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Background and Objective: Cytomegalovirus (CMV) infections are associated with severe morbidity and mortality in patients, especially pediatric renal transplantation patients. The use of immunosuppressive agents places these patients at the risk of viral infections. As cytomegalovirus infection influences the graft outcome, adopting useful strategies for limiting this virus after transplantation seems necessary.

Methods: This systematic review evaluates all articles about the prophylactic treatment in pediatric renal graft recipients.

Results: There are several anti-viral agents that are used alone or in combination for preventing CMV infection. The prophylactic agents that are used in pediatric recipients include CMV-Ig, IVIG, acyclovir/valacyclovir, and ganciclovir/valganciclovir. CMV-Ig is an adjective agent and it is less effective if used alone.  Although performed studies in children are not sufficient to determine valacyclovir effect in preventing reactivation of cytomegalovirus, valacyclovir is used in moderate risk recipients for CMV infection. It seems that valacyclovir is less effective than valganciclovir.

Conclusion: Nowadays oral valganciclovir is the most appropriate prophylactic agent used in most transplant centers for children and adults.  However it appears that valganciclovir prevents cytomegalovirus infection only during prophylaxis period. The incidence of late CMV infection does not reduce by this drug. Some trials in adults and a retrospective study in children recommend that longer duration of prophylaxis with valganciclovir lowers the incidence of CMV infection in late stage.

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Background and Objective: Since there are very few studies on the immunodeficiency state of the Iranian survivors of pediatric acute lymphoblastic leukemia (ALL), we conducted this study to determine the prevalence of humoral defects in children with ALL at least one year after completion of chemotherapy.

Methods: In this study, antibody titers for mumps, rubeola, rubella, tetanus and diphtheria toxoids, pertussis and poliovirus were measured in 28 survivor of childhood ALL and 29 normal children. Also, immunoglobulins titers for all participants were evaluated.

Results: In spite of normal serum immunoglobulin levels in all participants, the percentage of children with ALL who had protective titers was markedly lower than that anticipated for immunized controls (p<0.001). The rate of protective titers for mumps, rubeola, rubella, tetanus and diphtheria toxoids, pertussis and poliovirus were 7.1, 50, 25, 35.7, 10.7, 21.4, and 10.7 percent in patients and 93.1, 93.1, 100, 96.6, 86.2, 82.8, and 100 percent in controls, respectively.

Conclusion: The prevalence of humoral immune defects was high among the survivors of pediatric ALL. It appears that these survivors are at risk of developing these bacterial and viral infections and therefore have to be re-vaccinated as required.

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Kidney Transplantation in children is the treatment of choice to treat end stage renal disease. Improvements in immunosuppressive management have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Reducing of side effects are the challenges for improving the outcome of pediatric transplantation. This review will discuss the current trends and outcomes of the kidney transplantation in children.

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Background and Objective: The aim of this study was to analyze our indications, surgical procedures, and clinical outcomes of patients undergoing reoperation after surgical correction of tetralogy of Fallot (TOF).

Methods: Thirty seven consecutive patients who underwent reoperation late after intra-cardiac repair of TOF within a period of 10 years were assessed.

Results: The most common indications for correcting TOF was pulmonary valve insufficiency (51.4%) followed by right ventricular outflow tract (RVOT) dilatation (45.9%), residual ventricular septal defect (VSD) (43.2%), pulmonary valve stenosis (32.4%) and pulmonary artery stenosis (32.4%). The most common late complication for primary operation included pulmonary insufficiency (5.4%), followed by ventricular tachycardia (5.4%). Late complication rate following reoperation was 13.5%. There were three operative deaths with a mortality rate of 8.1%. One-year and three-year survival were 96.2% and 91.8%, respectively. Late mortality following reoperation was significantly higher in those with underlying coronary artery anomaly (p= 0.026), those with primary patent ductus arteriosus (PDA) (p= 0.026), and those with pulmonary stenosis (p= 0.028) as indications for repeated operation.

Conclusion: The most common indications of redo surgery following TOF repairing surgery are pulmonary valve insufficiency followed by RVOT dilatation, and residual VSD. Although the redo surgery is associated with serious complications, acceptable long-term survival following this repeated operation is expectable.

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Background and Objective: Different personality aspects including identity styles, self-efficacy, and cognitive abilities can play a certain role in successful learning result in high educational success. We assessed the value of identity styles, self-efficacy and metacognition beliefs for predicting the level of educational success in female high-school students.

Methods: In a cross-sectional study, 380 consecutive female high school students were selected using stratified multi-stage random sampling method.

Results: There were significant associations of educational success rate with informative identity style (r= 0.219, p< 0.001) and with commitment (0.205, p< 0.001). Direct association was revealed between level of self-efficacy and students' education success (r= 0.274, p< 0.001). Regarding relation between different subscales of metacognition and success in education, only subscale of cognitive self-consciousness was directly associated with education success (r= 0.194, p< 0.001).

Conclusion: High levels of informative identity style, commitment, self-efficacy, and cognitive self-consciousness can predict high educational success in students.

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Background and Objective: The present study investigated executive functions in students with high functioning autism (HFA) and students with educable Down syndrome (DS) with normal healthy students.

    Methods: Fifteen boy students with HFA, 15 boy students with educable intellectual disability and 15 normal healthy boy students (aged between¬ 7-15 years) were recruited from educational services. The study samples were controlled and matched based on their demographic criteria. The utilized research instruments were the 2nd version of Gilliam Autism Rating Scale (GARS2), Wechsler Intelligence Scale for Children (WISC) and its Digit Span subscale (direct and reverse) memory test, Color-Word Stroop test, Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT). To analyze the data, one-way ANOVA, multivariate analysis of variances, univariate covariate, multivariate covariate and Bonferroni and Tukey post-hoc tests were used.

    Results: Analysis of covariance showed that there was significant difference only between students with HFA and control groups in the response inhibition, mental flexibility index and continuous attention. Moreover, there was significant difference between students with Down syndrome and control group in short- term memory, while comparisons between other variables revealed no significant difference between groups.

    Conclusion: The results indicated that students with HFA considering their close IQ to normal students showed impairment in the executive functioning. This finding implicates the minor role of intelligence in the executive function level in these children.

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Background and Objective: Cystinosis is a rare inherited disease that leads to renal failure. Fanconi syndrome is the major renal involvement in cystinosis patients. Renal transplantation is the treatment of choice in cystinosis children with end-stage renal disease (ESRD).  The study aimed to assess the outcome of renal transplantation in Iranian children with cystinosis.

Methods: This retrospective study is a follow up of 21 cystinosis children transplanted in Labafinejad Hospital, Tehran, Iran.

Results: Three cystinosis patients involved by primary non-function because of graft vein thrombosis and/or severe acute tubular necrosis. The remaining cystinosis patients had excellent graft survival rate and only one patient lost the graft 3 years post-transplant due to noncompliance. The graft survival rate after excluding the patients with primary non-function was 100%, 94%, 94% and 94% at 1,3,5 and 10 years after transplant. The mean serum creatinine in patients with functioning graft 10 years after transplant was 1.6 mg/dl.

Conclusion: We showed that cystinosis patients had good graft function in long term after transplantation.

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Background and Objective: Vitamin D (Vit.D) has an important role as immunoregulator. Its deficiency is suggested as a risk factor for respiratory system infection. In this study the serum Vit.D level in pneumonia and healthy children will be compared.

Methods: This study is a prospective case control study and contains 31 children between 6 and 60 months old hospitalized because of pneumonia and 40 healthy children between 6 and 60 months old. Serum Vit.D level in these two groups were measured and compared with P value less than 0.05.

Results: There was significant difference between “weight for age” but not in “height for age “Z-score. There was no significant difference between serum Vit.D level in the two groups. The mean serum Vit.D level in case group was 30.71 ng/ml and in control group was 31.89 ng/m.l (P=0.77)

Conclusion: We found no significant difference for frequency of Vit.D insufficiency between the two case and control groups. Maybe it is because of consuming supplemental Vit.D by most of infants and toddlers in Iran. More study with paying attention to this factor can be helpful.

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Background and Objective: Chronic renal failure (CRF) may have many effects on nervous system and manifest as headache, seizure, dialysis disequilibrium syndrome, cerebral hemorrhage, hypertensive encephalopathy, uremic neuropathy, and some neurologic complications of transplantation. In this present study we investigate neurologic disorders in children with CRF.

Methods: In this descriptive, cross sectional study, we evaluated 60 cases. Thirty normal cases compared with thirty patients with CRF admitted in nephrology ward in Aliasghar Children Hospital between April and December 2014.Two groups were matched for age and gender. Data were recorded on age, sex, causes of CRF, renal transplantation and neurologic manifestations.

Results: Thirty patients had CRF and mean age was 10.86±5.25 years. Seventeen cases (56.7%) were male. Fourteen (46.7%) of cases had been transplanted. Twelve (40%) of patients had neurologic findings including seizures 7(23.4%), tension type headache 3 (10%), and developmental delay 2(6.6%). Causes of CRF were included congenital anomalies (46.6%), glomerulopathies (26.6%), tubulopathies (10%) and idiopathic cases (16.8%). Neurologic complications was significantly seen more in male patients (P=0.01).There was not significant relationship between age, causes of CRF, history of seizure in relatives, renal transplantation and neurologic findings. Two (7%) cases died of which both had seizures. In control group, neurologic findings was detected in two cases and there was significant differences between occurrence of seizure and neurologic findings in two groups (P=0.01, P=0.005).

Conclusion: Some neurologic manifestations such as seizure, headache and developmental delay in patients with CRF are seen especially in childhood period. It is recommended to evaluate neurologic disorders and treated properly in these cases.

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Background and Objective: Typhoid fever is still a major health problem for which there are limited options for the diagnosis. Current diagnostic methods are time consuming with undesirable sensitivity. Among newer diagnostic methods, PCR is attractive and could be potentially very helpful in developing countries where systemic salmonella infections are endemic among children but needs to be investigated.

Methods: We performed a cohort study in Aliasghar Children Hospital, a teaching hospital in Tehran, between May 2012 and July 2013 to include suspicious systemic salmonella infections. Clinical and laboratory findings as well as clinical courses were followed on daily basis. Overall, 45 patients assigned into 3 groups were included into the study. For each case all appropriate cultures as well as Widal agglutination test and a blood sample for PCR of salmonella were submitted after taking informed consent from parents.

Results: Twenty one (46.7%) boys and 24 (53.3%) girls with ages ranging from 1 month of age to 17 years (mean 4.5 years) diagnosed for typhoid fever. About 88.9% of the patients had diarrhea, 84.4% had fever, 66.7% had vomiting, 28.9% had abdominal pain, 15.6% had nausea, 11.1% had rash and 2.2% had constipation. Eighteen (40%) patients have received antibiotic treatment before coming to the hospital. Group I consisted of 18(41%) patients, group II consisted of 27 patients with positive Widal test of these, one was blood and stool cultures positive however PCR in blood was negative in this group. Group III represented 2 patients with positive blood and stool cultures. In one case PCR in blood was positive. In another patient Widal test was negative despite positive blood culture and PCR in a leukemic kids who passed away.

Conclusion: In our setting the role of conventional PCR in blood samples of kids with suspicious systemic salmonella infections was not clearly determined. Larger sample size, preferably in a multicenter study, and using more sophisticated methods of blood cultures and novel techniques to increase the availability of organism for DNA detection is needed before determination of its role in both groups with no prior antibiotic therapy and cases with previous history of antibiotic administration.

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Background and Objective: Serum creatinine is the most used endogenous marker of glomerular filtration rate (GFR), but it also has multiple limitations. Therefore, some surrogate GFR markers, such as beta trace protein, have been introduced for GFR estimation. The aim of our study was to estimate GFR by serum beta trace protein using three available equations and compare them to DTPA GFR as the gold standard and Schwartz GFR.

Methods: The three beta trace protein (BTP)-related GFR formulas were the White formula (1): GFR=167.8×BTP-0.758×creatinine-0.204, Pöge formula (2): GFR=974.31×BTP-0.2594×creatinine-0.647, and Benlamri formula (3): GFR=10^ (1.902+ (0.9515×LOG (1/BTP)). Twenty seven children were included in this study. All patients had a Schwartz and DTPA GFR more than 50 cc/min/1.73m2.

Results: We showed that there was no significant correlation between DTPA GFR and Schwartz-estimated GFR (r= -0.1, Pv= 0.5). There also was not any association between GFR estimated by Pöge and Benlamri formulas and DTPA scans. In contrast, there was a significant association between DTPA GFR and White BTP formula-estimated GFR (r=0.77 r=0.00).

Conclusion: This study showed that GFR estimated by serum beta trace protein and White formula had accuracy over Schwartz formula in children with normal or mild reduced GFR however, this result needs to be confirmed by additional studies with more cases.

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Background and Objective: Tumor lysis syndrome (TLS) could occur before, during or after the initiation of chemotherapy in patients with cancers especially those with hematologic malignancies. This study was designed to determine the prevalence and predictors of TLS in children with Acute Lymphoblastic Lymphoma (ALL) and to develop a sensitive prediction rule to identify patients at low risk of TLS.
Methods: In this cross-sectional study 160 children diagnosed by ALL in Ali-Asghar Children Hospital, Tehran (1996-2010) were recruited. TLS was defined as having two or more of the certain criteria. Predictors of TLS were determined using univariate and multiple logistic regression analyses.
Results: TLS was diagnosed in 41 cases (25.6%). The most common laboratory abnormality was hypocalcaemia (30%) in these patients. The results of univariate analysis showed that splenomegaly (OR, 2.38; p=0.005), mediastinal mass (OR, 4.45; p=0.003), T-cell phenotype (OR, 4.66; p=0.001), central nervous system involvement (OR, 10.93; p=0.001), lactate dehydrogenase ≥2000 U/L (OR, 3.88; p=0.003), and white blood count (WBC) ≥20×109/L (OR, 4.18; p<0.001) were predictors of TLS in these cases. Multiple regression analysis of variables that were available at presentation identified CNS and renal involvement, mediastinal mass, and initial WBC ≥ 20 × 109/L as independent predictors of TLS. When all 4 of those predictors were absent at presentation (n= 83 patients), the negative predictive value of developing TLS was 92.22%, with a sensitivity of 82.93%.
Conclusions: It could be suggested to evaluate the risk of TLS in all patients with hematologic malignancies before starting chemotherapy. Finding a model of independent factors to define a group of ALL children at low risk of TLS could be used to prevent the monitoring and high cost prophylactic treatment modalities.

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Background and Objective: In the present study, the diagnostic agreement between surgical and pathological findings of appendicitis in children was tested. The aim was to assess the association between patient body mass index (BMI) and this diagnostic agreement.

Methods: This cross-sectional study was carried out on 121 consecutive children aged less than 15 years suspected to acute appendicitis that were candidate for appendectomy in surgery ward of Ali-Asghar hospital between 2006 and 2011. The patients’ characteristics were collected from hospital recorded files.

Results: Assessment of surgical and pathological findings showed a good agreement between the two procedures with an agreement value of 0.69. The overall prevalence of obesity in those with and without pathological appendicitis was 8.7% and 21.5% with a significant difference between them (p= 0.012). Also, the mean BMI in patients with surgical appendicitis was 19.6 ± 4.9 kg/m² and in those with normal appendix was 20.9 ± 4.8 kg/m² that was significantly lower in former group (p= 0.041).Thus, the mean BMI in patients with appendicitis diagnosed surgically or pathologically was lower than those with normal appendix.

Conclusion: Obesity is more common in children with normal appendix surgically and/or pathologically.  Thus, the over diagnosis of appendicitis is higher in obese children

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Background and Objective: Achievement of motor skills is an important part of childhood development. There are some scales that commonly used for preschool-aged children including Peabody Developmental Motor Scales, 2^nd edition (PDMS-2). A cross sectional study designed to compare motor skills of high risk and normal infants of 3 to 6 months of age.

Methods: In this case control study, 45 high risk infants 3-6 month of age were compared with 45 normal cases that matched for age and sex, for evaluation of motor development by PDMS-2. Subjects were selected by cluster sampling from different health centers of Tehran. Data about gross, fine and total scores were analyzed using SPSS software version 13.

Results: There was a significant difference between gross, fine and total motor scores in normal and high risk infants with perinatal risk factors (P<0.05).

Conclusion: Fine, gross and total motor scores in normal and high risk infants of 3- 6 months old are significantly different. It is recommended to evaluate movement development by PDMS-2 in mentioned infants and starting rehabilitation as soon as possible

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Background and Objective: Some neurologic complications may be detected after renal transplantation in children including tremor, peripheral neuropathy, altered level of consciousness and seizure. The aim of our study was to detect the prevalence of seizure after renal transplantation and its risk factors in pediatric age groups.

Methods: In this descriptive study, 102 patients 5-14 year old in Ali-Asghar children’s hospital with renal transplantation were enrolled from December 2011 to December 2013. Data about age, gender, primary renal diseases, seizure type, history of previous seizure, and causes of seizure were analyzed through SPSS v.18.

Results: Mean (SD) age was 11.69±2.52 years. Fifty seven cases (57.8%) were male. Twelve (11.8%) cases had seizures. Mean age of seizure group was lower than group without seizure (P= 0.001). Causes of seizures were hypertension in 7(58%), febrile seizure in 3(25%), meningoencephalitis in 1(8.5%) and subdural hematoma in one patient (8.5%). Eleven (91.7%) patients had generalized seizure. Seven (6.9%) of all patients had history of previous seizures and 6(86%) were in seizure group (p=0.000). Four cases died and 2(50%) were in seizure group (P= 0.01).There was no significant relationship between gender, primary renal disease, and seizure occurrence after transplantation.

Conclusion: In our study, hypertension was common cause of seizure disorder after renal transplantation. Seizures were higher in patients with lower age at   transplantation time and with seizure history before transplantation. It is recommended to have more attention prior renal transplantation with neurology consultation and particular management of hypertension after renal transplantation

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Background and Objective: There has been a resurgence of nutritional rickets in children in many developing countries. Furthermore, Vitamin D deficiency is one of the major health problems and unexpectedly has a high prevalence in sunny countries (e.g. Middle East). In order to find out the association between vitamin D deficiencies in mothers and their neonates, we designed this study.

Methods: In a cross-sectional study, 49 pregnant women were recruited from Ali-Asghar children’s hospital in Tehran, in 2015. All blood samples were assayed for 25-hydroxyvitamin D3, calcium, phosphorus, parathyroid hormone, alkaline phosphatase and creatinine. Vitamin D deficiency defined as levels of 25(OH) D < 20 ng/ml for mothers and newborns.

Results: The mean±SD 25OHD levels of the mothers and their neonates were 26.1±8.44 ng/mL and 17.23 ±10.36 ng/Ml, respectively. Serum 25OHD of the mothers and their neonates were significantly correlated (r = 0.446, P< 0.001).

Conclusion: We found a significant correlation between vitamin D deficiency in mothers and their neonates. We think it is necessary to reconsider the recommendation of vitamin D supplementation for women during pregnancy.

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Background and Objective: Vitamin D (Vit D) has an important role as immunoregulator. Its deficiency is deemed as a risk factor for respiratory system infection. In this study the serum Vit D levels of healthy and with pneumonia children were compared.

Methods: In this prospective case control study, 31 hospitalized children due to pneumonia and 40 healthy children both aged between 6 and 60 months were included. Serum Vit D level in these two groups were measured and compared. P values less than 0.05 considered significant.

Results: There was a significant difference between the two groups regarding “weight for age Z-score”, however, no significant difference was found between them with respect to “height for age Z-score” as well as serum Vit D level. The mean serum Vit D level was 30.71 ng/ml and 31.89 ng/ml in case group and control group, respectively (P=0.77).

Conclusion: Our study did not support a straight relation between serum Vit D level and pneumonia. This finding might be due to consumption of supplemental Vit D by most of infants and toddlers in Iran. Further investigation in this area is recommended.

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This is a report of a case with unilateral cavernous sinus thrombosis due to ipsilateral ethmoid sinusitis.

A 10 year old female was admitted in our hospital with severe headache, purulent postnasal discharge, right eye proptosis and third cranial nerve palsy in the same eye. She had history of viral upper respiratory tract infection and then acute otitis media which did not improve with routine medications. Head imaging showed ethmoid sinusitis and cavernous sinus thrombosis. Clinical manifestation was subsided after thirty days aggressive antimicrobial and anticoagulant therapy.

Ethmoid sinusitis can cause cavernous sinus thrombosis. Appropriate management by antibiotic and anticoagulant therapy can prevent neurologic complications and death

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World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease
that can begin in earliest childhood. Chronic kidney disease (CKD) in childhood differs from that in adults, as
the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies
and kidney disease in the setting of diabetes being relatively uncommon. In addition, many children
with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later
childhood or in adult life. Children born early or who are small-for date newborns have relatively increased risk
for the development of CKD later in life. Persons with a high-risk birth and early childhood history should be
watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or
treatment. Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare
better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a
minority of children may require this ultimate intervention Because there are disparities in access to care, effort
is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective
of their geographic or economic circumstances. Our hope is that World Kidney Day will inform the general
public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood

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Background and Objective: Febrile convulsions (FC) are the most common seizure disorder in children. Lumbar puncture should be considered in any case with FC who is suspected to intracranial infections. This study determined white blood cell and polymorphonuclear cell counts, and protein and glucose levels in cere-brospinal fluids (CFS) of children hospitalized with FC.
Methods: In this cross sectional study, lumbar puncture samples of children with FC admitted to the Neurol-ogy ward of Ali-Asghar Children’s Hospital from 2010–2013 were evaluated. Recorded data included age, sex, type of seizure (simple, complex), frequent attack of FC, family history of FC or epilepsy and cerebrospinal indices (white blood cell, protein and glucose).
Results: In this study, 91 CSF specimens of patients with FC were evaluated. Mean (SD) age of cases was 17.66±10.81 months. Fifty seven (62.6%) of cases were male. Mean glucose and protein levels of CSF was 62.57±12.30 and 21.34±9.52 milligram per deciliter, respectively. Median of WBC and PMN count of CSF were 1 and 0 cell/mm3, respectively. There was not significant relationship between patients' characteristics and CSF indices (P >0.05).
Conclusion: During FCs, glucose and protein levels of CSF are in normal limits. Minimally changes may occur in CSF cell counts.