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Asparaginase is one of the most important agents in the treatment of ALL. However, it has some side effects including dislipidemia, hyperglycemia, coagulopathy and hepatotoxicity. We studied its side ef-fects on our patients. The effects of L-asparaginase were assessed on 25 new ALL patients (case group) and 25 patients with known ALL who had completed their treatment before. Sixty two percent of cases were male and remainder was female. The mean age of patients was 7.2 ± 3.8 years. In our patients, there was a rise in triglycerides (TG) was seen following L- asparaginase administration (P = 0.02). Also, PT prolongation (P = 0.02) and hypoalbominemia (P = 0.002) were detected which could PT prolongation and hypoalbuminemia may be seen with L-asparaginase therapy that can be prevented with transfusion of FFP. Hypertriglyceridemia is often asymptomatic with no need for therapy.

Introduction: The present study aimed to determine the effect of training parents through films, posters/graphics, and verbal explanations on increasing their satisfaction with lumbar puncture performance. Methods: This cross-sectional quasi-experimental study was conducted on children with febrile seizures referred to the Emergency and Pediatric Wards of hospitals affiliated with Mashhad University of Medical Sciences. They were LP candidates; however, their parents did not consent to this procedure. The children were randomly assigned to three groups. In the first group, videos of the location and method of LP were presented to the parents. The second group received this information via posters, and the parents in the third group were given verbal explanations. Results: The children included 49 (4.54%) females with a mean age of 15 months. There was a significant relationship between the reason for parental refusal of LP and their final satisfaction (P=0.022). There was a significant relationship between parents' satisfaction with LP and their education (P=0.029). The film method had the lowest chance of success, while the verbal explanation method had the most remarkable success in enhancing parental satisfaction (P= 0.013). Conclusion: Although posters and videos were less effective than verbal explanations, they increased satisfaction with LP in some parents. It is more beneficial to try to alter parental misperceptions of LP in non-emergency situations. [ABSTRACT FROM AUTHOR]

It is an autosomal recessive, and occasionally autosomal dominant mutant extremely rare disorder with only 100 reported case in literature. This fatal disorder occur in both sexes and all races. In most circumstances the newborn die soon after birth Also it is known as harlequin fetus, alligator baby or keratosis diffusa fatalis."nBecause of its rarity, we report 2 cases of this disorder, here.

Introduction: The aim of this study is the evaluation and comparison of the white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in febrile children with and without convulsion. Methods: We studied 368 febrile children aged 6 to 60 months with and without convulsion. Demographic data, WBC, ESR, and CRP were compared and analyzed. Results: In this study, 368 children, 184 patients with febrile convulsion as the case group and 184 febrile patients without convulsion as the control group, were enrolled with an average age of 26.6 ± 14.4 months and 17.71 ± 15.4 months respectively (P = 0.001). In the case group, 59.78%, and in the control group, 43.48% were male (P = 0.002). There was no statistically significant difference between the groups regarding the WBC, ESR, and CRP. There was however a significant relationship between the leukocytosis and convulsion in patients with longer than 15 minutes convulsion (P = 0.03). There was no significant difference between different febrile convulsion subgroups in ESR and CRP levels, according to the type, duration, and frequency of convulsion. Conclusion: Leukocytosis and elevated ESR and CRP levels in patients with febrile convulsion may represent the underlying etiology of the fever, and they may not be due to convulsion itself. But longer than 15 minutes convulsions may lead to leukocytosis. [ABSTRACT FROM AUTHOR]

Introduction: Febrile seizure (FS) is a highly frequent presenting complaint in children. It is defined as a seizure that occurs in children between 6 to 60 months related to a fever of 38°C or more without any other explanatory causes of seizure such as evidence of central nervous system (CNS) infection or a previous seizure without fever. The aim od study is to evaluate mean folic acid serum levels in febrile children with or without seizures. Methods: The mean folic acid serum levels and demographic data of 100 children aged 6 to 60 months, admitted to the Ghaem Hospital of Mashhad, Iran in 2018- 2019, were collected, where the patients with febrile seizure were considered as the case group and the febrile ones without seizure as the control group. The inclusion criteria were children aged 6 to 60 months with febrile seizures who were admitted to the pediatric ward. The exclusion criteria were having a past medical history of seizure, meningitis, or encephalitis. Results: There were 49 febrile convulsive children (cases) and 51 febrile children without a seizure (controls). The mean serum folic acid level was 7.07 and 9.89 ng/ml for cases and controls respectively (P-value < 0.001). Conclusion: Children with febrile seizures had significantly lower serum folic acid levels than febrile children without a seizure. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a chronic inflammatory airway disorder that is distinguished by coughing, wheezing, and dyspnea. It is the most common chronic disease among children. Epidemiological trials have suggested that there may be a correlation between vitamin C intake and the incidence of asthma. Specifically, according to these studies, a rapid increase in the occurrence of asthma may be caused by a decreased intake of dietary antioxidants and various vitamins such as vitamin C. A systematic review was performed to determine the role that vitamin C, in terms of both dietary intake and serum levels, had on asthma in children. Methods: PubMed and Scopus databases were searched for studies that provide information on the effects of vitamin C on asthma in children aged between 1 and 17 years. The inclusion criteria specified that the studies involved needed to be cohort and case series involving at least ten patients. Exclusion criteria were non-English articles, case reports, and articles involving children who were aged below or above the age 1 and 17 respectively. Result: A total of 13 studies involving 6503 patients met the inclusion criteria. Dietary vitamin C intake was lower in people with asthma than in those without asthma. Lower quantity dietary intakes and serum levels of vitamin C were also associated with increased incidents of asthma. Conclusion: According to the extracted data, a relatively low dietary intake of vitamin C is associated with an increased risk of asthma and wheezing. Moreover, asthmatic patients who consumed vitamin C exhibited an improvement in their diseases. [ABSTRACT FROM AUTHOR]

Objective To evaluate the incidence and risk factors of development of postdural puncture headache in children who had intrathecal chemotherapy injection. Materials & Methods: Two-hundred eighty patients (mean age, 7.23±3.92 years) who had intrathecal chemotherapy injection were studied prospectively during 2008-2009 in the pediatric ward of Dr. Sheikh hospital in Mashhad. Patients who had lumbar puncture for their chemotherapy drug injections were assessed daily for four days to detect postdural puncture headache. Results: There were 172 (61, 4%) male patients and the remainder were female. Postdural puncture headache was detected in 41 patients (14.6%). The body mass index did not show any significant difference between the two groups. Lumbar puncture (LP) attempts had a significant association with postdural puncture headache. The size and shape of the needle did not have a significant association with postdural puncture headache. Conclusion LP attempts have a significant relationship with postdural puncture headache. [ABSTRACT FROM AUTHOR]

Objective: Evaluating the effect of zinc sulfate in improving the clinical manifestations of acute bronchiolitis in children younger than 2 years. Methods: This was a double blind pilot trial on 50 patients aged 2 to 23 months at Ghaem and Dr. Sheikh Hospitals in Mashhad from January 2008 to March 2009. Patients were randomly divided into two groups: a case group received oral zinc sulfate and to the control group was given placebo. Findings: Mean age of case group was 168.0±108.6 days and control group 169.2±90.4 days (P=0.98) with male predominance in both groups. At first there was no statistically significant difference between the two groups in reducing the symptoms. But 24 hours after treating, improvement of some important manifestations including tachypnea, subcostal and intercostal retraction, wheezing and cyanosis revealed statistically significant difference in control group in comparison with case group (P=0.04). Conclusion: Zinc sulfate has no benefit in improving clinical manifestations of acute bronchiolitis. [ABSTRACT FROM AUTHOR]

Asparaginase is one of the most important agents in the treatment of ALL. However, it has some side effects including dislipidemia, hyperglycemia, coagulopathy and hepatotoxicity. We studied its side effects on our patients. The effects of L-asparaginase were assessed on 25 new ALL patients (case group) and 25 patients with known ALL who had completed their treatment before. Sixty two percent of cases were male and remainder was female. The mean age of patients was 7.2 ± 3.8 years. In our patients, there was a rise in triglycerides (TG) was seen following L-asparaginase administration (P = 0.02). Also, PT prolongation (P = 0.02) and hypoalbominemia (P = 0.002) were detected which could PT prolongation and hypoalbuminemia may be seen with L-asparaginase therapy that can be prevented with transfusion of FFP. Hypertriglyceridemia is often asymptomatic with no need for therapy. [ABSTRACT FROM AUTHOR]

A letter to the editor and a reply are presented in response to the article "The role of zinc sulfate in acute bronchiolitis in patients aged 2 to 23 months," by F. Heydarian and colleagues in the 2011 issue.

A letter to the editor is presented about a study on the management of chronic immune thrombocytopenia purpura (ITP) in children with high dose of intravenous dexamethasone.

Objective: To assess any relationship between serum sodium changes and seizure occurrence in children aged 2 months to 5 years with hypernatremic dehydration., Materials & Methods: This cross-sectional study was performed on 63 patients aged 2 months to 5 years from 20 March 2006 to 15 March 2012 at Ghaem Hospital and Dr. Sheikh Hospital in Mashhad, Iran. Patients were divided into 2 groups: case group with hypernatremic dehydration and seizure occurrence, and control group with hypernatremic dehydration and no seizures., Results: The mean age of patients was 10.38 (2-48) months. Thirteen patients had seizures, 11 out of them, before admission and 2 during hospital staying. Serum sodium level at admission in those 2 patients with seizure occurrence after hospitalization was 169 (158-180) mmol/L, and in 50 patients without seizure was 162.8 (148-207) mmol/l. Also, the rate of decrease of serum sodium levels in these 2 cases within the first 12 hours after admission was 1.12, and in those without seizure was 0.54 (mmol/L/hour), and it was 0.47 and 0.53 (mmol/l/ hour) after 24 hours of admission, respectively. Severe dehydration was seen in 38.5% of cases and 14% of controls., Conclusion: There was not any relationship between changes in serum sodium level and seizure occurrence in children with hypernatremic dehydration.

Objective: To assess the relationship between anemia and first simple febrile convulsion in patients 6 months to 5 years old., Methods: This cross-sectional study was performed on 240 patients aged 6 months to 5 years old from 10 October 2010 to 15 December 2011 at Ghaem Hospital, Imam Reza Hospital, and Dr. Sheikh Hospital, Mashhad, Iran. Patients were divided into 2 groups: the control group who had fever without seizure, and the case group who had first simple febrile seizure. The anemia levels in both groups were evaluated and compared., Results: The mean age of patients was 20.7+/-14.8 months. It was 20.53+/-15.07 for the case group, and 20.9+/-14.6 for the control group (p=0.74). The mean hemoglobin in the case group was 11.05+/-1.37, and 11.14+/-1.19 in the control group (p=0.58). Anemia was detected in 37.5% of the case group, and 36.7% of controls (p=0.89)., Conclusion: There was no relationship between anemia and first simple febrile seizure.

Hyperbilirubinemia is common in neonates; it can have a serious rising course. Due to its critical morbidity called "kernicterus", severe neonatal hyperbilirubinemia causes which lead to exchange transfusion, should be clarified. This descriptive cross sectional study performed with reviewing of files of 118 neonates weighting 2kg and more who had exchange transfusion in pediatrics ward at Ghaem training hospital in Mashhad from April 2004 to March 2007. Among 118 patients, 75 (63.6%) were male, and 43 patients (36.4%) were female. The most common cause of exchange transfusion was ABO incompatibility (38.1%). In order of frequency, unknown etiology (25.4%), Rh incompatibility (16.1%) with no immune hydrops, Sepsis(8.5%), urinary tract infection (5.1%) and others (3.4%) (Including Crigler-Najjar and cephalohematoma) were next ones. Vaginal delivery and exclusive breast feeding were detected as associated factors. Mean serum bilirubin levels was 28.7 mg/dl (SD. 9.2) ABO incompatibility. ABO incompatibility was the main cause of exchange transfusion. Male gender, vaginal delivery and exclusive breast feeding were seen more among patients who need to be exchanged. So in case of ABO incompatibility especially when delivery route is vaginal, newborns should be visited soon again after early discharge from hospital.

Objective: To compare the traditional yogurt and probiotic yogurt in improving acute non-inflammatory gastroenteritis., Methods: A double blinded case-control clinical trial, performed in 100 patients aged 6 months to 12 years of age from October 2008 to September 2009 in Ghaem and Dr. Sheikh Hospitals in Mashhad, Iran. The patients were assigned to the following groups: the case group received a probiotic yoghurt and the control group received the ordinary yogurt., Results: There were statistically significant differences between the case and control groups in reducing frequency of diarrhea in the first (p=0.000), second (p=0.013), third (p=0.028), and fourth (p=0.022), therapy. Also, there was a significant difference (p=0.000) in discontinuation of diarrhea between the case and control groups., Conclusion: Acute non- inflammatory gastroenteritis improvement is accelerated by probiotic yogurt consumption.

Objective: To evaluate the role of intravenous extra fluid therapy in accelerating the reduction of jaundice in newborns who received phototherapy., Methods: This study was performed on 100 terms, jaundiced neonates who had a total bilirubin of 18 mg/dl or more in the Pediatrics Ward of Ghaem Hospital, Mashhad, Iran from October 2007 to April 2008. The patients were randomly divided into 2 equal groups; group I (case group) were given extra parenteral fluid besides breast feeding, and group II (control group) received only breast milk. The rate of bilirubin decrement, length of hospital stay, and rate of blood exchange were compared., Results: The rate of serum bilirubin decrease per hour in the first 12 hours after admission in group I (0.41 mg/dl [95%CI 0.1] versus 0.38 mg/dl in group II [95% CI 0.3], [p=0.22]). It was 0.41 mg/dl for group I (95% CI 0.0001), and 0.21 mg/dl (95%CI 0.06) for group II in the second 12 hours (p=0.02). After 24 hours, it was 0.38 mg/dl in group I (95% CI 0.0001), and 0.29 mg/dl in group II (95% CI=0.09) (p=0.037). The mean hospital stay was 68.5 hours in group I, and 67.4 hours in group II (p=0.95)., Conclusion: Additional parenteral fluid therapy in icteric newborns can accelerate reduction in serum bilirubin levels in the first 24 hours.

Immune and inflammatory responses mediated by cytokines, play important roles in the pathophysiology of asthma. These responses are associated with overexpression of Th2 cytokines such as IL-4 and IL-13. These two cytokines use common receptors for signaling that lead to identical immunological effects and regulation of the Th1/Th2 balance. The aim of this study was to determine whether patients with allergic asthma display overexpression of IL-4 and IL-13 genes. Using RT-PCR, we examined the expression of IL-4 and IL-13 genes in twenty asthmatic cases and twenty normal individuals. Total levels of serum IgE and IL-4 were also determined by ELISA method. Expression of IL-13 gene in 70% of patients with allergic asthma was higher than controls (P=0.01). There was no correlation between the expression of IL-13 gene and total level of serum IgE (P=0.07). Expression of IL-4 gene was detected in 30% of the patients and none of the normal individuals as determined by RT-PCR (P=0.01). Mean of serum IgE levels in patients and controls were 84.9 IU/ml and 62.2 IU/ml, respectively. Level of serum IgE was more than 100 IU/ml in 30% of patients (P=0.03). Mean of serum IL-4 levels in patients and controls were 15.73 pg/ml and 13.07 pg/ml, respectively. There was a relation between levels of serum IgE and IL-4 in 73% of cases. The results showed that there was a correlation between the expression of IL-4 gene and the level of serum IL-4. Levels of serum IgE and IL-4 were considerably higher in asthmatics than non-asthmatic controls.

Background: This study was performed in children aged <15 years, at the Pediatric Neurology Clinic of Imam Reza Hospital affiliated to Mashhad University of Medical Sciences. The objective of this study was to recognize the main predisposing factors that result in uncontrolled seizures in patients so that we can start the treatment accurately., Methods: There were two groups of patients; group I, consisted of 51 patients, with minimum refractory seizures of one episode per month while taking at least two antieplieptic drugs, and group II, comprised of 80 well-controlled patients chosen at random, who had no fit within 6 months after starting the treatment., Results: Factors affecting the occurrence of refractory seizures included age <1 year, multiple seizures before starting the treatment, male gender, myoclonic seizures, neurologic defects, neonatal and daily seizures, and first abnormal electroencephalogram and brain computerized tomography scan., Conclusion: There are several factors that can predict development of uncontrolled seizures. Knowledge of these factors helps us to discriminate our patients and pay more attention to those at risk of developing uncontrolled seizures.