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Background Cystic fibrosis (CF) is a genetic disorder, which is caused by the CFTR protein defects. Along with CFTR dysfunction, inflammation plays a key role in the disease outcomes. Inflammation may develop due to the internal dysfunction of the CFTR protein or external factors. Curcumin affects the CFTR protein function primarily as a corrector and potentiator and secondary as an anti-inflammatory and antimicrobial agent. The present study aims to assess the impact of nano-curcumin on clinical and inflammatory markers in children with CF. Methods This prospective, double blind control trial will be conducted at the Akbar Children’s Hospital in Mashhad, Iran. Children with CF will be enrolled based on the eligibility criteria. Placebo and curcumin with the maximum dose of 80 mg considering the body surface of the patients will be administrated for 3 months. The primary outcome is to evaluate inflammation based on serum interleukin-6, interleukin-10, and hs-CRP, stool calprotectin, and neutrophil count of nasopharyngeal swab. The secondary outcome involved clinical assessment via spirometry, anthropometrics, and quality of life. They will be assessed before and after 3 months. Discussion Due to the multifarious effects of curcumin on CF disease, it could be proposed as a nutritional strategy in the treatment of cystic fibrosis. Trial registration Iranian Registry of Clinical Trials IRCT20200705048018N1. Registered on July 10, 2020.

Introduction: COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 increasingly involves people worldwide. Probiotics can improve immune system functions via different mechanisms. We proposed that Synbiotic Lactocare? may also reduce SARS-Cov2 infection in high-risk medical staff working in COVID-19 hospital wards. Method: In a randomized, controlled trial, 60 hospital staff without any history of clinical or laboratory evidence of SARS-Cov2 infection were received either once-daily oral synbiotic capsule (Lactocare?) that contains 1 billion CFU/Cap of L. (Lactobacillus) casei, L. rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, L. acidophilus, Bifidobacterium infantis, L. bulgaricus, and Fructooligosacharide (Zist Takhmir, Tehran, Iran) or placebo with the same appearance for 30 days. They were followed for two months. Result: During the two-month period of this study, SARS-COV-2 RT-PCR test results were positive in three participants (9.67%) in placebo group compared to zero positive tests in synbiotic group. The differences were not statistically significant (p = 0.238). During the study, two persons (7 %) of placebo group had respiratory complaints such as cough, rhinorrhea and/or dyspnea, compared with one in synbiotic group (p = 0.492). Conclusion: This study showed that overall frequency of SARS-COV2 infection in participants receiving synbiotic and those receiving placebo did not differ significantly. However, 3 hospital staff in placebo group compared to no one in synbiotic group had SARS-COV2 infection. Further studies with greater power and alternative probiotic strains and mixture are warranted to determine whether Synbiotic can prevent COVID-19 in at-risk hospital staff.

Introduction: COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 increasingly involves people worldwide. Probiotics can improve immune system functions via different mechanisms. We proposed that Synbiotic Lactocare® may also reduce SARS-Cov2 infection in high risk medical staff working in COVID-19 hospital wards. Method: In a randomized, controlled trial, 60 hospital staff without any history of clinical or laboratory evidence of SARS-Cov2 infection were received either once daily oral synbiotic capsule (Lactocare®) that contains 1 billion CFU/Cap of L. (Lactobacillus) casei, L. rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, L. acidophilus, Bifidobacterium infantis, L. bulgaricus, and Fructooligosacharide (Zist Takhmir, Tehran, Iran) or placebo with the same appearance for 30 days. They were followed for two months. Result: During the two month period of this study, SARS-COV-2 RT-PCR test results were positive in three participants (9.67%) in placebo group compared to zero positive test in synbiotic group. The differences were not statistically significant (p= 0.238). During the study, two persons (7 %) of placebo group had respiratory complaint such as cough, rhinorrhea and/or dyspnea, compared with one in synbiotic group (p= 0.492). Conclusion: This study showed that overall frequency of SARS-COC2 infection in participants receiving synbiotic and those receiving placebo did not differ significantly. However, 3 hospital staff in placebo group compared to no one in synbiotic group had SARS-COV2 infection. Further studies with greater power and alternative probiotic strains and mixture are warranted to determine whether Synbiotic can prevent COVID-19 in at-risk hospital staff. Keywords: COVID-19, Synbiotic, prevention, Lactocare, SARS-Cov2

The Streptococcus pluranimalium was isolated from both of animals and human infection. There is limited information about pathogenicity of S pluranimalium. As fastidious bacteria, S pluranimalium is not isolated in the routinely culture media and easily misidentified with other streptococci species with conventional microbiology test. According to review of the literatures, the cephalosporins, aminoglycosides, vancomycin, and linezolid are the first choice agents for treatment of infection caused by S pluranimalium.

Background: Alpha-1 antitrypsin (AAT) deficiency is a common genetic cause of childhood liver disorders. Its prevalence is highly variable around the world. Although this genetic deficiency is the main cause of neonatal jaundice, few studies have investigated AAT in Iran. Objectives: The current study aimed to investigate the association between specific alleles of AAT with idiopathic neonatal jaundice disease in patients with idiopathic jaundice. Methods: In this study, 30 neonates with a definitive diagnosis of neonatal cholestasis referred to Ghaem, and Dr. Sheikh hospitals in Mashhad (Iran) are included. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed on the extracted DNA from their blood samples. In the lack of commonly mutated alleles detected, the whole gene exons were DNA sequenced. Results: In the molecular test, we found no case of PiS or PiZ allele. The mutated alleles of PiS and PiZ were not appeared in patients with neonatal jaundice using the PCR-RFLP method. DNA sequencing was performed in 30 patients. Other rare missense variations were detected in the form of heterozygous (for Glu400Asp in 8 patients and Val237Ala in 2 patients), homozygous (for Glu400Asp in 1 patient), and compound heterozygous (for Glu400Asp/Val237Ala in 3 patients and Val237Ala/Asp280Val in 1 patient). Conclusions: The AAT deficiency caused by PiZ and PiS allelic variants was noted among infants with neonatal cholestasis in the Khorasan province of Iran. Other rare variants in the PiM might be caused by AAT deficiency and presenting the neonatal cholestasis. The possible functional study should be considered for the mutations identified.

Background: Cystic fibrosis(CF) is a genetic disorder, which is caused by the CFTR protein defects. Along with CFTR dysfunction, inflammation plays a key role in the disease outcomes. Inflammation may develop due to the internal dysfunction of the CFTR protein or external factors. Curcumin affects the CFTR protein function primarily as a corrector and potentiator and secondary as an anti-inflammatory and antimicrobial agent. The present study aims to assess the impact of Nano-curcumin on clinical and inflammatory markers in children with CF.Methods: This prospective, double blind control trial will be conducted at Akbar Children's Hospital in Mashhad, Iran. children with CF will be enrolled based on the eligibility criteria. Placebo and curcumin with the maximum dose of 80 milligrams considering the body surface of the patients will be administrated for three months. The primary outcome is to evaluate inflammation based on serum interleukin-6, interleukin-10, and hs-CRP, stool calprotectin, and neutrophil count of nasopharyngeal swab. The secondary outcome involved clinical assessment via spirometry, anthropometrics, and quality of life. They will be assessed before and after three mounts.Discussion: Due to the multifarious effects of curcumin on CF disease, it can be used as a nutritional strategy in the treatment of cystic fibrosis.Trial registration: Iranian Registry of Clinical Trials, IRCT20200705048018N1, Registered on 2020-07-10, https://en.irct.ir/search/result?query=IRCT20200705048018N1

Introduction: Cystic Fibrosis (CF) is a genetic disease with progressive lung disease, malnutrition, liver disease and CF-related diabetes (1). Viral infections are a major factor causing pulmonary exacerbations in CF (2). COVID-19 has caused a worldwide pandemic with high death rates. As science suggests, patients with CF would be severely affected with a high rate of morbidity, hospitalization and mortality. In a recent study published by Cosgriff et al. (3) people with CF who were 15 years and older, infected with COVID-19 appear to have better outcomes than initially anticipated. We report the only two cases of CF in literature less than 15 years of age with better than expected outcomes post COVID-19 infection and discuss the possible effects of hypertonic Saline as a plausible explanation.

A pilot study was done to assess whether synbiotics supplementation could optimize anthropometric indices in Iranian obese children. Participants included 46 overweight or obese children 7 to 13 years of age. The treatment group had a restricted diet, physical activity plan, and a synbiotics capsule per day for 12 weeks. The placebo group received a similar diet, activity plan, and placebo capsules. Body fat and z scores for body mass index showed significant reductions in both groups; however, waist circumference decreased significantly only in the synbiotics group. Between-group comparisons showed no significant differences in any variable. Our findings showed that synbiotics can improve the benefits of lifestyle modifications by decreasing waist circumference in overweight or obese children.

Background The popularity of probiotics is on the rise. Despite the beneficial effects of antibiotics, gastrointestinal health is at risk of diarrhea. This study aimed to investigate whether probiotic yogurt is of capability to prevent the incidence of diarrhea versus conventional yogurt. Materials and Methods This controlled, randomized, double-blind trial was designed to recruit 48 hospitalized children, whose treatments included different types of antibiotics. They were subsequently assigned into a 1:1 ratio into groups A and B at random. The first group was instructed to consume probiotic yogurt (Bifidobacterium strains and Lactobacillus acidophilus), while the second were on conventional yogurt (placebo containing Streptococcus thermophiles and Lactobacillus bulgaricus) at least for 7 days. The incidence of diarrhea, its onset and duration were compared between the two groups. Results The findings indicated that there was no statistically significant difference between the experimental and control groups (p > 0.05). No significant decrease was observed in the incidence of diarrhea between the groups following adjustment for negative C-reactive protein (CRP) (p > 0.05). Conclusion According to the results, the consumption of yogurt, either probiotic or conventional, reduced the incidence, duration, and onset of antibiotic-associated diarrhea in pediatric population. This study showed no significantly better performance for probiotic yogurt than conventional yogurt.

Background Celiac disease (CD) is a systemic autoimmune disorder due to immune response triggered by ingestion of gluten in the diet. Treatment with lifelong gluten-free diet may impact negatively on the health-related quality of life and may lead to psychological disturbances. The purpose of study was to evaluate quality of life, depression and anxiety in children with celiac disease. Materials and Methods In this cross-sectional study was done between 2013 and 2014 at the Gastroenterology Outpatient Clinic (Ghaem Hospital, Mashhad- Iran), patients with serology and biopsy-proven CD, on a gluten-free diet for at least one year, were included in this study and compared with non-celiac healthy children as controls. We used the questionnaire to investigate quality of life, anxiety and depression. Results There were statistically significant differences between the mean total anxiety (state, trait) scores and depression score in the celiac patients and control group. Correlations between state and trait anxiety and depression were statistically significant (P= 0.01, r= 0.35) and (P= 0.001, r= 0.52). Reverse correlations between quality of life of CD children and anxiety (state, trait) were statistically significant (P= 0.001, r= 0.51 and P= 0.02, r= 0.32). Mean total score of quality of life was not different in the two groups, but in the physical activity component, quality of life was better in CD patients (P=0.008). Conclusion In current study, anxiety and depression had a significant impact on the course of celiac disease.

Background: Inflammatory bowel diseases (IBD) can adversely affect children in many different ways. Health-related quality of life (HRQOL) involves all aspects of life quality, along with physical or mental perceptions of health, which could exert an overall effect on an individual’s health. The IMPACT-III questionnaire is a well-established and validated tool for evaluation of the HRQOL in children with IBD. Objectives: The objective of this work was to translate this tool into Persian so it could be utilized in Iran. Methods: In collaboration with the developer of IMPACT-III, a standardized translation and validation process was undertaken. Assessment steps included (1) translation of IMPACT-III into Persian; (2) assessment of the clarity and wording of the tool; and (3) ascertain the reliability and validity of the adapted instrument using a test-retest assessment. Patient scores were evaluated within four domains (social performance, body image, emotional and physical dimensions) and analysis undertaken with SPSS (version 16). The study was completed in Mashhad and Tehran University of Medical Sciences, Iran, between June 2014 and Jan 2015. Results: IMPACT-III total score in patients with inactive disease was significantly higher than patients with active disease (P 0.05). Children with ulcerative colitis had higher IMPACT-III scores than the children with Crohn disease (P = 0.001). Conclusions: This study indicates convincing validity and reliability for the four-factor IMPACT-III scores regarding HRQOL in children with IBD. The Farsi version of this tool can now be utilized for clinical and research applications.

Background: Cystic fibrosis (CF) is a multi-systemic disorder with an autosomal recessive inheritance. It is characterized by recurrent pulmonary infections and gastrointestinal problems, particularly pancreas insufficiency. Objectives: The aim of this study was to evaluate growth peptides in CF patients. Methods: This cross sectional study was approved by Mashhad University of Medical Sciences ethical committee. Patients were between six months to 18 years old, who were referred to Dr. Sheikh Hospital subspecialty clinic. They were enrolled for the study after obtaining a written constant. Demographic data was recorded. Of all cases, 10-cc blood sample was obtained and growth peptide levels were determined and measured. Data were analyzed by SPSS version 16 and Mann Whitney and χ2 tests were used. Results: Patients’ mean age at onset was 3.4 ± 1.1 months. Overall, 36 (60%) children were male and 24 (40%) were female. Mean body mass index (BMI) was 15.9 ± 3.2 kg/m2. Mean levels of growth hormone was 1.9 ± 0.37 (ng/mL), insulin-like growth factor 1 (IGF1) was 85.8 ± 9.6 microg/L and insulin-like growth factor binding protein 3 (IGFBP3) level was 18538 ± 10643 pg/mL. Conclusions: The mean serum levels of GH, IGF1, and IGFBP3 in CF children with growth failure was lower than children without growth failure. Regarding the relatively high prevalence of growth disorders in children with cystic fibrosis, selected, appropriate, and standard medical treatments could improve the outcome for these children.

Introduction Since the treatment of gastroesophageal reflux disease (GERD) symptoms in children is of the utmost importance, the current study is aimed to evaluating the efficacy of quince syrup and ranitidine in the management of pediatric patients with symptomatic GERD. Methods and Materials This double-blind, randomized clinical trial was performed on 96 children suspected of suffering from GERD. The patients referred to the gastrointestinal clinic of Ghaem Hospital, Iran, during 2017. The participants were randomly categorized into two groups (ranitidine and ranitidine plus quince syrup). The GERD symptoms, including the severity and frequency of vomiting, refusal of eating, difficulty in swallowing, choking at the time of eating, burping or belching, and abdominal or belly pain, were gathered before and after the intervention (4 weeks) using standardized Global Severity Questionnaire (GSQ-YC). Results The comparison of two groups in terms of vomiting, refusal of eating, burping or belching, and abdominal or belly pain showed a significant difference 4 and 6 weeks after the intervention (P ≤ 0.05). However, the comparison of difficulty in swallowing and choking at the time of eating between the two groups showed that there was no significant difference after 2, 4, and 6 weeks of the intervention (P > 0.05). The comparison of the total scores between the two groups showed that there was a significant difference 2 (17.8 ± 2.6 vs 23.4 ± 4.0; P ≤ 0.05), 4 (11.5 ± 2.3 vs 18.8 ± 3.6; P ≤ 0.05), and 6 (12.2 ± 2.3 vs 21.1 ± 4.1; P ≤ 0.05) weeks after the intervention. Conclusion The results showed that the administration of ranitidine plus quince syrup was useful to improve pediatric GERD. However, it is recommended to conduct the future studies with a larger sample size and different dosage.

BackgroundAbout 15 to 40% of children with seizures are refractory to standard anti-epileptic drugs and for such patients, other treatments such as surgery and the ketogenic diet can reduce seizure frequency. Melatonin is a natural pineal gland hormone. The use of melatonin for controlling pediatric seizures is still controversial. This study aimed to evaluate the effect of melatonin on seizures, parent's satisfaction, sleep, and behavior in children with drug-resistant epilepsy.Materials and Methods: In a pilot crossover study, children with drug-resistant epilepsy, who referred to the epileptic clinic of Ghaem Hospital, were randomly assigned to receive treatment with melatonin or a placebo for 4 weeks followed by a one-day washout period. Then patients who started with melatonin were switched to the placebo. Melatonin was administered 30 minutes before bedtime at a dose of 10 mg /m2 in 3mg tablets.ResultsTwenty patients, of which 11 (55%) were male, were enrolled into the study. The range and mean age of patients were 2 to 13 years and 7.28 ± 3.46 years, respectively. The mean number of diurnal seizures in the study group during placebo treatment was 11.05 and during melatonin treatment was 6.25, which was statistically significant (P=0.021). However, the reduction of the mean duration of diurnal seizures in the study groups was not statistically significant (P=0.386). There was no correlation between decreasing in number or duration of seizures with melatonin plasma levels. Drowsiness was the only side effect of melatonin, which occurred in three patients. ConclusionMelatonin has probable beneficial effects on some epileptic patients with unclear mechanisms. Physicians can use it in selected epileptic children to improve seizures.

Background: Critically ill children admitted to pediatric intensive care unit (PICU) are at increased risk of gastrointestinal bleeding due to stress related mucosal injury. Reducing gastric acid by acid suppressant medication is the accepted prophylaxis treatment, but there is not any definitive guideline for using prophylaxis in PICU patients. The present study aimed to assess the effect of Proton Pump Inhibitor (PPI) and H2 Blocker (H2B) prophylaxis on gastrointestinal bleeding in admitted patients of PICU, Mashhad- Iran.Materials and Methods: In this study, 100 patients admitted in PICU divided into two equal groups on the first day of admission. They received ranitidine or pantoprazole as prophylaxis of stress ulcer. Those patients who had history of gastrointestinal bleeding or coagulation disorder were excluded. 100 PICU patients who had not received prophylaxis during last 6 months retrospectively evaluated as control of the study. Data were collected as demographic characteristics, admission reason, definitive diagnosis, receiving corticosteroid and mechanical ventilation in each patient. Gastrointestinal bleeding (hematemesis, coffee ground aspirate, and melena) and clinically significant gastrointestinal bleeding were daily monitored. Data analyzed through descriptive statistical tests, Chi-square, logistic regression, t-test and using SPSS-16 software.Results: Among 204 patients (control group=105 and case group=99), incidence of gastrointestinal bleeding (GB) was 13.2% in which 6.9% of cases presented with clinically significant gastrointestinal bleeding (CSGB). Loss of consciousness and respiratory distress were the main reason of admission. There was no significant differences between the incidence of (GB) and (CSGB) in experimental and control groups (P>0.05) as well as ranitidine and pantoprazole prophylaxis (P>0.05). Significant risk factors of (GB) were mechanical ventilation and loss of consciousness and corticosteroid therapy.Conclusion: There is ambiguity about probable benefits of gastrointestinal bleeding prophylaxis in critically ill children. We proposed that prophylaxis should prescribe in patients with two or more risk factors of gastrointestinal bleeding.

Introduction: To supply quality services and healthcare, it is evident that medical ethics and patients' rights, while providing medical and healthcare services need to be observed. This study was conducted to evaluate observance of the Patients' Rights Charter among medical staff of educational hospitals affiliated to Mashhad University of Medical Sciences. Methods: This cross-sectional study was conducted in four educational hospitals in Mashhad on eighty physicians, nurses, nurse aids and medical students. Data were collected using a two-part inventory of patients' rights, including demographic data and inventory of patients' rights observance. Data analysis was conducted using SPSS-16 as well as descriptive statistics, independent t-test, chi-square, Spearman correlation coefficient and Pearson correlation. Results: Mean age of subjects was 36.3±8.3. Observance of human rights was perfect by 84.4 percent of subjects. The highest amount of observance of patients' rights was related to the area of respecting patients' privacy and observing the principle of confidentiality, which was evaluated to be perfect by all subjects (100%). The lowest value of patients' rights observance was related to presenting appropriate and adequate information for patients, which was perfect among 48.1% of subjects. There was no significant relation between personal details (age, gender, education and career) and observance of patients' rights (p>0.05). Conclusion: Although in this study, the observance of patients' rights by medical staff is optimal in most areas, the area of providing appropriate and adequate information needs to be promoted. Therefore, it is suggested that more stringent regulatory policies be compiled and implemented to the items of Patients' Rights Charter along with training courses, to strengthen medical staff's awareness in this regard.

Background and objective: Asthma is a growing problem worldwide. Acute exacerbations impose considerable morbidity, mortality, and increased cost. Viral respiratory infections are the most common cause (80-85%) of pediatric asthma exacerbations and admissions to the hospital. The aim of this study was to determine the effect of a new synbiotic Lactocare® on viral respiratory infections and asthma exacerbations in asthmatic children. Methods: In this double blind, placebo-controlled, randomized clinical trial, 72 children with mild persistent asthma, aged between 6 and 12 years, were randomized to receive either Lactocare®, a Synbiotic containing 1 billion CFU/Capsule of Lactobacillus casei, Lactobacillus rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, Lactobacillus acidophilus, Bifidobacterium infantis, Lactobacillus bulgaricus, and Fructooligosacharide (Zist Takhmir, Tehran, Iran) or placebo daily for 60 days. The primary outcome was the number of viral respiratory infections, and secondary outcomes were school absence, salbutamol and prednisolone usage, outpatient visits, and hospital admission for asthma. The outcomes were compared among study groups using the SPSS 11.5 program and the Mann Whitney and Fisher exact tests. Results: Of the 72 children who were enrolled with mild persistent asthma, 36 were assigned randomly to be treated with synbiotic and 36 with placebo. The number of viral respiratory infections was significantly higher in placebo group than the synbiotic group during the first month of intervention (0.74 ± 0.12 vs. 0.44 ± 0.1, p < 0.007) but not during the second month (0.5 ± 0.8 vs. 0.5 ± 0.8, p < 0.641). Considering the total duration of the study (two months), infection episodes also were significantly lower in the synbiotic group (0.92 ± 0.15 vs. 0.69 ± 0.11, p < 0.046). Salbutamol consumption was significantly lower in the synbiotic group, but there were no significant differences in school absenteeism, oral prednisolone use, outpatient visits, or hospital admissions. Conclusion: This new synbiotic (a mixture of seven probiotic strains plus fructooligosacharide may reduce episodes of viral infection in asthmatic children. Trial registration: This study is registered in Iranian Registry of Clinical Trials with registration number of IRCT201509234976N3. Funding: This research was supported financially by the Research Council of Mashhad University of Medical Sciences (Grant Number: 911048).

Superior Mesenteric Artery Syndrome (SMAS) resulting from proximal partial small bowel obstruction is one of possible causes of acute gastric dilatation (AGD). A child with refractory demyelinating Guillain-Barre syndrome which received 5 times IVIG and consequently 5 times plasmapheresis intubated until 59th day of admission. Because of complicated treatment and cardiopulmonary resuscitation (CPR) nutrition was completely neglected which lead to severe SMAS because of weight loss. Gradual advancements of continuous enteral and parenteral nutrition improved patient's symptoms significantly. Hypophosphatemia complicated the weaning from ventilator which after nutrition therapy resolved and patient extubated. Present case is the first report of pediatric demyelinating GBS suspected to SMAS.

ntroduction: Dermal ridges and craniofacial structures form from the same embryonic tissues during the same embryonic period. Thus, this might indicate a possible association between dermatoglyphics and facial skeletal disorders, such as malocclusions. Early diagnosis of skeletal malocclusions sometimes can prevent future surgical procedures. The aim of this study was to compare the dermatoglyphic characteristics of different malocclusions. Methods: In this cross-sectional study, 323 patients who were referred to Orthodontic Department of Mashhad Dental School were recruited. The participants were classified into three groups according to Angle´s classification, i.e., Skeletal Class 1 (n = 163), Skeletal Class 2 (n = 111), and Skeletal Class 3 (n = 49). For all participants, we recorded the total ridge counts of each finger (TRC), atd angles, a-b ridge counts, and types of fingerprint patterns. Right- and left-hand asymmetry scores were calculated. The chi-squared test was used to compare the dissimilarity of the types of patterns for each finger. Asymmetry of other parameters was analyzed statistically using the ANOVA or Kruskal-Wallis tests. P-values greater than 0.05 were considered to be significant. Results: A significant difference was determined between Class I and Class III patients in terms of left a-b ridge count (p=0.049). Loop was the most frequent pattern in the three groups, whereas the arch pattern occurred with the lowest frequency. No significant difference was found in the other parameters that were studied. Conclusion: Although there were some slight differences in dermatoglyphic peculiarities of different skeletal malocclusions, most of the palm and fingerprint characteristics failed to indicate any significant differences.

Aims: Patients with Cystic Fibrosis (CF) have increased risk of malnutrition. Early detection of nutritional deterioration enables prompt intervention and correction. The aims of this project were to define the nutritional status of CF patients in Iran and New Zealand, compare and contrast the McDonald Nutritional Risk Screening (NRS) tool with the Australasian Guidelines for Nutrition in Cystic Fibrosis, and validate these results with each patient’s evaluation by their CF clinical team. Methods: Children with CF (2 - 18 years) were assessed during routine outpatient visits over one year. Anthropometric measurements were obtained. Both tools were applied and the results compared to their clinical evaluation (as gold standard) with calculation of specificity and sensitivity. Results: Under-nutrition was seen more frequent in the 33 Iranian children than in the 36 New Zealand (NZ) patients (39% versus 0%, p=0.0001), whereas over-nutrition was more prevalent in NZ children (9% versus 17%, p=0.05). At the first visit, both guidelines were able to recognize 77% and 61% of under-nourished Iranian patients, respectively. The mean sensitivity and specificity for all visits for the McDonald tool were 83% & 73% (Iran) and 65% & 86% (NZ). Sensitivity and specificity for the Australasian guidelines were 79% & 79% (Iran) and 70% & 90% (NZ). Conclusions: Both tools successfully recognised patients at risk of malnutrition. The McDonald tool had comparable sensitivity and specificity to that described previously, especially in Iranian patients. This tool may be helpful in recognizing at risk CF patients, particularly in developing countries with fewer resources.

Introduction Valproic acid (VPA, Valproate) is an eight-branch fatty acid and varies from other antiepileptic drugs. VPA use might lead to mild to severe hepatotoxicity. The aim of this study was to investigate valproic acid impact on liver transaminases at the beginning of VPA treatment and after three and six months of it. Materials and Methods This study was designed as a cross sectional project in Pediatrics Neurology ward of a Tertiary Academic Hospital (Ghaem Hospital, Mashhad-Northeastern Iran). All children who needed valproic acid therapy alone were selected for study. Liver function test was performed for them at the beginning of VPA administration, three and six months after VPA, respectively. Data was analyzed by SPSS version 16. Results 60 children with mean age of 49±28.6 months were entered the study. 37 of them were male and 23 were female. 5% (3 children) were mental retard and 11.7% (7 patients) had neurologic or developmental deficit. Mean value of Aspartate Aminotransferase (AST), Alanine Transferase (ALT) and Alkaline phosphatase (ALP) were 27, 30.8 and 30.4 and 17.4, 20.7 and 22.8 and 425, 426 and 441 at the beginning of VPA administration, three and six months after VPA, respectively. In six months of our follow up, only one child (1.7%) had elevated liver transaminases. Conclusion Regard to our findings and its agreement with previous researches, it is important to control adverse drug events by measuring liver transaminases during antiepilepsy treatment.

Background Gastrointestinal (GI) bleeding, which has several clinical manifestation and origins, is known as one of the most life-threatening events in children. Several etiologies have been suggested for GI bleeding. Objective To determine the most important causes of GI bleeding in children referred to Ghaem Hospital and Dr. Sheikh Hospital, Mashhad, Iran. Methods In this cross-sectional study, after obtaining written informed consent of their parents, 113 patients aging from newborn infants to 18-year-old children with GI bleeding admitted to Ghaem Hospital and Dr. Sheikh hospital were enrolled in this study from June 2012 to June 2014. After performing routine diagnostic and therapeutic procedures, a checklist containing all necessary information including demographic data, clinical history of patients, endoscopy and pathology findings, clinical and preclinical information were collected. The data were then analyzed using Statistical Package for the Social Sciences (SPSS) version 16. Results Of a total 113 study children, 61 (54%) were male and 52 (46%) were female. The results of this study showed that the most important causes of bleeding in upper GI among all admitted patients were prolapse gastropathy (18.6%), esophagitis (15.9%) and esophageal varices, gastritis, and coagulopathy (7.1% for each). The main causes of lower GI bleeding were polyp (32.5%), chronic nonspecific colitis (20.7%), and proctitis (18.2%). Conclusion Findings of this study indicated that prolapse gastropathy and esophagitis are more prevalent causes of upper GI bleeding. Furthermore, esophageal varices were more common in children older than 13 years. Polyp, chronic nonspecific colitis and proctitis are the most prevalent causes of lower GI bleeding.

Aim Infant colic is a frequent problem affecting up to 10-30% of infants in first 3 months of life. Results from previous trials have shown that manipulation of gut microbiota can lead to symptomatic improvements. In a randomised clinical trial, we aimed to determine efficacy of synbiotic in reducing average infant crying time at day 7 and day 30 after starting intervention. Methods Fifty breastfed infants aged 15-120 days with infantile colic randomly assigned to receive either the synbiotic sachet containing 1 billion CFU of: Lactobacillus casei, L.”‰rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, L.”‰acidophilus, B.”‰infantis, L.”‰bulgaricus and fructooligosacharide (Protexin Healthcare, Somerset, UK), or placebo daily for 30 days. Parents were asked to record details of crying times in a symptoms diary. The primary outcome measure was the treatment success (reduction in the daily crying time >50%) and the secondary outcome measure was symptom resolution (reduction in the daily crying time >90%). Results The treatment success was significantly higher in synbiotic group (82.6%) compared with placebo (35.7%) at day 7 (P < 0.005). At day30, treatment success was 87% and 46% in synbiotic and placebo group, respectively (P < 0.01). Symptom resolution was also higher in synbiotic group (39%) compared with placebo (7%) at day 7 (P < 0.03) but not at day 30 (56% vs.36%, P = 0.24). We encountered no complication related to synbiotic use. Conclusion This synbiotic (a mixture of seven probiotic strains plus FOS) significantly improved colic symptoms in comparison with placebo.

زمینه و هدف: کولونوسکوپی روشی تهاجمی است که برای بیمار به ویژه کودکان ناراحت کننده و دردناک است. هدف از تحقیق حاضر بررسی میزان تاثیر تجویز قطره خوراکی سوپرمینت (اسانس نعناع) بر رضایتمندی بیمار و تیم کولونوسکوپی در حین عمل کولونوسکوپی اطفال می باشد. مواد و روش کار: این کارآزمایی بالینی بر روی 101 کودک 14-7 سال کاندید کولونوسکوپی در بیمارستان مرکز طبی کودکان تهران که بطور تصادفی به دو گروه مورد (51 نفر) و شاهد (50 نفر) تقسیم شدند، انجام گرفت. به گروه شاهد پلاسبو و به گروه مورد 20 قطره خوراکی سوپرمینت 30 دقیقه قبل از کولونوسکوپی خورانده شد. پس از عمل کولونوسکوپی با استفاده از پرسشنامه استاندارد، میزان رضایتمندی بیمار و تیم کولونوسکوپی بررسی شد. داده ها توسط نرم افزار 11.5 SPSS و آزمون های توصیفی و تحلیلی (تی مستقل-همبستگی) مورد تجزیه و تحلیل قرار گرفت. یافته ها: در گروه شاهد 2% اطفال و در گروه مورد 9/54% اطفال با درجه عالی رضایت داشته اند. به علاوه در گروه مورد درجه رضایت تیم کولونوسکوپی 7/64% بوده که به طور معنی داری با گروه شاهد که 2% بوده تفاوت داشته است ( 05/0 P< ). میانگین میزان درد در گروه شاهد 85/1 ± 60/5 و در گروه مورد 70/1 ± 20/4 بود که این تفاوت معنی دار می باشد( 05/0 P< ). نتیجه گیری: قطره سوپرمینت بر کاهش درد در حین عمل کولونسکوپی کودکان تاثیر مثبت داشت . لذا تجویز اسانس نعناع به کودکان حین عمل کولونوسکوپی باعث افزایش رضایتمندی بیمار و تیم کولونوسکوپی می شود. واژه های کلیدی: کولونوسکوپی، رضایتمندی، سوپرمینت

Cleft lip and palate are among the most common congenital defects with multifactorial etiology, and maternal stress may have a role in the development of the malformation; thus, the aim of this study was to explore the role of war on cleft lip and palate (CL/P) prevalence.In this study, records of 101,435 newborn infants delivered in the teaching hospitals of Mashhad and Ahwaz during wartime (1982-1987) and recent years (2005-2010) were reviewed. Samples were analyzed for prevalence of anomaly in both cities at 2 time intervals as well as some related factors; χ and t tests were used for data analysis.Results showed the incidences of CL/P in Mashhad during 1982 to 1987 and 2005 to 2010 were 2 and 2.2 per 1000 live births, respectively; however, its incidence in Ahwaz was 1 per 1000 during wartime and 0.7 per 1000 live births for recent years.Despite significant differences that were found in the prevalence of both cities in recent years (P = 0.001), no significant differences were observed during wartime (P = 0.28).The results revealed that CL/P was more prevalent in both cities, but in contrast to Ahwaz, cleft lip was more prevalent than isolated cleft palate in Mashhad, and significant differences were found between both cities (P = 0.007).The study concluded that the prevalence of CL/P in Ahwaz decreased after the war. However, in Mashhad, its prevalence, which was not affected during wartime, gradually increased. Thus, genetic research may be necessary to establish a genetic predisposition in northeast Iran.