Mofid Children's Hospital Research Articles

The Incidence, Risk Factors, and Outcomes of Acute Kidney Injury in Pediatric Hematopoietic Stem Cell Transplant Recipients.

Acute kidney injury (AKI) is a frequent complication after hematopoietic stem cell transplantation (HSCT), with reported incidences ranging from 20-70% within the first 100 days post-transplant. AKI can adversely impact outcomes and survival in this patient population. This retrospective study evaluated 110 pediatric patients who underwent HSCT at Mofid Children's Hospital, affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran, between 2016-2021. AKI was defined and staged according to the criteria for Kidney Disease Improving Global Outcomes (KDIGO). The cohort comprised 68 (61.8%) males and 42 (38.2%) females, with a mean age of 6.4 ± 4.1 years. Underlying disorders were malignant in 64 (58.1%) and non-malignant in 46 (41.9%) patients. Among the cohort, 84 (76.3%) patients underwent allogeneic HSCT, while 26 (23.7%) received autologous HSCT. Myeloablative and reduced-intensity conditioning regimens were used in 77 (70%) and 33 (30%) patients, respectively. AKI developed in 53 (48%) patients within 100 days post-transplant, with incidences of 38%, 40%, and 22% for stages 1, 2, and 3 AKI, respectively. AKI incidence was higher in allogeneic HSCT (52%) compared to autologous HSCT (17%; P = 0.023). Younger age (P = 0.033) and non-malignant disorders (P = 0.033) were associated with increased AKI risk. At the end of the study, 77 (70%) patients were alive, and 33 (30%) had deceased, with a significant positive correlation between AKI stage and mortality (P = 0.004). This study highlights the high prevalence of AKI among pediatric HSCT recipients, particularly those undergoing allogeneic HSCT, at a younger age, and with non-malignant disorders. Regular post-transplant renal monitoring may improve survival in this population.

Clinical Characteristics and Outcomes of COVID-19 in Pediatric Cancer Patients: A Retrospective Cohort Study

Background: The impact of COVID-19 on pediatric cancer patients remains a critical area of investigation. Objectives: This study aimed to compare the clinical characteristics and outcomes of COVID-19 in children with and without malignancies. Methods: A retrospective cohort study was conducted at Mofid Children's Hospital in Tehran, Iran, from July 2020 to December 2022. The study included 210 children with confirmed SARS-CoV-2 infection: 105 with malignancies (case group) and 105 without malignancies (control group). Clinical presentations, laboratory parameters, imaging findings, and outcomes were analyzed. Results: Children with malignancies exhibited lower rates of fever (P = 0.044), respiratory distress (P = 0.035), and nausea/vomiting (P = 0.002). Significant differences in laboratory findings were observed between the case and control groups, including WBC count (P = 0.007), hemoglobin levels (P < 0.001), platelet count (P = 0.002), and ESR (P = 0.001). Ground-glass opacity on chest imaging was significantly associated with malignancy (P = 0.003). Although not statistically significant, the malignancy group showed a trend toward higher mortality (OR = 2.686, P = 0.105). Thrombotic events were rare in both groups. Conclusions: Pediatric cancer patients with COVID-19 exhibited more severe symptoms and distinct laboratory and imaging findings compared to non-cancer patients. While mortality rates were similar, the trend toward higher risk in the malignancy group highlights the need for specialized management strategies for this vulnerable population.

Evaluation of Heath Care Commitment with Prevention and Infectious Control Protocols in Mofid Children Hospital, Iran

Background: The dedication of healthcare teams to adhering to protocols for the use of personal protective equipment (PPE), maintaining vaccination coverage among healthcare workers (HCWs), and ensuring environmental health are crucial elements in managing hospital-acquired infections. Objectives: This study aimed to evaluate adherence to PPE use, vaccination history, hand hygiene protocols, and environmental health practices in a tertiary children's hospital in Iran. Methods: This cross-sectional study evaluated compliance with PPE use, vaccination history among doctors, nurses, and hospital staff, adherence to strict hygiene practices, patient isolation protocols, and environmental health measures based on an Iranian Health Ministry query. Data collection was conducted over three months, from May to August 2023. Results: During the study, 285 staff members were assessed for compliance with hand hygiene protocols. Nurses demonstrated the highest level of compliance, reaching 51%. The highest compliance with hand hygiene protocols at the five designated moments was approximately 79%, with the transplantation and hemodialysis wards achieving the highest rates. Nurses also showed the most positive vaccination records. Personal protective equipment was used correctly in various wards, with an overall compliance rate of 79%. Conclusions: This study revealed that compliance with health protocols in different parts of the hospital was suboptimal and required significant improvement.

The Study of Lung Ultrasound, Chest CT and Chest X-ray in Children with COVID-19 Hospitalized in Mofid Children's Hospital During a Six-Month Period

Background: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The primary diagnostic tool for pediatric COVID-19 patients is polymerase chain reaction (PCR). Chest imaging findings in pediatric COVID-19 cases are often normal or mild. The correlation of lung ultrasound (LUS) with chest computed tomography (CT) and chest X-ray (CXR) in pediatric COVID-19 patients has not been extensively studied. Objectives: This study aimed to assess the correlation of LUS with chest CT and CXR in detecting COVID-19 pneumonia in children. Methods: This single-center cross-sectional study included patients under 18 years of age diagnosed with COVID-19 by PCR or by abnormal chest CT findings suggestive of COVID-19, admitted to Mofid Pediatric Hospital between December 2021 and August 2022. All patients underwent LUS. Approximately half of the patients also had a chest CT, and CXR was performed on 35 patients. Lung ultrasound and CT scores were calculated, and the correlation between these scores was evaluated. The correlation between LUS and CXR was also analyzed. Results: Sixty patients were included, of whom 21 were female, with a mean age of 4.9 ± 4.0 years. A significant correlation was observed between LUS and CT scores (correlation coefficient = 0.467, P = 0.011). Lesion distribution was similar between LUS and CT. However, no significant correlation was found between LUS scores and CXR findings (P = 0.392). Sixteen out of 19 patients with normal CXRs had LUS scores ≤ 4. Notably, three patients with normal CXRs had LUS scores of 8, 14, and 14. Conclusions: Lung ultrasound was more sensitive than CXR and demonstrated a significant correlation with CT. Lung ultrasound may serve as a safe alternative to CT for detecting COVID-19 pneumonia in pediatric patients.

Frequency of Bacteria Causing Exudative Diarrhea in Children Less Than Five Years Old in a Tertiary Hospital, Iran

Background: Exudative diarrhea is a significant global public health issue, particularly affecting children under the age of 5. Identifying the cause of diarrhea is crucial for epidemiological surveillance and, in some cases, for ensuring appropriate treatment for patients. Objectives: The aim of this study was to investigate the frequency of bacteria responsible for exudative diarrhea in samples from children under five years old in a tertiary hospital in Iran. Methods: In this multicenter cross-sectional descriptive study, 104 children with exudative diarrhea who were referred to Mofid Children's Hospital in Tehran, as well as hospitals in Hamedan, Ardebil, and Bandar Abbas, from December 2020 to March 2022 were enrolled. DNA extraction was performed using a commercial kit, and the identification of various causative bacteria was conducted through conventional and real-time PCR. Descriptive and inferential statistics were analyzed using SPSS version 22 software. Results: Most of the children with exudative diarrhea were under 12 months old (31%) or between 12 and 24 months old (22%). Boys made up 66% of the participants. Additionally, 70% of the children had a fever, and 58% experienced vomiting. Furthermore, 56% of the patients were dehydrated. The most prevalent bacterial causes of exudative diarrhea were Shigella spp., followed by Salmonella spp., Campylobacter spp., Clostridium difficile, E. coli-Stx1, and E. coli-Stx2. Conclusions: The findings indicated that *Shigella* spp. was the leading cause of diarrhea in children under five years old. The most common signs and symptoms associated with exudative diarrhea were fever and vomiting, which physicians should consider in their diagnostic and treatment processes.

Diagnosis of Causative Acute Childhood Viral Diarrhea by Multiplex Real-time PCR Among Children in a Referral Hospital, Tehran, Iran

Background: Viral gastroenteritis has significant public health implications and can greatly affect individuals' overall well-being. It spreads rapidly within communities, particularly among pediatric populations in settings like schools. Objectives: This study aimed to identify the most common viral causes of gastroenteritis in children aged one month to 18 years over a year in a referral tertiary children's hospital, highlighting the burden of the illness in this population. Methods: In this cross-sectional study, stool samples from children with viral gastroenteritis admitted to Mofid Children's Hospital were collected from January 2023 to October 2024. Total RNA extraction was performed following stool preparation. Detection of SARS-Cov-2, norovirus, sapovirus, rotavirus, adenovirus, and astrovirus was carried out using multiplex Real-Time PCR. Results: A total of 100 participants were included in this study, of which 62% were male and 38% female, with a mean age of 2.7 ± 3.44 years. Among all patients with diarrhea, 55.5% tested positive via PCR. Rotavirus was the most frequently detected virus, accounting for 43.6% of cases, followed by Norovirus and Adenovirus at 23.6%, Sapovirus and Coronavirus at 14.5%, and Astrovirus at 7.3%. Co-infection with two viruses was observed in 23.6% of patients, and 1.8% were co-infected with three viruses. Conclusions: This study highlights that gastroenteritis in young children has decreased in many countries following the introduction of the rotavirus vaccine. An important finding of this research is the prevalence of co-infection in pediatric patients, which should be taken into consideration by physicians.

Epidemiology and antimicrobial resistance of toxin-producing Klebsiella oxytoca clinical isolates from children admitted to the oncology chemotherapy center in Mofid Children's Hospital in Tehran, Iran: A cross-sectional study.

Klebsiella oxytoca (K. oxytoca) is the second bacterial cause of nosocomial infections in the general population after K. pneumoniae. This study surveyed the frequency of cytotoxin-producing strains of K. oxytoca and their antibiotic susceptibility profile in a cohort of children admitted to a referral hospital with different malignancies. The Stool samples of children admitted to the Cancer Chemotherapy Unit of the Mofid Children's Hospital, Tehran, Iran were analyzed using conventional biochemical tests and polymerase chain reaction targeting the pehX gene to identify K. oxytoca. The antibiotic susceptibility profile of isolated K. oxytoca against commonly prescribed antibiotics used in treating infection at the facility was determined using the Kirby-Bauer disk diffusion technique. Also, the prevalence of genes encoding toxins among K. oxytoca was identified by PCR assay. The Stool samples of 280 participants were taken for the study of which 38 samples [(55.3% (21/38) 42 males and 44.7% (17/38) females)] tested positive for various Klebsiella spp. Out of this, K. oxytoca was identified in 2.5% (7/280) stools using cultures and conventional biochemical tests. Also, the stools of 2.9% (8/280) of the participants tested positive for K. oxytoca using PCR assay. Using PCR, (2/7) of the K. oxytoca isolates tested positive for the npsA and npsB genes and were identified as toxigenic K. oxytoca strains. The prevalence of toxin-producing K. oxytoca strains in stool samples of children diagnosed with cancer in Iran is relatively low. Most of the K. oxytoca isolates were susceptible to tested antibiotics. Globally, active surveillance of toxigenic K. oxytoca strains in patients with different malignancies or immunocompromised patients is recommended in healthcare settings.

Comparative analysis of the RVA VP7 and VP4 antigenic epitopes circulating in Iran and the Rotarix and RotaTeq vaccines

Analyzing the lineages and detecting antigenic variation in immunogenic motifs of Group A Rotavirus (RVA) variants is crucial because it can impact vaccine efficacy. This study investigated the circulating lineages of VP4 and VP7 proteins of human RVA isolates and their phylogeny in ≤24-month-old symptomatic, rotavirus-positive children with transudative diarrhea within 48 h of admission to Mofid Children's Hospital between December 2020 and March 2022 in Tehran, Iran. Antigen detection was performed by ELISA, RNA extraction, and semi-nested multiplex PCR for G/P genotypes, followed by sequencing and bioinformatic analysis using multiple sequence alignments in MEGA and phylogenetic analysis by Geneious Prime. The similarity of VP7 and VP4 amino acids with the RotaTeq and Rotarix vaccine strains for cytotoxic T cell and antigenic epitopes was evaluated using the UCSF Chimera Molecular Modeling System. Overall, 27.3 % of the samples were RVA positive, showing untypeable (2.5 %), single (76.9 %), and mixed (20.5 %) genotypic characteristics. The strains clustered in the G1/II, G2/IV, G3/I, G4/I, G9/III, P[8]/III, P[4]/V, and P[6]/I lineages. Comparative analysis of VP7 antigenic epitopes showed that the G1/II strains were completely conserved, while the G2/IV, G3/I, G4/I, G6, G9/III strains contained 2, 3–5, 2, 4 and 9 amino acid substitutions, respectively. The P[8]/III genotypes differed by 3 amino acids, while the P[6]/I genotype had the most substitutions. CTL epitopes were completely conserved in G3/I strains, but other genotypes differed by 1–4 amino acids compared to the vaccine strains. Given the diversity of circulating RVA genotypes and the observed mutations in neutralizing and CTL epitopes, immune escape by some of the strains is likely in Iran. This finding underscores the importance of evaluating the effect of rotavirus vaccines on local genotypes and related lineages before implementing a vaccination program.

Evaluation of Gastrointestinal Manifestations and Predictive Factors in Pediatric Henoch-Schönlein Purpura

Background: Henoch-Schönlein purpura (HSP) is the most common type of vasculitis in children. Children with HSP often experience gastrointestinal symptoms, such as abdominal pain, nausea/vomiting, gastrointestinal bleeding, and intussusception. These symptoms are estimated to occur in 50 - 75% of cases. Objectives: In this study, we evaluated the prevalence of gastrointestinal manifestations in children with HSP and identified associated predictive factors. Methods: For this cross-sectional study, we collected data from 295 children with HSP, aged 1 to 16, who were treated at Mofid Children's Hospital in Tehran, Iran, between 2013 and 2022. We gathered the following information from hospital records: Laboratory results for ALT, AST, bilirubin, stool exam (S/E), WBC, RBC, and occult blood (OB), as well as demographic data. Clinical symptoms evaluated included fever, rash, abdominal pain, distension, tenderness, nausea/vomiting, diarrhea, anorexia, and icterus. Results: Our study included 295 children diagnosed with HSP, consisting of 46.77% females and 53.23% males. The average age was 5.3 ± 2.8 years for female patients and 6.2 ± 2.9 years for male patients. Further analysis indicated that anorexia was the most common symptom, followed by abdominal pain, diarrhea, nausea/vomiting, and bloody stool. We observed no significant differences in symptoms based on sex. Physical examination findings, including abdominal distension and tenderness, were similar across both sexes. Elevated levels of AST and ALT, as well as hyperbilirubinemia, were noted in some patients. Stool analysis revealed positive results for RBC, WBC, and occult blood in certain cases, with 21% testing positive for RBC, 24.85% for WBC, and 23.25% for occult blood. Anorexia showed a correlation with increased AST levels, while bloody stool was associated with higher ALT levels, hyperbilirubinemia, and direct hyperbilirubinemia. Logistic regression analysis confirmed a significant association between bloody stools and elevated ALT levels. Conclusions: In this study, we examined the clinical manifestations and laboratory findings in children with small vessel vasculitis to identify associated predictive factors. Our findings indicated that anorexia and abdominal pain were the most common clinical manifestations, with bloody stool also being a prevalent symptom. Additionally, logistic regression analysis demonstrated that the presence of bloody stool is a significant predictive factor for elevated ALT levels.

A Twelve-Year-Old-Girl with Intra-Tracheal Mucous Gland Adenoma: A Case Report

Introduction: Tracheal tumors are rare in the pediatric population. Primary tumors within the trachea often present with non-specific symptoms during the initial stages, leading to a delayed diagnosis. Prompt diagnosis of a tracheal tumor is crucial due to the risk of life-threatening airway obstruction it poses. This article discusses the case of a twelve-year-old girl who experienced 8years of breathing difficulties without an adequate response to treatment. Case Presentation: The patient was referred to Mofid Children's Hospital after experiencing 8 years of difficulty with dyspnea. Her dyspnea was classified as functional class 2 and was accompanied by dry coughs. Additionally, a biphasic stridor was observed during her auscultation. Further investigations revealed an intra-tracheal mass, identified as a mucous gland adenoma (MGA). Imaging and pathology showed no signs of malignancy. Following her surgery, she was completely free of symptoms, and her follow-up spirometry showed no abnormalities. Conclusions: In this article, we present a detailed case of MGA. Despite the low incidence of intra-tracheal tumors, conducting further studies in patients who respond poorly to treatment is crucial. The potential complications from these tumors can be catastrophic. Thus, enhancing our knowledge and expertise in this area is of great importance.

Patient-Reported Outcomes and Healthcare Practices: A Retrospective Analysis of Cystic Fibrosis Management During the COVID-19 Pandemic

Background: Cystic fibrosis (CF) is one of the most prevalent inherited diseases in children. Coronavirus can lead to more severe respiratory complications in patients with comorbidities, such as CF. Additionally, the coronavirus disease 2019 (COVID-19) pandemic has imposed a substantial burden on both national and international healthcare systems. Coronavirus disease could influence CF patients’ morbidities and mortalities. Methods: A descriptive retrospective study was performed at Mofid Children's Hospital to determine the effect of the COVID-19 pandemic on CF patients. A physician completed 128 valid and reliable questionnaires. Moreover, hospital medical records were also used to revalidate the data and complete the remaining part of the questionnaire. The information collected for this study included demographic data, patients' height, patients' weight, body mass index (BMI), past and current positive history of COVID-19-like symptoms, socially determined condition, and influence of COVID-19 on routine therapeutic measurements in CF. The data were analyzed using SPSS software (version 21). Results: The majority of cases continued to perform chest physiotherapy at home, maintained routine follow-ups with pulmonologists, and adhered to their previous medication regimens (59.4%, 42.2%, and 82%, respectively). Moreover, 65.5% of participants reported leaving home less frequently than before, and approximately 73% of patients’ parents also reduced their outings, with no statistically significant differences (P > 0.05). Conclusions: The daily habits of CF patients did not undergo significant changes during the COVID-19 pandemic, particularly during the Omicron wave, despite the dramatic increase in infection rates.

Determining the coverage and efficacy of the COVID-19 vaccination program at the community level in children aged 12 to 17 in Tehran.

The vaccination is one of the acceptable and recomended solution to prevent and control of COVID-19. The aim of this study was to determine the efficacy of sinopharm vaccination in children aged 12-17 in Tehran. The case population study was performed from October 2021 to March 2022 among 1,500 children with positive PCR test reffered in Mofid Children's Hospital in Tehran. 64 children aged 12-17 years were included. The data were collected by the hospital information system (HIS), vaccination information registration systems and questionnaire with their families. The coverage and efficacy of vaccination determined with equels commented by WHO. Out of 64 children, 52 children were 12 to 15 years old (13.35±1.08), 12 children were 16 to 17 years old (16.55±0.52). 48.4% had received two doses of vaccine. The highest rate of positive PCR was observed in February 2022. Sinopharm vaccine coverage in this age group was 93.6% for the first dose and 81.1% for the second dose. Based on this information, 48.4% children in this study have received two complete doses of the COVID-19 vaccine. The efficacy of the vaccine was estimated as 94.4% (95% CI 90.2 to 97.7). It seems the coverage of Sinopharm vaccination in the age group of 12-17 years in Tehran is favorable and has high efficacy in this age group. In order to obtain more accurate and comprehensive estimation, it is recommended to take a sample on a wider level of the community.

GM1 and GM2-Gangliosidosis: Clinical Features, Neuroimaging Findings and Electroencephalography.

Gangliosidosis is one of the hereditary metabolic diseases caused by the accumulation of Gangliosid in the central nervous system, leading to severe and progressive neurological deficits. Regarding phenotype, GM1 and GM2-Gangliosidosis are divided into Infantile, Juvenile, and Adult. In this study, thirty-seven patients with GM1 and GM2-Gangliosidosis were referred to the neurology department of Mofid Children's Hospital in Tehran, Iran, whose disease was confirmed from September 2019 to December 2021. This study assessed age, sex, and developmental status before the onset of the disease, clinical manifestations, brain imaging, and electroencephalography. 97.20% of patients were the result of family marriage. Approximately 80% of juvenile patients were developmentally normal before the onset of the disease. Developmental delay was more common among infantile GM1-Gangliosidosis than infantile GM2-Gangliosidosis, but in total, more than 50% of GM1&GM2-Gangliosidosis patients had reached their developmental milestone before the onset of the disease. With the onset of disease symptoms, 100% of patients regressed in terms of movement, 97.20% of them mentally, and 75% of them had seizures during the disease. The most common clinical findings were cherry-red spot, Mongolian spot, macrocephaly, organomegaly, hyperacusis, and scoliosis. The most common brain imaging findings included bilateral thalamus involvement, brain atrophy, PVL, and delayed myelination. The most common finding in electroencephalography was background low voltage with abnormal sharp waves. This study concluded that most of the patients are the result of family marriage, and most of the juvenile patients are developmentally normal before the onset of the disease. In addition, more than 50% of infantile patients reach their developmental milestones before the onset of the disease. The most common clinical findings of these patients are seizures, cherry-red spot, macrocephaly, hyperacusis, Mongolian spot, and bilateral involvement of the thalamus.

An analysis of the efficacy of universal PCR and BACTEC 9120 BD for identifying bacteremia in pediatrics.

Bloodstream infections (BSI) are serious diseases in pediatrics and can increase the rate of morbidity and mortality. Blood culture is time consuming and can have false negative results in some case such as the intracellular or fastidious bacteria. This study aimed to evaluate the PCR against automated blood culture with BACTEC. In this observational cross-sectional study the blood samples of hospitalized children in Mofid Children's Hospital with bacteremia signs from February to May 2023 were enrolled. The causative bacteria in bacteremia were identified by phenotypic and PCR methods. 150 blood samples were enrolled to identify the presence of bacteremia by BACTEC and PCR. 60% and 40% of samples have negative and positive results in both methods, respectively. PCR showed 100% sensitivity and specificity in detecting bacteremia compared to BACTEC. A variety of bacteria were identified by phenotypic and molecular methods and coagulase negative Staphylococcus (CONS) is the most of them. The rapid and accurate detection of bacterial pathogens with the high sensitivity and specificity compared gold standard method are the most important profits of molecular assay.

Comparing the Effectiveness of Computer-Based and Task-Oriented Cognitive Rehabilitation Programs on Epileptic Children’s Attention in Tehran

Background: There are important cognitive issues in patients with epilepsy, which can be referred to as impairment in executive functions such as attention. Objectives: This research aims to compare the effectiveness of computer-based cognitive rehabilitation programs and task-oriented cognitive rehabilitation programs on attention in children with epilepsy in Tehran. Methods: The present research was a semi-experimental study with a pre-test and post-test design with a control group. The statistical population of the study included all children with epilepsy who were referred to the neurology clinic of Mofid Children's Hospital in 2021. Using the purposeful sampling method, 45 eligible children were included in the study and were randomly divided into 2 experimental groups and 1 control group (15 people in each group). The Integrated Visual and Auditory Continuous Performance Test (IVA2) of Sohlberg and Mateer (2001) was used for data collection. The experimental groups underwent the intervention of the computerized cognitive rehabilitation program of the Cambridge Neuropsychological Test (1980) (12 sessions of 45 minutes) and the task-oriented cognitive rehabilitation program (12 sessions of 45 minutes). The control group did not receive any intervention. SPSS 20 software was used for data analysis. Univariate covariance analysis (ANCOVA) was performed using a significance level of 0.05. Results: The results demonstrated that both computer-based cognitive rehabilitation programs and task-based cognitive rehabilitation were effective in increasing the attention of epileptic children in Tehran (P < 0.001). There was no significant difference between the effectiveness of computer-based cognitive rehabilitation programs and task-based cognitive rehabilitation in increasing the attention of epileptic children (P = 0.67). Conclusions: It can be concluded that computer-based and task-oriented cognitive rehabilitation programs can be used to increase attention and executive functions in children with epilepsy.

Appropriateness of Antibiotic Prescribing in the Emergency Department of Mofid Children's Hospital: A Retrospective Cross-Sectional Study

Background: Antibiotics should be used to treat bacterial infections, while prescribing antibiotics for viral infections is ineffective. Sometimes, physicians do not diagnose diseases correctly and misdiagnose viral infections as bacterial. Objectives: In this study, we aimed to evaluate the appropriateness of prescribed antibiotics in the Children’s Emergency Department of Mofid Hospital, Tehran, Iran. Methods: This cross-sectional study was conducted in the Emergency Department of Mofid Children's Hospital during January-December 2019. All children younger than 16 years who were hospitalized and received antibiotics were included in this study. The degree of fever, diagnosis of disease, and laboratory findings were assessed. Results: We found 12.6% (38/301) inappropriate antibiotic prescriptions in the studied cases. The causes of antibiotic inappropriateness were incorrect diagnosis in 4.31% of patients (13/301), incorrect medication dose in 1.99% (6/301) patients, and no indication for the prescribed medicine in 6.31% (19/301) patients. Erythrocyte sedimentation rate, C-reactive protein, and neutrophil count were not significantly different between the two groups (P > 0.05). Conclusions: According to our results, incorrect antibiotic prescription is common in Mofid Hospital. Therefore, it is an urgent need to monitor and train the treatment system.

Factors Affecting Learning Essential Procedural Skills in Pediatric Residents: A Cross-sectional Study

Background: Clinical education is a vital component of physician education, where medical students learn by attending to patients and applying their knowledge and reasoning to solve their problems. However, many medical students struggle to acquire procedural skills, the ultimate goal of clinical education. Procedural skills are expected to be learned by the residents according to their academic year and are essential for providing better health services to children and families. Objectives: This study evaluates the status of the training provided and the level of learning the necessary procedural skills in pediatric residents based on standards. Methods: This research was a descriptive cross-sectional method from 1998 to 99. In the first part of the researcher-made questionnaire, the implementation of the educational program on all pediatric residents (115) of Mofid Children's Hospital was evaluated. In the second part, the residents' views on the current state of their learning of essential procedural skills were determined. Results: All residents from years one to four participated in the study. After assessing the status of skills acquired by residents with a questionnaire and comparing the average of each skill acquisition procedure with the desired standards, the average of all skills in all three methods was under the standards approved by the Ministry of Health, except for independent subcutaneous, intramuscular and intravenous injection skills and the skill of working with a ventilator. Also, according to the Friedman test, the lowest score for gaining skills in performing procedures was related to NG tube placement skills and subcutaneous, intramuscular, and intravenous injection skills. According to the statistical results obtained from the Spearman coefficient in all procedures, the level of subcutaneous, intramuscular, and intravenous injection skills had a significant correlation with independent skills. Conclusions: According to the specialized assistants of children participating in this study, the current training program of essential procedural skills implemented at Shahid Beheshti University of Medical Sciences was generally useful and effective. But there were also obstacles and limitations. Therefore, it is recommended to review the implementation of the training programs and implement effective measures, including providing more exposure conditions for independent procedures.

Investigation of Clinical Manifestations and Laboratory Findings of COVID-19 During National Peaks of Alpha, Beta, Delta, and Omicron in the Pediatric Emergency Department of Mofid Children's Hospital, Tehran, Iran

Background: The global spread of the coronavirus since 2019 has caused significant concern. Objectives: In this study, we aimed to investigate the clinical manifestations and laboratory findings of children infected with the alpha, beta, delta, and omicron strains. Methods: We included all patients who were referred to Mofid Children's Hospital during the peak of the alpha strain in November 2020, the beta strain in April 2021, the delta strain in August 2021, and the omicron strain in February 2022, corresponding to the national peaks of four SARS-CoV-2 variants of concern (VOC). All patients had a positive nasopharyngeal PCR test and were admitted to the emergency ward. We analyzed the collected data using SPSS software. Results: A total of 649 patients were included in this survey, of whom 58.1% were male. The most and least frequent clinical manifestations were fever and skin presentation, respectively. The mean white blood cell count (WBC) was 8423.9 ± 5427.3. The mean values for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 30.14 ± 20.07 and 38 ± 22.6, respectively. There was no significant association between coronavirus type, age, and gender. Gastroenteritis, urinary tract infection, and croup showed a statistically significant positive correlation with delta, beta, and omicron (P-values of < 0.003, 0.000, and 0.000, respectively). Cough was more frequent in patients infected with alpha and beta subtypes, while lymphocyte counts were elevated in patients suffering from delta, omicron, and alpha. C-reactive protein and ESR levels were significantly increased in patients with delta infection, and in patients with omicron infection, CRP levels were significantly elevated. Conclusions: Our study revealed that the different strains of COVID-19, corresponding to the World Health Organization (WHO) peak of VOCs, can cause variable clinical symptoms in children. These findings could be helpful in the diagnosis of COVID-19.

A report on the clinical efficacy of rituximab administration in patients with inborn errors of immunity and autoimmune manifestations

BackgroundRituximab (RTX), an anti-CD20 monoclonal antibody, is considered a novel therapeutic agent in a variable spectrum of immune disorders. Herein, we investigated the clinical efficacy of RTX in inborn errors of immunity (IEIs) with autoimmune manifestations. MethodsPatients with IEIs diagnosed clinically based on European Society for Immunodeficiencies (ESID) diagnostic criteria with at least one autoimmune manifestation referred to Mofid Children's Hospital, Tehran, Iran, between 2010 and 2021 were investigated. Medical records of patients were retrospectively investigated. All patients had received RTX as a course of at least four 375 mg/m2 infusions in weekly intervals. Complete and partial responses were defined as normalization or improvement of biological markers of hemolysis and the requirement for maintenance treatment. ResultsTwenty-three patients (65.2% females and 34.8% males) with common variable immunodeficiency (CVID) (5, 21.7%), unspecified primary immune regulatory disorder (PIRD) (5, 21.7%), LRBA deficiency (4, 17.4%), non-syndromic combined immunodeficiency (CID) (2, 8.7%), STAT3-GOF mutation (2, 8.7%), ataxia-telangiectasia (2, 8.7%), Epstein-Barr virus (EBV)-susceptible PIRD (1, 4.3%), Nijmegen breakage syndrome (1, 4.3%), and familial hemophagocytic lymphohistiocytosis (fHLH) (1, 4.3%) were enrolled.The median (IQR) age at the time of the study, the onset of symptoms, and diagnosis were 12 (6–14), 3 (1–5), and 5 (3–9) years, respectively. Fourteen (60.8%) patients had consanguineous parents. Autoimmune manifestations included cytopenia (17, 73.9%), Kawasaki disease (1, 4.3%), thyroiditis (1, 4.3%), juvenile idiopathic arthritis (JIA) (1, 4.3%), enteropathy (4, 17.4%), mixed connective tissue disease (MCTD) (2, 8.7%), systemic lupus erythematosus (SLE) (2, 8.7%), and Behcet's syndrome (1, 4.3%). The cumulative response rate was 86.8% (complete response: 14, 60.8%, partial response: 6, 26%). At the end of the survey, 8 (34.7%) patients were deceased. ConclusionsRituximab is a promising therapeutic option for autoimmune disorders in the context of IEI. Regular follow-up after the initial rituximab infusion is essential in IEI children.

Evaluation of the heart sounds in children using a Doppler Phonolyser

BackgroundHeart auscultation is an easy and inexpensive tool for early diagnosis of congenital heart defects. In this regard, a simple device which can be used easily by physicians for heart murmur detection will be very useful. The current study was conducted to evaluate the validity of a Doppler-based device named “Doppler Phonolyser” for the diagnosis of structural heart diseases in pediatric patients. In this cross-sectional study, 1272 patients under 16 years who were referred between April 2021 and February 2022, to a pediatric cardiology clinic in Mofid Children Hospital, Tehran, Iran, were enrolled. All the patients were examined by a single experienced pediatric cardiologist using a conventional stethoscope at the first step and a Doppler Phonolyser device at the second step. Afterward, the patient underwent trans-thoracic echocardiography, and the echocardiogram results were compared with the conventional stethoscope as well as the Doppler Phonolyser findings.ResultsSensitivity of the Doppler Phonolyser for detecting congenital heart defects was 90.5%. The specificity of the Doppler Phonolyser in detecting heart disease was 68.9% in compared with the specificity of the conventional stethoscope, which was 94.8%. Among the most common congenital heart defects in our study population, the sensitivity of the Doppler Phonolyser was 100% for detection of tetralogy of Fallot (TOF); In contrast, sensitivity of both the conventional stethoscope and the Doppler Phonolyser was relatively low for detecting atrial septal defect.ConclusionsDoppler Phonolyser could be useful as a diagnostic tool for the detection of congenital heart defects. The main advantages of the Doppler Phonolyser over the conventional stethoscope are no need for operator experience, the ability to distinguish innocent murmurs from the pathologic ones and no effect of environmental sounds on the performance of the device.