BackgroundGastrointestinal (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.ObjectiveTo determine the most important causes of GI bleeding in children referred to Ghaem Hospital and Dr. Sheikh Hospital, Mashhad, Iran.MethodsIn 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.ResultsOf 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%).ConclusionFindings 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.

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

Background and Objectives: Neonatal meningitis is one of the most important and serious neonatal infections with a high mortality and morbidity rate. The present study aimed to investigate the causes, clinical signs, laboratory parameters and mortality rates in newborns with bacterial meningitis. Materials and Methods: This cross-sectional study was performed on 468 neonates aged 2-28 days admitted to NICU in Ghaem Hospital Mashhad, Iran by available sampling method during 2009-2018. Meningitis was confirmed according to positive results of CSF culture and clinical feature. By using researcher-made questionnaire, neonate's individual data in- cluding cardiopulmonary resuscitation, the Apgar score of the first and fifth minutes, gestational age, birth weight, clinical symptoms and laboratory data such as ESR, WBC and positive culture of CSF were studied. Results: Among 468 newborn suspected to infection, lumbar Puncture (LP) was performed for 233 cases (50%). Of 233 neonates, 148 neonates (63.5%) had negative results for CSF culture and 85 cases (36.5%) had positive CSF culture. 94% of cases with meningitis were born premature. Blood culture had positive results in 80% of infants with late-onset meningitis and negative in 20%. The most common clinical findings were respiratory symptoms (94%). Klebsiella pneumoniae and Entrobacter aerugenes were the most common microorganisms of meningitis. Gestational disorders were observed in 55.3% of newborns with meningitis. C-Reactive Protein (CRP) of neonates with meningitis was twice higher than normal cases, and leukocytes and proteins in the CSF in neonates with meningitis were higher than healthy ones. Finally, 36% of neonates with meningitis died in our study. For analyzing the relationships between variables, independent t-test was used after controlling the normality, and Chi-square was used for analyzing the relationship of variables with nominal scale. Conclusion: The most common pathogens of meningitis were Klebsiella pneumoniae and Enterobacter aerogenes. Respi- ratory symptoms were the most common clinical signs, and laboratory symptoms included increased CRP, increased leuko- cytes and proteins in CSF

BackgroundAsthma is the most common chronic disease in childhood. Parents have an important role in managing asthma in children. Studies have shown a higher degree of depression and anxiety and lower family performance in mothers of asthmatic children in comparison with the control group.ObjectiveThe aim of this study was to evaluate the parenting styles and also depression, anxiety and stress parameters in mothers of children with asthma.MethodsThis case-control study was performed on 45 mothers of 3 to 15 years old asthmatic children in the allergy clinic of Mashhad University of Medical Sciences, Mashhad, Iran, during the years of 2014 to 2016. The control group was 45 mothers of non-asthmatic children who were matched for the age of their children with the case group in the same population. The parenting styles, as well as depression and anxiety of mothers were evaluated using parenting scales, and the depression-anxiety-stress scales (DASS). The mothers were also asked to fill a strengths and difficulties questionnaire (SDQ) for their children. Furthermore, parenting styles in the case group were compared to mothers of children without asthma as the control group. The data were then analyzed by SPSS 11.5, using Chi-square, ANOVA, and independent-samples t-test.ResultsThe results of this study showed that 21 mothers (74.6%) were normal, but 12 mothers (26.7%) had a mild −, 9 (20%) a moderate - and 3 (6.7%) a severe degree of abnormality according to DASS. Independent-samples t-test showed a significant difference between the case and control groups regarding depression in mothers and laxness (p<0.001), over reactivity (p<0.013) and verbosity (p<0.031) in children with asthma.ConclusionThe results of this study demonstrated that anxiety and depression are partially frequent in mothers of children with asthma, and parenting styles are less affective in these families.

Background: Neonatal jaundice is highly prevalent in Asia and has serious complications, such as kernicterus. Therefore, it is very important to identify the risk factors of jaundice requiring exchange transfusion since it can be helpful in the prevention of the disease and early diagnosis of its complications. Objectives: The present study aimed to identify the causes of neonatal jaundice requiring blood exchange. Methods: The present cross-sectional study was performed on 251 term and preterm neonates. The studied newborns were 2-14 days old (born at ≥ 35 weeks of gestation) with jaundice and bilirubin of more than 17 mg/dL and received exchange transfusion during 2011 - 2020 in Ghaem teaching hospital, Mashhad, Iran. The required data of the study variables, such as hyperbilirubinemia risk factors, laboratory tests, the documented history of the mothers and neonates, and physical examination results, were collected through a questionnaire and the medical records of the patients. Finally, the collected data were analyzed in SPSS software (version 20). Results: Based on the results, the mean value of the total serum bilirubin level in neonates who received exchange transfusion was 27.53 ± 10.05 mg/dL. The blood types of about 40% of mothers and their neonates were O and A/B, respectively. Moreover, 11.4% of mothers were Rh-negative; however, their neonates were Rh-positive. The results also revealed that the causes of exchange transfusion were unknown, ABO incompatibility, Rh incompatibility, glucose-6-phosphate dehydrogenase deficiency (G6PDD), and sepsis in 52.7 %, 24%, 7.1%, 5.3%, and 5.3% of the neonates, respectively. Conclusions: The findings of this study suggest that after unknown causes, the most common causes of exchange transfusion were ABO incompatibility, Rh incompatibility, G6PDD, and sepsis. Therefore, since most of these causes can be recognized, it is recommended to perform related tests and take related measures in the Midwifery Department of the hospital to prevent the occurrence and exacerbation of jaundice. Moreover, it is recommended to perform an early follow-up after the discharge.

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 χ 2 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/m 2. 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.

Background and Aims: Neonatal sepsis is considered a clinical syndrome characterized by signs and symptoms of infection associated with positive blood culture. The present study investigates the rate of sensitivity and resistance to antibiotics in neonates with definite sepsis. Materials and Methods: This cross-sectional study was conducted on 268 neonates with definitive sepsis (positive blood culture with clinical signs of infection) hospitalized in the NICU of Ghaem Hospital of Mashhad, from 2008 to 2018. To investigate the antibiotic susceptibility pattern, identifying microorganism and antibiogram tests was performed according to the standard microbiological method. The data were collected through a questionnaire designed by the researchers. It included neonates’ characteristics, types of microorganisms in neonatal unite, and sensitivity and resistance to neonatal sepsis’s common microorganism. Results: Based on the results, Klebsiella showed sensitivity to norfloxacin (100%), ciprofloxacin (100%), meropenem (100%), imipenem (94%), cotrimoxazole (73%), and vancomycin (67%). Similarly, Enterobacter showed 100% sensitivity to ciprofloxacin, meropenem, norfloxacin, and high sensitivity to imipenem (94%) and co-trimoxazole (83%). Acinetobacter turned out to be sensitive to co-trimoxazole and norfloxacin (both of them were 67%) and to amikacin in 33% of the cases. E. coli was sensitive to imipenem (83.33%), ciprofloxacin (80%), and ceftazidime (71.43%). Finally, staphylococcus coagulase negative was sensitive to piperacillin in 100%, vancomycin in 96.67%, and imipenem in 71.43% of the cases. Conclusions: The findings of the present study suggest that high-sensitivity drugs for the treatment of definite neonatal sepsis are Meropenem(Klebsiella and E. coli), Enterobacter(Ampicilin), Acinetobacter(Imipenem) and Staphylococcus coagulase negative (vancomycin).

Background: Preeclampsia is a hypertensive disorder of pregnancy, which is associated with increased maternal and prenatal morbidity and mortality. Oxidative stress associated with preeclampsia may be a consequence of reduced antioxidant defense pathways that might involve inadequate glutathione peroxidase (GPx) levels, perhaps linked to reduced selenium availability. The soluble FMS-like tyrosine kinase-1 (sFlt-1) that contributes to endothelial dysfunction may be partially responsible for the clinical manifestation of preeclampsia. Furthermore, elevated plasminogen activator inhibitor-1 (PAI-1) and decreased plasminogen activator inhibitor-2 (PAI-2) are found in preeclamptic women. Hence, the PAI1: PAI2 ratio maybe a predictor of preeclampsia. Objectives:The objective of this study was to evaluate the effects of selenium supplementation on sFlt-1, GPx activity and PAI1: PAI2 ratio in pregnant women. Materials and Methods: A total of 125 high-risk pregnant women (with a familial history of hypertension, hyperlipidemia and other risk factors for preeclampsia) in the first trimesters of pregnancy were assigned to either selenium (n = 61) or placebo (n = 64) groups. The selenium group received 100 μg/day of selenium as a selenium-yeast tablet for six months. The placebo group received a placebo yeast tablet for the same period. At the beginning of the trial and at the end, blood samples were collected and the levels of sFlt-1, PAI-1, PAI2 and GPx were measured in blood serum and plasma. Results: Serum selenium concentrations were raised in the selenium group (P < 0.001) from the first to the third trimester, but was unchanged in the placebo group (P = 0.85). The results showed that sFlt-1 had significantly increased in both groups by the end of the gestation period, and selenium supplementation had no significant effect on the selenium group (P = 0.51). However, GPx activity was significantly increased in the selenium treatment group after supplementation compared to the control group (P < 0.001). The PAI1: PAI2 ratio was not significantly different between the two groups (P = 0.44). Conclusions: Selenium intake during the second and third trimester of pregnancy increased GPx activity but did not have a significant effect on serum sFlt-1 levels or the ratio of PAI1: PAI2 in the serum.