Background: Malocclusion is a common condition in children, often requiring timely orthodontic intervention during critical stages of craniofacial development. Lateral cephalometric radiography remains a fundamental diagnostic modality; however, manual landmark identification suffers from subjectivity, time consumption, and inter-examiner variability—challenges that are amplified in growing pediatric patients. Objectives: To review recent applications of artificial intelligence in pediatric lateral cephalometric analysis, focusing on automated landmark detection, diagnostic accuracy, clinical usefulness, educational value, and radiation-reducing innovations. Methods: This narrative review synthesizes peer-reviewed literature published between January 2020 and October 2025. Studies evaluating artificial intelligence (AI) systems for cephalometric analysis in pediatric or adolescent populations were included, with emphasis on methodological approaches, accuracy metrics, clinical feasibility, and innovations such as low-dose imaging or photograph-based landmark prediction. Results: Deep learning models—particularly convolutional and region-based neural networks—consistently achieved landmark localization errors below 2 mm, meeting clinically acceptable thresholds. AI integration significantly reduced analysis time (from 10–30 minutes to seconds) and enhanced reproducibility, especially when used in hybrid workflows combining algorithmic output with clinician verification. Educational applications showed improved trainee performance, while emerging non-ionizing approaches (e.g. AI-driven prediction from facial photographs) offered promising radiation-reduction strategies. Nevertheless, limitations persist, including platform-specific performance disparities, insufficient diversity in training datasets, and limited model interpretability. Conclusions: AI is not a replacement for clinical expertise but a powerful adjunct in pediatric cephalometric analysis. It enhances diagnostic efficiency, supports education, and enables safer imaging alternatives. Future implementation must prioritize diverse pediatric data, transparent and explainable architectures, and real-world validation to ensure equitable, reliable, and ethically sound clinical adoption.
Background: Glycogen storage disease type I (GSD I), or Von Gierke disease, is a rare autosomal recessive disorder caused by mutations in the G6PC1 (GSD Ia) or SLC37A4 (GSD Ib) genes. Early genetic diagnosis is essential to prevent complications. Objectives: This study aimed to systematically review reported G6PC1 and SLC37A4 variants in Asian patients and to identify region-specific mutation patterns. Methods: A systematic search of Web of Science, PubMed, Embase, Scopus, ProQuest, and Google Scholar was performed through June 4, 2023, using appropriate MeSH terms and keywords. Eligible studies included cross-sectional studies, cohorts, case reports/series, and case-control designs that reported the type and frequency of pathogenic or likely pathogenic G6PC1 or SLC37A4 variants in Asian patients with GSD I. Two reviewers independently extracted data, with discrepancies resolved by a third reviewer. Variant pathogenicity was assessed using the American College of Medical Genetics and Genomics (ACMG) criteria and cross-validated with ClinVar and HGMD. Regional variant frequencies were summarized using descriptive methods. Results: Seventy studies from 14 Asian countries, comprising 680 patients, were included. Distinct regional mutation patterns were identified. In East Asia, the G6PC1 c.648G>T and SLC37A4 c.572C>T/c.521C>T variants predominated. In West Asia, G6PC1 c.247C>T and SLC37A4 c.1042_1043delCT were most frequent. In South Asia, G6PC1 c.648G>T/c.150_151delGT and SLC37A4 c.796_797del/c.898C>T were common. These patterns highlight both shared and region-specific variants. Conclusions: The study reveals diverse, region-specific G6PC1 and SLC37A4 mutations in Asian patients with GSD I, supporting targeted genetic screening and personalized diagnostics.
Background: Childhood health and development have a significant impact on mortality, morbidity, and long-term well-being indicators in developing countries. Objectives: This study aimed to evaluate the research and technological activities of Iranian pediatric research centers (PRCs) over a ten-year period (2014-2023). Methods: A cross-sectional study was conducted in 2024 to assess 33 licensed PRCs in Iran. Data were collected from annual evaluation reports and analyzed based on predefined research evaluation criteria, across three domains: stewardship, scientific authority, and research impact. Statistical analysis was performed using SPSS software (version 22.0), with the level of significance set at P<0.05. Results: Findings indicate that the Research Center for Immunodeficiency of Tehran University of Medical Sciences (TUMS), Child Growth and Development Research Center of Isfahan UMS and Maternal, Fetal and Neonatal Research Center of Tehran UMS ranked first to third in the evaluation, respectively. In terms of stewardship, all PRCs had a strategic plan; however stakeholder participation in its development was limited. The top three priority areas were related to childhood non-communicable diseases. Regarding scientific authority, 8,146 research articles have been published. Of these, 68.3% were indexed in Web of Science (WOS), and the mean five-year h-index of the centers was 9.2. PRCs submitted a total of eight research impact proposals. Conclusions: Iranian PRCs demonstrate clear strengths, including established strategic plans and a substantial body of high quality publications, reflecting growing scientific visibility. Nonetheless, limited stakeholder involvement in planning and the small number of research impact proposals reveal areas requiring further development to strengthen translation and enhance contributions to child health.
Background: Inhaled corticosteroids (ICS) are the primary anti-inflammatory therapy for long-term asthma management, with well-documented benefits in reducing airway inflammation, controlling symptoms, preventing exacerbations, and lowering asthma-related morbidity and mortality. Although systemic corticosteroids (SCS) remain the standard of care for acute exacerbations, the role of high-dose ICSs in this context is not fully established. Some studies—particularly in pediatric populations—have suggested potential benefits of early administration of high-dose ICSs, while evidence in adults remains inconclusive. Objectives: This narrative review aimed to evaluate nebulized ICS for the treatment or prevention of wheezing and asthma exacerbations, with emphasis on beclomethasone dipropionate (BDP). Methods: We reviewed studies published in English, French, Spanish, and Portuguese over the past 25 years in the following databases: PubMed, SciELO, Google Scholar, and the Virtual Health Library. Search terms included: acute asthma OR asthma exacerbation AND beclomethasone OR budesonide AND suspension OR nebulization AND children OR adolescents Results: ICS remain the primary anti-inflammatory drug used in asthma therapy. Their effects include both genomic and non-genomic mechanisms. Non-genomic proprieties have rapid onset of action and are exclusive to inhaled formulations, including the well described transient reduction in airway blood flow. Other non-genomic ICS mechanisms studied are the inhibition of mast cell degranulation and relaxation of airway muscle cells. Conclusions: Nebulizers are effective devices for inhaled administration, particularly used in young children because they eliminate the need of respiratory coordination. In the treatment of asthma exacerbations, ICS administered in high doses within the first hour of treatment in an emergency department, with or without concomitant SCS, may reduce the risk of hospitalization and decrease the need for SCS in children. Intermittent highdose ICS may be used to prevent asthma exacerbations in young children without persistent symptoms. The efficacy and safety of nebulized BDP have been demonstrated in several pediatric publications across various age groups.
Background: Chronic mucocutaneous candidiasis (CMC) is most commonly associated with gain-of-function (GOF) mutations in STAT1, which impair immune regulation and predispose to recurrent fungal infections, autoimmunity, and lymphoproliferative disorders. The clinical spectrum of STAT1 GOF is broad, ranging from severe multisystem involvement to milder phenotypes. Here, we present a case of a child carrying the STAT1 GOF mutation A267V, who exhibited an attenuated phenotype limited to mucocutaneous candidiasis. Case Presentation: A 10-year-old girl presented with recurrent episodes of oral thrush and chronic onychomycosis, consistent with isolated mucocutaneous candidiasis. She had no history of systemic infections, autoimmune disease, or lymphoproliferative manifestations. Family history was notable for early-onset esophageal cancer in her father. Immunological evaluation revealed a preserved CD4/CD8 ratio (2.05), normal immunoglobulin levels, and absence of autoantibodies. Despite normal B-cell counts, her vaccine response was impaired, with non-protective diphtheria-specific IgG levels, suggesting a defect in STAT1-mediated follicular helper T cell function. Genetic analysis confirmed a heterozygous STAT1 GOF mutation (A267V), consistent with autosomal dominant inheritance of CMC. The patient was treated with fluconazole for fungal infection control and the Janus kinase (JAK) inhibitor baricitinib to modulate hyperactive JAK-signal transducer and activator of transcription (JAK–STAT) signaling. This therapeutic approach resulted in resolution of infections and improvement in inflammatory activity. This case illustrates an attenuated phenotype of STAT1 GOF disease, in which the A267V variant was associated with susceptibility to candidiasis but preservation of broader immune homeostasis. Unlike the typical presentation of STAT1 GOF, the patient demonstrated normal immune parameters, including immunoglobulin levels and CD4/CD8 ratio, and no autoimmunity or systemic fungal disease. The clinical response to baricitinib highlights the therapeutic potential of JAK–STAT pathway inhibition in STAT1 GOF syndromes. Conclusions: This case expands the clinical spectrum of STAT1 GOF mutations by demonstrating that the A267V variant can present as an isolated mucocutaneous phenotype without systemic immune dysregulation. It also emphasizes the potential of JAK inhibition as a targeted therapeutic strategy and the importance of long-term cancer surveillance in these patients.
Background: Zinc is essential for growth, immune function, and numerous cellular processes. Zinc deficiency—prevalent in over 20% of children in low- and middle-income countries—is associated with stunted growth, cognitive impairment, and increased susceptibility to infections. Low zinc status may also impair taste perception, thereby reducing appetite and exacerbating nutritional deficiencies. Objectives: This study aimed to evaluate the effects of dietary zinc intake and/or supplementation on appetite and growth in healthy children aged 6 months to 18 years. Methods: Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a comprehensive search of PubMed, Web of Science, and Scopus for observational studies, prospective and retrospective cohort studies, case-control studies, and randomized controlled trials (RCTs) published between April 2015 and January 2024. Reference lists were also reviewed. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024578984). Studies assessing zinc status or intake (via supplementation or diet) and its relationship with appetite or growth in healthy children were included. Results: Of the 1,797 initial studies, 23 studies from 14 countries involving 79,319 participants aged 6 months to 18 years met the eligibility criteria and were included. Zinc supplementation doses ranged from 3 to 20 mg/day and were administered for durations between 1 and 24 months. Of the 23 studies, 10 examined zinc supplementation alone, and 7 assessed both dietary zinc intake and supplementation. Appetite was evaluated in nine studies (five RCTs, four observational studies). Five studies (55.6%, all RCTs) reported significant improvements in appetite among zinc‑deficient children (level I evidence), whereas four studies (44.4%, two RCTs, two observational studies) reported no significant effect (level I and II evidence). Growth outcomes were assessed in all 23 studies (12 RCTs and 11 observational studies). Sixteen studies (69.6%, nine RCTs and seven observational studies) demonstrated significant improvements in weight-for-age (WAZ) and height-for-age (HAZ) Z-scores (Level I and II evidence), particularly among zinc-deficient or malnourished children. Seven studies (30.4%, three RCTs and four observational studies) reported no significant effect (level I and II evidence). Zinc levels were measured in 18 studies using plasma or serum analysis, and 10 studies used placebo-controlled designs. Conclusions: Zinc supplementation demonstrates variable but generally positive effects on appetite and growth in healthy children, with stronger benefits in zinc-deficient or malnourished populations. The evidence (primarily level I from RCTs) supports zinc’s role in improving appetite and growth in specific contexts; however, inconsistencies across studies highlight the need for further research to optimize supplementation protocols and explore synergistic effects with other micronutrients.
Background: The seasonality of type 1 diabetes and diabetic ketoacidosis at diagnosis have been reported in most areas of the world, but there are few reports from north of Iran. Objectives: Considering the connection between type 1 diabetes mellitus (T1DM) diagnosis and environmental influences, this study aimed to evaluate the seasonal trends of T1DM and diabetic ketoacidosis (DKA) at the time of diagnosis over a 10-year period. Methods: In a retrospective study spanning two 5-year periods, 221 pediatric patients with T1DM were analyzed. They were categorized into two groups: Group 1 comprised those diagnosed from 2011 to 2015, while group 2 consisted of patients diagnosed from 2016 to 2020 (pre-COVID-19 quarantine). Changes in type 1 diabetes onset and DKA at diagnosis were assessed using Mann-Kendall trend test. Monthly and seasonal variation of type 1 diabetes and DKA at diagnosis were assessed over a 10-year period comparing two 5-year intervals. The data were analyzed using STATA software, version 17. Results: Of the 221 individuals, 101(45.7%) and 120(54.3%) patients were diagnosed in group 1 and 2, respectively. The Mann-Kendall trend test revealed significant changes in both T1DM onset and DKA at diagnosis over the period 2011-2020 (tau=0.6138, P=0.0191) and (tau=0.582, P=0.0287), respectively. The increase in T1DM onset occurred in spring and June during the second period. The mean age at diagnosis was 7.2 +/- 4 years, with group 1 (6.63, 95% CI, 5.75%, 7.51%) being younger than group 2 (7.58, 95% CI, 6.83%, 8.33%). The frequency of adolescent patients significantly increased in the group 2 compared to group 1 (71.2% vs 28.8%, P=0.04). In both periods, there was a predominance of female sex, and the seasonal pattern of female sex shifted towards spring and summer in group 2. The frequency of DKA at presentation was 37.1% (95% CI, 30.9%, 43.7%) over a ten-year period, with 32.7% (95% CI, 24.2%, 42.4%) in group 1 and 41% (95% CI, 32.4%, 50%) in group 2 (P=0.35). An analysis of the seasonal pattern of initial presentations with DKA indicates that group 1 patients exhibited the highest rate of DKA in the summer and autumn, with the lowest rate in the spring. Meanwhile, group 2 patients displayed that DKA at diagnosis was highest in summer and lowest in autumn. Conclusions: The onset of T1DM and DKA shows a shift toward warmer seasons.
Background: Febrile seizures (FS) are common in children and are associated with a high risk of recurrence. Even though several treatment options are available, no clear consensus has been established regarding the optimal prophylactic agent. Objectives: This randomized clinical trial aimed to evaluate the efficacy and safety of levetiracetam (LEV) versus clobazam (CLB) in preventing recurrent FS in children aged 6-60 months. Methods: This randomized, singleblind clinical trial was conducted among 69 children diagnosed with FS who were referred for treatment in 2024. Patients were randomly assigned to receive LEV or CLB and were followed for 9 months to assess recurrence of FS and drug-related side effects. Results: The average age of the children was 23.77 +/- 13.31 months. No significant differences were found among groups in age, sex, family history of FS, or epilepsy (P>0.05). FS recurred in 5.9% of the CLB group and 5.7% of the LEV group (P>0.05). Mean number of recurrences per child was 0.54 +/- 0.12 in the CLB group and 0.37 +/- 0.09 in the LEV group, representing the average number of seizure episodes across the cohort (P>0.05). Adverse reactions occurred in 58.8% in the CLB group and 60% in the LEV group, primarily drowsiness, with no significant difference between groups (P>0.05). Conclusions: Oral LEV and CLB demonstrate comparable effectiveness in reducing FS recurrence in children younger than 60 months, and have similar side effects. Treatment choice may be individualized based on patient factors.
International organizations report that nearly half of households in developing countries own at least one pet. Pets often function as family members for children, providing affection, companionship, and emotional security. Research indicates that children develop deep emotional attachments to their pets, and these bonds, expressed through affection and proximity, can resemble secure human attachment [1]. For children, interactions with pets offer numerous benefits, including better physical health, increased physical activity, reduced parental concerns regarding temperament, behavior, and learning abilities, and improved emotional regulation [2].
Background: Myeloid sarcoma (MS) is a rare condition characterized by extramedullary proliferation of myeloid blasts in various tissues, with or without bone marrow involvement. It is strongly associated with acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and myelodysplastic syndromes (MDS), and is often misdiagnosed as lymphoma. Case Presentation: We herein report a case of isolated unilateral orbital MS presenting as extramedullary infiltration of myeloid blasts without bone marrow involvement in a patient from Iran.
Approximately 430 million people worldwide need treatment for their hearing loss, and 80% live in low- and middle-income countries. Because hard-of-hearing patients have difficulty receiving oral hygiene education, they are unable to communicate easily with dental personnel and are therefore at increased risk of developing oral diseases.
Background: Child mortality remains a critical indicator of population health and development. While global under-5 mortality has declined significantly, disparities persist, particularly in low- and middle-income countries. In Iran, under-5 mortality remains a concern, with various social, maternal, and child-level factors contributing to regional and demographic disparities. Objectives: This study aimed to systematically review and synthesize evidence on risk factors associated with mortality among children aged 1 to 59 months in Iran. Methods: A systematic review was conducted using a narrative synthesis approach. Articles published between 2010 and 2023 were identified through a search of national and international databases, including IranDoc, SID, PubMed, Web of Science, and ScienceDirect. The inclusion criteria required studies to use multivariate regression, report odds ratios, and focus on children aged 1–59 months in Iran. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Results: Nine studies met the inclusion criteria: 6 case-control and 3 cross-sectional. Risk factors were categorized into 3 domains: Socioeconomic, maternal/pregnancy-related, and child-related. Significant risk factors included low maternal education, low socioeconomic status, paternal addiction, consanguinity, short interpregnancy intervals, history of abortion, inadequate prenatal care, low birth weight, preterm birth, and formula feeding. No significant associations were found with paternal education, parental employment, child sex, or multiple births. Conclusions: Multiple modifiable risk factors are associated with mortality among children aged 1 to 59 months in Iran. Targeted interventions focusing on maternal education, poverty reduction, prenatal care, and newborn health can effectively reduce child mortality. Future research should address regional disparities and underexplored determinants to inform comprehensive policy responses.
Background: Urinary tract infections (UTIs) are among the significant health concerns in children. In addition, recurrent UTIs pose a greater challenge with increasing rates of antibiotic resistance and acute kidney injury. Objectives: To study the clinical and bacterial profiles, resistance patterns, and associated risk factors for recurrent UTIs in the pediatric population. Methods: A prospective observational study over 18 months was conducted, during which 60 children aged 1 month to 18 years with recurrent UTIs were enrolled. Data on demographics, clinical presentation, underlying anomalies, bacterial isolates, and antibiotic susceptibility (antibiogram) and imaging results were recorded and analysed. Results: Of 60 patients, 35(58.3%) were female, and the mean age of the studied children was 4.88 +/- 3.99 years. The most common symptoms were fever in 42 patients (70%), abdominal pain in 40(66.7%), and dysuria in 25(41.7%). Congenital anomalies of the kidney and urinary tract (CAKUT) were present in 43 patients (71.7%), with vesicoureteral reflux in 27(45%) being the most prevalent. Bowel bladder dysfunction (BBD) was seen in 39(65%) enrolled patients. Urine culture grew gram-negative microorganisms in 46(76.7%); Escherichia coli was the most common, showing 100% sensitivity to nitrofurantoin and colistin but 100% resistance to ampicillin and cefotaxime. Gram-positive enterococci were isolated from 10/60 (16.6%) and showed 100% sensitivity to nitrofurantoin, vancomycin, and linezolid; however, they were 100% resistant to gentamicin. Conclusions: Children with underlying CAKUT and bowel dysfunction are predisposed to recurrent UTIs. E. coli and Enterococci are the most common uropathogens with concerning antibiotic resistance profiles. These findings highlight the need for targeted antibiotic stewardship and early management of BBD and CAKUT to prevent recurrence.
Background: The negative regulator of reactive oxygen species (NRROS) gene encodes a protein that functions as a general NRROS production in phagocytes. Reactive oxygen species (ROS) produced by phagocytes are essential for host defense, but excessive ROS can cause collateral tissue damage during inflammatory processes and therefore need to be tightly regulated. Microglia are tissue-resident macrophages that play essential roles in the development and homeostasis of the central nervous system. NRROS is associated with transforminggrowth factor beta-1(TGF-(31) and anchors it to the cell surface. TGF-(31 is essential for neural cell survival and for inhibiting induced microglial activation and associated inflammatory cytokine production. A deficiency in functional NRROS protein can lead to uncontrollable microglial activation by disrupting TGF-(31's inhibitory function. Microglial dysregulation causes neurological disease and cerebral calcification. Case Presentation: To the best of our knowledge, there are 5 published case reports of biallelic NRROS variants that involve 12 patients in total. The manifestations described in these reports include refractory seizures, developmental regression, and hypotonia. In this case, we report an 8-year-old boy with global developmental delay, refractory seizures, encephalopathy from early in life, and intracranial calcification due to a novel homozygous likely pathogenic mutation: c.1487delG (p.val498phefs*2) in the NRROS gene. Conclusions: A severe infantile-onset neurodegenerative disorder results from biallelic loss-of-function variants in the NRROS gene, and is characterized by intracranial calcification, neurodevelopmental regression, and refractory epilepsy that consists of febrile seizures first, followed by afebrile seizures.
Background: Dengue fever is an emerging mosquito-borne viral disease caused by four dengue virus serotypes (DENV 1–4) and transmitted mainly by Aedes aegypti and Aedes albopictus. Given the distinct clinical course and higher risk of severe complications in children, understanding pediatric-specific manifestations, diagnosis, and management is critical for preparedness in Iran. This study reviews available global and regional evidence on dengue fever with a specific focus on pediatric populations. Methods: This is a narrative review. Data were synthesized from epidemiological reports, World Health Organization (WHO) guidelines, and published clinical studies addressing pediatric clinical presentation, diagnostic strategies, disease progression, and management approaches, with contextual relevance to Iran. Results: In children, dengue fever frequently presents with nonspecific clinical features, including fever, gastrointestinal symptoms (vomiting, abdominal pain, diarrhea), rash, and lethargy, rather than the classic musculoskeletal pain commonly seen in adults. Pediatric patients are at higher risk of rapid disease progression to dengue hemorrhagic fever and dengue shock syndrome, primarily due to increased vascular permeability. Pleural effusion detected by ultrasound is the most common indicator of plasma leakage in children. Laboratory findings often include thrombocytopenia, hemoconcentration, and elevation of liver enzymes. Diagnosis relies on high clinical suspicion in endemic or affected areas and on confirmation by serological testing (IgM/IgG), NS1 antigen detection, or viral RNA detection. Management of pediatric dengue fever is primarily supportive, with timely, carefully monitored fluid therapy as the cornerstone of treatment. Early recognition of warning signs and meticulous fluid management are essential to prevent shock and organ failure. Recovery in children is typically rapid, occurring within 24-36 hours once the critical phase resolves. Conclusions: Dengue fever in children differs significantly from that in adults in terms of clinical presentation, risk of severe complications, and management priorities. With the recent emergence of dengue fever in Iran, heightened awareness of pediatric-specific features, early diagnosis, and standardized supportive care are essential to reduce its morbidity and mortality. Strengthening surveillance systems, educating healthcare providers, and implementing vector control strategies are vital for national preparedness. As Iran is not yet hyperendemic, vaccination against dengue fever is not currently mandatory; however, continued monitoring and preventive strategies remain crucial, particularly for protecting the pediatric population.
Background: Nowadays, caring for children with special conditions is one of the important areas of health and social welfare. Children with special needs, for reasons such as physical, mental, behavioral disorders, or chronic diseases, require specialized and comprehensive care. Parents, caregivers, other family members, home nurses, childminders, maternity assistants, and specialized educators, as shadow nurses, cover an important part of the vital, social, educational, and emotional needs of these children. Besides the children’s health, the health of these people also needs to be considered. Objectives: This study aims to highlight the crucial role of “shadow nurses” in enhancing the physical and psychological wellbeing of children with special needs and to offer recommendations to advance awareness and social support for this group within the nation’s healthcare and educational sectors. Methods: This review followed the PRISMA framework and included studies identified through searches across multiple databases, including PubMed, Scopus, Web of Science, Google Scholar, SID, Magiran, IranMedex, UpToDate, and Embase. The selection covered both Persian and English articles published between 2017 and 2025. Results: The findings indicate that providing specialized care by shadow nurses has a very positive impact on the child’s overall health and treatment process. Shadow nurses, by providing specialized medical, psychological, and social support, enhance the child’s capabilities, improve disease management, and reduce the risk of complications. The most important shadow nurses are parents, who are the child’s closest, most important, and most influential people. Conclusions: Extensive support from shadow nurses, particularly parents, is crucial. As primary shadow nurses, parents provide physical and therapeutic care, offer essential emotional support, teach life skills, and foster a safe and nurturing environment. This all-encompassing support boosts the child’s confidence, aids psychological and social growth, and enhances overall health and quality of life. As the child’s quality of life improves, it positively affects the wellbeing of family members, especially parents.
Background: Burkitt lymphoma (BL) is an aggressive B-cell non-Hodgkin lymphoma. It is more common in children and typically involves the lymph nodes and the abdomen. Rarely, atypical BL can present as acute pancreatitis or a gastric mass in immunocompetent children. Case Presentation: An 11-year-old boy presented with peri-umbilical abdominal pain, nausea, vomiting, and dental pain. Laboratory tests revealed high amylase and lipase, leading to an initial diagnosis of acute pancreatitis. He was discharged with proper management, but soon returned with recurrent abdominal pain, progressive right mandibular swelling, and hematemesis. Sonography of the jaw revealed a hypoechoic lesion next to the mandible, prompting further evaluation. CT and magnetic resonance cholangiopancreatography (MRCP) demonstrated pancreatic enlargement with nodules, mandibular destruction, and a gastric fundus mass. Endoscopic biopsy showed a monomorphic population of small blue round cells. Immunohistochemistry (IHC) confirmed Burkitt lymphoma, with tumor cells positive for c-MYC, CD20, CD10, and BCL6, and a Ki-67 index near 100%. The patient was treated with intensive chemotherapy, followed by bone marrow transplantation, achieving remission. He remains under follow-up to monitor recurrence and complications. Conclusions: This case highlights the importance of considering malignancy in atypical pediatric pancreatitis. A multidisciplinary approach was essential for timely diagnosis and management.
Background: Recent academic work highlights that combining nursing-based interventions with a family-centered care philosophy can markedly elevate the overall wellbeing of children with diabetic kidney disease (DKD). These care models prioritize developing children’s capacity for effective self-management, supporting their emotional and social adjustment, and strengthening general health through active collaboration between families and the healthcare team. Objectives: The purpose of this systematic review is to analyze the scientific literature to determine how nursing strategies and family-centered care practices influence quality-of-life outcomes for pediatric patients experiencing diabetic kidney complications Methods: A comprehensive search across multiple databases initially identified 1000 studies. After removing duplicates and screening titles and abstracts, 50 articles were reviewed in full; 7 studies met the inclusion criteria and covered research from January 2010 to March 2025. These studies focused on the psychosocial experiences of parents of children undergoing complex medical treatments. Two reviewers independently conducted study selection and data extraction. The methodological quality was assessed using the Cochrane risk-of-bias tool, the Newcastle–Ottawa scale, and the critical appraisal skills programme (CASP) checklist. Findings from qualitative and quantitative studies were integrated through interpretive thematic synthesis. Results: Studies consistently reported that family-centered care improves multiple domains of children’s wellbeing, including physical functioning, psychological health, and social interaction. Nursing interventions contributed to stabilizing fluid and electrolyte status, ensuring adequate nutritional intake and developmental progress, preventing clinical complications, and providing ongoing emotional and educational support to both children and their caregivers. Conclusions: Evidence suggests that nursing approaches grounded in family participation significantly enhance the quality of life (QoL) of children coping with DKD. Such care models not only strengthen physiological health but also foster emotional stability and broader psychosocial resilience in young patients facing long-term medical conditions.
Background: Insufficient adherence to medication regimens creates a major challenge in the management of chronic pediatric diseases. This challenge can result in unfavorable clinical outcomes, increased healthcare costs, and reduced quality of life. This narrative review examines and synthesizes the existing evidence on the effectiveness of integrated approaches (combining health psychology principles and digital technologies) for enhancing pediatric medication adherence. Methods: This study was a narrative review based on a systematic search across PubMed, Scopus, Web of Science, and PsycINFO from 2013 to 2025. The inclusion criteria comprised studies that examined integrated interventions in children with chronic diseases. The psychological principles included theoretical foundations such as motivational interviewing, parent education, and behavior change frameworks. The digital technologies encompassed mainly Wearables/ Telemonitoring, Web Portals, Mobile Apps, and other digital tools. Study selection and data extraction were performed according to the PRISMA narrative-adapted guidelines. Results: Digital technologies, including wearable devices, physical monitoring systems, web portals, mobile applications, and other useful technologies, are effective in promoting medication adherence among pediatric patients with chronic diseases. By providing reminders, feedback, and education, these tools increased self-efficacy and intrinsic motivation. They improved patients’ and families’ quality of life, consistent with the principles of health psychology regarding behavior change. Parental involvement was a key factor in the success of these interventions, with the highest effectiveness observed in diseases such as asthma, Type 1 diabetes, and epilepsy. Simultaneously, digital access inequality, low health literacy, and privacy concerns were identified as major challenges in implementing these programs. Conclusions: This review reveals that an integrated approach grounded in digital health psychology provides a comprehensive and effective framework for enhancing pediatric medication adherence. This approach not only targets the multiple barriers to adherence but also improves treatment outcomes and reduces readmissions. Nevertheless, effectiveness is influenced by factors such as active parental involvement, digital health literacy, and cultural and economic barriers. For future research, the development of integrated models using systematic frameworks, the engagement of stakeholders, the conduct of longitudinal trials with large and diverse samples, and the examination of ethical and legal dimensions, including data security and informed consent, are essential.
Background: Dental anxiety, especially fear of needles, hinders effective pain control in children. Conventional topical anesthetics have limited efficacy, while mucoadhesive patches offer improved drug delivery. This review evaluated their effectiveness compared with traditional topical methods in pediatric dentistry. Methods: Following Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar for studies published between 2015 and 2025, structured according to the patient or problem, intervention or exposure, comparison or control (PICO) framework. Eligible studies were English-language randomized controlled trials (RCTs) in pediatric dentistry. Of 136 identified records, 29 duplicates were removed, leaving 107 for screening. Ultimately, 5 RCTs involving 447 children aged 4–12 years met the inclusion criteria. The analyzed outcomes included pain reduction—assessed through faces pain scale-revised (FPS-R), Wong-Baker faces pain rating scale (WBFPRS), face, legs, activity, cry, and consolability (FLACC), Wong-Baker, sounds, eyes, and motor (SEM) scales, and heart rate—and adverse events. Results: Mucoadhesive patches consistently demonstrated superior pain reduction compared with the control groups (P<0.001). Children treated with these patches reported significantly lower pain scores than those receiving gels or placebo, with improvements across both subjective and objective measures. No systemic adverse events, such as local anesthetic systemic toxicity (LAST) or methemoglobinemia, were observed, though poor patch adhesion was noted in two studies. This systematic review has some limitations, mainly due to heterogeneity in study design, interventions, and outcome measures, including variations in anesthetic type, application time, and pain assessment methods. Conclusions: Mucoadhesive patch systems, especially those incorporating microneedle technology, appear to be effective and safe for reducing pain during pediatric dental procedures. However, variations in study design and potential biases indicate that the current evidence should be interpreted cautiously. Further well-designed RCTs are recommended to confirm and strengthen these findings.
