Journal of Pediatric Perspectives
Volume:13 Issue: 136, Apr 2025

We are writing to express our appreciation for the recent article titled "Effectiveness of Combining Medication and Lifestyle Modification with Iranian Traditional Medicine Measures Compared to Medication Alone on the Sleep Quality of Children with Attention-Deficit Hyperactivity Disorder" by Rahimi et al., published in the Journal of Pediatric Perspectives (2025; 13(1):19219-19241). This study addresses a critical and often overlooked aspect of Attention-Deficit Hyperactivity Disorder (ADHD) management -sleep quality in children- and provides valuable insights into the potential benefits of integrating lifestyle modifications with traditional pharmacological treatments. The findings contribute significantly to the growing body of research on holistic approaches to managing ADHD, and we commend the authors for their important work.

The increasing prevalence of antimicrobial resistance has emerged as a critical global public health issue. This study aimed to identify the predominant bacterial pathogens causing community-acquired urinary tract infections (UTIs) in children and to evaluate the evolving patterns of antimicrobial resistance among pediatric uropathogens in Shiraz, southern Iran. This research involved two prospective cross-sectional studies conducted among pediatric patients diagnosed with UTIs. The first study was carried out from 2005 to 2006 and included 435 children, while the second study, conducted from April 2010 to March 2011, enrolled175 children. Participants were children aged 1 month to 10 years suspected of having UTIs and referred to various outpatient pediatric clinics. Informed consent was obtained, and demographic data and laboratory test results were recorded using a standardized checklist. Urine samples were collected via urine bags for children under 2 years old and midstream clean-catch for older children. Patients were included if they presented with pyuria (white blood cell count >10 cells/µL) and UTI symptoms, such as dysuria, frequency, fever, etc. Bacterial culture was performed on blood agar and eosin methylene blue (EMB) agar, followed by antimicrobial susceptibility testing on isolated pathogens. Data were analyzed using SPSS version 19. Statistical analysis involved Pearson correlation and Chi-square tests, with a p-value of less than 0.05 considered significant. In the initial study (2005-2006), Escherichia coli was the most common pathogen (69.2%), followed by Klebsiella (13.33%) and Enterobacter (12.18%). The male-to-female ratio was 0.417, with the highest infection rate in infants under 12 months (p = 0.002). Resistance was highest for Amoxicillin (93.83%), Ampicillin (84.39%), Co-trimoxazole (60%), and Cephalotin (58.71%), and lowest for Nitrofurantoin (12.63%) and Ciprofloxacin (7.77%). In the follow-up study (2010-2011), E. coli remained dominant (67.43%), followed by Proteus (11.43%) and Klebsiella (6.85%). The male-to-female ratio was 0.2 and infections were highest in children under 12 months (p = 0.016). Resistance increased for Co-trimoxazole (64.85%), Cefixime (53.42%), Nalidixic acid (52.98%), and Nitrofurantoin (44.77%), while moderate resistance was noted for Gentamicin (39.19%) and Ciprofloxacin (22.55). A significant association existed between bacterial type and age groups in the second study (p = 0.002). An upward trend in resistance was observed for commonly used oral antibiotics such as Co-trimoxazole, Cefixime, Nalidixic acid, and Nitrofurantoin. However, resistance remained lower for parenteral agents including Gentamicin, Cefotaxime, Ceftizoxime, and Ciprofloxacin. This highlights the ongoing challenge in selecting effective empirical antibiotic therapies for pediatric UTIs.

Cytomegalovirus (CMV) is a common viral infection, with gastrointestinal CMV infection primarily seen in individuals with weakened immune systems, impacting the clinical outcomes of affected patients. This study aim to evaluate the clinical manifestations, endoscopic findings, and underlying causes among pediatric cases with gastrointestinal CMV infection. This retrospective study included all pediatric patients diagnosed with GI-CMV who were referred to Akbar Children's Hospital in Mashhad, Iran, and met the study’s criteria. The criteria included pediatric patients who underwent endoscopic examinations. Comprehensive checklists were used to document symptoms, clinical presentations, medical histories, and endoscopic findings, with data extracted from patient records. Statistical analysis was performed using SPSS software version 23, with statistical significance set at p < 0.05. In a study of 17 patients initially admitted with a probable diagnosis of  CMV, 12 (70.6%) were confirmed to have CMV during follow-up. The group consisted of 9 girls (75%) and 3 boys (25%), with a mean age of 42.75 months (SD ± 31.95). Most patients (83.3%) were discharged with partial recovery, and CMV infection was confirmed in 70.6% of cases. Pathology revealed that 75% had gastric involvement. The most common initial symptom was bloody vomiting (26%), followed by fever and diarrhea (13%). Ganciclovir was administered to all patients, and 8.33% received Prednisolone as well. Most patients exhibited elevated white blood cell counts, and liver enzymes and albumin levels were also impaired. Symptoms of CMV colitis tend to be nonspecific and can manifest across a spectrum ranging from mild to severe presentations. Notably, CMV-positive patients are predisposed to more severe forms of colitis, with prolonged hospitalizations and concomitant febrile episodes frequently noted in cases of CMV colitis associated with underlying inflammatory bowel disease (IBD).

Teaching clinical skills to nursing students in pediatrics faces numerous challenges due to the specific characteristics of patients, complexities of care, and communication sensitivities. The aim of this review study is to investigate and analyze the most important barriers and challenges in clinical education in pediatrics for undergraduate nursing students.

This study was conducted using a narrative review method and a structured search in the PubMed, Scopus, Web of Science, SID, Magiran, and Google Scholar databases. Articles published between 2017 and 2024 that examined the challenges of clinical education in pediatric nursing at the undergraduate level were selected and analyzed. A total of 35 articles were reviewed based on the inclusion and exclusion criteria.

The results showed that the challenges of clinical education in pediatrics include students' anxiety and fear, difficulty in communicating with children and families, lack of experienced instructors, limited clinical learning opportunities, weaknesses in curriculum design, emotional pressures, and lack of educational infrastructure. These barriers are effective at individual (lack of self-confidence and anxiety, poor communication skills, lack of motivation and sufficient commitment), environmental (lack of practical opportunities, inappropriate clinical environment, hectic schedule, and high work pressure), organizational (lack of specialized and experienced instructors, lack of proper planning of clinical training), and cultural (cultural attitudes towards children and their care, cultural differences between the student and the child's family) levels.

Improving the quality of clinical education in pediatrics requires reviewing educational programs, improving the capabilities of educators, using modern teaching-learning methods, and creating safe and collaborative clinical environments. The findings of this study can be a guide for educational planners and policymakers in the field of nursing education.

Auto-inflammatory diseases (AIDs) are a diverse group of disorders characterized by inappropriate activation of the innate immune system, leading to chronic inflammation. In children, these conditions can significantly impact multiple organs, including the kidneys. This review article is based on the most recent studies published after 2020, focusing on various auto-inflammatory diseases and their impact on kidney function. The review aims to provide a comprehensive overview of auto-inflammatory diseases and their renal involvement in pediatric patients, focusing on advancements in understanding the molecular mechanisms, diagnostic strategies, and treatment options. By examining the latest research, this article aims to enhance clinical awareness of renal manifestations and improve management strategies for pediatric rheumatologists.

Malaria is a life-threatening disease caused by Plasmodium species, with Plasmodium falciparum being the most virulent form. Cerebral malaria is a severe complication that can lead to various neurological manifestations. We report the case of an 8-year-old boy who presented with an unusual symptom of cerebral malaria—spastic gait. Diagnostic workup included a positive malaria rapid diagnostic test (RDT) and peripheral blood smear (PBS), confirming P.falciparum infection. Brain MRI revealed high signal intensities in the bilateral globus pallidus, consistent with cerebral involvement. The patient received intravenous Artesunate and a combination of antimalarial medications including Coartem, Primaquine, Quinine, and Clindamycin. He showed significant clinical improvement following treatment. This case highlights a rare neurological presentation of cerebral malaria and emphasizes the importance of early diagnosis and prompt treatment. Additionally, it underscores the value of neuroimaging, particularly MRI, in confirming cerebral involvement in atypical clinical presentations.