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Abstract Background Cystic fibrosis is an inherited disease, which is caused by the CFTR protein defects due to mutations in the CFTR gene. Along with CFTR dysfunction, exocrine pancreatic insufficiency plays a key role in persistent fat malabsorption in CF patients; therefore, deficiency of fat-soluble vitamins (A, D, E, and K) is still a therapeutic challenge. Even with efficient pancreatic enzyme medication and CF-specific vitamins, many patients with CF have fat-soluble vitamins deficiency. The present study aims to evaluate the efficiency of nanomicelle formulation of fat-soluble vitamins in children with CF in order to achieve the appropriate serum levels of these vitamins. Methods This prospective, single-blind control trial will be conducted at the Akbar Children’s Hospital in Mashhad, Iran. Patients with CF will be enrolled based on the eligibility criteria. The control group will receive the standard formulation of fat-soluble vitamins similar to the routine CF treatment, and for the intervention group, the nanomicelle formulation of fat-soluble vitamins will be administered for 3 months. The primary outcome of this study is the measurement of serum levels of fat-soluble vitamins. The secondary outcomes are clinical assessment by the Shwachman-Kulczycki score, anthropometrics, and quality of life. Outcomes will be assessed before and after 3 months. Discussion Due to persistent fat-soluble vitamin deficiency in CF disease, the nanomicelle formulation could be proposed as a new delivery method of fat-soluble vitamins in the treatment of cystic fibrosis. Trial registration Iranian Registry of Clinical Trials IRCT20220415054541N1. Registered on July 23, 2022.

Introduction: Epidermolysis bullosa (EB) represents a diverse set of disorders that affect the skin and mucous membranes. Ensuring proper nutrition for children and adolescents with Epidermolysis Bullosa is a vital aspect of their treatment plan. The objective of this study is to demonstrate how nutritional intervention in a specialized nutrition clinic can enhance their well-being.Methods and material: This longitudinal study was conducted over a 3-year period at Akbar Children Hospital, a tertiary facility affiliated with Mashhad University of Medical Sciences in Iran. The study included all patients diagnosed with EB based on clinical symptoms and genetic studies.Results: In the present study, the median (25-75 IQR) age of the participants was 81.0 (36.0-156.0) months, and 19% of the participants were girls. The median (25-75 IQR) weight was 17.5 (10.8-24.5) kg, and the mean ± SD of height was 109.9 ± 31.1 cm. Among all types of malnutrition, there was only a significant association between gastrointestinal complications and BMI-for-age z-score (OR: 0.08, P-value=0.039) in the crude model. After adjustment, there was no significant association between gastrointestinal complications and malnutrition. The mean values of weight at the baseline, the first, and the second appointment of the study were 21.3, 21.2, and 24.8 kg, respectively. Moreover, the mean height at the baseline, the first, and the second appointment of the study were 109.4, 121.0, and 123.4 cm, respectively.Conclusion: Regular clinic visits and tailored nutritional interventions positively impact EB patients, emphasizing the importance of managing anemia and deficiencies for their well-being.

Introduction: Epidermolysis bullosa is a genetic condition with skin fragility that leads to blister formation and erosion following minor trauma. This disease also involves the gastrointestinal tract by way of esophageal stricture and dysphasia. Some studies have recommended oral budesonide liquid therapy to decrease the need for balloon endoscopy and other aggressive treatments. The aim of the study was to evaluated clinical symptoms of patients who consumed oral budesonide in their daily routine therapies. Methods: This cross-sectional study was conducted in Akbar Hospital of the Mashhad University of Medical Sciences. All enrolled patients were followed between July and October 2021. Ten milliliter oral budesonide (0.5 milligram) liquid was administrated one hour before eating. They were followed up to determine and document any side effects after treatment, and any improvement of clinical symptoms such as amelioration of dysphasia, volume of food intake, duration of food consumption, and kind of food consumed (solid versus liquid).Results: About fifteen patients were studied. The mean duration + SD of using budesonide was 9.66±15.76 weeks. The mean percentage + SD was 41.33±34.61 for improvement in the volume of food intake, and the mean for improving dysphasia + SD was 42±33.63%. Three patients suffered from complications (i.e., mucositis and gastric fullness). Also, two patients did not want to continue treatment because they did not like the drug taste.Conclusion: Oral budesonide liquid could be recommended for epidermolysis bollusa patients to improve clinical symptoms.

Introduction:Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. Children with ASD are at risk of nutritional problems that could impact growth and anthropometric indices over both the short and long term. The aim of present study was to determine prevalence of malnutrition and other factors related to the malnutrition among children and adolescent with autism disorder.Material and method:To assess the prevalence of malnutrition indicators among preschool children with ASD, a cross-sectional study was conducted among 81 children and adolescents who referred to subspecialized and specialized Autism Akbar Children‘s Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Weight and height measurements were assessed based on standard protocols. The z-score of anthropometric indices was determined for all participants. Participants were asked about nutritional problems by the interview from their parents. Result:In the current study, the mean ± SD of age was 10.1±3.7 years old. Among participants 3.7% were with Diarrhea, 33.3% with Constipation, 4.9% with Reflux, 3.7% with Flatulence, and 1.2% with Steatorrhea. The prevalence of both of food neophobia and food Allergy was 16%. Furthermore, 18.5% had poor appetite, 23.5% had moderate and 58% had good appetite. Based on standardized z-scores, the overall prevalence of under-weight, risk of overweight, overweight, and obese was 1.2%, 22.2%, 12.3%, and 7.4%, respectively. Among participants 4.9% was stunting.Conclusion:Based on aforementioned prevalence, improving nutritional problems and anthropometric indices among ASD children and adolescents are crucial issue.

Introduction: Chamomile (Matricaria chamomilla L.), as widely used as a medicinal herb and is brewed beverages, and has been used for the treatment of several conditions. The evidence from in vitro, in vivo, and clinical studies suggests that chamomile and its many flavonoid components have anti-oxidant and anti-inflammatory properties. This review aimed to provide an overview of the chemical constituents of chamomile and the effectiveness of the chamomile preparations and several of its constituents for the treatment of several medical conditions. Methods: The present comprehensive review study was conducted by searching electronic databases including Scopus, Web of Sciences, Embase, and PubMed, using relevant keywords. Results: Both animal and human studies indicate the positive effects of chamomile on the antioxidant enzyme activity. However, the mechanisms involved in the action of chamomile against the production of ROS remain still unknown. When it comes to its anti-inflammatory properties, a number of in vitro, in vivo, and clinical investigations have been reported regarding to the selective inhibition of COX-2, suppression of NO production, prevention of IL-1β, IL-6 and TNFα-induced NO levels, reduction of iNOS mRNA and protein expression, impediment of leukocyte adhesion and adhesion protein up-regulation in human endothelial cells, and blockage of IL-1 α-induced prostaglandin production, TNF-α-induced IL-6 and IL-8 release. Conclusions: Current studies suggest that chamomile and its flavonoid components have anti-oxidant and anti-inflammatory properties. On the basis of the existing evidences, chamomile appears to ameliorate several diseases caused by oxidative stress as well as inflammatory reactions.

Abstract 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.

Microleakage has always been a problem in restorative dentistry. To decrease microleakage, differentrestorative techniques and materials have been recommended. The purpose of this study was to evaluate micro leakage of the composite restoration in deciduous anterior teeth using the open sandwich technique by two different liners.Materials & Methods:This cross-sectional experimental study was conducted at Khorasgan University in 2019. A total of sixty intact deciduous canine teeth were divided into 3 groups of 20. At the buccal surface of the specimens, the Class V cavity was extracted at 1 mm below the CEJ (Cementoenamel junction) and in groups 1 and 2, ionoseal liner and Fuji II ionomer glass were placed at the buccal floor. Cavities were restored with Z250 composite resin. In group 3 which served as the control, restorations was perfromed without liners. All samples are prepared for establishment after dying in methylene blue 0.5% solution. The buccal lingual incisions with a thickness of 1 mm were inspected under stereo microscope for micro leakage. A total of 5 samples were extracted from each group via random sampling to examine the marginal compliance under SEM (Scanning electron microscope). The intergroup comparisons were made using the chi-square and Kruskal-Wallis tests. Besides, intra-group comparisons were performed using the Mann-Whitney U test. All statistical procedures were performed at a significance level of less than 0.05 (p value < 0.05) using Gpower software.Results:The outcome of this study showed that microleakage of gingival margin in open sandwich techniques with ionoseal and Fuji II (group 1, 2) was significantly higher than in control group (p value = 0.033).but in comparison between group 1,2 there was no significant difference (p value = 0.795).In SEM evaluation there was no significant difference in gingival microleakage (p value = 0.232).Conclusion:Use of two liners: Ionoseal and Fuji II in Class V cavities restored by opensandwich technique in deciduce anterior teeth can reduce gingival microleakage.

Background: Despite using Citrullus colocynthis on treatment of various diseases, serious gastrointestinal disorders like bleeding are reported. In Traditional Iranian Medicine (TIM), administering equal weights of starch with this plant is suggested to produce more tolerable preparations from it. Hence, we assessed histopathological changes in rat liver and intestine after using starch as corrective agent. Methods: We designed three experiments in Veterinary Medicine School of Shahid Bahonar University in Kerman, Iran in 2016. The procedure was applied in 2016 for 15 days. In the first experiment, group No. 2 and 3 received single daily dose of alcoholic pulp extract of C. colocynthis at 300 and 600 mg/kg extract consecutively. In the second experiment, group No. 4 and 5 received 300 and 600 mg/kg extract plus the same amount of starch consecutively. In the third experiment, group No. 6 and 7 received extract at 300 and 600 mg/kg plus the three times weight of starch consecutively. The live rats were euthanized and their liver and intestine were removed for histopathology examination. The samples were stained with hematoxyline-eosin (H&E). Results: Rats in all of the groups died from bleeding and diarrhea except for group No.6 that showed no symptoms seen in other rats. Microscopic examination of their intestine showed no histopathological lesions or other degenerative changes of the epithelium. Conclusion: Clearly further works in modern phytotherapy will be required to delineate the role of starch in reducing C. colocynthis toxicity. Consumption of adequate weight of starch with the toxic dose of C. colocynthis make it safe for digestive system but could not prevent necrotic changes in the liver.