Sheikh Hospital Research Articles

Investigating the Relationship between Anxiety of School-age Children Undergoing Surgery and Parental State-trait Anxiety

Background: Surgery is a stressful experience for children, and preoperative anxiety in children could be affected by the level of parental anxiety. Aim: The aim of this study was to determine the relationship between anxiety in school-age children before surgery and parental state-trait anxiety. Method: This descriptive study was performed on 81 children within the age group of 6-12 years admitted for elective surgical operation and 128 parents in Doctor Sheikh Hospital, Mashhad, Iran, 2016. Children's anxiety and parental anxiety were measured before the entrance of the patients to the operating room via Revised Children's Manifest Anxiety Scale (RCMAS) and Spielberger’s State-Trait Anxiety Inventory, respectively. The data was analyzed in SPSS, version 16, using the relevant statistical tests. Results: The results of Pearson product-moment correlation test showed a positive correlation between children's anxiety and fathers' state anxiety and between children's anxiety and mothers' state anxiety (r=0.27, r=0.41; P=0.005, P=0.040, respectively). However, no statistically significant relationship was observed between children's anxiety and parents' trait anxiety, age of children, as well as parents' educational level, occupation, and level of trait anxiety. Implications for Practice: Considering the association between parents' state anxiety and children's anxiety, implementing preoperative interventions to prepare parents for surgery is recommended.

The effect of spiritual support on Caregiver's stress of children aged 8–12 with leukemia hospitalized in Doctor Sheikh hospital in Mashhad

Background: Since the caregivers of cancer patients have the main and basic role in caring, supporting and monitoring of treatment of these patients, providing their mental health is essential to continue such a care. Paying attention to spiritual needs is recognized as an indispensable component of the holistic care in nursing. Because of the importance of spirituality in recent years in the field of health, this research is done with the purpose of effect of Spiritual Support on caregiver's stress of children aged 8-12 with leukemia. Methods: In this clinical trial study 60 caregivers of children with leukemiaparticipated. Intervention group was instructed 5 sessions based on spiritual intervention according to the Richards and Bergin patternand focusing on the rituals of Islam every day during sixty minutes. Research tools consisted of demographic data questionnaire, spiritual health questionnaire, DASS questionnaire that was completed before and after the intervention. Statistical data were analyzed with SPSS version 16. Results: Based on the results with Paired t-test to compare before and after the intervention, stress in intervention group was significantly lower than the control group (p= 0.067). Conclusions: With respect to the results of this study, the stress inn intervention group were meaningfully lower than the control group, as a result the sessions of spiritual support had been able to reduce the stress of caregivers of children with leukemia. So it is recommended, such interventions be done for caregivers of children with leukemia due to the low cost, safety and effectiveness.

The Effect of Training on Communication Skills of Nurses with Child through Small Groups Discussion

Background: Communication is the key role in the nursing profession. Nurse-patient communication is highly important especially when the patient is a child. Studies indicate inappropriate contact with children in the pediatric wards. This study investigated effect of training on communication skills of nurse with child through small group discussion. Methods: This study is a clinical trial with pre-test and post-test, which was done on 60, nurses in Dr. Sheikh hospital in Mashhad. Nurses were randomly assigned into either intervention or control groups.Nurses' communication skills were measured using the tools of Calgary Cambridge communication skills assessment before and after the intervention. During one-day workshops, 6-hour training for communication skills with children was provided to nurses as small group discussion. Results: The results showed there was no significant difference between the two groups in terms of mean score of nurses' verbal and nonverbal communication skills before the intervention (verbal: p = 0.495, nonverbal: p = 0.307). However, after the intervention, the mean score of nurses in verbal and nonverbal communication skills in the case group was statistically significant and higher than those in the control group (p<0.001). Conclusions: Given weakness in the relationship between nurse and child at the bedside and since nurses do not receive essential instructions on specific skills related to children communication, it seems necessary to investigate the effect of implementing various educational practices on the nurses' communication skills.

Performance Evaluation of Mashhad University of Medical Sciences’ Hospitals During 2006-2011: Application of Pabon Lasso Model

Background: Performance evaluation is a process, which deals with the evaluation, measurement and judgment of performances over a certain period of time. Objectives: The aim of this study was to evaluate the performance of Mashhad University of Medical Sciences’ hospitals using the Pabon Lasso model. Methods: In this descriptive cross-sectional study, ten educational hospitals of Mashhad University of Medical Sciences (MUMS) were investigated. Data included the following indicators: bed turnover rate (BTR), bed occupancy rate (BOR) and average length of stay (ALS). The data-gathering tool was standardized by the deputy of curative services of the ministry of health and medical education (MOHME). Data was collected from the information technology and statistics management department of MUMS databank, entered into the Excel software, validated, and implemented to depict the Pabon Lasso graphic chart. The position of the hospitals was recognized and analyzed in terms of the above indexes. Results: Doctor Sheikh hospital has been shifting variably between the second and third quadrants; Hashemi Nejad hospital was moved to the third quadrant in 2006 to 2011 and finally to the first quadrant in 2011. The status of Shariati hospital and Omolbanin hospital remained constant in the first and second quadrants during these six years. Finally, the KhatamolAnbiya hospital was moved from the second quadrant to the third quadrant during these six years Conclusions: According to the results, only 30% of Mashhad’s medical centers (Hashemi-Nejad, Anbiya and doctor Sheikh hospitals) were in the third quadrant. In addition, the study findings showed the performance of each hospital according to the Pabon Lasso model. This information can be used to gain the awareness of hospital administrators about their hospital’s situation and position compared to other hospitals, to maintain and upgrade their performance.

Effects of Early Feeding Support on the Postoperative Weight Gain Status of Infants with Esophageal Atresia

Background: Infants may lose their body resources after surgery due to inadequate nutrient intake and undergoing long periods of fasting after surgery for esophageal atresia, increases risk of several complications. Aim: This study aimed to evaluate the effects of early feeding support on the postoperative weight gain status of infants with esophageal atresia. Method: This randomized, controlled clinical trial was conducted on 36 infants with esophageal atresia (type C) selected 48 hours after surgery during July 2015-March 2016 at Dr. Sheikh Hospital of Mashhad, Iran. In the intervention group, detecting no lack of leakage on chest X-ray, feeding was initiated and the control group received routine feeding. Neonatal weight changes were measured daily using a digital scale (TANITA model) since the first day after the surgery and one month after discharge from the hospital. Data was analysed using SPSS version 16 by independent T-test and Chi-square. Results: Mean neonatal weight on admission was 2558.1±337.4 grams in the intervention group and 2547.6±856 grams in the control group (P=0.47). Results of independent T-test showed that daily weight gain before and after feeding was significantly higher in the intervention group compared to the control group (P=0.01). Moreover, weight gain one month after discharge had a significant difference between infants of the intervention and control groups (P=0.03). Implications for Practice: According to the results of this study, early feeding support could improve the weight index of neonates with esophageal atresia. Considering the possible complications and long-term consequences of surgery, early initiation of feeding could be an appropriate remedial measure in infants with esophageal atresia.

The Effect of Spiritual Support on Caregiver's Stress of Children Aged 8-12 with Leukemia Hospitalized in Doctor Sheikh Hospital in Mashhad

Background: Since the caregivers of cancer patients have the main and basic role in caring, supporting and monitoring of treatment of these patients, providing their mental health is essential to continue such a care. Paying attention to spiritual needs is recognized as an indispensable component of the holistic care in nursing. Because of the importance of spirituality in recent years in the field of health, this research is done with the purpose of effect of Spiritual Support on caregiver's stress of children aged 8-12 with leukemia. Methods: In this clinical trial study 60 caregivers of children with leukemiaparticipated. Intervention group was instructed 5 sessions based on spiritual intervention according to the Richards and Bergin patternand focusing on the rituals of Islam every day during sixty minutes. Research tools consisted of demographic data questionnaire, spiritual health questionnaire, DASS questionnaire that was completed before and after the intervention. Statistical data were analyzed with SPSS version 16. Results: Based on the results with Paired t-test to compare before and after the intervention, stress in intervention group was significantly lower than the control group (p= 0.067). Conclusions: With respect to the results of this study, the stress inn intervention group were meaningfully lower than the control group, as a result the sessions of spiritual support had been able to reduce the stress of caregivers of children with leukemia. So it is recommended, such interventions be done for caregivers of children with leukemia due to the low cost, safety and effectiveness.

Comparison of the Effects of Play Dough and Bubble Making Distraction Techniques on Venepuncture Pain Intensity in Children

Background: Venepuncture is a minimally invasive procedure, which is commonly performed in hospitals; if the pain is inadequately managed, it can cause negative feelings in children. Distraction can reduce pain through affecting the central nervous system and releasing neurotransmitters that inhibit pain. Aim: In this study, we aimed to compare the effects of play-dough and bubble making as distraction techniques on the intensity of venepuncture pain in children. Method: In this randomized, controlled, clinical trial, 90 children aged three to six years old, were randomly allocated to the three groups of play dough, bubble making, and control (n=30 for each group). This study was performed in Qaem, Imam Reza, and Dr. Sheikh hospitals of Mashhad, Iran, in 2015. The interventions consisted of using play dough and bubble making, which were started five minutes before venepuncture. Following the intervention, pain assessment was performed using Wong-Baker Faces Pain Rating Scale. Chi-square, Fisher’s exact, and One-way ANOVA tests were performed to analyze the data, using SPSS version 16. Results: The mean of pain intensity in the play dough, bubble making, and control groups was 5.1±1.8 6.2±1.4, and 8.2±1.5, respectively (out of ten). One-way ANOVA reflected a significant difference between the three groups (P<0.001). Tukey’s post-hoc test showed that there was a significant difference between the play dough and control groups (P<0.001), bubble making and control groups (P<0.001), and bubble making and play dough groups (P=0.009). Implications for Practice: Use ofplay dough could reduce the children's pain during venepuncture more effectively. Thus, use of such simple, inexpensive, and easy to access techniques might relieve pain in children.

Comparison of Birth Defects in Infants Conceived by Assisted Reproductive Technologies vs. Naturally Conceived Infants in Mashhad, Iran

Background: Assisted reproductive technologies (ART) are known as a treatment for infertility in which oocyte undergoes manipulation outside body. The aim of this study was to study the evaluation of birth defects in infants conceived through assisted reproductive technologies (ART) and compare them with naturally-conceived infants. Materials and Methods: In this retrospective study, four hundred naturally-conceived infants and 400 infants conceived by ARTs between 20 March and 20 November 2012 in Gha’em Hospital and Sheikh Hospital of Mashhad in Iran participated in this study. Infants were evaluated by a pediatrician at the time of birth, 10 days and 40 days after birth. Correlation between the use of IVF and/or ICSI methods and birth defects was evaluated. Results: Of total 800 infants (450 boys and 350 girls), half of the infants were conceived through natural pregnancy, 200(25%) through in-vitro fertilization (IVF) and 200 (25%) intra- cytoplasmic sperm injection (ICSI). In Infants conceived by IVF, 5 cases (2.5%) had a kind of birth defect just similar to those conceived by ICSI; while 4 cases had birth defects in natural pregnancy. There was no significant correlation between the use of IVF and/or ICSI methods in terms of birth defects (P=0.280).Conclusion: We found that using IVF or ICSI methods is not associated with increasing birth defects.[GMJ.2015;4(4):146-50]

The Effect of Training on Communication Skills of Child’s Nurse through Role-playing

Introduction Nurse-patient communication is highly important especially when the patient is a child. One thing that has been overlooked in the nursing profession or less discussed is how to communicate with children. Design and training courses for the development of communication skills is considered as an important step in this direction. This study investigated the effect of training communication skills on children’s nurses through role- playing. Materials and Methods This study is a clinical trial with pre-test and post-test which was done on 60 nurses in Dr. Sheikh Hospital in Mashhad-Iran. Nurses were randomly assigned into either intervention or control groups. Nurses' communication skills were measured using the tools of Calgary Cambridge communication skills assessment before and three weeks after the intervention. During one-day workshops, 6 hours of teaching communication skills with children were given to nurses as role playing and based on preprepared scenarios. Results The results showed there was no significant difference between the two groups in the mean score of nurses' verbal and non verbal communication skills before the intervention (verbal :P=0.302, non verbal :P=0.795). But after the intervention, the mean score of nurses' verbal and nonverbal communication skills in the experimental group were statistically significant and higher than those in the control group (P<0.001). Conclusion Now, due to the weakness in the relationship between nurse and child at the bedside and nurses also receive instruction on communication specific skills related to children, it seems essential that the effect of the implementation of various educational practices be examined to nurses' communication skills.

The Effects of Structured Cognitive-Behavioral Group Play Therapy on Anxiety and Depression in Children with Cancer: A Pilot Study

Background: Cancer as one of the chronic diseases in children is associated with psychological problems. Utilization of low-risk and cost-effective methods (e.g., play therapy) for controlling emotional distress seems necessary in children. Aim: to determine the effects of structured cognitive-behavioral group play on anxiety and depression in children with cancer. Methods: In this quasi-experimental pretest-posttest study, 18 children (8-14 years old) with cancer, hospitalized at Dr. Sheikh Hospital of Mashhad, were selected via available sampling and were randomly allocated into control and intervention groups in 2014. The intervention group received 10 sessions (60 min) of structured cognitive-behavioral group play therapy. Both groups were assessed by the Hospital Anxiety and Depression Scale (HADS) before and after the intervention. For data analysis, covariance analysis, paired t-test and independent t-test were performed, using SPSS version 20. Results: The mean age of the participants was 10.5±2.4 years in the intervention group and 9.3±1.6 years in the control group. Independent t-test showed that anxiety and depression significantly decreased in the intervention group (6.7±2.1 and 8.1±1.2, respectively), compared to the control group (10±3.1 and 10.2±2.8, respectively) after the intervention (P<0.04). Conclusion: Structured cognitive-behavioral group play therapy could be effective in reducing anxiety and depression in children with cancer.

Probiotic for irritable bowel syndrome in pediatric patients: a randomized controlled clinical trial.

Background:Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in children. Recently, probiotics have been suggested as a treatment option for gastrointestinal disorders. The most effective species and the most appropriate doses are still unknown.Objective:The aim of this study was to assess the effects of Lactobacillus GG (LGG) for treating IBS in pediatric patients.Methods:In a controlled, double blind, randomized trial, patients with IBS diagnosed by Rome III criteria from August 2012 to September 2012 at Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Iran, were assigned to one of two groups, i.e., intervention and control groups. For four weeks, the intervention group received a probiotic in capsule form that contained LGG at a concentration of 1×1010 cfu/ml bacteria. For the same period, the control group received a placebo capsule that had the same shape and color but only contained inulin, which also was present in the LGG capsules. The primary outcome was any change in the severity of the patients’ pain, and we used a five-point Likert scale to evaluate the severity of their pain. Secondary outcomes were ghanges of the functional scale, stool patterns, and associated problems.Results:Fifty-two patients participated in the study, and 26 patients were assigned randomly to each of the two groups. The severity of the patients’ pain decreased significantly in the intervention group after one, two, three, and four weeks of treatment, as indicated by P-values of 0.01, 0.00, 0.00, and 0.00, respectively. Also, there was significant improvement in the functional scale after two weeks of treatment (P-value ≤ 0.00).Conclusion:Lactobacillus GG at a concentration of 1×1010 cfu/ml for a period of four weeks can lessen the severity of the patients’ pain and improve the functional scale in patients with irritable bowel syndrome. Probiotics can have therapeutic effects for IBS patients.

Effect of Empowering Caregivers of Children with Cancer Undergoing Chemotherapy on Their Adherence to Preventive Health Recommendations for Oral Ulcer

Inflammation of the oral mucosa is a common and debilitating complication of chemotherapy that is preventable and manageable following health advices. Empowering the primary caregiver can be helpful in management of this condition. Aim: To determine the effect of empowering the caregivers on preventing inflammation of oral mucosa in children with cancer undergoing chemotherapy. Methods: This non-randomized clinical trial was conducted in 60 children's caregivers aged between 3 and 18 years old undergoing chemotherapy in Sheikh Hospital of Mashhad in two groups of intervention and control. In the intervention group, training was based on clinical guide in 5 sessions and according to Gibson empowerment model in 4 steps. Data were gathered based on questionnaire of side effects of chemotherapy and adherence questionnaire of the prevention and treatment of mouth ulcers in three stages: the first, the sixth and the 12th week of intervention. For data analysis, SPSS version 18 and paired and independent t-tests, Spearman correlation coefficient and the Mann-Whitney tests were used. Results: 61.7% of the patients were men and 38.3 were women. The average ages of the children and caregivers were 5/6±3/2 and 32/1±8/1 years, respectively. The average adherence to prevention recommendations for oral ulcers in the empowerment group increased from 53/6±24/3 to 82/2±11/7 (p<0.001). The occurrence rate of mouth ulcers in the empowerment group in the first week of intervention was 1/8±1/1, in the sixth week 1/7±1/0, and in the twelfth week of treatment was 1/1±0/2 (p<0/001). Conclusion: The empowerment program can help the main caregiver to discover and use critical thinking skills, enhance their ability and increase adherence, which results in decrease of mouth ulcers in children undergoing chemotherapy.

Esophageal Strictures in Children

Introduction: To evaluate main aspects of esophageal strictures in children. Materials and Methods:This cross-sectional study was performed on 43 cases of esophageal stenosis ranging from 1 month to 10 years of age who were admitted in Ghaem and Dr. Sheikh Hospitals from 1995 to 2003 in Mashhad, Iran. Results: Most cases were male (56%). The most common cause of esophageal stricture was anastomotic stricture after esophageal atresia surgery (34.9%) followed by strictures due to gastroesophageal reflux (25.6%), chemical burns (11.6%), and congenital a (11.6%). Proximal esophagus was the most common site of stricture (48.8%). Dilatation and operation had been chosen as the treatment of choice for most of our cases (42%). The majority of our patients recovered after receiving the proper treatment (60.5%). Conclusion: Anastomotic stricture after surgical repair of esophageal atresia comprised the most common cause of esophageal stricture. Proximal esophagus was the most common site of stricture. Most of the patients recovered with dilatation, surgery, or a combination of the two.

Effect of Touch on the Intensity and Duration of Venipuncture Pain in the School-age Children

Background: Pain has physiological and psychological effects on a child's life and various body systems. Tactile stimulation affects the central nervous system and releases analgesic drugs resulting in the inhibition of pain. Aim: The main purpose of this study was effect of touch on the intensity and duration of pain during venipuncture in school-age children. Methods: This clinical trial was conducted on 60 children of school age in the emergency department of Imam Reza (AS) hospital and doctor Sheikh Hospital in 2014. Children were selected by convenience sampling and randomly divided into two groups, touch and control group. Touch group received intervention for 5 minutes by palms movements and kicks on the site before and during venipuncture by researcher, and then venipuncture was immediately performed by a nurse colleague. The control group did not receive any intervention. FACES instruments were used to assess pain intensity. Pain was measured for 5 min by a chronometer. Data were analyzed by Kolmogorov-Smirnov, Chi-square tests, Mann - Whitney and independent t-test using SPSS software version 11. Results: In this study, 65% were boys and 35% girls. The average age of children was 8.3±2.3 years. There was a significant difference between touch and control groups in pain of needle insertion into the skin within the first second (p<0.001). Independent t-tests showed that there was no significant difference between touch (242.0±67.7) and control (278.0±82.3) groups in duration of venipuncture pain (p=0.07). Conclusion: Touch is effective in reducing the intensity of pain during venipuncture in children. This is an easy and practical nursing intervention to reduce negative impact of pain on children.

Anesthesia related Complications in Pediatric GI Endoscopy

Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA). The objective of this study was to describe Anesthesia related complications in children undergoing elective GI endoscopy. Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data , location of GI endoscopy , perioperative vital singe , recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest). 8 patients (0.5%) have transient bradicardia in post operative care Unit. 83 patients (5.9%) have post operative nausea and vomiting controlled by medication. 6 patients (0.4%) have post operative agitation controlled by medication. Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

Effect of zinc supplementation on serum antibody titers to heat shock protein 27 in patients with thalassemia major

ObjectiveThis current study was conducted to determine the effect of zinc supplementation on antibody titers to heat shock protein 27 (anti-HSP27) in patients with beta-thalassemia major (β-TM).MethodsThis was a double-blinded placebo-controlled clinical trial conducted at Dr Sheikh Hospital (Mashhad, Iran) from 2011 to 2012. Sixty-four patients (41 females and 23 males), aged between 8 and 18 years with transfusion-dependent β-TM were randomly allocated to two age- and sex-matched groups. The zinc (case) group received 30 mg of daily zinc sulfate supplementation and the placebo (control) group received same shape and color placebo over 9 months period of the trial. Serum anti-HSP27 titers were measured at the third and ninth months of the trial, using an in-house enzyme-linked immune-absorbent assay.ResultThere was a significant difference in anti-HSP27 titers, between the groups after 9 months. The baseline value of anti-HSP27 was 0.44 ± 0.15 in zinc group and were significantly decreased to 0.40 ± 0.18 after 9 months on treatment, while the baseline value of anti-HSP27 were significantly increased from 0.43 ± 0.17 to 0.44 ± 0.18 in the placebo group (P = 0.01).ConclusionSerum anti-HSP27 titers were significantly reduced in patients with β-TM treated with zinc supplements compared to a group treated with a placebo. It suggests that the potential antioxidant and anti-inflammatory effects of zinc supplements may account for a reduction in anti-HSP27 titers in patients with β-TM.

Relationship between Changes in Serum Sodium Level and Seizures Occurrence in Children with Hypernatremic Dehydration.

To assess any relationship between serum sodium changes and seizure occurrence in children aged 2 months to 5 years with hypernatremic dehydration. This cross-sectional study was performed on 63 patients aged 2 months to 5 years from 20 March 2006 to 15 March 2012 at Ghaem Hospital and Dr. Sheikh Hospital in Mashhad, Iran. Patients were divided into 2 groups: case group with hypernatremic dehydration and seizure occurrence, and control group with hypernatremic dehydration and no seizures. The mean age of patients was 10.38 (2-48) months. Thirteen patients had seizures, 11 out of them, before admission and 2 during hospital staying. Serum sodium level at admission in those 2 patients with seizure occurrence after hospitalization was 169 (158-180) mmol/L, and in 50 patients without seizure was 162.8 (148-207) mmol/l. Also, the rate of decrease of serum sodium levels in these 2 cases within the first 12 hours after admission was 1.12, and in those without seizure was 0.54 (mmol/L/hour), and it was 0.47 and 0.53 (mmol/l/ hour) after 24 hours of admission, respectively. Severe dehydration was seen in 38.5% of cases and 14% of controls. There was not any relationship between changes in serum sodium level and seizure occurrence in children with hypernatremic dehydration.

Clinical Features and Treatment Outcomes of 132 Infants with Immune Thrombocytopenic Purpura

Introduction: To determine common clinical symptoms, admission length, and treatment outcomes of infants with Immune Thrombocytopenic Purpura. Method: analysis of 132 infants with Immune Thrombocytopenic Purpura admitted to the emergency and hematology ward of Dr. Sheikh Hospital, with reference to age, gender, immunization history (preceding six weeks), presenting clinical features, treatment, outcome, platelet count at admission and discharge time, admission length, and records of respiratory infections, diarrhea and vomiting in the past month. Results: 82 male and 50 female infants aged from five day to 2 years, with the median age of 163 days were observed. 49 percent of the patients had positive vaccination records during past 6 weeks. Presenting clinical symptom in order of commonality include: petechial rash (75%), gastrointestinal bleeding (8%), epistaxis (7%), gum bleeding (4%), and brain hemorrhage (2%). The average platelet count at admission time and discharge time was reported 10,000 ml. and 135,000 ml. respectively. 47% of the patients were treated with intravenous methylprednisolone, 16% with oral prednisolone, 12% with intravenous gamma globulin (IVIG), 7.5% with intravenous dexamethasone, 5% with IVIG. 6% received IVIG plus oral prednisolone, and for 5% IVIG and intravenous dexamethasone was administered. 93% of the patients completely recovered, 3% developed recurrent ITP, and 4% developed chronic ITP. Average admission length was reported to be 4 days. 34% of the patients had upper respiratory tract infection history, and 4.5% had positive diarrhea record. Conclusion: infants with ITP aged under 2 years respond favorably to treatment, and compared to older age groups, are less likely to develop recurrent and chronic ITP.

Postdural Puncture Headache: Incidence and Risk Factors in Children Following Intrathecal Chemotherapy

How to Cite this Article: Bani hashem A, Heydarian F, Gharavi M, Khoshnod M. Postdural Puncture Headache: Incidence and Risk Factors in Children FollowingIntrathecal Chemotherapy. Iranian Journal of Child Neurology 2012;6(1):19-22. Objective To evaluate the incidence and risk factors of development of postdural puncture headache in children who had intrathecal chemotherapy injection. Materials & Methods Two-hundred eighty patients (mean age, 7.23±3.92 years) who had intrathecal chemotherapy injection were studied prospectively during 2008-2009 in the pediatric ward of Dr. Sheikh hospital in Mashhad. Patients who had lumbar puncture for their chemotherapy drug injections were assessed daily for four days to detect postdural puncture headache. Results There were 172 (61, 4%) male patients and the remainder were female. Postdural puncture headache was detected in 41 patients (14.6%). The body mass index did not show any significant difference between the two groups. Lumbar puncture (LP) attempts had a significant association with postdural puncture headache. The size and shape of the needle did not have a significant association with postdural puncture headache. Conclusion LP attempts have a significant relationship with postdural puncture headache.

Relationship With Spouse and Restriction of Role in Mothers of Children with and Without Attention Deficit Hyperactive Disorder (ADHD)

Introduction: This research was down to compare Relationship with spouse and restriction of role between Mothers with ADHD sons and the normal ones. Materials and Methods: The research is a causal-comparing study and the statistical universe was all mothers of 5 to 12 years old sons with ADHD who referred to child psychiatry clinics (I bn-e-Sina and Dr Sheikh Hospitals) and all Mothers of normal son (5 to 12 years old) were selected in primary and pre-primary school at 4th educational area of Mashhad city, north-eastern part of Iran. Fifty mothers with ADHD children by at reached sampling and 80 Mothers with normal children were selected by cluster sampling. Parenting Stress Index (PSI) was used and data analyzed by descriptive and analytic statistical methods such as T-test in independent groups. Results: Results showed that there was a significant difference between relationship with spouse in mothers of ADHD children and mother of normal children (p<0.000).There was a significant difference between restriction of role in Mothers of ADHD children and mother of normal children (p<0.000)Conclusion: Mothers with ADHD children had more restriction of role compared with mothers of normal children and they also had more problems in their relationship with spouse which it is realized by parenting stress index.