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Abstract Background Sepsis, a severe inflammatory response to infection, is a global health priority due to its high mortality and long-term disability rates. Its pathophysiology involves both inflammation and immune suppression. Managing sepsis requires significant healthcare resources and expenditure, with sepsis being a leading cause of hospital costs. Gut microbiotas play a crucial role in sepsis, and probiotics show promise in managing it by restoring microbial balance. Despite advances, targeted therapies for sepsis remain elusive, necessitating innovative approaches such as probiotic therapy. Method Fifty-four eligible patients with sepsis will be randomly assigned to either the synbiotic or placebo group. The synbiotic supplement, KidiLact, comprises ten probiotic strains and prebiotic fructooligosaccharides. Participants will receive two sachets daily for 7 days, mixed with sterile water and administered orally or via gavage. Inflammatory factors including interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) will be evaluated. Anthropometric measurements, nutritional assessment, biochemical analysis, and clinical evaluation will be conducted to assess treatment outcomes. Statistical analysis will be performed to compare results between the two groups, employing SPSS version 19 with a significance level of P

Background: Nicolau syndrome is a rare condition that happens after intramuscular injection. All the intramuscular injections may have mild to moderate complications such as pain, focal abscess, nerve complication and anaphylactic reactions. Among these complications, wide necrosis of the skin like Nicolau syndrome happens very rarely. In this condition, Patients typically report acute, intense pain, immediately after drug injection and it is followed by an erythematous macular evolving after 24 hours into a livedoid violaceous patch with dendritic extensions. The study has been reported a case report of a 6-month-old infant who suffered from Nicolau syndrome after the injection of pentavalent vaccine. Methods: A 6-month-old girl infant without a history of any disease was referred to the emergency department with the signs of erythema, edema and purple like discoloration in the vaccine injection site at the left tight, after vaccination. One hour after admission, in the lower limb severe edema along with an extension of a dark red to purple discoloration happened on different parts of foot and after 5 days they turned necrotic. The infant suffered from Nicolau syndrome after the injection of the pentavalent vaccine. Conclusion: Although Nicolau syndrome is a very rare complication with no definitive treatment but can be prevented and not be aggravated by doing proper method of intramuscular injection and no application of cold compress (aspiration the needle for 5–10 seconds before injecting to make sure not to hit a blood vessel, the proper method of z-track, holding injection immediately if the patient complains excruciating pain on injection site, appropriate length of the needle to reach muscle, and different sites for multiple injections). However, due to lack of supporting evidence, needle aspiration is not recommended because no major vessel runs through the normal vaccination zone and that faster method is less painful. So, the vaccination must be done in right place with an appropriate length of the needle.

Abstract Although presentation of COVID‐19 in patients with immunodeficiency could be mild, it should not be missed, while early diagnosis and appropriate treatment can survive infected patients. Because even severe infections in PID patients may be presented with few symptoms and signs, this diagnosis should be considered in those immunocompromised patients who have exacerbating preexisting symptoms.

Background and purpose: Intravenous (IV) catheterization is one of the common painful procedures in children. This study aimed to investigate the effect of cold and warm vibration on pain caused by IV catheterization in 3- to 6-year-old children using a buzzy device. Materials and methods: A randomized clinical trial was carried out in 108 children in Mashhad Akbar Pediatric Hospital selected via random blocking. They were divided into three groups to receive warm vibration, cold vibration, or vibration only (control group). In this study, a musical vibrating device in a form of bee with either a warm or cold pack was attached for 5 min at approximately 5-10 cm above the intravenous continuous infusion (IVCI) site. In last minute, vibration was applied, then, IV catheterization was done. The Wong-Baker FACES Pain Rating Scale (WBS) was used to rate pain severity. ­Data were analyzed in SPSS V19 at a significance level of 95%. Results: Before the intervention, there were no significant differences in mean pain score between the three groups (P>0.05). Pain score was significantly different during the procedure (P0.05). Conclusion: Both cold and warm vibrations could reduce the pain caused by injection, but cold vibration showed greater effect on reducing pain. Therefore, cold or warm vibrating devices are suggested in management of aggressive painful procedures in children. (Clinical Trials Registry Number: IRCT20181104041553N1)

Introduction: Oxidative stress and inflammation could occur after major gastrointestinal surgeries. Selenium is a micronutrient with anti-inflammatory and antioxidant properties, which could improve the inflammatory markers in the children admitted to the intensive care unit (ICU) after gastrointestinal surgeries. Due to the lack of evidence on the potential effects of high-dose selenium on post-surgical critically ill children, the present study aimed to evaluate the effects of high-dose selenium supplementation on the levels of inflammatory markers and oxidative stress status in pediatric patients after gastrointestinal surgery. Methods and analysis: We will conduct a single-blinded, randomized, parallel group superiority trial at Akbar Pediatrics Hospital in Mashhad, Iran. The sample population will consist of 70 patients undergoing gastrointestinal surgery, who will admit to the ICU at the selected hospital. The control group will receive the recommended dietary allowance (RDA) doses of selenium, and the intervention group will receive 20 µg/kg/d of selenium. The primary outcomes, (the pro-oxidant-antioxidant balance (PAB) status, interleukin-1 beta (IL-1β), and high-sensitivity C-reactive protein (hs-CRP)) will be measured before surgery and upon discharge time. The secondary outcomes, (serum glutathione peroxidase (GPX) level and serum and urine selenium levels), will be measured before surgery, after surgery, and upon ICU discharge time. We will perform the intra-group and inter-group data analysis in SPSS software, and we will consider the intention-to-treat approach, statistical significance level of

Introduction: Poisoning is the most common method of non-fatal suicide. In recent years, poisoning caused by the use of medications and chemicals has increased. The present study aimed to investigate the rate of suicide using toxic compounds in Iranian children.Methods: This retrospective study was conducted using the data of 83 children aged 5-16 years who attempted suicide using toxic substances and were admitted to the pediatric and toxicology departments of Imam Reza Hospital in Mashhad, Iran. Results: Among 500 suicide cases, 83 committed suicide using toxic substances, and 8.4% of the suicides were committed by children aged 5-7 years. In addition, 60% of the suicide cases were aged 14-16 years. In total, 45.5% of the children committed suicide with prior planning (statistically significant). The peak time of referral to the emergency department was between 6-12 PM, and more than 90% of the patients were admitted with stable vital signs. The most commonly used toxic substance was organophosphate. During admission, psychiatric counseling was not provided to 36.1% of the patients, and the clinical outcomes also showed the use of non-lethal doses. Conclusion: According to the results, it is of utmost importance to assess the underlying causes of suicide attempts in early childhood (e.g., prior planning and antisocial behaviors), especially with the increased age of children to 14-16 years in such incidents.