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Dear Editor, Hydrocarbon compounds such as petroleum jelly and mineral oil can cause lower respiratory disease named exogenous lipoid pneumonia because of high viscosity and surface tension (1). Acute exogenous lipoid pneumonia occurs after exposure to large amounts of mineral oils. The acute form in children is mostly a consequence of accidental poisoning. (2). Consolidation, nodular lesions, reticular and alveolar-interstitial patterns are the most common findings in the chest X-rays. Lower lobes or right middle lobe commonly get involved, but multifocal and bilateral lesions are shown too (3). The diagnosis of exogenous lipid pneumonia is made by a positive history of mineral oil exposure and radiologic findings in favor of the disease and revealing lipid-laden macrophages on bronchoalveolar lavages (BALs) or sputum specimen. Multiple BALs can remove Lipid-laden macrophages as a leading cause of fibrosis in the alveoli and interstitium (3, 4). We present a rare case of exogenous lipoid pneumonia in a 2.5-year old boy with a history of mineral oil aspiration who admitted to the pediatric intensive care unit because of cyanosis and severe respiratory distress. On physical examination he presented with tachycardia (190 min), tachypnea (80 min), O2 saturation 50%, numerous crackles on auscultation of both lungs. Laboratory findings were leukocytosis with a left shift and increased CRP. A chest X-ray showed diffuse opacities with an alveolar pattern in both lungs (Figure 1). CT scans of the chest revealed bilateral diffuse severe pneumonitis with ground glass and alveolar appearance and crazy paving (Figure 2). Bronchoscopy was done. Mucopurulent secretions aspirated then rinsed with saline. After staining the BAL fluid with Sudan III many lipid laden macrophages (grade IV/IV) were seen. Multiple segmental BAL was done weekly, after that BAL fluid became nearly clear and cell counts reached near the normal range values. CT scan which was done after the forth therapeutic BAL, showed dramatic improvement in both lungs (Figure 3). The patient discharged after one month hospitalization and recommended to return to follow up. Figure 1. Simple Anteroposterior Chest X-Ray Demonstrating Bilateral Opacities, Mostly in the Lower Lobes Figure 2. High-Resolution Computed Tomography Scan of the Chest Demonstrating Alveolar Infiltrate, Mostly in the Lung Bases Figure 3. High-Resolution Computed Tomography Scan of the Chest Showing Dramatic Improvement in Both Lungs After Multiple Segmental BAL The best way to remove the oil is multiple BALs especially in the most severely involved segments (3). According to several surveys, multiple BALs is an effective therapeutic strategy with few risks, and better improvement in the clinical and radiological signs (5). The present study indicates that therapeutic multiple segmental BAL is a successful method in removing intra-alveolar mineral oil with significant resolution of clinical, radiological and laboratory findings.

Background: Obesity is associated with higher frequency of asthma and deterioration of lung function in healthy population as well as patients with chronic lung diseases. It has been suggested that physical activity (PA) may improve lung function via both reducing the weight and independently. This study is aimed at investigating the association of PA with frequency of wheezing and exercise-induced bronchospasm (EIB) in school-aged children. Methods: This cross-sectional study was conducted on 939 children (453 girls) with mean age of 12.7 ± 1.1 years. International Physical Activity Questionnaire (IPAQ) was used to assess the PA. International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to identify wheezing. Spirometry and exercise challenge test was done to investigate lung function. EIB was recognized in those with more than 10% reduction in forced expiratory volume in 1 second (FEV1). Results: Mean predicted percent of FEV1 and forced vital capacity (FVC) was 87.7 ± 35.2% and 81.3 ± 25.1%. PA duration but not intensity was positively associated with FEV1 (unadjusted B=0.358, adjusted B=0.280, all p Conclusion: PA duration but not intensity is associated with higher FEV1 and lower wheezing and EIB frequency in school-aged children.

Background: Previous studies demonstrated an adverse effect of air pollution on lung function. In addition, asthma severity and emergency department visits are significantly increased with air pollution. This study is aimed at investigating the association of particulate matter air pollution with exercise-induced bronchospasm (EIB). Methods: This cross-sectional study was conducted on 1622 adolescents aged 12-15 years (48.3% girls) living in 3 different geographic areas of IRAN. National air quality monitoring agency provided the mean daily concentration of particulate matters less than 10 µm (PM 10 ). The ISAAC questionnaire was completed by the investigators and exercise challenge test was performed for those with any reported exercise-induced respiratory symptoms. Decrease of more than 10% in FEV1 following challenge was considered EIB. Results: Average PM 10 during study period was 99.7, 114.3 and 140.6 µg/m 3 in areas 1 to 3, respectively. A total of 423 (26.7%) were found to have respiratory symptoms during exercise. Of them 302 (71.3%) agreed to do spirometry. Exercise challenge test was performed for 282 (66.7%) as 20 participants had FEV1 predicted 3 increase in PM 10 was associated with 10-14% increase in prevalence of EIB. Conclusion: Increase in particulate matter air pollution is associated with increased prevalence of EIB.

Background: High intake of fish oil, antioxidants, and fruits have been suggested to exert positive effects on lung function. However, the results are not concluding. This study is aimed at investigating the association of dietary composition on wheezing and lung function in school-aged children. Methods: A total of 1378 children (654 girls) with mean age of 13±1.5 years participated in this cross-sectional study. A detailed questionnaire regarding diet was used to assess the intake of different food groups. Dietary patterns were categorized into Western (high consumption of fast foods, meat with few vegetables), Asian (high amount of rice, and vegetables with few meat) and Healthy diet (balanced with vegetables, fruits, dairy products and meat and fish). Spirometry was performed to assess the lung function. Wheezing was recognized according to the International Study of Asthma and Allergies in Childhood. Results: A weak but significant positive correlation was found between consumption of dairy products, fish, egg, fruits and coffee with forced expiratory volume in 1 second ((FEV1), r=0.113, r=0.141, r=0.104, r=0.116, r=0.148, respectively, all p

Background:: Regarding the fact that halitosis has social and personal aspects which can lead to social embarrassment and consequently low self-esteem and self-confidence in subjects suffering from the problem, especially children, its proper treatment is an important issue. Objectives:: The aim of this study was to evaluate the effect of metronidazole as a nonspecific antimicrobial agent in the treatment of halitosis in children. Materials and Methods:: In this study, 2-10 years old children with oral halitosis were enrolled. Children without H. pylori infection and parasitic infection were randomized in two interventional and control groups. Metronidazole was given 5mg/kg/day for one week. Information regarding the demographic characteristics of studied population and halitosis (duration and time of day with more halitosis and its severity) before and after intervention was recorded using a questionnaire Results:: 77 children with halitosis were studied in two interventional (40 children) and control (37 children) groups. There was no significant difference between two groups before intervention. After intervention, halitosis improvement rate - according to the reports of mothers of studied children - was higher significantly in intervention group (P < 0.05). Conclusions:: The results support the effectiveness of metronidazole in the treatment of halitosis. Moreover, it supports recent findings regarding the participation of specific bacteria specially unculturable ones in the pathogenesis of the disease.

To assess the efficacy of nebulized magnesium sulfate as a bronchodilator in infants hospitalized with acute bronchiolitis.This three-center double masked randomized clinical trial comprised 120 children with moderate to severe bronchiolitis. They were randomly assigned into two groups: the first group was treated with nebulized magnesium sulfate (40 mg/kg) and nebulized epinephrine (0.1 ml/kg) and the second group (control) was treated with nebulized epinephrine (0.1 ml/kg). The primary outcome was the length of hospital stay. The use of oxygen, temperature, oxygen saturation (SPO2), pulse rate (PR), respiratory rate (RR) and respiratory distress assessment instrument (RDAI) score were measured in the beginning of the study and during hospitalization.The mean (SD) age of 120 infants was 5.1(± 2.6) mo and 60% were boys. The length of hospital stay was not different between the two groups (P0.01). Use of oxygen supplementation, SPO2 and vital signs were similar in the two groups. Improvement in RDAI score was significantly better in infants treated with nebulized magnesium sulfate than in the other group (P 0.01).Thus, in infants with acute bronchiolitis, the effect of nebulized magnesium sulfate is comparable to nebulized epinephrine. However nebulized magnesium sulfate can improve the clinical score so it may have additive effect to reduce symptoms during hospitalization.

In the original article, the authors failed to cite the study by Kose M et al. entitled "The efficacy of nebulized salbutamol, magnesium sulfate and salbutamol/magnesium sulfate combination in moderate bronchiolitis. Eur J Pediatr 2014;173: 1157-1160" as the first in literature to assess the efficacy of magnesium sulfate in the treatment of acute bronchiolitis. The authors apologize for this unintentional omission.

Cystic fibrosis (CF), as a fatal genetic condition, is associated with high morbidity and mortality rates. In Iran, limited studies exist on this disease. This study aimed to compare the demographic, clinical and paraclinical data of CF patients. This cross-sectional study was conducted in 2014-2015 on 174 CF patients referred to the Tehran Children Medical Center hospital, which is the main referral center for CF. For each patient, the forced expiratory volume in one second (FEV1) was measured, and the comparative demographic, clinical, and laboratory data of patients were recorded. Overall, 59 of studied patients were boys (n=102) and 41 were girls (n=72). The mean patient age (and standard deviations) was 7.1±5.7 years, with a range of 10 days to 28 years. In 67 of cases, the disease was diagnosed before their first birthday. The patients in this study were classified based on the FEV1 into mild (62), moderate (33) and severe (5), indicating the degree of pulmonary complications. Cultures of respiratory secretions were positive for Pseudomonas aeruginosa and Staphylococcus aureus, in 23 and 16 of cases, respectively. In total, 61 of patients (n=83) were assigned to receive oral azithromycin for prophylaxis. Gastroesophageal reflux (reflux) was the most common gastrointestinal complication (35). Regarding the complex nature of CF and the necessity of constant monitoring of patients during the life-span, the comparative demographic, clinical and laboratory analysis of patients and registering and standardization of patients� data can be a major step in the better understanding of the disease, and thereby increasing the quality of life and life expectancy in the affected population. © 2019 Tehran University of Medical Sciences. All rights reserved.

Background This study aimed to assess the relationship of air pollution and plasma surrogate markers of endothelial dysfunction in the pediatric age group. Methods This cross-sectional study was conducted in 2009-2010 among 125 participants aged 10-18 years. They were randomly selected from different areas of Isfahan city, the second large and air-polluted city in Iran. The association of air pollutants' levels with serum thrombomodulin (TM) and tissue factor (TF) was determined after adjustment for age, gender, anthropometric measures, dietary and physical activity habits. Results Data of 118 participants was complete and was analyzed. The mean age was 12.79 (2.35) years. The mean pollution standards index (PSI) value was at moderate level, the mean particular matter measuring up to 10 μm (PM10) was more than twice the normal level. Multiple linear regression analysis showed that TF had significant relationship with all air pollutants except than carbon monoxide, and TM had significant inverse relationship with ozone. The odds ratio of elevated TF was significantly higher in the upper vs. the lowest quartiles of PM10, ozone and PSI. The corresponding figures were in opposite direction for TM. Conclusions The relationship of air pollutants with endothelial dysfunction and pro-coagulant state can be an important factor in the development of atherosclerosis from early life. This finding should be confirmed in future longitudinal studies. Concerns about the harmful effects of air pollution on children's health should be considered a top priority for public health policy; it should be underscored in primordial and primary prevention of chronic diseases.