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CNS injury in preterm infants is still one of the leading causes of mortality and morbidity. Routine care events might affect the perfusion and cerebral oxygenation of preterm infants. Although positioning the infant's head in a particular condition to improve brain oxygenation is included in many institutions, there is no robust clinical evidence to support this intervention's effectiveness.The present study aimed to determine the effect of head positioning on brain tissue oxygenation in preterm infants.This study is a randomized clinical trial. In the first 48 h after birth, 39 infants who met the study inclusion criteria underwent head positioning intervention. In this case, the infants were placed in the supine position, and every 2 h, the head position was changed continuously to one of six randomized modes [using random modes generated by SPSS]. During each head positioning, brain tissue oxygenation was recorded by NIRS.The findings showed a significant difference in brain tissue oxygen saturation among these positions (P 0.001). Dunn's test showed that the brain tissue oxygen saturation in the third position (head rotates 45-60 degrees from the midline to the right and the head of the bed is zero degrees) was significantly lower than the baseline (P = 0.029; Mean difference = 2.3). Also, in the third position, compared to the first position (P = 0.002; Mean difference = 1.9) and compared to the fourth position (P = 0.003; Mean difference = -2.1), and in the second position compared to the first position (P = 0.046; Mean difference = 1.3), the brain tissue oxygen saturation of the infants was lower.Based on the results of the present study, head positioning was effective on brain tissue oxygenation in preterm infants in the first 48 h after birth; Therefore, it is recommended when possible, not to rotate the infant's head during the first 48 h after birth while the head of the bed is at 0°.

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: Chemotherapy is the main component of systemic cancer treatment; however, the effective application is restricted due to nausea and vomiting. We aimed to assess the effect of acupressure on nausea and vomiting in children undergoing chemotherapy. Materials and Methods: An extensive search was done in databases of Medline, Embase, Scopus, Cochrane, and Web of Science until February 2018. Two independent researchers screened articles, in the next step, full texts of probably relevant articles were summarized and categorized based on the evaluated outcomes and overall effect size was presented. Results: Four studies were included in the systematic review (including 223 children and adolescents aged 5 to 19 years). The first study assessed the effect of acupressure wrist bands and placebo bands; the results showed the feasibility of well tolerated acupressure, but not more effective than placebo. In the second study, researchers concluded that the acupressure bands compared to sham bands could not improve nausea and vomiting, neither in the acute nor the delayed phase. In addition, daily vomiting was not improved via acupressure bands in either the acute, or the delayed phases in chemotherapy. In the third study, a significant difference was observed between the two groups auricular acupressure intervention+ standard care (AAP), and auricular acupressure using sham auricular points (SAP) + standard care regarding occurrence, and severity of both nausea and vomiting. The results of fourth study showed that acupressure has a significant role in the reduction of nausea, vomiting and retching associated with chemotherapy among adolescents with cancer. Conclusion: The patients considered the acupressure as a safe, effective and well-received strategy though objective criteria exhibited no statistically significant improvements compared to conventional care.

Introduction: Glucagon-like peptide-1 hormone (GLP-1) contributes to the regulation of insulin and glucose concentration. However, the effects of fasting on GLP-1 response in different people has not been determined yet. The aim of the present research was to investigate the effect of fasting on GLP-1 and the lipid profile of obese and thin women.Materials and methods: In this research, 25 obese and thin women whose age ranged from 35 to 45 years were selected through a convenient sampling method and were divided into two groups of obese (n=12, body mass index ˃30 kg/m2) and thin (n=13, body mass index=18-20 kg/m2). GLP-1 in both groups was measured in four phases: 3 days before the beginning of Ramadan, 14 days after the beginning of Ramadan, 28 days after the beginning of Ramadan and 2 weeks after the end of Ramadan. Repeated –measure ANOVA was used to statistically analyse the data. Results: GLP-1 was reduced from phase 1 to 3 of the research. However, it was increased after Ramadan. In the thin group, GLP-1 was increased in 14 days of fasting, but did not show any change at the end of Ramadan, and also two weeks after this month. However, none of these changes were statistically significant. The two groups did not diverge from each other significantly in any of the phases.Conclusion: The present findings showed that fasting has no significant effect on the GLP-1 and lipid profile indices of the obese and thin women.

This review study aimed to investigate the role of PCT in the prognosis of mortality among patients admitted to the intensive care units (ICU). Procalcitonin (PCT) is a polypeptide and prohormone of calcitonin. This prohormone is secreted by thyroid gland C cells in response to hypercalcemia, and Its elevated level indicates infection, especially bacterial infections, in which there is a systematic response to infection.This narrative review study was performed based on Cochrane collaboration recommendations for reviews. We reviewed all the titles and abstracts of published research articles with the following inclusion criteria studies aimed to confirm the function of a prognostic model in predicting mortality or survival, (b) mortality or survival of a specific endpoint (for example, 30 days), (c) patients admitted to intensive care units, and d) the articles written in English. The exclusion criteria of the current review included: (a) articles whose data were not specifically focused on prognosis of patients in ICU, (b) articles that did not provide sufficient information on the cause of death of patients in ICU, and (c) articles focusing on the treatment of comorbid patients with infections in ICU. The search was conducted on Google Scholar, PubMed, Magiran, ScienceDirect, and SID. Also, to search Iranian databases, including SID and Magiran, the same terms and expressions were searched.Based on the findings of this review, serum levels of PCT were reported within the range of at least 5 to more than 16 ng/ml in patients admitted to ICU. The mortality rate was estimated at 5.7% to 79% in these patients. Moreover, the incidence of sepsis was reported from 13% to 77.6%.Serum levels of PCT as a prognostic factor may help early detection, and better classification of the poor prognoses sepsis patients and more invasive treatment of patients admitted to ICU and are at risk for mortality.

Background. In the recent coronavirus disease 2019 (COVID-19) pandemic, millions of people have been affected so far. Clinical manifestations and natural history of infections have a very wide range, which is important to know it in various underlying diseases. Although children are less affected than adults, its presentation especially in those with underlying diseases should not be neglected.Case presentation. Herein we report the first case of specific antibody deficiency, who was affected with COVID-19. The patient suffered from rhinorrhea and modestly increased in productive cough, but real-time reverse transcription polymerase chain reaction was positive for COVID-19.Conclusions. 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 affected patients.

Summary Introduction Malnutrition is known as one of the major health problems among critically ill children; optimum nutrition support is considered as a therapeutic strategy to improve clinical outcomes and minimize the length of Pediatric Intensive Care Unit (PICU) staying as well as its costs. Implementation of an algorithmic protocol can result in the upgrade of the quality of nutrition support system in PICU. Method In this study, we developed a stepwise algorithmic nutrition care protocol for PICU patients in two phases as follows: a critical review of past literature and an expert discussion panel. The final structured protocol includes three following steps for the nutrition care process: 1) Initial nutrition screening and assessment, 2) Nutritional intervention and 3) Nutritional monitoring. Pre and post-implementation audits were carried out in a 23 bed medical/surgical PICU in a children's hospital affiliated to Mashhad University of Medical Sciences over two 4-week periods to evaluate the impact of the algorithm implementation. The post-implementation audit was performed by passing 12 weeks from the protocol implementation. Critically ill children aged between 1month and 10 years, and PICU length of stay>24 h who were in post gastrointestinal surgery state, were enrolled. Results Totally, 34 eligible critically ill gastrointestinal surgical children in post-implementation audit were compared with 30 patients with similar eligibility criteria in the pre-implementation audit. Notably, there were no significant differences in gender, median age, length of PICU stay, and mechanical ventilation requirement in the two audits. The comparison of our pre and post-implementation audits showed a significant increase in the proportion of energy delivery goal achievement following performing our intervention (56.7%, and 85.3%, for pre and post-implementation audits, respectively; p-value = 0.01).Additionally, time of achieving energy and protein goals were significantly decreased (5.5 vs. 3 days; p-value = 0.008 and 4 vs 3 days; p-value = 0.002, for energy and protein delivery goal achievements, respectively). Conclusion The implementation of the algorithm have significantly improved the adequacy ratio of energy delivery and also decreased the time to achieve the goal in energy and protein intake among critically ill children in post-gastrointestinal state. In this regard, further prospective studies are needed for continuing the evaluation of the algorithm implementation outcomes in critically ill children with different surgical and internal underlying diseases.

Background: Critically ill children admitted to pediatric intensive care unit (PICU) are at increased risk of gastrointestinal bleeding due to stress related mucosal injury. Reducing gastric acid by acid suppressant medication is the accepted prophylaxis treatment, but there is not any definitive guideline for using prophylaxis in PICU patients. The present study aimed to assess the effect of Proton Pump Inhibitor (PPI) and H2 Blocker (H2B) prophylaxis on gastrointestinal bleeding in admitted patients of PICU, Mashhad- Iran.Materials and Methods: In this study, 100 patients admitted in PICU divided into two equal groups on the first day of admission. They received ranitidine or pantoprazole as prophylaxis of stress ulcer. Those patients who had history of gastrointestinal bleeding or coagulation disorder were excluded. 100 PICU patients who had not received prophylaxis during last 6 months retrospectively evaluated as control of the study. Data were collected as demographic characteristics, admission reason, definitive diagnosis, receiving corticosteroid and mechanical ventilation in each patient. Gastrointestinal bleeding (hematemesis, coffee ground aspirate, and melena) and clinically significant gastrointestinal bleeding were daily monitored. Data analyzed through descriptive statistical tests, Chi-square, logistic regression, t-test and using SPSS-16 software.Results: Among 204 patients (control group=105 and case group=99), incidence of gastrointestinal bleeding (GB) was 13.2% in which 6.9% of cases presented with clinically significant gastrointestinal bleeding (CSGB). Loss of consciousness and respiratory distress were the main reason of admission. There was no significant differences between the incidence of (GB) and (CSGB) in experimental and control groups (P>0.05) as well as ranitidine and pantoprazole prophylaxis (P>0.05). Significant risk factors of (GB) were mechanical ventilation and loss of consciousness and corticosteroid therapy.Conclusion: There is ambiguity about probable benefits of gastrointestinal bleeding prophylaxis in critically ill children. We proposed that prophylaxis should prescribe in patients with two or more risk factors of gastrointestinal bleeding.

Introduction: Recognition of the characteristics of neonatal jaundice with different levels of severity can help the physician with appropriate treatment and prediction of complications. This study aimed to determine the characteristics of neonatal jaundice in different levels of severity. Materials and Methods: This cross-sectional study was performed on 3005 neonates referring to the Neonatal Intensive Care Unit, Clinic, and Emergency ward in Ghaem Hospital of Mashhad, Iran, from 2009 to 2018. Sampling was carried out through the convenience sampling method. The data collection tool was a researcher-made questionnaire, including laboratory evaluation, as well as assessment of maternal and neonatal characteristics. The newborns were divided into six groups based on the serum bilirubin level and then compared in terms of characteristics, causes, and prognosis according to the severity of jaundice. The data were analyzed using the Student's t-test and Chi-square test. Results: In most cases, the present of jaundice was reported between 2 and 3 days of birth, and the age of neonates' reference was between 6 and 8 days of birth. Causes of neonatal jaundice included unknown reasons (61.25%), increased production of bilirubin (22%), severe weight loss (7%), infections (5.3%), endocrine disorders (2.5%), and other causes (1.7%). In jaundice level lower than 25 mg/dl, about 15% of neonates were reported with complications; however, at the bilirubin level higher than 35 mg/dl, approximately 40% of newborns had complications. Conclusion: The known causes of the jaundice were mostly observed in the increased bilirubin production level higher than 25 mg/dl.

Background: The purpose of this study is to determine the frequency of hyperglycemia in nondiabetic critically ill children and to investigate its relationship withmechanical ventilation, length of stay andmortality. Methods: In this original retrospective study, data was (were) collected between 2013 and 2014 from the pediatric intensive care unit data base of Sheikh’s Children Hospital inMashhad, Iran (one hundred admitted children). Results: From among 97 subjects, 49 subjects (50.5%) were hospitalized for more than 10 days, and the mean length of stay wa 14 days. The overall mortality rate was 16 subjects (16.5%) and frequency of hyperglycemia was 24 subjects (24.7%). The median fo blood glucose measurements was 100 mg/dl. Seventy three subjects (75.3%) had a mean blood glucose level in the normal range Overall, 18 subjects (18.6%) had at least one blood glucosemeasurement of 180mg/dL or higher. There was a significant association between hyperglycemia and mortality (P < 0.001). Linear regression analysis showed positive correlation between blood glucose level, length of stay and length of ventilation (P 0.001). The maximum serum glucose concentration positively correlated with duration of mechanical ventilation and length of stay (P < 0.001). Conclusions: Our study found thatmaximumserumglucose concentration positively correlatedwith the duration of mechanica ventilation, length of stay, andmortality.

Background Despite recent pharmaceutical advancements in the production of new antibiotics, antibiotic resistance is increasing at an alarming rate in mammals; given the high prevalence of infectious diseases. Objectives The current study aimed to determine the epidemiology of different infections in patients admitted to the infectious disease ward of Imam Reza hospital in Mashhad, North-East of Iran. Methods This cross-sectional study was conducted on 1681 patients referred to Imam Reza hospital of Mashhad during 2006 - 2008. Prepared checklists were used to collect the required data, including age, gender, employment status, place of residence, length of hospitalization and season of admission in patients diagnosed with infectious diseases. Results In the current study, prevalence of tuberculosis, septicemia, skin and soft tissue infections, urinary tract infections (UTIs), febrile neutropenia, myocarditis, and gastrointestinal infections were estimated at 8.4%, 8.3%, 7.1%, 5.4%, 4.9%, 3.9%, and 3.8%, respectively. Also, major respiratory infections were reported in 5.8% of the studied patients. Among the female patients in the study, 20.9% and 10.56% were diagnosed with pneumonia and tuberculosis, respectively. As for the male patients, 16.1%, 10.7%, and 7.1% were diagnosed with pneumonia, nervous system infections and tuberculosis, respectively. Conclusions According to the results of the study, the most common causes of hospital admission were respiratory infections (e.g. pneumonia), nervous system infections, tuberculosis, septicemia, skin and soft tissue infections and UTIs. Considering the diversity of infections, epidemiological evaluation of these diseases is essential, especially in regions with high prevalence of infectious diseases. Furthermore, etiological diagnosis is considered imperative for clinicians before initiating therapy in patients with infectious diseases.

Background: Bowel function has been reported to be adversely affected following surgery in cases of Hirschsprung. We retrospectively studied both the clinical outcome and bowel function status following surgery in patients diagnosed with Hirschprung's disease (HD). 161 cases, who underwent pull-through operations for HD in Sheikh Pediatric Tertiary Centre, Mashhad, Iran. The specified time bracket spanned between 2006 and 2011. Materials and Methods: Data was extracted from Health Information System with the aim of investigating patients for both short and long-term gastrointestinal (GI) complications after surgery bases in addition to the concurrence of any associated anomalies. Three main procedures were analysed in this respect (Swenson, Duhamel and Soave). Results: In a study of 96 (59%) boys and 65 (40.3%) girls, mortality rate was reported to be 15.5% (15 males and 10 females). A considerable majority of almost three fourths were detected with both early and late GI complications after surgery. The latter mainly included constipation (30.8%), incontinence (19.8%), enterocolitis (8%), diarrhea (11%) in a declining order of incidence. Down syndrome and others HD-associated anomalies were detected in 3.7% and 24.3% of cases respectively. Conclusions: Constipation and foecal incontinence were the most prevalent postoperative complications, which were reported almost as frequent in other studies. Yet, Enterocolitis, was reported slightly less in prevalence. Also mortality rates were considerably higher, compared to developed nations.

Background & Objective: Malnutrition is very common in hospitalized children and is associated with related clinical consequences such as increased risk of infections, increased muscle loss, impaired wound healing, longer hospital stay and higher morbidity and mortality. The estimated prevalence of acute malnutrition in hospitalized children varies from 6.1 to 40.9% in different countries. The current study was conducted with the aim of evaluating the efficiency of STRONGkids (Screening Tool for Risk On Nutritional Status and Growth) tool for assessing malnutrition in hospitalized children in Iran. Methods: All children older than 28 days admitted to the pediatric hospital (Dr. Sheikh, Mashhad, Iran) were enrolled in this study and the screening tool named STRONGkids was applied for them. The anthropometric measurements were measured by a trained operator using standard methods and equipments. The children were classified in three groups of being at high risk, moderate risk and low risk of malnutrition. Results: According to STRONGkids score; 17% of children were classified as low risk, 75% as moderate risk and 8% as high risk group. According to WFH, HFA and WFA z-scores31.4%, 19.2% and 28% of children were identified as moderately and severely malnourished respectively. According to MUAC cut-offs, 3.4% of children were classified as having moderate malnutrition and there was no child with severe malnutrition. Conclusion: It is very important to recognize the nutritional status of the children as early as possible because of its effects on children’s growth. Therefore, evaluating the nutritional status of the hospitalized children is an essential step in clinical assessment. We suggest to apply the STRONGkids score aside with other clinical and anthropometric data.