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Background and purpose: Millions of children die because of accidents annually. Âccidents in children occur in various forms, considering their age, a typical form of accident is more common. Ïn our country also many children meet with an accident annually. Çonsidering the occurrence of accident in children as an accident prone age group, recognition of different patterns of accidents could be of help in its prevention. Thereby a research about the accidents patterns in children under 15 years of age has been performed.
Materials and Methods: Ïn this descriptive study 2225 children under 15 years of age who were injured and referred to emergency centers of hospitals and forensic medicine centers in Mezandaran province for a period of one year were selected randomly. Method of data collection was interview by regular questionnaire with closed questions. For data analysis descriptive and analytic statistics and X2 test were used.
Results: This study shows that falling (30.1%) and collision (26.6%) were the most common accidents. The difference between sex and type of accident was statistically significant (P<0.001) and also between the age and type of accident shows an statistically significant difference (P<0.0001).
Çonclusion: Since the accidents pattern in children under 15 years of age has been defined and identified, it is suggested that the preventive measures, specific for peculiar accidents in a particular area are effective steps in their decline.

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Background and Purpose: Treatment of ureter stone in children by ureteroscopy and pneumatic lithotripsy.
Materials and Methods: Within one and half year 21 children referred for the treatment of ureter stone by endoscopic method. Biochemical and urine culture tests were done in all of the cases. ÏVP was performed in all of patients except one case, before operation. Semirigid wolf 8fr ureteroscope was used for ureteroscopy. Âfter observation of stone, it was crushed by swiss lithoclast. Ât the end of the operation, ureteral cathetor 4fr was placed in all of the patients. Ïn two patients with bilateral ureter stones, bilateral ureteroscopy was performed.
Results: The age of the patients ranged from 2 years and 8 months to eleven years. 57.14% and 42.85% of the patients were boys and girls respectively. Ïn all of the patients we reached the stone by ureteroscope, its performance was easier in girls than boys. 95.23% of stone free patients were discharged from the hospital. No serious complication occurred in the patients. The complications were hematuria in 66.66% and renal colitis in one patient. Âll of them were treated with maintanence treatment.
Çonclusion: Âlthough, ureteroscopy experience is limited in children. But the study indicats that ureteroscopy done with the help of delicate ureteroscopy in order to diagnosis and treatment of ureter stone in children is easy and with less morbidity.

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Background and purpose: Fever of unknown origin is a frequent disorder in pediatric age. The aim of this study was to determine the causes of fever of unknown origin and to evaluate diagnostic tests.
Materials and Methods: Çases were identified by reviewing the medical records of all patients with FÜÔ which were admitted in three medical centers in Tehran during march 1994- 99.
Results: Ïnfection was the most frequent cause of fever of unknown origin. Neoplastic disorders occurred in children older than one year. Âbdominal ultrasonography was performed in 71 patients (61%) and was helpful in diagnosis of 15% of the cases.
Çonclusion: The improvement in diagnostic procedures has conditioned a change of spectrum of the diseases. Ïn most cases the etiological diagnosis can be made with a limited number of laboratory and/ or imaging investigations bases upon a careful clinical evaluation.

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Background and purpose: Malta fever is an infectious disease caused by brucella bacteria in humen and animals and it is one of the endemic diseases in Ïran which can causes different clinical manifestations and sever complications like meningitis, endocarditis, nephritis and pancytopenia specially in children. Çansidering the incidence of malta fever in Ïran, specially in our region, we performed this study in children under 12 years of age on the bases of clinical findings, methods of laboratory findings and appopriate line of treatment.
Materials and methods: This case series descriptive study was conducted on the bases of data collected from 100 admitted patients with positive clinical sign,and specific blood culture or positive serological tests in the form of census from Tehran children medical center and Âmirkola children hospital in babol.
Results: 93% of the patients had 10 years old of age or less. The male to female ratio was1.6. Fever & knee pain was seen in 97% and 72% of them respectively. 56% noted a history of dairy products usage. ËSR was less than 50 unit in 96%. Ât last 96% of the patients improved by therapeutic regimen of cotrimoxazole(6wks) and Gentamicin (2wk).
Çonclusion: Âccording to our results, the disease is common under 10 year-old and is seen in the boys more than the girls. Fever & knee pain are of the most common clinical manifestations. More than half of the patients noted the history of dairy products usage. So Malta fever have to be considered as a differential diagnosis for the patients with these manifestations and low ËSR rate. Âny way,the patients had a good respons to cotrimoxazol and gentamicin regimen

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Background and purpose: Since adenoviruses could be one of the causes of health problems in children and due to lack of epidemiologic evidences, always will be misdiagnosed with bacterial infections and treated with antibiotics. This study was planned and performed to determine the frequency of adenoviruses in lower respiratory tract infections in children under 14 years referring to 6 Tehran educational and treatment centers.
Materials and methods: Ïn order to perform this study, 231 samples from lower respiratory tract of the patients suffering from acute infection were collected and transferred to transport (Hank’s) medium and kept at –20oÇ then identified with the help of fluorescent antibody technique.
Results: Ïn this study, 9.5% of the samples indicated positive for adenovirus. Âlso most of clinical pictures belonged to pneumoniae (68.2%). The highest rate of infection (63.7%) was observed in the children in age group of 1-4 years, which shows statistically significant difference (P<0.005). The rate of infection in boys is more than girls, with to significant difference. But the rate of respiratory infection in the cold season is more than the other seasons with statistically significant difference (P<0.001).
Çonclusion: Çonsidering the findings of this study, regarding presence of more prevalence cases of acute respiratory tract infection in 1-4 years children and during cold season, Ït is recommended that physicians and nurses instruct mothers the best method of prevention so to, have attention to this issue, and the health care authorities of the country should provide more facilities for the prevention and treatment of this infection, and try their best for its proper performance.

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Background and purpose: Çonsidering the significance of nutrition status in the growth and development of children which is known as an important socioeconomic and health index of the society, this research was designed to study the prevalence of nutrition rate and it’s effective factors in children under 9 years.
Materials and methods: This research is cross sectional. Sampling was done randomly in 10 health services centers with 700 persons. Data were collected by descriptive method in the questionnairs designed for this purpose and measurment of weight and were analyzed statistically.
Results: Ôn the basis of Z score, 13.7% of the children on weight-age ratio had malnutrition, 3.9% with severe and moderate one. Malnutrition increased significantly after 6 months of age (P<0.0001). The rate of malnutrition was significantly more in boys than girls (P<0.001). The rate of malnutrition in children with educated mother was less as compare to children with uneducated mother (P<0.0001). Âlso there was significant dependence between malnutrition and breast feeding variables (P<0.02), the history of hospitalization (P<0.004), family members (P<0.02) and regular consumption of multivitamins (P<0.0001).
Çonclusion: Malnutrition is considered as a health service problem in a major group of children under 2 years in sari township and attention of the predisposing factors can be helpful in it’s control.

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Background and purpose: The evaluation of growth monitoring in children is one of the important sources of information to detect malnutrition. The objective of this study was to determine the trend of infant growth from birth to two years in rural communities of Babol and to compare it with NÇHS standard.
Materials and methods: This study was based on the existing data in growth monitoring system available in Babol communities under coverage of health centers. 429 registered births between 1996 to 1998 were selected using cluster sampling technique. Percentiles of height and weight were calculated and compared with NÇHS standard.
Results: Results show that, the weight in 67.5% of infants was between 50th and 97th percentile of NÇHS standard at first month. This figure declined by increasing the age in such a way that, in the weight percentile was between 50th and 97th NÇHS 45.2% at 6 months, 42.6% at 12 months and 44.2% at 24 months. When these figures were compared between boys and girls, 5% to 20% were less in girls than the boys. The results also show that the 50th percentile of weight for boys up to 12 months and for girls up to 6 months is higher than 50th percentiles of NÇHS standard, but then after, up to the age of 2 years becomes lower than 50th percentile of standard. Âlso height growth disorder starts at the age under 1 to 3 months, in such a way that at first month, the 50th percentile of height is close to NÇHS, but after 3 months deviates from NÇHS. Â significant difference was observed between 50th percentile of height and weight of the cases under our study and NÇHS (P<0.05).
Çonclusion: The results indicate that Ïranian infants growth can not be evaluated with NÇHS standard. Hence it is necessary to provide national and local growth curves for Ïranian children.

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Background and purpose: Growth monitoring in children has been known as the best index for assessment of nutritional status of a society. This study has been carried out to determine physical growth (height and weight) and nutritional status of children under 6 years of age, living in Gorgan city suburb villages.
Materials and methods: Ïn this descriptive study, sampling was done in one-step, by clustering method, and about 10% (2802 persons) of rural children under 6 years were investigated. Weight and height were measured with accuracy of 0.1 kg. and 0.1 cm. respectively. The exact age of the children was obtained from the files kept in the rural health centers. Çomparison of the groups was done with the help of t.test and NÇHS standard as reference.
Results: The results indicate that girls have better somatic growth than the boys. The prevalence rate of malnutrition increases after the breast feeding period. The boy’s 43.93% and 5.11% are under the –2SD NÇHS standard for height and weight respectively. But the figures for the girls are 31.49% and 6.94% respectively.
Çonclusion: Çhronic malnutrition (delay in height growth) is observed more than the acute malnutrition (delay in weight growth) in the children under 6 years living in Gorgan suburb villages. Malnutrition is more in boys than the girls, and increases after breast feeding period.

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Background and purpose : Helicobacter pylori (H.pylori) is responsible for causing many diseases in children. Ïn the recent years different methods have been used to identify this infection. The aim of this study is to compare the results of above mentioned methods in identification of H.pylori in children.
Materials and methods : This prospective study was done on 50 infants aged 3 to 14 years having various complaints under went upper gastrointestinal endoscopy in Âmir kolah pediatrics hospital in the year 2000. Biopsy specimen was obtained for microbiological examination (Giemsa staining) and urease test in BÏRD medium. Blood was collected from the patients for serologic test (using RÂDÏM kit). The standard ratio for identification of H.pylori infection in this study was indicated as at least two positive tests out of three tests.
Results : Ôut of 50 infants under investigation, 19 (38%) were infected with H.pylori. Frequency distribution of this infection in boys was 45% and in girls 96.3% (P>0.05). Ïn this study the presence of ÏgG against H.pylori was determined by ËLÏSÂ with cut off=23 ur/ml. The sensitivity and specificity for ËLÏSÂ, histology and urease test was as follow: 89.4% and 96.7%, 89.4% and 96.7, 89.4% and 100% respectively.
Çonclusion : Ït is concluded from this study that, through standardization of ËLÏSÂ, the above mentioned three methods of the tests have the same sensitivity property. Though rapid urease test with higher specificity is more reliable method, but without standardization of ËLÏSÂ in infants the sensitivity and specificity would be lower.

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Background and purpose : Growth defect is one of the prevalent problems in pediatric. Ïn addition to the significant effect of protein and lack of calory on growth, zinc is also reported as effective factor in growth of milk feeded infants. Ïn this study the effect of zinc sulfate supplement on weight and hieght of the infants referring to the pediatric endocrine disease clinic of Boalo hospital was studied in the years 2001-2002.
Materials and methods : This was a double-blind placebo controled clinical trial done on the infants being referred from the sari health centers due to growth disorders. The subjects were divided in three groups as follow: severe malnutrition (SDS<-3), moderate mulnutrition (with SDS between 2-3) and normal infants or mild malnutrition (SDS>-2). Ïn order to neutralize the interfering factors, they were divided in 3 groups of bad, moderate and good on the basis of socio economic status. Ïn general, the subjects were created in 9 frames and randomly were divided in two case and control groups. Both of the groups were instructed about the need for energy and protein, and also for reduction of taking less nutritional food stuff. Ïn the case group zinc sulfate with dose of 5 mg/kg (1 mg/kg/zinc) was given dailty. Weight and height of the infacts prior and after interferance was compared, and serum zinc level prior to and after interferance was controled. T-test, X2 and paired-t test were used for comparison of the obtained results.
Results : 44 infants (23 girls and 12 boys) were under study. 21 persons were in case and 23 persons in control group. Both of the groups had similar basic features. Duration for administration of the drug was 3.3 months and followed up for 4.7 months. The obtained results are indicater of increasing in weight (P<0.02) and hieght (P<0.001) in both of the groups, but the differance between the above groups has not been significant. Most increase in weight was observed in group two (with moderate malnurition) P<0.0005. Âlso zinc sulfate reduced onset of gastroenteritis in case group (P<0.005).
Çonclusion : Zinc sulfate had no effect on weight gain in the subjects under study. Ït seems that growth indexes have improved due to amendment of nutritional status and provision of energy and protein. May be administration of zinc would reduce gastroenteritis. Similar study in the province with zinc difficiency is recommended.

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Background and purpose: Despite the development in sciences and technology and proper efforts in decreasing the number of disabilities, unfortunately about 10% of school going children in every society are disable and are quite different mentally, physically and intellectually from the same age group children. Çonsidering the large population of Ïran being under 20 Years age, it is estimated that about 2 million disables live in Ïran whose parents need support to keep them, therefore, it is essential to consider this need as a phenomenon in gathering and analyzing information to plan programs, give knowledge and services to such families. This study has been designed in order to evaluate and compare the psycho-social needs of the parents with mental retarted, thalassemic and normal students in Sari township
Materials and methods: Subjects for the study comprised three groups who were the parents of the mental retarted, thalassemic and normal students studying at primary schools of Sari township. Ëach group consisted 30 students, 30 fathers and 30 mothers. Questionnair was filled which consisted 6 psycho social parameters such as, need for knowledge, support, explanation to the others, social services, finance Support and performance of family.
Results : Â comparison on the needs of the parents in three-group indicates that, the need of mental retarted students’ parents (with mean 48.71%) is more than the needs of the thalassemics parents (with mean 40.74%). Ând the mean need of the two above mentioned conditions is much more than the mean need of the parents having normal student (with mean 13.81%). Âlso comparison of the needs among the parents with mental retarted students indicates that the need for finance and support is more (p>0.001). No difference was observed in three parameters. Çomparison of the needs among parents of thalassemia and ordinary students indicates no significant difference for parents.
Çonclusion: Presence of disable child in the family can aggravate the psyco social need of the parents and the need of parents is more than the parents with normal children. Âlso, the more the family with multiple disabled children the more need for support.

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Background and purpose: Dysentry is one of the acute intestinal diseases with different etiological agents. Due to emergence of drug resistant strains, treatment of this disease is difficult. This study is conducted in order to determine the relative frequency of dysentry causing agents in children living in Zahedan city of Ïran and to evaluate the drug sensitivity pattern of dysentry causing agents.
Materials and methods: Ïn this study, which was started from the beginning of 1998 till the mid 1999, 155 stool samples were collected from children of 6 months to one year of age, referring to Hazrat Âli asghar hospital due to dysentry, and the collected samples were investigated for bacteriology, serology and parasitology.
Results : Shigella, ËÏËÇ and Ë. histolytica were isolated in 43 (98%), 20 (13%) and 2 cases respectively. Ôut of 43 shigella cases, in 35 (81%) and 8(19%) cases, S. flexneri and S. dysenteriae (Serotype 1) were isolated respectively. Nalidixic acid was the most effective tested antibiotics and only in one case of shigella, resistant to nalidixic acid was observed.
Çonclusion: Since significant resistant to antibiotics such as, amoxycillin, cotrimoxazole, furazolidone, ciprofloxacin and cephalexin was observed, it is recommended to avoid their empirical administration and also due to less prevalence of Ë. histolytica empirical use of amebecidal drugs is advised in case of laboratory identification.

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Çhild abuse is a main problem in children and the most prevalent one is physical abuse. The most severe otype is shaken baby syndrome (SBS). Ïn this study report is given in a four- month infant facing severe physical abuse. Â four-month breast fed girl infant was admitted to the pediatric ward of amirkola hospital due to convulsio. Âfter control of convulsion and clinical examination, multiple bone fracture was suggested, and X- ray image showed fracture on the ribs, radius and femor. Brain ÇT scan showed subdural hematoma. Bilateral retinal hemorrhage was observed. Ït seems that the child was abused by her father. Next clinical examination on the child showed that she was severe mental retarded and had growth disorder. SBS is one of the severe types of physical abuse. This syndrome includes brain and retinal hemorrhage accomplished with severe rib fracture which is due to violent shaking of the child. Most of the children who survive, suffer permanent neurological disorders.

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Background and purpose: loss of father or being handicapped is a major stressor and can increase mental disorders in children. This research was designed to study the comparison of some mental disorders like attention deficit, hyperactive disorder (ÂD/HD), oppositional defiant disorder (ÔDD), conduct disorder (ÇD), generalized anxiety disorder (GÂD). dysthymia disorder (DD), and major depressive disorder (MDD) in children of fatherless, martyred, veteran, and ordinary (7-12 years old).
Materials and methods: This research is a retrospective study about mental disorders which is done on children of 591 martyred, deprived, veteran and ordinary children in order to have comparitive study of mental disorders. Tools of study includes questionnaries on personal features and questionnaire of children disorder symptom. ÇSÏ-4 statistical analysis were done by t-tests, variasion analysis and shefeh.
Results : Ôbtained results indicate that there is significant difference related to psychological disorders among 4 groups under study (P<0.001). Â comparison between fatherless, martyred’s veteran’s and children revealed that, fatherless and marhyred’s children suffer more from pychological disorders compared to the veteran’s children (P<0.05). Âlso psychological disorders were observed more in fatherless children than martyred’s children (P<0.05). Martyred’s children had more psychological disorders than veteran’s children (P<0.05). The results obtained based on the regression variasion showed some variables in all of the groups under study, (martyred’s veteran’s and fatherless) boys suffered more than girls (P<0.01). Ïn other words, boys are more susceptible to various psychological disorders (ÔR=1.42). Âlso results showed that, in the low economical condition families, children are more at risk of having psychological disorders (ÔR=1.48).
Çonclusion: Çonsidering the rate of psychological disorders among children of martyred, fatherless and veteran as compared to the children from ordinary families, and presence of higher rate of psychological disorders in the father less children as compared to the children of veterans, and presence of higher rate of psychological disorders in fatherless children as compared to the martyred’s children, it is necessary that the hygienic and treatment programmers of the society pay more attention to the primary and secondary prevention of health and hygiene of children from such families.

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Background and purpose : Çhildren with urinary stone disease for longer period of time are at risk of stone recurrence. Ïn two-thirds of the cases medical intervention is mandatory and minimally invasive therapy is advised. The purpose of this research was the evaluate the efficacy and complications of ËSWL in these children.
Materials and methods : Ïn this study 30 patients with renal stones were recruited. Patients with ureteral and bladder stones were excluded. Ïmaging study for diagnosis of renal stons were sonography (23 patients) kidney-ureter-bladder (3 patients) and intravenous pyelography (ÏVP) (4 patients). Âll patients were evaluated for PT, PTT and medical history of coagulophaty. 25 patients had renal stones lesser than 20 mm and 5 patients had stones greater than 20mm. Patients treated with 1200- 2200 shocks (mean1500) and 16-18 KV. Âll patients were evaluated with sonography 2 weeks, 4 weeks and 12 weeks after treatment. Ïn patients with renal stones greater than 2cm a double J stent inserted before ËSWL.
Results : Stones were from 9 to 26 mm in size. (mean 13 mm). 25 patients became stone free (83.3%) after on course of ËSWL. Ïn one patient (3.3%) three courses and in 4 patients (13.3%) 2 courses of ËSWL necessitated for removing of stones. Two cases (6.6%) complicated with steinstrasse one of whome was managed with conservative therapy and in the other TÜL was done.
Çonclusion : Ëxtracorporeal shock wave lithotripsy is effective in the treatment of renal stones in children. Ïn patients with stones greater than 2 cm additional course of ËSWL may be necessary. We recommend that in patients with stones greater than 2 cm insertion of a double J stent can reduce occurrence of steinstrasse. Çomplication of ËSWL in children is very low and no significant morbidity occurs with ËSWL.

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Background and purpose: We can examine the language abilities of a person through five parameters of speech quality including speech fluency, speech complexity, speech exactness, speech rate and lexical accessibility. These parameters are examined by the secondary parameters including mean length of utterance (MLÜ), mean length of five long utterances, mean number of verb in sentence, mean number of bound clause in sentence and richness of vocabulary. We have examined four parameters except the speech exactness in normal Persian children of 4-5 years old in Semnan, Birjand and Tonekabon cities. These parameters were then compared between children.
Materials and methods : 90 children were selected nurseries through testing and they were divided into three groups including 30 subjects from. Âfter examining the children’s speech, they were analyzed and secondary parameters were determined. Finally we compared the results through statistical tests.
Results : Semnani children’s MLÜ of descriptive speech exceeds tonekaboni children. Semnani children’s mean length of five long utterances of free speech exceeds Birjandi children. Semnani children’s mean number of verb in sentence of free speech exceeds Birjandi children, Birjandi and Toneckaboni children’s mean number of bound clause in sentence of descriptive speech exceeds Semnani children. Birjandi children’ richness of vocabulary of free speech exceeds Semnani and Toneckaboni children. Birjandi children’s speech rate of free and descriptive speech exceeds Semnani and Toneckaboni children.
Çonclusion : Dialect contributes to speech quality parameters therefore we must consider them in assessment, diagnosis and treatment of language disorders in children with different dialects.