Tehran University Medical Journal

Background: Excessive and irrational use of antibiotics in the treatment of acute diarrhea has caused increased resistance to these medications. It is well defined that most cases of diarrhea in children do not require the use of antibiotics. This study was aimed to determine the status of antibiotic administration for treatment of acute diarrhea in children younger than five years. All who admitted at the pediatric ward of Besat Hospital in Sanandaj.
Methods: First, the study was approved by the ethics committee of Kurdistan University of Medical Sciences. The archived files of all children under 5 years with a positive history acute diarrhea who were admitted in Besat Hospital of Sanandaj during the period of 1 years, from May 2016 to May 2016 were reviewed. Demographic information such as age, gender, type of diarrhea, type of nutrition, type of the prescribed antibiotic, results of the stool and blood samples were collected and recorded in the questionnaire.In Stool samples the contained a large number of WBCs and RBCs along with high fever, Shigellosis were considered. The results were analyzed by SPSS software, version 23 (SPSS Inc., Chicago, IL, USA).

Background: Urinary tract infection (UTI) is one of the most important pediatric health problems, which is occasionally associated with irreversible renal damage. Dimercapto-succinic acid (DMSA) scan is a diagnostic standard for the renal scar. Doppler ultrasonography (D.S) has been considered as a less invasive method. The purpose of this study was to determine the sensitivity and specificity of D.S in the diagnosis of renal scarring in children with a history of acute pyelonephritis (APN).
Methods: The present cross-sectional study was conducted on 120 children with APN, aged six months to twelve years in the University Pediatric Hospital of Qazvin, Iran, between August 2017 and August 2018. DMSA scan was performed in the acute phase of pyelonephritis for all patients. Half of the children with acute pyelonephritis had decreased radionuclide uptake in the first DMSA scan of whom thirty patients had kidney scarring in the second scan, six months later. Then renal vascular D.S was performed for these patients. Simultaneously, twenty children with a normal DMSA scan, assigned for D.S.
Results: The mean age of children was 5.30(3.50-11.8), and 4.80(2.50-10.09) in the scar and control group. Most of the patients in both groups were female, 25(83.8%) in renal scar, and 15(75.0%) in control. The scar group showed a greater rate of vesicoureteral reflux, 17(56.6%), of whom 11(36.7%) were bilateral. Among 30 patients with a renal scar, 2(6.7%) had first-time acute pyelonephritis, 11(36.7%) had second, and 17(56.7%) had more than two attacks of pyelonephritis. The frequency of renal scarring was 25% based on DMSA scan and 14% based on D.S. Accordingly, the sensitivity and specificity of D.S in the detection of renal scarring in children with APN was 23.3% and 100%.

Background: Developmental delay in preterm infants was estimated to be more common than term infants. Identifying the factors predisposing to developmental delay can help experts and health professionals in this field to prevent developmental delay of the infants, and leads to better management of the condition of them. This study aimed to evaluate and investigate the predisposing factors of developmental delay in preterm infants in the first year of their lives.
Methods: In this analytical cross-sectional study, 87 preterm infants were enrolled in the study by convenience sampling during the period of April 2016 to the end of March 2017 from two educational hospitals of Shahid Beheshti University of Medical Sciences (Imam Hussein hospital and Mahdiyeh hospital). Demographic and other initial data such as age, sex, gestational age, and the data about clinical problems observed at birth were collected through infants' medical records and were recorded in a special form for each infant. Also, the ASQ test was used to assess infants' developmental status at one year of age.

Background: Asthma is the most prevalent chronic disease in childhood and has been growing globally over the last three decades. Studies in this regard indicate different and irrelevant results in Iran. Different prevalence of asthma has been reported in industrialized countries, prevalence of 25.9% in the United Kingdom, 12.8% in Spain and 31% in Australia. This study aimed to evaluate asthma in Iranian children through systematic review and meta-analysis.
Methods: This study was performed as a systematic review and meta-analysis from January 2001 to December 2018. Related articles to the reviewed subject were obtained through searches of Scopus, ScienceDirect, Magiran, SID, Medline (PubMed), and Google Scholar databases. Cross-sectional studies were selected for inclusion in the study and observational studies as well as review studies were excluded from the study. Searches on Google search engine and the inspection of sites related to the topic were also incorporated to examine the grays literature. Duplicate articles and articles that were similar and obtained from the same source were removed through the EndNote software. The total number of articles was 896. Subsequently, the number of articles and studies that met the requirements of the first stage was 274. Ultimately after the elimination of 236 irrelevant articles and the elimination of 5 articles in the secondary examination, eventually 33 articles were added to the final stage. By the I² index, the heterogeneity of the studies was investigated and reported.

Background: Urinary tract infection is one of the most common infectious diseases in children, the most severe form of which is acute pyelonephritis. Vitamin D plays a very important role in regulating the immune system, this study was conducted to compare vitamin D levels in children with urinary tract infections and healthy children in Kerman, Iran in 2020.
Methods: This cross-sectional study was performed on 63 children with pyelonephritis hospitalized in Afzalipour Hospital and 68 healthy children who were referred to Samen Al-Hojaj Clinic in Kerman, Iran from January 2020 to January 2021. Inclusion criteria for patients include the following: a) the presence of clinical signs and symptoms of infection such as fever b) pyuria, neurogenic bladder, urinary stones, chronic renal failure and previous diagnosis of urinary reflux. The case group was evaluated by taking a complete history, completing a questionnaire and clinical examination, and laboratory tests. The two groups were compared in terms of variables of sex, age and vitamin D levels.

Conclusion: Inadequate vitamin D levels are associated with the prevalence of urinary tract infections, and vitamin D supplementation can be a low-risk option for preventing urinary tract infections.

Background: Mycoplasma pneumoniae is one of the causes of upper and lower respiratory tract infections especially in children, and antibiotics affecting the cell wall do not affect this type of infection. This study aimed to evaluate the prevalence of Mycoplasma pneumoniae and macrolide resistance in children with community-acquired pneumonia in Kerman city.
Methods: This cross-sectional study was conducted in a selected teaching hospital in Kerman city from July 2018 to July 2019. Fifty-one children hospitalized in the pediatric ward were diagnosed with bacterial pneumonia acquired from the community. These children were included in the study by census method. The data collection tool was a standard checklist. The checklist was completed by parents. Pharynx and nasal swab samples were taken from all patients. PCR was used to identify mycoplasma.

Background: Vesicoureteral reflux (urinary reflux) is one of the most common congenital anomalies in children. This study aimed to compare the ureteral opening distance from the midline in children with vesicoureteral reflux (VUR) and healthy children
Methods: This cross-sectional study was performed on the children with pyelonephritis who were referred to Afzalipour Hospital in Kerman, Iran from August 2019 to August 2020. Twenty children with vesicoureteral reflux (urinary reflux) and twenty healthy children were randomly selected. Then children with vesicoureteral reflux (urinary reflux) and healthy children were divided into two groups. The distance from the ureter to the midline in these children was then measured by a radiologist with a Philips affinity 70 ultrasound machine.

Results: In the group of children with tic disorders, the highest number of patients were girls and in the group of children who were healthy, the highest number of patients were girls. The average age of patients in the case group was 10.37±0.31 years old and the average age of patients in the control group was 10.06±0.41 years old. The average age difference between the children with tic disorders and healthy children was not statistically significant (P=0.971). The average body mass index (BMI) in the case group was 16.98±0.35 and the average BMI in the control group was 16.0±84.56. The average body mass index difference between the children with tic and healthy children was not statistically significant (P=0.838). The mean serum Vit 25(OH) D3 levels in the control group were higher than the average serum level of vitamin D in the case group. The mean serum vitamin D level difference between the children with tic disorders and healthy children was statistically considerable (P=0.036). Conclusion: The results showed that the average serum level of vitamin D in children with tic disorders was significantly lower than in children who were healthy. To investigate and confirm this relationship, more long-term studies with a larger number of patients are needed.

Background: Due to the chronic nature of diabetes, children with type 1 diabetes are prone to a number of long-term complications. One of the most important complications of this disease is cardiovascular involvement due to atherosclerosis, which is directly related to the control of blood lipids. The use of probiotics may be effective in the process of complications in these patients by affecting fat metabolism. The aim of this study was to evaluate the effect of oral probiotics on lipid profiles in children with type 1 diabetes.
Methods: This study was conducted at Bahrami Children's Hospital from May 2018 to May 2019. In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes (aged 2 to 16 years) were studied. We created two groups of 26 individuals. The inclusion criteria were determined as follows: Proof of T1DM by history and information of children’s medical record. Also, the Exclusion criteria were determined in this way: Patients consuming probiotics in the last 4 weeks, gastrointestinal infections in the last 2 weeks, and presence of chronic underlying intestinal diseases. The probiotic group received, in addition to insulin therapy, a daily probiotic capsule for 90 days. The control group received only routine insulin therapy. Blood samples were taken to measure lipid profiles at the beginning and end of the trial.
Results: A total of 52 patients were included. The mean age of children was 9.3±2.9 (4 to 14 years). The mean age in the probiotic and control groups was 9.6±3.5 and 9.4±3.0 respectively. The results of this study showed that HDL-C was increased in the probiotic group compared to the control group, although it was not statistically significant (P>0.05). Also, changes in total cholesterol, LDL-C, and triglyceride were not statistically significant.

Conclusion: In this study, the use of oral probiotics for 90 days in children with type 1 diabetes did not have a significant effect on blood lipid profiles compared to the control group.

Background: Idiopathic thrombocytopenic purpura (autoimmune), the most common cause of acute onset of thrombocytopenia in children who are otherwise healthy. This study was conducted with the aim of investigating the factors affecting the response to treatment in hospitalized children.
Methods: This retrospective study was conducted by examining the files of patients hospitalized due to ITP in Hazrat Masoumeh (S) Hospital from April 2009 to March 2019. The criteria for inclusion in the study included confirming the diagnosis of ITP and the age of 1 month to 14 years, and the exclusion criteria included cases of discharge with personal consent and not completing the patient's treatment course, the presence of pancytopenia or bicytopenia, the presence of moderate or severe splenomegaly or severe in clinical examinations, BMA based on the presence of a diagnosis other than ITP, not receiving any of the ITP treatment protocols, and patients whose first visit with the diagnosis of ITP was in another center or city. The information about age, sex, clinical symptoms on arrival, initial platelets and the platelets of days 3, 5, 14 and 180 were extracted from the patients' files. The type of treatment protocol, the need to repeat the treatment, the recurrence of the disease and the major complications of the treatment were extracted from the patients' files and finally the data were analyzed with SPSS software.
Results: The response to the treatment on different days was unrelated to the age, gender, and initial platelets (except for one exception) (P>0.05). In relation to clinical symptoms, the response to treatment on days three and five was related to the clinical symptoms at the time of presentation and on days 14 and 180 it was unrelated. Response to treatment on days 3 and 5 in different treatment protocols had a significant relationship (P<0.05), but there was no significant difference on days 14 and 180.

Conclusion: The best response was in the combined treatment group with methylprednisolone and IVIg, and the lowest response to treatment was observed in those receiving methylprednisolone alone.

Background: Today, the health of mothers and babies is of particular importance in health systems. So far, various interventions have been implemented to improve the health of pregnant mothers. The present study aimed to compare the effect of Entonox gas and Sufentanil epidural anesthesia in labor pain on the umbilical cord blood gas analysis and neonatal Apgar score.
Methods: The present study is a clinical trial on 800 pregnant women It was done in April 2020 to January 2022 at Shahid Akbarabadi Hospital. Mothers were divided into two groups: spinal anesthesia and the group receiving Entonox gas. To measure the effectiveness, Apgar scores were measured at 1 and 5 minutes along with BE, HCO3, and PCO2 parameters. Two independent sample t-tests and ANOVA were used in SPSS version 22 software to analyze the data.

Results: The results of the study showed that the average age of mothers participating in the study was 27 years, and the average Apgar score of 1 and 5 minutes in the group of mothers receiving Entonox gas and spinal anesthesia was 9.9 and 8.6, respectively. Also, the average Apgar score at minutes 1 and 5 in the group of mothers with spinal anesthesia was 9.8 and 8.2, respectively. The results of the analysis and comparison of the parameters obtained from the arterial gases of the umbilical cord of newborns were not significantly different between both groups of mothers. Also, no significant difference was found in Apgar scores between both groups of mothers. Conclusion: There is no significant difference between the effectiveness of using Entonox gas with spinal analgesia in the painless delivery of mothers; Therefore, considering the cost of each intervention along with their effect may cause a difference in the two interventions. This means that although both of the interventions have the same clinical and diagnostic effects, the one which costs less, will be more preferable from the point of view of the health system.

Background: Asthma is a chronic inflammatory disease of the airways. Various tests and questionnaires are designed to monitor the severity of asthma and help the therapist and the health system prescribe the best treatment to control it. This study was designed to compare two methods Asthma Control Questionnaires (ACQ) and Asthma Control test-child (ACT-CHILD) in children with asthma.
Methods: This descriptive cross-sectional study was conducted on 92 children with asthma referred to the Taleghani hospital, Gorgan, in 2022-2023. Patients were in a range of age 4-16 years. Asthma control was evaluated and compared by two methods ACT-CHILD and ACQ. ACT-CHILD included one version for 4-11-year patients completed by their parents and another one for 12-16 –year patients completed by the patients. The clinical symptoms, age, gender and the parents' records related to asthma were completed during the clinical interview. Data was analyzed using Chi-square and Spearman correlation tests. The degree of agreement between two questionnaires was determined using the Kappa coefficient.

Results: 84 children aged 4-11 years (91.3%) and 8 children aged 12-16 years (8.7%) were included in the study. According to the ACT-CHILD, 40.2% of children (n=37) had controlled asthma, 44.6% (n=41) had partially controlled asthma, and 15.2% (n=14) had uncontrolled asthma. Based on the ACQ, controlled asthma was observed in 18.5% (n=17), partially controlled asthma in 35.8% (n=33), and uncontrolled asthma in 45.7% (n=42) of children. Asthma control results based on two questionnaires were significantly different from each other (P<0.001). The agreement between the ACT-CHILD and ACQ methods in evaluating children's asthma was at a weak level (P=0.014, κ=0.157), however, a significant negative correlation was observed between the scores of the ACT-CHILD and ACQ questionnaires (r=-0.588, P>0.001) which after categorizing based on age group, this correlation was confirmed only in children aged 4-11 years (r=-0.627, P>0.001). Conclusion: Our findings showed that there is a poor agreement between ACT-CHILD and ACQ results in the assessment of asthma control. Further studies are recommended.

Case Presentation: We are reporting a case of Crohn's flare-up after trauma in a pediatric case. A 2.5-year-old male with a through and through anal trauma was presented in Akbar Children's Hospital, Mashhad, Iran, Spring 2023 with active bleeding but conscious. He then underwent a physical examination under general anesthesia in the operating room. At the Lithotomy position, a penetrating wound at the 3 o'clock anal verge and a tear in the perineal area at 9 o'clock, which, according to the evidence of pus discharge, were seen hours after the incident which was irrigated with normal saline and Hydrogen Peroxide respectively. Due to the contamination of the area, a supportive colostomy was decided to be closed after six months. At the appointed time during the colonoscopy, the pediatric gastroenterologist noticed extensive inflammation in the distal patch of the colon, which was consistent with Crohn's disease. Histopathological studies then confirmed this diagnosis. This was even though there were no symptoms of inflammatory bowel disease in the history of the boy's illness before the accident. The patient is then treated with prednisolone, Asacol, and ciprofloxacin, and after the disease subsides, the colostomy surgery team closes the disease. Conclusion: Trauma can be an immune-disrupting factor in the digestive system, and trying to reset the brain-gut axis can be chosen as a therapeutic goal.

Background: The type of delivery significantly affects a woman's life and her newborn's health. Various factors, including medical conditions, personal preferences, and cultural influences, shape this decision. Increasing cesarean delivery rates have raised concerns about associated risks. This study examines the health impacts of different delivery types on mothers and newborns in Yazd hospitals, with a focus on maternal and neonatal outcomes.
Methods: This cross-sectional analytical study involved a substantial cohort of 69,321 mothers who delivered in Yazd between March 21, 2018 to March 20, 2022. Comprehensive data were collected from Iman Hospital and relevant online patient records. To analyze the relationship between delivery type and health outcomes, independent samples t test and chi-square test were utilized. Additionally, odds ratios were calculated to assess relative risks concerning various maternal and neonatal outcomes. SPSS 26 software was employed for all analyses, with a significance level set at 5% to ensure robustness in the findings.

Background: Nephrolithiasis is one of the oldest known systemic diseases of kidney and urinary tract in children. This study aimed to compare the serum level of vitamin D in children with nephrolithiasis and healthy children.
Methods: The present descriptive-cross-sectional study was conducted from October 2017 to September 2019. 74 children with kidney stones and 63 healthy children referring to Afzalipour Hospital in Kerman were selected by simple sampling method. Healthy children who were considered as the control group were matched with the case group in terms of age and gender. All patients underwent kidney and urinary tract ultrasound. The diagnosis of kidney stones was based on the radiologist's opinion. Demographic characteristics of patients (age and sex) were recorded. Patients' blood tests were checked for vitamin D and calcium. Descriptive and analytical methods and SPSS software version 21 were used to analyze the data.

Results: The average age of children with kidney stones and healthy children was 5.41±1.8 and 10.06±0.41 years old, respectively (P=0.971). The most number of patients were boys (58.1%). 29.7% of patients and 15.9% of healthy children had a family history of kidney stones (P=0.056). 71.6% of patients had unilateral kidney stones and 28% had bilateral kidney stones. The mean serum level of vitamin D was higher in healthy children (P=0.021). The average calcium was higher in children with kidney stones (P=0.001). The average calcium was higher in children with kidney stones who had a family history of kidney stones (P=0.018). Average calcium was higher in children with bilateral kidney stones (11.4±1.1) (P=0.033). The mean calcium was higher in children with kidney stones with vitamin D deficiency (P=0.001) and sufficient vitamin D levels (P=0.037). Conclusion: The average level of vitamin D serum in healthy children was significantly higher than that of children with kidney stones, and the average level of calcium in children with kidney stones was significantly higher than that of healthy children. Larger studies with more patients are needed to investigate these relationships.

Background: Posterior urethral valve (PUV) is recognized as one of the most frequent causes of obstructive uropathy in the pediatric population, particularly in male infants. This congenital anomaly leads to variable degrees of urinary outflow obstruction, which may result in progressive renal damage and deterioration of kidney function over time. Despite advances in diagnostic modalities and surgical interventions, infants and children affected by PUV continue to demonstrate suboptimal long term renal outcomes, with a considerable proportion developing chronic kidney disease (CKD). Understanding early predictors of adverse renal prognosis is essential to guide timely interventions and optimize follow up strategies. The present study aimed to assess the long term renal outcomes, over a minimum of five years, of patients with PUV treated at the Children’s Medical Center, and to investigate the role of preoperative serum creatinine levels as a predictor of future CKD in this patient group.
Methods: A cross sectional and retrospective study design was employed. The medical records of patients diagnosed with PUV between March 2011 and March 2016 who had at least five years of documented follow up were reviewed at the Children’s Medical Center in 2021. Data extracted included demographic characteristics, laboratory tests—particularly pre and post operative serum creatinine—ultrasound imaging results, surgical details, and follow up findings throughout the study period.
Results:  Eighty one patients met the inclusion criteria, with a mean age at diagnosis of 105 days. At the five year follow up, the overall prevalence of CKD among these patients was estimated at approximately 9.9%. During the follow up period, one patient died due to kidney disease, one underwent kidney transplantation, and three required maintenance dialysis. Statistical analysis demonstrated that a preoperative creatinine level exceeding 1.15 mg/dL was strongly associated with the future development of CKD, showing 100% sensitivity and 75% specificity in predicting adverse long term renal outcomes.
Conclusion: This study underscores the persistent risk of CKD in children with PUV, even after surgical intervention. Regular and comprehensive monitoring of renal function remains vital in this high risk group. Preoperative serum creatinine may serve as a reliable, accessible, and clinically useful prognostic marker to identify patients who may benefit from closer follow up and proactive management strategies.
 

Background: Refractive errors are among the most common and preventable causes of visual impairment in children. Early detection and proper correction are essential to prevent long-term visual complications such as amblyopia and reduced academic performance. The present study aimed to determine the prevalence and distribution patterns of different types of refractive errors among elementary school boys in Hamedan Province, located in western Iran, where limited data are available on this age group.
Methods: This cross-sectional study was conducted between October 2022 and December 2023 on 1053 male students aged 6-12 years, selected through a multistage cluster sampling method covering both urban and rural areas. Examinations included Uncorrected visual acuity (UCVA), Best-corrected visual acuity (BCVA), cycloplegic refraction, cover test, and ophthalmoscopy, all performed by a trained optometrist following a standardized protocol. Based on cycloplegic spherical equivalent refraction, myopia was defined as -0.50 diopter or worse, hyperopia as +2.00 diopter or more, and astigmatism as a cylinder of -0.50 diopter or more. The data were statistically analyzed to explore the association between age and the type of refractive error.
Results: Data from 1027 students were included in the final analysis. The mean age of participants was 9.52±1.63 years. UCVA of 20/40 or worse was found in 16.5% of students, and BCVA of 20/40 or worse in 1.2%. The prevalence rates of myopia, hyperopia, and astigmatism were 6.5%, 5.6%, and 18.9%, respectively. With-the-rule astigmatism was the most frequent type observed. The prevalence of myopia tended to increase with age, while hyperopia showed a decreasing trend.
Conclusion: The findings revealed a relatively high prevalence of refractive errors, particularly astigmatism, among school-aged boys in western Iran. These results emphasize the importance of implementing periodic, school-based vision screening programs and ensuring better access to refractive care services. Promoting awareness among parents, teachers, and health authorities regarding the need for early eye examinations could play a crucial role in preventing avoidable visual impairment and improving children’s visual health and academic success.

Background: Chronic abdominal pain, which is defined as long-term or intermittent abdominal pain, is a common problem in children. Helicobacter pylori infection is acquired in childhood and is one of the important causes of peptic ulcer disease (PUD) and stomach cancer, so this study was conducted with the aim of investigating the prevalence of Helicobacter pylori in children with chronic abdominal pain referred to Imam Hospital in 1402.
Methods: This study is descriptive-cross-sectional and the statistical population of children with chronic abdominal pain referred to Imam Khomeini Hospital in Ilam city in 1402 was tested for Helicobacter bacteria. Helicobacter pylori was checked using stool antigen test.
Results: This study was conducted on 140 children with chronic abdominal pain with an average age of 7.06 years in the age range of 2-16 years, the majority of children living in Ilam city were boys. The type of feeding was reported in all children as regular, and the majority of them were the result of cesarean delivery (67.9%). The prevalence of 40.7% showed HP positivity in children with chronic abdominal pain. The majority of children in the age group of 4-8 years had Helicobacter pylori positive, 20 people (35.7%) and in children older than 12 years, Helicobacter pylori had the lowest frequency. The prevalence of Helicobacter pylori was reported more in girls than in boys, and among the studied cities it was the highest. The outbreak was in the city of Ilam. There was no difference between the prevalence of Helicobacter pylori with age, sex, place of residence and type of delivery.
Conclusion: The general results of our study show that Helicobacter pylori is an important factor for chronic abdominal pain in children, but factors such as sex, place of residence and type of delivery do not affect its prevalence. It is suggested that in future studies, the family history, parents' infection with Helicobacter pylori and its relationship with transmission to the child should be measured.

Background: Primary nocturnal enuresis (PNE) is a common and distressing childhood disorder characterized by involuntary urination during sleep after the age when bladder control is normally achieved. It affects not only the child’s quality of life but also family dynamics and social relationships. Previous studies have suggested a possible link between PNE and psychological or behavioral problems, yet findings have been inconsistent across populations. The present study aimed to investigate and compare the prevalence and patterns of psychiatric disorders among children with primary nocturnal enuresis and healthy controls in Sanandaj, Iran.
Methods: This case-control study was conducted in Sanandaj from October 2024 to April 2025. The study population included children referred to the Medical, Educational, and Therapeutic Center of Kurdistan University of Medical Sciences. A total of 228 participants were enrolled, comprising 108 children diagnosed with primary nocturnal enuresis and 120 age- and sex-matched healthy controls selected through convenient sampling. Psychiatric assessments were performed using the parent version of the Child Symptom Inventory-4 (CSI-4) questionnaire, which evaluates a wide range of childhood behavioral and emotional disorders based on DSM-IV criteria. Statistical analysis was performed using Stata version 18, and comparisons between groups were made using the chi-square and Fisher’s exact tests. A p-value < 0.05 was considered statistically significant.
Results:  Children with primary nocturnal enuresis had significantly higher frequencies of attention deficit disorder (ADD), hyperactivity disorder (HD), attention deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), generalized anxiety disorder (GAD), and tic disorder compared with the control group (p < 0.05). In contrast, the prevalence of phobia and obsessive-compulsive disorder (OCD) was slightly higher in the control group. No statistically significant difference was found regarding post-traumatic stress disorder (PTSD) between the two groups.
Conclusion: The findings suggest that primary nocturnal enuresis may serve as an indicator of increased vulnerability to certain psychiatric disorders in childhood. Early recognition and psychological evaluation of children with enuresis are recommended to improve long-term outcomes and mental well-being.

Background: Autism spectrum disorder (ASD) represents one of the most significant neurodevelopmental disorders in early childhood, where early diagnosis, particularly in children under five years of age, is crucial for effective interventions. Although global autism incidence has risen due to improved awareness, enhanced screening programs, and broader diagnostic criteria, epidemiological data from middle-income countries like Iran remain limited, especially for children under five. This study aimed to examine autism incidence trends among Iranian children under five from 1990 to 2021, stratified by sex and province. 
Methods: This ecological study was conducted from October 2024 to March 2025, analyzing data extracted from the Global burden of disease (GBD) database (1990-2021). Age-specific incidence data for children under five were obtained by sex and province. Incidence rates per 100,000 population were calculated for gender and provincial comparisons. Joinpoint regression analysis assessed annual trends and identified significant inflection points. Heat maps illustrated geographical distributions, while trend graphs stratified by sex and province were generated using GraphPad Prism. 
Results: The incidence rate of autism in children under five gradually increased from 1990 to 2005, followed by a sharp rise between 2005 and 2009, reaching its peak during this period. A subsequent decline was observed from 2009 to 2021. The male-to-female ratio remained consistently stable at approximately 3:1 throughout the study period and across all provinces. Notable provincial disparities were observed, with border provinces exhibiting greater fluctuations compared to central regions.
Conclusion: In contrast to the continuous global increase, autism incidence among Iranian children under five demonstrated an initial rise followed by a sustained decline after 2009. This trend may be attributed to declining birth rates, demographic shifts, evolving diagnostic criteria, improved prenatal care, and persistent challenges in early screening and case registration, alongside regional disparities in access to diagnostic services. These findings emphasize the need for enhanced early-screening programs, equitable resource distribution, and evidence-based child mental health policies in Iran.