Background: Celiac disease (CD) is an autoimmune mediated gluten sensitive enteropathy and Cardiac involvement in CD children is frequent. Objectives: This study aimed to investigate Cardiac Involvements in patients with celiac disease by using Doppler Tissue Echocardiography and conventional echocardiography to identify myocardial dysfunctions in celiac patients compared to healthy individuals. Patients and Methods: This case-control and approved study was performed on 120 children with celiac disease and 60 healthy children aged 1-18 years old in a single center. Patients with valvular disease, rhythm abnormality, CHD, malignancy, systemic inflammatory diseases, diabetes mellitus, renal insufficiency, chronic obstructive pulmonary disease and hypertension were excluded from the study. The participants underwent echocardiography. Data were analyzed through SPSS 17 using Student’ s t-test and Mann-Whitney U. A P value of < 0. 05 was considered as significant. Results: Out of 120 patients with celiac, 55. 83% were females and for the control group it was 43. 33%. The participants in the case and control groups were matched for sex and age. Weight and height showed significant differences between the groups. Right ejection time had significant mean differences of 245. 30 ± 24. 60 and 253 ± 22. 66 for the case and control groups respectively with the t =-2. 03 and P = 0. 044. Similar trends were observed for the left myocardial performance index by DTE with a mean of 0. 79 ± 0. 12 and 0. 72 ± 0. 12 for the case and control groups, respectively (t-3. 32, P = 0. 001). QT and heart rate by ECG and ET, IRT and MPI by DTE had significant differences in the case and control groups. LA in diastole and LVM and Peak A velocity had significant differences in both groups. ET, ICT, and IRT revealed significant differences in the case and control groups. Conclusions: Consistent with many study’ s results, we reached the conclusion that Doppler Tissue Echocardiography and Conventional Echocardiography are good determination methods of systolic and diastolic myocardial functions in patients with celiac disease. Between these two methods, the present study confirmed the importance and strong power for Doppler Tissue Echocardiography.

Background Celiac disease (CD) is an autoimmune mediated gluten sensitive enteropathy and a chronic inflammatory condition caused by immune pathology in the small intestines in genetically susceptible individuals. This study aimed to determine the efficacy of gluten free diet on Cardiac functions using conventional and Doppler tissue echocardiography (DTE) in children with CD compared to controls. Materials and Methods This case-control study was conducted on 107 children with CD and 45 healthy children. The study was performed in the Ali Ebne Abi Talib hospital, affiliated to Zahedan University of Medical Sciences, Zahedan (ZaUMS), Iran. After considering exclusion criteria, participants underwent echocardiography. Data were analyzed through SPSS software version 20. 0. Results: Results showed that tTG-IgA was different in participants. Left MPI was different in control-positive (p<0. 001), control-newly diagnosed (p=0. 024), and positive-negative (p<0. 001). Right MPI was different in control-positive (p<0. 001), control-newly diagnosed (p=0. 024), positive-negative (p<0. 001), and negative-newly diagnosed (p<0. 001). Left MPI’ was different in control-positive (p<0. 001), control-newly diagnosed (p<0. 001), positive-negative (p=0. 014), and negative-newly diagnosed (p=0. 010). Right MPI’ was different in control-positive (p<0. 001), control-newly diagnosed (p<0. 001), positive– negative (p=0. 010), and negative-newly diagnosed (p=0. 034). Left DT was different in positive-negative. Right ET was different in control-positive, control-newly diagnosed, positive-negative and negative-newly diagnosed. Right AT was different in positive-negative and positive-newly diagnosed. Conclusion It was concluded in patients with positive response to gluten free diet that some heart functions were similar to the controls and in patients with negative response, some were similar to newly diagnosed patients. Diastolic and systolic dysfunctions are important findings in CD children and TDE is a better method to identify Cardiac Involvements in subclinical patients with CD.

Background N-terminal pro– B-type natriuretic peptide (NT-proBNP) is a marker to evaluate the Cardiac involvement in thalassemia. We aimed to evaluate conventional and tissue Doppler echocardiography findings and its relation to plasma NT-pro BNP, Ferritin and Iron levels in beta-thalassemia patients. Materials and Methods This study performed on 164 participants equal of major beta-thalassemia patients (n=82), and controls (82 healthy children with normal cardiovascular status). The patients collected from outpatients after applied exclusion criteria. Blood samples were taken from participants in fasting to measure NT-pro BNP, Ferritin and Iron serum. Participants were under echocardiography by Pediatric cardiologist. The level of error considered as 0. 05 for data analysis by SPSS version 20. 0. Results NT-pro BNP, Iron, Ferritin, left S', left A', right A', EF, FS, left and right A/A'; right and left MPI were significantly different in patients group (P<0. 05). FS and EF were higher in younger’ s and left and right MPI were lower. In higher level of NT-pro BNP right S' had converse trends compared with the Iron, its level was higher in patients > 10 years, and FS had different values significantly in lower levels. In lower level of left E/E' resulted that FS was significantly higher in the age group < 10 years. Right peak E velocity was significantly higher in younger’ s in higher level of left E/E'. Right E/E' was significantly higher in elders in lower level of left E/E' (P<0. 05). Conclusion The study confirmed that NT-pro BNP increases in thalassemia and association with age and LV diastolic dysfunction. NT-pro BNP with E/E' and S' were shown diastolic and systolic dysfunction in thalassemia. Therefore, an increased level of ferritin and NT-pro BNP can be used as a marker for the intensification of iron chelation therapy, which reverses iron-induced cardiomyopathy.

Basic life support (BLS) following by Advanced Cardiac life support (ACLS) is intended to rescue the patients with acute circulatory or respiratory failure or both. The most important determinant of short and long-term neurologically intact survival is the interval from the onset of the Cardiac or respiratory onset to restoration of effective spontaneous functions of these vital activities.It is commonly accepted that every physician, regardless of specialty, should be able to  perform CPR. It must be also emphasized that CPR, almost invariably, necessitates a rapid interventional follow-care with ACLS procedure.Without well-performed basic life support, advanced Cardiac life support is of no remark-: able benefit, BLS and ACLS are processes that must be performed step by step and with respect to the patient's condition.

Pediatric coronary artery bypass surgery gained wide acceptance with the introduction of internal thoracic arteries (ITAs) for bypass operations for post Kawasaki disease (KD) lesions. The technique is now established as the standard surgical choice, and its safety even in infancy, graft patency, growth potential, graft longevity and clinical efficacy have been well documented. In this article the author reviews the development of pediatric coronary bypass as the main indication for the treatment of coronary lesions due to KD. I believe that coronary revascularization surgery in pediatric population utilizing uni- or bilateral ITAs is the current gold-standard as the most reliable treatment, although percutaneous coronary intervention with or without a stent has been tried with vague long-term results in children.

Rosai-Dorfman disease (RDD) is a rare lymphoproliferative disorder with nodal and extranodal Involvements. Here we report a case of RDD in a 15-year-old female who presented with epigastric pain, fatigue, Raynaud phenomenon in fingers, submandibular lymphadenopathy, proptosis, hepatosplenomegaly, and round shape painless patches on the extensor surfaces. Histological examination of the submandibular lymph nodes and skin biopsy demonstrated evidences of RDD. Patient was treated with prednisone and thereafter, with azathioprine. After one year, prednisone was discontinued and all of the symptoms and signs, except proptosis, were resolved. This report highlights the extranodal manifestations of RDD. The presentation, differential diagnosis, and treatment are discussed.

The study was aimed at identifying parent involvement (PI) barriers in qualitative evaluation (QE) and applied phenomenological qualitative research. For this purpose, semi-structured interview with 35 parents of 6th grade students was conducted, and sample was selected by extreme (opposition) and intensify (proponents) sampling methods. Data analysis revealed 89 base, 15 organizers and 6 comprehensive themes, which are the lake of parental awareness of the basics and characteristics of qualitative evaluation (QE), improper understanding of teachers from parents’ participation in qualitative evaluation (QE), lack of parents’ knowledge from their responsibility, governing quantitative evaluation methods and structure on formal and informal education system, parents’ experiences from education system and socio-cultural factors. According to the findings, suggestions are presented for future researches and Practical solutions.

Background: Rheumatoid arthritis is a chronic autoimmune disease characterized by synovial tissue inflammation and destruction of articular components which if not controlled properly, can cause disability in patients. For this reason, evaluation of disease activity and its control is very important. In recent years using sonography is promising for the evaluation of disease activity. This study aimed to compare “clinical examination” and “ultrasonography” methods in the detection of disease activity in patients with rheumatoid arthritis.Materials and Methods: This cross‑sectional study was conducted during 2015 in Al‑Zahra Hospital of Isfahan. Based on the American College of Rheumatology 2010 criteria, ninety patients with rheumatoid arthritis who diagnosed by rheumatologist entered into the study. All patients, collaborator by radiologists were subjected to sonography of specific joints structures using two methods, i.e., high‑resolution ultrasonography and power Doppler.Results: A total of 2520 joints from ninety patients were examined by physical examination and ultrasonography that 244 joints (9.7%) in physical examination and 348 joints (13.4%) in ultrasonography were involved and the difference between the two groups was statistically significant (P<0.001).Conclusion: Probably, ultrasonography can diagnose joint involvement better than physical examination in patients with Rheumatoid arthritis.

This work concerns the situations in which the framing effects emerge. This has not been an established feature in different studies, so the reasons for its variations have been the subject of various studies since 1980s. Present study aimed to determine the variables affecting the feature as well as to address the controversies exist on how these variables affect it. 551 students from engineering faculty, University of Tehran and different faculties at Tehran University and Medical Sciences were included in the study. They were assigned to eight categories in two steps and filled out the modified Kahnman and Tveresky's death, life, and trust text with the classical conditions. Results indicate that framing effects has a significant relationship with "the importance of sucrife's fate to the participant. In other words, the framing effects emerge as "emotional involvement" on the "the fate of human beings in danger" is produced in the participant. In addition, application of open-ended questions reveals that nationality distinction not only affects the emotional involvement, but can also highlight distinct emotional aspects in participants. In spite of their importance, these aspects have been neglected in the previous studies.