Background: Immune-mediated injury in celiac disease (CD) can have consequences beyond the gastrointestinal tract. In children, the extent to which CD is accompanied by measurable changes in cardiac electrical activity or systolic function remains unclear. Objectives: We compared electrocardiographic (ECG) and echocardiographic findings between children with CD and healthy controls and examined whether disease duration or adherence to a gluten-free diet (GFD) was independently associated with cardiac parameters. Methods: The cross-sectional sample comprised 52 children with CD and 50 healthy controls with comparable age and sex distributions. Electrocardiographic assessment included the QT interval, heart-rate-corrected QT interval (QTc), QT dispersion (QTd), T-wave peak-to-end interval (Tp-e), Tp-e/QT and Tp-e/QTc ratios, and P-wave dispersion (PWd). Echocardiography was used to assess left ventricular systolic function, including left ventricular ejection fraction. Within the CD group, disease duration and GFD adherence were examined in separate multivariable linear regression models for each cardiac outcome, with age, sex, and body mass index (BMI) as covariates. Results: Children with CD had a significantly higher heart rate and significant differences in several ECG indices compared with controls. The CD group had higher minimum QT (QTmin), minimum QTc (QTcmin), maximum Tp-e (Tp-e max), Tp-e/QTmax, Tp-e/QTcmax, and PWd values, as well as lower QTd and slightly lower maximum QTc (QTcmax). Left ventricular ejection fraction was modestly lower in children with CD but remained within the physiological range. In adjusted regression analyses, neither disease duration nor GFD adherence was independently associated with the evaluated electrocardiographic or echocardiographic parameters (all P > 0.05). We detected no clinically significant arrhythmia, conduction block, or overt cardiac dysfunction. Conclusions: Children with CD showed subtle electrical and functional cardiac differences; however, these findings were not independently associated with disease duration or current GFD adherence. Larger longitudinal studies are needed to determine their clinical significance.
Context: Early discrimination of septic shock in children with sepsis remains challenging, and the comparative value of routinely available pretreatment biomarkers is uncertain. This study aimed to compare admission white blood cell count, C-reactive protein, procalcitonin (PCT, modeled as ln(PCT)), and lactate for early discrimination of septic shock in children with sepsis. Evidence Acquisition: We retrospectively studied children aged 2 months to 15 years who were admitted to a tertiary referral pediatric intensive care unit between July 2022 and July 2025. Biomarkers were defined as the earliest pretreatment measurements obtained at admission or within 6 hours. Early septic shock was operationally defined as the initiation of continuous vasoactive/inotropic support for sepsis-associated cardiovascular dysfunction within 24 hours. Discrimination was assessed using receiver operating characteristic analysis, and associations were examined using multivariable logistic regression. Results: Among 193 children, 93 (48.2%) met the operational definition of early shock. Lactate and PCT levels were higher in the early-shock group (both P < 0.001), whereas WBC and CRP levels were not. Lactate had the highest observed area under the receiver operating characteristic curve, at 0.77 (95% confidence interval [CI], 0.70 - 0.85), followed by PCT (0.71; 95% CI, 0.63 - 0.79). At the exploratory cohort-derived lactate cutoff of 4.17 mmol/L, sensitivity was 64.4% and specificity was 80.0%. In the complete-biomarker cohort, lactate was not statistically superior to PCT by paired DeLong testing (0.782 vs. 0.708; P = 0.197). In the primary parsimonious multivariable model, lactate (odds ratio [OR], 1.34 per 1-mmol/L increase; 95% CI, 1.14 - 1.58; P < 0.001) and natural logarithm-transformed PCT (OR, 1.25; 95% CI, 1.04 - 1.50; P = 0.019) were associated with early shock. In the expanded exploratory model, lactate remained associated (OR, 1.41; 95% CI, 1.17 - 1.70; P < 0.001), whereas the association with ln(PCT) was attenuated (P = 0.057). Conclusions: Admission lactate demonstrated the highest observed discrimination and may complement early clinical and hemodynamic assessments. The cohort-derived thresholds are exploratory and require external validation.
Background: Malnutrition may affect the growth and size of visceral organs in children. Objectives: This study aimed to compare ultrasonographic liver and spleen dimensions between children with malnutrition and healthy controls and to determine whether these differences varied by selected demographic and perinatal characteristics. Methods: This case-control study included 194 children aged 3 to 108 months who were recruited from the Pediatric Gastroenterology Clinics of Ali Ibn Abi Talib and Ali Asghar Hospitals, affiliated with Zahedan University of Medical Sciences, during 2022 - 2023. Ninety-seven children with malnutrition were included as cases, and 97 healthy children were included as controls. Controls were selected from the same clinical setting and matched to cases on age and sex. Malnutrition was classified according to predefined World Health Organization growth criteria. Anthropometric characteristics and relevant perinatal and feeding variables were recorded. Liver and spleen dimensions were measured using standardized ultrasonography performed by a radiologist blinded to participants' nutritional status. Group differences were initially examined using appropriate comparative tests, followed by multivariable analyses to adjust for clinically relevant demographic and growth-related factors. Statistical significance was set at P < 0.05. Results: The study included children with malnutrition and healthy controls. The groups were similar with respect to age, sex, and gestational age, whereas feeding type differed significantly between the groups (P = 0.001). Mean current weight was lower in children with malnutrition than in controls (11,533.9 ± 8,395.3 vs. 15,515.4 ± 10,621.1 g; P = 0.004). The mean liver dimension was 90.5 ± 18.4 mm in the malnutrition group and 82.1 ± 24.9 mm in controls (P = 0.008), whereas the mean spleen dimension was 63.0 ± 21.2 and 69.9 ± 19.9 mm, respectively (P = 0.02). Exploratory subgroup analyses indicated differences in organ dimensions across categories of sex, age, feeding type, birth weight, and gestational age; however, differences between statistically significant and nonsignificant subgroup results were not considered evidence of effect modification in the absence of formal interaction testing. Conclusions: In this clinic-based case-control study, malnutrition was associated with differences in ultrasonographic liver and spleen dimensions. The direction and magnitude of these associations varied according to participant characteristics. Subgroup findings should be interpreted as exploratory and hypothesis-generating rather than evidence of causal effects or effect modification. Further multicenter prospective studies are needed to establish age- and body-size-specific reference ranges and to determine the clinical significance of ultrasonographic organ dimensions in children with malnutrition.
Background: The relationship between sleep and diabetes is bidirectional. Sleep disturbances can be triggered by clinical and psychosocial factors, including glycemic fluctuations, nightmares, parental nocturnal monitoring, and comorbid mood disorders. Conversely, disrupted sleep architecture affects metabolic homeostasis by modulating insulin sensitivity and cortisol secretion, thereby influencing blood glucose levels and glycemic indices in patients with diabetes. Objectives: Given the increasing prevalence of diabetes in children, the importance of sleep management in diabetes control, and the limited research in pediatric populations, this study aimed to investigate the association between glycemic control parameters and sleep quality in children with type 1 diabetes receiving care. Methods: This cross-sectional analytical study included 195 children and adolescents aged 12 - 18 years who had had type 1 diabetes for more than 1 year. After written informed consent was obtained from the parents of eligible participants, 60 children with good sleep scores and 135 with poor sleep scores were assessed as two groups based on Pittsburgh Sleep Quality Index (PSQI) scores (validity, 86.5%; reliability, 89.5%). Patients with chronic diseases, mental disorders, sedative or anticonvulsant use, confirmed psychiatric disorders, or treatment nonadherence were excluded. Age, sex, Body Mass Index (BMI), age at diabetes onset, diabetes duration, frequency of nocturnal blood glucose monitoring by parents, fasting blood sugar (FBS), HbA1c, recent diabetic ketoacidosis (DKA) episodes, daily insulin dosage (IU/kg), and PSQI score were recorded. Data were entered into SPSS version 19. Results: Subjective sleep quality, sleep latency, male sex, and higher BMI were independently associated with higher FBS levels. Similarly, subjective sleep quality, sleep efficiency, daytime dysfunction, male sex, and higher BMI were independently associated with higher HbA1c levels in the multivariate logistic regression analysis. Mean HbA1c and FBS levels, as well as the frequency of recent DKA episodes, were significantly higher in children with poor sleep than in those with good sleep (P < 0.001, P < 0.001, and P = 0.003, respectively). The proportion of children with abnormal HbA1c levels in the poor sleep group was approximately twice that in the good sleep group (P < 0.001). The poor sleep group had a higher proportion of children with a BMI below the 5th percentile (P = 0.006). Diabetes duration was also significantly longer in the poor sleep group (P = 0.021). Conclusions: This study demonstrates a significant association between sleep quality and glycemic control parameters. The results suggest that patients with suboptimal glycemic control are more likely to experience poor sleep quality.
Background: Cyclic vomiting syndrome (CVS) frequently overlaps with migraine; however, clinic-based data from the Middle East that use current standardized criteria remain limited. Objectives: We characterized age at diagnosis and follow-up duration in an unselected CVS population and compared patients with and without definite migraine according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. Secondary objectives were to describe patterns of prophylactic medication use by age group and to explore their relationship with migraine status. Methods: We conducted a retrospective chart review of patients with a physician-documented CVS diagnosis who were referred during the study period to the Pediatric Gastroenterology clinics at Shiraz University of Medical Sciences in southern Iran. Migraine was classified as definite when the treating clinicians had applied the ICHD-3 criteria. Time since diagnosis was calculated as the current age minus the age at the initial CVS diagnosis. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using the χ2 or Fisher exact test. Results: Of 472 patients analyzed, 68 (14.4%) had definite migraine and 404 (85.6%) did not. Patients with migraine were significantly older at the last clinic visit (median, 18 vs 16 years; P < 0.001), whereas age at CVS diagnosis was similar between the groups (median, 5.5 vs 5.0 years; P = 0.243). Follow-up duration was significantly longer among patients with definite migraine (median, 12 vs 10 years; P = 0.028). A binary threshold of > 8 years indicated higher odds of extended follow-up among patients with migraine (80.9% vs 67.7%; OR, 2.01; 95% CI, 1.06 - 3.82). Prophylaxis was recorded in 295 patients (62.5%) and was more common among those aged ≥ 18 years than among those aged < 18 years (69.5% vs 58.4%; P = 0.016), with no overall association with migraine (16.6% vs 10.7%; P = 0.078). Conclusions: In this large consecutive cohort of childhood-onset CVS, definite migraine according to ICHD-3 criteria was more frequently identified in older patients, although age at the initial CVS diagnosis did not differ between groups. Longer follow-up among patients with definite migraine largely reflected older current age rather than earlier disease onset. Prophylactic treatment was more common in adulthood, without a clear statistical association with migraine status. These findings highlight the value of routine, age-appropriate migraine screening in CVS care and support future time-to-event analyses to disentangle aging from follow-up duration.
