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: 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: Iron deficiency anemia (IDA) remains a major global public health concern, particularly among infants and young children. Conventional iron supplements are effective; however, they are frequently limited by gastrointestinal side effects and poor compliance. Liposomal iron formulations may provide improved absorption and tolerability, but evidence in infants is limited. Objectives: To compare the effects of liposomal iron drops and conventional ferrous sulfate drops on hemoglobin, serum iron (SI), ferritin, total iron-binding capacity (TIBC), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) in infants aged 4 - 6 months with IDA. Methods: In this single-blind randomized clinical trial, 68 breastfed infants with IDA were allocated to receive either liposomal iron (15 mg/mL elemental iron) or ferrous sulfate (25 mg/mL elemental iron) drops, 1 mL daily for six months in Kermanshah province, Iran. Primary outcomes were changes in hemoglobin, SI, and MCH at 2 and 6 months. Data were analyzed using hierarchical linear models adjusted for baseline values and confounders, with Bonferroni correction for multiple comparisons. Results: Both groups demonstrated significant improvements in hematologic parameters. After adjusting values, liposomal iron resulted in significantly greater marginal increases in hemoglobin (β = 0.35 at 2 months; β = 0.51 at 6 months; both P < 0.05), SI (β = 20.27 µg/dL at 6 months; P < 0.001), and MCH (β = 0.93 pg at 2 months; β = 2.43 pg at 6 months; P < 0.01). The TIBC decreased significantly over time in both groups, with a more pronounced reduction in the liposomal group (-26.6 µg/dL at 2 months; -35.2 µg/dL at 6 months; P < 0.001). Conclusions: Liposomal iron supplementation in infants with IDA resulted in superior improvements in hemoglobin, SI, MCH, and TIBC compared with ferrous sulfate, with similar effects on ferritin and MCV. Its enhanced efficacy suggests it may be a preferable option for pediatric IDA management.

Background: Cystic fibrosis (CF) is an autosomal recessive disease that occurs due to mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This disease is a multiorgan disorder; however, progressive lung involvement is the main cause of morbidity and mortality in most patients. Objectives: The current study aimed to evaluate the association between Impulse Oscillometry (IOS) indices and spirometric parameters in pediatric patients with CF. Methods: In this cross-sectional study, 51 children with CF aged 6 to 18 years from Mofid Children's Hospital, Tehran, Iran in 2022 and 2023 were included. For patients who met the inclusion criteria, spirometry was carried out using the Master Screen device. In addition, each patient underwent an IOS assessment, during which the corresponding parameters — including impedance at 5 Hz (Z5), resistance at 5 Hz (R5), and area of reactance (AX) — were measured and documented. Results: The mean ± standard deviation (SD) age of the studied patients was 12.06 ± 4.31 years. Of the patients, 58.8% were male. The mean ± SD sweat test result was 81.73 ± 10.86 mmol/L. There was a slight negative correlation between the R5 and forced expiratory volume in 1 second (FEV1, R = -0.298, P = 0.034). A stronger negative correlation was observed between the R5 Index and forced expiratory volume 25 - 75 (FEV25-75, R = -0.358, P = 0.01). There was a significant inverse relationship between R5 and the ratio of FEV1/forced vital capacity (FVC, R = -0.474, P = 0.0001). Additionally, resistance at 20 Hz (R20) had a notable negative relationship with FEV25-75 (R = -0.385, P = 0.005). The highest correlation value was between R20 and FEV1/FVC (R = -0.479, P = 0.0001). Other IOS parameters had no remarkable relationship with spirometry parameters (P > 0.05). Conclusions: Given the observed correlations between certain spirometry measures and IOS parameters, IOS may serve as an alternative assessment when a patient is unable to adequately perform spirometry.

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.

Background: Depression is one of the most common psychiatric disorders in childhood and adolescence, imposing significant costs on the health system. This disorder causes impairment in individual, interpersonal, social, and academic functioning of patients. Various pharmacological and non-pharmacological treatments have been recommended for the treatment of this disorder. Folic acid is a supplement used in the treatment of treatment-resistant depression in adults, but information on its use in children is limited. Objectives: This study was designed to investigate the effects of adding folic acid to fluoxetine in the treatment of major depressive disorder in patients less than 18 years of age. Methods: This study is a double-blind clinical trial conducted on 50 children and adolescents referred to outpatient clinics and inpatient child psychiatry departments affiliated with the university. These patients had been unsuccessfully treated with antidepressants for at least 8 weeks. Participants were divided into two groups; one group received folic acid plus fluoxetine, and the other group received a placebo and fluoxetine in equal proportions. These individuals were evaluated for three months and assessed for changes in depression severity and changes in blood markers. Results: After 12 weeks, the severity of depression decreased in both the folic acid and placebo groups, which was statistically significant, but no statistically significant difference was observed between the two groups. Hemoglobin levels in the placebo group and MCV levels in the folic acid group also decreased significantly after 12 weeks. Conclusions: Fluoxetine, with and without folic acid, improves depression in children, and folic acid has no effect on improving depression.

Background: COVID-19 is a novel virus, and research on its infectivity and pathogenesis in neonates is ongoing. Objectives: We aimed to introduce a population of neonates who displayed signs and symptoms of infection but tested negative for COVID-19 by PCR, despite having direct exposure to the virus within their families, as confirmed by PCR testing. Methods: We conducted an observational cross-sectional study in the NICU and neonatal ward of the Children's Medical Center Hospital in Tehran, Iran, between August 2020 and 2021. Results: We included a total of 11 neonates in this study. These neonates presented with symptoms of viral infection but had negative PCR results. The mean onset of symptoms in our patients was 2.73 days, with a minimum of 1 day and a maximum of 5 days. Discussion: The possibility of false negatives in PCR testing could be attributed to testing during the early stages of infection when the viral load is low. As parents are understandably worried about their baby's risk of COVID-19 infection, they bring their infants to the hospital promptly at the onset of symptoms. Therefore, additional and delayed tests may be required to improve the accuracy of detecting newborn infections. Conclusions: Despite the small sample size and lack of testing for other viruses, our findings highlight the importance of considering false-negative PCR results in neonates with COVID-19 exposure.