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Material and methods: This is a Double blind Randomized clinical trial study which was performed on 66 children of 2-7 years of age who had been referred for first time, for nonbrain non-liver elective surgery (class 1 Anesthesia). This study was designed to define the efficacy of oral ketamine on Anxiety and Agitation and crying of children after separation from these parents, toleration of Anesthesia mask and IV needle. Sleeping before Anesthesia and entry into the operating room samples were divided in to two groups, cases and control. 5mg/kg of ketamine plus 0.2cc/kg of fruit juice was given to the case group while only 0.2cc/kg of fruit was given to the control group 30 minutes before the operation.
Results: Our results showed that 78.8% of children in the case group did not cry when they were separated from their parents and 78.8% of them did not show any resistance. 34.4% of children in the case group showed no response and 59.4% also had low response. Only 6.1% of children in the control group had no response while 78.8% of them had responses such as intense body movements and pulling of hand. 69.7% of the case group were cooperative when putting on the anesthesia mask while 75.8% of the control group refused to wear the mask, 81.8% of the children in the case group were asleep before Anesthesia while all of the children in the control group were awake and uneasy.
Conclusion: These findings indicate that ketamine can be used as a preanesthetic drug to decrease the anxiety and fear of children and to calm them before their transfer to the operating room.

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Introduction: The protein-energy malnutrition is the most prevalent cause of malnutrition and always occures in infants and children under 5 years old. According to the harmful effects of malnutrition, such as high mortality, inability of learning and decrease of mental and physical ability, reconnoite and study of malnutrition qualification is very important.
Material and Methods: This analytic cross-sectional study was carried out on 811 children under 5 years old who were living in rural zone of Arak. Based on health files, clinical inspections and interview with mothers a checklist was fulfilled for every child. Data were analysed by EPI6 software
Results: In this study, none of the children had stricken with Kwashiorkor or Marasmic-Kwashiorkor. Undernourished were seen in 7.39% and Marasmus were also seen in 1.1% of subjects. The prevalence of malnutrition was 7.5% in Wellcome, 33.55% in Waterlow-Stunting, 23.05% in Waterlow-Wasting and 30.94% in Gomez classification. There was statistically correlation between malnutrition and respiratory infection rate, milstones, birthweight, maturity and begning of helpfood (P<0.05).
Conclusion: Considering the results, the most rate of malnutrition in each classification was mild. It is suggested that increasing of familial awareness is an important factor for preventing from next damages and additional treatment costs.

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Introduction: Children play an important role in the future of every country. In under developed countries like Iran, because of cultural and economic poverty, most children have malnutrition which will be result in physical and psychological growth disorders. In as much as zinc is one of the most important and essential elements in metabolism of different substances and human growth, this study was conducted to determine the effect of zinc supplementation on percentile weight of children with growth disorders.
Materials and Methods: In order to investigate the effect of zinc sulfate syrup on increasing the weight and percentile weight of children, a double-blind clinical trial was conducted in 70 children aging 9 to 36 months. The subjects lacked any associated disease-by laboratory testing. Thirty-five children consume zinc sulfate syrup 0.6% for three months (case group) and other consume daily placebo for the same time and dose (control group). The increase of weight percentile of children were measured in three times with the interval of one month.
Results: Our findings showed that during three months, the average amount of increasing in weight percentile was 4.5% and 3.7%, respectively. T test showed that the comparison of increasing in weight percentile between two groups was not significant
Conclusion: This investigation revealed that zinc supplementation had not any remarkable effects on increasing of weight and weight percentile of children with growth disorders.

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Introduction: Among the risk factors for coronary artery disease, less attention has been paid to physical activity, especially in children and adolescents. Various studies have shown that their level of physical activity is lower than the standard for maintaining lower health. In this study, the pattern of physical activity of children and adolescents in the central regions of Iran is examined.
Method: In this descriptive study, which is part of the first phase of the Isfahan Healthy Heart Project and was conducted in 2002, awareness of the attitude and performance of 4,000 urban and rural children and adolescents in preschool to high school in Isfahan (Isfahan, Najafabad) and Markazi (Arak city) and the parents of these students and 500 teachers and school officials have been examined about physical activity and the duration of watching TV through a questionnaire. Sampling was selected in the form of a random cluster and in proportion to the urban and rural population living in the two provinces. Data were analyzed with SPSS software and p<0.05 were considered significant.
Results: About 40 percent of middle and high school students in the two provinces practiced regular sports at school less than two hours a week. Regular morning exercise and school sports were more common in girls than boys (p<0.00001), but regular extracurricular exercise and sports team membership were more common in boys (P<0.001). More than 77 percent of parents were unaware of the importance of childhood exercise in their children's health. The average TV viewing time for children of different ages was 4 hours a day.
Conclusion: The level of physical activity of middle and high school students in the central regions of Iran is less than the desired level and the duration of watching TV is more than the recommended values.

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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.

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Introduction:Final examinations are important stressors in schools and universities that result in different psychoneuroimmunological outcomes but the study of these effects on children has not been paid enough attention to. The aim of this study is to investigate the effect of final examinations on salivary immunoglubulin A in children. Materials and Methods: In this clinical trial a total of 100 children (50 boys, 50 girls) in 5th grade, aged less than 12 years from two primary schools of 5th educational district in Tehran were choosen randomly. The subjects completed Test Anxiety Scales of Sarason & Abolghasemi. After making sure of their physical and mental health by reviewing their medical history, clinical examinations and after controlling sleep, food, drug and sport variables, based on time series design, salivary IgA samples were taken five times as followed: one week before and then three times through mathematics, history and science exams and at last one week after passing the exams at, 9 to 10 am. IgA samples were analyzed by nephlometry method. Data was analyzed using ANOVA. Results: Findings indicated that IgA level was decreased significantly during examinations comparing to IgA levels before and after examinations (p=0.01). The relations of sex and anxiety scores were not statistically significant. It means that decreased IgA levels are the same in all children. Conclusion: Final examinations as a stress resource, diminishes IgA and this change is not related to sex and test anxiety score.

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Introduction: Hydronephrosis in infancy and childhood is a frequent urinary malformation. We were unable to find any reports concerning rate and causes of hydronephrosis in Iranian children therefore, we decided to evaluate it, in under 12 years old children. Materials and Methods: This was a descriptive study done in a 9-month period starting from Novemger 2004. All children under 12 years old who had visited Amir Kabir hospital of Arak for UTI or FTT were enlisted and an ultrasonography was requested. If hydronephrosis was detected, then a VCUG was performed. For those with normal VCUG results, if hydronephrosis persisted in the follow up sonography, the next step was an IVP or DTPA scan. Results: 65 patients (39 girls and 26 boys) were evaluated for hydronephrosis. 18.5% presented with FTT , 75.4% with UTI and 6.1% with FTT+UTI. The most prevalent causes of hydronephrosis were VUR (40%) and UPJO (23.5%). Grade I hydronephrosis was the most prevalent form (65%), however when VUR was present , it was mostly grades III or IV (27% and 19% respectively). 70% of girls and 31% of boys had VUR and the average age at the time of diagnosis was 2-3 years. Conclusion: Vesicouretero reflux and UPJO are the most prevalent causes of hydronephrosis and must be evaluated in children with hydronephrosis.

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Introduction: Chronic and relapsing abdominal pain is one of the most common reasons that bring children to pediatric clinics. About 20% of these children are suffering from idiopathic hypercalciuria. Since Hydrochlorothiazide is effective in relieving hypercalciuria, we assessed its effects on reducing these relapsing pains in girls with idiopathic hypercalciuria. Materials and Methods:In this single blind clinical trial study, 100 girls, aged 5-12 years old, with chronic relapsing abdominal pain and hypercalciuria were divided to two groups by random block design. All children and their parents were trained about consuming plenty of liquids and decreasing salt in foods. In addition to these measures, Hydrochlorothiazide (1 mg/kg/day) was also administered to children in the case group. The control group was assessed for the number of abdominal pain episodes for 3 months following the commencement of the diet and the case group for 3 months after becoming normocaciuric. The results were analyzed by T-test. Results: The mean number of pain episodes in Hydrochlorothiazide group in the first, second, and third months were 0.38, 0.4, and 0.26 respectively much lower than the corresponding months in the control group which were 1.60,1.94, and 1.84 in that order (p<0.001). Conclusion: It seems that single dose daily Hydrochlorothiazide is a safe and effective drug in the treatment of chronic relapsing abdominal pain in children with idiopathic hypercalciuria.

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Association between biological factors and disruptive behaviors in children and adolescents is important to investigate. Antisocial, aggressive and delinquent behaviors in adults often begin early in life. Basal cortisol is a valuable biological characteristic of children with disruptive behavior disorder (DBD). In this study the effect of family training on basal salivary cortisol in children with DBD was investigated. Materials and Methods: This is a clinical trial study. Basal salivary cortisol levels were studied in 19 children between 8-13 years old with DBD, before and 2 months after intervention (family training). The disruptive behavior of the child was assessed with child behavior checklist (CBCL). Cortisol levels and score of behavior were compared before and after intervention. Data was analyzed using descriptive statistics, paired t-test and pearson correlation. Results: Salivary cortisol before family training was 7.9±4.6 nmol/L and after that was 10.46±3.84 nmol/L which was significantly different (p<0.001). Behavior score before intervention was 72.05±10.10 and after that was 49.361±1.89 that was also significantly different (p<0.0001). Children with lower basal salivary cortisol had a better response to intervention. Conclusion: Parent training is an effective method for behavioral modification in DBD. Salivary cortisol can be considered as a predictive factor for severity of disruptive behavior, also a factor to assess the response to parent training in children with DBD.

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Background: There has been an increase in the number of women willing to have a caesarean birth because of their fear of childbirth. It seems the childbirth preparation educational class is a good way to remove or alleviate fears associated with pregnancy and childbirth.This research designed to identify the effect of childbirth preparation classes on childbirth fear on the primiparous women. Methods and Materials: The present study is a clinical trial which was carried out in 2007 at Milad Hospital, with 100 nulliparous pregnant women. Childbirth fear was measured by childbirth attitudes questionnaire. Normal pregnant women in the second trimester with childbirth fear score was 28 or more were randomly selected and dirided into experimental and control group with 50 subject in each qroup. The experimental group attended nine childbirth preparation class sessions and control group received routine antennal care. Results: The mean scored fear of childbirth in case and control group were 39.35±6.96 and 40.71±6.23 respectively. There was not significant difference between two groups. After the sessions, comparing childbirth fear score between two groups in third trimester showed the mean score of childbirth fear among experimental group was lower than control group (29.82+/- 7.18 compare to 38.03+/-9.27), and the differences statistically was significant (p<0.001). Mode of delivery was significantly different between the two groups. Conclusion: Primiparous women attended childbirth preparation classes acquired lower score of childbirth fear in compare to women received routine prenatal care. The results of this research showed relaxation training decreased childbirth fear and increased normal vaginal delivery.

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Abstract Background: Prevalence of urolithiasis is increasing in children and maybe hematury is only sign. This study was conducted to investigate clinical manifestation and etiology of urolithiasis in children younger than 14 year-old. Materials and Methods: This descriptive and case-series study was carried out on 100 patients referring to Sahamie Pediatric hospital in Qom in 2007-8. Age, sex, family history, clinical manifestation (fever, dysuria and Pain) and laboratory tests (Na, K, Ca, P, urea, Cr, Albumin, Alkaline phosphates of serum ABG, urine sediment, urine culture Na, K, Ca, P, Cr, oxalate and citrate of urine/24h and cysteine in random sample of urine) were determined. Ceratenin correcting formula was used for adequacy controlling of urine collecting. Results: Hypocitraturia (56.8%), hypercalciuria (29.4%), hyperuricosuria (26.3%), hyperoxaluria (14.7%), phosphaturia (8.4%) and cystinuria (6.3%) were detected. Also, 54% patients had urinary tract infection. Pain (27.7%), fever (33.3%), irritability and dysuria (62.2%) and hematuria (77.7%) were seen. Positive family history was reported in 23% of patients. Conclusion: Most common clinical manifestations in children with stone were hematuria, dysuria, fever and pain. The common etiology of urolithiasis respectively was hypocitraturia, hypercalciuria, hyperuricosuria, hyperoxaluria, phosphaturia and cystinuria.

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Abstract Background: Developmental anomalies in sacral bone have been recognized as one of the causes of urinary incontinence. Sacral ration was suggested as a valuable scale in determining the sacral bone health. According to insufficient studies in this field and variation in results, a determination of relationship between sacral ratio (SR) with primary enuresis were seemed imperative. Materials and Methods: In a cross sectional-analytic study, two groups (n=59) of 5-9 year-old children who admitted in pediatric and urology clinics of Amir Kabir hospital in one year were determined. Primary enuresis group with normal urine-analysis and ultrasonography, no history of dysuria, frequency, and urgency and control group without primary enuresis were selected. The mean ratio between the greatest widths of the sacral bone to its greatest length in the AP radiogram was compared between both groups. Results: In case group, 98.3% had normal SR. The mean ratio of greatest width to length was 0.89. There were not a significant relationship between gender and normal or abnormal SR. In control group, 88.1% had normal SR. The mean ratio of greatest width to length was 0.91. Girls more than boys had normal SR. Significant difference between mean ratio of SR and greatest width to length in both groups were not seen. Conclusion: Significant relationship between SR with primary enuresis in 5-9 year-old children was not seen.

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  Background : Urine tract infection(UTI) among children is the most prevalent bacterial infection and the second prevalent infection after Viral Flu.Regarding this cfact that urine culturing has very important role in diagnisis and perseverance of this disease and sampling method has significant effect on this disease remedy.

  In this study the effect of genital area ablution on decreasing the contamination of urine culture is examined.

  Methods and Materials: This study is in the form of case_controlled.In this study 620 little girls (3-12 years –old) referring to Amir Kabir children special clinic are examined.Population under investigation was cpatients who had not history of taking antibiotic during last seven days, sondage and genital anomaly and inflammation and genital discharge. 

  Patients were randomly entered in two different groups one with ablution and the other without ablution.After data collection, available inputs were statistically analyzed with SPSS and the effect of genital area ablution was determined on decreasing the contamination of urine culture.

  Results: Among 310 patients in with_ablution group 11 patients were reported UTI(3/7%).3 patients were contaminated (1%),296 patients were normal (95/3%).Among 310 patients in the second group,14 patients were reported UTI(4/7%),6 patients were contaminated(2%),290 patients were normal(93/3%).Contamination rate in with_ablution group were 1% and in the other group was 2%Based on Pvalue :0/491 in both groups no significant statistically difference were found between these two groups and the analysis result distribution in both groups in a=0/05 level were statistically the same.

  Conclusion: In both group no significant statistically difference were found between these two groups ,so we concluded that the genital area ablution doesn’t have such an effect on decreasing the contamination of urine culture and we don’t suggest ablution of genital area in children before providing urine sampling.

 

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Background: The UN report on the 41% increase of cesarean labor and its risks in Iran in recent years on the one hand and its association with cognitive and psychological factors on the other motivated us to identify the involving variables so as to control unnecessary cesarean sections. The aim of this study was to investigate the role of fear of pain and related psychological variables (pain catastrophizing, catastrophic cognition, childbirth attitude, depression-anxiety-stress, and experience of pre-menstruation (PMS) in prediction of cesarean labor. Materials and Methods: In this cross-sectional study, 300 pregnant women from Atieh private and Shahid Akbar Abadi public Hospitals (150 participants from each) were selected and matched by variables, such as age, level of education, month of pregnancy, previous experience of deliveries, tendency to cesarean, type of hospital, and having PMS. To collect data, a battery of questionnaires, including fear of pain, pain catastrophising, catastrophic cognition, childbirth attitude, and depression-anxiety-stress (DASS) were used. The results were analyzed through correlation coefficient and logistic regression. Results: Education, previous experience of deliveries, month of pregnancy were not significant but such variables as the tendency to cesarean, type of hospital, and age were significant (P<0.05). Such variables as pain catastrophizing, catastrophic cognition, and childbirth attitude were significant but other variables, including fear of pain , depression-anxiety-stress, experience of PMS were not significant (P>0.05). Conclusion: Such variables as the experience of cesarean, type of hospital, and age as well as pain catastrophizing, childbirth attitude, and catastrophic cognition are significant variable in prediction of cesarean labor in pregnant women.

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Background: Transient hip tenosynovitis is one of the common causes of pain and limping in children and includes 0.4% to 0.9% of admissions in emergency wards. The aim of this study is to evaluate this disease in terms of clinical presentations, age and sex distribution, and six-month recurrence. Materials and Methods: In this cross-sectional study, 51 children with diagnosis of transient hip tenosynovitis were investigated. Inclusion criteria were physician's clinical suspicion of acute tenosynovitis according to clinical presentations, physical exam, and age range of 3 to 8 years. Results: Among the 51 children with tenosynovitis, 34 patients were male with age of 61.70±19.1 months and 17 patients were female with mean age of 48.35±20.49 months that presented a significant statistical difference (p=0.026). The most common complaint was hip pain and the most commonly involved joint was the hip. Also, most of the patients had the history of viral diseases. Conclusion: Transient hip tenosynovitis is more common in boys. The right hip is the most involved joint and the majority of patients have the history of recent viral diseases.

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Background: Leukemia, due to its widespread prevalence, high mortality rate, high treatment expenses, and long hospital stay, influences the families and their children to a great extent. This study was done to explore the experiences of parents whose children suffer from leukemia. Materials and Methods: Using qualitative research approach with applying content analysis method, 22 participants were interviewed in two teaching hospitals during 2 months. The study started by purposive sampling and continued by a theoretical one till data saturation. The obtained data were constantly analyzed through content analysis method. Results: Data analysis showed that “finding no solution in life, having a lot of problems, errors in treatment, concealing the illness, faith in God, parents’ devotion, hospital facilities, and consistency were the level 3 codes of parents’ experiences and “parents’ reaching a dead-end in life” was the main theme or core category of this study. Conclusion: Using a qualitative approach for exploring the experiences of parents with a child suffering from blood cancer helped recognize them more profoundly than quantitative methods. On the other hand, “parents’ reaching a dead-end in life” as the theme shows the importance of attention to parents’ problems. Using these experiences can increase hope among parents and help conduct the treatment more effectively.

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Background: Sleep behavior and movement disturbance (SBMD) is of a relatively high prevalence in children and has a significant impact on their performance in daily activities and quality of life. Snoring, on the other hand, is considered one of the main causes of sleep disturbance in children. This study aims to assess the relationship between snoring and SBMD in 2 to 12 years old children in Qom city.

Materials and Methods: In this case-control study, 100 children with snoring and 100 healthy children were studied over 3 months. The parents took Berlin questionnaire on snoring and childhood sleep questionnaire. Data analysis was done using SPSS software version 18.

Results: There was a significant correlation in mean SBMD between case (13.78) and control (11.45) groups (p<0.001). Independent t-test indicated a significant difference between the case and control groups in the mean of SBMD (p<0.001). Also, significant relationships were seen between snoring and adenotonsilar hypertrophy (p<0.001) and apnea and SBMD (p=0.036), but there was not any relationships between SBMD and age, children less than 7 and more than 7 years old (p=0.231), and severity of snoring and SBMD (p=0.202).

Conclusion: This study demonstrates the importance of sleep disorders, especially snoring and SBMD and their relationship, in children. Sufficient attention to this issue can raise parents and physicians awareness and pave the way for early diagnosis and treatment of these disorders.

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Background: Human brain consists of two hemispheres with contralateral control of the body. One hemisphere's function is predominate to another, so one side of the body is more powerful in performing special tasks comparing the other which this property is almost used to determine predominant hemisphere of the brain. This analytic study performed to assess the effect of handedness and gender on the result of school readiness assessment examination in children.

Materials and Methods: Of 6 to 6.5 years old children living in middle socioeconomic regions of Qazvin city, referred to preschool Examining center to assess educational readiness and other physical examination, 400 children equally of both sexes were randomly selected in two Left-Handed (LH) and Right-Handed (RH) groups to compare the results of school readiness assessment examination. The data was statistically analysed and P-Value less than 0.05 was considered significant.

Results: The results of School Readiness Assessment Examination in LH and RH children were 38.71±2.70 and 38.15±4.04, respectively without significant difference. These results were 38.8±3.8 and 38.30±3.4 in boys and girls respectively, without significant difference. Comparing RH and LH cases in each sex group did not show any significance.

Conclusion: No significance was observed comparing the results of School Readiness Assessment Examination in LH and RH groups and between two gender groups.

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Background: Hospitalization of a child in pediatric intensive care unit (PICU) is a very stressful experience for parents. High stress in father can product decline in psychological adaptation and associated problems. The present study aimed to determine effect of fathersʼ participation in the care of hospitalized child in PICU on fathersʼ stress and coping strategies.

Materials and Methods: This is a clinical trial with 60 fathers with children admitted to the PICU in intervention and control groups. Fathers in intervention group, participated in the care of the child in 5 times, during a 5-days course. Fathersʼ stress and coping strategies were surveyed in intervention group before and after participation course and in control group before and after a 5-days course.

Results: Fathersʼ stress in intervention group decreased significantly after participation (p˂0.001) but in control group difference was not significant after time course. Fathers in both groups applied similar coping strategies that majority were emotion focused.

Conclusion: Fathers having children in PICU would experience a lot of stress. Their participation in the care of the children would be very effective to decline their stress and reach most adaptation with disease, cure and cares in children.

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Background: There are few studies related to effects of exercise training, including concurrent training, on hormonal changes in children. Hence, the aim of this study was to Compare theeffects of 6 weeks of resistance training and concurrent resistance and endurance training on aerobic power (VO2peak) and resting levels of growth hormone and cortisol in healthy children.

Materials and Methods: The subjects ofthis quasi-experimental study were 35 healthy boys between 9-11 years old, which were randomly divided into three groups of concurrent training (n=12), resistance training (n=11), control (n=12). Experimental groups were trained during 6 weeks 3 times a week.Control group were performed only their routine activities. VO2peak test was taken 48 hours before and after implementation of 6-weeks protocols and samples were selected from all subjects.Measurement of resting levels of GH and cortical was performed with ELISA method. For data analysis, one way ANOVA and paired t-test were used.

Results: The results showed that VO2peak and resting levels of GH increased significantly in concurrenttraining group (p=0.001, p=0.003, respectively). Resting level of cortisol in concurrent group was significantly lower than the other groups (p<0.05) and it was reducedsignificantlyin concurrent training and resistance training groups (p=0.001, p=0.036).

Conclusion: It seems a concurrent training period has greater benefits on VO2peak and resting levels of GH and cortical in children in comparison with resistance training.