training (e.g., continuous improvement of core competence, research skills, and promotion). Chi-squared test was applied to assess the differences in effectiveness across subgroups. Results: In total, 209 (87.8%) out of 238 nurses responded to the survey among whom 73.7% launched new projects in their hospital after training and 75% published research articles in peer-reviewed journals. Also, 32.4% received promotions, and 67% participated in ICU-related continuing education programs. Based on multivariate regression analysis, the execution of new projects was closely related to the nurse's position and the level of their working hospitals. The job title and position were associated with publication, research performance, promotion, and continuing education. Conclusions: The nurse specialists of the PICU carried out a set of new projects implanting new skills that they had learned from the training program. Their core competence was improved, including theoretical knowledge and operation skills, teaching capacities, and scientific research abilities. Many trainees published papers, applied for research grants, got promotions, and had further opportunities for continuing education. [ABSTRACT FROM AUTHOR]

Context: Breastfeeding initiation is an important event during the postpartum period. Despite the significance of exclusive breast-feeding in infant health, some common breast issues lead to the early cessation of breastfeeding. Therefore, various complementary medicine techniques are used to increase the length and quality of breastfeeding. Objectives: The current review study collected evidence on the impacts of complementary medicine on successful breastfeeding and breastfeeding-associated problems in the postpartum period. Data Sources: A systematic search was performed on PubMed, Embase, Web of Science, Scopus, and ScienceDirect databases and all randomized clinical trial, quasi-experimental, observational, and case-control studies published from 1999 to 2018. The quality of the selected papers was measured based on their adherence to the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. After careful examinations, 18 papers were selected and reviewed. Results: According to the results of the current review, point massage was beneficial to prevent low milk supply postpartum. Oketani breast massage significantly increased total solids, lipids, and casein content, as well as the gross energy of breast milk and thus improved its overall quality. Reflexology enhanced breast milk supply. The Gua-Sha therapy, Oketani massage, and hollyhock leaf compress decreased the mean severity of breast engorgement. The six-step recanalization manual therapy (SSRMT) could be used as a safe and low-cost method to treat plugged milk ducts after delivery. Nipple fissures could be relieved by the use of Pistacia atlantica resin, silver impregnate medical cap, lanoline, menthol essence, and Ziziphus jujuba fruit. Conclusions: Supplementary medicine techniques are inexpensive and safe methods to resolve breastfeeding problems and empower mothers to perform successful breastfeeding. These methods can thus promote exclusive breastfeeding and decrease infant morbidity and morbidity. However, further details are needed in this area. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the relationship between a foreign body in the nose of a child and the dominant hand, the educational level of the parents and the habits of the mother in cleaning the nose with tissues or tweezers etc. Objectives: There is a lack of evidence about the foreign body in the nose in children and association among dominant hand, parental behaviour and education level. Methods: A retrospective examination was made of the records of 136 patients (78 male, 58 female) diagnosed with a foreign body in the nose in the period January 2014 - January 2017. A record was made of age, gender, the type of foreign body, treatment and complications, etc. Patients with a psychosomatic disorder were excluded from the study. Results: The vast majority of the patients were children aged 2-5 years (N = 124, 91.17%). The most common foreign bodies were a bead, a part of a plastic toy, a button, a safety pin, paper and paper tissues. The foreign body was removed from the same side as the dominant hand in 116 (85.29%) cases. The incidence of nasal foreign body was found to be statistically significantly higher in those with a parental level of education of primary school (P < 0.026). Conclusions: There was a statistically significant relationship between the localisation of a nasal foreign body and the dominant hand, so the patient's relatives must be asked about the side of the dominant hand. Taking into consideration that complications are greatly reduced with clinical experience, it is recommended that intervention for a nasal foreign body is made by an ear, nose and throat specialist. [ABSTRACT FROM AUTHOR]

Introduction: The recent pandemic is caused by the new coronavirus (COVID-19). The disease primarily affects adults but can also affect children of all ages, including infants. It is not known what the prevalence of this disease is in children, but it is evident that the severity of symptoms in children and infants is less than in adults. Case Presentation: Fifteen neonates with COVID-19 were reported in this paper who were hospitalized in neonatal intensive care units. Five of the neonates were preterm, and all of them tested positive for PCR. The most common symptom was respiratory distress. During their hospitalization, five neonates died. Conclusions: The results of this study indicate that clinical manifestations, laboratory findings, and radiological findings are less severe in infants than in other ages. Consequently, it can be predicted that the prognosis for infants will generally be favorable. [ABSTRACT FROM AUTHOR]

Context: Congenital heart disease (CHD) is a leading cause of mortality by birth defects with significant social and economic burden. Pulse oximetry as a safe and non-invasive screening method, and with its potential for early detection of CHD has improved neonatal health outcomes. Objectives: The aim of this study was to systematically review economic evaluation studies that compared pulse oximetry with current programs to diagnose early detection of CHD in full-term newborns. Data Sources: A systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and related articles published from 1995 up to March 2020 were searched in different databases (MEDLINE, EMBASE, PubMed, Science Direct, Google Scholar, Scopus, NHS EED, Science Citation Index, MagIran, Cochrane Library, EconLit and SID). The articles were selected based on inclusion and exclusion criteria. Consolidated health economic evaluation reporting standards (CHEERS) statement checklist was used to qualitatively evaluate the papers. Overall, 7 articles were included in the study. Results: Timely diagnosis was considered as main effectiveness health outcome in most studies. The highest and lowest values of incremental cost-effectiveness ratio (in two-phase studies) were €139,000 and $100 per infant in the Netherlands and Colombia respectively; and (in one-phase studies) were £24,000 and £1,489 per infant both belonging to the UK. Implementing pulse oximetry method concurrent with the clinical examination is more cost-effective. The reviewed studies had been conducted in high-income and upper middle-income countries; therefore, when the results are generalizing by policy makers in different health systems, a substantial precaution approach is needed. [ABSTRACT FROM AUTHOR]

Introduction: Gastric adenocarcinoma is extremely rare in children, and it is typically seen among the elderly in their sixth and seventh decades of life. There are few studiesonthe clinical manifestations, treatment, andprognosis of this malignancy in children. Case Presentation: In this paper, we describe a 12-year-old girl presented with abdominal pain, anorexia, nausea, and abdominal distension. A high volume of ascites was reported in ultrasound and computed tomography (CT) scan of the abdomen and pelvis. The patient underwent endoscopy and biopsy of the gastric mucosa. The histopathological findings were positive for gastric adenocarcinoma. Unfortunately, the patient died two months after chemotherapy because she was at the advanced stage of the disease. Conclusions: Although gastric adenocarcinoma is rare in children, it should be considered in patients with persistent upper gastrointestinal symptoms. [ABSTRACT FROM AUTHOR]

Context: Premature birth and the consequent neonatal intensive care unit (NICU) admission cause parents great distress, which makes them in need of support when their infant is hospitalized at the NICU. Objectives: The aim of this study was to determine the impact of creating opportunities for parent empowerment (COPE) program on parents’ mental health. This review emphasizes on mental disorders’ prevention. Data Sources: This systematic review was performed by searching the databases including Cochrane Library, PubMed, Scopus, Google Scholar, Proquest, Science Direct, SID, Magiran and Iranmedex databases for interventional papers from 2000 to 2015. Study Selection: The studies, which were considered for this review included, randomized controlled clinical trials and quasi-experimental studies on the impact of COPE program on the mental health of premature infants’ parents. Data Extraction: For determination of eligible studies, two authors extracted the data independently and discrepancies were resolved through discussion or, if required, through consultation with a third author. Results: Only four studies conducted on the impact of COPE program on parents’ mental health were included in this systematic review. According to these studies, the implementation of COPE program for the parents of premature infants hospitalized at the NICU decreased stress significantly after the second phase of the COPE program (-1.72 (95% CI: -1.97, -1.47)) and state anxiety after first phase of program (-1.01 (95% CI: -1.48, -0.53)) in mothers. Conclusions: The studies suggested the positive impact of COPE programs on parents’ mental health; however, more studies are recommended on all aspects of mental health along with further involvement of fathers. [ABSTRACT FROM AUTHOR]

Objectives: To improve the knowledge on Coronavirus Disease (COVID-19) infection, we aimed to study the prevalence of gastrointestinal symptoms and the dynamics of liver enzymes in children infected with COVID-19. Methods: We performed a systematic search of all the articles published up to May 2020 in the following databases: PubMed-MEDLINE, Scopus, and Cochrane. We chose the fixed- or random-effect model for analysis based on the I2 statistic. The included data were analyzed to identify the prevalence of gastrointestinal symptoms (diarrhea, vomiting or nausea) and to identify the dynamics of liver enzymes in children and adolescents diagnosed with COVID-19. Results: We detected an overall prevalence of all gastrointestinal symptoms of 26% (95% CI: 0.18 - 0.35). The pooled prevalence of diarrhea and nausea/vomiting was 12% (95% CI: 0.08 - 0.16) with no heterogeneity (P = 0.19; I² = 23.53%) and 11% (95% CI: 0.05 - 0.17), respectively. The pooled prevalence of elevated ALT and AST and LDH was 12% (95% CI: 0.07 - 0.17), 14% (95% CI: 0.10 - 0.18) and 33% (95% CI: 0.12 - 0.54), respectively among the included studies. Conclusions: According to our systematic review and meta-analysis, 26% of the children and adolescents diagnosed with COVID-19 present gastrointestinal symptoms. This paper has provided a comprehensive overview of the prevalence of digestive symptoms of COVID-19 and of the liver enzymes dynamics in children and adolescents. [ABSTRACT FROM AUTHOR]

Context: Children and adolescents with cerebral palsy may present with lower urinary tract dysfunction which increases their risk for urinary tract infection (UTI). Whereas few studies reported low prevalence rates of UTI in these patients, several studies documented high prevalence rates. Thus, it appears there is no unanimity about the burden of UTI in affected children and adolescents to justify routine screening and treatment of the infection. This systematic review aims to determine the risk and pooled prevalence rate of UTI in children and adolescents with cerebral palsy. Evidence Acquisition: Using appropriate descriptors, we searched the PubMed and Google Scholar databases. Eligible papers were primary studies published in English language: reporting an association between cerebral palsy and UTI or UTI prevalence in children and adolescents with cerebral palsy and healthy comparators, with a clear definition of UTI and cerebral palsy. We assessed the quality of included studies with the Newcastle-Ottawa Scale (NOS) and resolved inter-rater discrepancies by consensus. We independently retrieved relevant data from these studies using a preconceived data-extraction form. We analyzed the aggregate data on UTI prevalence in these pediatric patients, using the log odds ratio (OR) at 95% confidence interval as the summary estimate. Results: Of the seven included studies, only two (28.6%) were case-control studies, while five (71.4%) were cross-sectional studies. There was no uniform definition of UTI in these studies. Prevalence rates varied widely from as low as 2.2% to as high as 56.7%. The mean UTI prevalence rate estimated for six of the included studies was 31.8%. The log OR at 95% CI computed for the case-control studies was 10.9 (95% CI: 9.0, 12.9). Conclusions: The prevalence and risk of UTI in children and adolescents with cerebral palsy are significantly high. Routine screening and treatment for UTI may be justified in these pediatric patients. We however recommend more prospective case-control studies to strengthen the current evidence of the high UTI burden in these patients. [ABSTRACT FROM AUTHOR]

Context: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, and different hepatitis viruses might affect the prognosis of patients with HCC. Objectives: This study aimed to reveal the differences in the postoperative prognosis of patients with hepatitis B virus-related HCC (HBV-HCC), hepatitis C virus-related HCC (HCV-HCC), and non-HBV non-HCV hepatocellular carcinoma (NBNC-HCC). Methods: The databases PubMed, Embase, Cochrane, Web of Science, and Scopus were searched for articles published until April 2022. Stata software version 12 and Review Manager version 5.4 were used to conduct the meta-analysis, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was adopted in this study. Results: In the present study, 26 papers on a total of 20381 participants who met the inclusion criteria were analyzed. The 5-year overall survival in the HBV-HCC and HCV-HCC groups was lower than in the NBNC-HCC group (HBV-HCC vs. NBNC-HCC, P = 0.005; HCV-HCC vs. NBNC-HCC, P = 0.001). Patients with HBV-HCC and HCV-HCC had worse 5-year recurrence-free survival than patients with NBNC-HCC (HBV-HCC vs. NBNC-HCC, P = 0; HCV-HCC vs. NBNC-HCC, P = 0). In addition, the 5-year recurrence-free rate in the HCV-HCC group was lower than in the HBV-HCC group (P = 0). The observed association between serum alpha-fetoprotein levels and the postoperative prognosis was inconsistent in different subgroups. Conclusions: Patients with NBNC-HCC had a significantly better postoperative prognosis than those with virus-related HCC. The alpha-fetoprotein levels significantly correlated with the postoperative prognosis of patients with HCC. [ABSTRACT FROM AUTHOR]

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 article provides an in-depth review of anesthetic considerations in robotic pediatric urologic surgery, highlighting the advancements and specific challenges of this approach. It discusses how robotic techniques have become more common in pediatric urology, addressing the unique physiological impacts on younger patients and the need for tailored anesthetic strategies.

The article focuses on the modulation of the Wnt signaling pathway in wound healing using a cocktail of L-carnosine, zinc sulfate, and B-complex vitamins. Topics include the preparation of the cocktail, its effects on human dermal fibroblast (HDF) cells, and the measurement of gene expression involved in the Wnt pathway. It reports that the cocktail enhances wound healing by increasing fibroblast proliferation.

The article focuses on evaluating the therapeutic effects of Heracleum lasiopetalum Boiss in a rat model of acetic acid-induced ulcerative colitis (UC). It reports that Heracleum lasiopetalum extract reduces colon hyperemia, mucosal ulceration, inflammation, and fibrosis in a dose-dependent manner, suggesting its potential as an adjunct therapy for UC, warranting further investigation.

Objective: To Investigate the correlation between hypoglycemia and positive rate of Inborn error of metabolism (IBM) In neonatal Intensive care unit, Methods: 160 patients from a neonatal Intensive care unit were enrolled, Blood glucose was measured by Roche Modular chemistry, The dry blood on filter papers, collected from 160 patents was tested by tandem mass spectrometry to detect 35 inborn errors of metabolism, Clinical follow-up of all the patients was at least in an Interval of 12 months. The mean observation period was 13.5 months per child. Findings: Based on the ROC curve, the optimal cut-off value of hypoglycemia as an Indicator for screening for lEMs was projected to be 2.8 mmol/L, which yielded a sensitivity of 71,4% and a specificity of 76.5%. The patients were divided into two groups: hypoglycemia group (48 cases) and the control group (112 cases). 5(10.4%) of the 48 patients In the hypoglycemia group were positive while only 2(1.8%) of the,112 patients In the control group were positive. The difference of the positive rate In the screening for IEMs between the two groups was significant (χ2=4.10, P<0.05); the relative risk (RR) was 5.83 (95% Cl: 1.06-32.12). Conclusion: The risk of patients with hypoglycemia suffering from lEMs was significantly higher than that of the non-hypoglycemia patients in NICU based on cut-off value of 2,8mmol/L, [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]

Introduction: Lamellar ichthyosis (collodion baby) is a cornification disorder classified under the category of autosomal recessive congenital ichthyosis and characterized by hyperkeratosis. Early-stage retinoid treatment has been shown to improve survival in these patients. In this article, a lamellar ichthyosis case is presented of an infant who had the symptoms at birth and was treated successfully with acitretin. Case Presentation: A term newborn infant presented after delivery. Physical examination showed that the skin on her outer mouth, neck, axillae, and inguinal fold areas had collodion membranes and peelings. On the third day of life, the skin all over her body became dry and seemed similar to parchment paper, with peeling in some areas, as well as ectropion and eclabium development. After her daily bath, liquid Vaseline was applied all over her body, but it did not provide enough benefits. The infant was started on acitretin treatment. On the 14th day of treatment, the skin appeared nearly normal. On the 28th day of life, the infant was discharged. Conclusions: Early oral retinoid treatment facilitates increased quality of life improves survival rates for ichthyosis patients. [ABSTRACT FROM AUTHOR]

Context: Hepatitis C Virus (HCV) infection is amajor cause of chronic cirrhosis and hepatocellular carcinoma. Approximately 30% of infected persons with HCV spontaneously clear the viral infection; but, some of the remaining patients develop chronic HCV. Studies showthatHLAmoleculesplay animportant role intheoutcomeof HCVinfectionby influencing the efficiencyof the antiviral immune response to HCV infection. It is now known that polymorphisms in HLA loci are associated with HCV susceptibility or clearance. The purpose of the present study was to systematically review the studies that reported the association of HLA class II alleles (HLA-DQ and HLA-DR) with the outcome of HCV infection. Evidence Acquisition: Studies were identified by searching electronic databases, including PubMed and Scopus. A total of 12,265 relevant studies were identified by the electronic search, of which a total of 19 eligible papers were identified that were meta- analyzed for the association between HLA class II alleles and the outcome of HCV infection. Results: Subjects carryingHLA-DQB1*0301,HLA-DQB1*0501,HLA-DRB1*1303,HLA-DRB1*1201,HLA-DRB1*0401,HLA-DRB1*0101, andHLA- DRB1*1101 alleles were significantly associated with higher spontaneous clearance of HCV infection. Conclusions: The data fromthe current study confirm that several polymorphisms in HLA-DQ and HLA-DR loci are correlated with the clearanceof HCVinfection. Identifyingthesepolymorphismsmay contribute toabetterunderstandingof immunemechanisms of HCV clearance or persistence. [ABSTRACT FROM AUTHOR]

Background: Considering the excellent safety profile and the high efficacy rates, great benefits were expected with the availability of the new direct-acting antivirals (DAAs) in treating hepatitis C virus (HCV) infection. Following the publication of two articles in 2016 on the high incidence rates of HCC following DAAs, several papers revealed contradictory results, thereby casting shadows on the role of DAAs in hepatocarcinogenesis. Objectives: The present study aimed to assess the incidence and risk factors of HCC in patients with HCV genotype 1b infection and compensated cirrhosis with the sustained virological response (SVR) following DAAs. Methods: This multicentric prospective study encompassed 479 patients with HCV genotype 1b compensated cirrhosis treated with paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) +/- ribavirin (RBV) for 12 weeks in two tertiary centers in Northeastern Romania. The patients were prospectively followed up in the Institute of Gastroenterology Iasi, Romania, from November 2015 to December 2020. Results: During the follow-up period (mean 60.11-3.87 months), 23 patients (4.8%) developed HCC. The 1-, 3-, and 5-year cumulative incidence rates of HCC were 1.1, 1.9, and 2.6%, respectively. At the time of the diagnosis, 15 patients (65%)had a single tumor, 12 patients (52.2%)were within the Milan criteria, and nine persons (39%) had Barcelona liver cancer stage 0-A. In this regard, the mean AFP level was 35.3-93.1 ng/mL. A multivariate analysis, age above 65 years, and a cutoff point of AFP≥ 10 ng/mL at the end of treatment were independent factors associated with HCC. A majority of the patients (n = 11, 47.8%) received curative treatment by surgical resection. In this study, histopathological examination identified a moderately differentiated tumor (G2) in 5 patients, five patients had a poorly differentiated tumor (G3), and only one patient had a well-differentiated tumor (G1). Conclusions: Our study revealed no evidence of the high incidence rate of HCC after the long-term follow-up of patients with HCV-related liver cirrhosis and SVR following DAA treatment. However, the cumulative 5-year risk remained above the cutoff point, and this makes the HCC screening cost-effective. The HCC occurrence appears to be associated with aging and a moderately increased AFP level at EOT (≥ 10 ng/mL). [ABSTRACT FROM AUTHOR]

The article presents the results of a randomized controlled trial comparing the efficacy of Apotel and remifentanil patient-controlled analgesia in managing postoperative pain in patients who underwent total knee arthroplasty (TKA). Data collected include hemodynamic parameters, analgesic duration, pain levels, and drug consumption. Based on the results, remifentanil is better than Apotel in providing pain relief to patients.

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]

Context: Childhood obesity has become one of the most concerning public health issues and several innovative strategies are being applied to tackle the issue. Reformulation of children-oriented food products may play a role in improving childhood obesity. However, there is not sufficient evidence that shows the effectiveness of this policy. This paper provides a systematic review of the evidence to examine the efficacy of food product reformulation on calorie intake and weight modification of children with obesity. Evidence Acquisition: A comprehensive literature search was undertaken for different types of studies. PubMed, Cochrane Library Database, EMBASE and SCOPUS were referred to as the source of literature. Results: Seven thousand four hundred and three results were entered into our study for screening and evaluation. Our study showed that there was no clear evidence that supported the effectiveness of this intervention. However, some bodies of literature show calorie intake reduction, but no weight modification. Conclusions: Although there is enough evidence to show that reformulation may promote healthy dietary patterns, its impact on weight status is not convincing. Long term running intervention needs to be applied to examine the possible implications of food reformulation policy on the weight status of the children. [ABSTRACT FROM AUTHOR]

Background: Ordinary pressure dressing for hemostasis after cardiac catheterization is time consuming and might cause some problems, such as pain or loss of blood, which has to be controlled, particularly in pediatric patient. Using Celox® (chitosan) powder dressing might cause quicker initial hemostasis. Methods: In this prospective study, we assessed Celox® powder among patients in hospitals affiliated with Shiraz University of Medical Sciences, fromNovember2017 to February 2018. The patients were stratified in two groups. The case group included patients for whom Celox® powder was used along with sterile gauze pressure at the puncture site to achieve hemostasis, and the control group those in whom hemostasis was achieved by standard sterile gauze pressure method. Results: Sixty patients under 16 years of age with congenital heart diseases were evaluated and underwent cardiac catheterization. We stratified the patients in two groups called case (30 patients) and control group (30 patients). Considering both arterial and venous initial hemostasis, in the case group, the minimum and maximum, median and mean coagulation time were less than those in the control group; however, the initial hemostasis was statistically significant only in venipuncture site. Also, the venous coagulation time was shorter among the patients weighing less than 10 kilograms in comparison to those with higher weight. In the case group, using Celox® stirred hemostasis toward the lower percentiles, but based on 50th percentile, the distribution in each group was identical. Conclusions: Celox® powder dressing in children led to reduced coagulation time in venipuncture site, and we might recommend utilizing this type of dressing for venous hemostasis in children after venipuncture. [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]

Objective: It is believed that fingerprints and palm patterns may represent genetically determined congenital abnormalities in Cystic Fibrosis (CF). The main idea of this paper was to determine differences of fingerprints and palm patterns in CF and normal children. Methods: Forty-six CF children (27 males, 19 females) and 341 (113 males, 228 females) healthy individuals were recruited for this study. Fingerprint patterns, Total ridge count (TRC) of each finger, a-b ridge count, and atd angles of all participants were recorded. Asymmetry of the right and left hand for each value was determined and dissimilarity in fingerprint patterns between homologous fingers was compared using Chisquare analysis, Mann-Whitney U test and Fisher's exact test. Findings: There were significant differences in the mean TRC of the right digit IV (P=0.009), left digit III (P=0.02), left digit IV (P=0.03), and left digit V (P=0.03). Furthermore, we found significant differences in right atd angel (P=0.001), left atd angel (P=0.002), right a-b ridge (P=0.007) and left a-b ridge (P=0.001). In contrast, we found no significant differences in atd angle asymmetry, a-b ridge count asymmetry and pattern dissimilarity score between both groups (P>0.05). Conclusion: Dermatoglyphic characteristics could be used as a supplementary diagnostic method in CF children. [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: Mother-to-child transmission (MTCT) is one of the main transmission routes of chronic hepatitis B virus (HBV) infection. The successful rate of preventing MTCT has increased to over 90% after the administration of passive-active immunoprophylaxis (vaccine and hepatitis B immunoglobulin (HBIG)) on infants born to hepatitis B surface antigen (HBsAg)-positive mothers. However, 5%-10% of the infants had chronic HBV infection who were born to mothers with high HBV DNA levels. Therefore, the current domestic and international guidelines recommended that antiviral therapy in late pregnancy was to further decrease theMTCTrate. This study aimed at reviewing the mechanisms of MTCT and controversial issues in antiviral therapy for pregnant women with high viral load in order to provide clinicians with some strategies for preventing MTCT of HBV. Evidence Acquisition: Relevant English published papers were searched using online databases, including PubMed and EMBASE from January 2000 to January 2019. We summarized the findings of 61 relevant studies in this review. Results: The mechanism of MTCT is still unclear and further studies are needed. Antiviral therapy for pregnant women with high viral load can reduce the rate of MTCT and provide the appropriate safety for mothers and infants. Conclusions: The mechanisms underlying MTCT of HBV is still unknown and more investigations are required. The efficacy and safety of taking tenofovir disoproxil fumarate (TDF) orally in pregnant women with high viral load in the second or third trimester of pregnancy to block MTCT of HBV have been proved. The withdrawal of antiviral therapy during pregnancy due to MTCT should not exceed 3 months after delivery at the latest. Most pregnant women tend to suffer from increased alanine aminotransferase (ALT) after discontinuing antiviral drugs during pregnancy. Accordingly, close ALT levels monitoring after drug discontinuation is essential. [ABSTRACT FROM AUTHOR]

Introduction: Headache is a common neuropsychiatric manifestation of juvenile systemic lupus erythematous (JSLE). Pseudotumor cerebri (PTC) is an uncommon cause of headache, presenting especially in active JSLE. In this paper, we report a case of missed intractable headache that was eventually diagnosed as PTC and presented as the first manifestation of JSLE. Case Presentation: A 9-year-old girl with a history of progressive headache for four months, fever, fatigue, myalgia, arthralgia, small-joint arthritis of the hands, and recent diplopia was referred to our clinic. The diagnosis of PTC in the background of JSLE was made based on her history, physical examination, positive laboratory findings, and increased intracranial pressure, with normal neuroimaging. Treatment with high-dose prednisolone led to dramatic resolution of the headache. Conclusions: It seems that a complete neurologic examination in newly diagnosed SLE patients is mandatory, especially in the presence of any neuropsychiatric manifestations, such as headache. [ABSTRACT FROM AUTHOR]

Background: Waardenburg syndrome (WS) is a rare, autosomal dominant disorder characterized by congenital hearing loss; dystopia canthorum; broad nasal root; depigmantation of hair, skin or both; and. heterochromic iris. WS is classified into four types, WS1, WS2, WS3 and WS4. In this paper, we report a new case of Waardenburg syndrome type I in an Iranian female. Case presentation: This report describes a two-year-old female with Waardenburg syndrome type I with features such as unilateral profound sensorineural hearing loss, white forelock, dystopia canthorum, broad nasal root, hypopigmentation of skin and scalp defect. Conclusion: As no treatment is available for patients with WS1, conservative treatments such as skin graft and referral to a hearing specialist are crucial for the normal development of patients. [ABSTRACT FROM AUTHOR]

Context: The present systematic review aimed to investigate whether the lung ultrasound score (LUS) can accurately predict surfactant administration in premature neonates with respiratory distress syndrome (RDS). Methods: The systematic review was conducted according to the Cochrane collaboration or the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. English language databases included PubMed, Ovid, Cochrane Library, Embase, Web of Science, and Scopus. The coverage date of this review was from the inception of each database to the end of May 2022. Data were extracted independently by two authors, assessed for quality using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool, and analyzed for heterogeneity using MetaDisc1.4 software. Results: Seven eligible articles and 653 neonates were finally selected from 176 studies for meta-analysis. Considering the LUS to predict the surfactant need in premature neonates, we extracted the variable from the studies. Also, we plotted the summary receiver operating characteristic curve with an area under the curve (AUC) of 0.94 (95% confidence interval (CI): 0.92 - 0.95). Forest plots of the LUS showed a pooled sensitivity of 0.86 (95% CI: 0.82 - 0.90) and a pooled specificity of 0.79 (95% CI: 0.75 - 0.82). The Cochrane-Q test, chi-square test, and inconsistency index confirmed the heterogeneity of the non-threshold effect (I² > 50% or P < 0.05). The meta-regression analysis showed that the relative diagnostic odds ratio for the number of recruited cases (> 100 vs. < 100) was 0.65 (95% CI: 0.33 - 0.98, P-value < 0.05). The comparison of the cut-offs of the 4-6 score vs. the 8-12 score yielded aZ of 21.44 (P< 0.001). Conclusions: The LUS accurately predicts the onset of RDS in premature neonates and can guide surfactant administration but is subject to the cut-off effect. Variation in cut-offs is related to gestational age and disease severity. [ABSTRACT FROM AUTHOR]

Background: Intrapleural instillation of fibrinolytic agents is novel in treating empyema. Although the efficacy of this method for treating empyema remains a topic of debate among experts, several studies have shown that the results of this technique are almost equivalent to surgical operations in the lower stages of the disease. However, in more advanced stages of empyema, surgery maybe required. Despite the worldwide use of fibrinolytic agents instead of surgical procedures, the benefits of using these agents postoperatively still need to be defined. Objectives: In this prospective study, we aimed to compare the effects of streptokinase and alteplase in managing empyema in patients who underwent any surgical operations. Methods: We prospectively compared the outcomes of using alteplase and streptokinase in children who underwent surgical operations for empyema between 2015 and 2022. Following the surgery, fibrinolytic agents were instilled through thoracostomy tubes according to a specific protocol. The length of stay, frequency of complications, need for another surgery, and mortality were measured in each group. Results: Among 53 patients who met the inclusion criteria, 31 (58.5%) patients received streptokinase postoperatively, while the others were treated using alteplase. The length of stay after the surgery, wound infection, and mortality rate did not differ significantly between the groups (P-value = 0.394, 0.080, 0.767, respectively). However, the need for another surgery due to unexpanded lungs was significantly lower in the alteplase group (0% vs. 19.4%, P = 0.028). Conclusions: Alteplase as an intrapleural fibrinolytic is more effective than streptokinase in patients who underwent surgical operations due to empyema. The need for another surgery following the instillation of alteplase through chest tubes postoperatively maybe decreased. [ABSTRACT FROM AUTHOR]

Background: While severe hypoxia is known to contribute to neurotoxicity and lead to abnormal behavior, mild hypoxia may have beneficial effects mediated through endogenous adaptive responses. Objectives: The present study aimed to investigate the effects of mild hypoxia postconditioning and long-term neurobehavioral ability rehabilitation after hypoxic-ischemic brain damage (HIBD). Methods: Seven-day-old rats underwent left carotid ligation followed by 2 hours of hypoxia stress. Rats received different protocols of mild hypoxia postconditioning for 5 days and underwent neurobehavioral testing during the last week of the study. Hypoxia-inducible factor1 alpha (HIF-1a) expression was assessed, and neurobehavioral ability assays were performed. Results: Compared with the HIBD group, rats postconditioning with mild hypoxia showed increased HIF-1a expression, and their brain functions were better in neurobehavioral analyses. The rehabilitation of brain functions may be associated with high HIF-1a expression and better behavioral performance. Conclusions: Our findings indicate that mild hypoxia postconditioning improves neurobehavioral ability, and HIF-1a may be a potential mediator of the observed effects. Our findings suggest that there may be clinical implications for treating infants with HIBD. [ABSTRACT FROM AUTHOR]

Context: Nigella sativa (NS) has been used as an herbal remedy for the treatment and prevention of a variety of diseases. In this review, we aimed to summarize the current evidence on the effects of NS consumption on non-alcoholic fatty liver disease (NAFLD) characteristics. Evidence Acquisition: We reviewed the existing literature published by the end of 2017 using the following key words: "Nigella sativa", "black seeds", "black cumin", "thymoquinone", "NAFLD", "NASH", and "diabetes". Papers used in this study were collected by searching the PubMed, Google Scholar, Science Direct and Scopus databases. Our search was limited to English-language articles. All the articles published between 2000 and 2017 meeting the inclusion criteria were included in the study. Results: The results of current studies indicate that NS has many biological effects such as anti-inflammatory, anti-hyperlipidemic, anti-microbial, anti-cancer, anti-oxidative, anti-diabetic, anti-hypertensive and wound healing activities. In summary, it can be used as a valuable plant for designing therapeutic strategies in NAFLD. Conclusions: Results from available studies indicate that NS can ameliorate the main metabolic disturbances related to NAFLD including hyperglycemia, hyperlipidemia, and overweight. These effects are mainly attributed to the anti-oxidative and antiinflammatory properties of thymoquinone. Clinical trials on human subjects are highly essential to confirm the results found in in vivo and in vitro studies. [ABSTRACT FROM AUTHOR]

Context: The emergence of direct - acting antiviral agents (DAAs)with high sustained virological responses (SVR) is an epoch -making revolution. However, the value of antiviral agents in the field of hepatitis C - related hepatocellular carcinoma (HCC) is not clear. Further, the risk of tumor occurrence or recurrence following an antiviral regimen is not yet reached a consensus. Evidence Acquisition: All scientific evidence was collected through a systematic review of studies discussing DAA regimen and hepatitis C-related HCC, in PubMed, EMBASE, and Web of Science. The relevant articles were obtained and reviewed carefully before working on the paper. Results: The current review study aimed at discussing recent studies on hepatitis C - related HCC in the era of DAAs, including application of DAAs in the field of treatment of hepatitis C virus (HCV), efficacy of DAAs on HCV-associated HCC, and the effect of DAAs on occurrence and recurrence of HCC. Conclusions: It was shown that DAAs had a relatively poor therapeutic effect on HCV patients with HCC, based on the current studies. After analyzing the existing data, the conclusion cannot yet be reached that DAA treatment influences the risk of HCC in patients with HCV infection. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C Virus is the leading cause of death in liver-related diseases globally. The identification of innovative drug targets and inexpensive therapeutic agents remain a high priority for chronic HCV infection management. In the last few decades, the availability of highly effective interferon-free regimens for HCV treatment is the only possible option for cure of the large number of chronic HCV patients. Direct acting antiviral drugs, such as Sovaldi, are expensive and their efficacy varies from genotype to genotype. In addition, these drugs are advised in combination with ribavirin and interferon, which makes the treatment costly. Thiazolide derivatives are recently emerging antiviral agents that may change current and future therapies for liver complications caused by HBV and HCV. Nitazoxanides are synthetic nitrothiazolyl-salicylamide derivative of thiazolide, which have been used as anti-HCV drugs. The derivatives of thiazolides were randomly screened for anti-HCV and anti-HBV activity in a biological system, yet the stability and other properties of thesecompoundswere not tested. Representing chemicalcompoundswith Hosoya-polynomial produces closed forms of many topological indices, which correlate with the chemical properties of the material under investigation. These indices are used in the development of quantitative structure-activity relationships (QSARs), in which the biological activity and other properties of molecules like boiling point, stability, strain energy, radius of gyration, and viscosity are correlated with their structures.In this paper, Hosoya-polynomials and Weiner indices of some derivatives of thiazolides were determined. Graphs of Hosoya polynomial for these derivatives were also plotted. Objectives: In this study, therefore, it was attempted to extend the research to check the stability and other properties of thiazolide derivatives using the Hosoya-polynomial and Wiener index. Methods: In the first step, Hosoya polynomials of some famous classes of thiazolides were computed, followed by computation of F Wiener indices of thiazolide derivatives. Distance-based graph invariants were used as a structure-descriptor for predicting various physicochemical properties of organic compounds. The Weiner index of 8 derivatives of thiazolidines was computed, including RM-4832, RM-4848, RM-4850, RM-4851, RM-4852, RM-4850, Tizoxanide, and Nitazoxanide. Results: These indices indicate the physiochemical properties of these compounds in relation to stability in the given biological environment. The Wiener indices of the studied compounds ranged from 374 to 684. Out of 8 analyzed compounds, 3 showed Wiener indices of 374. RM-4863 had a maximum index value of 684. Graphs were also drawn for Hosoya polynomials of all these thiazole derivatives. Conclusions: The results confirmed that RM-4863 is a stable physiochemical compound, which might be used as an effective drug for treating viral infections, including HCV and HBV. [ABSTRACT FROM AUTHOR]

Background: School timings could influence teens' sleeping patterns by interrupting their sleep or the timing of light can shift their biological clock. The COVID-19 pandemic has altered teens' sleeping schedule making it important to analyze the effects of long-term social distancing on adolescents' sleep and mood. Objectives: This study analyzes the effects of long-term social distancing, due to the COVID-19 pandemic, on their sleeping patterns and mood. Methods: In this cohort study, data from the 2018 -- 2020 Korea Youth Risk Behavior Web-based Survey (KYRBS) were used to compare teens' sleep patterns in 2020 with those in 2018 -- 2019. The primary outcomes of this study were the sleep duration and sleep time of adolescents throughout the week, between 2018 and 2019, and in 2020. The secondary outcomes were the teens' mood, health perception, and sleep satisfaction, including differences in total sleep time and sleep discrepancies between weekends and weekdays. Results: Around 58 -- 63 thousand students were surveyed each year, and the participation rate was 94.9 -- 95.6%. After exclusion, 132,839 teens participated in the survey. From 2018-2020, the height and body weight of the participants did not change. After adjusting for participants' sex and school year, it was found that more teens felt happy, fewer teens experienced sadness and desperation, and fewer teens had suicidal thoughts in 2020, compared with the previous two years. They also slept 10 minutes later (9.743 (95% confidence interval 7.954 - 11.530)), with wake-up times of 3 -- 5 minutes later on weekdays (4.684 (3.449 - 5.919)). On weekends during social distancing, they slept 16 minutes later (15.721 (14.077 - 17.366)), with wake-up times of 12 minutes later (12.309 (10.393 - 14.225)). Although they slept five minutes less on weekdays (-5.059 (-6.817 to -3.301)) and three minutes less on weekends (-3.413 (-5.419 to -1.407)), their overall sleep satisfaction increased, and differences in sleep duration between weekdays and weekends decreased in 2020. Conclusions: During social distancing, the mood and sleep efficiency of teens improved. In the future, once the COVID-19 pandemic subsides, online classes can be included in the curriculum of school systems to ensure healthy sleep patterns in teenagers. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is a serious, common and occasionally under-recognized condition. To date, the clinical and some laboratory parameters are routinely applied to distinguish between functional and structural AKI which can be challenging in certain occasions. In the present paper, we investigate the accuracy of urinary calprotectin as a diagnostic biomarker in this dubious situation. Methods: This is a cross-sectional study among 75 children with AKI defined by Acute Kidney Injury Network (AKIN) and 20 healthy children as controls which was carried out for about six months (September 2014 to March 2015). Random urinary calprotectin concentration was assessed by ELISA in both groups within 48 hours after diagnosis. Patients with obstructive uropathy, malnutrition, renal transplantation, chronic renal failure, urinary tract infection, and malignancy were excluded. Receiver-operating characteristic (ROC) curves were drawn to determine the accuracy of urinary calprotectin to detect children with structural AKI. P value less than 0.05 was considered significant. Results: Median urinary calprotectin was 1240 ng/mL in structural AKI, 28.5 in functional, and 33 in controls. Receiver operating curve analysis revealed high levels of accuracy for measuring calprotectin in predicting structural AKI. A cutoff level of 230 ng/mL for urinary calprotectin showed high sensitivity and specificity. The urine calprotectin/creatinine ratio indicated the same accuracy as urinary calprotectin in diagnosing structural AKI. The ROC curve function was better for urine calprotectin and its ratio in comparison to fractional excretion of sodium (FENa). Conclusions: Calprotectin is a biomarker that can rapidly and easily recognize structural from functional AKI with high sensitivity and specificity in comparison to traditional most accurate diagnostic test; FENa. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis C virus (HCV) multiple infections can influence the course of the disease, either by boosting hepatocellular injury or by increasing the frequency of exacerbations. Their prevalence ranges from 5% to 39% in individuals with HCV infection, with a higher impact on injection drug users (IDUs), or in prison settings. Case Presentation: The current paper reported a case of dualHCVinfection in a 31-year-old female, with a referred vertical transmission of HCV infection and also a history of IDU, who harbored a subtype 4d since youth. Treatment failure, after a 24-week course of sofosbuvir/ledipasvir, prompted a reevaluation of present and past HCV status. HCV genotype was determined by INNO-LiPATM HCV II kit (LiPA II) (Innogenetics, Ghent, Belgium) and sequencing of NS5B region (nucleotide 8281 - 8679). Direct-acting antivirals (DAAs) resistance profile was investigated by NS3/4, NS5A and NS5B sequencing with specific primers. The Sentosa® SQ next generation sequencing (NGS) workflow was further performed in the baseline and failure samples. Unexpectedly, a subtype 4d in the pretreatment sample and a subtype 1a in the posttreatment were identified. No resistance associated mutations (RAS) were detected in the subtype 4d, although the 170AV and 174S in the NS3/4 gene, the 30R in the NS5A gene, and the 444D in the NS5B gene were detected in the subtype 1a virus from the failure sample. Conclusions: Two main hypotheses were raised: a reinfection with a new subtype 1a virus during the treatment with a wild type strain, which developed RAS after infection or with an already mutated virus; and a pretreatment hidden dual subtype 4d plus 1a infection. [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]

Objectives: The purpose of this study was to evaluate the feasibility and potential effect of a physical exercise package on the motor proficiency of children and adolescents with Down syndrome. Methods: In this research, an experimental design was conducted in two special schools to evaluate the effectiveness of this package and identify its strengths and weaknesses. Forty students with Down syndrome were selected and randomly divided into intervention and control groups. A total of 36 (22 male and 14 female) students out of 50 at two special schools for children with special needs between October 2020 and March 2021 were recruited for the study. Participants were aged 12.888 ± 2.375 (12.954 ± 2.609 for boys and 12.785 ± 2.044 for girls) years. The 18 students in the intervention group participated in the exercise sessions, 2 or 3 sessions per week for 12 weeks. Pre- and post-tests were performed on both groups. The Physical Exercise Package included the principles of exercise, the preferred exercise methods, and the details of exercise planning for Down syndrome individuals (FITT-VP) based on the etiology of Down syndrome and the characteristics of people with this syndrome. Motor proficiency was measured using the Bruininks Oseretsky Test of Motor Proficiency(BOT-2). Results: The results of the study showed that the designed exercise package was adhered to with all the participants attending 93.2% of the sessions, and participants significantly improved their total motor proficiency score, manual dexterity, upper-limb coordination, strength, balance, upper-limb coordination, running speed and agility and fine motor Integration (P< 0.05). However, the exercises did not significantly change the bilateral coordination and fine motor precision (P > 0.05). Conclusions: the current study result shows that developing and implementing the individualized exercise package and observing the principles set out in the program could have significant positive impacts on the motor proficiency of students with Down syndrome. [ABSTRACT FROM AUTHOR]

Background: Improving surgical and interventional modalities for treating congenital heart disease has increased these children's life expectancy, leading to increased cognitive and behavioral problems. Objectives: This study compared executive function between surgically and interventionally treated congenital heart disease children and their age-matched controls. Methods: In this retrospective cross-sectional study, we enrolled 30 children treated with surgery, 30 interventionally treated patients, and 30 healthy controls. These participants were compared in the executive function domains by the Stroop test, trail making test, cancellation test, visual and auditory memory span test, and behavioral problems using the parental form of strengths and difficulties questionnaire. Results: Executive function in memory span and sustained attention was lower in the surgical group than in the intervention group (P< 0.05). Both groups had lower flexibility, memory recall, simple and complex working memory, visual attention, and simple and complex selective attention performance (P< 0.05). The effect of behavioral problems on daily life was higher in surgical patients than in the intervention group (P< 0.0001). Both groups of patients had higher emotional, conduct, and communication problems than the control group (P< 0.0001). Conclusions: Interventionally treated patients had better performance than surgically treated patients. Regardless of disease severity or treatment, patients with congenital heart disease had poor performance than normal subjects and suffered from behavioral disorders affecting their daily lives. Therefore, it is essential to include diagnostic and therapeutic interventions for treating these patients' executive function and behavioral problems. [ABSTRACT FROM AUTHOR]

Background: Periventricular/intraventricular hemorrhage (PVH/IVH) has a major impact on neurodevelopment due to its complications and sequelae. Objectives: This study aimed to determine the frequency of neurosonographic examination and the length of the monitoring period in children diagnosed with PVH/IVH. Methods: This clinical observational analytical retrospective cohort study was performed on 102 children diagnosed with PVH/IVH. The examinations were done on the third, seventh, fourteenth, and twenty-first days after birth and then in the fourth and sixth weeks and the third and sixth months afterbirth. The results of the examinations performed overtime were subjected to the kappa measure of agreement test, with a significance threshold of 0.05, to determine the period when the most significant changes occur in the patient's condition, as well as to determine the optimum frequency of the examination. Results: There was statistically significant agreement between the results of all the examinations performed in the observed moments (P< 0.0005). However, it is indicative that the agreement was excellent for the fourth week (kappa agreement was more than 0.85), followed by the sixth week that was very good (kappa agreement was 0.79); however, the agreement for the sixth week and the third month was very small (kappa agreement was less than 0.1). Also, there were no major changes (kappa agreement between results from the third and sixth months was 0.88). Conclusions: The first neurosonographic examination should be conducted in the first 7 days after birth, and the control examination should be conducted at the age of 4 - 6 weeks. If a pathological finding is observed, the examination is repeated after the specified period until a stationary finding is observed. After the third month, no new changes in the finding are observed. [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: Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. Evidence Acquisition: A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Results: Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Conclusions: Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes. [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]