Background: Pediatric migraine prophylaxis is indicated when headaches are frequent and/or disabling. We aimed to conduct a study to compare the efficacy of cinnarizine and amitriptyline in pediatric migraine prophylaxis. Methods: In a randomized, double-blind trial, patients aged 4–17 years with migraine who were eligible for prophylaxis enrolled. The primary outcome was a reduction response rate of ≥50% with p < 0.005 with respect to headache characteristics. The secondary outcome was migraine disability assessment. We evaluated patients every four weeks for three months: T1: week 4, T2: week 8 and T3: week 12. The safety profile was also assessed. Results: Thirty patients were randomly assigned to each group. However, 43 patients completed the trial. Headache frequency decreased in amitriptyline group more effectively in T1 ( p = 0.004). Amitriptyline was more successful in reducing the headache duration in all three periods ( p < 0.005). There was no significant difference in severity improvement and reducing disability score between the two groups ( p > 0.005). No serious adverse events were observed. Conclusions: Both medications are effective in ameliorating migraine headaches and related disabilities. However, amitriptyline appears be a preferable option over cinnarizine, given its faster onset of action, efficacy in reducing headache duration and longer-lasting effects. Trial Registration: The study was registered with the Iranian Registry of Clinical Trials (IRCT) under the code IRCT-20191112045413N1.

Varicella is a common viral disease of childhood that is usually benign and self-limiting, but it can lead to rare complications, including streptococcal toxic shock syndrome (STSS) and Kawasaki disease (KD). The simultaneous or sequential occurrence of these 2 complications after varicella has been reported very rarely. A 2.5-year-old girl presented with fever, swell ing, and neck erythema 5 days after varicella infection and a history of ibuprofen use. She was admitted with a diagnosis of cellulitis. Despite initial antibiotic therapy, the patient’s clini cal condition rapidly deteriorated, and she developed shock, thrombocytopenia, organ failure, and pleural effusion. The patient was transferred to the pediatric intensive care unit, intubated, and received Interavenous Immunoglobulin (IVIG). Blood culture revealed beta-hemolytic Streptococcus group A, confirming the diagnosis of STSS. After recovery and discharge from the hospital, the child presented again with fever and peeling fingertips and was admitted with suspicion of KD. Echocardiography revealed coronary artery ectasia, and she received IVIG again. The ectasia resolved on subsequent follow-up. This is one of the rarest cases of sequen tial occurrence of STSS and KD after varicella infection. Clinical attention to unusual compli cations of varicella, timely diagnosis, and appropriate treatment are essential in preventing severe and long-term outcomes in pediatric patients.

Background: COVID-19 can lead to hematological abnormalities, including anemia. Pre-existing anemia can exacerbate the severity of the disease by increasing the peripheral tissue demand for oxygen. Both conditions can contribute to hypoxia. Objective: We aimed to investigate the relationship between COVID-19 infection and on-admission anemia in critically ill children and assess their effects on severe outcomes. Methods: This retrospective study was conducted at Children’s Medical Center during the COVID-19 pandemic. Patients were divided into two groups based on the first hemoglobin level: Anemic and non-anemic. For statistical analysis, we used univariate and multivariate logistic regression models in SPSS and Stata software. Results: A total of 133 patients were enrolled with a mean age of 63.2 months. Fifty-eight patients had anemia for age, and 75 were non-anemic. Among the patients, 53.5% of females and 35.6% of males were anemic (P = 0.04). Additionally, 50.5% of anemic patients had significant prehospital comorbidities compared with 20% of previously healthy patients (P = 0.03). Overall, 72.9% of patients survived, and 27.1% died. Using univariate analysis, death occurred significantly more in anemic patients compared to others (OR: 2.27, 95% CI: 1.042 - 4.948, P = 0.037). A logistic regression model was used to adjust the impact of potential confounders, showing that death occurred 1.82 times more often in anemic patients versus non-anemic patients (OR: 1.77, 95% CI: 0.79 - 3.98, P = 0.162). Furthermore, 54.9% of patients needed vasoactive agents, and 42.7% underwent mechanical ventilation (MV) (P = 0.413 and 0.155, respectively). Conclusions: The mortality rate in our study was 27.1%. In the logistic regression model adjusting for comorbidity and sex, we found a small effect relationship between anemia and mortality. However, wide confidence intervals and non-significant p-values indicate the low power of the study, mostly due to the small sample size. Further prospective studies with a larger sample size are recommended to determine the exact relationship between anemia and mortality.

: The patient was an 11-year-old boy who was referred to our emergency department with a chief complaint of dry cough and shortness of breath. He was diagnosed with asthma when he was three years old and was treated with inhalers as needed. On physical examination, he had respiratory distress and biphasic wheezing. The patient was initially managed as an asthma attack; however, he did not respond to the treatment completely. After a pulmonology consult, he underwent a spirometry test, which was compatible with an obstructive pattern. He was a candidate for fiberoptic bronchoscopy, which revealed findings in favor of vocal cord dysfunction (VCD) and adult-onset laryngomalacia. As part of the management of VCD, we referred him to a psychiatric clinic, evaluating for psychological problems as aggravating factors. We found that he suffered from psychological disorders, including somatic symptoms disorders and mild to moderate depression. The patient was treated for his psychiatric problems. He responded to the treatment well, and the cough and dyspnea attacks resolved gradually after a few months.

Remdesivir (RDV) is an FDA-approved drug for the treatment of COVID-19 in children weighing at least 3.5 kg. While its safety and efficacy are well established in adults, data in pediatric populations remain limited and are largely extrapolated from adult studies. Therefore, we aimed to assess the clinical outcomes and safety of RDV in pediatric patients. We performed a systematic review and meta-analysis of studies evaluating RDV in hospitalized children under 18 years with COVID-19. The primary outcomes were in-hospital mortality and the level of respiratory support (baseline and highest). The secondary outcome was the safety profile of RDV identified by adverse events and treatment discontinuation. Meta-analysis was performed only on patients who received RDV. From 1298 records, 16 studies were included. A total of 722 patients who received remdesivir were included in this study. Pooled analysis at admission showed that 28% of patients required no oxygen, 23% needed low-flow oxygen, 21% needed high-flow oxygen, 11% required non-invasive ventilation (NIV), and 9% were treated with mechanical ventilation (MV). During hospitalization, the highest respiratory support required was no oxygen in 27%, low-flow oxygen in 33%, high-flow oxygen in 32%, NIV in 5%, and MV in 19%. Overall mortality was 2% (95% CI: 0.00, 0.04, I² = 59.81%, p < 0.001). The most frequent RDV-related adverse events were elevated ALT in 11% (95% CI: 0.00, 0.42, I² = 94.02%, p < 0.001), increased AST in 10% (95% CI: 0.00, 0.41, I² = 94.56%, p = < 0.001), unspecified liver enzymes elevation in 8% (95% CI: 0.01, 0.20, I² = 81.84%, p < 0.001), and hypertension in 10% (95% CI: 0.00, 0.58, I² = 97.16%, p < 0.001). Bradycardia (3%) and increased creatinine (2%) were also reported. Almost all studies reported no drug-related serious adverse events. This meta-analysis suggests that RDV has an acceptable safety profile in pediatric patients with COVID-19. The most commonly reported adverse events were elevated hepatic enzymes and hypertension, with occasional reports of bradycardia and increased creatinine. The pooled results should be interpreted with caution due to study heterogeneity and possible publication bias.