Prebiotic-supplemented and regular formula were similar to breast milk regarding prophylactic effects for diarrhoea, constipation and respiratory tract infections in the first year of life. Prebiotic-supplemented formula may be an appropriate substitution for breast milk when breast milk in unavailable.

Background:Natural delivery is the most painful event that women experience in their lifetime. That is why labor pain relief has long been as one of the most important issues in the field of midwifery. Thus, the present study aims to explore the perception of primiparous mothers on comfortable resources for labor pain.Materials and Methods:In the present study, qualitative content analysis technique was used. The participants had singleton pregnancy with normal vaginal delivery. These women referred to the Imam Javad Health Center within 3–5 days after delivery for screening thyroid of their babies.Results:During the content analysis process, five themes emerged that indicated the nature and dimensions of the primiparous mothers' perception of comfortable resources. These themes were: “religious and spiritual beliefs,” “use of analgesic methods” (medicinal and non-medicinal), “support and the continuous attendance of midwife and delivery room personnel,” “family's and husband's support during pregnancy and in vaginal delivery encouragement,” and finally “lack of familiarity with the delivery room and lack of awareness about structured delivery process.”Conclusions:The results showed that mothers received more comfort from human resources than from the environment and modern equipment. Despite the need for specialized midwife with modern technical facilities, this issue shows the importance of highlighting the role of midwife and humanistic midwife care. Therefore, considering midwives and the standardization of human resources in health centers are more important than physical standardization. This will result in midwife interventions being performed with real understanding of the patients' needs.

Background: Knowledge, attitude, and practice (KAP) is necessary for better management of COVID-19. The study aimed to assess knowledge, attitude, and practice about COVID-19 among parents or guardians of children who referred to the pediatric clinics, until March 16, 2020, in City of Zahedan City located at southeast of Iran. Methods: A researcher-made questionnaire was developed and given to the parents or guardians of illness children who referred to the Pediatric hospital of Ali Asghar to visit pediatricians. Demographic characteristics and KAP score was assessed. T-test and ANOVA tests were used for data analysis considering 0.05 as significant error. Results: Of 524 participants, 60.1% were female. The mean age of participants was 32.15 (SD = 7.69). There was positive correlation between knowledge and attitude (r = 0.308), knowledge and practice (r = 0.233), and attitude and practice (r = 0.207). Illiterate parents had lowest knowledge score compared to other educational level. Married participants had significantly higher score of knowledge and practice than divorce or widow participants. Conclusion:This study concluded that the participants had good knowledge, positive attitude and sufficient practice towards COVID-19. Knowledge was associated with educational level and marriage status of parents or guardians of patient children.

Objective: Cardiac complications are the major cause of morbidity and mortality in beta-thalassemia major. The aim of the study was to evaluate right (RV) and left (LV) ventricular systolic and diastolic functions using myocardial performance index in young, asymptomatic children suffering from thalassemia major, for early detection of cardiac function impairment, preventing further cardiac damage by modifying disease progression and treatment. Methods: A case-controlled, cross-sectional study involving 80 patients suffering from beta-thalassemia major and 80 children adjusted in terms of age and sex served as a control group were studied in Research Center for Children and Adolescent Health Zahedan. The relevant echocardiographic parameters were measured in both subject groups: myocardial performance index (MPI), isovolumic relaxation time (IRT), isovolumic contraction time (ICT), pre-ejection period (PEP), ejection time (ET), PEP/ET ratio, deceleration time (DT) and acceleration time (AT). Data were analyzed by unpaired Student t test. Results: The left ventricular mean IRT in the patient group was 114±21 and in the control group 94±10 msec (p<0.05). The mean MPI (LV) in the patient group was 0.58±0.18 and in the control group 0.41±0.08 (p<0.05). The mean ET (LV) in the patient group was 237±36 msec and in the control group 266±25 msec (p<0.05). The mean ET (RV) in the patient group was 237±39 msec and in the control group 261±36 msec (p<0.05). Conclusion: There is an early systolic and diastolic dysfunction in children younger than 10 years with beta-thalassemia major. Even in young asymptomatic children with beta-thalassemia major, serial echocardiography seems warranted in order to adjust cardioprotective therapy. (Anadolu Kardiyol Derg 2010; 10: 150-3) Key words: Beta-thalassemia major, systolic function, diastolic function, echocardiography, children ÖZET Amaç: Çalışmanın amacı, kalp fonksiyon bozukluğunu erkenden teşhis ederek, daha sonraki kalp hasarını önlemek için hastalığın seyrinde ve tedavisinde gerekli değişiklikleri yapmada talasemi majörlü genç ve asemptomatik çocuklarda miyokart indeksini kullanarak sağ ve sol ventrikülün sistolik ve diyastolik fonksiyonlarını değerlendirmekti. Yöntemler: Zahedan Çocuk ve Genç Sağlığı Araştırma Merkezinde yaş ve cinse göre uyumlu, 80 sağlıklı çocuk ve beta-talasemi majörlü 80 hastanın dahil olduğu olgu-kontrollü, enine-kesitsel bir çalışma yapıldı. Her iki grupta da ilgili ekokardiyografik parametreler ölçüldü: Miyokart performans indeksi (MPI), izovolümik relaksasyon zamanı (IRT), izovolümik kasılma zamanı (ICT), pre-ejeksiyon dönemi, PEP/ET oranı, deselerasyon zamanı (DT) ve akselerasyon zamanı (AT). Veriler eşleştirilmemiş Student t testi ile analiz edildi. Bulgular: Sol ventrikül ortalama IRT hasta grubunda 114±21 ve kontrol grubunda 94±10 msn (p<0.05) idi. Hasta grubunda ortalama MPI (LV) 0.58±0.18 ve kontrol grubunda 0.41±0.08 (p<0.05) oldu. Hasta grubunda ortalama ET (LV) 237±36'ydı ve kontrol grubunda 266±25 msn oldu (p<0.05). Hasta grubunda ortalama ET...

This study assessed cardiac and pulmonary dysfunction in 26 asymptomatic patients with beta-thalassemia major. This investigation was a case-controlled study considering 10-20-year-old patients with beta-thalassemia major and no cardiac or pulmonary symptoms. Healthy individuals matched for age and sex were used as controls. At 48-72 h after blood transfusion, the patients underwent echocardiography and spirometry by a cardiologist and a pulmonologist. The results were compared to those of the control group. The right and left myocardial performance index, preejection period/ejection time ratio, ejection fraction, acceleration time, isovolumic contraction time, and bilateral isovolumic relaxation times in the study group demonstrated significant differences from the data of the controls. Right deceleration time was significantly different between the 2 groups. Myocardial performance index, peak early velocity of the right heart, and peak atrial velocity-to-peak early velocity ratio of the right side by Doppler tissue imaging were also significantly different between the 2 groups. Spirometry showed a significant difference in forced expiratory volume in 1 s/forced vital capacity between groups. Based on spirometry, pulmonary involvement in the patients was 77% restrictive. These findings show that systolic and diastolic dysfunction of the heart and pulmonary disturbances are unavoidable in patients with beta-thalassemia major.

Objective: Cardiovascular changes are related to some of epilepsy disorders such as seizures and breath holding. The study objective was to evaluate ECG findings in breath-holding and febrile convulsion compared to healthy individuals. Methodology: This Cross-sectional study was conducted on 270 children of 90 with febrile convulsion, 90 with breath-holding patients and 90 healthy children in 2019.  Electrocardiography parameters of; QT interval, dispersion QT, corrected QT and dispersion QTc measured for participants. Consent form was asked to be signed by the parents before the study execution. Data analysis done by SPSS 20.0 considering 0.05 as significant error. Results: Females were 46(51.1%), 38(42.2%) and 35(38.9%) in control, febrile convulsion and breath holding, respectively. QTc was normal in 97.8%, 76.7% and 71.1% of controls, febrile convulsion and breath holding respectively. A significant association observed between QTc measures in different groups (p<0.001). QTd was normal in 100.00%, 98.9% and 96.7% of controls, febrile convulsion and breath holding respectively with a non-significant association in groups of participants (p=0.196). QTcd was normal in 95.6%, 72.2% and 85.6% of controls, febrile convulsion and breath holding respectively with a significant association (p<0.001). Conclusion: Concluded that QTc was higher in breath-holding compared to febrile convulsion. QTcd was higher in febrile convulsion compared to breath-holding spells. Both were higher than controls QTd were higher significantly in the febrile convulsion compared to children with breath-holding spells. The results of the study suggested performing ECG for children who suffered from seizures or breath- holding spells to control their cardiac dysrhythmia.

Background:In electrocardiography (ECG), QT is the interval between the onset of Q wave to the end of the T wave. This interval may be a sign of changes in the ventricular structure in hematologic disorders such as thalassemia major.Objectives:The main goal of this study was to compare the diagnostic value of corrected QT dispersion (QTcd) and QT dispersion (QTd) with left ventricular mass (LVM) and left ventricular mass index (LVMI) as well as to determine their sensitivity and specificity in early detection of the cardiac involvement in patients with β-thalassemia major.Patients and Methods:In a case-control study, 60 patients older than ten years of age with thalassemia major who received regular blood transfusion and iron chelators were selected as the case group and were compared with 60 healthy age- and sex-matched subjects. All patients had myocardial performance index (MPI) of more than 0.5 and MPI for controls was less than 0.5. Echocardiography and ECG were performed for both groups and data were analyzed using appropriate statistical tests.Results:The mean age of cases and controls were 16 ± 2.8 and 16.08 ± 3.01 years, respectively. Male to female ratio was 33:27 in case group and 31:29 in the control group. LVMI in the case group was greater than control group. QTd and QTcd were larger in case group than in control group. The sensitivity and specificity of LVM, LVMI, QTd, and QTcd were as follows: 88.3%, 77.1%; 86.7%, 80%; 93.8%, 80%; and 91.7%, 86.7%, respectively.Conclusions:This study showed acceptable sensitivity and specificity of QTcd and QTd in comparison to LVMI; it seems that standard ECG can be used for early diagnosis of cardiac involvement in asymptomatic patients with thalassemia major.

Cardiovascular diseases are the most common illness that needs special medical care in thalassemia particularly in children and adolescents. We aimed to compare aortic stiffness in thalassemia major and healthy children. The study included 65 asymptomatic thalassemia major 6 to 19-year–old children without known history of heart disease and 65 age- and sex-matched healthy controls. Arterial stiffness indices determined using two-dimensional (2D) and Doppler echocardiography. Data were analyzed by SPSS 20.0 with 0.05 as significant error. From the study, results showed that systolic (p = 0.009) and diastolic (p < 0.001) blood pressures were higher in controls. Left ventricular mass index (LVMI) was higher in patients (p < 0.001). Aortic stiffness index (p < 0.001), pulse pressure (p < 0.001), and pressure strain elastic modulus (p < 0.001) were higher in patients, while aortic strain (p < 0.002) and aortic distensibility (p < 0.001) were lower significantly. Aortic stiffness index was correlated with diastole aorta (p = 0.005), systole aorta (p < 0.001), and LVMI (p < 0.001). Strain was correlated with diastole aorta (p < 0.001). Pulse pressure was correlated with systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.002) significantly. Aortic distensibility was correlated with systolic blood pressure (p = 0.039) and diastole aorta (p < 0.001) significantly. The pressure strain elastic modulus was correlated only with diastole aorta (p = 0.029). Concluded, aortic stiffness index, pulse pressure, and pressure strain elastic modulus were higher in thalassemia children, while aortic strain and aortic distensibility were lower. This increase may result in reduction of mechanical efficiency of the heart. Therefore, assessment of aortic elastic properties as nontraditional cardiovascular risk factors may contribute to the identification of cardiovascular risks in children with thalassemia