Effect of face mask on pulmonary artery pressure during echocardiography in children and adolescents.

BACKGROUND: Face masks have become an important tool for preventing the spread of respiratory diseases. However, we hypothesized that face masks with reduced nasal airflow may alter pulmonary artery systolic pressure (PASP). PURPOSE: This study aimed to evaluate the effect of face masks on PASP in children and adolescents. METHODS: This case-control study was conducted between March 2021 and April 2022 at the Pediatric Cardiovascular Research Center in Isfahan, Iran. Using a convenience sampling method, a total of 120 children and adolescents, boys and girls aged 3-18 years, were allocated into 2 groups of 60 each (case group with congenital heart disease (CHD), control group of healthy subjects). For each patient in the case and control groups, echocardiography (ECHO), heart rate (HR), and blood oxygen saturation (SpO2) were performed and measured twice-once with a surgical mask and once without a surgical mask-by a pediatric cardiologist at 10-min intervals. RESULTS: A total of 110 participants were analyzed. The mean patient age was 9.58±3.40 years versus 10.20±4.15 years in the case (n=50) and control (n=60) groups, respectively. Approximately 76.0% (n=38) of the participants in the case group versus 60.0% of those in the control group were male. In the case and control groups, there was a statistically significant reduction in the mean changes in tricuspid regurgitation (P=0.001), pulmonary regurgitation (P=0.002), and PASP (P=0.001) after face mask removal. Although this study showed a reduction in pulmonary arterial pressure after face mask removal in patients with CHD and healthy subjects, no significant changes in HR (P=0.535) or SpO2 (P=0.741) were observed in either group. CONCLUSION: Wearing a face mask increased PASP in healthy children and adolescents with CHD; however, the SPO2 and HR remained unchanged. Therefore, mask removal during ECHO is recommended.

Factors associated with preventive behaviors of COVID-19 among children with congenital heart disease: Application of protection motivation theory.

BACKGROUND: Congenital heart disease (CHD) is one of the underlying medical conditions that put children at increased risk for coronavirus. This study aimed to predict preventive behaviors of COVID-19 among children with CHD based on the protection motivation theory (PMT). MATERIALS AND METHODS: This cross-sectional study was conducted from March 2021 to April 2021, on 240 children 3-7 years with CHD whose data had been registered in Persian Registry of Cardiovascular Disease/CHD (PROVE/CHD) System in Isfahan, Iran. The research variables were measured using an online researcher-made questionnaire that was based on PMT constructs. The collected data were analyzed using statistical tests (e.g., Pearson correlation coefficient and linear regression analysis). RESULTS: From a total of 240 participants (mean age of 4.81 ± 1.50) in the present study, 122 (50.8%) were girls. The most common types of CHD among children participating in this study were related to atrial septal defect (ASD) (29.2%, n = 70) and ventricular septal defect (VSD) (26.7%, n = 64), respectively. Protective behaviors showed a significant correlation with all constructs of PMT. The PMT constructs explained 41.0% of the variances in protective behavior, in which the perceived reward (ß = 0.325) and perceived self-efficacy (ß = 0.192) was the most important, respectively. CONCLUSION: The results of this study showed well the effectiveness of PMT on the preventive behaviors of COVID-19 in children with CHD. This theory can be used to teach preventive behaviors of COVID-19 to children with CHD in education programs.

Risk factors of congenital heart diseases: A hospital-based case-control study in Isfahan, Iran.

BACKGROUND: Improving knowledge towards risk factors for congenital heart disease (CHD) is important because of its high mortality and morbidity and trying for prevention of occurrence of CHD. METHODS: This case-control study was conducted on a total of 898 children with their mothers, who referred to the Clinic of Pediatric Cardiology of School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, during the years of 2014 to 2016. Cases comprised of 464 children with CHD diagnosed by echocardiography and controls were 434 sex- and age-matched children without any evidence of CHD, who were admitted for a heart check-up at the same study period and in similar conditions. The children's parents completed check lists for collecting demographic characteristics, family history of CHD, history of obesity in mother, history of abortion and diseases in mother, use of medicine during pregnancy, exposure to teratogens during pregnancy, and children characteristics such as birth height and birth weight, etc. RESULTS: Based on the results of data analyses with multiple logistic regression model [odds ratio (OR) with 95% confidence interval (CI)], history of obesity in mother before pregnancy, history of abortion, parental consanguinity, exposure to cigarette smoke during pregnancy, exposures to teratogens in the first trimester of the pregnancy, and use of medicine during pregnancy were associated with an increased odds of CHDs. CONCLUSION: Results of this study emphasizes the use of policies that enhance pre-marital counseling, regular counseling during pregnancy, treatment of mothers' disease, and enhancing knowledge of women of childbearing age about exposure to certain teratogens for controlling risk factors of CHD.

Early Results of the Persian Registry of Cardiovascular Disease/Congenital Heart Disease (PROVE/CHD) in Isfahan.

Background: In 2016, a prospective registry for pediatric patients with congenital heart disease (CHD) was established in Isfahan, Iran. Data on pediatric CHD in Iran are scant; accordingly, we aimed to report the early results of the Persian Registry Of cardioVascular diseasE (PROVE/CHD) Registry in Isfahan. Methods: All patients with CHD and associated defects diagnosed by pediatric cardiologists were assessed via echocardiography for inclusion in the present study between late 2016 and August 2019. The participants' sociodemographic characteristics, maternal history, birth history, medical history, current clinical presentations in the clinic or hospital, paraclinical data, cardiac diagnoses based on the International Classification of Diseases, 10th Revision (ICD-10), disease management plans, and medications were entered into a questionnaire by the subjects' parents/legal custodians and physicians and then transferred to the PROVE/CHD Registry. Results: The PROVE/CHD registry encompasses 1252 patients with CHD (49.9% male) at a mean age of 6.50±6.36 years. The most frequent cardiac diagnoses were ventricular septal defect (39.3%), atrial septal defect (29.7%), patent ductus arteriosus (25.4%), pulmonary stenosis (11.0%), tetralogy of Fallot (6.1%), coarctation of the aorta (5.4%), and aortic stenosis (5.1%), respectively. The most frequent interventions were patent ductus arteriosus closure (4.3%), atrial septal defect closure (3.6%), pulmonary valvuloplasty (2.2%), coarctation of the aorta angioplasty (1.9%), and ventricular septal defect closure (1.1%), correspondingly. The approximate corresponding rates of corrective and palliative surgeries were 32.0% and 13.1%. The corrective surgeries were mainly comprised of ventricular septal defect closure (7.8%), patent ductus arteriosus closure (7.3%), atrial septal defect closure (5.1%), and tetralogy of Fallot repair (3.8%), respectively. The palliative surgeries mainly consisted of the Glenn shunt (9.0%) and pulmonary artery banding (3.6%). Conclusion: The PROVE/CHD Registry collects data on pediatric patients with CHD. The results of this registry can provide epidemiological data and a set of homogeneously defined cases for further studies.

The effects of aerobic training, resistance training, combined training, and healthy eating recommendations on lipid profile and body mass index in overweight and obese children and adolescents: A randomized clinical trial.

BACKGROUND: The aim of this study was to evaluate the effects of 8 weeks of aerobic training, resistance training (RT), combined training, and nutritional recommendations on lipid profile and body mass index (BMI) in obese and overweight children and adolescents. METHODS: This randomized, clinical trial was conducted on 120 children and adolescents (10-19 years of age) with overweight and obesity. Participants were divided into 4 groups, the 3 intervention groups of high-intensity interval training (HIIT), RT, and combined training, and 1 non-exercising control group with healthy eating recommendations. We considered 24 sessions of training during 8 weeks for the intervention groups. The participants' anthropometric indices and lipid profile were assessed before and after the intervention. RESULTS: There were no significant differences between the groups in terms of anthropometric indices and lipid profiles before the intervention. After the intervention, there was a significant difference between the groups in terms of high-density lipoprotein (HDL) level; the control group (37.70 ± 9.45) and the HIIT group (43.65 ± 9.09) displayed the lowest and highest mean, respectively (P = 0.040). Comparison of physical variables and blood lipid profiles before and after the intervention showed a significant difference in waist circumference (P = 0.030), hip circumference (P ≤ 0.001), and HDL level (P = 0.040) in RT, HIIT, combined, and control groups. CONCLUSION: These results demonstrate that the combined training program and HIIT program with nutritional recommendations in overweight and obese children and adolescents were more effective in reducing BMI and hip circumference, respectively.

The effect of educational intervention on weight loss in adolescents with overweight and obesity: Application of the theory of planned behavior.

BACKGROUND: The increased prevalence of overweight and obesity in children and adolescents is associated with type 2 diabetes, hypertension, dyslipidemia, and cardiovascular diseases. The theory of planned behavior (TPB) efficiently explains the ability of perceived behavioral control and possibly attitude to enhance the motivations of the obese people to lose weight. Our aim was to investigate the effect of TPB-based education on weight loss in obese and overweight adolescents. METHODS: In an interventional study, simple random sampling was used to select 86 overweight and obese adolescents aged 13-18 years in the pediatric clinic at the Isfahan Cardiovascular Research Institute. Anthropometric measures and TPB constructs were collected using a researcher-made questionnaire. The questionnaires were filled out before and six weeks after the intervention. Participants received 5 sessions of training based on the constructs of the TPB. RESULTS: A significant increase was observed in the mean score for knowledge and TPB constructs (attitudes, subjective norms, perceived behavioral control, intention, and behavior) six weeks after the educational intervention (P < 0.001). Moreover, significant decrease in body mass index (P < 0.001), weight (P = 0.001), and waist circumference (P < 0.001) of adolescents were found after the educational intervention. CONCLUSION: The TPB-based interventions seem to be effective in losing weight in obese and overweight adolescents. This theory serves as a helpful theoretical framework for health-related behaviors and can be an appropriate pattern to plan for educational interventions.