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Background: This study was performed to determine the relationship between chest X-ray findings and the severity of bronchiolitis using the modified Tal score scale (MTS). Methods: This retrospective study was conducted among 999 children aged 2-24 months admitted to a referral teaching hospital in Isfahan, Iran. The severity of bronchiolitis was determined by MTS criteria, with scores ranging from 0 to 12. We considered scores 0-5 mild, 6-9 moderate, and 10-12 severe bronchiolitis. The patient's CXRs were also extracted from the hospital's picture archiving and communication system (PACS) and reported by an expert Pediatric radiologist. The radiologic findings were compared with the MTS criteria. Results: The mean (SD) of the MTS score in the patients was 4.58 ± 1.92. Overall, 757 patients (75.78%) had normal radiographies. The frequency of normal radiography was 75.3% in the group of mild bronchiolitis and 77.3% in the group of moderate bronchiolitis. Reports of 9 patients with severe disease showed that 6 of them had normal CXRs (66.7%), 2 had hyperinflation, and 1 had atelectasis. There was no statistically significant relationship between radiographic results and the severity of bronchiolitis, according to MTS criteria (P = 0.23). The agreement between radiographic results and the severity of bronchiolitis was very weak (0.004) without statistical significance (P = 0.632). Conclusion: Considering that 99.3% of children with bronchiolitis do not have significant findings in chest X-rays, routine chest X-ray is not recommended in these patients. [ABSTRACT FROM AUTHOR]

BACKGROUND. Medical treatment of pediatric empyema consists of appropriate antibiotics, chest tube insertion, and intrapleural fibrinolytic drugs to facilitate pleural drainage. There is a lack of consensus about the drug of choice for fibrinolytic therapy, so this study was designed to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema. METHODS. The medical records of all children with empyema treated with intrapleural alteplase at a university hospital between January 2016 and December 2020 were retrospectively reviewed. Efficacy outcomes were assessed by chest tube output before and after the first dose of alteplase, pleural fluid volume before and after therapy, a need for surgical intervention, and length of hospital stay. Safety was assessed by the frequency and severity of side effects. RESULTS. 40 children aged 2 months to 9 years hospitalized with empyema received intrapleural alteplase. Thirty patients (75%) experienced full recovery after three doses of intrapleural alteplase. The median length of hospital stay was 16 days. Chest tube output increased significantly after the first dose of alteplase. Pleural fluid volume decreased significantly after treatment. The most common side effect was pain (30%). Two patients experienced severe complications: 1 had a pulmonary hemorrhage and the other experienced a bronchopleural fistula. These patients recovered fully spontaneously. CONCLUSION. According to our results, the administration of intrapleural alteplase was safe and effective in facilitating pleural drainage in pediatric patients with empyema. However, further clinical trials will be needed to determine the optimal dose, frequency, and duration of intrapleural alteplase treatment. [ABSTRACT FROM AUTHOR]

Background: Among the most common causes of death in preterm infants are neonatal infections, which remain high despite antibiotic therapy and preservative measures. The control of hospital infections is now a global priority, and many factors contribute to the spread of these infections. This study aimed to determine the frequency of bacterial infections in neonates and identify the common causes of infection in neonates admitted to the neonatal intensive care unit (NICU) of Alzahra Hospital in Isfahan, Iran. Methods: In this cross-sectional study, the population consisted of all neonates who were admitted to the NICU of Al- Zahra Hospital in Isfahan, Iran, from April 2017 to March 2018. Neonates who had a positive culture (blood, cerebrospinal fluid, urine, eye discharge, and tracheal tube secretions) were enrolled. The data were collected by a structured questionnaire, including maternal and neonatal information. Results: In this study, 56 newborns admitted to the NICU of Alzahra Hospital in Isfahan were studied. Their age range was within 5-28 days (18.88+8.41). Thirty-two (57.1%) neonates were male, and 24 (42.9%) newborns were female. In total, 26 (46.4%) neonates had prematurity that was the most common reason for hospitalization. The most isolated microorganisms were Staphylococcus epidermidis, Enterococcus, Klebsiella, Enterobacteriaceae, Candida spp., Acinetobacter, Streptococcus pneumoniae, E. coli, and Streptococcus viridans, respectively. Conclusion: According to the results of this study, the frequency of nosocomial infections in the NICU of Alzahra Hospital in Isfahan was 7.4%. The indings of this study highlighted the importance of paying more attention to controlling and preventing hospital infections in NICUs. [ABSTRACT FROM AUTHOR]

Background: The relation between interleukin-33 (IL-33) and asthma is not precisely known yet. The present study set to compare the serum level of IL-33 in patients with asthma and controls and study the relation with the severity of disease. Methods: The serum level of IL-33 and total IgE in 89 asthmatic patients and 57 controls were analyzed. The association of levels of IL-33 with the severity of disease, levels of total IgE, measures of spirometry (forced expiratory volume in 1 s [FEV1]), age, sex, presence or absence of other allergic diseases, and the disease duration was evaluated. Results: Higher levels of IL-33 and total IgE were detected in asthmatic patients compared with controls (P = 0.0001 and P = 0.008, respectively). In the asthmatic group, a significant direct association of IL-33 with age (P = 0.02, R = 0.23) and with total IgE level (P = 0.003, R = 0.31) were observed, but there was no relationship between other variables. Comparison of mean level of IL-33 in different asthma groups concerning the disease severity showed the statistically significant difference between them and a significant increased serum level of total IgE was observed in more severe disease. The results showed a significant negative correlation between FEV1 and total IgE (P = 0.028, R = -0.23) and IL-33 level (P = 0.0001, R = -0.83). Conclusions: IL-33 is suggested as a new inflammatory marker of severe and refractory asthma. Therefore, it may be a unique therapeutic target in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Medical treatment of pediatric empyema consists of appropriate antibiotics, chest tube insertion, and intrapleural fibrinolytic drugs to facilitate pleural drainage. There is a lack of consensus about the drug of choice for fibrinolytic therapy, so this study was designed to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema., Material and Methods: The medical records of all children with empyema treated with intrapleural alteplase at a university hospital between January 2016 and December 2020 were retrospectively reviewed. Efficacy outcomes were assessed by chest tube output before and after the first dose of alteplase, pleural fluid volume before and after therapy, a need for surgical intervention, and length of hospital stay. Safety was assessed by the frequency and severity of side effects., Results: 40 children aged 2 months to 9 years hospitalized with empyema received intrapleural alteplase. Thirty patients (75%) experienced full recovery after three doses of intrapleural alteplase. The median length of hospital stay was 16 days. Chest tube output increased significantly after the first dose of alteplase. Pleural fluid volume decreased significantly after treatment. The most common side effect was pain (30%). Two patients experienced severe complications: 1 had a pulmonary hemorrhage and the other experienced a bronchopleural fistula. These patients recovered fully spontaneously., Conclusions: According to our results, the administration of intrapleural alteplase was safe and effective in facilitating pleural drainage in pediatric patients with empyema. However, further clinical trials will be needed to determine the optimal dose, frequency, and duration of intrapleural alteplase treatment.

Objective: We aimed to evaluate the efficacy of an oral combined tablet of Glycyrrhiza glabra, Viola odorata, and Operculina turpethum (Anti-Asthma ® ) as an add-on therapy for the relief of the severity of symptoms in mild-to-moderate childhood asthma., Methods: This randomized placebo-controlled clinical trial was performed on 60 children and adolescents with chronic mild-to-moderate childhood asthma. Patients were randomly divided into cases who received Anti-Asthma ® oral combined tablets 2 tablets twice dailt for 1 month and controls, received placebo tablets identically the same to Anti-Asthma ® (2 tablets, twice daily, for 1 month) as add-ons to their standard therapy according to the guideline. The severity and frequency of cough attacks and shortness of breath, respiratory test indices (based on spirometry), and the extent of disease control and treatment adherence were measured clinically by validated questionnaires at the beginning and after the study., Findings: Respiratory test indices improved and the severity of activity restriction decreased significantly in the cases compared to the controls However, the mean difference before and after the study was significantly different between the cases and controls only for the number and severity of coughs and the severity of activity restriction. In the scores of the Asthma Control Questionnaire, the cases group had a significant improvement compared to the controls., Conclusion: Anti-Asthma ® oral formulation may be effective as an adjunct add-on treatment in the maintenance therapy of mild-to-moderate childhood asthma., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Research in Pharmacy Practice.)

Background: Given the association between chronic sodium losses and growth parameters and establishment of normal weight gain and linear growth in patients with cystic fibrosis (CF), in this study, we aimed to evaluate the sodium status in Iranian CF patients and its association with their growth parameters., Methods: In this prospective cross-sectional study, 44 children with CF were included. Serum and urinary sodium and creatinine levels were measured in patients, and the fractional excretion of sodium was calculated. The patients categorized in groups with FENa <0.5%, between 0.5% and 1.5% and >1.5%. Growth parameters were compared in the group, and its association with FENa level was evaluated., Results: In this study, 44 (27 boys and 17 girls) children with CF were included. Mean age of the studied population was 55.63 (33.2) months. In the studied patients with CF, 90.9% had a z score of -2&#95;+2 (normal range) for BMI, 72.7% for weight, and 70% for height. From children with CF, 18 (40.9%) had FENa less than 0.5, 17 (38.6%) had FENA between 0.5-1.5, and 9 had FENa >1.5. From studied patients with CF, 16 (88.9%) had normal serum Na levels, but the FENa was ≤0.5. Based on the Spearman correlation test, there was not any significant correlation between FENa classification and the Z score of weight (P=0.92), height (P=0.83), and BMI (P=0.99)., Conclusion: Our findings indicated that most patients with a low level of FENa had normal serum sodium levels. We did not find a significant association between FENa and growth parameters. The association had a trend to be significant for BMI. It is suggested that it may be due to appropriate follow-up of the studied population. However, it is recommended to plan more studies by including healthy subjects to obtain results that are more accurate., Competing Interests: None., (AJCEU Copyright © 2022.)

Background: Cystic Fibrosis (CF) is a chronic disease associated with low sodium status. The patients are usually treated with oral sodium chloride to control the side effects of low sodium status. Therefore, the fractional excretion of sodium (FE Na ) was assessed in patients with cystic fibrosis (CF) treated with oral sodium chloride (NaCl). Methods: This was a prospective cross-sectional study that was conducted on forty children with cystic fibrosis who were under treatment with oral NaCl and were referred to Imam Hossein Hospital-Isfahan-Iran between 2017 to 2019. The patients were under treated with 2-4 mEq/kg per day oral NaCl and urinary and plasma sodium and creatinine, as well as FE Na , were assessed after three months of taking NaCl. Also the patients were compared in terms of efficacy of treatment based on sodium level (between 135 and 145 mmol/L) and acceptable FE Na level (between 0.5% and 1.5%). The sensitivity and specificity of FeNa and plasma sodium were assessed with ROC curve test. Results: Plasma sodium was normal in 65% of treated patients, and FE Na was also normal range in 47.5% of treated patients. The treatment also was desirable for 35% of the patients. The sensitivity and specificity of FeNa were 42.9% and 57.7%, respectively, and the sensitivity and specificity of plasma sodium were 85.7% and 26.9%, respectively. Conclusion: Using of plasma sodium had higher sensitivity than FeNa and FeNa had higher specificity than plasma sodium to follow up of patients with CF., Competing Interests: None., (AJCEU Copyright © 2020.)

Background: Knowledge about cystic fibrosis (CF) in Iran is very limited. The objective of this study was to determine the prevalence of CF among a group of high-risk children with suggestive clinical features in the main referral hospital in Iran., Materials and Methods: This study children consisted of 505 patients who had presented with one or more of the following symptoms: chronic or recurrent respiratory symptoms, gastrointestinal symptoms as rectal prolapse, steatorrhea, hepatobiliary disease as prolonged jaundice, failure to thrive, hyperglycemia and glycosuria, hypochloremic metabolic alkalosis, hypoprothrombinemia, anemia or edema, and positive family history of CF. Patients were screened using pilocarpine iontophoresis to collect sweat and chemical analysis of its chloride content with classic Gibson and Cooke technique., Results: Of 505 patients, 89 (17.6%) had positive sweat chloride screening test. Five (1%) patients had required cystic fibrosis transmembrane conductive regulator protein mutation analysis to confirm CF., Conclusion: Our findings suggest that in Iran, CF is more common than what previously anticipated. Larger studies are warranted to identify the incidence, molecular basis, and clinical pattern of CF in the Iranian population., Competing Interests: There are no conflicts of interest.