Background: The effectiveness of inhaled therapy in childhood asthma depends not only on the pharmacological properties of the medication but also on the inhalation device and proper inhalation technique. Evidence comparing dry powder inhalers (DPIs) and metered-dose inhalers (MDIs) for combination inhaled corticosteroid/long-acting β2-agonist therapy in pediatric populations remains limited. Objectives: To compare pulmonary function outcomes after fluticasone/salmeterol administration via a DPI versus an MDI in children with moderate asthma using a randomized, crossover design. Methods: This randomized crossover clinical trial was conducted in 86 children with moderate asthma (age range: 6 - 12 years; 48% female; mean asthma duration: 3.4 ± 1.2 years; previous controller therapy: inhaled corticosteroids). Participants were randomly assigned to two treatment sequences (DPI→MDI or MDI→DPI), with each treatment period lasting 1 month. Results: Pulmonary function improved over time in both treatment sequences. Mean forced expiratory volume in 1 second (FEV1) increased from 76.02 ± 9.92 to 86.42 ± 7.38 in the DPI→MDI sequence and from 74.46 ± 12.18 to 85.82 ± 9.12 in the MDI→DPI sequence. However, no statistically significant differences were observed between DPI and MDI for FEV1 (P = 0.544), FEV1/FVC (P = 0.579), forced vital capacity (FVC) (P = 0.359), or forced expiratory flow at 25 - 75% (FEF25 - 75%) (P = 0.671). Patient-reported comfort was slightly higher with DPI use. No treatment-related adverse events were reported. Conclusions: Fluticasone/salmeterol delivered via DPI and MDI resulted in similar improvements in pulmonary function in children with moderate asthma, with no statistically significant differences between the devices. Inhaler selection should be guided by patient preference, inhaler technique, accessibility, and clinical considerations rather than expected differences in efficacy.
Background: Sleep disorders in children can be caused by psychological disorders or birth defects such as congenital heart disease (CHD). While physiological factors associated with CHD are recognized as major factors, the environmental influences and parental mental health on sleep disorders in children are often overlooked. Objectives: This study examines the association between parental stress and anxiety and sleep disorders in children with CHD. Methods: A cross-sectional study was conducted on 147 children aged 4 to 12 years with CHD and their mothers attending Shahid Rajaee Heart Center in Tehran. Data were collected using a demographic questionnaire, the Children’s Sleep Habits Questionnaire (CSHQ), and the Depression, Anxiety, and Stress Scales-21 (DASS-21) completed by mothers. Results: In this study of 147 children with CHD (52.1% boys, 47.9% girls), 68.7% had undergone cardiac surgery, mainly open-heart (63.3%) or angioplasty (24.5%). Most families lived in urban areas (83.7%), 91.8% of parents were married, and 70.8% of mothers had a high school education or lower. The mean CSHQ score was 48.3 ± 7.2, with parental stress, anxiety, and depression (DASS-21) averaging 12.5 ± 5.4, 11.7 ± 4.8, and 10.2 ± 4.7, respectively. Parental anxiety showed the strongest association with child sleep disorders (r = 0.36, P < 0.001) and remained the only significant predictor in adjusted analysis (β = 0.36, P < 0.001). Conclusions: Parental anxiety and stress are significant predictors of sleep disorders in children with CHD. Integrating regular psychological support and mental health interventions for parents into the care of these children is essential to improve their sleep quality and overall well-being.
Background: Fever without focus (FWF) is a frequent diagnostic challenge in pediatric practice, occurring when febrile children present without any identifiable localizing signs. Objectives: Understanding its etiologies, clinical evolution, and optimal management is essential to avoid unnecessary testing and antibiotic use. Methods: This study included consecutive children aged 0 - 15 years presenting with fever ≤ 10 days and no focal findings on examination, with normal urinalysis and negative urine culture, at a tertiary pediatric outpatient clinic from 2015 to 2023. Demographic, clinical, laboratory, seasonal, and follow-up outcome data were collected. All children underwent structured follow-up at 24 - 72 hours and again at 7 days. Descriptive statistics were applied. Results: Of 16,325 children presenting with illness, 6,245 were febrile and 384 met criteria for FWF. Half were under 2 years old and 85% were younger than 5 years. Most cases occurred during warm seasons (63%). Final diagnoses were predominantly viral: Self-limited febrile illness (70%), roseola (9.3%), pharyngitis (4.1%), upper respiratory infections (4.1%), and viral gastroenteritis (4.1%). Urinary tract infection occurred in 2% and COVID-19 in 1.5% of cases. Approximately 75% of children became afebrile within 72 hours. Conclusions: Most FWF cases are viral and self-limiting. A structured follow-up strategy and age-based risk assessment enable safe management while minimizing unnecessary antibiotic use. Findings apply to similar outpatient pediatric settings with comparable epidemiological patterns.
Context: Febrile seizures are among the most common neurological conditions in children and typically occur between 6 months and 5 years of age. Emerging evidence suggests a possible association between iron deficiency and an increased risk of febrile seizures; however, findings across studies have been inconsistent. Clarifying this relationship is important for developing effective preventive and therapeutic strategies. Evidence Acquisition: This systematic review examined the association between iron deficiency and the risk of febrile seizures in children and synthesized the available evidence regarding the potential influence of iron status on seizure susceptibility. Of 2854 identified studies, 16 met the eligibility criteria and were included after a comprehensive screening process. Studies published between January 2010 and March 2025 were searched in PubMed, Scopus, Web of Science, Google Scholar, and SID using predefined search terms. Results: Most studies reported lower mean serum ferritin and iron levels in children with febrile seizures than in febrile or healthy controls. However, several studies found no significant differences. Where available, meta-analytic evidence supported a modest but statistically significant association between iron deficiency and an increased risk of febrile seizures. Heterogeneity in diagnostic criteria, study design, and population characteristics contributed to variability in the findings. Conclusions: Current evidence suggests a possible association between iron deficiency and febrile seizures in children, indicating that iron status may influence seizure susceptibility. However, due to methodological limitations and inconsistent findings, further well-designed longitudinal and interventional studies are needed to establish causality and determine whether iron supplementation can reduce the risk of seizures.
Background: Solitary Rectal Ulcer Syndrome (SRUS) is a rare disease that commonly manifests in children. Its diagnosis is often delayed due to misdiagnosis with other diseases. Objectives: The aim of this study is to evaluate prognosis and related factors in children. Methods: In this retrospective cohort study, medical records of 101 children with histologically confirmed SRUS were reviewed over a 12-year period (2012 - 2024). Demographic data, clinical presentations, colonoscopic and histopathological findings, treatment modalities, and therapeutic responses were analyzed. Statistical analysis was performed using SPSS, and a P-value ≤0.05 was considered significant. Results: The mean age at diagnosis was 10.46 ± 2.94 years (range: 2.75 - 16.7), and 77.2% were male. The most common presenting symptom was rectal bleeding (89.1%), followed by constipation (73.3%) and abdominal pain (67.3%). Endoscopic findings revealed single ulcers in 53.5% and multiple ulcers in 28.7% of cases. The most frequently prescribed treatments were polyethylene glycol (PEG) (88.1%) and mesalazine (70.3%). After a median follow-up of three years, 68% of patients achieved complete remission with medical management, while 32% experienced recurrence. Rectal bleeding, constipation, digital manipulation, and chronic constipation were significantly associated with relapse (P
Background: Gastroenteritis remains a leading cause of morbidity and mortality among children worldwide. Vitamin D has been implicated in immune modulation and inflammatory regulation, yet its association with pediatric gastroenteritis remains unclear. Objectives: This study investigated the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and clinical as well as laboratory indicators of gastroenteritis in children. Methods: In this cross-sectional study conducted between 2018 and 2019 at Amirkabir Hospital in Arak, Iran, 66 pediatric patients (> 2 years old) diagnosed with gastroenteritis were enrolled. Participants were classified as vitamin D–sufficient (≥ 30 ng/mL) or vitamin D–insufficient/deficient (< 30 ng/mL). Demographic data, clinical findings (duration of diarrhea, vomiting frequency, fever, dehydration severity, hospitalization duration), and laboratory parameters (stool white blood cell (WBC) and red blood cell (RBC) presence, urea, sodium, potassium, and C-reactive protein [CRP]) were compared between groups. Statistical analyses included t-tests, Mann–Whitney U, chi-square, and analysis of variance (ANOVA), with significance set at P < 0.05. Results: Of the 66 participants (33 per group), no significant differences were observed between vitamin D–deficient and sufficient groups in age, sex, diarrhea duration, vomiting frequency, fever, dehydration status, or laboratory indices (P > 0.05). However, CRP positivity was more common among children with low vitamin D levels (81.8% vs. 57.5%, P = 0.046). Conclusions: Although most clinical and laboratory parameters were not associated with vitamin D status, the higher CRP positivity in vitamin D–deficient children may suggest a link between low vitamin D and enhanced inflammatory response during acute gastroenteritis.
Background: Bronchiolitis is a common viral respiratory disease in infants, characterized by variable clinical severity. Disease severity is typically assessed using clinical criteria and scoring systems. The role of D-dimer in predicting bronchiolitis severity remains unclear. Objectives: This study aimed to evaluate the association between serum D-dimer levels and clinical severity in children. Methods: In this retrospective cohort study, 102 infants and young children hospitalized with bronchiolitis were randomly selected. Clinical severity was assessed using the Global Respiratory Severity Score (GRSS), a validated scoring system that incorporates parameters such as age, respiratory rate, oxygen saturation, wheezing, and other respiratory signs. Data were collected from medical records and systematically recorded. Outcomes included clinical severity, length of hospital stay, and need for Pediatric Intensive Care Unit (PICU) admission. Statistical analyses were performed using STATA, including t-tests, and logistic and linear regression analyses, with significance set at α = 0.05. Results: No significant correlation was observed between serum D-dimer levels and clinical severity (P = 0.533), length of hospital stay (P = 0.787), or PICU admission (OR = 1, P = 0.480). No mortality was recorded in the cohort. Conclusions: D-dimer is not a reliable predictor of clinical outcomes in hospitalized children with bronchiolitis.
Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition associated with deficits in attention, hyperactivity, and impulsivity, often accompanied by social and emotional difficulties. Although international studies have examined these aspects, limited data exist on the social and self-esteem profiles of children with ADHD in Iran. Objectives: To compare social skills and self-esteem between children and adolescents with ADHD and healthy peers, and to examine the association between these domains. Methods: In this cross-sectional study conducted from March 2024 to September 2025 at Isfahan University of Medical Sciences, 50 children diagnosed with ADHD (DSM-5-TR criteria) and 50 controls aged 6 - 18 years were evaluated. Social skills were assessed using the Matson Evaluation of Social Skills with Youngsters (MESSY), and self-esteem was assessed using the Coopersmith self-esteem Inventory. Group differences were analyzed using Mann-Whitney U and χ² tests, and correlations were examined with Spearman’s ρ. Results: Children with ADHD showed significantly lower total social skills scores (178 ± 23.9 vs 199 ± 36.7; P < 0.001) and reduced performance in appropriate social behavior (P = 0.016), antisocial behavior (P = 0.001), and aggressive/impulsive behavior (P = 0.001). They also exhibited lower total self-esteem (27.1 ± 7.1 vs 31.8 ± 7.4; P = 0.004), particularly in social (P = 0.001) and family (P = 0.001) dimensions. A positive correlation between social skills and self-esteem was observed in the total sample (ρ = 0.50, P = 0.001) and controls (ρ = 0.59, P = 0.001) but not in the ADHD group (ρ = 0.22, P = 0.12). Conclusions: Children with ADHD demonstrate significant impairments in social functioning and self-esteem relative to healthy peers. The absence of a strong correlation between these domains within the ADHD group suggests complex psychosocial mechanisms that warrant targeted behavioral and family-based interventions.
Background: Cystic fibrosis (CF) is a chronic and the most common autosomal recessive disorder caused by mutations in the CFTR gene. Sleep disorders are prevalent among patients due to the mechanism of the disease. Objectives: The aim of this study was to investigate and compare sleep disorders in children and adolescents with CF and without CF. Methods: In this case-control study, 52 children aged 4 – 16 years with confirmed CF and 52 healthy controls were recruited from the Children’s Medical Center Hospital in Tehran, Iran, between January and February 2024. Sleep disturbances were assessed using the validated Persian version of the Children’s Sleep Habits Questionnaire (CSHQ), completed by parents. Demographic and clinical data were collected, and statistical analyses included independent t-tests, chi-square tests, and logistic regression, adjusting for weight and BMI. Results: Children with CF had significantly higher total CSHQ scores (mean ± SD: 51.05 ± 5.20) than healthy controls (47.85 ± 5.05; P = 0.002), indicating a greater prevalence of sleep disturbances. The CF group showed significantly higher rates of bedtime resistance, delayed sleep onset, night wakings, parasomnias, and daytime sleepiness. After adjusting for weight and BMI, children with CF had nearly five times higher odds of having a sleep disorder (adjusted OR: 4.89, 95% CI: 1.95 – 12.27; P < 0.001). Clinical symptoms such as cough, shortness of breath, and gastrointestinal complications were also more prevalent in the CF group. Conclusions: This study demonstrates that Iranian children and adolescents with CF experience a substantially higher prevalence and severity of sleep disorders compared to healthy controls. Routine screening and management of sleep problems should be integrated into comprehensive CF care, as addressing them may improve overall health-related quality of life.
Background: Influential factors on dental fear and anxiety of 8 - 12-year-old Children. Dental fear is highly common, especially among children. Dental fear and dental anxiety are often used interchangeably; however, anxiety is defined as the anticipation of an adverse event, while fear is a normal unpleasant psychological reaction to a threat. Objectives: This study aimed to identify the influential factors on dental fear and anxiety of 8 - 12-year-old children. Methods: This cross-sectional study evaluated 88 children between 8 - 12 years, including 44 girls (50%) and 44 boys (50%), presenting to a private dental clinic. Demographic information of the participants was collected, and dental anxiety of children was assessed using the Modified Child Dental Anxiety Scale Figurated (MCDASF). Dental fear was assessed using the Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS). Data were analyzed by independent t-test, Mann-Whitney test, ANOVA, and Kruskal-Wallis test (alpha = 0.05). Results: Age and birth order had significant effects on dental anxiety, such that children ≥ 10 years had significantly higher dental anxiety than those < 10 years (P = 0.03); also, children who were not the first child had a higher level of dental anxiety than those who were the first child (P = 0.005). Gender had a significant effect on dental fear, such that dental fear was significantly higher in girls than boys (P < 0.001). Conclusions: Children ≥ 10 years and those who were not the first child had a higher level of dental anxiety than others. Girls had a significantly higher dental fear than boys.
Background: Bone marrow aspiration and biopsy are essential diagnostic procedures in pediatric hematology, yet often cause considerable discomfort. Safe and effective oral sedation regimens are required to optimize procedural tolerance. Objectives: This study compared the effects of ketamine-atropine-midazolam (KAM) versus dexmedetomidine-atropine-midazolam (DAM) on sedation quality and physiological stability in children undergoing bone marrow biopsy (BMB). Methods: In this double‑blind clinical trial, 72 children scheduled for BMB were randomly allocated to two equal groups. Forty‑five minutes before the procedure, the KAM group received ketamine (4 mg/kg), atropine (0.1 mg/kg), and midazolam (0.5 mg/kg); the DAM group received dexmedetomidine (8 µg/kg), atropine (0.1 mg/kg), and midazolam (0.5 mg/kg). Vital signs and sedation scores [Ramsay Sedation Scale (RSS) and Richmond Agitation-Sedation Scale (RASS)] were recorded at baseline, 2, 5, 10, and 45 minutes after drug administration. Data were analyzed with SPSS v22 using appropriate statistical tests. Results: Demographic characteristics were similar between groups. Mean Body Mass Index (BMI) values did not differ significantly (P = 0.32). There were no significant intergroup differences in blood pressure, respiratory rate, temperature, or oxygen saturation. Pulse rate was lower in KAM at 5 - 45 minutes (P < 0.01). Sedation induction was faster, and specialists’ satisfaction higher in KAM (both P < 0.01). Mean Ramsay and RASS scores were significantly greater in KAM (4.97 vs. 3.08; 8.41 vs. 5.80). Conclusions: The KAM regimen provided deeper and more stable sedation with comparable physiological safety, suggesting it as an effective alternative for pediatric bone marrow procedures. This study was limited by its single-center design and the relatively small sample size, which may affect the generalizability of results.
Background: Diarrhea is one of the most common gastrointestinal problems in children, potentially leading to dehydration, weakness, and hospitalization. Various treatments have been proposed to reduce the severity and duration of diarrhea; however, the need for more effective approaches remains. Objectives: This study aimed to evaluate the efficacy of Cordia myxa syrup, known as “Sepestan,” in reducing the severity and duration of diarrhea in patients with gastroenteritis. Methods: This double-blinded, randomized controlled clinical trial was conducted using the simple randomization method. A total of 140 patients with gastroenteritis aged 1 - 8 years, referred to Abuzar Hospital in Ahvaz, Iran in 2024, were enrolled. Patients with gastroenteritis whose symptoms had occurred within less than 24 hours, with no prior medication use, no severe dehydration, and no abnormal stool findings were included. These eligible patients were divided into two equal groups: The intervention group (receiving C. myxa syrup) at a dose of 20 mg/kg/day, and the control group (receiving placebo). Data on age, sex, diarrhea severity and frequency, stool volume and consistency, duration of diarrhea, and other clinical symptoms were recorded and analyzed on days 1, 2, 3, and 7. Both the patients (and their parents) and the researchers were blinded to the assigned treatment groups. Results: The mean age of participants was 27.53 ± 18.81 months. The C. myxa group demonstrated a statistically significant reduction in diarrhea duration (mean 3.91 days vs. 4.71 days in the control group, P = 0.000) and diarrhea frequency at 72 hours (P = 0.023). Stool volume analysis indicated a remarkable treatment effect (F = 49.929, P < 0.001), and stool consistency analysis also showed considerable improvement in the intervention group (F = 39.803, P < 0.001). Age had no significant effect in any statistical model, such as stool volume (P = 0.892) or stool consistency (P = 0.961). Conclusions: Our findings suggest that C. myxa syrup can significantly reduce both the duration and severity of diarrhea. This syrup may serve as an effective therapeutic option for patients with gastroenteritis. Limitations of this study were the single-center nature of the study, the short follow-up period, and restriction to a specific age group. Further multicenter studies with longer follow-up periods are recommended to confirm its effectiveness.
Background: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It is the most common psychiatric disorder in childhood, and research shows that children with ADHD tend to use screens more frequently. Evidence also suggests that appropriate parenting strategies can improve the management of screen time. Objectives: This study aims to investigate the impact of parenting education on the screen use of children and adolescents with ADHD attending child and adolescent psychiatry outpatient centers. Methods: This quasi-experimental study focused on children and adolescents with ADHD and their mothers who visited outpatient psychiatric centers in Rasht in 2022. Participants were divided into intervention and control groups. The study assessed screen time (TV, mobile, computer, etc.) by asking participants about their screen use before and after the intervention, which was conducted over 8 weeks with weekly 45-minute sessions. The intervention, led by a child psychiatry specialist and assisted by a psychiatric assistant, utilized constructive education techniques, including PowerPoint presentations, pamphlets, and question and answer sessions. Screen time was re-evaluated three months after the intervention. Results: This study involved children with ADHD, divided into two groups to assess the impact of parenting training. Of the children, 62.5% were boys and 37.5% were girls, with no significant difference in sex distribution between groups. The mean age was 9.36 ± 3.22 years. The average total hours of using screens in the group without educational intervention not only did not decrease but also showed a steady increase. However, in the group with educational intervention, screen time dramatically and significantly decreased from before the intervention to 8 weeks. This trend continued from 8 weeks to 3 months (P < 0.05). Conclusions: This study showed that parenting education for mothers of children with ADHD can significantly create positive changes in decreasing the time spent using screens.
Introduction: Congenital anomalies involving the first branchial cleft are uncommon and may occasionally present as a duplicated external auditory canal. These developmental disruptions, stemming from incomplete closure of the cleft during embryogenesis, can result in symptoms such as chronic otorrhea, recurrent external ear infections, and varying degrees of hearing impairment. Case Presentation: We describe a male infant, aged 18 months, who exhibited an accessory external auditory canal along with a cutaneous tag near the right ear opening. Audiological assessments, including auditory brainstem response (ABR), identified mild conductive hearing loss in the right ear and moderate to severe mixed-type hearing loss on the left. These findings highlight the diagnostic value of early hearing evaluations in patients with rare congenital ear malformations. Conclusions: Duplication of the external auditory canal is a rare but clinically significant condition with potential for substantial auditory compromise. Prompt recognition and regular hearing assessments are essential to guide appropriate interventions. Depending on the anatomical and functional severity, management options may include surgical correction and hearing rehabilitation strategies.
Background: Improving parental awareness and skills regarding autism spectrum disorder (ASD) can ease caregiving challenges and mitigate stigma-related stress in mothers. Objectives: This study aimed to evaluate the effectiveness of a psychosocial intervention on internalized stigma and quality of life among parents of children with autism. Methods: This quasi-experimental study utilized a pre-test and post-test design with a control group and a two-month follow-up. Targeting parents of children with ASD in Tehran, diagnosed at least four years prior, 30 parents were conveniently sampled and randomly matched by child age into experimental and control groups. The sample size was estimated based on previous studies and statistical power calculations, resulting in 15 participants per group. Parents aged 25 - 50, children aged 3 - 12 with a confirmed autism diagnosis at least four years prior, and willingness to participate were eligible criteria. Participants were excluded if they missed more than two sessions or had recent involvement in similar programs within the past six months. The experimental group underwent 10 psychosocial intervention sessions, while the control group received only necessary rehabilitative services. Assessments were conducted using the World Health Organization Quality of Life Scale (WHOQOL-100) and an Internalized Stigma Questionnaire (ISQ) at three intervals, with data analyzed using SPSS version 25 through analysis of covariance (ANCOVA) and repeated measures ANOVA. Results: Participants averaged 40.3 ± 9.85 years, with no significant age differences between groups, and their children’s mean age was 10.17 years. The ANCOVA revealed significant improvements in internalized stigma and overall quality of life in the experimental group post-intervention, with 27% and 23% of variance explained, respectively. Effect sizes indicated that participation accounted for 23%, 16%, and 43% of the variance in psychological health, social relationships, and environment domains. Repeated measures ANOVA confirmed significant group and time effects on internalized stigma and quality of life, with 61% and 12% of variance attributable to the intervention. Only the social relationships subscale showed significant differences (P < 0.05), explaining 15% of its variance; other subscales showed no significant change. Other subscales, including physical health, psychological health, and environment, did not exhibit significant differences (P > 0.05). Conclusions: The psychosocial intervention program significantly improves stigma perception and quality of life for parents of children with ASD, offering strategies to cope with autism-related challenges effectively.
Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious post-infectious inflammatory condition associated with SARS-CoV-2 infection in children. While the pathogenesis remains unclear, it is considered an immune-mediated hyper inflammatory reaction triggered by the virus. Objectives: To investigate the clinical characteristics, laboratory findings, treatments, and outcomes of MIS-C cases in an Iranian hospital. Methods: A retrospective review was conducted of 102 children meeting the World Health Organization (WHO) diagnostic criteria for MIS-C admitted to Firoozabadi Hospital in Tehran from March 2020 to February 2021. Demographic, clinical, laboratory, and outcome data were extracted from medical records. Results: Fever (96.1%) and cough (47.1%) were the most common presenting symptoms, followed by ill appearance (47.1%), nausea/vomiting (36.3%), and dyspnea (35.3%). Neurological involvement included seizures in 28.4% of cases. Lymphopenia was observed in 55.5% of patients, and abnormal blood gas levels, including hypocapnia or hypercapnia, were present in 90.6% of cases. Common treatments included antibiotics (78.0%), corticosteroids (44.0%), remdesivir (25.0%), and IVIG (13.0%). The recovery rate was 90.2%, with 26.5% of patients requiring PICU admission, and a mortality rate of 9.8%. Conclusions: This study provides epidemiological data on MIS-C in Iran, demonstrating both similarities and differences compared to previous literature. The high rate of respiratory and neurological involvement, along with distinct treatment patterns, highlights the need for further research to optimize management strategies across different healthcare settings.
Introduction: Henoch-Schonlein purpura (HSP) is the most common vasculitis in children, often following an upper respiratory tract infection. The classic tetrad of symptoms and signs includes palpable purpura (mandatory criterion), arthralgias, abdominal pain, and renal involvement. Other clinical findings, such as subcutaneous edema in the hands, ankles, and feet, are quite common in pediatric HSP. However, lumbar edema is a rare and atypical manifestation, with very few cases reported worldwide. Case Presentation: A 6-year-old girl was admitted to the pediatric ward with severe lumbar pain and swelling, along with leg pain, without a history of trauma. On initial examination, she had severe edema and tenderness of the back and a limited number of petechiae and purpura in the lower extremities. During hospitalization, the patient developed edema in her right ankle. She was clinically diagnosed with HSP. Conclusions: Lumbar involvement is a rare manifestation of HSP. During the literature review, only seven cases of HSP with lumbar edema were identified. Recognizing the rare and atypical manifestations of this disease can be helpful in its early diagnosis, especially in patients who have a delayed onset of the typical rash of the disease.
Context: Cardiopulmonary bypass (CPB), commonly used in cardiac surgeries, often disrupts thyroid hormone levels, leading to conditions like sick euthyroid syndrome (SES), which can impair myocardial function and delay recovery. Objectives: This narrative review examines the impact of levothyroxine therapy on cardiac performance and survival outcomes in patients undergoing heart surgery, particularly those with thyroid dysfunction. Methods: This narrative review was conducted through a literature search on articles in English with the relevant keywords. Results: The review highlights that levothyroxine, a synthetic thyroid hormone, helps restore normal thyroid function, improving hemodynamic stability and cardiac output, and reducing postoperative complications. Studies suggest that levothyroxine therapy facilitates faster recovery, shorter ICU stays, and potentially lower mortality rates. However, the optimal dosing, timing, and duration of therapy remain unclear. Conclusions: While short-term benefits are evident, further research is needed to evaluate the long-term effects of levothyroxine on cardiac function and survival.
Background: Sleep plays an important role in brain function, impacting critical periods of brain development and maturation. Sleep disturbances in children must be addressed, as they increase the risk of emotional disturbances. Sleep quality has been associated with melatonin levels. However, evidence of the association between sleep quality, emotional disturbance, and melatonin levels in children is still lacking. Objectives: The present study aimed to assess the association between sleep and emotional disturbances with melatonin levels in children experiencing online learning. Methods: This analytical cross-sectional study involved 82 elementary school students aged 6 - 12 years in Banyumas Regency, West Java, Indonesia, from August to September 2022. Subjects with major depressive disorder and attention deficit hyperactivity disorder (ADHD) were excluded to minimize potential bias. Salivary melatonin levels were measured using enzyme-linked immunosorbent assay (ELISA). Sleep disturbance was assessed using the Sleep Disturbance Scale for Children (SDSC), and emotional disturbance was measured by the Strengths and Difficulties Questionnaire (SDQ). The Mann-Whitney test with α < 0.05 was applied to test the difference in melatonin levels among various groups of children with sleep and emotional disturbances. Results: Of the 82 subjects, 7 children (8.5%) experienced sleep and emotional disturbances. The melatonin levels varied widely, with a median of 301.9 pg/mL. No significant difference was found in melatonin levels between children with sleep disturbance compared to those without sleep disturbance (P = 0.67), as well as for children with emotional disturbance compared to those without emotional disturbance (P = 0.79). Conclusions: Sleep and emotional disturbances were not associated with variations in melatonin levels in children experiencing online learning.
