A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century.

INTRODUCTION: Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates. MATERIAL AND METHODS: This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels. RESULTS: The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off. CONCLUSIONS: This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.

Normal spirometry prediction equations for the Iranian population.

BACKGROUND: This study aimed to establish normative spirometric equations in a healthy population of Iranian children and adults, and compare these equations with those developed by the Caucasian Global Lung Initiative (GLI) for the first time. METHODS: Spirometric data from healthy Iranian aged 4-82 years sampled in 2019 were used to derive reference equations using the generalized additive model for location (mu), shape (lambda), and scale (sigma). RESULTS: A total of 418 females and 204 males were included in the study. Applying the GLI standards for the Iranian population resulted from the Z scores of FEV1, FVC, FEV1/FVC, and FEF25-75% was not different from zero. Based on the newly calculated LLN, eleven individuals showed significant values below the LLN for FEV1/FVC. In all age groups, this frequency was less than 5%, except for men over 70 years of age, which was 12.5%. There are significant differences between new data and GLI for Caucasian data. CONCLUSION: It is recommended that the values and equations generated from this study should be used by physicians and technicians in their routine practice for the diagnosis and assessment of pulmonary disorders.

The effects of betamethasone on clinical outcome of the late preterm neonates born between 34 and 36 weeks of gestation.

BACKGROUND: Prenatal corticosteroid administration in preterm labor is one of the most important treatments available to improve neonatal outcomes; however, its beneficial effects on late preterm infants (after the 34th week of gestation) remained unknown. We aimed to assess the effects of betamethasone on the clinical condition of the late preterm infants born between 34 and 36 weeks of gestation. METHODS: This retrospective cohort study was performed on 100 consecutive infants born between 34 and 36 weeks of gestation and received betamethasone before delivery as the cases and 100 neonates with the same delivery conditions but without receiving betamethasone. All neonates were followed up within hospitalization to assess the neonatal outcome. RESULTS: The neonates receiving betamethasone suffered more from respiratory distress syndrome (49% versus 31%, p = 0.008, RR = 1.59 95% CI (1.12-2.27)) and requiring more respiratory support (71% versus 50%, p = 0.002, RR = 1.43 95% CI (1.13-1.80)) as compared to the control group. There was no difference between the two groups in other neonatal adverse events or death. CONCLUSION: the use of betamethasone in the late preterm period (after 34 weeks of gestation) has no beneficial effects on lung maturity or preventing neonatal adverse outcomes, even may lead to increase the risk for RDS and requiring respiratory support.

Perinatal factors influencing the neonatal hearing screening results.

BACKGROUND: Previous studies have indicated that the majority of cases with "failed" results related to transient evoked otoacoustic emissions (OAE) test have the normal hearing. The present study aimed to assess the possible relationships between perinatal factors and the false-positive OAE results. METHODS: A case-control study was carried out in an Iranian Hospital in 2020. Based on the OAE results on the first day of life, newborns were divided into 2 groups; Control group included subjects with "Pass" OAE results. Every neonate with "Fail" OAE result was referred for auditory brainstem response (ABR). Neonates with bilateral fail OAE but normal ABR results (false-positive OAE) were considered as the case group. All recorded data were analyzed to assess the possible correlations between maternal/neonatal factors and the false-positive OAE results. RESULTS: One hundred and eighty-one neonates entered the study. Of all included neonates, 87 (48.1%) cases showed bilateral fail OAE and 94 (51.9%) subjects passed the OAE test. Normal ABR results (false-positive OAE) were observed in all cases with bilateral fail OAE. Comparisons of variables affecting the OAE results showed that of all perinatal factors, neonate's sex (p = 0.046) and cesarean section (p = 0.003) were the only influencing factors that increased the risk of false-positive OAE results. CONCLUSION: Based on the results, the cesarean section delivery and neonate's male sex increased the risk of false-positive results related to OAE test. Implementing other screening tests such as ABR or Automated ABR as the initial screening test could be suggested for such cases.

An information-based framework for development national twin registry: Scoping review and focus group discussion.

BACKGROUND: Registries in various clinical domains have been established in the last decades. The specific genetic structure of twins has enabled researchers to find answers to the role of genetics and the environment in medical sciences. Thus, twin registries were developed across the world to support twin studies. Our main objective was to devise a conceptual model for developing the national twin registry to ensure the success of this registry. METHODS: In this descriptive and qualitative study, the combination of literature review and focus group discussions was applied to achieve suitable models for developing a national twin registry based on lessons learned from founded registries. The qualitative synthesis and reporting results were conducted based on the COREQ checklist. RESULTS: According to a systematic literature review, the characteristics and employed strategies employed by established twin registries were recognized. Moreover, based on our objectives, suitable models for registry development were defined. The source of information, the different levels of data, and the information flow were determined based on this model. CONCLUSION: Suggesting a conceptual framework for twin registry development at the national level based on the experiences of other countries could contribute to a greater understanding of twin registry implementation efficiently.

Maternal death due to COVID-19.

BACKGROUND: Despite 2.5 million infections and 169,000 deaths worldwide (as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity have been reported to be related to COVID-19 disease. Given the disproportionate burden of severe and fatal respiratory disease previously documented among pregnant women following other coronavirus-related outbreaks (SARS-CoV in 2003 and MERS-CoV in 2012) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected. OBJECTIVE: To describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease. STUDY DESIGN: We describe here a multiinstitution adjudicated case series from Iran that includes 9 pregnant women diagnosed with severe COVID-19 disease in their second or third trimester. All 9 pregnant women received a diagnosis of SARS-CoV-2 infection by reverse transcription polymerase chain reaction nucleic acid testing. Outcomes of these women were compared with their familial/household members with contact to the affected patient on or after their symptom onset. All data were reported at death or after a minimum of 14 days from date of admission with COVID-19 disease. RESULTS: Among 9 pregnant women with severe COVID-19 disease, at the time of reporting, 7 of 9 died, 1 of 9 remains critically ill and ventilator dependent, and 1 of 9 recovered after prolonged hospitalization. We obtained self-verified familial/household cohort data in all 9 cases, and in each and every instance, maternal outcomes were more severe compared with outcomes of other high- and low-risk familial/household members (n=33 members for comparison). CONCLUSION: We report herein maternal deaths owing to COVID-19 disease. Until rigorously collected surveillance data emerge, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed as having COVID-19 disease in their second or third trimester.

Comparison of facilitated tucking and oral dextrose in reducing the pain of heel stick in preterm infants: a randomized clinical trial.

BACKGROUND: With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings. METHODS: This study was a randomized controlled clinical trial with cross-over design. Sixty infants were recruited from a Neonatal Intensive Care Unit (NICU) at Valiasr hospital in Tehran, Iran from March 2015 to September 2016. They were randomly allocated into three groups (no pain relief method, oral dextrose and facilitated tucking). Six blood samples were collected by heel stick for each infant. Oral dextrose and facilitated tucking were compared with the routine method of blood sampling and pain was measured two times for each method. The pain scores was measured by the Premature Infant Pain Profile (PIPP). Repeated Measure ANOVA, ANOVA and Scheffe post-hoc test were used with SPSS 16. RESULTS: The pain score's increase during heel stick was significantly lower after using oral dextrose (3.58 ± 0.34) and facilitated tucking (5.58 ± 0.53) in comparison to the routine method (8.91 ± 0.18) of blood sampling (P < 0.001, η2 = 0.971). Oral dextrose was more effective than facilitated tucking (P < 0.001, Cohen's d = 4.49). The emergency nurses rated oral dextrose as easier (t = 2.20, df = 118, p = 0.02, Cohen's d = 0.39) and more applicable method (t = 2.99, df = 118, p = 0.003, Cohen's d = 0.54) for the emergency department. CONCLUSIONS: Facilitated tucking is an effective method of pain reduction which can be used in the absence of oral dextrose, in a situation in which it is contraindicated or in combination with oral dextrose. Based on the increase of infant's admission in emergency department future studies are needed to identify the best method of pain reduction for procedures in this setting. TRIAL REGISTRATION: Current Controlled Trials IRCT201408029568N9, 2014-09-08.

Personality traits of volunteer females of normal vaginal delivery or cesarean section based on HEXACO's personality model: a comparison study.

BACKGROUND: Child birth is one of the most important events in a mother's life. Different factors influence whether a child is delivered by cesarean or normal vaginal delivery. Despite the complications of cesarean, demand for this type of delivery is increasing. The purpose of this study was to examine the influence of personal traits on the choice of the delivery method based on HEXACO personality model. METHODS: Two hundred and ten pregnant women in some health centers in Tehran volunteered to participate in this research. To identify their personality dimensions, the pregnant women first filled out HEXACO personality forms. Then, the received data were analyzed through multivariate analysis of variance using a software package called SPSS-23. RESULTS: 104 women selected cesarean and 106 other women preferred normal vaginal delivery. The results of the multivariate analysis of variance showed that there is a significant difference between the two groups of women for six personality factors in HEXACO (P = 0.001). The linear combination of personality characteristics of pregnant women has a significant effect on the choice of delivery method (P < 0.05). CONCLUSIONS: Personality differences of pregnant women can be considered in psychological interventions and antenatal counseling to overcome psychological resistance to vaginal delivery and increase its choice.

Duration of Breastfeeding and Maternal-Related Factors in Iran, Systematic Review and Meta-Analysis.

BACKGROUND: Although the benefits of breastfeeding are commonly approved, there remains a significant discrepancy between maternal practices and World Health Organization (WHO) guidelines in some countries. OBJECTIVES: We had two aims in this study; average duration of breastfeeding, and its maternal determinants. DATA SOURCES: A web-based citation index was used for citing documents. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: We included observational studies evaluating breastfeeding duration among children who were at least two years old and not older than five were included in Iran. SYNTHESIS METHODS: The pooled mean and mean differences were considered. Heterogeneity was evaluated with the I2 statistic. RESULTS: The pooled mean of breastfeeding duration was calculated at 17.31 months. Children with younger mothers and lower birth orders had shorter durations of breastfeeding. Women with a high school and higher education level had early cessation of breastfeeding in comparison with less educated women. LIMITATIONS: The main limitation of the current study was lack of librarian assistance. CONCLUSIONS: The pooled mean of breastfeeding duration in Iranian children aged 2-5 was less than WHO recommendations. Accurate identification of the effect a mother's level of education has on duration of lactation requires standardized categorization. IMPLICATIONS OF KEY FINDINGS: Raising awareness among women can be an effective strategy in increasing the duration of lactation.

The sequential embryo transfer compared to blastocyst embryo transfer in in vitro fertilization (IVF) cycle in patients with the three repeated consecutive IVF. A randomized controlled trial.

The purpose of this study was to determine the pregnancy rate in the double sequential transfer of embryos on both day 3 and day 5 compared to day 5 alone, in in vitro fertilization-embryo transfer (IVF/ET) in patients with the three repeated consecutive IVF failures. In this controlled trial, women scheduled for IVF/ET with the three repeated consecutive IVF failures were randomized to either sequential transfer of embryos on day 2 and on day 5 after ovum pick-up (group 1, n = 60) or blastocyst ET on day 5 (group 2, n = 60) as a control group. The primary outcome measures were the chemical and clinical pregnancy rate. Baseline and cycle characteristics were comparable in both groups. Chemical and clinical pregnancy rate was similar in the sequential ET group (40%) compared to the day 5 of ET group (38.3%) (p value = .85). It seems that the double ET does not increase the chance of pregnancy rate compared to blastocyst ET on day 5 in the patients with the three repeated IVF-ET failures.

Effect of intrauterine device insertion on Candida species in cervicovaginal specimen identified by polymerase chain reaction technic: A longitudinal study on Iranian women.

AIM: To assess the effects of copper T-380-A intrauterine device (IUD) insertion on Candida species in cervicovaginal specimen by a molecular method, polymerase chain reaction. METHODS: This is a longitudinal prospective study performed on 95 women attending Health Centers of Tehran, Iran in 2012, who selected copper T-380-A IUD for contraception and had no history of local or systemic antibiotics or antifungals use during the previous 2 weeks. Cervicovaginal specimens were twice collected and cultured on Sabouraud dextrose agar and CHROMagar Candida, before and 3 months after IUD insertion. Finally, a molecular method, PCR-RFLP was performed for identification of Candida species. P-values <0.05 were considered significant. RESULTS: The mean age of participants was 28 ± 7.44 years. Positive Candida cultures were significantly increased 3 months after IUD insertion (25.3% vs 11.6%, P = 0.007). The most common identified species before and after IUD insertion, were Albicans, Glabrata and then both 'Albicans & Glabrata', respectively. The prevalence of Albicans and Glabrata decreased, while both 'Albicans & Glabrata' increased insignificantly. CONCLUSION: There was more than about fourfold increase in positive Candida cultures after IUD insertion. As the prevalence of simultaneous infection with both 'Albicans & Glabrata' species which are resistant to usual treatment, increased, it seems necessary to provide more intensive follow-up care for IUD users.

Exclusive Breastfeeding Duration and its Effect on the Health of the Children in Iran, a Meta Analysis.

PROBLEM: Given the importance of exclusive breastfeeding (EB) duration on growth and to maintain health in children, we decided to systematically review the existing research on EB duration and its effect on the health of 2- to 5-year-old children in Iran. ELIGIBILITY CRITERIA: A systematic literature search was conducted in the Database of Abstracts of Reviews of Effects (DARE), Google Scholar, PubMed, Psyc INFO, Thomson Reuters, Cochrane, and Medical Library (MedLib) to detect appropriate studies (1994 to 2016). Outcomes of mean, mean difference, and proportions were pooled. SAMPLE: In this meta-analysis, 38 studies met the eligibility criteria. RESULTS: The pooled mean of EB was calculated as 4.1 months (CI 95%: 3.2, 4.99). The meta prevalence of EB up to 4 months and 5 to 6 months was estimated 65.0% (CI 95%: 54.0, 77.0) and 54% (CI 95%: 46.0, 62.0) respectively. Based on studies conducted over the years from 1994 to 2016, an increasing trend of EB was found in infants up to 4 months (p ≤ 0.0001). Among children with anemia and respiratory diseases EB until 5 to 6 months was more common than in healthy children (CI 95%; 1.1, 2.11, and 1.01, 1.47 respectively). CONCLUSION: The duration of EB (4.1 months) was equal to the lower limit recommended by the World Health Organization (WHO). Overall, the duration of EB until 5 to 6 months is sufficient if the child's iron intake is well-monitored. IMPLICATION: Monitoring of the implementation of recent guidelines or even modification of the duration period of the iron administration is potentially necessary.

The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial.

PURPOSE: Evaluating early iron supplementation in non-anemic mothers with postpartum depression (PPD). METHODS: This randomized, double-blind, placebo-controlled trial evaluated 70 mothers with PPD. One week after delivery, the mothers were randomly allocated in the iron-treated (50 mg elemental iron/daily) and placebo-treated groups. After 6 weeks, the improvement of PPD symptoms was compared between the groups. RESULTS: Ferritin significantly increased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.09). After intervention, ferritin was higher in the iron-treated group (medians: 78.2 vs. 37 mg/dl, p = 0.01). The rate of iron deficiency significantly decreased in the iron-treated group (p = 0.009), but not in the placebo group (p = 0.4). After intervention, the rate of iron deficiency was higher in the placebo group (31.4 vs. 8.5 %, p = 0.01). The Edinburgh Postnatal Depression Scale (EPDS) score significantly decreased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.13). After intervention, the EPDS score was lower in the iron-treated group (medians 9 vs. 12, p = 0.01). The improvement rate for PPD was significantly higher in the iron-treated group (42.8 vs. 20 %, p = 0.03). After intervention, mothers with continued PPD had lower ferritin than the improved mothers (41.8 vs. 67 mg/dl, p = 0.03). Mothers with continued depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p = 0.02). CONCLUSIONS: Early iron supplementation in mothers with PPD significantly improves the iron stores and causes a significant improvement in PPD with a 42.8 % improvement rate during 6 weeks. Continued PPD might be related to the lower postpartum ferritin levels in untreated mothers.

Is early breast milk fortification more effective in preterm infants?: a clinical trial.

OBJECTIVE: Breast feeding alone does not provide adequate nutrition for growth in preterm infants; therefore, fortifiers are added when over 70-80 cc/kg/day of breast milk is tolerated. As there are few studies comparing early and late breast milk fortification, the following study was conducted. STUDY DESIGN: This double-blind clinical trial was performed on 80 preterm infants (gestational age of 28-34 weeks, birth weight <2 kg). The newborns were randomly divided into two groups to receive either early or late fortification. The primary and secondary outcomes were the difference in growth indices and complications (including feeding intolerance, necrotizing enterocolitis (NEC), and septicemia) between the two groups, respectively. RESULTS: Both groups showed increases in growth indices; however, there was no statistically significant difference in increments of growth indices and complications between the two groups. CONCLUSION: Our findings suggest that early fortification from the first feeding in neonates with exclusive breast feeding did not improve growth in the first 4 weeks in preterm neonates in comparison with late fortification; so early fortification may not be cost effective.

Comparison of efficacy of folic acid and silymarin in the management of antiepileptic drug induced liver injury: a randomized clinical trial.

BACKGROUND: Liver injury associated with antiepileptic drugs accounts for a large proportion of drug-induced liver injuries (DILI) in children. Although withdrawal of the causative agent is the only proved treatment for DILI, in some clinical situations it is not possible. Recent studies have reported promising results of using hepatoprotective drugs with antioxidant actions for the management of DILI. This study aimed to evaluate the efficacy of folic acid versus silymarin treatment in relation to decreasing liver enzymes in patients with DILI due to antiepileptic therapy. METHODS: This randomized, open-label, clinical trial evaluated 55 children with epilepsy who were on antiepileptic treatment and experienced DILI. The children were randomized to receive either silymarin (5 mg/kg per day) or folic acid (1 mg per day) for one month and were followed up for three months. RESULTS: Liver enzymes significantly decreased in both groups. The decrease trend in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were stronger in the folic acid group compared to silymarin group (P=0.04 and P=0.007, respectively). At the end of the study patients in the folic acid group had significantly lower ALT (P=0.04), AST (P=0.02), and gamma-glutamyl transferase (GGT) (P<0.001) levels and also higher percentage of normal ALT (30.7% vs 3.4%, P=0.009) and AST (42.3% vs 0%, P<0.001), and GGT (23.1% vs 0%, P=0.008) values compared to the patients in the silymarin group. No rebound elevations in ALT, AST and GGT levels or adverse reactions were noted in neither of the study groups. CONCLUSION: Although both treatments were safe and effective in decreasing liver enzymes, folic acid seems to be superior to silymarin in the management of DILI.

The impact of gestational weight gain in different trimesters of pregnancy on glucose challenge test and gestational diabetes.

PURPOSE: Assessing the effects of excessive weight gain before pregnancy, in the first and second trimesters and in the month preceding glucose challenge test (GCT) on GCT results and gestational diabetes mellitus (GDM). STUDY DESIGN: This prospective cohort study evaluated 1279 pregnant women who were referred for their first prenatal visit in 2012-2015. Mother's body mass index (BMI) was recorded before pregnancy, during the first visit and every 4 weeks until 28 gestational weeks. All mothers underwent GCT at 28 weeks and when 1 h glucose ≥140 mg/dL (≥7.8 mmol/L), they were referred for a 100 g fasting glucose 3 h glucose tolerance test. RESULTS: Obesity and being overweight prior to pregnancy were associated with 2.8-fold and 1.5-fold higher rates of developing GDM (p<0.001, p=0.04) and 1.9-fold and 1.8-fold higher rates of having false-positive GCT results (p<0.001). First-trimester excessive weight gain was significantly associated with false-positive GCT in women who were lean, overweight and obese before pregnancy (all p<0.001). When these women kept gaining excessive weight during the subsequent period the risk of developing GDM was significantly increased regardless of their pre-pregnancy BMI (p=0.03). When these women adhered to the recommended weight gain during the subsequent period, the risk of developing GDM was not increased, however the risk of having false-positive GCT remained high (p<0.001). CONCLUSIONS: Elevated pre-pregnancy BMI independently increases the risk of GDM and false-positive GCT. First trimester weight gain is the most important predictor of GCT and GDM regardless of pre-pregnancy BMI. The weight gain during the subsequent period affects the risk of developing GDM only in women with excessive first-trimester weight gain.

Comparison of citalopram and venlafaxine's role in treating sleep disturbances in menopausal women, a randomized, double-blind, placebo-controlled trial.

INTRODUCTION: Sleep disturbance is a common complaint in postmenopausal women. Few studies compared symptom improvement taking antidepressants versus placebo. This study aims to evaluate the efficacy of venlafaxine and Citalopram compared to placebo in treatment of sleep disturbance in healthy postmenopausal women. METHOD: This randomized, double-blind, placebo-controlled clinical trial was conducted in three groups of 20 postmenopausal women. The patients took venlafaxine 75 mg/daily (group I) or citalopram 20 mg/d (group II) or placebo (group III). Each patient filled Pittsburgh sleep quality index (PSQI) and Pittsburgh and Beck depression questionnaires. The frequency of hot flashes in a day and its severity were measured through diaries. Somatic symptoms and adverse side effects were evaluated. Follow-up visit was conducted after 3 months. The prior and the later results were compared. RESULTS: The PSQI scores in three placebo, venlafaxine, and citalopram groups before treatment were 14.25 ± 3.85, 11.55 ± 3.96, and 13.50 ± 3.56, respectively (p = 0.076). These values after treatment reached 9.95 ± 5.07, 8 ± 3.06, and 6.95 ± 1.84, respectively. PSQI score in citalopram and venlafaxine group was not significantly different (p = 0.19) but the score in both groups was significantly lower compared with placebo group after treatment (p = 0.01). The frequency of hot flashes in a day was reduced significantly by both citalopram and venlafaxine (p < 0.05), although it was more reduced by citalopram than venlafaxine (p = 0.03). Severity of hot flashes in both venlafaxine and citalopram was significantly lower in comparison with placebo group (p = 0.02), and there was no significant difference between two drugs, though (p = 0.84). Beck score decreased more in venlafaxine group in comparison with other groups but it did not reach significant (p = 0.06). CONCLUSION: Citalopram and venlafaxine are equally more effective than placebo in reducing sleep disturbance and severity of hot flashes, while citalopram is more effective in reducing frequency of hot flashes than venlafaxine. Meanwhile, venlafaxine is more effective than citalopram in treatment of depression in postmenopausal women. TRIAL REGISTRATION: Iranian Registry of Clinical Trials 201210152576N6.

Diagnostic Value of the Urine Mucus Test in Childhood Masturbation among Children below 12 Years of Age: A Cross-Sectional Study from Iran.

BACKGROUND: Childhood masturbation (CM) is considered a variant of normal sexual behavior; however, it is commonly misdiagnosed as epilepsy and movement disorders. As the first study from Iran, we analyzed a large population of infants and children with CM in a case-control study and evaluated the value of mucus in urine analysis as an alternative diagnostic tool for CM. METHODS: A total of 623 children referred to the Pediatric Neurology Clinic of Imam Khomeini Hospital for an evaluation of seizure or movement disorders were studied between 2008 and 2011. Totally, 359 children were found to have masturbatory behaviors (Group A) and the rest (264) were assigned to Group B. CM was diagnosed by direct observation. Collected data comprised demographic characteristics, clinical and neurodevelopmental examinations, laboratory findings (particularly urine analysis), and electrocardiography. RESULTS: The age of the children with CM was below 12 years old, and the girl-to-boy ratio was 7:1. Mucus in urine was positive in 357 (99.44%) children in Group A and 22 (8.3%) in Group B (P<0.001). A significant correlation was found between the presence of mucus in urine and masturbatory behaviors (P<0.001). CONCLUSION: Our findings suggest that the presence of mucus in urine can be used as an alternative laboratory test in children with CM below 12 years old and even in infants (≤24 months old). Further studies are needed to confirm the results.

Phenobarbital versus morphine in the management of neonatal abstinence syndrome, a randomized control trial.

BACKGROUNDS: Evaluating the efficacy of the loading and tapering dose of Phenobarbital versus oral Morphine in the management of NAS. METHODS: This randomized, open-label, controlled trial was conducted on 60 neonates born to illicit drugs dependent mothers at Vali-Asr and Akbar-Abadi hospitals, Tehran, Iran, who exhibited NAS requiring medical therapy. The neonates were randomized to receive either: Oral Morphine Sulfate or a loading dose of Phenobarbital followed by a tapering dose. The duration of treatment required for NAS resolution, the total hospital stay and the requirement for additional second line treatment were compared between the treatment groups. RESULTS: The Mean ± Standard Deviation for the duration of treatment required for the resolution of NAS was 8.5 ± 5 days in the Morphine group and 8.5 ± 4 days in the Phenobarbital group (P = 0.9). The duration of total hospital stay was 12.6 ± 5.6 days in the Morphine group and 12.5 ± 5.3 days in the Phenobarbital group (P = 0.7). 3.3 % in the Morphine group versus 6.6 % in the Phenobarbital group required adjunctive treatment (P = 0.5). CONCLUSIONS: There were no significant differences in the duration of treatment, duration of hospital stay, and the requirement for adjunctive treatment, between the neonates with NAS who received Morphine Sulfate and neonates who received a loading and tapering dose of Phenobarbital. TRIAL REGISTRATION: This study is registered at the Iranian Registry of Clinical Trials ( www.irct.ir ) which is a Primary Registry in the WHO Registry Network. (Registration Number = IRCT201406239568N8 ).