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Objective. In this study, by using clinical and paraclinical characteristics, we have aimed to predict the severity of the disease in hospitalized COVID-19 children. Method. This cross-sectional study was conducted on medical records about epidemiologic data, underlying diseases, symptoms, and laboratory tests from March to October, 2020, on 238 hospitalized confirmed COVID-19 paediatric cases in several children’s hospitals of Tehran, Ahwaz, Isfahan, and Bandar Abbas. Results. From 238 patients, 140 (59%) were male and most of them were in the age group of 1 to 5 years (34.6%). Among all hospitalized patients, 38% had an underlying disease and in total, 5% of cases were expired. Conclusion. Determining patient severity is essential for appropriate clinical decision making; our results showed that in hospitalized pediatric patients, by using several variables such as SGOT, CRP, ALC, LDH, WBC, O2sat, and ferritin, we can use clinical and paraclinical characteristics for predicting the severity of COVID-19.

Background Multi-system inflammatory syndrome in children (MIS-C) involves multiple organs and shows increased inflammatory markers. Since the onset of the COVID-19 pandemic, several studies have reported the association between severe COVID-19 and MIS-C. Reversible cerebral vasoconstriction syndrome (RCVS) presents with thunderclap headaches and multifocal reversible vasoconstriction on imaging. RCVS is very rare in children. This paper reports two cases of pediatric COVID-19 with severe MIS-C and clinical and imaging features indicative of RCVS. Methods Clinical, laboratory and imaging data of the patients were reviewed. The diagnosis of RCVS was confirmed based on clinical symptomatology and brain magnetic resonance imaging findings. Results Two pediatric patients with clinical findings compatible with severe MIS-C and hemodynamic compromise presented to the hospital. During their hospitalization course, they developed thunderclap headaches and neurological deficits. Both were receiving vasoactive agents, intravenous immune globulin (IVIG), and immunosuppressants. Imaging studies showed marked multifocal cerebral vasoconstriction in both cases and infarcts in one. The course and management of the patients will be presented. After controlling inflammation and elimination of triggers, both patients were ultimately symptom-free upon discharge. Cerebral vasoconstriction had completely resolved on follow-up imaging. Conclusions Although a variety of symptoms including headaches may be seen in pediatric COVID-19 patients with MIS-C, RCVS should be considered as a differential diagnosis in cases of thunderclap headache accompanied by neurologic signs in these patients. Imaging findings and follow-up are also key in establishing the diagnosis.

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-alpha/beta (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23-dependent induction of IFN-gamma is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling. ANRS Nord-Sud ; CIBSS ; CODI ; Comité para el Desarrollo de la Investigación ; Fulbright Future Scholarship

COVID-19 infection can cause inflammatory reactions that could involve several organs. In the pediatric population, Multi-System Inflammatory Syndrome in Children (MIS-C) has been reported as one of the consequences of COVID-19. We report a unique pediatric COVID-19 patient with MIS-C, associated with paralysis of the extremities. MRI showed abnormal signal in the cervical spinal cord compatible with transverse myelitis. Methylprednisolone and IVIG were administered, without significant symptom improvement. As a next step, Infliximab was tried for her, and she responded remarkably well to this treatment. Infliximab may be considered as a treatment option in COVID-19 patients with transverse myelitis.

Diarrhea and vomiting with or without fever are common symptoms in children, while one of the most common clinical findings of Coronavirus disease 2019 (COVID-19) is gastrointestinal symptoms. Therefore, there is a need to develop an algorithm for dealing with a patient with gastroenteritis in the SARS-CoV-2 epidemic.

The coronavirus disease 2019 (COVID-19) pandemic has imposed a significant burden worldwide, manifesting as a severe disease and causing mortality even in children. Severe COVID-19 disease is characterized by cytokine storm with progression to secondary hemophagocytic lymphohistiocytosis (sHLH). We describe an 18-month-old boy in Iran, previously healthy, diagnosed with COVID-19-induced sHLH. Three weeks after close contact with COVID-19 confirmed cases, he was admitted with high fever, lethargy, mild respiratory distress, skin rash, and conjunctivitis with swollen eyelids and lips. Laboratory data revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and liver enzymes, and mild thrombocytopenia. His clinical condition rapidly deteriorated, with septic shock, hepatosplenomegaly, and respiratory failure. Laboratory tests showed cytopenia, coagulopathy, hyperferritinemia, and hypertriglyceridemia, which met the criteria for sHLH diagnosis. Chest computed tomography (CT) revealed bilateral infiltrations that suggested acute respiratory distress syndrome (ARDS) of COVID-19 that was confirmed by a positive real-time polymerase chain reaction (RT-PCR) test. Therefore, the child was treated with intravenous immunoglobulin (IVIG), glucocorticoid, hydroxychloroquine, lopinavir/ritonavir, and interferonβ-1a. This therapeutic strategy enabled complete recovery from fever, regaining consciousness, weaning from respiratory support, and resolving shock. Serial chest radiographs showed diminishing infiltrations. Sequential physical examinations revealed an overall significant reduction in spleen and liver span. Laboratory data showed rapid improvement from cytopenia and coagulopathy, normalization of liver enzyme levels, and reduction in hyperinflammation markers. Although ARDS is the most common cause of death from COVID-19, other complications such as sHLH may be lethal; thus, early diagnosis and appropriate treatment are necessary for saving patients’ lives.

The first case of Kawasaki-like disease in children infected with COVID-19 was reported in a preprint case report. In the present case series, three pediatric probable cases with COVID-19, who presented signs and symptoms of Kawasaki-like syndrome, and their three-month follow-up are provided.

We herein report a case of large intracardiac thrombus in a child with SARS-CoV-2 infection (COVID-19). The diagnosis of COVID-19 was confirmed through HRCT and RT-PCR. Transthoracic echocardiography revealed a large thrombus in the right atrium treated successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory condition incurred by the COVID-19 virus.

COVID-19 is an ongoing pandemic that is not known well. According to our current knowledge, although respiratory manifestations are the most common symptoms of COVID-19, but non-pulmonary manifestations are also commonly reported, such as rashes, appendicitis, volvulus, diverticulitis, and mesenteric lymphadenitis. In this case series, we introduced four children with COVID-19 who presented with gastrointestinal symptoms.

Diarrhea, vomiting and fever are common symptoms in pediatrics; on the other hand, recent studies have shown that, gastrointestinal symptoms are increasing in patients with COVID-19. This fact indicates the need to develop a screening and diagnostic algorithm in dealing with a patient with gastroenteritis in the epidemic SARS-CoV-2.

Brucellosis, with multi-organ involvement, is recognized as a zoonotic infection in Iran. This infection has multiple signs and symptoms. On the other hand, hemophagocytic lymphohistiocytosis (HLH) is described as an uncommon disorder. The secondary type of this disease may be associated with infection. However, the association between HLH and brucellosis has been rarely reported, especially in pediatric populations. Herein, we present a pediatric case of secondary HLH associated with brucellosis. Based on our findings, HLH should be considered in patients diagnosed with brucellosis with profound cytopenia and increased spleen size despite treatment.

Background: Antibiotic-associated diarrhea (AAD) is of great concern in children due to the wide range of antibiotic administration among this population. Studies considering the use of synbiotics for prevention or treatment of AAD are limited. In the current study, the effectiveness of synbiotics in preventing AAD was investigated. Methods: This randomized, double-blinded clinical trial was conducted on 100 patients undergoing antibiotic therapy for over five days. The patients were randomly divided into a case group receiving synbiotic therapy (Protexin; The United Kingdom) and a control group undergoing placebo therapy (consisting of starch sachets). Both groups began their medication within 24 hours after antibiotic initiation and continued it for further seven days after antibiotic therapy cessation. The two groups were compared regarding the incidence of diarrhea, stool consistency based on the Bristol Stool Scale (BSS), and the duration of diarrhea. Results: The members of case and control groups were not statistically different regarding age, gender distribution, length of hospitalization, the frequency of defecation, and stool consistency based on BSS before antibiotic therapy, primary and final diagnosis, the type of antibiotics prescribed, and duration of antibiotic therapy (P > 0.05). The incidence of AAD was significantly less in the case group compared with the control group (P = 0.016), while those with AAD did not show significant difference regarding the duration of diarrhea, stool consistency based on BSS, and the frequency of defecation a day (P = 0.51, 0.26, and 0.18, respectively). Conclusions: The findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent AAD; however, in case of AAD occurrence synbiotic therapy cannot positively affect duration, stool consistency, and the frequency of defecation.

Background: Vitamin D plays an important role in regulating the immune system, calcium and phosphorus homeostasis, and bone formation. This micronutrient plays an important role in the incidence and severity of respiratory infections. Objectives: The aim of this study was to evaluate the vitamin D serum level in children with acute lower respiratory infections (ALRIs) and its association with the severity of infection with vitamin D serum level. Methods: This cross-sectional study was conducted on 99 children with ALRIs aged 20.13 ± 17.55 months who were selected with a simple random sampling technique. The children were examined and evaluated at the time of admission. Their data, including demographic characteristics and the findings of the physical examination and laboratory, were recorded in the questionnaires. Serum level of 1,25-dihydroxy vitamin D3 [1,25(OH)2D] and 25-hydroxyvitamin D3 [25(OH)D] were measured by HPLC method. Results: children with severe acute lower respiratory infection had a significant lower level of 25(OH) D (P = 0.02). Indeed, data analysis showed a level of 25(OH) D inversely associated with severity of acute lower respiratory infections in children (B = -0.7, P = 0.00). Conclusions: The severity of the lower respiratory tract infections was inversely proportional to the level of 25(OH)D, and it may be hoped that increasing 25(OH)D level may reduce the severity of ALRIs.

Salmonella typhi is a Gram-negative microorganism. This enteric pathogen causes a variety of signs and symptoms, but the more prevalent is fever and gastrointestinal signs. It is important to consider this microorganism in the differential diagnosis in patients coming from the regions with a high prevalence of salmonella typhi and unusual signs and symptoms.

Methicillin resistanceIn a cross-sectional study, a total of 695From a total of 695 samples, 170 (24.46%) were found to be MRSA. 142, 82, and 132 samples of MRSA were hla, hlb, and eta positive, respectively. hla gene was significantly found more frequently in patients at least 18 years (MRSA strains from

Objectives: The aim of this study was to evaluate endothelial dysfunction in pediatric patients with Helicobacter pylori infection. Methods: In a cross sectional study, 50 children between six and twelve years old were evaluated for Helicobacter pylori infection by a histopathologic specimen. C-reactive protein (CRP) and Interleukin -12 of all subjects was checked. Endothelial dysfunction was evaluated by echocardiography of brachial artery and through measuring flow mediated dilatation (FMD). Results: Mean of FMD level was significantly higher in children with H. pylori infection (P value: 0.04). Interlukin-12 (IL-12) was higher in children with H. pylori infection (P value: 0.04). Linear regression showed a positive association of Helicobacter pylori infection and endothelial dysfunction (beta = 0.3, P value = 0.08). Conclusions: Children with Helicobacter pylori infection have more endothelial dysfunction independent of IL-12.

Background Antidepressants are effective in adults with pain-related functional gastrointestinal disorders. We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP). Methods Children with FAP, based on the Rome III criteria (n = 115, aged 6–18 years), were randomized to receive either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥2 point reduction in the 6-point Faces pain rating scale or ‘no pain’. Depression, anxiety, somatization, and physician-rated global severity and improvement were also evaluated. Patients were followed up for 8 weeks after medication period. Key Results Eighty-six patients completed the medication (43 in each group). Response rate in the citalopram and placebo groups based on per-protocol (intention-to-treat) analysis was 55.8% (40.6%) and 39.5% (30.3%) at week 4 (p = 0.097 [0.169]) and 72.0% (52.5%) and 53.4% (41.0%) at week 12 (p = 0.059 [0.148]), respectively. In per-protocol analysis, more reduction was observed in pain (F = 3.84, p = 0.024) and global severity scores (F = 4.12, p = 0.021) in the citalopram group compared with the placebo group over the study period. Such differences were not present in the intention-to-treat analysis. No difference was found between the two groups regarding change in depression, anxiety, or somatization score over the study. Conclusions & Inferences Overall, we found a trend toward the effectiveness of citalopram in the treatment of children with FAP. Trials with longer treatment duration in larger samples of patients are required in this regard.

In recent decade the prevalence of antibiotic associated diarrhea was increased because of more antibiotic usage. Colstridum difficile is a microorganism which can cause mild to severe colitis. But the only cause of colitis related to Antibiotics is not colstridum difficle. In this case report we explain a child whit antibiotic associated colitis due to klebsiella oxtyoca.

AIM To evaluate the prevalence of salt sensitivity and the impact of cardiometabolic and psychological characteristics on salt sensitivity in normotensive population. METHODS Of all participants, anthropometric measurements and fasting venous blood samples were collected, and study questionnaires were completed. Salt Sensitivity was defined based on the difference in mean arterial pressure with infusion of 2 L of normal saline followed by a low sodium diet and administration of three doses of oral furosemide the day after. RESULTS Of 131 participants, 56 (42.7%) were diagnosed with salt sensitivity. Crude and age and sex adjusted regression analysis showed that low-density lipoprotein cholesterol and depression were positively associated with salt sensitivity (OR = 1.02, 95%CI: 1.01-1.04 and OR = 1.15, 95%CI: 1.00-1.34, respectively). CONCLUSION The high prevalence of salt sensitivity and its significant relation with prevalent risk factors necessitates considering its reduction actions at the population level and the need for further research.

BACKGROUND: There are few literatures evaluating the association between cytotoxin-associated gene A (CagA) positive strains of Helicobacter pylori (HP) and the severity of coronary heart disease (CHD). This study was designed to investigate this association. METHODS: Medical and drug history of 112 consecutive patients who were candidate for coronary angiography were taken. Fasting blood samples were obtained to measure C-reactive protein (CRP), anti Helicobacter pylori immunoglobulin G (anti-HP IgG), anti-CagA antibody (Ab) and interlukine-6 (IL6). According to angiography reports, participants were divided into patients with mild (n = 69) and with sever CHD (n = 36). To measure the association between CagA positive strains of HP with the severity of CHD, multivariate logistic regression tests were used by adjusting age, sex, history of diabetes mellitus (DM), and/or dyslipidemia (DLP), and/or hypertension (HTN), CRP status and IL-6 level. RESULTS: The analysis was concluded on 105 subjects. HP infection and CagA Ab were not significantly higher compared to the patients with severe and mild CHD (P = 0.28 and P = 0.68, respectively). Colonization of CagA positive HP did not significantly associate with severity of CHD (OR 1.05, 95% CI 0.33-3. 39). CONCLUSION: Colonization of CagA positive HP was not an independent risk factor for severe coronary heart disease. Keywords: Helicobacter Pylori, CagA, Coronary Heart Disease, Severity &nbsp

Background: Dental health is one of the most important health burdens of children health. The association between dental health and endocarditis has been already demonstrated, but there is controversy about different frequency of dental caries, periodontitis, and saliva microorganism in comparison to healthy population and children with congenital heart diseases (CHDs). In this study, we evaluated these differences. Methods: Seventy-six healthy children and 68 CHD patients were enrolled in the present case–control study. Dental decay, periodontitis, oral microorganisms, serum calcium, phosphorus, and frequency of carbohydrate and protein consumption of all participants were evaluated by standards method. Results: CHD patients experienced more periodontitis, but the difference was not significant (0.12 vs. 0.09, P = 0.2). In healthy children, the mean saliva colony counts of Streptococcus mutans were more significant (50639 ± 3324 vs. 35285 ± 27226, P = 0.03), which was diminished by adjusting the carbohydrate consumption. The mean colony count of Lactobacilli in children with CHD was nonsignificant higher than healthy children (P = 0.3). Conclusions: Pediatric patients with CHD experience insignificantly higher dental decay, periodontitis, and saliva Lactobacilli colony counts. The frequency of decayed tooth and gingival diseases in healthy children is high, and hence, more dental care attention in our health system is needed for healthy children.

We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP (n = 115, aged 6–18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or “no pain.” Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and intention-to-treat (ITT) analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117[0.469]) and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503[0.416]). There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723) or after 12 weeks (P = 0.870) in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted.

To investigate the association between obesity indices, abdominal fat distribution, and lipid profile in patients with stable angina (SA). Body weight, height, waist circumference (WC), body mass index (BMI), and waist /height ratio (WHtR) of 123 patients with SA who underwent coronary angiography were measured. Fasting blood samples were taken to measure the levels of fasting blood sugar (FBS), total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), apolipoproteins A and B (apo A and apo B), and triglycerides (TG). According to angiography reports, the participants were divided into patients with or without coronary heart disease (CHD). All patients underwent an abdominal computerized tomography (CT) scan to measure the visceral, superficial, and deep subcutaneous fat. The mean ages of the patients with CHD (n = 73) and without CHD (n = 50) were 50.5 ± 7.6 and 53.7 ± 7.6 years, respectively (P = 0.03). The patients with CHD had significantly higher levels of TC, TG, and superficial subcutaneous fat, while the patients without CHD had higher levels of apo A (P ≤ 0.05). Multivariate analyses showed a significant association of visceral fat with TC, LDL-C, TG, and apo B, in the patients without CHD, while significant inverse associations were found between WC and HDL-C, WHtR, and apo A as well as visceral fat and LDL-C in the patients with CHD. Among anthropometrics and imaging indices of obesity, WC and WHtR have shown better association between central obesity with dyslipidemia in the patients with CHD, while CT-measured visceral adipose tissue area was the best correlate of dyslipidemia in the patients without CHD.

Objective. Current study was designed to investigate the association of metabolic syndrome (MetS) with depression, anxiety, psychological distress, and quality of life (QoL). Design. Two hundred and fifteen contributors with MetS and 253 participants without MetS were randomly selected from 2151 participants of Isfahan Cohort Study who were residents of Isfahan city. Measurements consisted of fasting blood samples, anthropometrics, and self-reported data of 12-item General Health Questionnaire, Hospital Anxiety and Depression Scale, and European Quality of Life-5 Dimension. Binary logistic regression analysis was used to find the association between MetS and four psychological factors. Results. Participants mean age was 56.3 ± 9.8 years. Male/female ratio was 0.86 (217/251). Mean score of depression ( 𝑃 = 0 . 0 0 3 ), anxiety ( 𝑃 = 0 . 0 1 8 ), distress ( 𝑃 = 0 . 0 4 7 ), and QoL ( 𝑃 ≤ 0 . 0 0 1 ) was significantly higher in MetS group. There were significant increasing relationships between depression (OR 1.10, 95% CI 1.03–1.22), anxiety (OR 1.03, 95% CI 1.05–1.11), and QoL (OR 1.13, 95% CI 1.05–1.23) and MetS when associations were adjusted for other risk factors, but it was not the case for distress (OR 1.03, 95% CI 0.99–1.08). Conclusion. It might be better to consider MetS as a combination of biological and psychological risk factors. Thus, a person with metabolic disease should be recognized as a patient with these factors and be screened for all of them.

Symptoms of gastroesophageal reflux disease (GERD) are common in various chronic respiratory diseases, but little is known about GERD in the setting of chronic obstructive pulmonary disease (COPD). The aim of this study was to determine the effect of GERD symptoms on COPD exacerbations and subsequent hospitalization and drug usage.This retrospective study was conducted from December 2008 to February 2009 in the Pulmonary Clinic of Dr. Shariati University Hospital, Isfahan, Iran. Consecutive patients who were diagnosed with COPD based on clinical features and pulmonary function tests were included. Patients were categorized in GERD positive and GERD negative groups based on the Mayo GERD questionnaire. Exacerbation of COPD, hospitalization, and drug usage were compared between the two groups.During the study period, 110 patients with COPD (mean age = 68.0 +/- 8.4 years, 87.3% male) were included; 59 (53.6%) patients were GERD positive. There was no significant difference between the GERD positive and GERD negative patients in age, gender, tobacco use, or body mass index. GERD positive patients experienced significantly more acute exacerbations of COPD than patients who were GERD negative (p0.001). The rate of hospitalization due to COPD exacerbations was significantly higher in GERD positive patients and they had a more severe COPD (p0.05) and more concurrent use of multiple therapies as compared with GERD negative patients (p0.05).Patients with GERD symptoms have more COPD exacerbations and subsequent hospitalizations and drug usage. Clinical trials and preventive strategies for GERD in patients with COPD are warranted.

To evaluate the efficacy of one- and two-week regimen of quadruple therapy containing azithromycin for Helicobacter pylori infection eradication.A total of 84 H. pylori-infected patients, were randomized into three groups: First group (n=31): 6 g AzOAB: Azithramycin 500 mg twice daily for 6 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 2 weeks. Second group (n=28): 3 g AzOAB: Azithramycin 500 mg twice daily for 3 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 1 week. Third group (n=25): 1.5 g AzOAB: Azithromycin 250 mg twice daily for 3 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 1 week. Eradication was defined as a negative urea breath test, four weeks after the end of treatment.The eradication rate in the first, second and third group was 92% (95% CI: 84-99.8%), 88.46% (95% CI: 84.47-84.74%), 80% (95% CI: 79.88-80.11%) respectively, based on per-protocol analysis. There was no significant difference between eradication rates (P=0.44). The frequency of drug side effects in the study groups was respectively 19.23%, 7.6% and 0%. There was no statistically significant difference between the three regimens (P=0.06). However, frequency of drug side effects between 6 g AzOAB and 1.5 g AzOAB was statistically significant (P=0.02).According to the results of these 3 regimens, it seems that one week quadruple regimens of 3 g Azithromycin may be more favorable for H. pylori eradication.

Summary Background Psychological factors have been recently proposed as cardiovascular risk factors. This study was designed to evaluate the association of lifelong coping strategies and social support with progression of chronic stable angina (CSA) to acute coronary syndrome (ACS). Methods and materials Coping strategies and social support of patients based on a stress management questionnaire and Norback social support questionnaire were evaluated in a case–control study. Seventy eight hospitalized patients with ACS and 146 patients with CSA were included as the case and control groups, respectively. Positive angiographic findings were defined as the criteria for CSA. Logistic regression analysis was used to examine the aforementioned association. Results The mean age of 224 participants was 55 ± 10.4 years and 69.6% of them were male. After adjusting for age, sex, and traditional coronary artery disease risk factors, acute life event [odds ratio (OR): 1.09, 1.05–1.13 95%CI], maladaptive coping strategies (OR: 5.81, 1.93–17.49 95%CI), adaptive coping strategies (OR: 0.21, 0.05–0.94 95%CI), total functional support (OR: 0.49, 0.26–0.97 95%CI), and total network support (OR: 0.27, 0.15–0.53 95%CI) were significantly associated with ACS. Conclusion Improvement in social support and adaptive coping strategies should be considered in patients with chronic ischemic heart disease (IHD) to reduce the risk of ACS.

After the outbreak of 2019 novel corona virus infection in China, we have the outbreak of disease in Iran and until March 05, 2020 have been reported a total number of confirmed cases more than 3500 and approximately 3.3% deaths. The corona virus disease 2019 (COVID-19) infection as a newly emerging disease in East Asia has caused a great challenge in managing the patients and controlling the disease especially in children. This algorithm is based on the standard diagnosis and treatment strategies for pediatric viral infections and available strategies to prevention of COVID-19 infection. It is hoped that with international co-operation, this global dilemma will end with the least burden of disease. Due to the lack of scientific evidences in children, this algorithm is essential for decision making.