Background: In addition to the benefits of mechanical ventilation, this method is, sometimes, associated with complications, especially in long-term use. The present clinical trial attempted to evaluate the neonatal outcomes of three methods of self-extubation, negative pressure extubation, and positive pressure extubation. Methods: A double-blind, randomized controlled trial was conducted from 2021 to 2023, at Ayatollah Taleghani Hospital, Ilam, Iran. The eligibility criteria included neonates who were connected to a ventilator and ready for extubation by their physician's order. In the positive pressure group, extubation was done with an expandable ambobag, squeezing the ambobag 3–4 times, slowly. Neonates in the negative pressure group were extubated using a negative pressure of 80–100 mmHg. The self-extubation group consisted of neonates who see trachea separated from a ventilator without the intervention. Data was analyzed by SPSS software version 20. A p-value of 0.05 was considered significant. Results: Overall, 101 newborns were included in the study. The results showed non-statistically significant differences between duration of intubation, need for oxygen after extubation, and duration of hospitalization among the neonates (P> 0.05). Re-intubation was performed for one-third of neonates. The need for re-intubation was not significantly different among the groups. Conclusion: Neonatal outcomes were similar in the positive and negative pressure groups. It is recommended that neonatologists consider the use of positive pressure extubation as a useful method -particularly in neonates who are deemed to experience adverse effects, if negative pressure extube is employed.
Background: Knee and ankle joint proprioception plays an important role in balance. Balance can also be influenced by non-environmental conditions such as anthropometric dimensions. The aim of the present study was to investigate the relationship between knee and ankle proprioception and anthropometric indicators in elementary school children. Methods: The present study is a semi-experimental research in correlational design. The statistical population of this research included all male students in the second to fifth grades of elementary schools, in north of Marand city, 160 of whom met the conditions to enter the research. Anthropometric dimensions were measured by calipers and scanners along with a tape measure; and photography was used for the accuracy of proprioception in ankle and knee joints (ICC ≤0.97). Data analysis was done by Pearson correlation test. All statistical calculations were done at a significance level of p≤0.05. Results: Knee joint proprioceptive sense was negatively correlated with the length difference between thumb and third toe (r=-0.240, p=0.030), and with the second and third toe length difference (p=0.022 r=-0.253). Also there was a significant negative correlation between ankle joint proprioception sense and foot width (r=0.363, p=0.001), ankle circumference (r=-0.240, p=0.030) and hip circumference (r=-0.242, p=0.02). Conclusion: The anthropometric dimensions that are subject to heredity and are least affected by the environment, are effective for developable and changeable functions such as proprioception sense.
Background: Inflammatory bowel diseases (IBDs) are complex and multifaceted disorders characterized by recurrent and persistent intestinal inflammation. The incidence of inflammatory bowel disease (IBD) is on the rise among both children and adults worldwide. In this review, we provide an update on genomic studies of IBD, with a particular focus on Very Early-Onset IBD (VEO-IBD), which often presents with a more severe phenotype than IBD at an older age.Methods: The methods used in this systematic review were performed according to the guidelines of the PRISMA checklist. A search was conducted by two independent researchers in international databases (PubMed, Web of Science, Scopus, and Google Scholar) to find relevant studies published in English.Results: Patients with VEO-IBD have rare or novel genes associated with immunodeficiency that may play a role in the pathogenesis of the disease. To date, ten regions for 240 genes, which are usually monogenic, have been identified for this disease, mostly due to mutations. But the most important cause of VEO-IBD is mutation in interleukin 10. It has also been reported that VEO-IBD is associated with increased expression of S100A8 and S100A9 genes in rectal mucosa and serum.Conclusion: Considering the multifactorial nature of IBD, all the changes that cause protein expression and function should be taken into account; so for early diagnosis and timely treatment of this disease, more extensive phenotypic sequencing is needed to discover new gene loci. And these children can be treated with hematopoietic stem cell transplantation, as the most efficient method.
Background: Inflammation has a remarkable role in Acute Respiratory Distress Syndrome (ARDS) pathophysiology. Pentoxifylline is a phosphodiesterase IV inhibitor with anti-inflammatory and anti-thrombotic properties, which has had positive results in rodents with ARDS. Due to the lack of human studies, we designed this clinical trial to evaluate the pentoxifylline effect on ARDS prevention in high-risk pediatric patients. Methods: We included thirty-four children from Akbar hospital’s pediatric intensive care unit (PICU). These patients were highly susceptible to ARDS progression. Using a randomized, double-blind method, 17 patients received pentoxifylline tablets three times a day for a week, while others received placebo tablets at the same interval for seven days. Lung Injury Prediction Score (LIPS), vital signs, pulse oximetry, PaO2, pH, and PaCO2 were measured at baseline and every day for a week period. CRP was assessed at baseline, then on the third and seventh days. Finally, we imported all the data to SPSS software to compare the treatment and placebo groups. Results: Each placebo and treatment group had seventeen patients who had no statistically significant difference in baseline demographic information or lab data. The variations in LIPS score (P=0.475), CRP (P=0.053), pH (P=0.199), PO2 (P=0.077), PCO2 (P=0.528), Heart rate (P=0.086), Respiratory rate (P=0.512), Diastolic blood pressure (P=0.572), Systolic blood pressure (P=0.517), and SPO2 (P=0.260) were compared between the two groups; and no significant difference was observed. Conclusion: The results of this clinical trial suggest that pentoxifylline had no prophylactic effect on pediatric ARDS, but for confirmation, further clinical trials with different designs and larger sample sizes are required.
Background: Factors like low-protein diet may impose Phenylketonuria (PKU) patients to impaired skeletal disease. The present study assessed the status of Bone Mineral Density (BMD) among PKU patients on a low-protein diet. Methods: A cross-sectional study was conducted (Tehran, Iran, 2019). Patients aged ≥ 4 years old with a definite diagnosis of PKU on a low-protein diet were included. BMD values of the lumbar spine and femoral neck were assessed. The primary objective was assessing femoral and lumbar BMD status in PKU patients. Results: Forty-one PKU patients entered the study. The mean BMI was 20.712±4.833 Kg/m2. The mean bone age was significantly lower than chronological age (10.9 vs. 12.4 years; P=0.008). The results showed a bone mass reduction in 23.1% of all patients. A significant correlation was observed between lumbar and femoral BMD values (P=0.001; r=0.516). Most patients (about 77%) had lumbar Z-scores>-1 and 10.3% showed Z-scores in the range of osteoporosis. Age (P=0.004) and age at diagnosis (P=0.002) were the influencing factors on BMD status. The results showed a significantly inverse correlation between BMD lumbar levels with the patient’s chronological age (P=0.016), age of PKU diagnosis (P=0.002), and phenylalanine level (P=0.025) Conclusion: The results delineated impaired skeletal status among PKU patients on a low-protein diet. Lumbar Z-score values inversely correlated with the patient’s chronological age, age at PKU diagnosis, and phenylalanine level. Hence, early PKU diagnosis and treatment during neonatal period, as well as controlling phenylalanine concentration may improve BMD status.
