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Background and Objective: The child mortality is a index of development and plays an important role in determination of population growth. This study was done to determine the effect of sociol-economical conditions on mortality rate of under 5 years children, Khuzestan- Iran. Materials and Methods: This descriptive study was done on 372 women aged. 20-48 years with at least one child under 5 years whome were admitted to the health centers in urban and rural area of gotvand town in Khuzestan province, Iran during 2004. Individuals questionnaires included variables such as mortality, demographic, economic and social index were completed for each subject. Data were analyzed using SPSS-17, ANOVA, Chi-Square and Pearson’s correlation coefficient tests. Results: Providing maternal health care during pregnancy and up-grading occupational status of parents significantly reduced child mortality rate (P<0.05). Child mortality rate increased in mothers of <18 and >35 years (P<0.05) and parents desire to have male infant (P<0.05). Conclusion: This study showed that up-grading occupational status of parents, maternal health care and maternal age and desire to have male infant play important role on the child mortality rate in Khuzestan province in south west of Iran.

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Background and Objective: Down syndrome is a genetic disorder due to trisomy of 21 chromosome, which mainly is manifested by moderate to severe mental problems, including physical, sensory and motor symptoms. This study was done to determine the related factors associated with the birth of children with Down syndrome. Materials and Methods: This cross-sectional study was carried out on 913 mothers with children or fetuses of Down syndrome who were referred to genetic counseling clinics in Tehran, Iran during 2011. Diagnosis of Down syndrome confirmed by the chromosomes culture. Maternal age, maternal age at menarche, parents interfamilial marriage, maternal blood group, the number of abortions and children, collected through the questionnaires. Results: Out of 913 affected children and fetuses with Down syndrome, 420 (46%) and 493 (54%) were female and males respectively. 1.17 considered to be The male/female ratio. 32.4% of mothers were in 25-30 years of age and 42% of parants had interfamilial marriages. The abortion in mothers varied from lack of ahortion (96.7%) up to 5 repetitive abortion (0.1%). The number of children in families with affected subject consisted of 1 (15.1%), 4 (16.5%) and 11-13 (1.3%). Conclusion: This study showed that Down syndrome infants are mostly born with the mothers of 25-30 years age.

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Background and Objective: Viral upper respiratory tract infection and cold drugs consumption is prevalent among children. These drugs have no effect on disease improvement, but it may also have accompanied with many side effects. This study was conducted to compare the effect of honey and diphehydramine on the alleviation of cough in 2-5-year-old children with viral upper respiratory tract infection. Materials and Methods: This double-blind clinical trial study was carried out on 170 children (60 boys and 66 girls) aged 2-5 years old with viral upper respiratory tract infection who were taken to the pediatric clinic of Shariatee hospital in Bandar Abbas, Iran during 2010. Children demographic charactrastics were including age, gender, period of illness, vaccination history, weight, growth, overall health, and cardiopulmonary examinations. Patients were randomly divided into two groups of 63 children receiving honey (three times a day and the last dose an hour before bed) and diphehydramine syrup (5mg/kg/BW). Two days later, subjects were examined again for the severity and frequency of coughs during day and night. Data were analyzed using SPSS-19, independent t-test and chi-square test. Results: Mean±SD of the age of children was 45.21±11.39 and 43.98±11.95 months in honey and diphenhydramine groups, respectively. The frequency and severity of night coughs was lower in the honey group (97.4%) as compared to the diphenhydramine group (58.7%) (P<0.02). The frequency and severity of daily coughs was lower in the honey group (84.1%) while it was lower in 58.7% of the diphenhydramine group (P<0.01). Conclusion: This study showed that honey is more effective than diphenhydramine in the alleviation of cough caused by viral URTI in 2-5-year-old children.

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Background and Objective: There is not a general protocol strategy about the necessity of routine microscopic examination of tonsillar samples in children. This study was conducted to determine the histopathological characteristic of tonsillar tissue in 1250 children, Tabriz-Iran. Materials and Methods: This descriptive study was conducted on 1250 children (724 male and 526 female) aged 2-14 years old who underwent tonsillectomy in Tabriz, Iran during 2008-11. Variables including age, sex, clinical diagnosis and surgical indications were recorded. Paraffin blocks were prepared from samples of tonsillectomy and stained with haematoxylin and eosin. Histopathologocal results were categorized in four groups: Follicular hyperplasia, follicular hyperplasia with infection, malignancy and normal. Results: None of the children had initial clinical suspicion of tonsil tumor. Patients’ primary complaints were as follows: 92.5% mouth breathing, 93% nocturnal snoring, 74.3% recurrent and chronic cold and infections, 56.4% sore throat, 48.2% halitosis, 26% nocturnal apnea, 22.2% dysphasia, and 18.2% anorexia. Children with tonsillar hypertrophy and obstructive symptoms (57%), and tonsillar hypertrophy and recurrent infections (42.2%) underwent tonsillectomy. In the histopathlogical examination of all patients being hyperplasia together with lymphoid hypertrophy were observed and there was no evidence of malignancy in any of the patients. Conclusion: No instance of malignancy was found in the histopathological examination of children’s tonsil-removed tissues and all of the tonsils had benign hyperplasia with lymphoid hypertrophy.

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Background and Objective: Children constipation is one of the common causes of abdominal pain. Cow´s milk in children diet is suggested to be one of the main cause of chronic constipation. This study was performed to determine the effect of cow´s milk elimination from children diet with chronic constipation. Methods: This quasi-experimental study, was performed on 80 children with chronic constipation. Rome-III criteria were considered for disease diagnosis. Cow’s milk was eliminated for three weeks from children’s diet and the clinical symptoms in children were surveyed, subsequently. Results: Constipation was cured in 33.8% of children as result of cow's milk free diet. The rate of treatment response in affecting children whom their disease in began under 2 years of age (52.6%) was significantly higher than others (16.6%) (P<0.05). Children treatment was not significantly related to child’s gender and amount of milk consumption. Conclusion: Eliminating of cow's milk from the diet improves the chronic constipation in children.

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Background and Objective: Hematuria is one of the common causes of pediatric nephrology and urology diseases and is reported in 0.5-2% of children. This study was performed to determine the causes of hematuria in infants and children. Methods: This descriptive study was done on 200 infants, children and adolescents in one month to 18 year old ages with chief complaint of hematuria in Hamadan, Iran. Patients were evaluated by urinalysis, urine culture, measurement of calcium, creatinine and uric acid in random urine sample and abdominal sonography. Results: Microscopic and gross hematuria was detected in 79.5% and 20.5% of patients, respectively. Hematuria was idiopathic in 74 (37%) of patients. Urinary tract stones (18%), urinary tract infections (15.5%), hypercalciuria (13%), hyperuricosuria (10%), urinary tract anomalies (5.5%) and glomerulonephritis (1%) were diagnosed as causes of hematuria. Conclusion: In 56% of patients, hematuria was caused by three common etiologies of stone, urinary tract infections and crystalluria.

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Background and Objective: Urinary tract infection is the second common bacterial infection in children. Constipation as a risk factor in urinary tract infection was reported by several studies. This study was carried out to evaluate the relationship between rectal diameter and constipation with urinary tract infections in children. Methods: This case – control study was performed on 40, 2-12 years old hospitalized children with urinary tract infections as cases and 40 healthy children with the same age as controls in Boali Hospital in Sari, Iran. Rectal diameter was measured by ultrasonography. Demographic characteristics, rectal diameter, during of infectious and disease clinical signs were recorded for each subject. Results: Constipation was observed in 62.5% and 17.5% of cases and controls, respectively (P<0.05). Rectal diameter was 47.64 mm and 26.48 mm in case and control groups, respectively (P<0.05). Conclusion: Regarding to increasing of rectal diameter in patients with urinary tract infections in comparison with healthy subjects, ultrasonography can be a reliable method either to confirm or reject the presence of constipation in urinary tract infections.

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Background and Objective: Attention deficit and hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. 20-50% of ADHD affacted children have sleep disorders which can cause cognitive and behavioral disorders. This study was done to determine the sleep problems in children with ADHD. Method: In this case control study, 52 children with ADHD was considered as cases and 52 school age children without ADHD as a control group in Gorgan, northern Iran during 2013. Sleep habits (CSHQ) and DSM-IV questionnaires were filled for each child. Results: Sleep problems were observed in 45 (86.5%) and 36 (69.2%) of children in case and control group, respectively (P<0.05). The mean score of sleep problems in case and control group was 48.25±6.61 and 45.87±6.23, respectively (P<0.05). The score of resistance to sleep, anxious habits of sleep and waking during night in cases were more than controls (P<0.05). Conclusion: Sleep problems in children with ADHD are more frequent than children without ADHD.

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Background and Objective: Yersinia enterocolitica is a worldwide pathogen belong to genus Yersinia. The association between acute childhood diarrhea and other diseases caused by Yersinia enterocolitica has been established by several researchers. Due to the lack of sufficient information on other pathogenic Yersinia species, this study was done to determine the prevalence and the pattern of antibiotic susceptibility of atypical Yersinia spp isolated from children, less than 14 years old. Methods: This descriptive cross - sectional study was carried on 384 children with diarrhea whom referred to the Tehran children medical center, Tehran, Iran during August 2011 to August 2012. 384 fecal specimens of children were transferd to the laboratory and cold enrichment in alkaline buffer with pH of 7.2 for 21 days. The samples were cultured in Cefsulodin-Irgasan-Novobiocin Agar (CIN) differential media in 7, 14, and 21 days. The identification of Yersinia species were carried out by conventional procedure. Antibiotic susceptibility test to Ciprofloxacin, Co-trimoxazole, Tetracycline, Chloramphenicol, Erythromycin, Ampicillin, Gentamicin, Penicillin were determined by standard disk diffusion method. Results: Out of 384 fecal samples, 3 (0.7%) were infected with Yersinia. Three species of Yersinia were Y.enterocolitica, Y.Kristensenii and Y.frederiksenii. All three strains were sensitive to Cotrimoxazole, Tetracycline, Chloramphenicol, Ciprofloxacin and Gentamicin. Conclusion: This study showed that atypical Yersinia play important role in diarrhea. Therefore, more attention should be noticed to atypical Yersinia species in addition to Yersinia enterocolitica.

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Background and Objective: Low birth weight (LBW) is one of the most important problems in the world. Many morbidity are more prevalent in LBW included in attention deficit and hyper activity disorder (ADHD). This study was done to find the Relation between low birth weight with attention deficit and hyper activity disorder in children. Methods: This historical cohort study was done on 226 rural children in Yazd province, central area of Iran. ADHD symptoms were evaluated in LBW and NBW using DSM-IV criteria. Results: Frequency of ADHD was 22.8% in LBW and 12.5% in NBW (P<0.05). The mean of family members was 4.7±0.6 and 4.2±0.8 in child with ADHD versus child without ADHD (P<0.05). Odd's ratio for ADHD was 3.1 in patient with more than one sister or brother (95% CI: 1.2-7.9, P<0.001), and 5.7 in patients with positive familial history (95% CI: 2.6-12.4, P<0.001). Conclusion: Relationship between ADHD and LBW was statistically significant. Positive familial history for ADHD and over-crowded family were social factors related with ADHD. LBW is one of the risk factors for ADHD and can be considered in children health program ADHD was frequent in child with low birth weight than child with normal birth weight.

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Background and Objective: Malnutrition is considered as one of most serious disorder in childhood. This study was carried out to determine the prevalence of malnutrition and its relation to serum level of Magnesium, Zinc, Iron and Calcium in 6-36 months hospitalized children. Methods: In this case-control study upon CDC chart, 166 children were in control group diagnosed with no malnutrition and 151 children were also in case group with malnutrition. BMI and serum level of Magnesium, Zinc, Iron and Calcium were measeared for each child. Results: Out of 151 children with malnutrition, 128 (84.76%) and 23 (15.23%) were involved in mild and moderate malnutrition, respectively. The serum level of Magnesium and Zinc in case group was non-significantly lower than controls, while the serum level of Calcium and Iron non-significantly higher than controls. BMI was significantly reduced in cases in compared to controls and this reduction was related with malnutrition (95% CI: 0.38-0.59, OR=0.47, P<0.05). Conclusion: Malnutrition in 6-36 month children was not related to serum level of Zinc, Magnesium, Iron and Calcium, while children with malnutrition had lower body mass index.

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Background and Objective: Child abuse is a common phenomenon with variety of reasons; the most important one is mother psychiatric disorders. Concurrent interventions in the family can recover the mother and reduce child abuse. This study was done to evaluate the effect of therapeutic intervention on general health of child abused mothers. Methods: This clinical trial study was conducted on 57 children and their child abused mothers whom referred to child psychiatry and pediatric department of Imam Hossien hospital, Tehran, Iran during November 2009- April 2010. Children and their families were visited by a psychiatrist and depend on the child and the family after either pharmaceutical or psychological interventions was taken. Parent management training was done for all mothers in 8 weekly sessions. General health questionnaire were filled by mothers before intervention in the third and sixth months following the intervention. Results: Total score of general health, depression and anxiety of child abused mothers were 31.3±1.90, 5.26±0.66, 8.10±0.46, respectively. It was significantly increased after six months intervention in comparison with pre-intervention (37.3±2.34, 7.48±0.72, 10.44±0.58, respectively). Conclusion: Appropriate therapeutic intervention and parent management training for mothers can improve general health of child abused mothers.

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Background and Objective: Poisoning is a major public health problem and a serious form of the common causes of hospital emergency visits in many countries. Incidence of toxicity based on cultural and economic characteristics of communities are varied. This study was done to determine the pediatric poisoning factors in children.

Methods: This descriptive-cross sectional study was performed on 201 patients younger than 12 years old with posinnig symptoms whom referred to hospitals in Shahroud city of central part of Iran from April 2011 to March 2012. Demogaphic data, posinnig symptoms, posinnig agents, time of hospitalization and outcome of posinnig for each child were recored in quetionare.

Results: Opium was the most common consumed material with (51.2%) while metadon considered to be the major opium. 180 (89.6%) and 21 (10.4%) children were poisoned accidentaly by their parant respectively. The clinical manifestation of the affected children were 15 (7.5%), 11 (5.5%), 93 (46.3%), 26 (12.9%), 19 (2.5%) and 22 (10.9%) without any symptoms, neuro-respiratory, nervous, gastrointestinal, gastrointestinal-respriatory and weakness respectively. Two children were died in the course of this project. There was a significant statistical correlation between the reason for poisoning and age parant education level and type of poisoning. Also, there was a relation between the type of poisoning and place of residence (P<0.05).

Conclusion: This study shows that the most common cause of poisoning among children was opiums.

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Acute necrotizing encephalopathy (ANEC) is a rare illness with high incidence in East Asia. It is accompanied with respiratory infection, gastrointestinal infections, and high fever with quick impaired consciousness, and convulsion. In this case report, Turkmen 6 month's girl that was introduced after an infection with no disease or clinical abnormalities. She was vaccinated accordingly; initially she had fever with generalized tonic-clonic convulsion (seizures) for 5 to 10 minutes level of consciousness decreased later on. She was transferred to Talghani Medicat Education center in nortern Iran. At the time of admition her vital signs were as below: RR: 30, GCS: 8-9, RP: 110, BP: 90/80. In the patient's history, there was neither Trauma history, nor food or drug poisoning, also no clinical history. After convulsion, the level of consciousness decreased and serum biochemistry showed normal electrolytes concentration. In further follow - up, AST increased to 98 units, ALT to 58 units, and ammonium to 215 units. In CSF Sample, protein level increased to 330 units, without any avidences of pleocytosis, blood, or Serum glucose drop. In CT without contract, hypodensity the cornea in thalamus and caudate cores were seen in 2 sides. The ventricles were normal and there were no signs of bleeding and pressure. In brain M.R.I, abnormal signal in 2 sides, blood samples cultivation, CSF, and testing urine for bacterial infection were negative. The patient was diagnosed with necrotizing encephalopathy and subsequently was treated with metyle prednisolone (20 mg daily). During hospitalization, level of consciousness increased and fever stopped. There was not recurrence of convulsion, but the patients still had some problems in moving, verbal and communication.

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Background and Objective: Several methods are available for measuring fever in children. This study was done to compare the accuracy of three method of measuring body temperature using left and right tympanic, axillary and rectal methods in three months to five years old children.

Methods: This descriptive-analytic study was done on 126 children (63 without fever and 63 children with fever) with 3 months to 5 years age in Mofid hospital, Tehran, Iran. Rectal temperature lower than 38°C was considered as Gold standard to determine fever. Body temperature was also recorded for subjects through right and left tympanic and axilary methods.

Results: Body temperature was recorded in axillary method 37.1°C (sensitivity: 92.1%, specificity: 90.5%), right tympanic 36.9°C (sensitivity: 74.6%, specificity: 84.13%) and left tympanic 37.3°C (sensitivity: 93.65%, specificity: 84.13%). The mean temperature in the axillary method 0.77°C, right tympanic 1.02°C and left tympanic 0.48°C was lower than the mean rectal method (P<0.05). The correlation between right, left tympanic and axillary with rectal method was 0.84, 0.894 and 0.925, respectively (P<0.05). The area under the receiver operating characteristic (ROC) curve for left and right tympanic and axillary were 0.95, 0.87, 0.965, respectively.

Conclusion: The difference between rectal and left tympanic method was at the lowest level due to the ease of measuring temperature through tympanic membrane in three months to five years old children.

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Background and Objective: Varicella zoster virus (VZV) can cause a moderate disease in children, but with high risk of serious disease or death in children with acute lymphoblastic leukemia (ALL) Vaccination from infection can be safe, immunogenic, and effective in children with leukemia. This study was done to evaluate the IgG and IgM antibodies against VZV in children with acute lymphoblastic leukemia.

Methods: The descriptive-analytic study was performed on 66 children who were on chemotherapy in Dr Shigh hospital in Mashhad, Iran during 2012. Patients were receivied VZV vaccine. The title negative or positive serum sample for IgG-anti-VZV avidity was determined by using a test kit before and after injection of vaccines VZV for considering the efficacy of vaccines on pediatric patients.

Results: Title serum sample IgG were positive in 32.6% patients, these children have history of chicken pox disease and to be safe against of VZV. 78.3% of the patients were negative for IgG antibody and sensitive against of VZV.

Conclusion: Children with ALL receiving chemotherapy are sensitive to chicken pox disease according to negative IgG titer against VZV.

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Background and Objective: Nonalcoholic fatty liver disease is the most common cause of liver disease worldwide and it is defined as a disorder of excess fat accumulation in the liver. This study was done to determine the prevalence of fatty liver among overweight, obese and normal children.
Methods: This historical cohort study was conducted on 90 children ages 5 to 13 years old in Taleghani pediatric theching hospital in Gorgan, north of Iran during 2014. Subjects according to Body Mass Index (BMI) classified into obese (95%>BMI), over weight (85-95% BMI) and normal (5-85% BMI). Childern were matched for age and sex. Liver enzymes (ALT Alanine aminotransferase and AST (Aspartate aminotransferase) and lipid profile includingTriglyceride: TG (High Density Lipoprotein: HDL and (Low Density Lipoprotein: LDL were measured and fatty liver evaluated based on sonographic parameters by a radiologist who didnot know children's BMI.
Results: The prevalence of fatty liver was 23.3% in obese children that was non- significantly higher than normal (16.7%) and over weight (16.7%) children. The prevalence of fatty liver was not significantly different between two sexes. AST was significantly higher in children with normal BMI in compared to obese and over weight children (P<0.05). The highest and lowest level of cholesterol was seen in obese and normal children (P<0.05).
Conclusion: This study showed that the prevalence of fatty liver non-significantly was higher in obese children in comparision with normal and over weight children.

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Arachnoid cysts have primary and secondary types. The prevalence of Arachnoid cysts is about 1% of all tumors in cranial cavity. Based on anatomic position, arachnoid cyst can cause different clinical manifestations including hemiparesis, increase intracranial pressure, macrocephaly and isolated headache and stop body growth. The natural course of the disease is not exactly clear. Some of patients have no symptoms during life and some of them may show some symptoms after a while. This case report is about a 10 years boy who had no sign except generalized headache. Anatomic position of the cyst was in right temporal lobe of the brain on the temporal, parietal and the great wing of sphenoid bones. Arachnoid cyst diagnosed through MRI and CT-Scan. Patient treated with ibuprofen for three days and then patient followed up to treat with surgery method when other clinical symptoms appeare in the patient.

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Background and Objective: Anxiety disorder (AD) is one of the most common children disorders. In last two decades, several studies conducted to determine the mechanisms of child anxiety disorder specifically in base of neural mechanisms. However, studies about the electrophysiology of child anxiety disorder particularly in the quantitative electroencephalography (QEEG) are less than imaging studies. This study was performed to compare the quantitative EEG between children with anxiety disorder and normal subjects.
Methods: This case- control study was done on 30 children with anxiety disorder and 30 normal healthy children with 6-7 years old. Electroencephalography was recorded for each subject. Power of 19 channel and 5 frequency bands delta, theta, alpha, beta and high beta (25-30 Hz) in the frontal, central and occipital area were recorded, respectively.
Results: There was significant  difference in delta absolute power in frontal lobe, theta and beta2 absolute power in central and high beta wave in occipital area between AD and normal children (P<0.05). In other words, the delta absolute power in frontal lobe and theta and beta2 absolute power in central area of brain was less in AD children in compared to normals. Also, the high beta absolute power in occipital lobe was more in AD children in compared to normals.
Conclusion: Recorded QEEG in relax time is a proper index of brain cortex metabolic activity. Therefore, low metabolic activity in particular parts of brain is determined by increasing slow waves power (delta and theta) or decreasing fast waves power (alpha and beta).

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Background and Objective: Attention deficit / hyperactivity disorder (ADHD) is one of the most common psychiatric disorders. This study was conducted to determine the effect of ear acupuncture on ADHD symptoms in children aged 7-14.
Methods: This quasi-experimental study was performed on 30 children with ADHD whom did not receive Ritalin, whom referred to the private psychiatric clinic of children in Tehran. A questinare child syndrome inventory (parental form) and integrated visual and auditory (IVA) test with a pre-test and post-test design was used in this study. The ear acupuncture treatment for 8 weeks with uniform pressure on the ear seed was applied on five points of the ear, including brain, excitement, prefrontal cortex, shen men and tranquilizar.
Results: The auditory vigilance subscale from the attention area and the auditory prudence subscale of the auditory response from the inhibition area in the pre-test phase in compared to the post-test were statistically significant (P<0.05).
Conclusion: The 8-week acupuncture on the ear improves the auditory vigilance subscale and the auditory prudence subscale in children with ADHD.