text:
2020-07-16T18:54:25Z http://ijp.mums.ac.ir/?_action=export&rf=summon&issue=433 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Challenges and New Treatment in Childhood Constipation M Sobhani Shahmirzadi Chronic Constipation is a debilitating condition that is often associated with different abdominal problem. It can cause distress for the child and family and can result in emotional disturbance and family problem.
Based on the current algorhytm, the treatment of chronic constipation consists of 4 important phases, 1: education, 2: disimpaction, 3: prevention of re-accumulation of feces and 4: follow up.
Challenges in treatment are related to many issues:
a) Discussing the importance of problem for parents,
b) Family concern about safety and side effects of drugs,
c) Adherence to long term treatment, which is often crucial but unacceptable by family,
d) Amelioration of withdrawal behavior in toddlers group which don't understand the facts,
e) Planning a appropriate diet for constipation which is again unacceptable by children,
f) Cost of treatment
g) Anismus
Besides of known treatment consist of various drugs:

Biofeedback is one of the approaches that have proven benefits but with less emphasis and introduction, so application of this obsolete method needs further works.
Tegaserod, a selective agonist that acts at 5-HT4 receptors and increases small bowel transit, stimulates intestinal secretion and inhibits visceral afferent responses has proven effective in the treatment of chronic constipation in adults.
 In children with hard stools, 5-HT4 agonist might benefit children with constipation and tendency to form hard stools, and large rectal masses. The role of this promising new agent in pediatric constipation has to be established in future studies.
Pre and Probiotics:
 Non-digestible oligosaccharides consist mainly of fructooligosaccharides (FOS). FOS reduces fecal pH, increases the water, holding capacity of stool and fecal weight and decreases intestinal transit time. Furthermore, it has prebiotic effects by selectively stimulating the growth of probiotics bacteria, such as bifidobacteria.
Surgery:
If conventional therapy (dietary advice, toilet training, Oral and rectal laxatives in combination with behavioral therapy) fails, surgery may then be considered. However it is well known that current surgical approach have significant associated morbidity. An alternative surgical approach to constipation might be sacral nerve stimulation.
 Oral Presentation N 1 2014 04 01 1 1 http://ijp.mums.ac.ir/article_2439_449920fabc22448de0361d7f47b84eb6.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Clinical Protests Food Allergy in Children P Ataei The best recognized intestinal manifestation of food allergy is food allergic (food-sensitive) enteropathy. The feature of enteropathy may include lymphocyte and plasma cell infiltration, epithelial abnormality, or crypt hyperplastic villous atrophy, and impairing absorption, enterophaty continues while the food remains in the diet, remitting on an exclusion diet, and usually recurring on food challenge. Diagnosis is now usually based on histological features at initial biopsy and clinical response to antigen exclusion and challenge. Clinical findings in food allergic enteropathy include abdominal distension, loose stools, micronutrient deficiency, and rarely protein-losing enteropathy. There may be other features of allergic disease, most commonly eczema unlike coeliac disease, food allergic enteropathies are usually transient in early life, and later challenge is usually tolerated. Cow's milk-sensitive enteropathy (CMSE) was the first recognized food allergic enteropathy and remains the most common cause.
The best-characterized syndrome is CMSE, classically presenting with chronic loose stools and failure to thrive, often beginning after an episode of gastroenteritis in a formula-fed infant. Other clinical features include abdominal distension, perianal erythema or napkin rash (due to malabsorbed dietary carbohydrates), and deratographia. Associated clinical features may include colic, gastroesophageal reflux, rectal bleeding, or eczema. There may be evidence of micronutrient deficiency, notably for iron and zinc. Up to 40% of infants with classic CMSE also sensitize to soy, often after an initial period when it is tolerated. The great majority however settle on extensively hydrolyzed formulate. Classic CMSE is usually self-limiting, with most children tolerating reintroduction at the age of 2 to 3 years. By contrast, some children may have persistent low-grade symptoms for a prolonged period. A proportion of children manifest additional immediate reactions to food antigens, such as rash, urticaria, angioedema, or anaphylaxis. However, many children suffer enteropathy without immediate reactions, and it is important to recognize that food allergic entropathy often occurs in the absence of systemic signs of food allergy. Thus, skin prick tests may be negative and specific IgE undetectable. Review of growth records in classic CMSE often shows a period of good weight gain prior to the onset of symptoms, followed by downward drift against the centiles until antigen exclusion is adequate. This presentation probably represents the loss of initially established oral tolerance.
 Oral Presentation N2 2014 04 01 2 2 http://ijp.mums.ac.ir/article_2440_3f62a252a9acde811c8f0a693d2bf128.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Role of Probiotics and Prebiotics in Functional Gastrointestinal Disorders in Children M Sabbaghian Introduction:
Functional gastrointestinal disorders (FGID) are non-fatal, unknown etiology disorders with absence of a structural or biochemical explanation and accounting for up to 50% of gastroenterology referrals.
Infant regurgitation, rumination and cyclic vomiting constitute the vomiting disorders. Abdominal pain disorders are classified as: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain, abdominal migraine and aerophagia. Disorders of defecation include: infant dyschezia, functional constipation, functional fecal retention and functional non-retentive fecal soiling.
Current researches suggest a role of gut microbiota in pathogenesis of FGID and qualitative and quantitative alterations in the normal gut flora in some functional disorder such as IBS, chronic constipation and formula-fed infants which suffering colic or regurgitation have been described.
Probiotics are nonpathogenic microorganisms, when they are ingested, have positive effects on the host's health. They influence intestinal physiology by different ways. Prebiotics are non-digestible carbohydrates which promote the growth and/or activity of probiotic bacteria.
Evidences for the therapeutic or preventive effect of particular probiotic strains with or without prebiotics in FGID are available in many of articles. Results are encouraging in symptomatic alleviation and improvement in quality of life in IBS, functional constipation, functional abdominal pain, infantile colic, aerophagia and infantile regurgitation.

Conclusion:
Different probiotic strains have different effects, so selection of strains with specific health benefits is important. In general according to review of articles, although some of specific probiotic strains can provide a health benefit in these disorders, it seems, more high-quality and long-duration placebo-con-trolled trials are required.

Keywords: Functional gastrointestinal disorders, Probiotic.
 Oral Presentation N 3 2014 04 01 3 3 http://ijp.mums.ac.ir/article_2441_cec2b4c30087e320a2391dbcb502a723.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Sever Gastrointestinal Caustic Injury and Surgical Treatment A Bazrafshan Approximately 20% of caustic ingestions result in some degree of esophageal injury. Alkaline materials are the most frequent corrosive materials ingested.

The physical form and PH of ingested materials play a critical role in the site and type of gastrointestinal injury (PH > 12 or PH < 1.5, crystalline drain cleaners).
Unlike Alkaline solutions, strong acids are bitter, burn on contact and usually produce vomiting but when swallowed pass rapidly through the esophagus and damage the antrum of the stomach.
I will present the results of 5 cases of gastric out let obstruction after acid ingestion (subtotal gastrectomy and billroth 1) and 4 patients with extensive esophageal damage and perforation ( Total esophagectomy and gastric pull up).
 Oral Presentation N 4 2014 04 01 4 4 http://ijp.mums.ac.ir/article_2442_f6e6bce897ef0bd51c3fee865b6d482b.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Diagnostic Challenges in AIH A Taghavi Ardakani Autoimmune hepatitis is a chronic hepatitis that occurs in children and adults of all ages. Diagnosis is based upon characteristic serologic and histologic findings and the exclusion of other forms of chronic liver disease. Guidelines issued by the AASLD suggest the following diagnostic considerations:
The diagnosis should be made in patients with compatible clinical signs, symptoms, and laboratory abnormalities. Other conditions that can cause chronic hepatitis should be excluded.
In unclear cases a standardized scoring system should be used in the assessment.
In those who are negative for conventional autoantibodies, additional autoantibodies should be sought.
All patients with autoimmune hepatitis and inflammatory bowel disease should undergo cholangiographic studies to exclude primary sclerosing cholangitis.

Scoring systems- A scoring system developed and subsequently revised by the International Autoimmune Hepatitis Group to standardize the diagnosis with using simplified criteria based upon titers of autoantibodies, IgG levels, liver histology, and the exclusion of viral hepatitis.
Autoantibodies: assign one point if the ANA or SMA are 1:40 OR assign two points if the ANA or SMA are ≥1:80 (OR if the LKM ≥1:40 OR if the SLA is positive).
IgG: assign one point if the IgG is > the upper limit of normal OR assign two points if the IgG is >1.10 times the upper limit of normal.
Liver histology: assign one point if the histological features are compatible with autoimmune hepatitis OR two points if the histological features are typical of autoimmune hepatitis.
Absence of viral hepatitis
A probable diagnosis of autoimmune hepatitis is made if the total points are six, while a definite diagnosis is made if the total points are ≥seven.
 Oral Presentation N 5 2014 04 01 5 5 http://ijp.mums.ac.ir/article_2443_f66b6d43ad5f9df3e21b13523dfb0602.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Pediatric Liver Transplant SM Dehghani The goals of post-transplant management are to manage and treat postoperative complications, and develop a balanced long-term immunotherapy regimen that minimizes infection and side effects but controls rejection. While modern immunosuppressant regimes have reduced rates of graft loss due to rejection, they impart major risks for infection, growth failure, metabolic complications, and malignancy. There is significantly more post-transplant morbidity and mortality from infection than from rejection, particularly in infants. This has led to a trend toward minimization of immunosuppression, which is supported by evidence that some rejection facilitates graft tolerance and thus is not necessarily always harmful.
Post-transplant complications are divided into those that occur in the first 3–12 months ("early"), and these are relatively common, and those occurring after 12 months ("late"), which are generally uncommon. Most "early" complications relate to surgical issues, and/or immunosuppression, most notably infection, vascular complications of the graft, and biliary leaks. Infection is the most common cause of post-transplant mortality. Rejection does occur but usually responds to treatment with steroid pulse dosing, and appears not to contribute to either graft or patient mortality. "Late" complications include biliary strictures, which are uncommon and generally respond to percutaneous biliary dilatation and stent procedures. Most late complications are primarily related to the effects of long-term immunosuppression, notably infections such as EBV and associated PTLD, and side effects of immunosuppression such as renal dysfunction, hypertension, and immune dysregulation.
 Oral Presentation N 6 2014 04 01 6 6 http://ijp.mums.ac.ir/article_2444_6bc04c59c626257ac2972fc0ddbb6df0.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Refractory Celiac Disease K Khatami Refractory celiac disease (RCD) is when malabsorption symptoms and villous atrophy persist despite strict adherence to a gluten free diet (GFD) for more than 12 months and other causes of villous atrophy have been ruled out. RCD is considered a rare disease and almost exclusively occurs in adults. Persistent diarrhea, abdominal pain, weight loss are the most common symptoms in RCD. Also, anemia, fatigue, malaise, thromboembolic events and coexisting autoimmune disorders are frequent.
Diagnosis of RCD is based on other causes of unresponsiveness to the GFD, particularly collagenous sprue, ulcerative jejunitis, and enteropathy-associated T-cell lymphoma. Many disorders such as autoimmune enteropathy, tropical sprue, common variable immunodeficiency, and intolerance to non-gluten dietary proteins may have similar histological findings but not necessarily identical with CD and therefore should be excluded. Repeat intestinal biopsy may help to differentiate causes of non-responsive CD associated with ongoing villous atrophy (e.g., gluten contamination, small-bowel bacterial overgrowth, RCD).
There are 2 subtypes of RCD according to absence (type I) or presence (type II) of an abnormal intraepithelial lymphocyte population. RCD type 1 usually becomes better with a combination of aggressive nutritional support, adherence to GFD, and pharmacologic therapies such as prednisone, budesonide and azathioprine. For RCD type 2, more aggressive therapeutic approach is needed since clinical response to therapies is less certain and may evolve into aggressive enteropathy associated T-cell lymphoma and the prognosis is poor.

Key words: Celiac Disease, Refractory.
 Oral Presentation N 7 2014 04 01 7 7 http://ijp.mums.ac.ir/article_2445_568123f1fd9e945302f2fea610933be4.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Treatment of Helicobacter Pylori in Children F Famouri Childrenwith Helicobacter infection need treatment. The aim of treatment is elimination of H.Pylori. Most patients with this infection are asymptomatic and without peptic disease. Treatment and management of these patients are controversy.
Conventional Treatment:
The best treatment for H. pylori eradication regimens should have cure rates of at least 80%,
be without major side effects, and induce minimal bacterial resistance. Antibiotics alone have not achieved this. Luminal acidity influences both the effectiveness of some antimicrobial
agents and the survival of the bacteri; thus antibiotics have been combined with acid suppression such as proton pump inhibitors (PPIs), bismuth, or H2 antagonists. The "classic" regimen is treatment twice daily for 7 days with a PPI and clarithromycin plus either amoxicillin or metronidazole Bismuth has been used in the treatment of peptic ulcer disease and 1 part o quadruple therapy for H.Pylori but compliance of children for it is low.

Sequential Therapy
 Sequential therapyinvolves dual therapy with a PPI and amoxicillin for 5 days followed sequentially by clarithromycin, Tinidazole and omeperazole for 5 days or other triple therapy for 7 days. This treatment has had 97% efficacy.

Adjunctive Therapies
A number of studies have showed the potential benefits of probiotic therapy in H. pylori treatment regimens.Consumption of these drugs accompanied with other medications increase H.Pylori eradication.

 Oral Presentation N 8 2014 04 01 8 8 http://ijp.mums.ac.ir/article_2446_7a5d15e0f70a0c7c482c0f0bf594a739.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Maintaining Respiratory Health in Cystic Fibrosis Patients MR Modaresi Cystic fibrosis (CF) is an inherited disease that primarily affects the lungs and the digestive system, however, it also affects a number of other organs and systems. More than 90% of mortality of CF patients is due to lung complications. Healthy lungs are important for a long life for people with CF, We will discuss two important topics for maintaining respiratory health.
Chronic use of drugs for maintaining respiratory health
There are a number of drugs available to keep CF lungs healthy. We will discuss the science behind the recommendations for use of:
Inhaled antibiotics
Dornase alfa
Azithromycin
Hypertonic saline
High-dose ibuprofen
Ivacaftor
CF Airway Clearance Therapies
Airway Clearance therapy is very important to keeping CF lungs healthy. Our discussions cover the following topics such as the:
Daily airway clearance
Different techniques of airway clearance
Effect of aerobic exercise on airway clearance
 Oral Presentation N 9 2014 04 01 9 9 http://ijp.mums.ac.ir/article_2447_f775f64f76a66d7bed5b26f8eca7ab70.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Prebiotic and... _ Hashemi Prebiotic: A nondigestible food ingredient that benefits the host by selectively stimulating the favorable growth and/ or activity of 1 or more indigenous prebiotic bacteria.
Prebiotics can modify the intestinal flora and interact with the immune system of the host against specific pathogens. However clinical trials are currently limited and a beneficial effect of prebiotic in treatment acute diarrhea is still lacking. Prebiotics is not helpful to prevention of diarrhea. there is a paucity of data on the use of Prebiotics in the prevention of ADD (antibiotic – associated diarrhea).
Probiotic: An oral supplement or a food product that contains a sufficient number of viable microorganisms to alter the micro flora of the host and has the potential for beneficial health effects.
Result of published randomized controlled trials (RCT) have indicated that there is modest benefit of giving probiotics in preventing acute gastroenteritis but have good therapeutic benefit in treatment of acute diarrhea. LGG is the most effective. Probiotics also more effective when given early in the course of diarrhea and are most helpful for otherwise healthy children with watery diarrhea secondary to vial gastroenteritis but no invasive bacterial infection. Probitic can be use to reduce the incidence of ADD specially when started in initiate of treatment. Probiotics is associated with a significant reduced risk of diarrhea lasting more than 3 days.
 Oral Presentation N 10 2014 04 01 10 10 http://ijp.mums.ac.ir/article_2448_7c2c8aecb4cdeb1090326b954c29eb9a.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Autoimmune hepatitis F Motamed Autoimmune hepatitis is (AIH) is a chronic hepatitis that occurs in children and adults of all ages. It is characterized by immunologic and autoimmune features, including circulating auto antibodies and high serum globulin concentrations. It was first described in the 1950s by term of chronic active hepatitis. It has 2 types with different auto antibodies.
Diagnosis is based upon serologic and histologic findings and exclusion of other forms of chronic liver disease.

A scoring system should be used in assessment based upon:
1) Auto anti bodie titer
2) Serum IgG level
3) Liver histology
4) Absence of viral and other causes of hepatitis.
Clear indications for treatment:
1) rise of aminotrasferases
2) clinical symptoms of liver disease
3) histological features in liver biopsy
4) Children with AIH initial treatment involve glucocorticoid with or without azathioprine. For patients with fulminant hepatitis liver transplantation, should be kept in mind.

Remission is defined by:
1) Resolution of symptoms
2) Normalization of serum trasaminases
3) Normalization of serum bilirubin and gamma globuline levels.
4) Improvement in liver histology
5) Treatment is continued for at least 2-5 years, glucocorticoids are with drawn first, by tapering over six weeks. Azathioprine will be with drawn.
 Oral Presentation N 11 2014 04 01 11 11 http://ijp.mums.ac.ir/article_2449_d502409b33be090b9d9aa150459f23c5.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Distinguishing Functional Constipation from Organic Causes in Children MR Esmaeili
The diagnosis of functional constipation (FC) is usually straightforward. Almost 95% of childhood constipation is functional in nature. The remaining 5% can be attributed to wide variety of conditions. Many of these etiologies are obvious by history and examination and many have other specific symptoms besides constipation. It is especially important to look for presence of any symptoms or signs that might suggest an organic etiology (red flag).
FC can usually be diagnosed with a through history and physical examination (Rome III criteria), diagnostic tests are usually not required in most children with FC. Further testing is necessary when an organic etiology is suspected children who do not seem to respond to conventional treatment should have blood tests to look for organic etiologies such as hypercalcemia, hypothyroidism and celiac disease and children suspected of having Hirschsprung disease should have an evaluation consisting of anorectal manometery, barium enema, rectal biopsy. Oral Presentation N 12 2014 04 01 12 12 http://ijp.mums.ac.ir/article_2450_49f3c41eeaa96c3f4cee91e862ad02db.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Effects of Probiotics and Prebiotics in Inflammatory Bowel Disease V Modaresi Inflammatory bowel diseases (IBD) including most important forms; Crohn's disease (CD) and ulcerative colitis (UC); are chronic diseases affecting the gastrointestinal tract with unclear etiology and pathology. The role of gut microbiota has recently been considered as major a factor, since altered microbiome or "dysbiosis" is a key player in the protracted course of inflammation in IBD.
However, despite of new treatment program IBD is still in difficult managing disorders. Although, biologics have revolutionized the treatment of IBD recently and probiotics and prebiotics have provided some clues in developing a new class of therapeutic agents for the treatment/ prevention of IBD. Probiotics are living microorganisms with good tolerability and minimal risk, which confer a health benefit for the host when administered in adequate amounts. Their effect is closely related to maintaining the natural function of the intestinal flora. Probiotics and prebiotics could be used in prevention and therapy of many disorders of gastrointestinal tract including inflammatory bowel diseases.
VSL#3 for example, is a mixture of various strains of lactic acid bacteria and bifidobacteria at a concentration of 450 billion microorganisms per sachet and has been proven effective in several IBD trials.
Here we review advances in our understanding of microbial involvement in IBD pathogenesis over the past years and offer insight into how this will shape our therapeutic management of the disease in the coming years.

 Oral Presentation N 13 2014 04 01 13 13 http://ijp.mums.ac.ir/article_2451_80dc330a3e0fbea5e1599f52655bea67.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Treatment of Functional Constipation H Karami Childhood constipation is ofton a long_term problem requiring treatment over months or years. There is no single treatment metod for constipation and many children do not respond and continue to have chronic problems. Treatment is consisted of: Disimpaction,Drug adminstration , Diet modilation, and behaverial therapy. It is necessary in all cases that not responding to conventional therapy, un diagnosed organic causes, non proper drug, short course therapy, behaverial disorder and withholding should be considered. Internal anal achalasia, Neural tube defect, Neurointestinal dysplasia. and food allergy are the most important predisposing factors in treatment failer . PEG is drug of choice for treatment and therapy must be continued for several months or years. Psycologic consulting should be considered in patients with severe behaverial disorder.

Key words: Children, Functional Constipation, Treatment. Oral Presentation N 14 2014 04 01 14 14 http://ijp.mums.ac.ir/article_2452_d4d4086f89db36efb52cc4b194ec6a7a.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Management of Food Allergy Sh Maleknejad Although food allergy is a major public health problem, currently there is no effective and safe treatment except to avoid the foods .But the need for new options is critical now as the number of children diagnosed with food allergies rises. Avoiding the offending allergen in the diet is the primary treatment of food allergy. Once a food to which the patient is sensitive has been identified, the food must be removed from the diet. People with severe food allergies must be prepared to treat an anaphylactic reaction. These individuals also always should carry a syringe of adrenaline (epinephrine [EpiPen]), and be prepared to self-administer it if they think they are developing an allergic reaction.
Several medications are available for treating the other symptoms of food allergy. For example, antihistamines can relieve gastrointestinal symptoms, hives, sneezing, and a runny nose. Bronchodilators can relieve the symptoms of asthma. They are not effective, however, in preventing an allergic reaction when taken prior to eating the food. In fact, no medication in any form is available to reliably prevent an allergic reaction to a certain food before eating that food.Novel therapeutic approaches to food allergy can be classified as food allergen-specific therapy(immunotherapy with native or modified recombinant allergens, or oral desensitization) or food allergen-nonspecifictherapy (anti-IgE, traditional Chinese medicine).

Key Words: Children, Food Allergy, Management.
 Oral Presentation N 15 2014 04 01 15 15 http://ijp.mums.ac.ir/article_2453_3eb8139ac4f15f32a3debb46816bd3d8.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Endocrine-Manifestations of Cirrhosis and Liver Disease M Khalili The liver is involved in the synthesis and metabolism of many kinds of hormones, various abnormalities hormone levels are found in advanced liver disease. For example the liver is, extremely sensitive to changes in insulin or glucagon levels. The liver is the primary organ of iron storage is frequently involved, diabetes is common in patients with iron overload and may be seen in cirrhosis.
Chronic infection with HCV is associated with insulin resistance. Thyroid disease often accompanies chronic hepatitis C infection .Anti thyroid autoantibodies are also found in chronic HCV infection. Nonalcoholic liver disease (NAFLD)as a most common cause of chronic liver disease in western world ,as well accompanied by Type 2 diabetes and hyperlipidemia. Hypopituitarism and hypothyroidism also have been in NAFLD.The patients with NAFLD and Hypopituitarism may be susceptible to central obesity, dyslipidemia and insulin resistance leading to disease progression. Hepatic cirrhosis as the end stage of chronic liver disease is also associated with hypogonadism and signs of feminization. The peripheral metabolism of steroids is altered in many of hypogonadism, low testosterone level decreased libido, infertility, reduced secondary sex hair and gynecomastia, reduced spermatogenesis and peritubular fibrosis are found in men with cirrhosis .The normal function of the hypothalamic-pituitary gonadal axis is affected in liver disease. In cirrhotic patients the estrogen/androgen ratio is usually increased, the level of testosterone and dihydroepiandosteron are reduced while the estradiol level are normal or slightly elevated, these alterations are dependent on the severity of the liver disease.Succsesfull orthotropic liver transplantation leads to improvement of the sex hormone disturbances.
The pathogenesis of gynecomastia is due to the loss of equilibrium between estrogen and androgen caused by a feminizing state but it is due to increased estrogen precursor in cirrhosis. Here it reviews some endocrine-manifestations related to cirrhosis and the liver disease.

 Oral Presentation N 16 2014 04 01 16 16 http://ijp.mums.ac.ir/article_2454_b2df11c8a1359b31d9b01824d9ab8acd.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Moral Considerations in Pediatric Food Allergies M Shoaran Food allergies are common health problem among children. They carry a significant risk of severe allergic reactions. These disorders are chronic conditions in which the immune system becomes hypersensitive to some food products. It is estimated that 8% of children under the age of three have a type of food allergy. The common allergenic foods include cow's milk, wheat, peanuts, egg, soy and fish.The mainstay of treatment is to eliminate the allergenic food from the patient's diet which in case of a child mandates special behavioral and ethical problems. Considering the growing incidence of food allergy, and the risk of anaphylaxis, diverse moral-ethical challenges face parents, school administrators and health professionals.
Older children have the right to keep the fact of their disease private and this is a matter of their autonomy and may be an effort to prevent stigmatization by other students followed by psychosocial discomfort.Some moral & ethical principles in implementing management guidelines for allergic children include:
-Imagine if the patient was your own. What level of protection would you expect for him/her?
-Do protective policies cause the child to be isolated from others?
-Are medical recordings confidential?
-Avoid unduly limiting the diet of these children.
A certain scenario is an infant with cow milk allergy. In this condition specific consideration should be paid to the mother's nutritional status when a dietary elimination strategy is to be implemented.
Considering the costs /benefits of diagnostic and therapeutic measures in food allergic children is recommended.
 Oral Presentation N 17 2014 04 01 17 17 http://ijp.mums.ac.ir/article_2455_3effc47d30e205a076607e009553a461.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Healthy Diet for Fatty Liver in Children M Nematy SS Khayyatzadeh Manshadi Introduction:
Non-alcoholic fatty liver disease (NAFLD) has become the most common cause of liver disease worldwide. It has been suggested that dietary composition plays a role in NAFLD pathogenesis; thus, changing dietary patterns may constitute a therapeutic resource even in the absence of weight reduction. The aim of this study was to identify the characteristic of suitable dietary pattern in patients with NAFLD.
 Materials and Methods
ISI, Medline, Scopus, Google Scholar and text books were reviewed for suitable diet in children's fatty liver.
Results:
Two major dietary patterns- healthy and unhealthy- were seen. The healthy dietary pattern was associated with lower incidence of non-alcoholic fatty liver disease while the Western dietary pattern was associated with higher NAFLD. Patients with NAFLD had higher carbohydrate intake.
Conclusion:
A healthy dietary pattern was associated with lower risk of NAFLD whereas a Western dietary pattern was associated with higher risk of NAFLD.
Keywords: Diet, Non- Alcoholic Fatty Liver Disease.
 Oral Presentation N 18 2014 04 01 18 18 http://ijp.mums.ac.ir/article_2456_785e7a2f5a4ab4a79c8cbcc7338868f4.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Diagnostic challenges in celiac disease M Haghighat
1-The most important challenge in diagnosis of celiac disease is not- performing the diagnostic tests in suspected persons. Because of multi-organ damage and multiple manifestations of disease, diagnosis of celiac disease may be delayed. It seems general physicians should be awared about uncommon presentations of disease and indications of celiac tests
2-The second most important challenge is in patients with suspected disease but negative serologic tests. In these cases evaluating of HLA can be useful.
3- The third challenge is in cases with positive serologic tests but negative histopathological findings. There may be false positive serologic response or consumption of gluten before testing. We recommend introduction of gluten for at least 3 mo and re- endoscopy and if diagnosis is equivocal HLA-typing for DQ8 and DQ2 should be done.
4-The forth challenge is about performing endoscopy. Based on guideline from ESPGHAN if there are typical clinical manifestations of celiac disease, Anti-TTG more than ten times UPN , positive Anti-EMA and HLA DQ2, performing endoscopy may not be necessary, but many physicians don't agree with this idea.
5-In people who are genetically predisposed to celiac disease antibody levels may be fluctuating thus endoscopy with biopsy should be done in these patients.
6-In children lower than 2years, Anti- TTG and Anti –EMA have low sensitivity. we recommend Anti-TTG and Anti-DGP in these patients.
7-Resolution of symptoms after gluten free diet is not necessarily a feature of celiac disease. This condition may be seen in patients with IBS or non-celiac gluten sensitivity.
 Oral Presentation N 19 2014 04 01 19 19 http://ijp.mums.ac.ir/article_2457_721d5437b99dd48c09bedf65840e7f65.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Prevalence of Gastroesophageal Reflux during First Year of Life in Infants Admitted in Pediatric Department of Imam Reza Hospital-Mashhad MH Amirian S Kouzegaran A Hamedi Introduction:
Gastroesophageal reflux (GER) is the most common of esophageal disorder in all ages. GER defined as passage of gastric contents into the esophagus, and GER disease (GERD), (symptoms or complications of GER), are common pediatric problems. Clinical manifestations of GERD in infants include regurgitation, irritability, choking, gagging vomiting, poor weight gain and respiratory disorder. The purpose of this study is evaluation prevalence of Gastroesophageal reflux and its symptoms in infants during first year of life.

Materials and Method:
This study was performed on 75 infants younger than one year old, who were admitted in pediatric department of Imam Reza Hospital in Mashhad during 3 months.

Results:
In this study in a three- month period, GER was assessed in 75 infants younger than one year who were admitted in pediatric department of Imam Reza Hospital. Their parents reported GER in 66% of these infants. The most common symptom of reflux was regurgitation. Regurgitation was reported at least once a day to seven times a day. The other reported symptoms were respectively: irritability (16%), choking (10%), and failure to thrive (0.3%). Peak reported regurgitation was 60% at 3.5 months.

Conclusion:
Gastroesophageal reflux is a common problem in infancy. Complaints of regurgitation are common during the first year of life. So understanding the symptoms of GER and recognition of GERD should be considred.

Keyword: Infant,Gastroesophageal Reflux, Prevalence. Poster Presentation N1 2014 04 01 20 20 http://ijp.mums.ac.ir/article_2461_f96b352fcabe2eb7dcc7ce21a20b23bb.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Iron and Multivitamin Supplements in Children and its Association with Growth rate M Saeidi R Vakili A Khakshour H Taghizadeh Moghaddam MA Kiani Introduction:
Vitamin deficiency and iron deficiency anemia are common nutritional problems, at least in children under 5. These materials shortage, especially in the first two years of life, impair physical and brain growth, reduces the child's learning ability, reduces body resistance against infections, behavioral changes, apathy and finally social and economic adverse consequences would be followed. This study aimed to determine the supplements used in children under two years and its Association with Growth rate in Mashhad City.

Materials and Methods:
In this cross-sectional descriptive study, 300 children 6 to 24 months were recruited in health centers in Mashhad, Data was collected from mother and and children' records and valid and reliable questionnaire was used to collect data. The data was analyzed by statistical tests and SPSS 11.5 and P
Results:
Results showed that 13.7 percent of families were with low income, 82.7 percent middle income and 3.7 percent well income. In growth chart, 86.7 percent of children showed appropriate growth, 10.3 percent had delayed growth and 3 percent had horizontal growth curve .In 80.7 percent of families, maternal multivitamin and iron drops have been used to their children regularly, 1.7 percent did not believe in these supplements and 17.7 percent of mothers sometimes used these supplements for their children. Results also showed statistical correlation significant variables of parental education, family income, mothers referred to health centers for monitoring the growth and get face to face training of personnel center drops of multivitamin with iron and growth status of children variable is available, so children who regularly have used supplements and income level and above are literate parents have grown more favorable than the other kids (P<0.05).

Conclusion:
Regarding the importance of iron and multivitamin use in children under two years, necessary training must be provided to mothers in this field by health centers personnel. Meanwhile, it is recommended that the authorities must distribute periodical and enough drops to health centers.

Keywords:Children, Iron, Multivitamin, Growth rate, Supplements.
 Poster Presentation N2 2014 04 01 21 21 http://ijp.mums.ac.ir/article_2475_0dfa060a8c54d59932a2a6b6ffda47cd.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Congenital Rickets: Report of Four Cases R Vakili M Saeidi P Eshraghi A Ataei Nakhaei S Vakili A Khakshour Introduction:
Vitamin D deficiency and rickets continue to be health problems in developing countries and most of the infants with congenital rickets may present with hypocalcemic seizure.

Case Report:
In this article, the report on four infants who presented with hypocalcemic seizures but subsequently were found to have congenital rickets is presented. All of them had hypocalcaemia and low level of serum 25- hydroxy vitamin D. Their mothers had not received vitamin D supplementation during pregnancy and so evidence of vitamin D deficiency was presented.

Conclusion:
Although current vitamin D supplementation guidelines for infants was effective in prevention of rickets in Iranian children, it is necessary to evaluate women before pregnancy to prevent this entity. Also infants without vitamin D supplementation therapy who present with seizures during the first 6 months of age should undergo biochemical and other investigations for rickets.

Keywords:Congenital rickets, Vitamin D deficiency, Hypocalcemia, Seizure.
 Poster Presentation N3 2014 04 01 22 22 http://ijp.mums.ac.ir/article_2474_d258fcff2b7241a5849f9135dbac7860.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Determinants of Nutritional Status in Children living in Mashhad, Iran T Shafieian LA Latiff MH Soo Lee M Mazidi M Ghayour Mobarhan G Tabatabaei G Ferns Introduction:
Children are one of the most vulnerable groups to sub-optimal nutritional intake in most societies. We have investigated some of the potential determinants of malnutrition in children of 2-5 years of age.

Methods and Materials:
A cross sectional study was conducted to determine the relationship between nutritional status (weight for age, height for age and weight for height) and dietary and socioeconomic factors in 671 children (24-59 months of age) from selected health centers in Mashhad city, Iran. Children were assessed for weight and height and the care givers were interviewed and a questionnaire was completed by the interviewers. The data were analyzed using SPSS13 software and the Z-scores were calculated using the WHO anthropometric software package.

Results:
The study showed that 24.4% of children were mildly underweight, 4.3% were underweight, 13% were mildly stunted, 23.6% of children were mildly wasted and 3.1% were stunted. Educational attainment, whether the children had been breast feed, average daily consumption of milk, feeding practices and type of first food were found to be the main factors determining nutritional status in our study.

Conclusion:
A higher daily consumption of milk, lower age at which first solid food was started; lower age for consumption of meat and good feeding practices may resolve malnutrition in this population. These findings support the need for a family-based prevention program that focus on guiding parents to foster appropriate feeding practices as well as to promote healthy food intake in the children. Future research should determine the cost-effectiveness of both short- and long-term interventions for child malnutrition.

Keywords:Malnutrition Prevention, Nutritional Intake, Nutritional Status, Preschool Children.
 Poster Presentation N4 2014 04 01 23 23 http://ijp.mums.ac.ir/article_2476_bfcd717e6336c40726c8c9ebb035d01d.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Status of Hepatitis B Immunization in Medical Stuffs at Children Medical Center Hospital-Tehran M Najafi F Motamed E Kiani A Khakshour M Saeidi Introduction:
Hepatitis B is a disease caused by the hepatitis B virus (HBV), which is transmitted through percutaneous (i.e., puncture through the skin) or mucosal (i.e., direct contact with mucous membranes) exposure to infectious blood or body fluids. HBV can cause chronic infection, resulting in cirrhosis of the liver, liver cancer, liver failure, and death. Persons with chronic infection also serve as the main reservoir for continued HBV transmission.

Material and Methods:
This is a prospective cross sectional study was performed in Children Medical Center Hospital on 396 medical personals (including 172 students, 92 interns, 56 residents and 56 fellowships) during September 2012 to October 2013.

Results:
All of medical staff had done HB vaccination. In 93% of them the vaccination was complete. The others, 16% had only one, and 84% had two dose injections. 73% didn't check HBsAb after vaccination. Results showed in 21.4% of fellowships, 42.8% of residents, non of interns and 35% of students, had checked HBsAb.

Conclusion:
Hepatitis B is a vaccine-preventable disease. HB is a serious world wide infection and medical staff are one of the most high risk groups. So Vaccinate their and HBS Antibody titer determination after complete vaccination is mandatory.

Keywords:Immunization, Hepatitis B, Medical Staff, Vaccination.
 Poster Presentation N5 2014 04 01 24 24 http://ijp.mums.ac.ir/article_2477_0b011ec1cc6e51d9c5d3845a045b7aeb.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Effect Supermint oil (peppermint oil) on Patient Satisfaction and the Colonoscopy team during Colonoscopy MA Kiani M Sabbagh M Najafi A Khodadad A Khakshour HR Kianifar SA Jafari M Ghayour Mobarhan M Saeidi Introduction:
Colonoscopy is an invasive method that is painful for patient especially for children. The objective of this research was investigation into the effect of supermint oral drop (peppermint essence) on the patient and colonoscopist group satisfaction during colonoscopy.

Material and Methods:
In this clinical trial study, 101 children candidate colonoscopy (7-14 years old) in children's medical center were randomly divided into two groups, case (n=51) and control (n=50) respectively. Control group received placebo and about half an hour before the colonoscopy control group case group was administrated 20 oral drops Supermint oil (peppermint oil). A standard questionnaire was filled after the colonoscopy for satisfaction of the patient and colonoscopist group. Data were analyzed using SPSS version 11.5 (T-test and Corraletion).

Results:
Two percents in control group and 54.9% in case group have a great degree of satisfaction. Besides, degrees of satisfaction in case group was 64.7% that significantly difference with those of control group (2%) P<0.05). Mean value of pain, duration of colonoscopy in control group was 5/60+1/85 and in case group was 4/20+1/70 and this difference was significant (P<0.05).

Conclusion:
The results of this study showed that drop Supermint oil on pain relief have a positive influence in during colonoscopy in children, so peppermint essence causes increase in satisfaction in both patient and colonoscopy group.

Key words: Colonoscopy, Peppermint, Pain, Supermint.
 Poster Presentation N6 2014 04 01 25 25 http://ijp.mums.ac.ir/article_2478_b39178a5aa42226890efbfb0e4d1d4b6.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 The Effect of Music on Pain, Anxiety and Vital Signs of Children during Colonoscopy M Najafi F Motamed MA Kiani M Sabbagh P Attaei M Ghayour Mobarhan M Saeidi A Vakilian A Javan Introduction:
This study aimed to investigate the effect of music on pain, anxiety and vital signs in children undergoing colonoscopy.

Method and Materials:
This randomized study was carried out on 101 children (7 to 14 years old) requiring colonoscopy. Children were randomly allocated to a control or case group. The case group was played relaxing music (by Clayderman) during the procedure. Spiegelberger and pain questionaires were administered immediately after the colonoscopy. Pulse rate, blood pressure and percent blood oxygen saturation were recorded for each subject. The control group was treated in an identical manner, but was not played music during the procedure. Data were analyzed using SPSS software.

Results:
Satisfaction, anxiety, pain, and blood pressure were significantly different between the groups (P<0.05), but oxygen saturation and heart rate did not differ significantly (P>0.05).

Conclusion:
Music can reduce anxiety and pain during colonoscopy.

Key words: Anxiety, Music,Vital signs, Colonoscopy Poster Presentation N7 2014 04 01 26 26 http://ijp.mums.ac.ir/article_2479_39c274083b179cf5bb16bba3c9b6fa4b.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Assesment of Malnutrition in Hospitalized in Iran and Newzeland V Moeeni T Walls SA Day Introduction:
Hospitalized children are often at increased risk of nutritional impairment at or during admission.

Objectives:
The aims of this study were to (1) define the nutritional state of hospitalized children with comparison to healthy children in two different countries and (2) compare and contrast three nutritional risk screening (NRS) tools for hospitalized children in terms of the ease of completion and the validity of scores with comparison to current nutritional status.

Materials and Methods:
Children admitted to two paediatric teaching hospitals located in Iran and New Zealand were enrolled, along with healthy control children from the same communities. Nutritional state was assessed by anthropometry and classified as moderate/severe malnutrition according to WHO criteria. Three NRS tools (Screening Tool for the Assessment of Malnutrition (STAMP), Screening Tool for Risk On Nutritional status and Growth (STRONGkids) and Paediatric Yorkhill Malnutrition Score (PYMS)) were applied to all inpatients and patients classified from low to high risk.

Results:
281 inpatients and 262 controls were recruited in the two countries. The prevalence of moderate/severe under-nutrition in the Iranian inpatient group was 25.2% versus 3% in the control group, respectively (P=0.0001). The rate of under-nutrition in NZ inpatients was 9.9% versus 3.7% in the community group (P=0.04). In contrast, the prevalence of overweight/obesity in the Iranian control group was 22% compared to just 2.5% in the inpatient group (P=0.04), while there was no difference between the two groups in NZ (P=1.0). NRS tools were able to identify most of the malnourished patients in the medium to high risk groups in both countries.

Conclusion:
Hospitalized children have higher rates of under-nutrition than healthy children from the same community. The three NRS tools were able to identify children at nutritional risk, but with differing utility. STRONGkids appeared to be the most useful and reliable tool in both countries.

Key Words: Iran, Hospitalized, Malnutrition, Newzeland.
 Poster Presentation N8 2014 04 01 27 27 http://ijp.mums.ac.ir/article_2480_879def9ffb4f713a45974cf70e964ff5.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Maternal Knowledge and Attitude toward Exclusive Breast Milk Feeding (BMF) in the First 6 Months of Infant in Mashhad-Iran M Saeidi BL Hoseini R Vakili A Khakshour Introduction:
Breast milk is a complete food for growing children until 6 months of age, and mothers, as the most important child health care, play a decisive role in their growth. So promoting their attitude toward the benefits of breastfeeding ensures guarantee child health in the future. This study aimed to assess maternal knowledge and attitude of Mashhad toward exclusive BMF in the first 6 months of infant life.

Materials and Methods:
This cross-sectional descriptive-analytic study was conducted on 126 mothers who referring to Mashhad health-care centers for monitoring their 6-24 month year old infants. They completed questionnaire. Participants were selected by cluster and simple random sampling. Data were analyzed by descriptive- analytic tests and using SPSS 11.5.

Results:
Mean score of maternal attitude toward exclusive BMF was 14.32±5.28 (out of 28) and maternal knowledge score toward advantages of breast milk was 19.59±4.80 (out of 28). The incidence of exclusive BMF in the first 6 months of life study was 73.8%. Child growth was as follows: excellent growth (5.6%) and good growth (42.1%). ANOVA showed a significant difference between parents' education and maternal attitude towards exclusive BMF; whatever higher education of parents, more positive maternal attitude towards exclusive BMF (P<0.05). There was a significant direct relationship between knowledge and attitude (Spearman test, P-value= 0.000& r= 0.4).

Conclusion:
Maternal attitude towards exclusive BMF was moderate. It is essential to plan for mothers by officials in order to promote breast-feeding in the first 6 months of baby's life to enhance positive maternal attitude in this regard.

Keywords:Attitude, Exclusive Breast Milk Feeding, Infant, Mashhad.
 Poster Presentation N9 2014 04 01 28 28 http://ijp.mums.ac.ir/article_2481_81e2183e34a5716230fdb09aee45652a.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 How Probiotic Reduce Symptoms of Irritable Bowel Syndrome? M Khalesi Introduction:
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in children that may lead to anxiety, frequent physician visits and school absenteeism. The aim of this study is to reviewe effects of probiotic for irritable bowel syndrome.

Materials and Methods:
This study review articles about probiotic for irritable bowel syndrome in pubmed and google scholar.

Results:
Multiple etiologic factors were suggested for IBS, including psychosocial factors, altered gastrointestinal motility, malfermentation of food residues and changes in the intestinal micro flora. It is reported that patients with IBS have a great homogeneity in the fecal flora with a decrease in lactobacilli, coliforms and bifidobacteria in comparison to healthy individuals. The beneficial effects of probiotics in IBS could be explained by increasing the mass of beneficial bacteria such as lactobacilli strains in the digestive tract, decreasing bacterial overgrowth in the small bowel. Recently it was also demonstrated that some lactobacilli strains may modulate intestinal pain attacks by inducing the expression of μ-opioid and cannabinoid receptors in the intestinal epithelial cells. Probiotics can also reinforce the intestinal mucosal barrier and normalize the motility of the digestive tract and its visceral sensitivity and reversing the imbalance between the pro- and anti-inflammatory cytokines so that suggested as a therapeutic option for IBS.

Conclusion:
Probiotic has been suggested as a therapeutic option for IBS by modulation pathophysiologic events in these patients.
Keyword: Probiotic, IBS, Children. Poster Presentation N10 2014 04 01 29 29 http://ijp.mums.ac.ir/article_2482_8051a14a0508b720cd27a3de6a2973a9.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Constipation due to Liver Disorder in Iranian Traditional Medicine`s Viewpoint R Choopani M Tansaz M Movahhed M Mokaberinejad M Khodadoost Introduction:
Constipation is one of the most common pediatric disorders.In many cases, there is no anatomic endocrineor metabolic cause in explanation of chronic constipation.More than 85% of them called functional or idiopathic.Constipation is one of the serious disease in Iranian Traditional Medicine. Besides the problem it causes, chronic constipation can be the origin of many disease. That is why, ithas been called Mother of disease.The purpose of this study is to investigate the Constipation in children and the role of other organs such as the liver by view of Iranian Traditional Medicine

Materials and Method:
This study is a review through Iranian traditional medicine references. At first, all the main available traditional books were reviewed. All the data about therapies of vaginal discharge in ITM were collected then classified.

Results:
In traditional medicine different reasons have been mentioned for constipation especially for childrenwhich most of them are similar to etiology in Modern Medicine.Constipation due to liver disorder is one of the causes of constipation.In Iranian Traditional medicine` viewpoint, one of the mechanism for excretion is existence of secreted bile in intestine.If by any reason,measure or quality of its which secreted in intestine through bile changes or if intestinal mucous secretion becomes barrier for absorbing the food,it will caused disorder in excretion and finally will lead to constipation.Well known Iranian Traditional Medicine scientists, has mentioned all reasons for liver disorders and changing quality& quantity of secreted bile .he has mentioned the solutions as well.

Conclusion:
It is hoped that by paying attention to constipation and with advanced clinical research we will be able to explain idiopathic constipation and prepare new ways of treatments for constipation. New researches have approved the effectiveness of these foods and drugs for treating the constipation.

Keywords: Constipation, Children, Liver, Iranian Traditional Medicine. Poster Presentation N11 2014 04 01 30 30 http://ijp.mums.ac.ir/article_2483_cc6b6d515ce2dbc74960bf1959aae78d.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Effect Supermint oil (Peppermint oil) on children's pain during Colonoscopy M Najafi F Motamed MA Kiani A Khakshour M Saeidi SA Jafari P Attaei M Ghayour Mobarhan M Sabbagh A Javan A Vakilian Introduction:
Pain during colonoscopy, especially in children, including the challenges faced by the medical team. The aim of study was investigation the analgesic effect Supermint oil (peppermint oil) on pain in children during colonoscopy.
Methods and Materials:
In this clinical trial study, 101 children (7-14 years old) candidate colonoscopy were randomly divided into two groups, respectively. About half an hour before the colonoscopy case group (n=51) was administrated oral drops Supermint oil (peppermint oil). Patients were filled a pediatric pain questionnaire. In control group (n=50) filled a questionnaire without any administration. Data were analyzed using SPSS version 11.5 and (T-test and Paired sample t-test, Corraletion,Man withney).
Results:
Mean value of pain, duration of colonoscopy in control group was 5/60+1/85 and in case group was 4/20+1/70 and this diference was significant (P<0.05). The comparison of pain, between the two groups was significant ,as in control, frequency of abdominal pain were two times at maximum, but in the case for some patients were more than 3 times(p<0.05). In the case group abdominal pain lasting less than 1 minute and the control group were between 1 to 3 minutes, and this diference were significant(P<0.05).

Conclusion:
We recommend using peppermint oil as a safe, without complications and inexpensive pain medication during child colonoscopy.

Key words: Colonoscopy, Pain, Peppermint, Supermint.
 Poster Presentation N12 2014 04 01 31 31 http://ijp.mums.ac.ir/article_2485_84a6158d51d5f02b86fb07cb629bb5c6.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Enteroaggregative Escherichia Coli (EAEC) in South of Iran P Abbasi M Kargar A Doosti J Mardaneh S Ghorbani-Dalini M Anvarinejad MA Dehyadegari Introduction:
 The aim of the present study was to investigate the presence and the frequency of EAEC as etiologic agent of diarrhea in Shiraz. Enteroaggregative E. coli (EAEC) is increasingly recognized as a cause of often persistent diarrhoea in children and adults in both developing and developed countries, and have been identified as the cause of several outbreaks worldwide.

Materials and Method:
A total of 715 stool samples were collected from patients with diarrhea in Shiraz. Diarrheagenic E. coli were isolated by biochemical tests and culture from 715 stool samples collected from different hospitals. Diarrheagenic E. coli strains isolated from diarrheal stool samples were examined for the detection of the aggR gene by Real time PCR and PCR method.

Results:
In this study, a total of 101 (14.12%) diarrheagenic E. coli were isolated from 715 stool samples collected from different hospitals. Diarrheagenic E. coli were isolated much more frequently in the summer months than other season. Out of these 101 diarrheagenic E. coli identified, 5 were confirmed as EAEC in patient. The high prevalence of EAEC isolates was also found in watery diarrhea.

Conclusion:
We therefore, recommend the routine isolation and identification of EAEC strains from patient with diarrhea in all the clinical laboratories and other pathotype diarrhoeagenic E. coli in Iran.

Keywords: Diarrhea, Enteroaggregative Escherichia coli (EAEC), Real-Time PCR.
 Poster Presentation N13 2014 04 01 32 32 http://ijp.mums.ac.ir/article_2486_189974ff47913e2b08bcf6c6313db3c3.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Principles of Proper Nutrition in Children with Celiac Disease H Khajavikia N Taleschian-Tabrizi
Introduction:
Celiac disease (CD) is a hereditary disorder of the immune system which damages the mucosa of the small intestine caused by gluten consumption(even very small amounts). Villous atrophy, leads to malabsorption, which is due to decreased absorption levels. The first bowel symptoms are seen during the first 2 years of life. Currently, the only treatment is to compliance with a gluten-free diet lifelong. The purpose of this study was to introduce the principles of proper nutrition in children with CD to prevent complications of malabsorption.

Results:
The patients do not tolerate the proteins of cereals in bread such as wheat, barley, black barley and rye. Substituting wheat flour with rice flour, corn and potatoes and using olive oil, sunflower, corn oil and peanut oil for cooking is recommended. Until the disappearance of symptoms, consumption of milk, fat and high-fiber foods should be avoided. Deficiency of folic acid, iron, vitamin B12 and calcium are common. If necessary, iron, folic acid and multivitamin can be used. These children need proper energy according to their personal needs and should have a diet high in protein. Consumption of potatoes, corn, vegetables, fruits, meat, fish, poultry, eggs, dairy and nuts (non- roasted) in any form is allowed. Identifying foods which contain gluten (prepared sauces, sausages, salami, herbal supplements, all canned meat products, crushed barbecue, prepared soups, espresso and coffee , white vinegar, curd, dried milk, pasta, pastries prepared by wheat flour, compote and food supplements) is recommended.

Conclusions:
The identification of substances containing gluten by parents and children, and removal of harmful substances from the diet causes the intestines to quickly begin to rebuild itself.
Keywords: Nutrition, Child, Celiac, Diet. Poster Presentation N14 2014 04 01 33 33 http://ijp.mums.ac.ir/article_2487_7ac9a852e827b4f911526bd3aee88990.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Comparison of Zinc Level between Neonates with Jaundice and Healathy Neonates H Boskabadi Gh Maamouri H Mohsen Zadeh MT Shakeri M Ghayour Mobarhan Introduction:
Neonatal jaundice is the most common cause of hospitalization.Animal study demonstrated a decrease in serum bililrubin level after zinc treatment in hyperbilirubinemic rats. The objective of this study was the investigation of serum zinc level in the neonates with idiopatic .

Materials and Methods:
A case-control study was undertaken on 263 neonates in a neonatal intensive care unit and obstetrics department in Ghaem Hospital, Mashhad, Iran. Health Infants with gestational age more than 35 weeks or with idiopathic jaundice were included to the study. Serum levels of zinc and bilirubin were compared for 114 neonates without jaundice jaundice(control group) and 149 neonates with jaundice (case group) using atomic absorption spectrometry. The maternal and neonatal information were recorded. Data were analyzed using SPSS software, spearman correlation coefficient, and chi-square and Mann-Whitney tests.

Results:
The mean value of the zinc serum level was 1024.74±245.17 μmol/L in the control group and 841.42±211.99μmol/L in the case group (P<0.001). There was no significant correlation between zinc level and factors such as maternal age, multi parity, Mode of delivery, hospitalization and gender of infants (P>0.05). Also, there was no significant correlation between serum levels of Na, BUN, Cr, WBC, platelet, HTC and zinc (P>0.05).

Conclusion:
The level of serum zinc in the neonates with hyperbilirubinemia jaundice was lower than those without jaundice. It seems that zinc has a protective effect. However, more studies are needed for better decision.

Keywords: Laundice, Zinc, Neonate, Hyperbilirubinemia.
 Poster Presentation N15 2014 04 01 34 34 http://ijp.mums.ac.ir/article_2488_c3f56353ecd2504f3dfbffc580d6f151.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Study of Relationship between Hypernatremia in Neonates and Way of Maternal Breast Feeding H Boskabadi M Godarzi M Zakerihamidi F Bagheri Introduction:
The extreme reduction in breast milk intake during the first days of life leads to weight loss, kidney failure and hypernatremia. The aim of this study was to examine the relationship between hypernatremia in neonates and way of maternal breastfeeding in hospitalized infants in Ghaem Hospital of Mashhad.

Materials and Methods:
After obtaining parental consent, 687 infants referred to the neonatal ward and clinic of Ghaem hospital of Mashhad participated in this cross-sectional study. First, complete history of the mother and baby regarding pregnancy and delivery problems, way of breastfeeding, and the first time of lactation beginning were obtained. Then neonates were divided into two groups of normal and hypernatremia (sodium≥150 mg/dl) according to the amount of blood sodium level. Data was analyzed using correlation tests, chi-square, t test and Mann-Whitney tests with SPSS software (version 11.5).

Results:
According to the findings of this study, the average age (P=0.911), Apgar scores (P=0.192), time of the first lactation (P=0.081) and breast feeding duration (P=o.108) showed no statistically significant difference between normal and hypernatremia groups. But the admission weight (P=0.011), times of lactation (P=0.108), breast-feeding status (P=0.001), let down reflex in mother's breast (0.001), kind of nutrition (P=o.oo1), breast filling after childbirth and lactation (P=0.000), and breast softening after breast-feeding (P=0.000), urination frequency (P=0.000), defecation frequency (P=0.000) and duration of maternal hospitalization (P=0.007) showed statistically significant difference between the groups.

Conclusion:
Neonatal weight control, times of lactation, lactation status, breast changes during breast feeding and frequency of urination and defecation may be effective in the early detection of the reduced breast milk intake and the control of the related complications.

Key Words: Breast Feedinf, Breast Milk, Hypernatremia, Neonate, weight loss. Poster Presentation N16 2014 04 01 35 35 http://ijp.mums.ac.ir/article_2489_3835de69afc220b6c13088ff14c99342.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Oral Zinc Supplementation for the Treatment of Acute Diarrhea Sh Gheibi Z Kousehlou Z Sahebazzamani Introduction:
Diarrheal diseases are a serious health problem and important causes of growth retardation and death in the developing world, especially those of prolonged duration. Since diarrhea is constantly found in children with zinc deficiency, very studies supported zinc supplements beneficial on the duration and severity of diarrhea among children. We review the impact of zinc effects on diarrhea in South-West Asia to update the evidences and to assess its effect on the global burden of diarrhea.

Materials and Methods:
We conduct a systematic review through January 2014, for randomized controlled trials relevant to effect of zinc on diarrhea in children. We searched the MeSH terms zinc, acute gastroenteritis and children from various databases of Cochrane Library and PubMed, then clinical trials done in South-West Asia, selected for making written.
Results:
In recent years, several studies have reported the therapeutic effect of zinc supplementation on diarrheal diseases that was beneficial on decreased episode duration, stool output, stool frequency, hospitalization duration. In some countries in West Asia such as Lebanon, Israel, Saudi Arabia and Iran in clinical trials showed a faster improvement in acute gastroenteritis in children less than five years. But in some countries, such as Turkey, this effect was not significant.

Conclusions:
Oral zinc supplementation significantly decreases diarrhea duration and has a greater effect on malnourished children. Zinc supplementation seems to be an appropriate public health strategy, mainly in areas of endemic deficiencies. Global attempts should is increased to support recommended regimen of therapeutic zinc by WHO in all areas.
Keywords: Acute Gastroenteritis, Children, Zinc, South-West Asia.
 Poster Presentation N17 2014 04 01 36 36 http://ijp.mums.ac.ir/article_2490_54f7d91044cba9314060b7c1782217b6.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Diagnostic Accuracy of Polyclonal Stool Antigen for Detection of Helicobacter Pylori Infection in Children E Khodashenas SA Jafari HR Kianifar A Khakshour S Hiradfar N Zabolinejad Introduction: Helicobacter pylori infection has various clinical features. One of the most common presentations of this infection is upper abdominal pain. Complications such as gastritis, gastric ulcer, gastric carcinoma and MALT lymphoma mandate early diagnosis of H.P infection by a low cost and non invasive manner. The aim of this study was to evaluate the diagnostic role of H.P stool antigen detection as a simple and non invasive method for diagnosis of this infection.   Materials and Methods: Upper endoscopy with gastric biopsy was done on all patients between 6 months to 18 years old with upper abdominal pain. Stool test was done by polyclonal anti-h.p antibody. Results of stool Test were compared with results of RUT and histologic examination Results: Overall 110 patients (57 boys,53 girls) were studied, 32 patients were Helicobacter pylori positive and 78 patients were Helicobacter pylori negative based on RUT and histologic examination. Stool antigen testing was positive for 39 patients. Sensitivity and specificity of stool Ag were 100% and 91% respectively. Conclusion: Stool Ag test has high sensitivity and negatity predictive value for diagnosis of Helicobacter pylori infection. Keywords: Helicobacter pylori, Sensitivity, Stool antigen test, Specificity. Poster Presentation N18 2014 04 01 37 37 http://ijp.mums.ac.ir/article_2491_84f84babb2a46af24e10b04e85be7f50.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Children Sedation during Gastrointestinal Endoscopy Comparison of Two Methods E Khodashenas HR Kianifar J Akhondian A Sharifian M Pirozi Introduction: Endoscopy is an invasive and painful procedure in children. Since children can not tolerate pain and stress, sedation is necessary in pediatric endoscopy. The aim of this study was comparison of propofol versus intravenous midazolam for reducing anxiety in children.   Materials and Methods: In this study, 103 patients (2-14 years old) in whom endoscopy was indicated were divided into three groups. In the first group, patients received propofol, in the second group, intravenous midazolam was given and patients in the third group received no sedation. Procedures were performed in the endoscopy room. Heart rate, respiratory rate and oxygen saturation were recorded before and during endoscopy in 1 minute intervals. Tremor, sweating and pain scores were recorded by using Visual Analogue Scale (VAS).   Results: A significant increase in heart rate was documented in all groups (P=0.038). Respiratory rate also increased in all groups. Too Oxygen saturation decreased in the propofol group, but it was not statistically significant (P=0.17). Pain score in propofol group was significantly lower than those receiving midazolam (20±22 vs 50±27, P<0.001). No noticeable side effect was seen in the propofol group.   Conclusion: It seems that propofol is a very useful and effective drug for reducing pain and stress in children and its administration leads to a safe sedation in pediatric endoscopy.   Keywords: Endoscopy, Propofol, Midazolam, Sedation. Poster Presentation N19 2014 04 01 38 38 http://ijp.mums.ac.ir/article_2492_7af04b5e25a4bd886618cf37c0e705e9.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Special Formula in the Pharmaceutical Market B Imani F Kalani Introduction:
Infants born with congenital anomalies demand individualized nutritional evaluations and recommendations. The anatomical changes of neonatal surgical diseases create specific physiological constraints.Patients with different congenital anomalies have different nutritional support needs. It is essential to know the exact physiology of these anomalies in order to be able to manage and provide them with appropriate and suitable nutritional supports. This article reviews several nutrition-centered options to aid the medical provider caring for babies with common surgical diseases.
Method and Materials:
Medline searches were performed using the keywords congenital anomalies, gastroesophageal reflux, motility, nutrition and the text word nutrition in congenital GI anomalies . Bibliographies of recent review articles and relevant primary research reports, as well as Current Contents of ASPEN, ESPEGHAN guidelines were reviewed for additional relevant citations. This article describes the nutritional needs of infants with congenital anomalies that require surgical repair or palliation. It is limited to several commonly encountered surgical diseases of infants:
• Foregut and midgut anomalies (esophageal atresia / tracheoesophageal fistula, intestinal atresia, malrotation)
• Pulmonary hypoplasia: congenital diaphragmatic hernia (CDH) and lung malformations
• Abdominal wall defects (giant omphalocele, gastroschisis)
• Diseases treated with enterostomy (eg, Hirschsprung's disease [HD], imperforate anus

Discussion:
Infants born with congenital anomalies demand individualized nutritional evaluations and recommendations. Just within general and thoracic pediatric surgery, diseases include congenital anomalies in the infant, common acquired conditions such as pyloric stenosis and necrotizing enterocolitis, trauma, feeding tube placement, and organ transplantation. With the exception of the surgical repair itself, few interventions hold greater power to alter the outcome of these problems than attention to nutrition. To successfully support these patients, the dietitian must understand not only the essential details of these diseases but also the particular ways that the diseases and their surgical treatments impose demands and constraints on nutritional support. Nutritional challenges commonly include delayed oral feeding, GER, dysmotility of the distal esophagus and strictures each of which needs different kind of support and management will be discussed specifically in this article.

Keywords: Congenital Anomalies, Gastroesophageal Reflux, Motility, Nutrition. Poster Presentation N 20 2014 04 01 39 39 http://ijp.mums.ac.ir/article_2493_e5414893450cd72a603e785398307f38.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Congenital Hepatic Fibrosis: An Uncommon Cause of Chronic Renal Failure A Azarfar MA Kiani Ag Keykhosravi Y Ravanshad Congenital Hepatic Fibrosis (CHF) is a rare disease that affects both the liver and kidneys. Congenital hepatic fibrosis (CHF) is an autosomal recessive inherited malformation defined pathologically by a variable degree of periportal fibrosis and irregularly shaped proliferating bile ducts. Affected individuals also have impaired renal function, usually caused, in children and teenagers, by an autosomal recessive polycystic kidney disease (ARPKD). Impaired renal function associated with CHF in adults is caused by an autosomal dominant polycystic kidney disease (ADPKD).
Case presentation:
We report the case of a 8-year-old Iranian girlwas admitted to our hospital for evaluation ofrenal failure. In patient hepatomegaly was noted incidentally on a routine physical examination and then kidney biopsy showed global sclerosis and A liver biopsy revealed proliferation of collagen fibres surrounding the portal area, a finding that was compatible with congenital hepatic fibrosisand our patient was scheduled for kidney and liver transplantation.
Conclusion:
The relationship of ARPKD to CHF is the subject of substantial controversy. Some clinicians suggest that the two conditions represent one disorder with a range of clinical/pathological presentations
Key word: Congenital Hepatic Fibrosis Polycystic Kidney Disease, CRF. Poster Presentation N 21 2014 04 01 40 40 http://ijp.mums.ac.ir/article_2494_6248f4ac9a539275966ddb2ac651815a.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Prevention of Malnutrition in Children, Slimming Yesterday, Obesity Today S Sharafi M Razi Z Pouresmail Introduction:
The future of any nation depends on how its children's care, According to their likely future health needs of the adult population model for healthy living and wealth has increased. One of the most pressing health diet. This study is done to aimed investigate the factors influencing malnutrition in children in the past for weight loss and weight gain can be seen today.

Methods and Methods:
Related articles referring to achieve in the field of databases to Google scholar, Pub Med, proquest, SID, Magiran, Springer Link,… and studies until 2013 with the key words malnutrition, child, obesity and examine their English.

Results:
In the past, malnutrition was associated with weight loss, but for now he has to weight gain and obesity. Childhood obesity is emerging as a phenomenon caused health problems in childhood and adolescence, including hyperlipidemia, obstructive sleep apnea, early puberty, diabetes, hypertension and cardiovascular. In addition to the health problems of obese children will benefit from the social and psychological problems such as anxiety, fewer friends, loss of confidence, lower education, and fewer chances for marriage.... Overweight in children can be caused by poor eating habits and low activity, which is affected by the parents and the family environment.

Conclusions:
Since the patterns learned in childhood affect all life on lifestyle, understand the causes of obesity and to eliminate or reduce them and reinforce the correct patterns of feeding Through education and the incidence is somewhat reduced, especially for parents to deal with this phenomenon.

Keywords: Child,Malnutrition, Obesity

 Poster Presentation N 22 2014 04 01 41 41 http://ijp.mums.ac.ir/article_2495_d5322cacbdd2d4a68a27a81c0a70150b.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Anesthesia related Complications in Pediatric GI Endoscopy A Sabzevari M Gharavi MA Kiani A Peivandi Yazdi E Ghorbanian M Joudi 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. Poster Presentation N 23 2014 04 01 42 42 http://ijp.mums.ac.ir/article_2496_c6eec007c65715f17acdce55a1d8dfc3.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Treatment of Functional Gastrointestinal Disorders in Children and Future Challenges K Eftekhari Functional gastrointestinal disorders (FGIDs) are a common problem in children. These disorders in children are classified into the following categories according to the ROME III classification: Functional Dyspepsia, Irritable bowel syndrome (IBS), Abdominal Migraines, Childhood Functional abdominal pain (FAP), Childhood functional abdominal pain syndrome and functional constipation. FGIDs are diagnosed based on history and normal physical examination provided that there is no evidence of underlying disease such as anatomical abnormalities, infectious, inflammatory and malignancies. This group of poorly defined diseases represent a huge treatment challenge to the specialist, because, until now there is no therapy that has been effective in improving the symptoms. FGIDs also cause deep family problems as the disease interrupts their routine and positive response to treatment is rarely seen. On the other hand there is no objective document of the disease neither endoscopic, radiologic nor pathologic.
Therapeutic strategies of FGIDs are: education and parent's assurance, detection and modifying physical and psychological stress, dietary intervention, pharmacological treatment, psychotherapy and other complementary medical treatments. Some foods may trigger the illness such as coffee, fatty foods and spicy foods, therefore they should be avoided. Lactose-free diet cannot improve symptoms of FGIDs, except in children with lactose intolerance. The beneficial effect of fiber supplement in children with FGIDs remains unknown but it has been useful in adults with IBS. Probiotics have potential efficacy in treating IBS but the efficacy in children with FGIDs remains uncertain and needs to be further studied. In patients with severe symptoms, pharmacological agents can be effective. These drugs include Antacids, Prokinetics, Anticholinergic, Tricyclic antidepressants (TCAS) and Serotonergic agents (Agonists and anti agonists). Psychotherapy in FAP and IBS is preferred rather than standard drug treatments. Cognitive Behavioral treatment is useful in children with RAP and hypnotherapy in adults with IBS. Complementary and alternative therapies include massage therapy, acupuncture and traditional medicine such as Peppermint oil, Fumitory, Ginger and Zingier could have a role in treatment of FGIDs.
Keywords: Functional Gastrointestinal Disorders (FGIDs), Irritable Bowel Syndrome (IBS), ROME III, Functional Abdominal Pain (FAP), Psychotherapy.
 Poster Presentation N 24 2014 04 01 43 43 http://ijp.mums.ac.ir/article_2497_5bca69544151a01012f28aaed9cd43c2.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Role of Probiotics in the Management of Helicobacter Pylori Infection A Zare Javid N Niknezhad Helicobacter pylori is a gram-negative, spiral-shaped, microaerophilic organism that colonizes the stomach of humans and causes chronic-active gastritis, peptic ulcer disease, and gastric cancers, including adenocarcinoma of the stomach and MALT (mucosal-associated lymphoid tumor) lymphomas. H. pylori colonizes the stomach of over 50 % the world's human population, primarily those who reside in developing nations. Infection is generally first acquired in children, who may be entirely asymptomatic, and then persists for life, unless specific eradication therapy is initiated. All infected individuals have mucosal inflammation in the stomach in response to the organism, but only a subset will develop disease complications, such as an ulcer in the stomach or proximal duodenum and cancer in either the body or the antrum of the stomach. It is estimated that the lifetime risk of developing peptic ulceration is roughly 15%. However, this is an exceedingly important disease, because it has serious morbidity and mortality. Eradication of H. pylori infection is not successful when using antibiotics as monotherapy or dual therapy using combinations of an acid-suppressing agent and an antibiotic or two antibiotics without acid blockage.
Multiple studies show that some probiotic strains can inhibit the growth of H. pylori. To date, probiotics do not appear to have a role as sole therapy for use in the prevention or treatment of H. pylori infection. However, there is increasing evidence that a variety of probiotic agents are useful as adjunctive therapy, which can both enhance the success of eradicating the gastric pathogen while, reduce the frequency and severity of adverse effects arising from the other agents that are employed in current combination treatment regimens.
Future studies should assess the role of prebiotics and synbiotics and products derived from probiotics as additional options for use in the prevention and treatment of H. pylori infection in humans.
Key words: Probiotic, Helicobacter pylori Poster Presentation N 25 2014 04 01 44 44 http://ijp.mums.ac.ir/article_2498_290c2a07dc38d67ab6950656529c8d7e.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 The Role of Probiotics in the Prevention and Treatment of Diarrhea in Children M Razi Z Pouresmail S Sharafi Introduction:
Diarrhea remains a major cause of death in children under 5 years are considered. However, following the overuse of antibiotics and the arbitrary use of broad-spectrum antibiotic, as well as diarrhea associated with antibiotic use is increasing. This study aimed to determine the role of probiotics in the prevention and treatments of diarrhea in children have been conducted.

Materials and Methods:
Search on the subject of electronic journals and databases such as Web sites SID, Iran Medex, Pubmed and Google scholr from 2010 to 2014 was conducted.

Results:
Food and Agriculture Organization of the United Nations as probiotic " microorganisms that have beneficial health effect on the host has sufficient volume " can be defined. Probiotics on the intestinal microbial balance improves. The most important function of probiotics , development , maturation and regulation of the secretory immune system - is mucous . Other proposed mechanisms include probiotics strengthen the immune system by strengthening tight junctions , stimulation of cytokinin production and the production of secondary materials as protective nutrients ( short chain fatty acids, arginine) for visceral action , is .Thibault and their colleagues in their study on 90 children were living in orphanages, kindergartens in France showed that days of diarrhea and daily probability of diarrhea in the probiotic group consumed significantly reduced compared with the control group.

Conclusions:
According to studies, due to the wide acceptance and lack of side effects of probiotics, probiotic products are increasingly the trend is rising, so it is recommended due to the high incidence of diarrhea among children in the prevention and used to treat diarrhea.

Keywords: Child, Diarrhea, Probiotics. Poster Presentation N 26 2014 04 01 45 45 http://ijp.mums.ac.ir/article_2499_d8aea0f9da2726459fc0d44098f5a991.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Viewpoints of Iranian Traditional Medicine about Child Nutrition R Mokaberinejad R Choopani M Tansaz M Khodadoost M Movahhed Introduction:
Optimal child development necessitates proper nutrition in childhood. Despite of improvements in child nutrition, there are still lots of challenges in proper child nutrition which shows the necessity of using the Past experiences more than ever. Despite of particular interest of Iranians to cardinal humors (temperaments), unfortunately, families and medical staffs are not appropriately familiar with these important issues. Whereas Traditional Medicine tries to protect & promote health through humors and temperaments that, unfortunately, these days this issue is not considered as noteworthy matter, this study tries to bring up new dimensions of child nutrition through different attitude.

Materials and Methods:
Research methodology of this study is library research which surveys principles of child nutrition on some Iranian Traditional Medicine scientists ` works.

Results:
According to Iranian Traditional Medicine findings, there are particular rules in child nutrition. Some important rules are:
1-Food with special properties, play important role in child development like mutton, beans.
2-Food combination also can help child development and decrease the side effects of some foods like combination of thyme and yogurt.
3-There are simple and practical instructions in Iranian Traditional Medicine for preventing and treating some disease like common cold and viral gastroenteritis. So, use of these instructions can decrease the use of medications in children. Effectiveness of some instructions has also been approved in modern medicine.
4- Incompatible food combination is one of the important issues in child nutrition that paying attention to it can promote children health.

Conclusion:
Since the physical health and mental health of children necessitate proper nutrition; families` knowledge (specially mothers) about children`s food requirements can help children to have appropriate food program. It is hoped that with further research in this field & using the scientists` experiences of Iranian Traditional medicine, we will be able to play an important role in children health who are the future of our society.
Keywords: Nutrition, Children, Development, Iranian Traditional Medicine
 Poster Presentation N 27 2014 04 01 46 46 http://ijp.mums.ac.ir/article_2500_07ad42238a6ef9df09ddc6683c0f26fe.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Hepatitis E among Pregnant Women in Urmia, Iran Z Rostamzadeh Khameneh N Sepehrvand Dr. khalkhali Z Shirmohamadi Introduction:
Although the hepatitis E virus mostly causes a self-limited disease in general population, but the disease is more severe in pregnant women. Hepatitis E accounts for about 10% of pregnancy associated deaths in southern Asia. But the prevalence in Iran is almost unclear, so this study is aimed to investigate the seroprevalence of anti-HEV IgG among a population of pregnant women in West Azerbaijan of Iran.

Materials and Methods:
136 pregnant women who referred to an urban health centers of Urmia for pursuing pregnancy-related health services were selected randomly and enrolled in a descriptive, cross-sectional study. Each subject was tested for the presence of anti-HEV IgG antibody using an enzyme-linked immunosorbent assay (ELISA, Dia.Pro; Diagnostic Bioprobes, Italy).

Results:
The mean age among 136 pregnant women was 25.12±4.91 years old (range of 14-39 years). Only five cases (3.6%) among all 136 subjects were demonstrated to be seropositive for anti-HEV IgG using ELISA method. There was no significant difference between age (P=0.88), income level (P=0.19) of two seropositive and seronegative groups. All seropositive cases were from urban areas.

Conclusion:
The seroprevalence of anti-HEV IgG is low in the population of pregnant women in Urmia, Iran. Because of limited sample size in this study, we recommend to perform further studies with larger sample size in other regions of Iran in order to be able to systematically generalize the findings of studies to the population of Iranian pregnant women.

Keywords: Pregnancy, Hepatitis E, women ELISA
 Poster Presentation N 28 2014 04 01 47 47 http://ijp.mums.ac.ir/article_2501_7d725416757dac83a9a95140da6e3267.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 The Role of Evidence Based Nursing in Prevention of Gastrointestinal Side Effects of Chemotherapy in Children with Cancer Z Pouresmail S Sharafi M Razi Introduction:
Today, due to the broad spectrum of pediatric cancers are treated by the chemotherapy drugs, but these drugs have side effects and gastrointestinal toxicity is the most prevalent. One of the main roles of nurses is to better health through patient education and care for him. Evidence-based nursing is a process during which the nurse can use the available research evidence, their clinical expertise and the patient has to take appropriate decisions. This study reviews the role of evidence-based nursing in the prevention of gastrointestinal side effects of chemotherapy in children with cancer was conducted.

Materials and Methods:
Seeking information was performing through databases PubMed, SID, Since Direct, magiran, Ovid and etc. Within the years 2014-2002, the key issues in terms of evidence-based nursing, gastrointestinal side effect, chemotherapy was performed and 20 were studied English equivalents.

Results:
The most common gastrointestinal side effects in children undergoing chemotherapy are oral ulcers, vomiting, diarrhea, and dysphagia. Different strategies for prevention studies suggest that these effects need to perform their roles in teaching and nursing care. Nurses can use the results of studies such as music, ginger, semi sitting positions during chemotherapy, use of ice and etc. To prevent vomiting, the use of Persica for oral wound healing, hygiene perform especially hand washing for preventing diarrhea. The most important roles of nursing are recommended, Education on prevention of chemotherapy complications, adverse effects of proper nutrition and etc.

Conclusion:
Nurses can play an effective role in the education and care to relieve symptoms and prevent progression of gastrointestinal side effects of chemotherapy.

Key words: Evidence-based nursing, Gastrointestinal side effects, Chemotherapy, Cancer
 Poster Presentation N 29 2014 04 01 48 48 http://ijp.mums.ac.ir/article_2502_9ac83f78fc461defce6140bb23d83d80.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Caustic Ingestions M Rafeey L Vahedi M Shoaran Prevention has a main role in reducing the occurrence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. Because of the accidental nature of the ingestions, the case fatality rate for pediatric patients is significantly less than that of adolescents and adults. Currently, esophagoscopy is recommended for all patients with a history of caustic substance ingestion because clinical criteria have not proved to be reliable predictors of esophageal injury. The presence or absence of three serious signs and symptoms-vomiting, drooling, and stridor—as well as the presence and location of oropharyngeal burns could be compared with the findings on subsequent esophagoscopy. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data.
The purpose of this lecture is to outline the current epidemiology, mechanism of injury, clinical manifestations, management and long-term complications of caustic ingestions in pediatric patients.

Key Words: Caustic, Children, Ingestions. Poster Presentation N 30 2014 04 01 49 49 http://ijp.mums.ac.ir/article_2503_65745278e0f8a07d507d863e4e2bfe54.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Nutritional Assesment in Cystic Fibrosis Patients( Iran and Newzeland) V Moeeni P Shojaee HR Kianifar T Walls P Pattemore AS Day Introduction:
Patients with Cystic Fibrosis have increased risk of malnutrition. Early detection of nutritional deterioration enables prompt intervention and correction.
The aims of this project were to:
- Define the nutritional status of CF patients in Iran and New Zealand
- Compare and contrast the MacDonald Nutritional Screening tool with the Australasian guidelines for Nutrition in Cystic Fibrosis
- Validate these results in comparison with patient's evaluation by their CF clinical team.

Materials and Methods:
69 CF patients (2-18 years) were assessed during routine outpatient visits over one year. Anthropometric measurements were obtained. Both tools were applied for each patient and the results compared to their clinical evaluation (as gold standard) with calculation of specificity and sensitivity.
Results:
Under-nutrition was more frequent in Iranian than NZ patients (39% versus 0%, p=0.0001), whereas over-nutrition was more prevalent in NZ children (9% versus 17%, p=0.05). At the first visit, MacDonald and Australasian guidelines were able to recognize 77% and 61% of under-nourished Iranian patients, respectively. The mean sensitivity and specificity for all visits for the MacDonald tool were 83% & 73% (Iran) and 65% & 86% (NZ). Sensitivity and specificity for the Australasian guidelines were 79% & 79% (Iran) and 70% & 90% (NZ).
Conclusions:
Both tools successfully recognised patients at risk of malnutrition. The MacDonald tool had comparable sensitivity and specificity to that described previously, especially in Iranian patients. This tool may be helpful in recognizing at risk CF patients, particularly in developing countries with fewer resources.
Key words: Iran, Cystic Fibrosis Patient, Newzeland, Nutritional Assesment. Poster Presentation N 31 2014 04 01 50 50 http://ijp.mums.ac.ir/article_2504_b73ed20be7f0cb34a4e0859b1c9454b5.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Functional Disoders of Gastreointestinal System H Shafagh Based on Rome III criteria, functional disorders of GI are listed below:
 Infant regurgitation:
-regurgitation two or more times per day for 3 or more weeks
-no retching, hematemesis, aspiration, apnea, FTT, abnormal posturing
Infant rumination syndrome:
-repetitive contraction of abdominal muscle
-regurgitation of gastric content in to the mouth and reswallowed
Cyclic vomiting syndrome:
-Two or more periods of intense nausea and vomiting lasting hours to days and return to usual state of health lasting weeks to months
Infant colic:
-paroxysms of irritability, or crying that start and stop without obvious cause
- episodes lasting 3 or more hours pre day and occurring at least 3 days per week for at least 1 week
Infant Dyschesia:
In a child less than 6 months old, must include:
- At least 10 minutes of straing and crying before successful passage of soft stools
Functional dyspepsia:
- Persistent or recurrent discomfort centered in the upper abdomen
- Not relieved by defecation
-No evidence of an inflammatory or other causes that explains the symptoms
-Criteria fulfilled at least once per week for at least 2 months
Irritable bowel syndrome:
-Abdominal discomfort associated with two or more of the following
-Improvement with defecation
-Change in frequency of stool
-Change in form of stool
-No evidence of an inflammatory or other causes that explain the symptoms
-Criteria fulfilled at least once per week for at least 2 month
Functional diarrhea, functional constipation, aerophagia, abdominal migraine, functional abdominal pain, are other functional GI disorders.

 Poster Presentation N 32 2014 04 01 51 51 http://ijp.mums.ac.ir/article_2505_6973063fca09174ae828678331585d20.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Metabolic Disturbances in Children with Chronic Liver Disease A Rezaeian E Ghayebi F Amiri Moghadam E Shajari Introduction:
Liver disease results in complex pathophysiologic disturbances affecting nutrient digestion, absorption, distribution, storage, and use. This article aimed to present a classification of metabolic disturbances in chronic liver disease in children?

Materials and Methods:
In this review study databases including proquest, pubmedcentral, scincedirect, ovid, medlineplus were been searched with keyword words such as" chronic liver disease" " metabolic disorder""children" between 1999 to 2014. Finally, 8 related articles have been found.

Results:
Metabolic disorder in this population could be categorized in four set: 1)carbohydrates, 2)proteins,3) fats and 4)vitamins.
1) Carbohydrates: Children with CLD are at increased risk for fasting hypoglycemia, because the capacity for glycogen storage and gluconeogenesis is reduced as a result of abnormal hepatocyte function and loss of hepatocyte mass.
2) Proteins: The liver's capacity for plasma protein synthesis is impaired by reduced substrate availability, impaired hepatocyte function, and increased catabolism. This results in hypoalbuminemia, leading to peripheral edema and contributing to ascites. Reduced synthesis of insulin-like growth factor (IGF)-1 and its binding protein IGF-BP3 by the chronically diseased liver results in growth hormone resistance and may contribute to the poor growth observed in these children.
3) Fats: There is increased fat oxidation in children with end-stage liver disease in the fed and fasting states compared with controls, which is probably related to reduced carbohydrate availability. The increased lipolysis results in a decrease in fat stores, which may not be easily replenished in the setting of the fat malabsorption that accompanies cholestasis. Reduced bile delivery to the gut results in impaired fat emulsification, and hence digestion. The products of fat digestion are also poorly absorbed, because bile is also required for micelle formation. In various liver diseases, there may be reduced bile production by inadequately functioning hepatocytes, reduced hepatocyte excretion into the bile canaliculus (as in PFIC), or obstruction to biliary flow. The circulating bile salt pool may be depleted secondary to treatment with binding agents, such as cholestyramine, which is often prescribed for pruritus in cholestatic patients. Pancreatic insufficiency may further exacerbate fat malabsorption in certain cholestatic liver diseases. Vitamins: Fat malabsorption occurs in cholestatic disorders, and one must also consider any accompanying fat-soluble vitamin and essential fatty acid deficiencies.Breastfed infants with CLD are at high risk for vitamin D and K deficiencies.

Conclusion:
The clinician should proactively evaluate, treat, and re-evaluate response to treatment of nutritional deficiencies. Because a better nutritional state is associated with better survival before and after LT, aggressive nutritional management is an important part of the care of these children. Poster Presentation N 33 2014 04 01 52 52 http://ijp.mums.ac.ir/article_2506_fef6a52b43f7715732b107ececf7531e.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Mineral Requirements in Children with Chronic Liver Disease A Rezaeian E Ghayebi MT Yazdan Panah Gh Rahmanian A Golestani Introduction:
Decreased oral intake or impaired function / structure in the gut, such as hypertension port associated with atrophic changes in the protein nutrition - calories can lead to micronutrient deficiencies.This paper examines the status of micronutrients in chronic liver disease in children.

Materials and Methods:
In this review study databases including proquest, pubmedcentral, scincedirect, ovid, medlineplus were been searched with keyword words such as" chronic liver disease"" minerals""children" between 1999 to 2014. Finally, 3 related articles have been found.

Results:
In chronic liver disease changes in micronutrient metabolism lead to changes in the daily requirements, such that in certain circumstances intake increasing or decreasing is needed.
Low serum calcium and phosphate concentrations are often the reflection of malabsorption-induced bone disease that is unresponsive to vitamin D store normalization. Iron is usually deficient in children with CLD and supplementation frequently needed. The origin of iron deficiency is multifactorial and includes ongoing losses, inadequate intakes, serial blood draws and malabsorption secondary to hypertensive enteropathy.
Zinc plays an important role in cognitive function, appetite and taste, immune function, wound healing, and protein metabolism. Low plasma zinc levels are frequent in children with chronic cholestasis, but unfortunately plasma concentrations are not reflective of total body zinc status.
Copper and manganese, unlike other minerals, are increased in CLD, because they are normally excreted through bile. Parenteral nutrition in cholestatic patients can induce manganese intoxication and accumulation in basal ganglia.

Conclusion:
 In fants with CLD are prone to multiple nutritional deficiencies. Mineral state should be evaluated, treated and reevaluated, until sufficient daily requirement achieved.
Poster Presentation, N 33
 Poster Presentation N 34 2014 04 01 53 53 http://ijp.mums.ac.ir/article_2507_f9d145891d5fe7a7a977cb04cbdca22e.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Gluten - Not a Friendly Protein E Tafreshi A Jafarzade Noghani B Khairkhah M Yazdani S Seddighi S khayam Introduction:  Gluten is a protein found in grains. Research has shown that the gluten that is in grains of wheat, barley, rye, and oats (to a lesser degree) is toxic to many individuals. While gluten is essential for the make-up of these 4 grains, our bodies do not need it. Is it healthful? The protein in today's wheat is poorly digested and can be harmful. An estimated 95% of prepared foods on the grocery shelves contain the toxic forms of gluten. Non-Celiac Gluten Sensitivity: When Gluten Gets into Our Bloodstream Non-Celiac Gluten Sensitivity is an immune response to gluten that can happen to anyone. This type of response is not inherited like Celiac Disease. Rather, it involves a normal response to the abnormal appearance of gluten in the body. Health problems result from eating too much gluten in the diet (overload) and/ or the development of a common condition called "Leaky Gut Syndrome." Mild problems include fatigue and anxiety. However, if the overload of gluten or the intestinal "leakiness" is prolonged, gluten can wreak havoc with consequences like migraine, arthritis, and ADHD. Celiac Disease: When Gluten Harms Our Digestive Tract Celiac Disease is an inherited susceptibility to physical and mental harm from eating gluten. Once triggered, an auto-immune response causes inflammation and damage to vital tissues lining the small intestine, which in turn, results in failure to absorb nutrients in food. Various degrees of damage may occur at any time and at any age. In the majority of people born with the susceptibility, there are few telltale signs, so that most of us are not aware that we carry this genetic capability to make auto-immune antibodies. Left untreated, active Celiac Disease can lead to serious health consequences. Making the connection to Celiac Disease may be difficult, unless there are classic problems like abdominal bloating, pain, heartburn, or diarrhea. Symptom Guide: Manifestations of Gluten Damage to Our Bodies This section details the many different and seemingly unrelated effects that can be caused by gluten damage. The GlutenFreeWorks Symptom Guide identifies manifestations in an easy to access format. Testing for Celiac Disease and Gluten Sensitive Disorders Diagnosis starts with a high degree of suspicion, meaning the doctor needs to look for symptoms based on an accurate health history and a complete physical examination. Testing begins with bloodwork looking for the presence of 1) auto-immune antibodies that are produced against our own cells because of gluten and 2) specific antibodies that are directed against gluten itself. Treatment: The essential treatment for Celiac Disease and other gluten sensitive disorders is a gluten-free diet. More than this, here you can learn the following six key elements for better management as advanced by the National Institutes for Health: Consultation with a skilled dietitian Education about celiac disease Lifelong adherence to a gluten-free diet Identification and treatment of nutritional deficiencies and other manifestations Access to an advocacy group Continuous long-term follow-up by a multidisciplinary team Poster Presentation N 35 2014 04 01 54 54 http://ijp.mums.ac.ir/article_2514_3eb840349b6a1c4296d35697d7908e86.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Complementary and Alternative Medicine (CAM) Use in Pediatric Diseases: A Short Review MR Noras M Yousefi MA Kiani CAM (Complementary and Alternative Medicine) therapies have become increasingly popular in pediatric populations. phytotherapy are the most common CAM used in children. Yet, little is known about children's preferences for CAM. But It is expected to become more widely integrated into the modern medical system, including the medical curriculum.The aim of this study is to introduce the prevalence and characteristics of CAM use in Pediatrics disease. Further research is warranted to examine the safety and effectiveness of this popular non-allopathic approach to children's health. Keywords: CAM, Complementary and Alternative Medicine, Herbal Medicine, Pediatric Disease. Poster Presentation N 36 2014 04 01 55 55 http://ijp.mums.ac.ir/article_2515_318cb651fc07715423f577632e3f2b13.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Viewpoints of Traditional Iranian Medicine (TIM) about Etiology of Pediatric Constipation MR Noras MA Kiani Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. The diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Laboratory investigations such as barium enema, colonoscopy, anorectal manometry and colonic transit studies are rarely indicated except in those who do not respond to standard management. Treatment of childhood constipation involves several facets including education and demystification, toilet training, rational use of laxatives for disimpaction and maintenance and regular follow-up. Surgical options should be considered only when medical therapy fails in long standing constipation. . Complementary and alternative medical therapies and practices are widely employed in the treatment of the children Constipation. This article aims to be a practical guide for paediatricians and primary care physicians, to outline the current etiology an TIM for the medical management of constipation in children. Keywords: Children Constipation, Etiology, Iranian Traditional Medicine. Poster Presentation N 37 2014 04 01 56 56 http://ijp.mums.ac.ir/article_2516_6343e3ef7e3cdff4cf2c77ac63c09681.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Comparative Study of Frequency and Severity of Neonatal Jaundice without a Known Etiology in Two Groups of Term Neonate Born Via Cesarean Section and Vaginal Delivery Ash Farhat L Hafizi A Mohammadzadeh M Hasanzadeh MT Poorhosieni Introduction: Neonatal jaundice has a significant prevalence, and in severe cases, causes permanent neurological Sequela. Many studies have carried out on neonatal jaundice and its predisposing and exacerbating factors. On the other hand, delivery method (cesarean vs vaginal) has been suggested as a predisposing factor for many of neonatal complications in many studies. The aim of this study is to investigate and compare frequency and severity of neonatal jaundice without a known etiology in two groups of term neonate born via cesarean section and vaginal delivery. Materials and Methods: Samples included 182 term 7 days old neonates with minimum serum bilirubin of 5 mg/dl. Half of these neonates born via cesarean delivery and half of them born via vaginal delivery. All of these neonates had neonatal jaundice without a known etiology. The data of the two groups was compared with statistical tests.    Results: Mean serum bilirubin in the neonates was 9.60 mg/dl (SD=3.21 mg/dl). Mann-Whitney test showed that there is not any significant relationship between serum bilirubin value and the delivery method (P=0.53). Bilirubin value in the group with the family history of jaundice in siblings was significantly higher than the group without the family history (P=0.003). Mothers with the age of <20 years had the least serum bilirubin levels (P=0.01). Serum bilirubin level did not have significant relationship with neonatal sex. Neonatal bilirubin levels had a significant relationship with the type of cesarean indications (P=0.01).    Conclusion: There is not any significant relationship between serum bilirubin level in neonates and type of delivery method (vaginal vs cesarean). However, the results of investigations in this field are controversial and additional studies are recommended.   Key words: Neonatal jaundice, Hyperbilirubinemia, Delivery, Cesarean Poster Presentation N 38 2014 04 01 57 57 http://ijp.mums.ac.ir/article_2517_d94374046d3ef05affe4f68bb59bf069.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Gastrointestinal Anomalies in Imam Reza Hospital Deliveries- Mashhad Iran A Mohammadzadeh Ash Farhat Introduction:  Congenital gastrointestinal (GI) malformation occurs due to mal development of GI organs. The diagnosis is based on clinical exam and radiography. The aim of this study was to determine prevalence of gastrointestinal anomalies in Imam Reza hospital deliveries Mashhad, Iran. Materials and Methods:  In retrospective descriptive study for one year since 1.8.1391 all deliveries in our maternity hospital were elected. During this period there were 10 documents of GI malformation cases admitted to NICU. Then data were analyzed. Results: During one year 2728 births were occurred in this hospital, 10 GI malformation cases were admitted to NICU. Therefore GI malformations occurred 3.6 in 1000 live births. 4 newborns (40%) were male. From 10 GI malformations, 4 (40%) cases had gastrointestinal obstruction, 4 (40%) diaphragmatic hernia, 1(10%) abdominal mass and 1(10%) rectal hemorrhage. Prevalence of gastrointestinal obstruction or diaphragmatic hernia each one were 1.46 in 1000 live birth. All gastrointestinal obstruction occurred in cold months. Conclusion: Gastrointestinal obstruction and diaphragmatic hernia occur 1 in 1500 and 2000 live birth respectively in all references. As our hospital is a referral one, distribution of GI malformations are high (3.6 in 1000 live births). Female predominance and more distribution of gastrointestinal obstruction in cold months need further investigation. Keywords: Congenital gastrointestinal malformation, Newborn, Neonatal intensive care unit. Poster Presentation N 39 2014 04 01 58 58 http://ijp.mums.ac.ir/article_2519_d09729524c6fc1331ab9ea77d8e9d422.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Assessment the Relationship between Parents' Literacy Level with Children Growth in Mashhad: An Analytic Descriptive Study Bibi Leila Hoseini M Saeidi R Vakili MA Kiani M Rabiei A Khakshour SM Rasti Sani Introduction:
Present children are the investments of community in the future. Preparing children health which leads to the stability of community health, provided to accurate implementation of educational and health programs in the community and especially in mothers. So it is necessary to determine the relationship between parents' literacy with growth rate in children.

Materials and Methods:
This cross-sectional descriptive-analytic study was conducted on 300 mothers referring to 10 selected Mashhad health-care centers for monitoring their 6-24-month year old infants. They completed questionnaire. Participants were selected by cluster and simple random sampling. Data were analyzed by descriptive- analytic statistics and using SPSS 16.

Results:
Presentfindings showed a significant relationship between literacy level of parents with child growth status, breast feeding rate, junk food consumption, referring to health care center for growth monitoring, the age of initiating supplementary nutrition, the use of oil and butter in baby food and rate of attending in educational classes. So that higher literacy level of parents was associated with using more formula, less junk food, oil and butter in baby's food and more referring times to health care center for monitoring child growth, desirable growth, and also initiating supplementary food more at the assigned time (P<0.05).

Conclusion:
Parents' literacy level influence on children growth status. However, with increasing parents' literacy level, using formula for infants has been increased, but breast milk feeding is also high in this group.

Keywords:Children, Growth, Literacy, Mashhad, Parents. Poster Presentation N 40 2014 04 01 59 59 http://ijp.mums.ac.ir/article_2521_91fd9edeca8069056a0bc9908729220a.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Survey of Effect Peppermint on Pyloric Spasm in Children During Endoscopy S Partovi MA Kiani E Poursoltani A Khakshour M Sabbagh Introduction: Gastrointestinal Endoscopy is as a diagnosis and treatment of gastrointestinal diseases in children. Due to severe response and spastic in the muscles of the digestive tract is created during endoscopy,endoscopy is often face with difficult. The aim of this study is to evaluate peppermint impact in pyloric spasm in children undergo endoscopy. Material and Methods: In this clinical trial study, 120 children (under 14 years old) in Ghaem hospital that Pyloric spasm during endoscopy were randomly divided into two groups, peppermint (n=60) and control (n=60) respectively. Case group recieve peppermint and control group receive placebo. Data were analyzed using SPSS version 11.5 and descriptive and analytical tests (T-test, Corraletion, Mann-Whitney). Results:  Pyloric sphincter stayed open in 48.3% of peppermint group patients and 5% of controlgroup (P<0.000). The mean time to endoscopy in peppermintgroup (9/301+0/351) and control group was (10/149+0/337) and this difference was significant. Pyloric spasm in peppermint groupduration less than 60 seconds and in control group at 60% of them, more than 60 seconds. Conclusion: Peppermint could reduce endoscopy duration in children and increase endoscopic team satisfaction and decrease pyloric spasm. Key words: Pyloric spasm, Endoscopy, Peppermint Poster Presentation N 41 2014 04 01 60 60 http://ijp.mums.ac.ir/article_2529_4c6f61442e8cfde013cb63ef5cdbf9c4.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Maternal Knowledge and Practice in Mashhad City about Breast-feeding in First 6 -Month of Infant's Life S Tehranian P Shojaee S Jafarzadeh HR Kianifar Sa Jafari Introduction: Breastfeeding is an important principle in pediatric health. It decreases their mortality and protect them fromm diseases in the first 6-month of life. This study aimed to determined Maternal Knowledge and practice in Mashhad City about Breast-feeding in first 6 -month of Infant's life. Materials and Methods:  This Analytic study was conducted on 105 mothers who had a child between 6 to 12 months,and selected by the cluster sampling and simple random, completed the Knowledge and Practic questionnaire who was made by researchers. Information were analyzed by descriptive- analytical test (ANOWA,T-test,corelation) in spss software in version11.5. Results:  This findings showed that 72/4% of infants have had exclusive until end of the first 6-month. breast-feeding. Average of maternal knowledge about exclusive breast-feeding was 19/818+4/545 of total score 28 and average of maternal practice was 7/106+2/338 of total score 12. Status of growth infants at 4/8% was very good and in 42/9% was good. There was a significant relationship between maternal practice about Breast-feeding and fathers' education, number of children, status of growth (P<0.05(. There was a significant relationship between maternal knowledge about Breast-feeding and area who lived there (P<0.05) and also there was a direct and positive correlation between maternal knowledg and practice (P=0.000, r=0.212). There was a significant relationship and reverse between maternal practice and age of mothers (P = 0.007, r = -0.266). Conclusion:  Maternal Knowledge and practice about breast-feeding infants is moderate. Planning is essential to target groups to promote breastfeeding in the first 6- month of infant's life. Keywords: Knowledge, Practice , Exclusive,Infant. Poster Presentation N 42 2014 04 01 61 61 http://ijp.mums.ac.ir/article_2544_6f513a9ebf8585eedeb2555340a25de9.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Effect Supermint oil (Peppermint oil) on the Patient's and Colonoscopy Team Satisfaction During Colonoscopy in Children A Khodadad MA Kiani M Najafi A Khakshour M Saeidi SA Jafari M Ghayour Mobarhan Introduction:
Colonoscopy is an invasive method that is painful for patient especially for children. The objective of this research was investigation of the effect of supermint oral drop (peppermint essence) on the patient and colonoscopist group satisfaction during colonoscopy.

Materials and Methods:
One hundred and one patient's candidate for colonoscopy was randomly divided into two groups. Control group did not receive any drug. Case group was administrated oral drop of supermint 30 minute before colonoscopy. A standard questionnaire was filled during the colonoscopy for satisfaction of the patient and colonoscopist group. Data were analyzed using SPSS software version 15 and T-test.

Results:
Two percents in control group and 54.9% in case group have a great degree of satisfaction. Besides, mean degress of satisfaction in case group was 64.7% that significantly difference with control group (2%) (P<0.05(. Mean value of pain, duration of colonoscopy in control group was 5/60+1/85 and in case group was 4/20+1/70 and this diference was significant (P<0.05).

Conclusion:
The results of this study showed that peppermint essence causes increase in satisfaction in both patient and colonoscopy group.
Key words: Peppermint, Pain, Colonoscopy, Supermint Poster Presentation N 43 2014 04 01 62 62 http://ijp.mums.ac.ir/article_2530_592472e39660278c36edd9d82aaca05c.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Nonalcoholic Fatty Liver Disease Treatment M Sadeghian A Torabi Nonalcoholic fatty liver disease (NAFLD) is increasing in pediatric age group parallel to the growing prevalence of obesity and overweight all around the world. So changing in life style and interventions on obesogenic environment is cornerstone of NAFLD therapy in obese children. Some experts recommend that children and adolescents be encouraged to follow a low-fat, low-glycemic-index diet that includes eating a minimum of 5 servings of vegetables and fruits daily, engaging in physical activity for at least 1 hour daily, and minimizing television/computer time to 2 hours daily.
 In spite of effectiveness of weight loss and exercise in improvement NAFLD, this goal is very difficult to be achieved and pharmacological approaches have become necessary. Pharmacologic therapies against one or more specific factors and/or molecules involved in the development of NAFLD (i.e., insulin resistance, free fatty acid lipid toxicity, and oxidative stress) also might slow the progression of NAFLD to NASH or cirrhosis. On this basis, insulin sensitizers, antioxidants, cytoprotective agents, and dietary supplementations have been evaluated in pediatric clinical trials but there is no approved pharmacologic therapy for NAFLD or NASH. Not all obese children affected by NAFLD. Diet modification and regular exercise beside to serial medical follow up highly suggested for this group of children. Normal weight and thin children with NAFLD or NASH should be investigated appropriately in a logical manner based on causes of primary liver steatosis in children and treatment of underlying disease can cause improvement fatty liver in these patients.

Keywords: Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Children; Steatosis; Treatment Poster Presentation N 44 2014 04 01 63 63 http://ijp.mums.ac.ir/article_2531_e1df09104cac48acf20875c51e30d58f.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Mebeverine for Pediatric Functional Abdominal Pain: A Randomized, Placebo-Controlled Trial Z Pourmoghaddas H Saneian H Roohafza A Gholamrezaei Introduction:  Few studies are conducted on the efficacy of antispasmodics in the treatment of functional gastrointestinal disorders in children. We evaluated the effectiveness of a smooth-muscle relaxant (mebeverine) in the treatment of childhood functional abdominal pain (FAP).   Materials and Methods: Children (n=115, aged 6-18 years) with FAP were randomized to receive mebeverine 135 mg twice daily or placebo for 4 weeks. Response was defined as ≥ 2 point reduction in the 6-point pain rating scale or "no pain". Secondary outcome measures were physician-assessed global severity and improvement. Patients were followed for 8 weeks after medication period.   Results: Eighty seven patients completed the trial (44 in the mebeverine group). Response rate in the mebeverine and the placebo group was 54.5% and 39.5% at week 4 (P=0.117) and 72.7% and 53.4% at week 12 (P=0.050), respectively. No significant difference was observed between the two groups in change of the global severity or improvement at week 4 (P=0.723 and 0.057) or at week 12 (P=0.870 and 0.183), respectively. In regression analysis, male gender (Beta=3.470, P=0.025) and baseline pain score (Beta=3.665, P<0.001) were associated with response at week 4, but the association of mebeverine was not significant (Beta=2.585, P=0.078). At week 12, mebeverine was non-significantly associated with response (Beta=2.616, P=0.0503). Conclusions: Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo due to high placebo response and limited sample of the study. Further trials are recommended in this regard (ACTRN12613000158763). Poster Presentation N 45 2014 04 01 64 64 http://ijp.mums.ac.ir/article_2532_8554d121392336c81e50899962def825.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Survey of Caustic Ingestion Symptoms in Children H Yarmohammadi N Yarmohammadi M Mohammadpur Introduction:  Complications of caustic ingestion swallowing in children of singe to gullet severe stricture and andoscopic actions and multiple surgeries Is different that increase the risk of gastrointestinal perforation and gastrointestinal malignancies ..... Because Acid substances have bad taste and these are tissue coalescence in location of contact thus attribute alkali make lose of injury. In other words,alkalis substance are weak and attribute to acids make a more severe tissue damage.but,in any form, acids and alkalis conscious Serious damage to the gastrointestinal tract, particularly the esophagus if swallowed. Pipe solutions, batterie water, disinfectant, liquid bleach, detergen, salt ink,….are torrid substance that make a esophageal burns fairly common in children. Results:  Acidic or alkaline Caustic ingestion in children 1 to 5 years old. Severe burns Ingestion pipe , battery water, solid, strong alkaline compound that is used as a pipe ) are more common . house hold bleach swallowing ,shampoo,Soap in low value make a little damage to the gastrointestinal tract; but how ever this children in first opportunities should Be examined by physician. Materials and Methods: This study is review of studies motor research google, pubmed, web of knowledge, science direct, Cochrane and were used of key words: symptoms, swallow, torrid substances, children.   Conclusions:  torrid substances Swallowing in children often occurs randomise. Symptoms include runny mouth, restlessness , difficulty or painful swallowing , vomiting blood, abdominal pain and mouth burns and lips . Note that inflammation may be a little sore around the mouth and inward lips not seen the baby's mouth , but contemporary, severe burns of the esophagus exist should be taken to the phisision. The most effective action about torrid substances Swallowing by children ,is prevent it. Due to the importance in many national poisoning , provide specialized information . Due to the caustic ingestion in children is easily preventable , it is necessary importance to family physicians and the public Health Personnel be clear. Media , newspapers , radio and tv have effective role in increasing awareness poisoning , especially the poisoning by acids substances. Key words: Children, Symptoms, Swallow, Torrid Substances. Poster Presentation N 46 2014 04 01 65 65 http://ijp.mums.ac.ir/article_2533_eca1c82c12abb726501707ab7fa9833c.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Evaluation of Antibody Response to Polysaccharide Vaccine and Switched Memory B Cells in Pediatric Patients with Inflammatory Bowel Disease Gh Fallahi A Aghamohammadi A Khodadad M Hashemi P Mohammadinejad H Asgarian-Omran M Najafi F Motamed Kh Soleimani H Soheili N Parvaneh B Darabi R Nasiri Kalmarzi Sh Pourhamdi H Abolhassani B Mirminachi N Rezaei Background/Aims: Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract, whose etiologies are still unknown. This study was performed to evaluate the humoral immune response in terms of B cell functions in selected IBD patients. Methods: Eighteen pediatric patients with IBD, including 12 cases of ulcerative colitis (UC) and six with Crohn disease (CD), were enrolled in this study. The pneumococcal vaccine was injected in all patients, and the IgG antibody level to the polysaccharide antigen was measured before and 4 weeks after injection. The B cell switch-recombination process was evaluated. Results: Five patients with IBD (three CD and two UC) had defects in B cell switching, which was significantly higher than in controls (p=0.05). Ten patients had a specific antibody deficiency and exhibited a higher frequency of bacterial infection than the healthy group. The mean increased level of IgG after vaccination was lower in IBD patients (82.9±32.5 μg/mL vs 219.8±59.0 μg/mL; p=0.001). Among the patients who had an insufficient response, no significant difference in the number of switched memory B-cell was observed. Conclusions: A defect in B lymphocyte switching was observed in pediatric IBD patients, and especially in those patients with CD. Owing to an increased risk of bacterial infections in those patients with antibody production defects, pneumococcal vaccination could be recommended. However, not all patients can benefit from the vaccination, and several may require other prophylactic methods. (Gut Liver 2014;8:24-28) Poster Presentation N 47 2014 04 01 66 66 http://ijp.mums.ac.ir/article_2534_fb83a9d7cdadff58550959ba3a7b0baa.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 The Study of Levofloxacin Effects on Liver Tissue in Wistar Rat N Vahidieyerisofla M Ahmadi Far M RabieeGolmakani A Mohammad Eini Introduction  In this study, we examined the effects of the antibiotics levofloxacin on the liver as well as its devastating effects which are ensued from its over-prescription. Levofloxacin serves as one of the antibiotics of genitourinary system and inferior respiratory system. Since liver is the foremost organ that receives all the materials absorbed by intestine through the portal vein, and it is the organ that must neutralize venoms, the toxic effect of most medications on liver manifest itself quicker than other organs. Materials and Methods: for this study, 50 series of male rats from the strains of Wistar were used; the rats were eight weeks old and had a weight of about 250 g. During the study which lasted 60 days, the rats were exposed to lightness and then darkness for 12 hours respectively. The room temperature stood at 24.7-26.4 ° C as its moisture was counted as %55-60.30 series of rats were divided into three groups, receiving the antibiotics with different dilutions; 250,500 and 750 ml; the drug is taken orally. 20 series of rats were put in to the two groups—control and sham; the first group received treatment as the sham group received water through gavage. After the completion of this round, blood samples were taken from all groups, and dispatched to laboratory for medical diagnosis. The rats were then anesthetized with ether and slit open from the peritoneal area as transverse-abdominal cut, letting the liver out of the body; the samples of the liver tissue were stabilized in 10% formalin and sent to pathology laboratory for block making and preparing the slides. Result: Comparing the enzyme levels of SGOT and SGPT in the treatment, control and sham groups, it represented that there was a rise in the enzyme levels as a result of liver damage caused by taking antibiotics. Observing the microscopic slides of the liver tissue of the treatment group, it suggests sinusoid destruction, the loss of bile ducts, irregular placement of adjacent cells and the absence of Kupffer cells, which in turn confirms the negative effect of levofloxacin on liver tissue. Conclusion: Like other medications, levofloxacin can exert adversary effects as well as positive effects. Since one of the tissues which is susceptible to this effect is liver, we must bear in mind when it comes to prescribing this medication. Key words: Antibiotic, Levofloxacin, Liver . Poster Presentation N 48 2014 04 01 67 67 http://ijp.mums.ac.ir/article_2535_fcc61207836f6af25504dac892174b2f.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Evaluation of Bone Mineral Density in Children with Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin's Lymphoma (NHL) A Ghasemi A Banihashem N Ghaemi S Elmi H Esmaeili R Erfani Sayyar Sam Elmi Introduction:  Acute lymphoblastic leukemia (ALL) and Non-Hodgkin's Lymphoma (NHL) are the most common childhood and adolescence malignancy respectively.Due to the increasing survival of these children, today late side effects of treatments are important. Therapies such as corticosteroids, cytotoxic and radiotherapy effect on bone density and put the child at risk of osteoporosis and pathological fractures.   Material and Methods:  This 3-year cross sectional study was performed in Dr. Sheikh Children's Hospital in Mashhad on 50 children with ALL (n=25) and NHL (n=25). Half of them were received (n= 25) chemotherapy alone and half of them chemotherapy plus radiotherapy (n=25). All children were in the remission phase. We assessed them by DEXA bone mineral densitometry (BMD) on the lumbar spine and femoral neck (hip). We also measured some bone biomarkers include calcium (ca), phosphorus (p), parathoromone (PTH), alkaline phosphatase (ALP) in plasma. Results by age, height, sex and Body Mass Index (BMI) were adjusted with a special software.   Results:  Mean age was 8.28 ± 3.93 years. There was no significant difference on bone biomarkers (Ca, P, ALP.PTH) between ALL, NHL and also between the two treatment groups. Children with ALL had lower density at the hip and lumbar spine. (Respectively p value < 0.001 and p value =0.018 ) . A total of 50 patients, the hip BMD showed normal results in 3 patients (6%) , in 14 patients (28%) osteopenia were seen and 33 patients (66%) had osteoporosis. In whom received radiotherapy plus chemotherapy, one patient had normal BMD and 24 patients (48% of total patients) at the hip and 22 patients (44%) at lumbar spine had decreased BMD. In contrast, in whom had only chemotherapy, 24 patients (48%) had osteoporosis at hip and 23 (46%) at the lumbar spine. There was no significant difference in BMD between the sexes.   Conclusion:  Given that 94% of children had abnormal bone density, Seem to pay more attention to the metabolic status and BMD in children with cancer can develop appropriate strategies to improve health and quality of their life. Keywords: Acute Lymphoblastic Leukemia (ALL), Bone Mineral Density, chemotherapy, Non-Hodgkin's Lymphoma (NHL), Radiotherapy. Poster Presentation N 49 2014 04 01 68 68 http://ijp.mums.ac.ir/article_2536_348964c5c588b4a30254e803eea4da36.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Infective Endocarditis in Children Hospitalized During 10 Years in Imam Reza Hospital- Mashhad H Mottaghi Moghadam M Horri S Elmi N Motevalli Haghi R Erfani Sayyar Sh Rahmani Sam Elmi Introduction:  Infective endocarditis is a rare, fatal ,with high morbidity in children, Since infective endocarditis in children was not assessed in our conditions so our study was attempted.   Material and Methods:  This cross-sectional study include 19 patients less than 18 years old with endocarditis were hospitalized in the Department of Pediatric Cardiology( University of Mashhad Medical Sciences) between 1381 to1391.Clinical symptoms, risk factors, underlying heart disease,laboratory- echocardiogeraphic results were studied. Finally using SPSS 16 software data were analyzed. Results: Variety of infections were seen in 21.1%. Staphylococcus aurous was the most common crime in 21% of microbial cultures. coagulase-negative staphylococci, Staphylococcus epidermidis and gram-negative cocci were seen in only one patient each .Umbilical /vein catheter were as a risk factor in 10.6% of children. The most common underlying factor was congenital heart disease (CHD)(47.7%). Surgery were performed in 7(36.8%) patients due to CHD before endocarditis .Vegetation were resected in 2 (10.5%)children as a treatment after endocarditis .There was no significant difference between time of surgery and microbial crime .(p-value= 0.069).18 children(94.7%) had cardiac vegetation. Conclusion: Due to the often negative cultures in our conditions, strong clinical suspicion of underlying causes, especially in children with congenital heart disease can be very important in reducing mortality and complications. Key words: Children, Congenital Heart Disease, Infective Endocarditis. Poster Presentation N 50 2014 04 01 69 69 http://ijp.mums.ac.ir/article_2537_da1599a44ef4cee81dc110bc78ef605a.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 The Efficacy of Citalopram in the Treatment of Functional Abdominal Pain in Children: A Randomized, Double-Blind, Placebo-Controlled Study Z Pourmoghaddas H Saneian Introduction:  Limited data are available on the effectiveness of antidepressants in the treatment of functional gastrointestinal disorders in children. We evaluated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP). Material and Methods:  Children with FAP (n=115, aged 6-18 years) received either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥ 2 point reduction in the 6-point pain rating scale or "no pain". Depression, anxiety, somatization, and physician-assessed global severity and improvement were also evaluated. Patients were followed for 8 weeks after medication period. Results: Eighty six patients completed the trial (43 in each group). Treatment response rate in the citalopram and the placebo group was 55.8% and 39.5% at week 4 (P=0.097) and 72.0% and 53.4% at week 12 (P=0.059), respectively. Controlling for baseline characteristics, more reduction was observed in pain (z=-2.67, P=0.008) and global severity scores (z=-3.08, P=0.002) in the citalopram group compared with the placebo group. Changes in depression, anxiety, and somatization scores were comparable between the two groups. Receiving citalopram (OR=7.718, P=0.006), father education level (OR=3.179, P=0.040), baseline pain score (OR=5.621, P<0.001), baseline somatization score (OR=0.863, P=0.017), and change in somatization severity (OR=1.168, P=0.039) were predictors of treatment response at week 4. The association of receiving citalopram and treatment response at week 12 was not statistically significant (OR=2.944, P=0.096). Conclusion: Four-week treatment with citalopram is effective in reducing pain in children with FAP, independent from patients' baseline psychological status or psychotropic effects of the drug. Keywords: Abdominal Pain, Antidepressive Agents, Child, Serotonin Reuptake Inhibitors, Randomized Controlled Trial. Poster Presentation N 51 2014 04 01 70 70 http://ijp.mums.ac.ir/article_2538_98967656de02e932ae60aeb749703c03.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Study on Endoscopic Results in Children Admitted with Caustic Ingestion at Ghaem Hospital in 2011-2013 MA Kiani M Zakerian E Roudi M Sabbagh Introduction: Esophagus injuries secondary to caustic ingestion occurs frequently in children. Oral damages cannot give us a clear image of what has happened in upper GI. Therefore endoscopy is only diagnostic way to evaluate upper GI injuries. In this study, we found out the endoscopic results in children admitted with caustic ingestion in Qaem(A. S.) hospital between 2011 to 2013 , and compare it with the result of other studies Method and Material: This is a both retrospective and prospective study in children admitted with caustic ingestion in Qaem (A. S.) hospital between 2011 to 2013. All of the children admitted in this period were 54 cases. Patient information inserted into check-lists and analyzed with statistical software. Results: The whole 54 cases were admitted with caustic ingestion.59.3 % were boys and 40.7 % were girls.34 % were under 2 years old, 34 % between 2-4 years old, 17 % between 4-6 years old and 15% more than 6 years old. 69.2 % ingested substances were acids and 30.8 % were bases. Esophagus endoscopy showed: 2 % Grade 0, 11.8 % Grade 1, 29.4 % Grade 2a, 52.9% Grade 2b, 3.9 % Grade 3a, and 0 % Grade 3b. Stomach endoscopy showed : 30 % normal, 12% mild erythematic, 10 % moderate erythematic, 2% severe erythematic, 30% mild ulcerative, 10% moderate ulcerative, 6 % severe ulcerative. Conclusion: In this study 8602 % of cases had severe esophageal corrosion in grade 2 or more. This percent in the study of Temez in Turkey was 34.5 %, in the study of Sanches in Mexico was 84.6 % and in the study of Rafiei in Tabriz was 62 %. It shows more severity of esophageal corrosion in our study than other studies. Key words: Caustic substances, Clinical findings, Endoscopy. Poster Presentation N 52 2014 04 01 71 71 http://ijp.mums.ac.ir/article_2539_836325b1c1f607aeeab2fc6274d12903.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Wilson's Disease: Nutrition Support M Ghayour-Mobarhan M Mazidi Wilson's disease (WD) or hepato-lenticular degeneration is a rare autosomal-recessive disorder. A prevalence rate of 30 cases per million and a birth incidence rate of one per 30,000 to 40,000 are often quoted. In 40 to 50% of individuals with WD, hepatic dysfunction is the initial clinical manifestation. With the exception of liver transplantation, treatment of WD is only palliative and intended to restore and maintain copper balance. It does not eliminate the underlying defect responsible for WD. Thus, a lifelong commitment to treatment is required. Limitation of dietary copper intake is generally ineffective, and pharmacological management is necessary. Administered either as acetate, sulfate, or gluconate, zinc reduces intestinal absorption of dietary copper via induction of metallothionein formation in intestinal enterocytes. Antioxidants, mainly vitamin E, may have a role as adjunctive treatment. Serum and hepatic vitamin E levels have been found to be low in WD. Symptomatic improvement when vitamin E was added to the treatment regimen has been occasionally reported but no rigorous studies have been conducted. No correlation of antioxidant deficiency with clinical symptoms was reported in one study. A vegetarian diet may be useful as adjunctive therapy; copper is less available. Adherence to a low copper diet is most important during the initial phase of treatment. The recommendation is to avoid the foods highest in copper content: organ meats, shellfish, chocolate, nuts, and mushrooms. Once copper levels have stabilized at normal levels, these foods are allowed occasionally. Copper content of the drinking water you consume should also be tested. If the water is over 0.1 ppm (parts per million) (which is 0.1 mg/L), consider an alternative water source or invest in a good filtering system that removes copper. Keywords: Copper, Nutrition Support, Wilson's Disease. Poster Presentation N 53 2014 04 01 72 72 http://ijp.mums.ac.ir/article_2540_0b3b71a9f11b2ed479b2c1f921b69823.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Comparison of Growth Impairment in Pediatric Patients with ALL, NHL Treated with Chemotherapy alone and Chemoradiotherapy A Ghasemi A Banihashemi N Ghaemi S Elmi Introduction: Acute Lymphoblastic Leukemia (ALL) and Non Hodgkin's Lymphoma(NHL) are the most common cancers in childhood and adolescence. Most children with ALL and NHL have long term survival (>80%). Endocrinopathy is a common complication in pediatric cancers following the treatment (20-50% prevalence), in addition, cytotoxic chemotherapy and radiotherapy can influence side effect on growth parameters. Material and Methods: We evaluated growth percentiles in 50 children with ALL(n=25),NHL(n=25) . Age of our patients was 3-17 years in remission period who received chemotherapy with (n=25) or without (n=25) head and neck radiation. Patients with in less than 5th percentile height referred to assess the growth hormone deficiency (GHD) by insulin stimulating test.   Results:  Six (12%) Patients had less than 5th percentile height. From these patients 5 children (83.0% ) had isolated GHD. Cortisol, ACTH, Prolactin , IGF-1and IGF-BP3 were at normal value children underwent head and neck radiotherapy in addition to chemotherapy. We didn't find significant difference between 2 treatment group in exact–fisher test (P= 0.189 (. Two patients (4.0%) had over weight in assessing BMI ( Body Mass Index). Conclusion: We have some patients with short stature and GHD then it is important to pay more attention about growth in pediatric with malignancy. Key words: ALL, Growth Hormone Deficiency, NHL, Radiotherapy. Poster Presentation N 54 2014 04 01 73 73 http://ijp.mums.ac.ir/article_2541_95d1387101d102f65826407c255b017a.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Nasoalveolar Molding: A new Method for Cleft Lip and Palate Rehabilitation A Jahanbin Introduction:
Cleft lip and palate is a congenital anomaly occurring in 3 in 1000 live birth. One the major concern in this patient is about cleft gap and its surgical problems. Several surgical and non-surgical procedures have been done to decrease this gap. They aimed to achieve the more esthetic results as well as feeding success. Nasoalveolar Molding (NAM) is a new method for reshaping nasal and alveolar bones, presurgically.
Matsuo et al described that auricular cartilage could be molded permanently when treatment was done within 6 weeks of life. High levels of maternal estrogen in the fetal circulation can triggers hyaluronic acid which can alter the cartilage, ligament and connective tissue elasticity.Estrogen level continue to drop after 6 weeks of age. This concept was applied for the correction of nasal deformities in cleft lip patients. Nasolaveolar molding may stimulate immature nasal chondroblasts and produce interstitial expansion.

Aims of Nasoalveolar Molding:
a. Active molding and repositioning of the deformed nasal cartilages and alveolar processes.
b. Appropriate Lengthening of the columellac. Better bone healing after surgey due to reducing the gaped. Reduces the need for secondary alveolar bone grafts. Correction of lip position with minimal scarf. Reducing hospital stay for nasal esthetic surgeryg. Better weight gain in early infancy

Conclusion:
Management of cleft lip and palate has been changed with more emphasis on the nasal and alveolar molding prior to the primary lip repair. This method reduces the number reconstructive surgeries for the purpose of esthetics as well as may cause better feeding in early infancy.

Keywords: Cleft Lip and Palate, Infant Orthopedics, Nasal Molding.
 Poster Presentation N 55 2014 04 01 74 74 http://ijp.mums.ac.ir/article_2542_c9ee66dbc3a869d0e07ce47a6665cf8d.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Severity Assessment of Chronic Liver Disease in Children S Tehranian P Shojaee S Jafarzadeh HR Kianifar SA Jafari Introduction: Chronic liver disease and cirrhosis are the most important causes of growth failure, morbidity and mortality in children. Cirrhosis consists of a variety of congenital, genetic, metabolic, and infectious causes in children. Models for predicting of chronic liver disease severity, survival, and transplantation are useful for decision-making as well as medical interventions. The most important application of this model is to estimate the true mortality rate at a specific time. Therefore, it helps the correct selection of patients for liver transplantation. In this study, we examined the relationship between disease severity and pediatric end-stage liver disease (PELD) scoring system in children with chronic liver diseases. Materials and Methods: This cross–sectional study conducted on 106 children with chronic liver diseases from 2011 to 2012 admitted to Ghaem Hospital, Mashhad, Iran. We used the clinical files of the patients to determine PELD score and recorded all information on a special form. Following that, PELD/MELD (model for end-stage liver disease) scores were calculated. SPSS software version 18 was performed for the analysis of the data applying independent t-test. Results: A total of 106 patients, 53% females and 47% males with the mean age of 68.3±41.8 months participated. The most common clinical finding was hepatomegaly (76%), followed by jaundice and splenomegaly. Jaundice, hepatopulmonary syndrome, cirrhosis and splenomegaly were clearly correlated with PELD score. The increasing of PELD/MELD (model for end-stage liver disease) scores were in line with the high level of liver alkaline phosphatase enzyme and there was a significant relation between them (P<0.05).   Conclusion: In our study, all the results showed that the scoring system had the reasonable efficiency in the prognosis and morbidity of chronic liver diseases in children, which has been demonstrated in previous studies. Keywords: Chronic liver disease, MELD score, PELD score. Poster Presentation N 56 2014 04 01 75 75 http://ijp.mums.ac.ir/article_2543_0000b59f21dcaeafefb5e6e7e0aea767.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Study of Inappropriate prescribing of antibiotics in pediatric Gastroenteritis in Imam Reza Hospital-Bojnurd A Khakshour Zh Sheikhi M Saeidi Introduction:  Increasing microbial resistance to antibiotic medications are a common phenomenon in developing countries and development country. In this study, administration of correct, incorrect and inappropriate antibiotic in children under 7 years of age with
Gastroenteritis in the pediatric ward of Imam Reza (AS) in the years 2012-2013 was performed Bojnurd-Iran. Materials and Methods:  This cross-sectional study on 400 children under 7 years of age with gastroenteritis in the pediatric in Imam Reza Hospital-Bojnurd in 2012-2013 was performed. Data were analyzed with SPSS 11 software and chi-square and Mann-Whitney tests.   Results: 56% of children were boys and 44% were girls. Chi-square test showed there is a significant relationship between administration antibiotics and Stool(p<0.05(.So that in the group with prescribed antibiotics, 78% of them Stool samples were negative. Kappa coefficient ( -0.125). There was reverseagreement between the antibiotic and the stool. Conclusion:  Selection antibiotic regimen based on culture and diagnostic tests, is a complex process involving several differentfactors. Due to majority of gastroenteritis in children are viral, it is necessary to prevent resistance microbial antibiotic diarrhea based on experimental results (stool culture and stool analysis) in the case of appropriate antibiotics may be prescribed. Keywords: Antibiotics Inappropriately, Microbial Resistance, Non-Inflammatory Diarrhea. Poster Presentation N 57 2014 04 01 76 76 http://ijp.mums.ac.ir/article_2545_74a8b7fce5ce0c4b24b767280a233fb7.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Evaluation of Omeprazole in the Treatment of Moderate to Severe Persistent Asthma in Children F Behmanesh SA Jafari A Khakshour E Khodashenas A Motiee Background and Objective:  Asthma is the most common chronic disease of childhood. The disease is caused by a temporary blockage of airflow due to chronic inflammation of the airways . One of the conditions that often occur with asthma and exacerbate disease, is gastroesophageal reflux. The aim of this study is to evaluate the role of acid suppressing therapy in patients with refractory asthma. Materials and Methods:  In this study children with moderate to severe asthma under maintenance therapy at least for 3 months and poor response to treatment were evaluated.after exclusion of other exacerbating conditions, treatment with proton pump inhibitor was initiated and reassessment was done. Results: The frequency of mild intermittent asthma increased from 0 to 30% and mild persistent from 40 to 70% whereas moderate persistent asthma decreased from 60% to 0 and there is no case of severe persistent asthma.differences in disease stage before and after treatment were statisticaly significant. Conclusion: Based on the role of antireflux therapy in persistent asthma, we recommend treatment with proton pump inhibitor for these patients after exclusion of other exacerbating conditions. Key words: Asthma, Omeprazol, Reflux . Poster Presentation N 58 2014 04 01 77 77 http://ijp.mums.ac.ir/article_2546_7ccbb109e7051098719cafa89de0afe0.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 The Study of Upper Gastrointestinal Endoscopy in Patients with Inflammatory Bowel Disease and Ulcerative Colitis F Farahmand MA Kiani A Khodadad M Najafi Gh Fallahi F Motamed P Ostad Rahimi M Vasei GR Khalili M Ghayour- Mobarhan M Sabbagh Background and aims:  In diagnosing inflammatory bowel disease, one of diagnostic way is upper gastrointestinal endoscopy, which helps in differential diagnosis of unspecified colitis as well. The aim of this study was to investigate the necessity of upper gastrointestinal endoscopy in patients with inflammatory bowel disease. Materials and Methods:  In this descriptive cross-sectional study, 30 children with definite diagnosis of Crohn's disease and ulcerative colitis underwent upper endoscopy in Medical Center Hospital from October 2009 to March 2011 and the data were analyzed using SPSS software and T-test.   Results:  Of 30 children with inflammatory bowel disease, 15 patients were diagnosed with Crohn's disease and fifteen patients with ulcerative colitis. The present results demonstrated that esophageal, stomach, and duodenum involvements in patients were 93%, 87%, and 26%, respectively. Esophageal, stomach, and duodenum involvements with ulcerative colitis were observed in 80%, 66%, and 20% of patients, respectively. Patients' involvements with Crohn's disease were in esophageal (94%), stomach (80%), and duodenum (47%). Conclusion:  Regarding the high percentage of upper gastrointestinal involvement in patients with inflammatory bowel disease, endoscopy and histopathological examinations seem necessary for all patients irrespective of the type and locality of involvement. Keywords:Crohn´s disease, Endoscopy, Ulcerative Colitis, Inflammatory Bowel Disease, Upper Gastrointestinal Tract. Poster Presentation N 59 2014 04 01 78 78 http://ijp.mums.ac.ir/article_2547_1477d3860220f9153d1c88a07324ec30.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Challenges in Diagnosis of H. Pylori Infection in Children M Sobhani Shahmirzadi H. pylori infection is usually acquired in early childhood. Its role in gastrointestinal and extra intestinal complaints and serious consequences in adulthood make it as challenging issues. Despite different clinical presentations, in most children, the presence of H. pylori infection does not lead to clinically apparent disease, even when it causes chronic active gastritis. Some of most important recommendations for managing H. pylori infection in children based on Guidelines from ESPGHAN and NASPGHAN consisted as: 1. Diagnostic testing for H pylori infection is not recommended in children with functional abdominal pain. 2. In children with first-degree relatives with gastric cancer, testing for H pylori may be considered. 3. In children with refractory iron-deficiency anemia, in which other causes have been ruled out, testing for H pylori infection may be considered. 4. There is insufficient evidence that H pylori infection is causally related to otitis media, upper respiratory tract infections, periodontal disease, food allergy, sudden infant death syndrome (SIDS), idiopathic thrombocytopenic purpura, and short stature. 5. It is recommended that the initial diagnosis of H pylori infection be based on a positive histopathology plus a positive rapid urease test or a positive culture. 6. The 13C-urea breath test (UBT) is a reliable noninvasive test to determine whether H pylori has been eradicated. 7. ELISA-test for detection of H pylori antigen in stool is a reliable noninvasive test to determine whether H pylori has been eradicated. 8. Tests based on the detection of antibodies (IgG, IgA) against H pylori in serum, whole blood, urine, and saliva are not reliable for use in the clinical setting. 9. It is recommended that clinicians wait at least 2 weeks after stopping proton pump inhibitor (PPI) therapy and 4 weeks after stopping antibiotics to perform biopsy-based and noninvasive tests (UBT, stool test) for H pylori. Poster Presentation N 60 2014 04 01 79 79 http://ijp.mums.ac.ir/article_2548_91526931d81343c822decb0afa05ec94.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Synbiotic for Prevention of Antibiotic-Associated Diarrhea in Children: A Randomized Clinical Trial SA Jafari H Ahanchian MA Kiani A Khakshour Z Noorbakhsh E Zamani E Ansari HR Kianifar Introduction:
Antibiotic- associated diarrhea is a common problem in pediatric population. There is growing interest in probiotics, probiotics and synbiotics for prevention of this complication because of their worldwide availability as dietary supplements. The aim of this study was to assess the efficacy of a synbiotic mixture in prevention of antibiotic- associated diarrhea.

Materials and Methods:
 In this randomized controlled trial, 218 patients ( 111 in the synbiotic and 107 in the placebo group) aged 6 months to 14 years with respiratory tract infection and/ or otitis media who needed antibiotic treatment in outpatient setting, were enrolled. They received 1 billion Colony Forming Unit of seven probiotics species plus Fructooligosaccharide in form of powder or placebo ( matched for size, shape, and volume) for 7 days. Amoxicillin, Amoxicillin-clavalanic acid, cefixim and Azithromicin were the most common drugs used by physcicians Mothers recorded stool frequency and consistency daily for 7 days.

Results:
We found no significant difference (P>0.05) in occurrence of diarrhea between synbiotic and placebo groups.

Conclusion:
This synbiotic mixture did not appear to reduce antibiotic- associated diarrhea in children. Further studies are needed to investigate the potential benefits of Synbiotics in prevention of this disease.

 Keywords:
 Antibiotic-Associated Diarrhea, Prevention, Synbiotic. Poster Presentation N 61 2014 04 01 80 80 http://ijp.mums.ac.ir/article_2549_09a4b74e82f38d2bcfe94d3825c91632.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Hyperbilirubinemia and Neonatal Infection Gh Maamouri H Boskabadi F Khatami A Mohammadzadeh R Saeidi Ash Farhat MA Kiani Introduction: Hyperbilirubinemia is a relatively common disorder among infants in Iran. Bacterial infection and jaundice may be associated with higher morbidity. Previous studies have reported that jaundice may be one of the signs of infection. The aim of this study was to determine the incidence rate, presentation time, severity of jaundice, signs and complications of infection within neonatal hyperbilirubinemia.   Materials and Methods: This cross sectional study was conducted between 2003 and 2011, at Ghaem Hospital, Mashhad- Iran. We prospectively evaluated 1763 jaundiced newborns. We finally found 434 neonates who were categorized into two groups.131 neonates as case group (Blood or/and Urine culture positive or sign of pneumonia) and 303 neonates with idiopathic jaundice as control group. Demographic data including prenatal, intrapartum, postnatal events and risk factors were collected by questionnaire. Biochemical markers including bilirubin level, urine and blood cultures were determined at the request of the clinicians.   Results: Jaundice presentation time, age on admission, serum bilirubin value and hospitalization period were reported significantly higher among case group in comparison with control group (p<0.0001). Urinary tract infection (UTI), sepsis and pneumonia were detected in 102 (8%), 22 (1.7%) and 7 (0.03%) cases, respectively.   Conclusion:  We concluded that bacterial infection was a significant cause of unexplained Hyperbilirubinemia among jaundice newborns (10%). Therefore, we advise performing screening test for UTI as part of the evaluation in asymptomatic jaundice infants presenting after five days of life and sepsis workup should be request in symptomatic infant especially in the first week of life.   Keywords: Hyperbilirubinemia,Neonate, Pneumonia, Sepsis, Urinary Tract Infection. Poster Presentation N 62 2014 04 01 81 81 http://ijp.mums.ac.ir/article_2550_33ed205bfec5eaa81763e6fbd03862c7.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Effectiveness of Group Cognitive Bbehavioral Therapy on Anxiety, Depression and Glycemic Control in Children with Type 1 Diabetes S Ahmadi Z Tabibi A Mashhadi P Eshraghi F Faroughi P Ahmadi The present study aimed to investigate the effectiveness of group cognitive behavioral therapy in reducing anxiety and depression and glycemic control in children with type I diabetes. The study was quasi- experimental with a pre-test, post-test design with control group. For this purpose, 30 children with diabetes were selected from Imam Reza Hospital in Mashhad. The children were randomly assigned into two experimental group (15) and control group (15). The experimental group was undergone eight 2-hour sessions of cognitive-behavioral training. Before and after the intervention, the Multidimensional Anxiety Scale for Children, which included four components of social anxiety, physical symptoms, harm avoidance, and separation anxiety, and Children Depression Inventory was administrated in both groups. The findings from the covariance analysis test revealed that depression and anxiety and glycemic control in experimental group was controlled at post-test and depression score in experimental group compared to the control group at post-test was decreased. The findings from the multivariate covariance analysis test between components of, physical symptoms, harm avoidance, separation anxiety, and social anxiety revealed meaningful differences between the two groups in social anxiety post-test score. Thus, cognitive behavior therapy can be effective for depression, anxiety, and blood sugar control in children. Poster Presentation N 63 2014 04 01 82 82 http://ijp.mums.ac.ir/article_2551_284d5241dcc339f1e8b8a576ef22e548.pdf 2014-04-01 10.22038 International Journal of Pediatrics ijp ; Int J Pediatr 2345-5047 2345-5047 2014 2 2.1 Ethical Aspects of Obesity Management in Children Sh Gheibi N Ghasemzadeh Introduction: Childhood obesity is a growing global health problem, but in the view of medical ethics, obesity management in children is associated with challenges. Method and materials: This study is a comprehensive review in English (Cochrane Library, and PubMed) and Persian literature which pointed to the ethical aspects of pediatrics obesity management with content analysis. Results: In the childhood obesity interventions, clinical trials should be carefully designed with obtaining approval of ethics committee, selection of the appropriate outcomes, contributing to the family, the assent of the child and consent of family, confidentiality, truth telling, fairness and avoiding discrimination and stigma paid investments. Each of community, government, health systems, media and family have special responsibilities in these interventions that cause a somehow violation of personal freedom, privacy invasion and interference with lifestyle options. In the meantime, with the help of four ethical principles (Autonomy, Beneficence, Justice, Non-maleficence) interventions within the ethical boundaries can be identified. In principle of autonomy with regard to parents are the child's legal guardians, sometimes with focus on the right refuse obesity interventions. But Islamic ethics and sound medical judgment dictate that with the observance of other moral principles [like la darar wa la dirar (No harm and no harassment) and maslaha (benefit)] in the cases of severe or complicated obesity which obviously affected the lifetime or health of the child done interventions, in the view of duty-oriented. However, obesity in children can be deemed a kind of negligence or neglect of children's health and opposed with provisions of the Convention of rights of children which based on medical paternalistic attitude build Medical intervention obligatory. Conclusion: To fight obesity, appropriate interventions require full compliance with medical ethics in schools, families and society. In this context, the compiling of ethical guidelines in child obesity interventions will be helpful. Keywords: Obesity, Children, Management, medical Ethical. Oral Presentation N 20 2014 04 01 83 83 http://ijp.mums.ac.ir/article_2577_0c995efb55862678cdba9ada614ac207.pdf