---

---

Introduction: Stress  is  a  condition  that  causes  tension, disturbance  in  body  and  mind , discomfort  and  unpleasant  status.  Adolescents  are  the  most  susceptible  group  of  the  community, a  susceptibility  which  intensifies  with  age  and  kind  of  stressful  events  that  happened  during  life. In  this  study  we  intend  to  find  types  of  stressors  and  their  severity  in  central  area  of  Iran.
Materials  and Methods: This  is  a  descriptive  study  carried  out  on  2000  students between  12-18  years  from  urban  and  rural  selected  school  of  Isfahan, Arak  and  Najaf  Abad  in  1381 (2002) as  a  part  of  an  annual  report  on  healthy  heart  assessment   program.  Sampling  methods  was  randomized  clustering, and  after  collecting  data  based  on  GHQ12 (generalized  health  questionaire)  data  was  analyzed  by  mean, standard  deviation  and  chi-square  based  on  SPSS  version  software.
Results: Of  the  total  subjects  under  9360 (51.2%)  were  males, and 887 (48.8%)  were  female, with  a  mean  age  of  15/97±1/90, 15/52±2/20  respectively.  In  general, the  proportion  of  female  students  with  high  GHQ  score  was  higher  than  male  students. 38.8%  against  32.7%. The  score  was  higher  in  Arak  than the  other  two  cities.  The  most  common  stressful  item  was  concern  for  a  future  career, which  was  also  the  most  effective  life  event, and  next  to  it  was  the  parental  death.
Conclusion: The  severity  of  stress  in  female  students  of  central  area  of  Iran  was  higher  than male, with  a  direct  positive  correlation  with  age, moreover, the  most  common  stressful  item was  concern  for  a  career  and  the  most  effective  life  event  was  also  the  same, and  next  to  it  was  the  parental  death.    
 

---

Introduction: Iron  deficiency  anemia (IDA)  is  still  a  major  nutritional  and  public  health  problem  among  young  children  in  developing  countries. Anemia  during  childhood  is  known  to  be  linked  with  impaired  mental  and  cognitive  development  and  learning  capacity. Daily  oral  supplementation  with  iron  is  considered  to  be  an  effective  strategy  for  reducing IDA  but  non-compliance  is  a  major  problem  with  this  strategy.
Materials  and  Methods:  This  is  a  descriptive  study  on  400  mothers  who  had 6-24 month  old  children  which  was  performed  at  health  centers  of  Arak  in  1383. Data  was  analyzed  with  SPSS  and  p<0.05  was  considered  meaningful.
Results: 10%  of  infants  didn’t  take  iron  drops, and  regular  and  irregular  consumption  was  33.3%  and  56.8%  respectively. The  mean  (with  95%  CI)  knowledge  and  attitude  of  mothers  was  33.2 (32.7-33.7)  from  70, 25.2 (24.8-25.6)  from  40  score. 68.8%  mothers  had  begun  the  drops  in  appropriate  age, 72.3%  gave  it  in  appropriate  amounts  and  only  3.3%  had  appropriate  method  of  giving  the  drops.
Conclusion: The  most  common  causes  of  irregular  consumption  were  poor  acceptance  (40.5%), vomiting  after  consuming  (16.5%) and  forgetting  to  give  the  drug.  Regarding  the  results  of  this  study, unpleasant  taste  and  its  complications as  well  as  inappropriate  knowledge. Attitude  and  practice  of  mothers  were  important  causes  of  irregular  use  of  ferrous  sulfate  drops.
 

---

Introduction: Idiopathic hypercalciuria (IH) has been recognized as a common disorder in childhood and is an important and common factor in formation of renal stones. Recurrent urinary tract infection is a clinical presentation of hypercalciuria. Regarding that Hydrochlorothiazide is effective in hypercalciuria treatment, therefore in this study we assessed the efficacy of Hydrochlorothiazide in preventing recurrent UTI in hypercalciuric girl patients. Materials & Methods: This research was a single blind randomized clinical trial. 100, 1 to 12 years old girls, who were followed by pediatric nephrology outpatient clinic in Vali-Asr and Amir Kabir hospitals, with the diagnosis of idiopathic hypercalciuria and at least two urinary tract infections in year, were included in study. Patients were randomly divided into two equal groups. First group received a general preventive treatment consisted of a liberal fluid , urination every 2 hours , reducing dietary salt intake , washing genitalia from front to back , wearing cotton loose underwear and complete urination. In second group, in addition to the general treatment, Hydrochlorothiazide was used with initial dose of 1mg/kg/day in a morning dosage.Then, urinary tract infection recurrence in two groups was assessed by student T test. Results: All patients who received Hydrochlorothiazide were normocalciuric. In each group, incidence of UTI non recurrence was 34% (17 cases), that was not significantly different. Conclusion: This study rejected the presence of hypercalciuria treatment effect in preventing recurrent urinary infection. Therefore, the association between UTI and IH needs to be closely studied with the attention to eliminate confounding factors.

---

Introduction: Children with reflux who fail prophylaxis management or reflux which do not resolve spontaneously are candidates for sugery. Delay in surgery increases the development of new renal scars. Finding a modal factor for prediction of reflux resolution likelihood can decrease complications of treatments. Regarding that sacral bone anomalies have a direct influence on the final function of urinary and bowel systems, this study is done to investigate the relationship between sacral ratio and reflux. Materials and Methods: This is a case-control study. The case group included 76 children less than 9 years old refered to Vali-e-Asr and Amir Kabir hospital clinics with urinary tract infection and according to voiding cystouretrograply (VCUG) results, children with III, IV and V grade vesicoureteral reflux (VUR) entered the study. The control group included 76 children with previous urinary tract infection and normal VCUG. Sacral ratio in the two groups was measured and was compared by student t, Chi square and Mann Whitney tests. Results: The case group included 24 males and 52 females with average age of 2.7 years old and the control group included 23 males and 53 females with the average age of 3 years. The percent of sacral ratio abnormality were 40% and 23.7% in the case and control groups respectively, which was significantly different (p=0.001). The difference between the mean sacral ratio in case group with the value of 80% and the control group with the value of 84% was not different. The ratio distribution pattern in the two groups was not different. Conclusion: The percent of sacral ratio abnormality in children with vesicoureteral reflux were more than children without reflux.

---

Background: Oetection of congenital hypothyroidism (CH) in Arak has begun since 2006. The aim of this study was to investigate on recall rate (RR) and the incidence of this disease in Arak. Materials and Methods: In this descriptive study, according to the national screening program for CH in Iran, heel blood samples of 3-5 day- old neonates were taken on special filter paper and TSH values were measuned using ELISA method. TSH values bigger than 5mu/lit were recalled and thyroid function tests (TSH, T4 and T3RUP) were done on venous blood samples and assayed using ELISA method. Neonates with TSH values >10 mu/lit, T4<6.5 ug/dl were viewed as patients. Data related to neonates born up to the end of March 2009 were recorded in special forms. Results: Of 25685 screened neonates, 608 newborns were recalled. RR was estimated to be 2.36%. TSH values in 3.78% were less than 5, in 83.55% between 5-9.9, in 7.56% between 10-19.9 and in 5.09% more than or equal to 20. Eighty six neonates had CH (1/300 live births). Disease rate in recalled neonates was 14.2%. In 80.26 percent of neonates, sampling was done between 3-5 days while the times of sampling in 18.5 and 1.1 percents of the newborns were in days 6-21 and after day 22, respectively. Conclusion: The incidence of CH in Arak is remarkably higher than national and international rates. RR in Arak is higher than the national but lower than the international rates. Also, the ratio of the disease to the recalled neonates is low.

---

Background: Osteopenia is a common and sometimes disabling consequence of the treatment of common neoplastic diseases, such as acute lymphoblastic leukemia (ALL) and lymphoma in children. The aim of the present study was to evaluate the preventing effects of alendronate on steroid-induced osteopenia in children with ALL and non- Hodgkin’s lymphoma (NHL).

Materials and Methods: In this clinical trial, 30 children with ALL and NHL were purposefully selected. All patients received the same induction chemotherapy protocol. Then they were randomly divided into two matched groups. All of them received equivalent supplement of 400 IU/d vitamin D and 30-40mg/kg/d calcium. The patients of the case group received 35mg/week alendronate for 6 months as well. Lumbar spine and whole body bone densitometry were performd before and after intervention and Z score was calculated for all patients.  

Results: The mean age of the studied population was 6.11(±3.36) years and 15 of the children (50%) were male. There was no statistically significant difference in lumbar spine and whole body bone densitometry and Z score before and after intervention between the two groups (p>0.05). The improvement of bone densitometry and Z score were seen in both groups after intervention which was more in the case group but it was not statistically significant (p>0.05).

Conclusion: Administration of 35 mg/week alendronate for 6 months does not cause significant improvements in bone densitometry variables in children with ALL and NHL.  

---

background: Early detection and treatment are crucial to prevent mental retardation in congenital Hypothyroidism (CH). The aim of this study was to evaluating of screening program of CH in Markazi Province.

Materials and Methods: In cross sectional descriptive study we used recorded data in Markazi province health center. From 2006 to 2012,127112 newborns were screened by measurement of serum TSH level by heel prick. Neonates who had blood TSH&ge5MIU/L were recalled for more evaluation. Neonates with confirmed hypothyroidism underwent treatment.

Results: From127112 screened neonates, 414 were diagnosed as CH patients (both permanent and transient). The prevalence of CH was . Recall rate was 4.8%. In 94.4% of patients, treatment were begun before the 40th day of life. The coverage percent in the province was 100% from the second year of the program.

Conclusion: Recall rate and the incidence of CH were higher than those in other studies, both in Iran and other countries. The mean age of treatment initiation and coverage percent were in favorable range.

---

Abstract

Background: Acute bronchiolitis is the most common lower respiratory tract infection in infant and one of their hospital admission reasons. Due to the high prevalence of the disease and unclear effectiveness of existing treatments, the present study was designed to evaluate the therapeutic effect of single dose of injected dexamethasone and inhaled epinephrine in patients with acute bronchiolitis treated with inhaled salbutamol.

Materials and Methods: In this double-blinded clinical trial, 90 infants with age of 2-24 months who were admitted to hospital with acute bronchiolitis were studied. All patients received inhaled salbutamol (0.15 mg/kg) and then were randomly assigned to three groups (n=30) of dexamethasone (0.6 mg/kg), inhaled epinephrine (0.15 mg/kg) and control (distillated water). Heart rate (HR) and respiratory rate (RR), arterial blood oxygen saturation (O₂ sat) and respiratory distress scores (RDS) of children at baseline, 30, 60,120 minutes and, 24 hours after intervention were recorded and compared between groups.

Results: The mean of HR, RR and RDS had significant improvement and the mean of O2 sat had significant rising trend and improvement during the study in all groups (p<0.05). The mean of HR in epinephrine group was upper than placebo in all measurements (p<0.001). RDS in epinephrine group was significantly upper than dexamethasone (p=0.002, CI95%=0.58- 2.69) and placebo (p=0.014, CI95%=0.27-2.8) 

Conclusion: Based on the result of present study, it seems that inhaled epinephrine or injected dexamethasone have no superiority to placebo in treating infantile acute bronchiolitis and their administration is not recommended.